Group supervision for nursing students during their clinical placements: its content and meaning

Elements of group dynamics that influence learning in small groups in undergraduate students: A scoping review

BACKGROUND

Learning in small groups is a frequent activity in undergraduate programs to enrich learning, as well as in nursing programs during clinical experiences. Being in a small group adds elements of group dynamics that influence learning. Research into the influence of these elements on learning in small groups is not clear in the literature. This makes it challenging for educators to promote the optimal environment for learning.

OBJECTIVE

To explore the literature on elements of group dynamics that influence learning in small groups among undergraduate students.

DESIGN AND DATA SOURCES

A scoping review was performed, inspired by the five-stage approach of Arksey and O'Malley and the methodology outlined by the Joanna Briggs Institute. Various databases were used including CINAHL, ERIC, psycINFO, PubMed and Science Direct.

REVIEW METHOD

Our research question was: What are the elements of group dynamics that influence learning in small groups among undergraduate students? At least two authors analyzed the relevant studies and data were extracted to describe the elements of group dynamics that influence learning in small groups among undergraduate students.

RESULTS

Thirty papers were included in our review. Five elements emerged: engagement, openness, support, quality of communication and style of dominant behavior.

CONCLUSIONS

The results suggested the utilization of these elements in establishing a group dynamic favorable for learning in small groups. Since little research has been done into group dynamics in nursing education, it was useful to explore this concept in other disciplines. Further research is needed with a focus on clinical education for nursing students.

Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students' Experiences

INTRODUCTION

Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students´ learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period.

OBJECTIVE

The study aimed to explore nursing students' experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes.

METHODS

A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation.

FINDINGS

Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery.

CONCLUSION

The supplementary simulation training seemed to complement clinical practice by consolidating the students' learning during the clinical practice period, enhance the students' motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment.

Enhancing the quality of clinical supervision in nursing practice

Clinical supervision has been an aspect of nursing practice in various forms for several years; however, it remains challenging to ensure its widespread implementation across healthcare organisations. There is an increasingly evident need for formalised support in nurses' busy practice settings, so it is important to improve the quality of clinical supervision in healthcare. This will also assist nurses in providing evidence of their continuing professional development as part of revalidation. This article provides an overview of clinical supervision, outlining its features and functions in healthcare practice. It includes three case studies related to group clinical supervision, discussing how this was implemented in each case and the various methods of group-working that were used.

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

Background

Schwartz Center Rounds®(Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.

Objectives

How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.

Design

(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).

Setting

(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).

Participants

(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.

Results

(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.

Limitations

Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.

Conclusion

Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.

Future work

The adaptation of Rounds to new contexts and to increase reach needs evaluation.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Clinical Supervision and Support: Exploring Pre-registration Nursing Students' Clinical Practice in Malawi

Background:

Supervised clinical practice plays a significant role in the nursing profession, as it has an influence on the students’ clinical learning.

Objectives:

The aim of this study was to explore how the pre-registration nursing students find their experience on clinical supervision in the clinical placements.

Methods:

The study used both quantitative and qualitative approach to collect data through focus groups (n = 144) and self-administered questionnaires (n = 590) from nursing students of various programmes in selected colleges in Malawi.

Results:

About 75% (n = 443) of the participants indicated that they received supervision from both clinical staff and Nurse Educator. However, qualitative results indicated that students received inadequate clinical supervision. Themes that emerged from the discussion included lack of human resources, learning support, availability of instructors yet not supporting learning, job insecurity and lack of remuneration as reasons for lack of supervision, role models and student guidance despite pressure and self-directed.

Conclusion:

There is a need for clear policies regarding clinical supervision as well as a structured and well monitored process.

Developing advanced clinical practice skills in gastrointestinal consequences of cancer treatment

This article explores the transition from a clinical nurse specialist (CNS) towards developing advanced clinical practice skills within a gastrointestinal consequences of cancer clinic. It presents data on the first 50 patients assessed by the CNS from a prospective service evaluation, demonstrating how this informed the nurse's future learning. There is high demand for advanced clinical practice skills to address unmet health needs and improve the quality, efficiency, and sustainability of healthcare services. However, a literature review found no literature on developing advanced clinical practice skills in this setting. Emerging themes from the service evaluation focused on barriers and enablers, ongoing support, organisational commitment and working in a multidisciplinary team. Blended learning provided both structured and opportunistic learning, embedding both formal and tacit knowledge, as roles require increasing flexibility. Clinical supervision and reflective practice were key in maintaining professional and peer support.

The importance, impact and influence of group clinical supervision for graduate entry nursing students

This paper will report on an evaluation of group clinical supervision (CS) facilitated for graduate entry nursing (GEN) students whilst on clinical placement. The literature suggests educational forums which enable GEN students to engage in critical dialogue, promote reflective practice and ongoing support are an essential element of GEN curricula. The model of supervision employed was informed by Proctor's three function interactive CS model and Inskipp and Proctor's Supervision Alliance. Both emphasise the normative, formative and restorative functions of CS as task areas within an overarching humanistic supervisory approach. The three-function model informed the design of a questionnaire which intended to measure their importance, impact and influence through both structured and open-ended questions. Findings suggest the restorative function of supervision is most valued and is facilitated in an environment where humanistic principles of non-judgement, empathy and trust are clearly present. Also the opportunity to learn from others, consider alternative perspectives and question personal assumptions regarding capability and confidence are a priority for this student group. It is suggested that the restorative function of CS should be prioritised within future developments and models which view this function as a key purpose of CS should be explored.

Clinical group supervision for integrating ethical reasoning

Background:

Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students’ education and especially the focus on ethical reasoning.

Aim:

The aim of this study was to explore and describe nursing students’ ethical reasoning and their supervisors’ experiences related to participation in clinical group supervision.

Research design:

The study is a qualitative interview study with interpretative description as an analysis approach.

Participants and research context:

A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5).

Ethical considerations:

The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden.

Findings:

The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions.

Discussion and conclusion:

Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice.

Using flash cards to engage Indonesian nursing students in reflection on their practice

BACKGROUND

Reflective practice is now widely used as a critical learning tool in undergraduate and postgraduate nursing programs in most developed countries. However in developing countries, reflective practice is in its infancy.

AIM

To introduce reflective practice to postgraduate students in an Indonesian nursing education institution. This paper presents the positive meanings of reflection and reflective practice experienced by the students and the way they used reflection within their practice.

DESIGN

A descriptive qualitative study was conducted to explore the meaning of reflection or reflective practice using flashcards.

METHOD

A clinical reflective practice model taking into consideration Indonesian culture was developed and applied during students' clinical placement. A few weeks post clinical placement, 21 students participated in an evaluation session. The meaning of reflection or reflective practice was explored using flash cards containing images of people and environment with different situations and events. Students were asked to choose a card that represented their viewpoints about reflective practice and share it with the group. Data were digitally captured and analyzed using thematic analysis.

FINDINGS

Reflection provided a positive experience for the students. In their own words, they discussed their journey of using reflection during the clinical placement period. The use of reflection was identified as expanding their view of nursing practice, providing a safe place to explore their experiences and clarity when they encountered challenging situations during their clinical practice. Reflecting on practice experiences resulted in increased self-awareness, and enhanced their learning.

CONCLUSION

The findings indicate that reflective practice can be implemented successfully in Indonesia and may have value for other Eastern countries that share similar cultural characteristics. The use of flash cards assisted the students describe through stories their experiences of participating in this reflective practice program.

Perspectives on good preceptorship: A matter of ethics

BACKGROUND

Clinical education is an essential part of the Bachelor's program in Nursing and a keystone of professional nursing education. Through clinical experiences, the student nurses acquire nursing knowledge and essential skills for professional practice. The preceptor plays a vital role in the development of student nurses becoming professional nurses.

AIM

The aim of this Nordic qualitative study was to explore the experiences of good preceptorship in relation to undergraduate student nurses in clinical education from the perspective of the preceptors themselves.

METHOD

Data were collected by narrative interviews with 27 preceptors in Finland and Sweden and analyzed using a hermeneutical approach.

FINDINGS

A caring relationship, based on caring ethics, is seen as the foundation for learning and development. Moreover, a mutual respect is a prerequisite for fellowship and a good atmosphere. As such, encounters are characterized by reciprocity and mutuality. The preceptors have a deep sense of responsibility toward the students and the profession. Furthermore, the preceptors have an inner responsibility to guide the students into working life and to share their knowledge by acting as role models.

CONCLUSION

The findings suggest that preceptorship should be examined through new lenses. Moreover, preceptorship is an ethical issue that should be recognized by all stakeholders.

Receiving group clinical supervision: a phenomenological study

This study examined the process of group supervision as experienced by one team of biofeedback therapists working in the south of England. A phenomenological study was undertaken to examine the team's perceptions of attending group supervision over time. Ten one-to-one in-depth interviews were conducted, six of which were with biofeedback therapists currently receiving supervision, three with nurses who used to receive this supervision and one interview with the supervisor. A four-stage model detailing how supervisees' experiences changed as a consequence of continued group supervision was developed. Study data revealed how this process allowed the biofeedback therapists to examine their clinical interventions and align their approach and perspective alongside other team members. This was a valuable and safe way of learning 'on the job' for the newer members of the team. The opportunity for free-thinking and reflection on practice supported clinical decision-making and therapeutic nursing. The more experienced supervisees demonstrated how their continued attendance of the group supervision sessions not only confirmed their expertise in role, but also facilitated their colleagues' development, which enhanced role satisfaction. The data also indicated some of the essential supervisory features of this process.

Facilitator versus preceptor: which offers the best support to undergraduate nursing students?

INTRODUCTION

There is an abundance of literature regarding factors that influence student learning within the clinical environment. Within this discourse, there is a paucity of research on the impact of supervision models on the learning support needs of students. This paper presents the results of research that focused on nursing students' perceptions about the effectiveness of the support they received during their work integrated learning (WIL) experience.

BACKGROUND

The majority of students placed within health care facilities are in groups. The group model incorporates a facilitator who supervises the students who are placed across a number of wards. At the ward level students are then assigned a Registered Nurse (RN) who is their mentor. This occurs on a shift by shift basis. Another model of clinical supervision involves preceptorship. This approach is via a one-on-one supervision of students. Within the preceptorship model, students are supervised by a RN who is responsible for supporting them during their WIL experience and for completing their assessment.

METHODS

This study compared two models of clinical supervision to better understand the learning support needs as perceived by undergraduate nursing students during their WIL experience. Survey method using a self reporting online questionnaire developed by the researchers was used to collect data.

RESULTS

159 undergraduate nursing students enrolled in a Bachelor level programme of study completed the on-line survey. When comparing the two models of supervision, students supervised within the facilitator model were statistically more likely to be challenged to reflect, think, build on existing skills and knowledge and to problem-solve issues. Notably, all factors integral to RN education. Overall, students considered the quality of support to be the most important facet of supervision.

CONCLUSIONS

The findings of this study demonstrate that the facilitator model is the better approach for the development of critical thinking, but both models enable the development of a student's professional identity and the development of their role within nursing. This highlights the significance of clinical experiences during undergraduate nursing education.

Finnish and Swedish nursing students' experiences of their first clinical practice placement--a qualitative study

BACKGROUND

Nursing is a practice-based discipline. Clinical practice settings are important in preparing undergraduate nursing students for the role of registered nurse.

AIM

The aim of this Nordic qualitative study is to illuminate first year undergraduate nursing students' experiences of clinical practice during their first clinical placement, with a focus on preception, reflection, and the link between theory and practice.

METHOD

Data were collected by focus group interviews with 22 nursing students, and analyzed with qualitative content analysis.

FINDINGS

Positive experiences included stimulating and visible preceptors, a permissive atmosphere, and reflection as a matter of course. Negative experiences were related to feelings of abandonment and powerlessness when preceptors were invisible and the atmosphere at the ward was non-permissive. The implementation of research-based knowledge was insufficient.

CONCLUSIONS

A permissive atmosphere and visible preceptors are crucial if learning is to be maximized. Consequently, it is important to set aside time for preceptors to be more visible and to make the atmosphere at the clinical placement more permissive. The student must have the opportunity to combine scientific knowledge with evidence-based knowledge in order to develop nursing actions.

Group supervision to strengthen nurses in their preceptor role in the bachelor nursing education--perceptions before and after participation

BACKGROUND

A collaborative project was carried out at four bachelor nursing colleges in Sweden and Norway, to support preceptors in the clinical fields by means of group supervision. The aim of this study was to investigate the preceptors' views on their own ability and satisfaction in the role before and after taking part in group supervision during one year and to describe their perception of the supervision model used.

METHOD

Forty-five preceptors participated in the study. Baseline and endpoint questionnaires were used for data collection.

RESULTS

Before taking part in group supervision most preceptors expressed that they were content with their ability and knowledge with regards to the preceptor role. Despite this most of them considered that the participation had increased their ability to supervise students, and more than half of them considered that it also had promoted to their personal development. At the end of the project a majority of them had positive experiences of group supervision. Most of the structure and climate factors in the supervision model were considered important and almost all were highly realised.

CONCLUSION

The study showed that group supervision could be a valuable tool to provide support to clinical preceptors in bachelor nursing education.