Nurses’ development of professional self – from being a nursing student in a baccalaureate programme to an experienced nurse

The potential influences of professional identity for undergraduate nursing students during the COVID-19 pandemic: A cross-sectional study

AIM

We aimed to investigate the level of undergraduate nursing students' professional identity (PI) during the COVID-19 pandemic and its potential influences.

METHODS

This cross-sectional study included 742 undergraduate nursing students from Chengdu Medical College. Basic demographics, personal characteristics and PI score were collected. Chi-squared test, one-way analysis of variance, and multivariable logistic regression analysis were used to analyze the data.

RESULTS

In the classes of 2019, 2020, and 2021, the PI score was 96.85 ± 18.26, 105.37 ± 17.46, 106.67 ± 22.08 (P < .001). PI score was the independent predictive factor for both "want to be a nurse" and "willingness to serve during COVID-19 or other pandemics".

CONCLUSIONS

PI contributes greatly to nursing students' willingness to be a nurse and overcome pandemics. The challenge of culturing PI during COVID-19 pandemic revealed the necessity of developing individual management strategies for nursing education.

A transition programme to enhance ICU new graduate nurses' professional identity and intention to remain employed: A pre- and postevaluation

AIMS

To investigate the effect of a transition programme including cognitive-behaviour-based preceptorship intervention on ICU new graduate nurses' (NGNs)' professional identity and their intention to remain employed.

DESIGN

One-arm pre- and post-test design followed the TREND Statement.

METHODS

NGNs' professional identity and intention to remain employed were measured at baseline (T1), postintervention (1 month, T2) and 6-month follow-up (T3).

RESULTS

Fifty-three NGNs completed the programme, and their professional identity score significantly increased postintervention [from 111.5 (SD = 16.72) at T1 to 114.2 (SD = 9.12) at T2, p < 0.05], but decreased at T3 [105.8 (SD = 9.44) compared with T1 and T2, p < 0.05]. There was no significant difference in ICU NGNs' intention of remain employed outcomes at three time points (p > 0.05). The transition programme was effective to improve ICU NGNs' professional identity immediately after the intervention, but the increment did not maintain at the 6-month follow-up.

Novice nurses' transition to clinical setting in the COVID-19 pandemic: a phenomenological hermeneutic study

Background

: The COVID-19 pandemic both exposed and increased weaknesses in the healthcare system, so that novice nurses have become a more vulnerable group during this context.

Aim

: This study sought to illuminate experience of novice nurses in providing care during the COVID-19 pandemic.

Method

: It consists of a qualitative study conducted with data collected by means of semi-structured interviews, audio recorded, transcribed, anonymised, and analysed in the light of the phenomenological hermeneutic approach. Fourteen registered novice nurses from two health areas in northwest X, being twelve women and two men, who experienced the COVID-19 pandemic within their first five years of professional experience, were selected through a non-statistical snowball sampling.

Results

: After analysing the narratives, we identified four main themes: "Transitioning to a hostile, unknown and uncertain clinical setting from inexperience," "Invisible wounds because of being on the front line," and "Healing to return to the front line."

Discussion

: The uncertainty of an unknown illness and the lack of support during the COVID-19 pandemic has been affecting novice nurses, impacting their health conditions. At the same time, this context created opportunities for professional development. According to the interviewees, self-care and social support were elements to cope with exhaustion.

Conclusion

: Our study investigates the experiences of a group barely approached in the literature, highlighting the reality and difficulties of these nurses in transitioning to the clinical setting and providing insights to managerial leaders and educators.

The Relationship Between Nurses' Professional Values and Their Attitudes Towards Care Giving Roles: A Structural Equation Model

Objective: The study was carried out to examine the relationship between nurses' professional values and caregiver roles. Methods: This study is based on a descriptive correlational research design using a structural equation model. 366 nurses participated in the study. It was gathered using Nurse Promotion Form the Professional Values Scale of Nurses and the Attitude Scale for Their Caregiver Roles. Results: The total mean score of the Nurses' Professional Values Scale was determined as 94.73±17.87. Nurses' Perceptions of Caregiving Roles Attitude Scale total score mean was determined as 62.41±9.22. According to the Structural Equation model, professional values of nurses explain 39% of the change in the value of the attitude towards caregiver roles (R2 =0.39). Conclusion: Nurses' professional values and attitudes towards caregiver roles are at a good level and professional values of nurses partially affect the attitude towards caregiver roles.

Hospital nurses' experiences of assessing health status changes in stem-cell transplanted patients in home care: A qualitative study

AIMS AND OBJECTIVES

To explore hospital nurses' experience assessing changes in the health status of stem-cell transplanted patients in home care (HC).

BACKGROUND

Stem-cell transplanted patients in HC are treated at home instead of in hospital wards. Hospital nurses visit patients daily and play a key role in assessing the patients' health status. Previous studies on HC for stem-cell transplanted patients focus mainly on safety in HC versus hospital care. No studies regarding nurses' experience assessing patients' health status at home when patients undergo stem-cell transplantation were found.

DESIGN

Qualitative study with an explorative design.

METHODS

Data were collected via 14 individual semi-structured interviews with hospital nurses working with stem-cell transplanted patients in HC. Data were analysed using systematic text condensation. The reporting of the study was guided by the COREQ checklist.

RESULTS

Three categories emerged from the data analysis: 1) Effective communication and clinical intuition enhances the assessment of patients' general health condition; 2) It is challenging to rely on one's own judgment in remote assessment; and 3) There are key facilitators in performing remote clinical assessments.

CONCLUSIONS

Effective communication and clinical intuition enhanced the assessment of patients' general health conditions. The lack of physical presence during remote assessments made using clinical intuition in the assessment process difficult. Experience with hematopoietic stem-cell transplantation was seen as important to facilitate accurate remote clinical assessments.

RELEVANCE TO CLINICAL PRACTICE

Nurses with responsibility for hospital at-home telephone care should receive training in remote communication and should shadow hospital at-home nurses during in home visits to gain experience assessing patients' health status. Telehealth aspects such as videoconferencing and remote patient monitoring should be considered for more accurate remote assessment. This could potentially result in more effective assessments and reduced readmissions and could promote nurses' confidence in their assessments.

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate

BACKGROUND

Nursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession.

PURPOSE

Using a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs.

METHOD

This was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI).

RESULTS

Scores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (β = 0.93, p < .01), CCTIDI (β = 0.13, p < .001), and class climate (β = 5.20, p < .01). An intraclass correlation coefficient was 55.48%.

CONCLUSION

This study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.

Coronavirus disease 2019 pandemic promotes the sense of professional identity among nurses

Background

Under the COVID-19 pandemic, nurses are the mainstay in the fight against the pandemic.

Purpose

To evaluate potential impact of the pandemic on nurses’ professional identity.

Method

Self-report questionnaires were distributed online. Data collected were compared with available norms. Multivariate logistic regression analyses were employed to calculate the OR of frontline vs. nonfrontline nurses.

Findings

The mean of the total score of the scale was 121.12 out of 150. Both the total score and scores on the five dimensions were significantly higher than norms. Frontline nurses had a significantly higher professional identity than non-frontline nurses (total score: odds ratio [OR], 1.19; professional identity evaluation: OR, 1.27; professional social support: OR, 1.18; professional social proficiency: OR, 1.33; and dealing with professional frustration: OR, 1.19). The most frequently mentioned tags were Hope, Frontline, Protection, Outbreak, Work, Situation.

Discussion

COVID-19 outbreak was associated with an enhancement in the professional identity of nurses.

Postsurgical Follow-Up Phone Calls: Worth the Investment?

PURPOSE

To analyze differences in health confidence levels regarding discharge instructions between two groups of same-day surgery patients.

DESIGN

Comparative and descriptive design.

METHODS

Phone surveys to two groups: those who received follow-up phone calls from a registered nurse (RN) and those who received standard care instructions at discharge only.

FINDINGS

In 74 same-day surgery patients (n = 37 per group), all participants expressed high health confidence in implementing discharge instructions. Results revealed no higher health confidence levels in patients who received RN follow-up phone calls, no difference between groups attending postoperative appointments, and no relationships between subject demographics, health confidence level, and postoperative complications between groups.

CONCLUSIONS

The use of specialized RNs to conduct postoperative phone calls may not be cost effective. When RNs provide excellent instructions to patients in person, it may lead to sufficient patient health confidence. Personal and nurse-provided education should be considered a standard, and the outcomes of costly follow-up phone calls should be examined.

Examining subacute nurses' roles in a changing healthcare context

AIMS AND OBJECTIVES

To explore and describe nurses' role in the rehabilitation and care of patients in one subacute care facility in Melbourne, Australia.

BACKGROUND

The role of nurses in subacute care and within the rehabilitation team is evolving and remains unclear.

DESIGN

Mixed methods.

METHODS

Fourteen nurses from seven rehabilitation and geriatric evaluation and management wards in one subacute facility in Melbourne, Australia, were observed in practice for two hours and then interviewed. Activities were recorded electronically. Interviews were audio-recorded and transcribed. Data were analysed using content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

RESULTS

Three main themes are as follows: (a) Nurses as rehabilitators; (b) Teamwork in rehabilitation; and (c) The changing context of subacute care. Nurses prioritised patient personal and clinical care above other responsibilities. They were largely excluded from team decision-making because clinical responsibilities precluded them from attending team meetings. Unsuitable buildings, increased patient acuity and time constraints were further challenges.

CONCLUSIONS

Nurses have a multifaceted role in patient rehabilitation that is poorly understood. An evaluation of the nursing role within the interdisciplinary team, skills and processes of care may increase understanding, and improve communication and relationships between disciplines potentially benefiting patients. Role clarity and differentiation in nursing skills are required within the nursing workforce.

RELEVANCE TO CLINICAL PRACTICE

Nurses have a unique role in both clinical care and rehabilitation of patients, and as part of the interdisciplinary team. Respectful professional relationships need fostering within the interdisciplinary team to achieve optimal patient outcomes. The way that team meetings and decision-making occur in the subacute wards requires adjustment to ensure that the valuable contribution of nurses, both to the interdisciplinary team and to the rehabilitation of patients, is used and acknowledged to improve patient care.

A Phenomenological Investigation of the Interplay Among Professional Worth Appraisal, Self-Esteem and Self-Perception in Nurses: The Revelation of an Internal and External Criteria System

Nurses’ professional self-concept is strongly associated with professional worth appraisal, which encompasses their feelings and perceptions regarding their task efficacy and value of input to clinical outcomes. Professional self-concept and professional worth appraisal are incorporated in one’s overall professional role perception. Data show that the way nurses think and feel about themselves personally and professionally, is associated with their well-being, the quality of provided patient care, their job satisfaction and retention. Although researchers indicate that professional self-concept is a different entity from personal self-concept, however, a clear differentiation and possible interaction between these constructs has not been yet adequately described in nursing literature. Personal self-concept mirrors the way people interpret them-selves, incorporating their self-awareness and personal effectiveness. Following purposeful sampling and informed consent, a phenomenological approach based on Munhall’s methodology was employed to explore the living experience of professional role perception in 16 critical and emergency nurses, with special focus on their perceptions and feelings about personal and professional-role worth appraisal. Data and theoretical saturation criteria were implemented, along with all nine Munhall’s criteria for the rigor and trustworthiness of phenomenological studies. The participants’ narratives suggested a possible interaction between professional attitude and personality traits, illuminating as the core theme an interplay among self-perception, personal and professional worth appraisal process. Additionally, the present study emphasized the way self-evaluation criteria system may be associated with the personal and professional self-concept in nurses. In particular, it was highlighted that the way nurses think and feel about themselves is associated with the way they experience their professional role and vice versa, and that professional role-based self-concept and professional worth perception can be linked with their well-being. Furthermore, positive feelings about the self and personal competencies seemed to enhance the perception of effectiveness in clinical settings and adequacy of professional skills, resulting in empowered professional identity and vice versa. Overall, the present findings are discussed in relation to nurses’ experience of work-related stressors and relevant interventions. Further exploration of the effectiveness of interventions for facilitating adaptive personal and professional self-appraisal are suggested.

Nursing Students’ Knowledge of Palliative Care at a University in Turkey

Background and Purpose:

Nursing students must acquire knowledge and skills sufficient to deliver high-quality services. Previous studies indicated that students’ palliative care knowledge was insufficient. Few studies evaluating nursing students’ palliative care opinions and skills are available in Turkey. This study aimed to determine student nurses’ knowledge of palliative care.

Methods:

This descriptive survey study included 658 students. Researchers collected the data via a 19-item questionnaire. Frequency, percentage, and mean values were used in analysis of the data.

Results:

Only 5.3% of participants correctly answered all items, while 26.3% gave correct answers in line with palliative care theoretical framework, and 5.3% gave correct responses for symptom management. Students were found to be quite lacking in palliative care knowledge.

Implications for Practice:

A content increase in the curriculum could improve students’ theoretical knowledge. In addition, students can be incorporated, as team members, into the palliative care process beginning at patient diagnosis.

Professional values and career choice of nursing students

BACKGROUND AND AIM

Professional values are abstract and general behavioral principles that provide basic standards to judge aims and actions, and these principles are formed by strong emotional loyalty of members of the profession. Research was conducted to compare the career choice and professional values of nursing students at two universities in the upper Midwest of the United States and in the middle of Turkey.

MATERIALS AND METHODS

A descriptive and comparative design was used. The participants of the study were comprised nursing students from a university in the upper Midwest of United States and a university in the middle of Turkey. The sample consisted of 728 students in all grades. Data were collected by a questionnaire, The Nurses Professional Values Scale-Revised and Vocational Choices in Entering Nursing Scale. Number, percentage distribution, mean, standard deviation, t test, and one-way variance analysis were used in the analysis of data. Ethical considerations: Ethical approval was obtained from the Ethics Commission. Informed consent was received from the students.

RESULTS

The students' mean age for American students was 24.3 ± 5.6 years, while the mean age for Turkish students was 19.8 ± 1.7 years. Mean score of American students on The Vocational Congruency (a subgroup of the Vocational Choices in Entering Nursing Scale) was 38.5 ± 5.9 and Turkish students was 29.6 ± 8.9 (p < 0.05). Mean score of American students on The Nurses Professional Values Scale-Revised was 109.2 ± 12.3 and that of Turkish students was 101.6 ± 17.0.

CONCLUSION

This study concluded that the majority of nursing students had high professional values, and when students' scores were compared, American students had higher professional values, and in career choice, they considered primarily fitness of the profession to themselves and their goals, while Turkish students primarily thought of their living conditions.

Assessment of cognitive bias in decision-making and leadership styles among critical care nurses: a mixed methods study

AIMS

To raise awareness of critical care nurses' cognitive bias in decision-making, its relationship with leadership styles and its impact on care delivery.

BACKGROUND

The relationship between critical care nurses' decision-making and leadership styles in hospitals has been widely studied, but the influence of cognitive bias on decision-making and leadership styles in critical care environments remains poorly understood, particularly in Jordan.

DESIGN

Two-phase mixed methods sequential explanatory design and grounded theory.

SETTING

critical care unit, Prince Hamza Hospital, Jordan. Participant sampling: convenience sampling Phase 1 (quantitative, n = 96), purposive sampling Phase 2 (qualitative, n = 20).

METHODS

Pilot tested quantitative survey of 96 critical care nurses in 2012. Qualitative in-depth interviews, informed by quantitative results, with 20 critical care nurses in 2013. Descriptive and simple linear regression quantitative data analyses. Thematic (constant comparative) qualitative data analysis.

RESULTS

Quantitative - correlations found between rationality and cognitive bias, rationality and task-oriented leadership styles, cognitive bias and democratic communication styles and cognitive bias and task-oriented leadership styles. Qualitative - 'being competent', 'organizational structures', 'feeling self-confident' and 'being supported' in the work environment identified as key factors influencing critical care nurses' cognitive bias in decision-making and leadership styles. Two-way impact (strengthening and weakening) of cognitive bias in decision-making and leadership styles on critical care nurses' practice performance.

CONCLUSION

There is a need to heighten critical care nurses' consciousness of cognitive bias in decision-making and leadership styles and its impact and to develop organization-level strategies to increase non-biased decision-making.

Swedish-Registered Nurse Anesthetists' Evaluation of Their Professional Self

PURPOSE

This study aimed to explore how the nurse anesthetist values their professional self, compared with their peers, and also to explore whether professional self is affected by age, work experience, and/or gender.

DESIGN

An explorative and prospective cross-sectional design.

METHODS

During April 2011, a total of 108 registered nurse anesthetists from three different hospitals were surveyed using the Professional Self-Description Form with questions covering 21 items.

FINDINGS

A total of 87 (80%) responded: 21 men and 66 women with a mean age of 45 years (range, 28 to 64 years) and mean professional experience of 12 years (range, 1 to 41 years). Four factors were found: professionalism, trait of character, scientific knowledge, and empathy, with Cronbach alpha of 0.96 overall. Analysis showed that perceived professional self depends on age and amount of work experience, but not on gender.

CONCLUSIONS

The Professional Self-Description Form exhibits satisfactory internal consistency. Work experience and age influenced the development of professional self of nurse anesthetists.

Nurses' perceptions and experiences of work role transitions: a mixed methods systematic review of the literature

AIM

To understand nurses' perceptions and experiences of work role transitions.

BACKGROUND

Globally an uncertain healthcare landscape exists and when changing work roles nurses experience periods of transition when they may not cope well. A greater understanding of work role transitions may help facilitate workforce retention and successful careers.

DESIGN

Mixed methods systematic review.

DATA SOURCES

Six data bases were searched for peer reviewed primary empirical research, published in English language between January 1990 and December 2014, supplemented by hand and citation searching.

REVIEW METHODS

Evidence for Policy and Practice Information and Co-ordinating Centre methods for systematic reviews principles were followed. Analysis and synthesis of the qualitative and quantitative papers was conducted separately using thematic analysis. A third synthesis combined the narrative findings and a narrative synthesis of results is presented.

RESULTS

Twenty-six papers were included. Across nurses' work role transitions two pathways were found: Novice and Experienced. 'Novice' comprises pre-registration and newly qualified nurses. 'Experienced' comprises, Enrolled/Licensed Practical Nurse to Registered Nurse, experienced to specialist nurse and clinical role changes. Each pathway results in different emphasizes of two themes; 'Striving for a new professional self' includes emotional upheaval and identity while 'Know how' includes competence and boundaries. Novice nurses are more susceptible to the extremes of emotional upheaval while experienced nurses' competence eases aspects of transitions while boundary issues pervade.

CONCLUSION

Informed work and educational environments are required for all groups of nurses. Using existing models of transition can facilitate successful individual transitions and develop the workplace.

Self-assessment of clinical nurse mentors as dimensions of professional development and the capability of developing ethical values at nursing students: A correlational research study

INTRODUCTION

Providing adequate training for mentors, fostering a positive mentorship culture and establishing the necessary operational procedures for ensuring mentorship quality are the keys to effective clinical mentoring of nursing students.

PURPOSE

The purpose of the research was to explain different dimensions of clinical mentors' professional development and their capability of developing ethical values in nursing students.

METHODS

A non-experimental quantitative research design was employed. Data were collected by means of a questionnaire administered to the population of clinical mentors (N=143). The total number of questions was 36. Descriptive statistics were used, and bivariate analysis, factor analysis, correlation analysis and linear regression analysis were performed.

RESULTS

The professional development of clinical nurse mentors was explained (R(2)=0.256) by career advancement (p=0.000), research and learning (p=0.024) and having a career development plan (p=0.043). Increased professional self-confidence (R(2)=0.188) was explained by career advancement (p=0.000) and the time engaged in record keeping (p=0.028). Responsibility for the development of ethical values in nursing students (R(2)=0.145) was explained by the respondents' level of education (p=0.020) and research and learning (p=0.024). Applying ethical principles and norms into practice (R(2)=0.212) was explained by self-assessed knowledge in ethics (p=0.037) and research and learning (p=0.044).

CONCLUSIONS

Clinical nurse mentors tended to lack a career development plan, had low work time spent on research and insufficiently participated in education and training activities, which turned out to be significant explanatory factors of their professional development and their capability of developing ethical values in nursing students. The research showed that nursing and higher education managers often failed to assume responsibility for the professional development of clinical nurse mentors.

Professional socialization of students in clinical nurse specialist programs

Graduate nursing programs facilitate the transition of RNs to advanced roles through a complex process of professional socialization. The purpose of this study was to explore the professional socialization of clinical nurse specialist (CNS) students. Two hundred twenty-five students, representing 73 CNS programs, responded to an online survey. Both preprogram variables and educational experiences contributed to an adequate level of CNS socialization. Students' self-concept was strong, and they felt prepared to practice in the role, which was highly correlated with their perceptions of how well the program prepared them academically and experientially. Having a CNS mentor was positively associated with readiness to practice. Outcomes did not vary with cohort status, and online instruction did not impede socialization. These findings provide implications for CNS program advisement and design.

Nurses' reflections on good nurse traits: Implications for improving care quality

BACKGROUND

Good nurses show concern for patients by caring for them effectively and attentively to foster their well-being. However, nurses cannot be taught didactically to be "good" or any trait that characterizes a good nurse. Nurses' self-awareness of their role traits warrants further study.

OBJECTIVES

This study aimed (a) to develop a strategy to elicit nurses' self-exploration of the importance of good nurse traits and (b) to explore any discrepancies between such role traits perceived by nurses as ideally and actually important.

RESEARCH DESIGN

For this mixed-method study, we used good nurse trait card play to trigger nurses' reflections based on clinical practice. Nurse participants appraised the ideal and actual importance of each trait using a Q-sort grid. The gap between the perceived ideal and actual importance of each trait was examined quantitatively, while trait-related clinical experiences were analyzed qualitatively.

PARTICIPANTS AND RESEARCH CONTEXT

Participants were 35 in-service nurses (mean age = 31.6 years (range = 23-49 years); 10.1 years of nursing experience (range = 1.5-20 years)) recruited from a teaching hospital in Taiwan.

ETHICAL CONSIDERATIONS

The study was approved by the Institutional Review Board of the study site.

FINDINGS

Good nurse trait card play with a Q-sort grid served as an icebreaker to help nurse participants talk about their experiences as embodied in good quality nursing care. Nurses' perceived role-trait discrepancies were divided into three categories: over-performed, least discrepant, and under-performed. The top over-performed trait was "obedience."

DISCUSSION

Patients' most valued traits ("patient," "responsible," "cautious," and "considerate") were perceived by participants as ideally important but were under-performed, perhaps due to experienced nurses' loss of idealism.

CONCLUSION

Good nurse trait card play with Q-sort grid elicited nurses' self-dialogue and revealed evidence of the incongruity between nurses' perceived ideal and actual importance of traits. The top over-performed trait, "obedience," deserves more study.

Do educational outcomes correspond with the requirements of nursing practice: educators' and managers' assessments of novice nurses' professional competence

Objective

This study evaluated weather educational outcomes of nurse education meet the requirements of nursing practice by exploring the correspondence between nurse educators' and nurse managers' assessments of novice nurses' professional competence. The purpose was to find competence areas contributing to the acknowledged practice–theory gap.

Design

A cross-sectional, comparative design using the Nurse Competence Scale was applied.

Subjects

The sample comprised nurse educators (n = 86) and nurse managers (n = 141).

Methods

Descriptive and inferential statistics were used in the data analysis.

Main outcome measures

Educators assessed novice nurses' competence to a significantly higher level than managers in all competence areas (p < 0.001). The biggest correspondence between educators' and mangers' assessments were in competencies related to immediate patient care, commitment to ethical values, maintaining professional skills and nurses' care of the self. The biggest differences were in competencies related to developmental and evaluation tasks, coaching activities, use of evidence-based knowledge and in activities which required mastering a comprehensive view of care situations. However, differences between educators' and managers' assessments were strongly associated with their age and work experience. Active and improved collaboration should be focused on areas in which the differences between educators' and managers' assessments greatly differ in ensuring novice nurses′ fitness for practice.

Development and psychometric testing of the Ascent to Competence Scale

AIM

This paper reports the development and psychometric testing of the Ascent to Competence Scale, an instrument designed to measure nursing students' perceptions of the quality of their clinical placement experience.

BACKGROUND

The key purpose of clinical placements is to facilitate students' learning and progress toward the attainment of competence. The attainment of competence requires personal commitment and active involvement of students; support and guidance of clinical and academic staff; and clinical environments that are welcoming and inclusive of students.

METHOD

The items for the Ascent to Competence Scale were identified following a critical review of the literature. Content and face validity were established by an expert panel. During 2010 the instrument was tested with third year nursing students (n=88) from one Australian university. Exploratory factor analysis with promax oblique rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability.

RESULTS

The final scale demonstrated satisfactory internal consistency (alpha 0.98). Exploratory factor analysis yielded a three-component structure termed "Being welcomed"; "Belongingness" and "Learning and competence". Each subscale demonstrated high internal consistency: 0.89; 0.96; and 0.95 respectively.

CONCLUSION

The Ascent to Competence Scale provides a fresh perspective on clinical placements as it allows for the relationship between belongingness, learning and competence to be explored. The scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.

RELEVANCE TO CLINICAL PRACTICE

The Ascent to Competence Scale profiled in this paper will be of benefit to both educational and healthcare institutions. The use of a quantified yardstick, such as the Ascent to Competence Scale, is important in evaluating the efficacy of programs, placements and partnerships between higher education and health services.

Nurse residency programs: an evidence-based review of theory, process, and outcomes

Nursing shortages exist worldwide while job stress, dissatisfaction, lack of peer support and limited professional opportunities still contribute to attrition. The aim of this systematic review is to describe and evaluate the quality of the science, report recommendations and lessons learned about implementing and evaluating nurse residency programs (NRPs) designed to improve new graduate transitioning. Databases were searched between 1980 and 2010 using five search terms: nurse, intern, extern, transition and residency programs. Twenty studies reporting programs for new RNs fit the inclusion criteria. Three major discoveries include: 1. Wide variation in content, teaching and learning strategies make comparison across programs difficult; 2. Lack of theory in designing the educational intervention has limited the selection and development of new instruments to measure program effectiveness; and 3. Well designed quasi-experimental studies are needed. As a major nursing education redesign, NRPs could be used to test the principles, concepts and strategies of organizational transformation and experiential-interactive learning theory. By focusing on fiscal outcomes, current administrators of NRPs are missing the opportunity to implement an organizational strategy that could improve workplace environments. Healthcare organizations need to envision NRPs as a demonstration of positive clinical learning environments that can enhance intra- and interprofessional education and practice.

Changing institutional identities of the student nurse

This paper emphasises the tensions between the ideal of the compliant within care settings and the ideal of the critical thinker within the university setting with reference to student nurse education and identity. Identity is an important part of who we are as people. While modernisation and increased professionalisation of nursing have impacted on staff and patients mostly in a positive way, changes in the management of nursing education in the past 20 years have also heralded a remarkable change in the student identity. Historically informed by association with a particular hospital or health service provider, student nurse identity was shaped by institutional rituals and routine, physically embodied in objects such as uniforms and hospital medals and informed by claims to honesty, virtue and personal integrity (Bradby, 1990). Once part of the structure and fabric of hospital life, nursing students functioned as part of the health care service. As such, their identity was synonymous with that of practicing nurses, whose learning needs were secondary to that of the organisational needs. While this social milieu provided the platform for the formation of institutional pride, belonging and identity, such forms of identity can result in institutional compliance; with the associated risk of ritualistic practice, poor levels of transparent accountability and barriers to whistle blowing should substandard practice arise. Increased student freedom and an emphasis on teaching and learning within the university setting may have benefitted students, patients and the profession, however, the potential impact on student identity is less certain. There is evidence to suggest that students are ill-equipped for their professional identity once qualified and thus require more support for this within universities. This paper explores the tensions between traditional hospital identity and contemporary university identity with reference to student nurse education. The ideal of the compliant versus the ideal of the critical thinker will be debated.

Professional socialization in dietetics: a review of the literature

The process of professionalization has been widely studied in nursing, but little is known about it in dietetics. We explored the process of professionalization using an integrative review of nursing literature. Three research questions were addressed: 1. What are the stages of professional socialization? 2. Who are the participants in the socialization process? 3. What challenges are associated with the socialization process? From an initial list of 322 articles compiled from a search of relevant databases, 49 English-language primary research papers were selected for review. A form of constant comparative analysis was conducted to extract relevant data into categories based on the research questions. Findings suggest that the process of professional socialization is a complex and stressful process, which occurs in three phases and begins before entry into the formal education system. Within the formal education system, faculty and preceptors can have a positive or negative impact on an individual's professional growth and development. Much work is needed to develop an understanding of this process in dietetics, but the findings will have immediate relevance to dietitians' educational and practice contexts.

A triadic interplay between academics, practitioners and students in the nursing theory and practice dialectic

AIM

  This article is a report of a descriptive study of the effectiveness of classroom teaching by clinical nurse specialists on students' transfer of theory into practice.

BACKGROUND

  Ongoing concern about a theory-practice merger in nursing has led to collaborative initiatives between academics and practitioners globally. There are different forms of collaborative efforts, but information on their evaluation is scarce and inconclusive. Integration of theory and practice is important for an outcome-based approach, which emphasizes students' clinical competence as the measure of success. The limited nursing discussion on theory and practice collaboration in education was our impetus for the study.

METHODS

  Between 2007 and 2008, focus group interviews were held, first with 75 and then with 35 from the same group of first-year students, regarding their learning experience from the lectures of the two clinical nurse specialists in diabetes and colostomy care, respectively, prior to and after their clinical placements. Six of their clinical instructors and the two clinical nurse specialists were also interviewed. The audiotaped interviews were transcribed verbatim and analysed using content analysis.

FINDINGS

  Three themes were identified: impact of students' vicarious learning from clinical nurse specialists' stories of experience; improving the collaboration between clinical nurse specialists and subject lecturers for junior students' learning experience; continuity in the clinical integration of theory-practice as dialectic through an interplay between academics, practitioners and students.

CONCLUSION

  The theory and practice issue is best addressed as a triadic paradigm in a community of practice with the collaboration among academics, practitioners and students.