Academic nursing education guidelines: tool for bridging the gap between theory, research and practice

Student Nurse Anesthetists' and Supervisors' Perspectives of Learning in the Operating Room: An Integrative Review

PURPOSE

The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives.

DESIGN

An integrative review.

METHODS

Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method.

FINDINGS

Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment.

CONCLUSIONS

SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.

The relationships between the types of learning approaches used by undergraduate nursing students and their academic achievement: A systematic review and meta-analysis

Identifying and promoting an appropriate learning approach among nursing students is important in nursing education. The objective of this study was to examine the relationship between undergraduate nursing students' approaches to learning and their academic achievement. A systematic review with a quantitative synthesis was conducted. Abstract searches of CINAHL, MEDLINE, PubMed, ERIC and Scopus were conducted in November 2020 to identify the relevant publications. In total, 11 studies involving 12 cohorts were identified as eligible for the meta-analysis. Based on nine studies with 10 cohorts (N = 1830), a significant positive relationship between the deep approach to learning and academic achievement was identified, with the summary effect size of r = 0.259 [95% CI: 0.184, 0.330]. In addition, based on 11 studies with 12 cohorts (N = 2138), a significant negative correlation between the surface approach to learning and academic achievement was found, with the summary effect size of r = -0.247 [95% CI: -0.318, -0.174]. Higher education institutions should encourage the use of the deep approach and discourage the surface approach to learning by utilising appropriate educational instructions and assessment methods.

Operating theatre nurses' self-reported clinical competence in perioperative nursing: A mixed method study

AIMS

The aim of this study was to investigate how operating theatre nurses (OTNs) self-rated their clinical competence and describe their experience of important factors for the development of clinical competence in perioperative nursing.

DESIGN

A cross-sectional study with a mixed-method approach was chosen. Data were collected through a modified version of the questionnaire Professional Nurse Self-Assessment Scale of Clinical Core Competence I, which was supplemented with an open-ended question.

METHODS

Data were collected from 303 operating theatre nurses in Sweden. Statistics analysis was used to identify the relationship between the participants' background variables. The open-ended question was analysed by using a qualitative conventional content analysis.

RESULTS

Academic degree and professional experience of perioperative nursing were significant for the development of clinical competence. Academic degree appeared to affect operating theatre nurses' leadership and cooperation in the surgical team, as well as how consultations took place with other professionals.

Strategies for bridging the theory-practice gap from the perspective of nursing experts

The gap between education and the clinical practice has always been challenge for educational experts in the field. This article aims to explore the perspective of Iranian nursing experts about strategies used for coordinating education and clinical performance in nursing. This qualitative study was conducted by using a conventional content analysis approach; individual interviews were conducted at the participants’ work place; while focus group discussions took place at the Nursing and Midwifery Faculty of Iran University of Medical Sciences. Participants in this study included nursing instructors, educational supervisors and nursing managers with a clinical background and teaching experience of at least five years. In addition, a graduate nursing student and a nursing PhD candidate were also interviewed to ensure data saturation. Purposive sampling was conducted between April 2016–October 2017 among scholars and nursing professional experts who were highly experienced in this field. The two focus groups, obtained the views of nursing managers and educational supervisors working in educational hospitals. Analysis involved open stepwise coding with an emphasis on continuous comparison of data, and reference to written notes of the interviews. The analysis process was carried out in three main phases of preparation, organization, and reporting. The results of this study were classified in three main categories: developing context base curriculum, interactive collaboration among nurses and faculties, the Design and Implementation of a Standard Clinical Guideline. It seems that strong intention and active participation of all beneficiaries are needed to bridge the gap between theory and practice. Creating an appropriate context for nurses and nursing trainers for mutual learning along with the use of pragmatic language in the form of clinical guidelines can help decrease this gap.

A comparison of inquiry-oriented teaching and lecture-based approach in nursing ethics education

BACKGROUND

With developing nursing ethics education, the traditional methods of teaching could not meet the learning needs of undergraduates. Improving ethical decision-making to undergraduates is necessary toward promoting nursing ethics.

OBJECTIVE

The aim of study is to compare the effect of inquiry-oriented teaching and lecture-based approach on nursing ethics education for undergraduates.

DESIGN

A quasi-experimental study was conducted for undergraduate nursing students.

SETTINGS

Two nursing schools participated in the study in mainland China.

PARTICIPANTS

A total of 97 undergraduate nursing students participated in the study.

METHODS

The study adopted a quasi-experimental design.

RESULTS

The inquiry-oriented teaching group was significantly higher on average scoring than the lecture-based group after intervention in 2 aspects including: professional relationship (P = 0.015) and ethical decision making (P = 0.021). Contrarily, this study also showed that in the lecture-based group the score of foundational theories of nursing ethics was higher than Inquiry-oriented group (P = 0.038). A statistically significant difference was not found between the two groups in 3 scenarios: ethics related to nursing practice, ethics related to nursing research and necessity of learning nursing ethics.

CONCLUSION

Combination of inquiry-oriented teaching and lecture-based approach is suggested as part of design for curriculum of nursing ethics education.

Strengths-Based Nursing: A Process for Implementing a Philosophy Into Practice

Strengths-Based Nursing (SBN) is both a philosophy and value-driven approach that can guide clinicians, educators, manager/leaders, and researchers. SBN is rooted in principles of person/family centered care, empowerment, relational care, and innate health and healing. SBN is family nursing yet not all family nursing models are strengths-based. The challenge is how to translate a philosophy to change practice. In this article, we describe a process of implementation that has organically evolved of a multi-layered and multi-pronged approach that involves patients and families, clinicians, educators, leaders, managers, and researchers as well as key stakeholders including union leaders, opinion leaders, and policy makers from both nursing and other disciplines. There are two phases to the implementation process, namely, Phase 1: pre-commitment/pre-adoption and Phase 2: adoption. Each phase consists of distinct steps with accompanying strategies. These phases occur both sequentially and concurrently. Facilitating factors that enable the implementation process include values which align, readiness to accept SBN, curiosity-courage-commitment on the part of early adopters, a critical mass of early adopters, and making SBN approach both relevant and context specific.

Learning to nurse: combining simulation with key theory

Following a recent Nursing and Midwifery Council revalidation of a university undergraduate nursing programme, simulation skills sessions and anatomy and physiology theory were integrated into one unit (module). This was done in order to integrate the basis for patient assessment and care provision with the anatomical and physiological theory and thereby enhance student learning and nursing practice. Students evaluated the new unit well and valued the close link between theory and practice simulation. Improvements were seen in the simulation skills sessions as students were better able to apply their underlying theory to their actions. Learning was enhanced as both simulation and theory were seen as more meaningful to practice and patient care.

Nurses and midwives professional support increases with improved attitudes - design and effects of a longitudinal randomized controlled process-oriented intervention

Background

Becoming parents for the first time is challenging. Mothers need both social and professional support to handle these challenges. Professionals’ attitudes affect quality of care and support. So to improve professional support, an intervention consisting of a process-oriented training was performed. Due to the positive results of the intervention there is a need to illuminate the methodological approach further. The overall aim was therefore to describe a methodological approach to improve and evaluate health care professionals’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing.

Methods

This study was a longitudinal randomized control intervention study, in which groups of mothers received care in childbearing from midwives and child health nurses. These health professionals had gone through a process-oriented training, or not. In order to improve attitudes of health professionals the training was based on evidence, practical skills and reflective processes (both private and professional experiences) in relation to breastfeeding and parental support. Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45. All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study. Mothers who accepted to participate were included in the interventions group (n = 206) or control groups (n = 162, n = 172 respectively) based on which municipality they belonged to.

Results

The results of the process-oriented training improved the professionals’ attitudes toward breastfeeding and parental support. These improved attitudes in health professionals increased intervention-group mother’s satisfaction with professional and social support. Intervention-group mother’s relation to and feelings for their baby as well as breastfeeding was also improved.

Conclusion

These results stress the importance of professionals’ attitude in quality of care during childbearing, as well as pointing to the possibility to improve professionals’ attitudes with a process-oriented training.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR), trial registration: ACTRN12611000354987.

Women's use of nipple shields-Their influence on breastfeeding duration after a process-oriented education for health professionals

AIM

This study investigated if a process-oriented training for health professionals will influence women's use and reasons for using a nipple shield, the baby's weight, and the duration of breastfeeding.

MATERIALS AND METHODS

An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support. Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with those for the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, at 3 months, and at 9 months postpartum.

RESULTS

The mothers' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy, the babies had difficulty in grasping over the nipple, and the mothers had pain or wound on the nipple. For the mothers in the IG group, there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration. In contrast, the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields. In the IG, there were no significant difference between the use of nipple shields and the babies' weights at 3 or 9 months. The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields (p=0.02).

CONCLUSIONS

A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems, where the problems are remedied by the use of nipple shields.

Process-oriented training in breastfeeding for health professionals decreases women's experiences of breastfeeding challenges

BACKGROUND

The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women's satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months.

METHODS

An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n = 540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n = 162) started before the intervention was initiated. Data for control group B (n = 172) were collected simultaneously with the intervention group (IG) (n = 206). Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.

RESULTS

Women in IG were more satisfied with the breastfeeding counselling (p = 0.008) and felt the breastfeeding counselling was more coherent (p = 0.002) compared to control groups, when exclusive breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p = 0.01).

CONCLUSION

A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in line with their planned breastfeeding duration, compared to women who had breastfeeding duration < 3 months.

TRIAL REGISTRATION

ACTRN12611000354987.

Stressors of dual-qualification nursing teachers in the ChengDu-ChongQing economic zone of China--a qualitative study

Nursing and teaching are considered risk professions with high levels of stress and burnout. Dual-qualification nursing teachers (DQNT) are nurses who both teach and practise. These nurses face additional stress. This study explored the stressors of DQNT in the Chengdu-Chongqing Economic Zone of China. This qualitative study used in-depth, open-ended interviews. The interview responses were analysed using a grounded theory approach. The participants in this study included 21 DQNT from 5 teaching hospitals in the Chengdu-Chongqing Economic Zone of China. The results indicated that heavy workload, personal safety, inadequate pay, role overload, and poor working environment are stressors of DQNT. Furthermore, Chinese DQNT face violence from patients and students. The study provides a theoretical basis to help DQNT to cope with stress.

Development of Instruments for Assessment of Knowledge and Skills in Performing Venepuncture and Inserting Peripheral Venous Catheters

Purpose

Performing venepuncture is one of the most routinely performed invasive procedures in nursing care. The aim of this study was to develop instruments for the assessment of nursing students' knowledge and skills when performing venepuncture and inserting a peripheral venous catheter.

Methods

Two instruments were developed using the following steps. 1) Assessment items of importance for the procedures (venepuncture 48 items and peripheral venous catheter 51 items) were collected from focus groups including nurses, lecturers and patients. 2) The number of items was reduced using a method based on the Delphi method. Experts (n=51) reviewed the instruments in two rounds. The revised versions included 31 items for venepuncture and 33 items for peripheral venous catheter insertion. 3) Usability tests were conducted by nurses who tested the instruments to confirm that items were possible to assess. 4) Inter-rater reliability was assessed by twelve lecturers who in pairs, but independently of each other, used the instruments to assess 50 nursing students.

Results

Proportion of agreement and Cohen's kappa coefficient were calculated for each item to determine inter-rater reliability. Among the tested items for both instruments, the median proportion of agreement was 1 (range 0.66-1) and the median kappa was 0.52 (range 0.22-1).

Conclusions

The instruments developed for assessing nursing students' knowledge and skills of venepuncture and peripheral venous catheter insertion showed satisfactory inter-rater reliability.

Nursing students' perceptions of clinical supervision: the contributions of preceptors, head preceptors and clinical lecturers

AIM

The aims of the study were 1) to investigate to what extent nursing students were satisfied with the supervision provided by facilitators (preceptor, head preceptor, and clinical lecturer), 2) to compare nursing students' ratings of facilitators' contribution to supervision as supportive and challenging, and 3) to examine relationships between facilitators' supportive and challenging behavior in supervision and nursing students' perception of fulfillment of expected learning outcomes in clinical education.

BACKGROUND

Although there are many studies on support of students in clinical education, few have addressed this from the students' point of view or made comparisons between different facilitators.

METHODS

A cross-sectional survey study was conducted during April to November 2010, where 107 nursing students, from a university in central Sweden, answered a questionnaire about supervision immediately after their period of clinical education.

RESULTS

Supportive behavior in supervision was rated higher by students for all facilitator groups as compared with challenging behavior. The students rated preceptors and clinical lecturers as more supportive than head preceptors and clinical lecturers as providing more challenges than the two other facilitator groups. Supportive and challenging behavior in supervision explained 39% of the variance in students' overall learning outcomes. However, the regression coefficient was only significant for students' ratings of supportive behavior for the preceptor.

CONCLUSIONS

Nursing students were satisfied with facilitators' supervision and by their contribution to fulfillment of overall learning outcomes. Comparisons showed that preceptors in a higher degree were perceived as supportive while clinical lecturers were perceived as more important as challengers for critical thinking, reflection and exchange of experiences between students. The model of supervision seems to be promising, but the roles across facilitators need to be made clearer, especially the head preceptor's role, which seemed to be the most unclear role in this model.

Information retrieval - Swedish specialist student nurses` strategies for finding clinical evidence

The care that intra-operative nurses perform has to be based on scientific knowledge. It is therefore vitally important that they have access to different databases and the Internet, as well as knowledge of the search procedure to find evidence for best practice. This means that specialist nurses should be proficient in the search procedure, interpretation of data, and implementation of available knowledge.The aim of this study was therefore to highlight the search strategies of specialist student nurses for finding scientific knowledge with regard to specific clinical issues. An additional aim was to assess their ability to critically evaluate scientific articles.

METHODS

The participants, n 16, all students enrolled in a university programme for specialist nursing in anaesthesia care, were required to find support for six questions, by using scientific knowledge databases. The tasks that required support are related to their future profession and were divided into three main areas: pre-, intra-, and post-operative care. Two distinct questions for each main area had to be answered. The data was analysed quantitatively using manifest content analysis as a basis.

RESULT

This study reveals that the student nurses mostly used the CINAHL and PubMed databases to search for answers related to the areas in focus. The keywords the participants used differed between the individuals and were applied more frequently than MESH terms. In addition, the critical evaluation of articles of scientific value that were found was not optimal. The study demonstrated that most of the participants were unable to complete all the required tasks. With regard to the initial questions, all 16 participants provided answers, while only eight student nurses completed the final questions.

CONCLUSIONS

The specialist student nurses in this study used the databases Chinal and PubMed to find scientific knowledge with the help of MESH-terms and keywords. Further research is needed to understand how education of the specialist student nurses should be carried out, in order to optimise their search strategies and critical evaluation of scientific articles.

A process-oriented breastfeeding training program for healthcare professionals to promote breastfeeding: an intervention study

AIM

The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding.

MATERIALS AND METHODS

Ten municipalities in Sweden were randomized to either the intervention or control groups. The intervention included a process-oriented training program for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) living in either an intervention or control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, 3 months, and 9 months postpartum.

RESULTS

As a result of the process-oriented training program for midwives and postnatal nurses, the IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03).

CONCLUSION

A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.

'With a bit of tweaking…we could be great'. An exploratory study of the perceptions of students on working with older people in a preregistration BSc (Hons) Nursing course

BACKGROUND

With ageing demographics, it is important that nurse education curriculum can prepare students to work with older people.

AIMS AND OBJECTIVES

To explore students' perceptions of working with older people and the extent to which their preregistration curriculum is preparing them for this role.

DESIGN

A qualitative research design, incorporating focus groups in data collection.

METHODS

Four focus groups were held in January 2011, involving a total of 32 students undertaking a preregistration BSc (Hons) nursing degree course.

RESULTS

An overt focus in the preregistration curriculum on acute and critical care and perceived deficits in care of older people content left some students feeling underprepared to work with older people and to challenge ritualistic practice. Clinical placement experience and mentor support appeared to be influencing students' decisions about whether they would consider working with older people in the future.

CONCLUSION

Education providers should ensure that students are adequately prepared to work with older people and that students are supported when they observe poor practice. A finding that observation of ritualistic practice could prompt some students to consider working with older people, warrants further research. Implications for practice. Nurse educators should evaluate the content and delivery of their preregistration courses to ensure that the prerequisite knowledge, skills and attitudes required to work with older people are accorded appropriate value and attention.

Nursing students' views on the effectiveness of problem-based learning

A descriptive study was conducted with 28 nursing students in Macao and 23 nursing students in Shanghai to explore students' views on the effectiveness of problem-based learning (PBL). The PBL Evaluation Questionnaire was used. It used a 20-item self-report Likert scale with a 5-point response choice (1=ineffective and 5=very effective). The value of the content validity index tested by five experts was determined as one and the internal consistency (Cronbach's alpha) was 0.90. The test-retest reliability with a two-week internal check was 0.89. Two open-ended questions were asked to determine students' comments on the positive and negative features of PBL. The response rate was 100%. Overall, students considered PBL to be moderately effective with a mean of 3.58 (S.D.=0.52). Students from Macao considered PBL to be less effective than students from Shanghai. However, half of the Macao students and 21.74% of the Shanghai students indicated that PBL was a time-consuming and stressful process that involved an increased workload. A small number of students indicated that sometimes the information they received was vague and this resulted in a lack of student confidence. It is clear that the initial implementation of PBL is not always a smooth process. Tutors should be prepared to provide students with substantial support in developing their understanding of PBL, and help students develop appropriate strategies for coping and engaging in the PBL learning process.

The theory-practice gap and skill acquisition: an issue for nursing education

Matching textbook descriptions of clinical situations with the reality of practice is an ongoing problem faced by members of the nursing profession and is commonly referred to as the "theory-practice gap". This ubiquitous gap is inevitably encountered by all nurses at various times; yet it is widely agreed that it is student nurses--given their novice, rule governed status--who find themselves in the midst of the theory-practice void. This paper will discuss the nature of the theory-practice gap and skill acquisition, in relation to a personal experience of mine as an undergraduate nursing student, and its significance in relation to student anxiety levels, nurse education (specifically the roles of the classroom teacher and clinical educators), teaching methods and the responsibility of the student to become accountable for their own education. I intend to communicate how my personal situation was dealt with and evaluate that experience in relation to current nursing literature. Ultimately, this discussion will demonstrate the value of reflection underpinning the development of competency in nursing and its role in bridging the theory-practice gap.

Finding and using evidence in academic assignments: the bane of student life

Within schools of nursing, students are expected to produce academic assignments which demonstrate their abilities, to find, appraise and apply research findings in clinical practice. The main objective of academic education is to develop lifelong learning skills in the student (Jerlock et al., 2003) with lecturers being expected to educate students who are competent, knowledgeable, and able to successfully complete both academic and clinical assignments and assessments. However, little is known about how student nurses acquire such skills or whether they perceive such skills to be valuable to their future role as qualified nurses.

AIMS

To explore student nurses' experiences of learning to search for and use evidence in order to support their academic assignments, and unearth their perceptions of the value of such skills to their future role as qualified nurses.

METHODS

An exploratory pilot study at two schools of nursing in the United Kingdom, using questionnaires, with a sample size of 110, Year 3 nursing students from adult and children's nursing fields of practice.

FINDINGS

The findings indicate that students value specific teaching sessions (taught by members of library staff) delivered at the beginning of the programme. Students make good use of in-house search engines where these are provided and are mainly searching for nursing literature with a small minority appearing to have no clear search strategy. Students appear to associate literature searching skills as potentially valuable in their future role as a qualified nurse, however, consider that such skills are more closely associated with further academic study rather than with clinical practice.

CONCLUSION

It seems that more work is required by educators in order to help students to associate literature searching skills with nursing practice.

The clinical credibility of nurse educators: time the debate was put to rest

The proverbial discussion surrounding the clinical credibility of nurse lecturers has almost become a preoccupation within the nursing literature and professional circles. It is not coincidental that it this has occurred alongside the cessation of hospital-based training and the associated reassignment of the responsibility for nurse education to institutes of higher education. This paper aims to put the debate to rest and proposes that the focus of the nurse lecturer should not be on establishing clinical credibility but on developing strong partnerships between academic and service areas. Such partnerships or communities of practice are more likely to facilitate high quality preparation of nursing students for future roles within a diverse and dynamic profession.

Evaluation of a PBL strategy in clinical supervision of nursing students: patient-centred training in student-dedicated treatment rooms

AIM

The present study aimed at investigating staff members' and nursing students' perception of and satisfaction with an intervention involving patient-centred training in student-dedicated treatment rooms during clinical supervision.

BACKGROUND

It is well known that clinical education is important and that the clinical learning environment influences the development of nursing students' ability to solve clinical problems. In the present study, an intervention using a problem-based learning (PBL) strategy was introduced and evaluated in clinical education. The PBL strategy is called 'Patient-centred training in student-dedicated treatment rooms'.

DESIGN AND METHODS

Descriptive; both quantitative and qualitative methods were used. A questionnaire and focus group interviews were used.

RESULT

Most participants found the PBL strategy to be highly satisfactory, both for staff and for students. The students seemed to feel that their time in clinical education had been used efficiently.

CONCLUSION

Integration of theory and practice during clinical training has been emphasized as a necessary component, and the new strategy, which involves a method of promoting students' reflection, represents one way of facilitating such integration, in that it may bridge the gap between theory and practice. More extensive and more specific research is need in the future.

Predictors of knowledge, attitudes, use and future use of evidence-based practice among baccalaureate nursing students at two universities

Nursing students are strategically positioned to influence adoption of evidence-based practice within the nursing profession. The purpose of this study was to identify the predictors of knowledge, attitudes, use and future use of evidence-based practice among baccalaureate nursing students at two universities. A cross-sectional survey design was used to study a convenience sample of 436 nursing students (response rate of 63.3%) enrolled at two baccalaureate nursing programs at the beginning of 2007 fall semester in the United States. The surveys included demographic questionnaire and knowledge, attitudes and behaviors questionnaire for evidence-based practice. EBP Knowledge, Attitudes toward EBP and Future Use of EBP subscales demonstrated statistically significant increase in mean scores with advancing academic levels. Confidence in clinical decision-making and clinical preparedness had moderate positive correlation with EBP Use and Future use of EBP. Simultaneous multiple regression analyses indicated that the clinical preparedness and confidence in clinical decision-making were statistically significant predictor variables for EBP use and Future use of EBP. Clinically well-prepared nursing students with high confidence in clinical decision-making are most likely to use evidence-based practice, both in the present and the future.

Reflecting on the essence of our problem-based learning discussions: the importance of faculty development and our continuous quest for applications of problem-based learning

While problem-based learning (PBL) is a teaching strategy to promote critical thinking, creativity and self-directedness in learning is very important. It is the meaning of the learning, with a contextual understanding, that marks the significance of this approach in our healthcare education. At the 2008 Kaohsiung Medical University International Conference and Workshop on PBL, the scholarly discourse on sharing empirical findings and practical experience with various aspects of PBL brought forth the importance of the teachers' continued learning about the meaning, the dynamics of the process, and the pragmatic details of PBL. This quest for a continuous learning and understanding about PBL parallels our search to extend the classroom PBL into students' clinical experience. The development of clinical teachers in the understanding of PBL was explored as part of their experiential learning in clinical teaching after their PBL workshops. While the clinical teachers who participated in the project appreciated the merits of clinical PBL, the complex balance between patient service and student teaching--in an unpredictable clinical setting--has led to the use of a simulated clinical environment with simulated patients. We also piloted PBL for interprofessional education of undergraduate students of nursing and social work. The ways we can adopt PBL in various settings with different intents will help prepare our healthcare graduates in meeting the challenges of our ever more complex healthcare systems, and the demands of holistic patient care.

District nurses' experience of supervising nursing students in primary health care: A pre- and post-implementation questionnaire study

Nursing students go through clinical supervision in primary health care settings but district nurses' (DNs) circumstances when supervising them are only briefly described in the literature. The aim of this study was to investigate DNs experience of supervising nursing students before and after the implementation of a new supervision model. Ninety-eight (74%) DNs answered a questionnaire before and 84 (65%) after implementation of the new supervision model. The study showed that DNs in most cases felt that conditions for supervision in the workplace were adequate. But about 70% lacked training for the supervisory role and 20% had no specialist district nurse training. They also experienced difficulty in keeping up-to-date with changes in nurse education programmes, in receiving support from the university and from their clinic managers, and in setting aside time for supervision. Improvements after the implementation of a new model chiefly concerned organisation; more DNs stated that one person had primary responsibility for students' clinical practice, that information packages for supervisors and students were available at the health care centres, and that conditions were in place for increasing the number of students they supervised. DNs also stated that supervisors and students benefited from supervision by more than one supervisor. To conclude, implementation of a new supervision model resulted in some improvements.

Defining the construct of Masters level clinical practice in healthcare based on the UK experience

BACKGROUND

Growing emphasis on Masters level provision has been facilitated by the migration of education into Higher Education and the requirement for Continuing Professional Development. Paralleling this has been the development of specialisation in clinical practice. These factors have contributed to a proliferation of Masters courses aiming to develop specialist clinical practice.

AIMS

The aim of the study was to define the behaviours that are indicative of the construct of masters level clinical practice, using the UK experience as an example.

METHOD

A modified Delphi study employed a total population sample of course tutors of masters courses (nursing/midwifery, physiotherapy, radiography, interprofessional) in the UK assessing clinical practice (n = 48). Round 1 requested behaviours indicative of the construct of Masters level clinical practice. Data were analysed through descriptive coding identifying emerging themes to inform the behaviours included in round 2 that asked the participants to rank the importance of each behaviour on a 1-5 scale. Round 3 requested ranking the importance of the different behaviours to the construct. Descriptive analysis and the use of Kendall's coefficient of concordance and Spearman's rho enabled interpretation of consensus in rounds 2 and 3.

RESULTS

The response rate for the Delphi study was very good. There was good consensus amongst the 28 behaviours identified for round 1. The second round enabled 21 behaviours agreed to be very important indicators of the construct to be taken into round 3. The ranking process in round 3 highlighted the importance of for example, a critical approach to practice and advanced clinical reasoning.

CONCLUSION

The resulting 20 behaviours demonstrate good measurement validity and external validity. The components of the construct can therefore be used as the basis for further research.

User perceptions of the knowledge underpinning practice orientation dial (KUPOD) as a tool to enhance learning

The concern of academics and clinicians about the alleged dichotomy between theoretical concepts and the practice of nursing has been the catalyst for the development of a pocket-sized aid for nurses, known as the Knowledge Underpinning Practice Orientation Dial (KUPOD [N]/The Dial). A mixed method approach was used incorporating a questionnaire and a focus group of educators. The Dial was introduced, as part of a module, undertaken by a cohort of second-year Diploma in Nursing (Adult Branch) students. Twenty-eight students returned the questionnaire (response rate=85%). Results revealed that the Dial was easy to use in a variety of situations and locations. Respondents used the Dial within clinical and classroom settings and for self directed study. They reported that it was a practical and effective aid to learning, assisting in correlating theory and practice. It supported reflection and enhanced confidence in the clinical area, indicating that this economically produced tool helps to bridge the theory-practice gap. The Dial is now being introduced as a learning resource to a wider range of students.

Nursing students learning to utilize nursing research in clinical practice

The purpose of the study was to examine the significance of a learning assignment in relation to research skills and learning of nursing students in clinical practice. The learning assignment included an oral presentation of a nursing research article, which the students gave to their fellow students and ward nurses. The students also chaired the discussion after the presentation. The target group for the study was nursing students of a Finnish polytechnic who had been studying for 2-2 1/2 years and had accomplished a minimum of 120 ECTS credits of the total of 210 ECTS credits. When participating in the study, the students were completing a six-week clinical practice of optional studies. The data were collected with a questionnaire designed for the study. It consisted of six open-ended questions. Three of the questions were related to learning of research skills. Two questions were concerned with learning during the ongoing clinical practice. The final question inquired the students' views on the development of the learning assignment. The students received the questionnaire before the commencement of their clinical practice, and they returned it to the other researcher after their clinical practice. The questionnaire was given to 80 students, of which 50 returned it; the response rate was 63%. The data were analysed by content analysis question by question. According to the results, the learning assignment advanced the understanding of research concepts for the majority of the students. In particular, the students reported that the oral presentation clarified the research concepts, and the structure of a scientific article was also elucidated. The students stated that the assignment generated ideas concerning the development of nursing care. In relation to the ongoing clinical practice, the assignment advanced patient encounters and interaction, and bearing responsibility the most. Proposals for the further development of the learning assignment were expressed by more than half of the nursing students. Half of them suggested ensuring the interest in the topic from the ward.

The Turkish version of the Omaha System: its use in practice-based family nursing education

The aims of this manuscript are to examine the validity and reliability of the Turkish version of the Omaha System, and to demonstrate its effectiveness as a tool for nursing education. In this methodological and descriptive study, seventy students attending a training program used the Omaha System in clinical practice settings for assessing health problems of 157 clients and for nursing interventions during 378 home visits. After the system's adaptation to the Turkish language, its content validity was reconfirmed through feedback from the students and interrater reliability was tested on six independent students with kappa statistics. The reliability scores were at a statistically significant level when coding the records using the Omaha System. Clinical practice was explained with 332 problems and 1783 nursing intervention terms. Study findings indicate several strengths, including high reliability - except in target terms, coding of problems and interventions, improved understanding of the course, as well as some limitations: the need for new terms and more time required for manual documentation. The findings of the study supported the usefulness of the Omaha System in describing the practice of community health nursing.

Process-oriented training in breastfeeding alters attitudes to breastfeeding in health professionals

AIM

The purpose of the study was to measure the attitudes of antenatal midwives and postnatal nurses to breastfeeding before and after common, process-oriented breastfeeding training.

METHOD

Antenatal centres and child-health centres in 10 municipalities were randomized to either an intervention or a control group. The antenatal midwives and postnatal nurses in the intervention group were together given process-oriented breastfeeding training and were, in addition, asked to develop a common breastfeeding policy. A previously developed instrument was used to measure the effects of a training programme on breastfeeding attitudes among midwives and postnatal nurses. It consisted of four scales measuring a person's attitudes toward breastfeeding in four dimensions: regulating, facilitating, disempowering, and breastfeeding-antipathy attitudes. A mean score was calculated for each individual on these four dimensional scales. The higher the score, the stronger the attitude.

RESULTS

After one year, the intervention group reduced their scores on the regulating scale when compared with the control group (p<0.001). The intervention group decreased their scores on the regulating scale and increased their scores on the facilitating scale over the first year after training. The control group also significantly increased their scores on the facilitating scale. When the results were analysed profession-wise, the postnatal nurses in the intervention group decreased their scores on the regulating and disempowering scales and increased their scores on the facilitating scale. In contrast, the midwives in the intervention group decreased their scores only on the breastfeeding antipathy scale. The control group midwives decreased their scores on the disempowering scale. No differences were found among the postnatal nurses in the control group.

CONCLUSION

Process-oriented breastfeeding training made both antenatal midwives and postnatal nurses better disposed to breastfeeding; postnatal nurses in particular improved their attitudes. Attitudes to breastfeeding tended to be stable over time, but process-oriented training lowered the scores a little on the regulating scale, suggesting that after this kind of training counsellors would find it less necessary to schedule and control the mothers' breastfeeding behaviour.