Empowerment of nursing students in clinical practice: spheres of influence

Collaborating for co-researching: A multi-stakeholder case narrative of student nurses co-researching technology-supported care

AIM

Evaluate the impact of LS@H project participation on stakeholders.

BACKGROUND

As populations age and workforces decline, care technology in nursing is becoming increasingly commonplace. Collaboration between nurse academia, education and practice can result in practice-based research and meaningful learning for nursing students and staff. However, little is known about the factors influencing effective collaboration. Based on the knowledge that narratives can be an effective vehicle for healthcare practice change, a Dutch school of nursing and its practice partners collaborated on the Living Longer and Safe at Home! (LS@H) project. This project aimed to explore a more person-centred approach to the use of technology in nursing care. Having gathered data from multiple sources to construct case narratives on the use of technology in older persons care, students nurses were able to contribute to practice development as their narratives were fed back to local and regional teams.

DESIGN

To evaluate the impact of the LS@H project, we employed the same methodology used in the project: mixed data gathering methods to construct a case narrative. LS@H project students, supervisors, mentors and higher management shared their experiences and the research team constructed the case narrative.

METHODS

Qualitative data were gathered via individual, duo and group interviews and supplemented with a survey among students. Transcription and thematic analysis followed, with multiple rounds of critical peer review before the thematic framework was agreed, survey results integrated and the case narrative constructed.

RESULTS

According to stakeholder participants, the LS@H project led to an unfreezing of the status quo in both education and practice. The approach was new and guidelines with community support was needed to allay fears. The project design enabled a sense of shared ownership, across individuals and organisations for improving practice. Perspectives on the use of technology and older persons nursing were transformed. Critically dialoguing case narratives encouraged purposeful action to improve practice and fostered reflective practice among students and teams.

CONCLUSIONS

Collaborative practice-based research can be a valuable learning experience for student nurses, positively influencing their view of nursing practice as well as enabling them to actively contribute to practice development. Adequate preparation, supervision and practice mentorship is vital, alongside practice (leader) commitment to ensure continued student assignments with subsequent critical dialogue of the multi-stakeholder case narratives produced.

REGISTRATION NUMBER

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Predictors of Empowerment Among Undergraduate Nursing Students: A Cross-Sectional Study

Objective

To predict the factors that influence undergraduate nursing students' perception of empowerment.

Methods

A cross-sectional design was used, and fourth-year nursing students (n = 164) were selected using convenient sampling. The data collection methods included the Arabic version of self-reported questionnaires: The (LES), (LOGO-II), and (UNSASS).

Results

The results showed a positive correlation between nursing students' perception of empowerment and their attitudes toward learning. Also, the results showed a strong correlation between students' perception of empowerment and their academic satisfaction. In addition, in-class teaching was found to be the strongest predictor of students' perception of empowerment.

Conclusions

Verified the factors that may contribute to promoting the teaching-learning process to focus and stress on them. Teachers and instructors should utilize the available resources in the teaching environment to maximize the learning outcomes. All these factors are not limited and will enhance the nursing students' perception of empowerment.

The Usefulness of Peer Tutoring and its Impact on Nursing Students' Academic Performance, Psychological Empowerment, and Satisfaction: Pre-Post Design

Introduction

The entry to a professional course such as nursing is challenging for the students, due to its multifaceted curriculum and learning expectations.

Objectives

This study investigates the impact of peer tutoring on academic performance, psychological empowerment, and satisfaction among first-year nursing students.

Methods

A quantitative approach with one-group pre-test post-test design was utilized. The study participants were 104 students, with 98 completing both pre- and post-test assessments.

Results

Findings revealed a significant increase in academic performance following peer tutoring (t = 8.97, p < .001), particularly among female participants (t = 4.14, p < .001). Analysis of perceived usefulness showed higher ratings among peer tutors compared to tutees (t = 4.380, p =< .000). Additionally, students with lower GPAs (Grade Point Average) demonstrated significant improvement in academic performance post-tutoring in the ANOVA (F = 6.214, p < .001). A positive correlation was found between psychological empowerment and the perceived usefulness of peer tutoring. Peer tutors reported high levels of satisfaction and positive experiences (r = 0.639, p = 0.001).

Conclusion

This study emphasises the value of peer tutoring in enhancing academic outcomes and highlights the significance of demographic variables in educational interventions. The need for widespread implementation of peer tutoring programs, personalized approaches addressing gender biases, and comprehensive support for students with diverse academic backgrounds would enhance academic outcomes. The correlation between psychological empowerment and the perceived usefulness of peer tutoring climaxes the importance of addressing students' psychological needs in educational interventions.

Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study

OBJECTIVE

To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme.

DESIGN

A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated.

SETTING AND PARTICIPANTS

To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study.

FINDINGS

Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

Exploring crucial programme characteristics and group mechanisms of an empowerment programme for certified nursing assistants-A qualitative study

Aims

To identify crucial programme characteristics and group mechanisms of, and lessons learned from hindrances in an empowerment programme for certified nursing assistants and contribute to the development of similar programmes in other care settings.

Design

Exploratory qualitative study.

Methods

Between May 2017 and September 2020, we used in‐depth interviews and participant observations to study four groups participating in an empowerment programme for certified nursing assistants (N = 44).

Results

We identified three crucial empowerment‐enhancing programme characteristics: (1) inviting participants to move outside their comfort zone of caregiving; (2) stimulating the use of untapped talents, competencies and interests; (3) supporting the rediscovery of participants' occupational role and worth. Crucial group mechanisms encompassed learning from and with each other, as well as mechanisms of self‐correction and self‐motivation. Hindrances included a perceived lack of direction, and a lack of organizational support and facilitation.

Conclusion

We showed the significance of creating an inviting and stimulating environment in which participants can explore and function in ways they otherwise would not. Likewise, we identified how this can help participants learn from, critically correct and motivate one another.

Impact

The programme under study was uniquely aimed to empower certified nursing assistants. Our insights on crucial programme characteristics and group mechanisms may benefit those who develop empowerment programmes, but also policymakers and managers in supporting certified nursing assistants and other nursing professions in empowerment endeavours. Such empowerment may enhance employee retention and make occupational members more likely to address challenges affecting their occupational group and the long‐term care sector.

Distributed leadership as a predictor of employee engagement, job satisfaction and turnover intention in UK nursing staff

AIM

To investigate how distributed leadership via the Shared Governance programme influences employee engagement, empowerment, job satisfaction and turnover intentions among direct care nursing staff in a large UK hospital.

BACKGROUND

Increasing turnover rates and shortages of health care staff in the UK has called for interventions to improve employee engagement and job satisfaction.

METHODS

116 direct care nursing staff were sampled in a mixed-methods explanatory sequential design. A maximum variance sample of 15 participants were subsequently interviewed to gain a deeper understanding of the motivations and attitudes that influenced employee outcomes through distributed leadership.

RESULTS

Higher levels of distributed leadership predicted increased employee engagement and job satisfaction, and lower turnover intentions. Staff also felt more empowered and committed to the organisation despite some challenges experienced in implementing the Shared Governance programme.

CONCLUSION

Distributed leadership was found to be beneficial in promoting employee engagement and empowerment, increasing job satisfaction and organisational commitment and reducing turnover intention in the UK health care setting.

IMPLICATIONS FOR NURSING MANAGEMENT

By encouraging the practice of distributed leadership at work, health care staff can become more engaged and empowered, leading to higher rates of job retention, job satisfaction and organisational commitment.

An evaluation of the experiences of radiography students working on the temporary HCPC register during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has changed the world's perspective and had a profound impact on all those residing in the United Kingdom, resulting in unprecedented changes being made to the education and training of healthcare students. Universities and practice partners had to respond quickly and work in close collaboration with their wider system partners, Health Education England and the Department of Health, to ensure the changes made within the Health and Care Professions Council (HCPC) emergency measures were implemented. The aim was to explore the experiences of final year diagnostic and therapeutic radiography students who joined the HCPC temporary register during phase one of the COVID-19 pandemic.

METHODS

This study was informed by a phenomenological approach, in which a purposeful sample of seventeen participants comprising of nine students, six practice educators and two academics were chosen to participate. Semi-structured interviews and focus groups were conducted to collect the data via a virtual platform.

RESULTS

The results highlighted three themes, professionalism and transition to registration, benefits and challenges of working through a pandemic, and emotional impact. Students described how they gained confidence and competence during their time on the temporary register and suggested that professional bodies could consider curriculum changes to encompass a final transitional placement similar to their experience. They said they had been well supported but felt a sense of loss having been denied the normal rite of passage associated with completion of their course and graduation.

CONCLUSION

The results provide insight into how students, practice educators and academics transformed their practice to meet the necessary requirements whilst working during the first phase of the COVID-19 pandemic. They highlight the importance of having good support mechanisms in place and the rewards and challenges for students joining their professional register early.

IMPLICATIONS FOR PRACTICE

Some consideration could be made to changing the curriculum in the future to allow for early temporary registration and paid Band 4 final placements for students working as assistant practitioners.

An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

AIMS

To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre.

BACKGROUND

Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses.

METHODS

This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019.

RESULTS

One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession.

CONCLUSION

Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

Nurses' knowledge, attitudes and preparedness to manage women with intimate partner violence

AIM

To investigate nurses' knowledge, attitudes and practices related to intimate partner violence among women in Saudi Arabian healthcare settings.

BACKGROUND

There is a global focus on abuse experiences in clinical settings. However, nurses' practice in managing intimate partner violence patients in Saudi healthcare settings has not yet been examined.

INTRODUCTION

Intimate partner violence is a health issue that can lead to mortality and morbidity. It has recently received attention in an Arabian context. Thus, scrutinizing nurses' role in responding to intimate partner violence patients is needed to fill a current gap.

METHODS

A cross-sectional study was conducted with a convenience sample of 114 nurses from two hospitals in Saudi Arabia using a questionnaire.

RESULTS

Minimal previous intimate partner violence training was reported, as 63% of nurses had not received training related to intimate partner violence, and 52% believed that they did not receive adequate training to respond to intimate partner violence survivors. The results show that nurses had both low perceived knowledge and low preparedness in managing intimate partner violence, and only had basic intimate partner violence knowledge. Results indicated that nurses did not have appropriate attitudes towards intimate partner violence. The majority were not aware about intimate partner violence protocols or policies in their institutions. Only 2.6% had diagnosed intimate partner violence in the last six months.

CONCLUSION

There were gaps in nurses' perceived preparedness, knowledge, attitudes and behaviours. There was also limited training and preparation for nurses to assess and address intimate partner violence.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The study suggests the need for clear institutional health policies related to detecting, responding to, and preventing intimate partner violence. Guidelines about integrating intimate partner violence in nursing curricula and implementing in-service training should be developed and implemented. A multi-level intervention that enables nurses to respond to intimate partner violence is also needed.

Whistleblowing over patient safety and care quality: a review of the literature

PURPOSE

The purpose of this paper is to review existing research on whistleblowing in healthcare in order to develop an evidence base for policy and research.

DESIGN/METHODOLOGY/APPROACH

A narrative review, based on systematic literature protocols developed within the management field.

FINDINGS

The authors identify valuable insights on the factors that influence healthcare whistleblowing, and how organizations respond, but also substantial gaps in the coverage of the literature, which is overly focused on nursing, has been largely carried out in the UK and Australia, and concentrates on the earlier stages of the whistleblowing process.

RESEARCH LIMITATIONS/IMPLICATIONS

The review identifies gaps in the literature on whistleblowing in healthcare, but also draws attention to an unhelpful lack of connection with the much larger mainstream literature on whistleblowing.

PRACTICAL IMPLICATIONS

Despite the limitations to the existing literature important implications for practice can be identified, including enhancing employees' sense of security and providing ethics training.

ORIGINALITY/VALUE

This paper provides a platform for future research on whistleblowing in healthcare, at a time when policymakers are increasingly aware of its role in ensuring patient safety and care quality.

Nurse educators' perceived organizational factors affecting their psychological empowerment: An exploratory qualitative study

BACKGROUND

Organizational culture affects nurse educators' psychological empowerment. Limited research exists on the organizational culture and psychological empowerment in nursing educational environments and about the type of organizational factors affecting nurse educators' psychological empowerment.

AIM

To explore nurse educators' perceived organizational factors that affect their psychological empowerment.

METHODS

A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed-methods study. Semi-structured interviews were conducted with 12 educators with both clinical and educational experience. The data were analyzed using thematic analysis.

RESULTS

We generated three themes: poor organizational structure, dynamics of educators-academic administrators' relations, and educational tools and physical environment. The educators perceived factors were poor organizational structure, lack of collaboration across institutions and regulatory bodies, condescending attitudes of administrators and educators toward novice educators, limited teaching aids and scholarly resources, poorly defined roles, and underdeveloped and inconsistent curricula.

CONCLUSIONS

The identified organizational factors should be addressed to enhance educators' psychological empowerment so that they can effectively teach students. Emphasis should be placed on developing collaboration among educators, academic administrators, and regulatory bodies to address these factors. Further quantitative research is warranted to assess the degree and strength of association of these factors with psychological empowerment.

A Japanese version of the stressors in nursing students (SINS) scale

OBJECTIVES

To translate and study the factor structure of a Japanese version of the Stressors in Nursing Students scale.

METHODS

The Stressors in Nursing Students scale was translated into Japanese and administered to a large cohort (N = 1298) of female Japanese nursing students across five universities and across all four years of the nursing programme. The data were analysed using exploratory factor analysis.

RESULTS

Exploratory factor analysis revealed four factors: 'Clinical'; 'Conflict and confidence'; 'Education'; and 'Free time'. The relationship between the total score on the Stressors in Nursing Students scale and the demographic aspects of the sample was weak but there was a significant increase in the perception of stressors between first and second year students.

CONCLUSIONS

There were similarities and differences between the perception of stressors by nursing students in Japan compared with, for example, the United Kingdom and China mainland. While a four-factor structure was found here, the distribution of items in the Stressors in Nursing Students scale differed from previous studies in the United Kingdom and China with the 'Free time' factor being unique to this study. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their work and study. Findings can inform the development of strategies to reduce such stressors among nursing students in multiple, global contexts.

The facilitators and impediment factors of midwifery student's empowerment in pregnancy and delivery care: A qualitative study

Background:

The organizational environment and its existing context may deeply affect on empowerment of individuals. In educational institutions as well as other organizations, students are going to be powerful when opportunities for growth and achievement of power are provided for them in learning and educational environments. This study has been carried out to explain the facilitators and impediment factors of midwifery student's empowerment in pregnancy and delivery care.

Materials and Methods:

The current qualitative study has been conducted with participation of 15 midwifery senior students, 10 midwifery academic teachers, and 2 employed midwives in educational hospitals. The given data were collected through individual and group semi-structured interviews, and there were analyzed using directed content analysis method.

Results:

Three main categories of opportunity for acquisition of knowledge, opportunity for acquisition of clinical skills and opportunity for acquisition of clinical experiences formed structure of access to opportunity in the course of an explanation of facilitators and impediment factors for midwifery student's empowerment in pregnancy and delivery care.

Conclusion:

To prepare and train the skilled midwives for giving care services to mothers during pregnancy and on delivery and after this period, the academic teachers and clinical instructors should pay due attention to providing the needed opportunities to acquire the applied knowledge and proficiency in the required skills for clinical work and the necessary clinical experiences in these individuals during college period.

Are we failing to prepare nursing and midwifery students to deal with domestic abuse? Findings from a qualitative study

AIMS

To investigate student nurses' and midwives' knowledge, confidence and educational needs regarding recognition and responses to domestic abuse.

BACKGROUND

Domestic abuse is a serious global problem and has greater, negative effects on long-term health than more obvious diseases, such as diabetes. Nurses and midwives are well-placed to recognize and respond to domestic abuse but many lack confidence in this area. There is firm evidence that training can increase the confidence of Registered Nurses and midwives in responding to domestic abuse. But the issue of undergraduate preparation is significantly under-investigated.

DESIGN

A qualitative study.

METHODS

Nursing and midwifery students were recruited using purposive sampling. We facilitated eight focus groups with a total of 55 students (student midwives N = 32; student nurses n = 23). Data were collected between May-November 2014.

FINDINGS

Students in the study viewed the issue of domestic abuse as important and they possessed sound theoretical knowledge of its nature and consequences. However, they lacked confidence in recognizing and responding to abuse and were concerned about the implications of this for their future practice as registered practitioners. Interactive learning opportunities that engaged with service users and involved experts from practice were viewed as important educational requirements.

CONCLUSION

Most students in the study felt insufficiently prepared to deal with the issue of domestic abuse. They perceived this as a cyclical state of disempowerment that would impact negatively on their practice and on their own ability to support nursing and midwifery students of the future.

The role of the clinical preceptor: an integrative literature review

The clinical learning environment has been identified as being central to nursing education. The clinical learning environment provides undergraduate nursing students with the opportunity to combine cognitive knowledge with the development of psychomotor and affective nursing skills. The preceptor role in undergraduate nursing education is complex and multifaceted. Undergraduate nursing students identify preceptors as key to their learning in the clinical setting; however, staff nurse preceptors often feel unprepared to serve in this role. This integrative literature review explores the role of the staff nurse preceptor through the perspective of undergraduate nursing students, nursing faculty, and staff nurses who are assigned to precept students as a function of their nursing role. Recommendations are made to facilitate the preparation of clinical preceptors to fulfill this essential role in preparing nursing students for clinical practice.

Empowerment and being valued: a phenomenological study of nursing students' experiences of clinical practice

AIM

The aim of the study was to explore the empowerment of nursing students in clinical practice. This paper focuses on 'being valued' as an important element of empowerment.

BACKGROUND

Empowerment of nursing students is necessary in order for them to foster a sense of control and self-efficacy for those in their care. However, there is very little research on how to empower nursing students. Moreover, there is limited literature that specifically addresses the importance of students being valued in clinical practice.

METHODS

Thirteen, first-year nursing students were recruited using purposive sampling. Data were generated through the means of in-depth, semi-structured interviews. Hermeneutic phenomenology was chosen as the underpinning philosophical approach because of its emphasis on actual experiences.

FINDINGS

Being valued as a learner, being valued as a team member and being valued as a person are important factors in the empowerment of nursing students in clinical practice. These invariant themes are evident either implicitly or explicitly in the experiences of most students.

DISCUSSION

When nursing students are valued as learners, team members and people, they feel empowered. Too often however, they experience disempowerment as a result of feeling devalued. This has a detrimental impact on their learning and intention to continue on the programme. According to the accounts of many nursing students effective mentorship and a supportive environment are factors that influence empowerment significantly.

CONCLUSIONS

Strategies to promote the empowerment of nursing students in clinical practice need to address their sense of value.