Understanding the influences on self-confidence among first-year undergraduate nursing students in Ireland

Preparedness for a first clinical placement in nursing: a descriptive qualitative study

BACKGROUND

A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students' perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students' emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience.

METHODS

The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically.

RESULTS

Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants' feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students' expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers.

CONCLUSIONS

This unique study of first-year postgraduate entry-to-practice nursing students' perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students' narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Success factors in adaptation of newly graduated nurses: a scoping review

BACKGROUND

Difficulties in adapting to the workplace can affect newly graduated nurses' transition. Such nurses must adapt quickly, as it can affect their future career prospects. Therefore, this review aimed to identify the success factors that promote newly graduated nurses' effective transition and adaptation.

METHODS

The Joanna Briggs Institute scoping reviews methodology was used. Data were extracted from MEDLINE, Scopus, EBSCOhost, and Web of Science publications published between 2011 and 2020. A total of 23 articles were included in this review, which comprised qualitative, quantitative, and mixed methods primary research studies focusing on the contributing factors that aided newly graduated nurses' adaptation to the work environment during their transition period. Key emerging themes were identified with thematic analysis.

RESULTS

Three main themes were identified: (1) organisational contribution (social development, organisational culture, work characteristics, work readiness, work commitment, professional role), (2) personality traits (self-embodiment, personality masking, being proactive and confident), and (3) academic institutions (pre-entry knowledge and role of nursing faculty). Newly graduated nurses' adaptation should begin during nursing education, be supported by the workplace organisation, and driven by the nurse's personality. We determined that that the role of nursing education in aiding the provision of the required knowledge and actual clinical experiences to students profoundly affected developing nurses' self-confidence levels in delivering nursing care effectively. Additionally, a warm environment supported nurses emotionally and physically.

CONCLUSIONS

While organisations and educational institutions have undertaken numerous efforts to ensure that newly graduated nurses are adequately supported, the nurse's personality and values are also equally important to ease adaptation during the transition process. Academic and workplace programs designed for newly graduated nurses should apply and emphasise this knowledge to develop and strengthen their personalities and values, especially to increase confidence and promote proactive values that facilitate newly graduated nurses' rapid and effective adaptation to their new employment.

The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes

This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross-sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of  Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses' lifelong learning level explained the three subdimensions of self-confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision-making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses' lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses' lifelong learning awareness.

Second-year undergraduate nursing students' experiences with clinical simulation training in mental health clinical practice: A focus group study

AIM

The aim of this focus group study was to investigate second-year undergraduate nursing students' experiences with clinical simulation training as part of their clinical practice in acute mental health care.

BACKGROUND

The quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students' experiences with clinical simulation training as an integrated part of nursing students' clinical practice in acute mental health wards.

DESIGN

Explorative qualitative focus group study.

METHOD

Three focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.

RESULTS

Clinical simulation training as part of the clinical practice increased the students' preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.

CONCLUSION

Clinical simulation training as part of clinical practice contributed to increasing the students' self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.

Effect of High-Fidelity Simulation on Self-Satisfaction and Self-Confidence Among Nursing Students

Introduction

Newly graduating nurses should be able to enter clinical practice as safe, accurate, competent, and compassionate professionals in health care settings that necessitate them to be learners who can easily get familiar with a broad diversity of clinical practice settings.

Purposes

The purpose of this study was to evaluate the effect of high-fidelity simulation experiences on self-satisfaction and self-confidence among the pediatric nursing students.

Methods

A quasi-experimental design, post-test, was carried out through the recruitment of a convenience sample of 150 nursing students from Arab American University. The students were randomly assigned to the study (n  =  75) or control (n  =  75) groups. Data were collected using learner satisfaction and self-confidence scales.

Results

The results of the post-test revealed that there was a significant difference between both groups in self-satisfaction (t (148)  =  11.14, P < .001) and self-confidence (t (148)  =  13.04, P < .001). The mean score of self-satisfaction for the study group (22.45  ±  2.27) was higher than control group (16.80  ±  3.76). Also, the study group' mean self-confidence score (35.72  ±  3.49) was higher than the control group (27.28  ±  4.39).

Conclusion

High-fidelity simulation was confirmed to be an helpful tool to keep an effective and safe learning method for pediatric nursing students, thus increasing their satisfaction and confidence.

Personal qualities needed by undergraduate nursing students for a successful work integrated learning (WIL) experience

BACKGROUND

International research has shown that during work integrated learning (WIL) undergraduate nursing students may experience stress, self-doubt, and coping issues, however personal qualities these students bring to their WIL journey or those needed to succeed during WIL remain unknown.

OBJECTIVE

To describe the views of students midway through their Bachelor of Nursing program regarding personal qualities they bring to and need for WIL success.

DESIGN

This article reports on a descriptive study that used an electronic questionnaire to collect the data.

SETTINGS AND PARTICIPANTS

Bachelor of nursing students (n = 421), who were studying fulltime or part time equivalent, at a regional university in Queensland Australia, were invited to complete the anonymous electronic questionnaire that was developed by the research team following an extensive review of literature. Inclusion criteria required participants to have completed at least one WIL experience and be midway through their three-year Bachelor of Nursing program.

METHODS

Data were collected during January and February 2017. The electronic questionnaire consisted of demographic, forced choice questions, and open-ended questions. This paper presents the qualitative analysis of responses to two of the open-ended questions that focused on personal strengths and work integrated learning experiences. Data were analysed using the inductive content analysis approach.

RESULTS

Six personal qualities were identified including: enthusiasm to succeed, commitment to learning, self-motivation, confidence, effective communication skills, and compassion.

CONCLUSIONS

Pre-entry screening of applicants to bachelor level nursing programs and the delivery of learning opportunities that encourages both reflection and debriefing may assist in describing personal qualities needed to succeed in WIL.

Nursing students' evaluation of clinical learning environment and supervision in a Norwegian hospital placement - A questionnaire survey using CLES+T scale

AIM

The clinical learning environment and supervisor-student relationship play vital roles in the learning outcomes of nursing students. The aim of this study is to evaluate nursing students' experiences with the clinical learning environment and supervision in a hospital placement organised with a dual preceptor team - preceptors holding dual positions both in the clinic and the nursing faculty in addition to the standard one-to-one supervision by a clinical preceptor.

DESIGN

The study is a paper-based survey based on a validated questionnaire developed and tested in hospital settings in various European countries, including Norway.

METHOD

The Norwegian version of the CLES+T Evaluation Scale, was distributed to all second-year students in three different years (2015-2017) at a nursing faculty.

RESULTS

A total of 61% students (n = 261) returned the questionnaire. Overall, the students considered that their hospital placement provided a good clinical learning environment. The results suggest that the dual preceptor team on top of one-to-one supervision did not interfere negatively with the clinical learning environment Nevertheless, the dual preceptor model did not compensate for a poor relationship with the clinical preceptor. Thus, the association between a reported 'strained relationship' with the clinical preceptor and low scores on the CLES+T, reported on by other studies, remained in our data.

CONCLUSIONS

To better grasp the complexity in this area, various methods are needed, such as in-depth interviews with students, nurse teachers and clinical preceptors. Further studies need to elaborate on students' experiences of clinical learning environment according to how supervision is organised.

Nursing Students' Academic Success Factors: A Quantitative Cross-sectional Study

BACKGROUND

Attrition from nursing programs is an ongoing concern. Capitalizing on nursing students' strengths and supporting areas for remediation will maximize student success.

PURPOSE

This study explored undergraduate nursing student strengths and areas for remediation at program entry and across all years of nursing education study.

METHODS

We used a cross-sectional design and collected data via the Academic Success Inventory for College Students survey tool. Baseline data were collected on first-year students after program start, and data were collected for all years of study at the end of the academic terms.

RESULTS

Compared with other undergraduate students, nursing students exhibited strengths in study skills, in self-organization strategies, in their certainty of progress toward career goals, in recognizing the importance of their studies, and in levels of socializing that did not hinder academic performance. At some data collection points, they had strengths in motivation, confidence, and concentration. Nursing students indicated areas for remediation in studying or test-taking anxiety and their perception of the educator's ability to organize, teach, and assess student progress.

CONCLUSION

Nurse educators' pedagogical approaches should augment nursing student strengths. Remediation is required to support student success relative to anxiety, and students need orientation to the process of learning.

Self-confidence of Nurses Philosophy: A Concept Analysis

BACKGROUND: The philosophical and theoretical values of nursing moved away from a systematic review of the science of nursing and experienced a shift based on paradigms. The results may be interpreted by several nursing theorists in different ways. AIM: This paper aims to analyze the development of a more comprehensive understanding toward the meaning of confidence concept of the nurses and stimulated services health, person, environment and nursing resolutions based on nursing discussions, and nursing-related literature. The definition of this resolution has been completed and synthesized successfully to fit our nursing philosophy. METHODS: The main argument from the researchers shows the renewal of several nursing theorists and critical appraisal adopted by Walker and Avant in eight steps of the broader concept that was agreed at the beginning in the construction of phased planning from positivistic to questionable views of the research the philosophy in nursing provers that nurses confidence is also important. RESULTS: They are academically constructed so that they do not highlight the daily improvement of nurses as nurses need to be confident in performing their job. We need to offer a philosophy of nursing with four things: Social, environmental health, passenger care, and self-confidence. CONCLUSION: The selection of philosophy and ideology of the second paradigm among various options must be agreed on. Nurses must have strong self-confidence and smart collaboration who can make changes in the quality of life of others considering the good and bad for their health.

Directions of the 100 most cited nursing student education research: A bibliometric and co-citation network analysis

AIMS

To identify and analyze the 100 most cited articles on nursing student education (NSE) that were published in nursing journals.

BACKGROUND

The citation frequency of an article indicates its scientific impact. Analyzing highly cited articles on NSE enabled researchers to identify mainstream research types and acquire relevant information and knowledge.

DESIGN

A retrospective bibliometric analysis with co-citation network analysis.

DATA SOURCES

We searched for journal articles on NSE from the Web of Science, and analyzed the 100 most cited articles (date of search: June 3, 2020).

REVIEW METHODS

The theme, article type, journal, country, source of institutional articles, and publication year were counted and analyzed. The citation relationships among the most 100 cited articles of NSE were calculated and visualized.

RESULTS

Articles included in this study were mostly empirical quantitative studies with a cross-sectional design, and were published in international nursing journals between 2000 and 2020. Their authors were mostly from the United States and the United Kingdom. According to the co-citation network analysis, four main research directions were identified: workplace mental health, simulation learning, spiritual care, and medication administration.

CONCLUSION

Workplace mental health was the major research topic on NSE. This research topic has spanned two decades (2000-2020). These articles were mainly published in the Journal of Advanced Nursing and Nurse Education Today. Some recent research topics, such as simulation learning and spiritual care were also identified. Findings provide a fresh review of the highly cited NSE articles, including the visualization of the NSE network.

Developing and sustaining nurses' service improvement capability: a phenomenological study

BACKGROUND

Service improvement to enhance care quality is a key nursing responsibility and developing sustainable skills and knowledge to become confident, capable service improvement practitioners is important for nurses in order to continually improve practice. How this happens is an under-researched area.

AIM

A hermeneutic, longitudinal study in Northern England aimed to better understand the service improvement lived experiences of participants as they progressed from undergraduate adult nursing students to registrants.

METHOD

Twenty year 3 student adult nurses were purposively selected to participate in individual semi-structured interviews just prior to graduation and up to 12 months post-registration. Hermeneutic circle data analysis were used.

FINDINGS

Themes identified were service improvement learning in nursing; socialisation in nursing practice; power and powerlessness in the clinical setting; and overcoming service improvement challenges. At the end of the study, participants developed seven positive adaptive behaviours to support their service improvement practice and the 'model of self-efficacy in service improvement enablement' was developed.

CONCLUSION

This study provides a model to enable student and registered nurses to develop and sustain service improvement capability.

New Graduate Nurse Transition Into the Intensive Care Unit: Qualitative Insights From a Longitudinal Study-Part 1

BACKGROUND AND PURPOSE

Patients admitted to intensive care units (ICUs) are critically ill and suffer from life-threatening sickness of injury. To work in ICU, registered nurses require additional knowledge and skills. While practices regarding the hire of new graduate nurses (NGNs) into settings such as the ICU vary, it is common that NGNs are being hired. However, NGNs in general, are at a higher risk for turnover within the profession as compared to their more experienced colleagues. NGNs in ICU settings may be at higher risk of turnover due to the complexity of the care context. It is of particular importance that the experiences of NGNs in ICU be explored with the intent of identifying what these nurses experience but also to consider how they can be best supported during a period of transition. This manuscript reports the findings from a mixed design study that sought to understand the transition of a cohort of NGNs over a period of 2 years.

METHODS

This study used both a purposive and convenience sample of NGNs. The qualitative component incorporated Thorne's (2016) interpretive description. Face-to-faceinterviews were completed.

RESULTS

Five themes were identified: an emotional transition, a social transition, a transitioning mindset, transitioning through firsts, and transitioning with confidence. Within each theme, there is a distinct difference and elements of transition were evident. Findings demonstrate that the NGNs appeared to be more confident in their skills and in their nursing practice over time. Findings from this study provide important insight into the experiences of NGNs in ICUs.

New Graduate Nurse Experiences in Clinical Judgment: What Academic and Practice Educators Need to Know

AIM

The aim of the study was to determine if use of a structured reflection exercise using a clinical judgment framework would result in more practice-ready new graduate nurses (NGNs).

BACKGROUND

Clinical judgment is a critical skill for all nurses, yet it is identified as a deficit in NGNs.

METHOD

Seventy-four NGNs in two groups participated in this mixed-methods study in their first year in practice. Scores from two quantitative measures were collected for all participants. The Lasater Clinical Judgment Rubric framed the structured intervention.

RESULTS

Although the quantitative data showed no significant differences between the groups, use of the reflection exercise indicated a positive impact on NGNs. Qualitative data revealed four themes that present challenges for preparation of NGNs: enhancing communication, finding interprofessional support, responding to complexity of care, and appreciating the role of the nurse.

CONCLUSION

Implications provide guidance for academic and practice educators to smooth the transition into practice.

Undergraduate nursing students' strategies for coping with their first clinical placement: Descriptive survey study

BACKGROUND

Clinical placement is an essential component in academic nursing programs to provide nursing students with an opportunity to apply theoretical knowledge to practice. The first clinical placement can be an extremely stressful experience for some nursing students, which may affect their decision to be a nurse.

OBJECTIVE

The aim of this study was to identify factors and strategies that enable a positive experience of the first clinical placement for first year nursing students.

DESIGN

Mixed methods descriptive survey design.

SETTINGS

The study was conducted in a nursing school at one university in South Australia.

RESPONDENTS

Respondents were all first year undergraduate nursing students at a higher education facility in South Australia.

METHODS

Data collection tool was an online questionnaire including quantitative and qualitative questions. Coping strategies framework informed qualitative analysis.

RESULTS

Respondents identified a range of strategies that had enabled them to positively cope with their first clinical placement experience. Strategies included use of debriefing sessions with their clinical lecturers and seeking-out their friends and family to talk about their first clinical placement experiences. Other strategies included being adequately prepared before the clinical placement, identifying and seeking advice from supportive nursing staff and effective communication between nursing schools and clinical institutions about placement arrangements and expectations.

CONCLUSIONS

It must not be forgotten how stressful first clinical placements are. This experience will leave a lasting impression on students' introduction to the nursing profession. Sharing coping strategies used by nursing students will assist to provide a positive introduction to nursing practice.

Comparing Outcomes of Active Student and Observer Roles in Nursing Simulation

BACKGROUND

Because of large class sizes and limited resources, students participating in high-fidelity simulation experiences may be assigned to an observer role as opposed to an active nursing role.

PURPOSE

Educators need to determine if anxiety levels and student learning outcomes are comparable for students in active and observer roles.

METHODS

A quasi-experimental study was conducted with 132 prelicensure baccalaureate students. Active nursing roles consisted of primary care, documentation, and medication nurse roles. Observer role students were provided with resources to guide them with developing their observational skills and achieving the simulation objectives.

RESULTS

There were no significant differences between simulation roles for anxiety levels, satisfaction with learning, self-confidence in learning, clinical ability, problem solving, confidence in clinical practice, and collaboration.

CONCLUSIONS

These findings suggest that either role is an appropriate assignment during simulation. Educators should identify ways to be supportive and reduce anxiety in students during simulation experiences.

Comparing student clinical self-efficacy and team process outcomes for a DEU, blended, and traditional clinical setting: A quasi-experimental research study

BACKGROUND

Clinical education is vital to both the development of clinical self-efficacy and the integration of future nurses into health care teams. The dedicated education unit clinical teaching model is an innovative clinical partnership, which promotes skill development, professional growth, clinical self-efficacy, and integration as a team member. Blended clinical teaching models are combining features of the dedicated education unit and traditional clinical model.

OBJECTIVES

The aims of this study are to explore how each of three clinical teaching models (dedicated education unit, blended, traditional) affects clinical self-efficacy and attitude toward team process, and to compare the dedicated education unit model and blended model to traditional clinical.

METHODS

A nonequivalent control-group quasi-experimental design was utilized. The convenience sample of 272 entry-level baccalaureate nursing students included 84 students participating in a dedicated education unit model treatment group, 66 students participating in a blended model treatment group, and 122 students participating in a traditional model control group. Perceived clinical self-efficacy was evaluated by the pretest/posttest scores obtained on the General Self-Efficacy scale. Attitude toward team process was evaluated by the pretest/posttest scores obtained on the TeamSTEPPS® Teamwork Attitude Questionnaire.

RESULTS

All three clinical teaching models resulted in significant increases in both clinical self-efficacy (p=0.04) and attitude toward team process (p=0.003). Students participating in the dedicated education unit model (p=0.016) and students participating in the blended model (p<0.001) had significantly larger increases in clinical self-efficacy compared to students participating in the traditional model.

CONCLUSIONS

These findings support the use of dedicated education unit and blended clinical partnerships as effective alternatives to the traditional model to promote both clinical self-efficacy and team process among entry-level baccalaureate nursing students.

Prelicensure Employment and Student Nurse Self-Efficacy

There is a lack of literature regarding how prelicensure employment affects self-efficacy in nursing practice. The purpose of this study was to examine the relationship among prelicensure employment and self-efficacy in nursing practice of senior student nurses. Healthcare experience was identified as the best predictor of positive self-efficacy in managing an assignment of three and four patients. Findings of this study provide insight for providing orientation for newly licensed nurses regarding their readiness to practice.

A Web-Based Module to Enhance BSN Students’ Knowledge and Confidence in Teaching Parents About Newborn Behavior

As an adjunct to traditional instructional strategies, students enrolled in a Bachelor of Science in Nursing maternity course completed a Web-based module called “HUG Your Baby” (HYB) about newborn behavior, interpreting and responding to an infant’s cues and body language, and teaching new parents. Students who completed the HYB program were compared with students enrolled in another semester of the same maternity course in which only traditional teaching strategies were used. Both groups were compared on knowledge and confidence about newborn behaviors and teaching new parents. Knowledge and confidence scores increased significantly in both groups from beginning to end of the semester. Students who completed the HYB program demonstrated a significantly greater increase in knowledge and confidence compared with students who did not complete the HYB program. Students highly rated the HYB program and recommended it for incorporation into the maternity course.

Needing to Belong: First Practice Placement Experiences of Children's Nursing Students

This study examines first year children's nursing students' anxieties before their first practice placement and their support needs during that time. Strategies to address needs are highlighted. A questionnaire was completed by children's nursing students (n = 21) before their initial practice placement to establish their expectations and concerns. A subgroup (n = 5) took part in a focus group following placement to establish consensus around the support that helped and what could help future students prepare for first placement. The resultant data indicated the importance of students having a sense of belonging to their practice placement, trusting website information, induction days, and the involvement of a more senior student in their preparation, in addition to facilitative mentors. Using similar methodology to that used with students, a subgroup of professional staff took part in two focus groups (FG1 n = 5, FG2 n = 4) to establish consensus around support initiatives using areas identified by students as priorities that could better facilitate this initial practice placement. Although commonalities existed within both students and professionals, some differences were highlighted. A student's first practice placement is of utmost importance in affirming their choice to study nursing. Academic and clinical staff play a crucial part in this decision-making.

Clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland; a qualitative study

BACKGROUND

A preceptorship model of clinical teaching was introduced to support the new all-graduate nurse education programme in Ireland in 2002. Little is known about how this model impacts upon the pedagogical practices of the preceptor or student learning in clinical practice leading to question what constitutes effective teaching and learning in clinical practice at undergraduate level.

AIM

This study aimed to explore the clinical teaching and learning within a preceptorship model in an acute care hospital in Ireland and identify when best practice, based on current theoretical professional and educational principles occurred.

METHOD

A qualitative research study of a purposively selected sample of 13 students and 13 preceptors, working together in four clinical areas in one hospital in Ireland. Methods were semi-structured interviews, analysed thematically, complemented by documentary analysis relating to the teaching and assessment of the students. Ethical approval was gained from the hospital's Ethics Committee.

FINDINGS

Preceptor-student contact time within an empowering student-preceptor learning relationship was the foundation of effective teaching and learning and assessment. Dialoguing and talking through practice enhanced the students' knowledge and understanding, while the ability of the preceptor to ask higher order questions promoted the students' clinical reasoning and problem solving skills. Insufficient time to teach, and an over reliance on students' ability to participate in and contribute to practice with minimal guidance were found to negatively impact students' learning.

CONCLUSIONS & IMPLICATIONS

Concepts such as cognitive apprenticeship, scaffolding and learning in communities of practice can be helpful in understanding the processes entailed in preceptorship. Preceptors need extensive educational preparation and support to ensure they have the pedagogical competencies necessary to provide the cognitive teaching techniques that foster professional performance and clinical reasoning. National competency based standards for preceptor preparation should be developed.

Concerns of nursing students beginning clinical courses: A descriptive study

BACKGROUND

Students harbor fears related to the clinical environment that influence their participation and learning. Some studies have addressed general anxieties in undergraduate nursing students, but few have asked students to report their fears and concerns prior to entering the clinical environment. Therefore, this study examined the fears and concerns of undergraduate nursing students beginning clinical courses as well as their continued concerns upon completion of the first year of instruction. The study also assessed their confidence in physical assessment skills.

METHODS

Ninety-six junior nursing students enrolled in a generic baccalaureate nursing program completed a survey, two items of which asked about their fears and concerns related to beginning clinical experiences and their confidence in physical assessment. A follow up survey was completed at the end of the junior year by 72 students.

RESULTS

Making a mistake, lack of course success, and not knowing how to do something were students' major concerns prior to the start of clinical experiences. Bad experiences with a nurse or instructor, freezing up, and uncomfortable patient/family experiences were also concerns. Not knowing how to do something persisted as a concern at the completion of the first year. Fears about being/feeling left alone in a clinical setting as well as concern about the senior year also emerged on the post survey. Confidence in physical assessment was a mean of 60.46 on a scale of 0-100 at the beginning of clinical instruction and 71.28 at the end of the junior year.

CONCLUSIONS

Faculty should structure learning activities that decrease anxiety and enhance students' confidence prior to initial clinical experiences. Opportunities might include in-depth orientation to clinical settings and various simulations that allow practice of skills and communication. Awareness of predominant student fears and concerns can also guide staff nurses to provide a welcoming environment and enhance learning.

Development and psychometric evaluation of the arterial puncture self-efficacy scale

BACKGROUND

Arterial puncture for arterial blood gases (ABG) analysis can be a risky, painful, difficult-to-perform procedure that is often insufficiently practised and generates stress and discomfort amongst patients and healthcare professionals. Self-efficacy is a key component in the acquisition of procedural skills. Therefore, professionals' self-efficacy in arterial puncture should be measured before attempting the procedure on real patients.

OBJECTIVE

To develop and psychometrically assess a self-efficacy scale in arterial puncture.

DESIGN

An observational cross-sectional design was used in this study.

SETTING

Faculty of Education Sciences, Nursing and Physiotherapy in a higher education institution in the south of Spain.

PARTICIPANTS

A convenience sample of 342 nursing students entered and completed the study. All participants met the following inclusion criteria: (1) ≥18years old and (2) enrolled in a nursing degree programme during the 2014/2015 academic year. Participants were 74% female (n=254) and their age ranged from 18 to 50, with a mean age of 21.74years (SD=5.14).

METHOD

The Arterial Puncture Self-Efficacy Scale (APSES) was developed and psychometrically tested. Reliability and content validity were studied. Predictive validity and concurrent validity assessed criterion validity. In addition, principal component analysis and known-group analysis evaluated construct validity.

RESULTS

Principal component analysis revealed the two-subscale structure of the final 22-item version of the Arterial Puncture Self-Efficacy Scale (APSES). A total Cronbach's alpha coefficient of 0.97 showed its high reliability. The APSES' content validity index was excellent (S-CVI/Ave=0.95). Predictive and concurrent validity analysis demonstrated the good criterion validity of the tool. Supporting the APSES' sensitivity and specificity, known-groups analysis evidenced significant differences (p<0.001) in self-efficacy levels between groups.

CONCLUSION

The APSES showed good psychometric properties for measuring self-efficacy in arterial puncture for ABG analysis.

The effectiveness of peer mentoring in promoting a positive transition to higher education for first-year undergraduate students: a mixed methods systematic review protocol

BACKGROUND

The global transfer of nursing and midwifery education to higher education institutes has led to student nurses and midwives experiencing challenges previously faced by traditional third-level students, including isolation, loneliness, financial difficulties and academic pressure. These challenges can contribute to increased stress and anxiety levels which may be detrimental to the successful transition to higher education, thus leading to an increase in attrition rates. Peer mentoring as an intervention has been suggested to be effective in supporting students in the transition to third-level education through enhancing a sense of belongingness and improving student satisfaction, engagement and retention rates. This proposed systematic review aims to determine the effectiveness of peer mentoring in enhancing levels of student engagement, sense of belonging and overall satisfaction of first-year undergraduate students following transition into higher education.

METHODS

MEDLINE, Web of Knowledge, ProQuest, Embase, CINAHL, ERIC, PsycINFO and CENTRAL databases will be searched for qualitative, quantitative and mixed methods studies on the implementation of peer assessment strategies in higher education institutes (HEIs) or universities for full-time, first-year adult students (>17 years). Included studies will be limited to the English language. The quality of included studies will be assessed using a validated Mixed Methods Appraisal Tool (MMAT). The findings will be presented as a narrative synthesis or meta-analysis as appropriate following sequential explanatory synthesis.

DISCUSSION

The review will provide clear, non-biased evidence-based guidance to all third-level educators on the effectiveness of peer-mentoring programmes for first-year undergraduates. The review is necessary to help establish which type of peer mentoring is most effective. The evidence from qualitative and quantitative studies drawn from the international literature will be utilised to illustrate the best way to implement and evaluate peer mentoring as an effective intervention and will be useful in guiding future research and practice in this area. These findings may be applied internationally across all disciplines.

Graduating nurses' self-efficacy in palliative care practice: An exploratory study

BACKGROUND

Educational institutions and the health care industry agree that graduates from professional programs need to be "work ready" and capable of delivering competent and confident nursing care. One measure of program success is the student's self-efficacy in meeting expected graduate capabilities. In this study student's self-efficacy is related to palliative care graduate capabilities.

AIM

To explore graduating Bachelor of Nursing Science (BNSc) students' self-efficacy in caring for palliative care patients.

DESIGN

A qualitative design using semi-structured face-to-face interviews.

SETTING

A regional Australian university.

PARTICIPANTS

A purposive sample of 10 students in their final semester of study in a Bachelor of Nursing Science degree program.

METHOD

Semi-structured face-to-face interviews were conducted. Interview questions were informed by published palliative care graduate capabilities. Interview data were transcribed verbatim and coded by capability. The coded data were then analysed to determine evidence of self-efficacy in caring for palliative care patients.

RESULTS

All participants had experiences in caring for palliative care patients. However, the responses did not consistently reflect high degrees of self-efficacy in four documented palliative care graduate capabilities required to care for persons with a life-limiting illness.

CONCLUSIONS

The findings support others that have identified gaps between curriculum and health care industry requirements in terms of students' beliefs about their empowerment to deliver nursing care as graduates. Education interventions and approaches to program evaluation require further development to better support students' growth of self-efficacy in undertaking their graduate roles.

Using Facebook to enhance commencing student confidence in clinical skill development: A phenomenological hermeneutic study

AIM

The purpose of this study was to explore commencing nursing students' experience of Facebook as an adjunct to on-campus course delivery to determine its impact as a learning strategy for improving confidence in clinical skill development.

BACKGROUND

Approaches supporting nursing students in the development of clinical skills have relied on 'real-life' clinical placements and simulated on-campus clinical laboratories. However students continue to report a lack of confidence in their clinical skills for practice. Social networking sites including Facebook are being used as a learning strategy to stimulate active and collaborative learning approaches.

DESIGN

A hermeneutic phenomenological approach was used to provide an understanding of the experience of confidence in clinical skills development for nursing students.

METHODS

Data were collected through in-depth interviews with commencing students about their experience as learners using Facebook and their perceptions of the impact on their clinical skill development.

SETTINGS AND PARTICIPANTS

Ten first-year student nurses at one university in south-east Queensland, Australia.

FINDINGS

Four themes emerged from the data including: 'We're all in this together'; 'I can do this'; 'This is about my future goals and success'; and, 'Real time is not fast enough!'. These themes provide new meaningful insights demonstrating students' sense of confidence in clinical skills was increased through engagement with a dedicated Facebook page.

CONCLUSIONS

The findings of this study have relevance to academics in the design of learning strategies for clinical courses to further support student confidence and engagement through peer collaboration and active learning processes.

An evaluation of a structured learning program as a component of the clinical practicum in undergraduate nurse education: A repeated measures analysis

BACKGROUND

There is evidence that nursing students experience stress and anxiety and a reduction in self-efficacy when undertaking clinical placements. Previous reports have identified that a structured three-day program within the Bachelor of Nursing (BN) clinical practicum reduces the students self-report of anxiety and increases self-efficacy. However, it is unreported whether these improved outcomes are sustained for the duration of the clinical placement.

OBJECTIVE

The aim of this study was to evaluate the duration of the effect of a three-day structured learning program within the clinical placement on final year Bachelor of Nursing student's report of anxiety and self-efficacy pre- and post-program participation in this intervention and following completion of the clinical practicum.

DESIGN

A repeated measures design.

SETTING

University-based Clinical School of Nursing, acute care clinical practicum.

PARTICIPANTS

Final year Bachelor of Nursing students.

METHODS

The intervention comprised the three-day program on starting the clinical practicum. A questionnaire included the anxiety subscale of The Hospital Anxiety & Depression Scale (The HAD) and the General Self-Efficacy Scale (GSES-12). The questionnaire was completed on day one (time one), upon completion of the three-day program (time two) and upon completion of placement on day 18 (time three).

RESULTS

The questionnaire response rate varied over time. There was a statistically significant effect in reducing anxiety over time: F(1.73,74.46)=25.20, p<0.001 and increasing self-efficacy over time F(1.32,41.04)=7.72, p<0.004.

CONCLUSIONS

This is the first report that we are aware of that has measured final year Bachelor of Nursing student's report of both anxiety and self-efficacy over repeated measures of time. Students continue to benefit from a structured learning program and the benefit of the intervention is sustained for the clinical placement duration.

Exploring midwives' perception of confidence around facilitating water birth in Western Australia: A qualitative descriptive study

OBJECTIVE

the option of labouring and/or birthing immersed in warm water has become widely available throughout hospitals in the United Kingdom and Europe over the last two decades. The practice, which also occurs in New Zealand and interstate in Australia, has until recently only been available in Western Australia for women birthing at home with a small publically funded Community Midwifery Program. Despite its popularity and acceptance elsewhere, birth in water has only recently become an option for women attending some public health services in Western Australia. The Clinical Guidelines developed for the local context that support water birth require that the midwives be confident and competent to care for these women. The issue of competency can be addressed with relative ease by maternity care providers; however confidence is rather more difficult to teach, foster and attain. Clinical confidence is an integral element of clinical judgement and promotes patient safety and comfort. For this reason confident midwives are an essential requirement to support the option of water birth in Western Australia. The aim of this study was to capture midwives' perceptions of becoming and being confident in conducting water birth in addition to factors perceived to inhibit and facilitate the development of that confidence.

DESIGN

a modified grounded theory methodology with thematic analysis.

SETTINGS

four public maternity services offering the option of water birth in the Perth metropolitan area.

PARTICIPANTS

registered midwives employed at one of the four publicly funded maternity services that offered the option of water birth between June 2011 and June 2013. Sixteen midwives were interviewed on a one to one basis. An additional 10 midwives participated in a focus group interview.

FINDINGS

three main categories emerged from the data analysis: what came before the journey, becoming confident - the journey and staying confident. Each contained between three and five subcategories. Together they depicted how midwives describe the journey to becoming confident to support women who have chosen the option to water birth and how they are able to retain that confidence once achieved.

IMPLICATIONS FOR PRACTICE

three key implications emerged from this study, the first was that students and graduate midwives could benefit from the opportunity to work in midwifery led maternity settings that support normal physiological child birth and that accessing such practical placements should be encouraged. Secondly, maternity services would benefit from learning opportunities directed specifically at experienced midwives addressing their particular requirements. Finally, midwives are the custodians of normal physiological birth, attendance at educational days with a focus on supporting this primary role should be mandatory, to inform midwives on current evidence found to support normal birth which includes options such as water birth.

Experiences of newly graduated nurses on strategies of gaining self-confidence during their initial work: a qualitative study

BACKGROUND

The presence of newly graduated nurses (NGNs) in clinical settings increases the rates of clinical errors and patient injury. In addition, the turnover rate for NGN staffs is significantly higher than the average turnover rate. Therefore, familiarizing NGNs with their workplace and increasing their professional self-confidence increase their empowerment and efficiency.

PURPOSE

This article elicits the strategies used by NGNs to gain self-confidence during their early career.

METHODS

This qualitative study was conducted using the purposive sampling method and was based on the data saturation principle. Data were collected using in-depth, semistructured interviews from 30 NGNs working at teaching hospitals in four northwest provinces of Iran during 2012 and 2013. Data were collected by means of in-depth semistructured interviews. Qualitative content analysis was used to analyze the data.

RESULTS

The interviews elicited eight coping strategies that participants used to form self-confidence during the first 6 months of their career. These strategies included familiarity, knowledge enhancement, clinical skills learning, self-exploration, validation, responsibility, mutual interaction, and personal creativity. In addition,participants used these strategies to reinforce their self-confidence during their first 2 years at work.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results of this research increase the understanding of NGNs, managers, and healthcare professionals regarding the strategies used by NGNs to gain self-confidence. This knowledge may be applied in programs designed to increase the empowerment and efficacy of nurses to improve the quality of patient care and reduce nurse turnover.

'Newcomer adaptation': a lens through which to understand how nursing students fit in with the real world of practice

Aims and objectives

To present a discussion on newcomer adaptation as a lens through which to understand how nursing students adapt to clinical practice and raise awareness of strategies that can be used to enhance their learning experiences.

Background

Socialisation is an important factor that facilitates students’ learning in the clinical setting. Therefore, it is beneficial to examine organisational socialisation literature, particularly that pertaining to newcomer adaptation.

Design

This is a critical review of organisational socialisation literature.

Methods

Seminal literature and more recent research in the field of organisational socialisation and newcomer adaptation were accessed. In addition, nursing and allied health literature examining students’ socialisation and the clinical learning environment was retrieved.

Conclusions

It is revealed in this article that to create an appropriate clinical learning environment, an understanding of socialisation tactics could be beneficial. Role modelling is deemed crucial to successful newcomer adaptation. Peer support is necessary but must be advocated with caution as it can have a negative impact when students form a ‘parallel community’. Students with some knowledge of the workplace tend to adapt more easily. Likewise, students’ disposition and, in particular, their confidence can also enhance the socialisation process.

Relevance to clinical practice

Both the organisation and the student can impact on how successfully the nursing student ‘fits in’. Understanding this through the lens of newcomer adaptation means that strategies can be put in place to facilitate this process.

What factors facilitate good learning experiences in clinical studies in nursing: bachelor students' perceptions

Clinical studies constitute 50% of the bachelor program in nursing education in Norway, and the quality of these studies may be decisive for the students' opportunities to learn and develop their professional competences. The aim of this study was to explore what bachelor students' in nursing perceived to be important for having good learning experiences in clinical studies. Data was collected in a focus group interview with eight nursing students who were in the last year of the educational program. The interview was transcribed verbatim, and qualitative content analysis was used for exploring and interpreting the content of the interview text. One main theme emerged from the analysis: “being in a vulnerable and exposed position characterized by conflicting needs.” Four categories were found: “aspects related to the clinical setting”, “aspects related to the nurse supervisor,” “aspects related to the student,” and “aspects related to the student-supervisor relationship”. The findings revealed that the students' learning experiences and motivation were related to individual, relational, and organizational aspects. The students highlighted their own as well as their supervisors' attitudes and competences and the importance of positive relationships. In addition, feeling welcomed, included, and valued in the ward improved their motivation, self-confidence, and self-respect.

The experiences of staff in a specialist mental health service in relation to development of skills for the provision of person centred care for people with dementia

It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over £50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia.

This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs.

The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives’ views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis.

Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience.

Motivational journey of Iranian bachelor of nursing students during clinical education: a grounded theory study

This study explored how nursing students can be kept motivated throughout their clinical education. Motivation is a key issue in nursing clinical education for student retention. The study was conducted using grounded theory methods, which are appropriate when studying process in a social context. Sixteen students and four instructors, who were purposefully selected, participated in semistructured interviews. Data were analyzed using the constant comparative method. Students' motivational journey occurred in three steps: (i) social condition; (ii) encountering the clinical education challenges; and (iii) looking for an escape from nursing, or simply tolerating nursing. Struggling with professional identity emerged as the core variable. Iran's social context and many other conditions in the clinical education setting affect students' motivation. Identifying motivational process might assist educational authorities in offering solutions to promote motivation among students.