Practical skill development in new nurses

Learning practical nursing skills in simulation centers - A narrative review

Background

Practical skills are complex procedures integrating communication and caring, as well as technical and manual aspects. Simulation at a simulation/skills center offers a wide range of learning activities and aims to imitate patient situations.

Objectives

To investigate the international research literature on practical skills learning in simulation/skills centers in nursing education. Research questions: 1. What are the range and type of practical skills studied? 2. What learning activities are focused on in the studies included in the review? 3. What are the learning outcomes and how are they assessed?

Design

Narrative review.

Methods

We searched electronically and included studies from Medline Ovid, CINAHL, Eric, Embase, Academic Search Premiere, and Cochrane. Unique indexing terms and search strategies were developed for each database. The criteria for inclusion were bachelor nursing students as the study population and practical nursing skills learning in simulation/skills centers. We used Rayyan QCRIt for the initial screening and the Mixed Method Appraisal Tool for quality assessment. We used a narrative approach to synthesize the diverse range of studies.

Findings

One hundred and twenty-one studies from 26 countries published between January 2013 and March 2022 were included. The amount of quantitative research was overwhelming (n = 108). A total of 50 different practical skills were represented. The studies focused on which learning modalities resulted in the best learning outcomes. Only 8.5% (n = 7) of the included studies concerned students' learning processes. Skill performance (n = 101), knowledge (n = 57), confidence (n = 34), and satisfaction (n = 32) were the main learning outcomes measured.

Discussion

The quality assessment indicated that 10 of the studies achieved 100% on the mixed method appraisal tool criteria. In many of the studies with quasi-experimental and randomized controlled trial designs, the intervention group received some form of educational treatment while the control group received no treatment. The choice of no treatment for the control group in pedagogical research seems to disregard the inherent purpose and effect of teaching and learning.

Conclusion

Heterogeneity in the use of learning modalities and measuring instruments precludes the possibility of building on other research. Technical skills were the preferred choice of skill, while skills that involved a fair measure of communication and collaboration were only sparingly studied. Students' learning processes were barely touched on in the included studies. More focus should be placed on this area in further research, since the choice of learning modalities may affect the students' learning processes in significant ways.

Nursing Students' and Preceptors' Experiences with Using an Assessment Tool for Feedback and Reflection in Supervision of Clinical Skills: A Qualitative Pilot Study

Background

There is a need to improve students' learning in clinical practice. Undergraduate students need guidance when it comes to transferring knowledge from the classroom to clinical practice in community health services. Competence Development of Practical Procedures (COPPs), a simulation assessment tool, was used to explore students' and preceptors' experiences with feedback and reflection during the supervision of clinical skills in real practice.

Method

This was a pilot study with a qualitative exploratory and descriptive research design. Four students in their first year of a bachelor's programme in nursing and four preceptors participated. Data were collected from eight clinical skills performance assessments, audio recordings of supervision, and open-ended questionnaires. Data were systematized, categorized, and analysed using qualitative content analysis. Findings. Participants' experiences were divided into five categories: “learning environment, an atmosphere of respect, acceptance, and encouragement,” “students' reflections on their own personal learning,” “students' reflections on various care situations,” and “students' and preceptors' assessment and feedback.” Participants found COPPs easy to use and providing structure for assessment, feedback, and reflection during supervision. Concepts related to learning clinical skills became visible for both students and preceptors and helped students assess their performance of clinical skills. Through verbalization and reflection in supervision, participants established a consensus around what students knew and what they needed to learn.

Conclusions

The students and preceptors experienced the tool as a supportive structure to enhance feedback and reflection for the learning of clinical skills in municipal healthcare services. COPPs filled a gap in practice by providing a language for students and preceptors to articulate their knowledge and increasing students' awareness of what constitutes a good performance. The tool supported the coherence of concepts, enhanced clinical reasoning, and promoted deeper thinking and reflection, and the students gained insight into their own needs related to learning clinical skills.

Improving Clinical Nurses' Development of Supervision Skills through an Action Learning Approach

The aim of this study was to investigate action learning as an implementation method in a large-scale project with many participants in several autonomous and geographically spread groups. The focus of the implementation was the Model of Practical Skill Performance as a learning and supervision tool in the clinical education of nursing students. Nineteen action learning groups were established, and a total of 129 clinical supervisors and 13 facilitators were involved. To evaluate the implementation process, qualitative data were generated through three focus group interviews, questionnaires, and notes. Data illuminate clinical supervisors' perceptions of value, impact, and sustainability when they participate in an action learning group to become familiar with the Model of Practical Skill Performance. The deductive data analysis was guided by central concepts from action learning. Action learning proved to be an engaging and effective tool in the implementation where the main strength seemed to be the autonomous local group supporting collective reflections on actions. Clinical supervisors had the right competences to adopt a reflective process-oriented approach, which is the hallmark of action learning. This study shows the necessity of collaboration between stakeholders in practice, education, and management to implement large-scale projects in clinical practice. The findings imply that managers should choose participants on the basis of their motivation and their voluntary wish to participate and that nurses' immersion in the project over time aids implementation.

Conditions Affecting the Performance of Peripheral Vein Cannulation during Hospital Placement: A Case Study

Learning practical nursing skills is an important part of the baccalaureate in nursing. However, many newly qualified nurses lack practical skill proficiency required to ensure safe patient care. The invasive skill peripheral vein cannulation (PVC) is particularly challenging to learn and perform. This study explored conditions influencing nursing students' learning and performance of the technical implementation of a PVC during their clinical placement period. A qualitative and descriptive case study design with two students in Norway practicing PVC during their clinical placement was conducted. One student who mastered the vein cannulation was compared with one student who did not. Data were collected in late 2012 using multiple data sources: semistructured interviews, ad hoc conversations, and video recordings. Video recordings of the two students' cannula implementations were used to help clarify and validate the descriptions and to identify gaps between what students said and what they did. Thematic analysis of the transcribed text data enabled identifying themes that influenced skill performance. There were two overall themes: individual and contextual conditions influencing the technical implementation of a peripheral vein cannula. These findings were evaluated in terms of Benner's work on scientific and practical knowledge, defined as “knowing that” and “knowing how.”

Nursing students' evaluation of a new feedback and reflection tool for use in high-fidelity simulation - Formative assessment of clinical skills. A descriptive quantitative research design

Clinical skills training is an important part of nurses' education programmes. Clinical skills are complex. A common understanding of what characterizes clinical skills and learning outcomes needs to be established. The aim of the study was to develop and evaluate a new reflection and feedback tool for formative assessment. The study has a descriptive quantitative design. 129 students participated who were at the end of the first year of a Bachelor degree in nursing. After highfidelity simulation, data were collected using a questionnaire with 19 closed-ended and 2 open-ended questions. The tool stimulated peer assessment, and enabled students to be more thorough in what to assess as an observer in clinical skills. The tool provided a structure for selfassessment and made visible items that are important to be aware of in clinical skills.

CONCLUSIONS

This article adds to simulation literature and provides a tool that is useful in enhancing peer learning, which is essential for nurses in practice. The tool has potential for enabling students to learn about reflection and developing skills for guiding others in practice after they have graduated.

Defining and comparing learning actions in two simulation modalities: students training on a latex arm and each other's arms

AIMS AND OBJECTIVES

To explore, describe and compare learning actions that nursing students used during peripheral vein cannulation training on a latex arm or each other's arms in a clinical skills centre.

BACKGROUND

Simulation-based training is thought to enhance learning and transfer of learning from simulation to the clinical setting and is commonly recommended in nursing education. What students actually are doing during simulation-based training is, however, less explored. The analysis of learning actions used during simulation-based training could contribute to development and improvement of simulation as a learning strategy in nursing education.

DESIGN

A qualitative explorative and descriptive research design, involving content analysis of video recordings, was used.

METHODS

Video-supported observation of nine nursing students practicing vein cannulation was conducted in a clinical skills centre in late 2012.

RESULTS

The students engaged in various learning actions. Students training on a latex arm used a considerably higher number of learning actions relative to those training on each other's arms. In both groups, students' learning actions consisted mainly of seeking and giving support. The teacher provided students training on each other's arms with detailed feedback regarding insertion of the cannula into the vein, while those training on a latex arm received sparse feedback from the teacher and fellow students.

CONCLUSION

The teacher played an important role in facilitating nursing students' practical skill learning during simulation. The provision of support from both teachers and students should be emphasised to ensure that nursing students' learning needs are met.

RELEVANCE TO CLINICAL PRACTICE

This study suggest that student nurses may be differently and inadequately prepared in peripheral vein cannulation in two simulation modalities used in the academic setting; training on a latex arm and on each other's arms.

Nursing students' perceptions of factors influencing their learning environment in a clinical skills laboratory: A qualitative study

BACKGROUND

The mastery of clinical skills learning is required to become a trained nurse. Due to limited opportunities for clinical skills training in clinical practice, undergraduate training at clinical skills laboratories (CSLs) is an essential part of nursing education. In a sociocultural learning perspective learning is situated in an environment. Growing student cohorts, rapid introduction of technology-based teaching methods and a shift from a teaching- to a learning-centered education all influence the environment of the students. These changes also affect CSLs and therefore compel nursing faculties to adapt to the changing learning environment.

OBJECTIVES

This study aimed to explore students' perceptions of their learning environment in a clinical skills laboratory, and to increase the knowledge base for improving CSL learning conditions identifying the most important environmental factors according to the students.

DESIGN

An exploratory qualitative methodology was used.

PARTICIPANTS

Nineteen second-year students enrolled in an undergraduate nursing program in Norway participated in the study. They took the same clinical skills course. Eight were part-time students (group A) and 11 were full-time students (group B).

METHODS

Focus group interviews and content analysis were conducted to capture the students' perception of the CSL learning environment.

RESULTS

The study documents students' experience of the physical (facilities, material equipment, learning tools, standard procedures), psychosocial (expectations, feedback, relations) and organizational (faculty resources, course structure) factors that affect the CSL learning environment.

CONCLUSION

Creating an authentic environment, facilitating motivation, and providing resources for multiple methods and repetitions within clinical skills training are all important for improving CSL learning environments from the student perspective.

Caring for ethnic minority patients: a mixed method study of nurses' self-assessment of cultural competency

BACKGROUND

Research shows that nurses tend to be lacking cultural competence, which may influence treatment and care for ethnic minority patients negatively.

PURPOSE

To investigate how Medical Unit nurses and Psychiatric Unit nurses assess their own competency concerning patients with minority backgrounds. The topics covered are: intercultural knowledge, knowledge of medical traditions and differences in illness etiology, symptom assessment, and in-service education and availability of advice. These topics are seen in relation to the nurses' years of work experience.

METHODS

Three focus group interviews were conducted before the development of a Likert-type questionnaire containing six topics and a total of 35 statements. 145 Medical Unit nurses (90%) and 100 Psychiatric Unit nurses (81%) returned the questionnaire. SPSS was used to analyze the quantitative data; hermeneutic thematic analysis was used for the qualitative data.

RESULTS

Both the Medical Unit nurses and the Psychiatric Unit nurses indicated that knowledge about illness and treatment philosophies other than Western biomedicine was inadequate. The respondents also found symptom assessment difficult, and they were offered little, if any, in-service education. Work experience added little substantive knowledge.

CONCLUSION

Experience alone does not equip nurses with adequate knowledge for intercultural symptom assessment and culturally competent treatment and care. Formal education, in-service classes, courses, feedback and access to relevant information are needed together with reflection upon clinical practice.

From theoretical model to practical use: an example of knowledge translation

AIM

To present a case of knowledge translation in nursing education and practice and discusses mechanisms relevant to bringing knowledge into action.

BACKGROUND

The process of knowledge translation aspires to close the gap between theory and practice. Knowledge translation is a cyclic process involving both the creation and application of knowledge in several phases. The case presented in this paper is the translation of the Model of Practical Skill Performance into education and practice. Advantages and problems with the use of this model and its adaptation and tailoring to local contexts illustrate the cyclic and iterative process of knowledge translation.

DISCUSSION

The cultivation of a three-sided relationship between researchers, educators, and clinical nurses was a major asset in driving the process of knowledge translation. The knowledge translation process gained momentum by replacing passive diffusion strategies with interaction and teamwork between stakeholders. The use of knowledge creates feedback that might have consequences for the refinement and tailoring of that same knowledge itself. With end-users in mind, several heuristics were used by the research group to increase clarity of the model and to tailor the implementation of knowledge to the users.

IMPLICATIONS FOR NURSING

This article illustrates the need for enduring collaboration between stakeholders to promote the process of knowledge translation. Translation of research knowledge into practice is a time-consuming process that is enhanced when appropriate support is given by leaders in the involved facilities.

CONCLUSION

Knowledge translation is a time-consuming and collaborative endeavour. On the basis of our experience we advocate the implementation and use of a conceptual framework for the entire process of knowledge translation. More descriptions of knowledge translation in the nursing discipline are needed to inspire and advise in this process.

An exploration of student midwives' experiences of the Objective Structured Clinical Examination assessment process

This paper reports on a qualitative descriptive study that explored student midwives' experiences of the Objective Structured Clinical Examination assessment process for obstetric emergencies within a university setting. The development of fundamental clinical skills is an important component in preparing students to meet the responsibilities of a midwife. There is an international concern that the transfer of midwifery education into universities may impact on the development of midwifery clinical skills. Objective Structured Clinical Examinations (OSCEs) have the potential to promote integration and consolidation of skills prior to clinical placement. Twenty six students (n=36) from two midwifery programmes (BSc and Higher Diploma) participated in four focus groups and Burnard's (2006) framework was used for data analysis. Three main themes emerged following analysis: preparation for the OSCE assessment, the OSCE process and learning through simulating practice. Preparation for the OSCE's which included lectures, demonstrations, and practice of OSCE's facilitated by lecturers and by the students themselves, was considered central to the process. Learning via OSCEs was perceived to be more effective in comparison to other forms of assessment and prepared students for clinical practice. Positive aspects of the process and areas for improvement were identified. Using OSCE's increased the depth of learning for the students with the steps taken in preparation for the OSCE's proving to be a valuable learning tool. This study adds to the evidence on the use of OSCE's in midwifery education.

A typology of practice narratives during the implementation of a preventive, community intervention trial

Background

Traditional methods of process evaluation encompass what components were delivered, but rarely uncover how practitioners position themselves and act relative to an intervention being tested. This could be crucial for expanding our understanding of implementation and its contribution to intervention effectiveness.

Methods

We undertook a narrative analysis of in-depth, unstructured field diaries kept by nine community development practitioners for two years. The practitioners were responsible for implementing a multi-component, preventive, community-level intervention for mothers of new babies in eight communities, as part of a cluster randomised community intervention trial. We constructed a narrative typology of approaches to practice, drawing on the phenomenology of Alfred Schutz and Max Weber's Ideal Type theory.

Results

Five types of practice emerged, from a highly 'technology-based' type that was faithful to intervention specifications, through to a 'romantic' type that held relationships to be central to daily operations, with intact relationships being the final arbiter of intervention success. The five types also differed in terms of how others involved in the intervention were characterized, the narrative form (e.g., tragedy, satire) and where and how transformative change in communities was best created. This meant that different types traded-off or managed the priorities of the intervention differently, according to the deeply held values of their type.

Conclusions

The data set constructed for this analysis is unique. It revealed that practitioners not only exercise their agency within interventions, they do so systematically, that is, according to a pattern. The typology is the first of its kind and, if verified through replication, may have value for anticipating intervention dynamics and explaining implementation variation in community interventions.

Unfolding the invisible of the visible: gendered constructions of patient participation

The article draws attention to the unexploited potentials in using visuals within nursing research and especially in using visuals as data. Initially, the authors give a brief description of what is meant by visual research methods and present a short overview of the different approaches that are possible. Visual methodologies are situated within different theoretical frames, often within a postmodern framework. We present a study using a postmodern approach inspired by the works of Foucault. The study demonstrates the possibilities inherent in using visuals as data by exemplifying how illustrations from health journals from Scandinavia reflect otherwise veiled and/or unconscious gendered attitudes on user participation.

Challenges for new nurses in evidence-based practice

AIM

The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment.

BACKGROUND

These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care.

EVALUATION

This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them.

KEY ISSUES

The key issues relate to the need to support new nurses in evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process.

CONCLUSIONS

We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice.

A South West regional survey to identify education staff development needs in clinical skills and practice

This paper reports tentative findings from a survey (undertaken in 2001) of education staff employed to teach nurses and midwives in four highereducation institutions in the South West of England, with specific focus on answers regarding clinical skills and practice within a wider aim of evaluating training needs. A 57 item self-administered postal questionnaire was sent out to 760 educators, 426 were returned with a response rate of 56%. The results were analysed using SPSS version 9, using descriptive statistics focusing on the responses of HE staff and lecturer practitioners on joint appointments. Findings suggest HE staff teach a limited range of (defined) clinical skills, they have varying and wide definitions of clinical skills, less confidence in teaching skills in practice, minimal experience in working in practice settings and difficulties in engagement in practice. They continue to experience role diversity and a wide variation in meeting clinical demands for clinical competence. Definitions of clinical practice and practice skill are explored in relation to the need for nurse teachers to have ‘recent and practical experience of nursing’. A range of education roles are explored.

Implementing objective structured clinical skills evaluation (OSCE) in nurse registration programmes in a centre in Ireland: a utilisation focused evaluation

This paper presents findings from a research study of two objective structured clinical skills evaluation (OSCE) processes that were used in the new BSc. in General and Psychiatric Nursing Registration programmes offered in an Institute of Technology in the south west of Ireland. OSCEs, which have gained widespread acceptance throughout the western world as valid academic measures of nursing competence has yet to be established in this country. This research aimed to evaluate the process and outcomes of OSCE from the perspective of the major stakeholder groups: first and second year nursing students, lecturers, clinical placement coordinators and assessors. A utilisation focussed evaluation approach was adopted which values the opinions and experiences of stakeholders. It is intended to use the findings to develop the validity and quality of the OSCE assessment. The OSCE process was found to have a positive impact on all stakeholders. OSCEs were perceived to be a meaningful and fair form of assessment. Students identified that they felt more prepared for and more confident about forthcoming placements. The OSCE process was, however, perceived to be a stressful experience and requires considerable preparation effort by students and academic staff. Mature students claimed that more practice effort was required but also felt more prepared for placements and achieved higher OSCE scores.

Nursing in a technological world: searching for healing communities

A research dialectic between philosophy of technology and nurses' work in acute care surfaces parallel technological practices that threaten the healing nature of two modern projects: health care and ecological restoration. A metaphor of ecological restoration is used to explore the consequences of denatured health care work for the welfare of patients, families, practitioners, and healing communities. It is argued that in health care systems where the mismatch between treatment options and resources for care steadily grows, the nursing discipline must develop ecological literacy for a technological world.

From simplicity to complexity: developing a model of practical skill performance in nursing

The purpose of this article is to present and discuss a new model of practical skill performance in nursing. The model is conceptualized as having five components: substance and sequence; accuracy; fluency; integration; and caring conduct. The model challenges the truism of 'simple' nursing procedures. It is argued that performance of practical skills in nursing is characterized by complexity on many levels. Complexity lies within and between the components of the performance model and in the interaction between the nurse and the clinical context where practical nursing actions are performed. These complexities are described. Examples that illustrate the complex and reciprocal nature of these components are drawn from an empirical study of graduate nurses' development of practical skill in surgical hospital units. Implications of the model for education, practice and research are discussed.