A framework to develop a clinical learning culture in health facilities: ideas from the literature

The approaches and motivations to learning of student nurses: a phenomenological study

This research study was undertaken to elicit a group of final-year student nurses' perceptions of their motivations and approaches to learning, and the implications of their views. It is important to explore this subject because students' motivations and approaches to learning can potentially impact patient care. This study was part of a larger research project. The sample consisted of 18 final-year student nurses at a large UK university. Students completed semi-structured interviews that used a qualitative constructivist approach to explore their educational experience. Students described what motivated them to learn, and how they approached their learning because of their understanding of which subjects they believed were and were not important. Students felt that clinical skills were the most important subjects, and topics such as health promotion, law and ethics, were less important and therefore they approached these subjects in a superficial way, learning just enough to pass their course. Clinical skills were perceived as more useful because they would be used directly in clinical practice. The findings of this study are significant to inform nurse educators as they plan curricula and provide an insight into what may potentially adversely affect patient care when students become registered nurses.

Learning beyond a single field of nursing through a virtual case-based approach to pre-registration nurse education

Ensuring that pre-registration student nurses gain the richness of clinical practice to allow them to feel confident and knowledgeable to care for patients of the 21st century is often a challenge. Clinical practice challenges often mean that students will be strategic learners. This article discusses the development of a virtual case-based learning site to provide a rich experience for students to learn.

Development of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement Instrument

BACKGROUND

Instruments that measure clinical learning environments have lacked rigorous methodological approaches in their development and validity.

METHOD

Development research using a survey design approach was conducted for an instrument to evaluate the quality of nursing students' clinical practice placement.

RESULTS

The development and validity of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement (SNEP) resulted in a 40-item instrument to evaluate nursing students' experience of their completed clinical practice placement. Adequate level of model fit was indicated (χ²[719] = 1909.47, p < .001) for the confirmatory factor analysis (χ²/df = 2.66, comparative fit index = 0.92, Tucker-Lewis Index = 0.92, and root-mean-square error of approximation = 0.07). Standardized factor loadings were high, ranging from 0.68 to 0.95.

CONCLUSION

The SNEP was designed and validated incorporating the perspective of various nurse stakeholders and can be used in both research and clinical learning environments. [J Nurs Educ. 2022;61(10):559-569.].

Developing an interprofessional learning and working culture to improve person-centred care in nursing homes: a realist action research protocol

INTRODUCTION

Healthcare is changing due to the ageing of the general population, complex care demands and growing attention to person-centred care. To deal with these changes and provide the best possible person-centred care, the different professionals in nursing homes should all collaborate intensively. However, most professionals work within the field of their own expertise and share very little knowledge, experiences and insights. A lack of an interprofessional learning and working culture also prevents professionals with different expertise from working and learning intensively together to achieve high-quality person-centred care. There is a gap of knowledge about how to develop such a culture. Our aim is to provide insights into what actions, in what context and to what extent can contribute to an impactful development of an interprofessional learning and working culture.

METHODS AND ANALYSIS

The realist action research design will be applied. It consists of three iterative steps: plan, act and observe, and reflect. First, we will formulate the theory about interprofessional learning and working culture and measure this culture by means of interviews, focus groups and questionnaires. Second, we will apply the nine principles of Practice Development to coach professionals from six Dutch nursing homes to improve their interprofessional learning and working culture. Finally, we will evaluate the impact of the changed attitudes and skills on healthcare practice.

ETHICS AND DISSEMINATION

Approval for the project was given by the Hogeschool van Arnhem en Nijmegen (HAN) Research Ethics Committee, the Netherlands, registration number EACO 164.12/19. All organisations, professionals and residents/family members will be informed verbally and by letter about the study and asked for informed consent. The results will be presented in peer-reviewed scientific journals, professional journals and at symposia and conferences. The findings will be transferred to an online toolbox and e-learning modules for graduated professionals and students.

Twelve tips for surgeons to maximise medical student learning in the operating theatre

Theatre-based learning is an essential component of undergraduate surgical education and offers a wide range of learning opportunities. However, studies have demonstrated that medical students have not always benefited from this holistic learning environment due to many reasons, including intimidation, hierarchies within the surgical environment and fear of making mistakes. The lead surgical educator's approach is an important influence on the experience and learning of their medical students. These twelve tips are aimed at surgical educators with undergraduate teaching responsibilities. This guidance is based upon evidence from literature and established theories of teaching and learning, supplemented by qualitative interviews with surgeons and medical students. The resulting tips were checked and refined by surgical teaching fellows. These learner-centred tips provide guidance on thorough induction, managing mutual expectations and approaches that optimise teaching and learning in the operating theatre. They are designed to support surgical educators in improving their students' engagement and learning experiences in this setting.

First-year nursing students' collaboration using peer learning during clinical practice education: An observational study

The purpose of this observational study was to describe the collaboration between first-year nursing students using peer learning during their first clinical practice education. In earlier, predominantly interview studies, peer learning has been described as a model with several positive outcomes. However, no studies on how students act in collaboration in a real-life context have been found. The present study observed sixteen arbitrarily paired nursing students (eight pairs) on three to five occasions per pair, in total 164 h from September 2015 to March 2016. Repeated unstructured observations including informal conversations were used. Using qualitative content analysis, one theme 'Involuntary collaboration leads to growth in different competencies' emerged and three categories 'Practising nursing skills and abilities when working together', 'Establishing knowledge by helping each other to understand' and 'Sharing thoughts, feelings, and knowledge and put them into words'. In conclusion, nursing students using peer learning were observed practising several competencies, some of them not so easily elicited according to earlier research as organization, nursing leadership, teaching, and supervision.

Nursing and midwifery students' experiences and perception of their clinical learning environment in Malawi: a mixed-method study

Background

The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives' experiences and perception of the clinical learning environment in Malawi.

Methods

A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed.

Results

A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment.

Conclusion

Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

Nursing Students’ Perceptions of the Dedicated Education Unit Model in 2 UAE Hospitals

Background: Initially developed in Australia, Dedicated Education Unit (DEU) is an innovative approach to support the growth and development of nursing students while on clinical placement in the hospital setting. With the increasing number of nursing students requiring clinical placement, nursing needed to explore further ways to support students and preceptors in the clinical area. Methods: The study followed a sequential explanatory mixed-methods design to investigate participants’ perceptions of the effectiveness of the DEU model in improving nursing students’ learning experiences. The DEU model was implemented in 2 Abu Dhabi Health Services Company (SEHA) hospitals in Al Ain City, and feedback was obtained from both students and their preceptors via survey and focus group sessions. Results: The study showed positive results with students feeling supported to learn new knowledge and skills by their preceptors. Preceptors reported that they were better able to facilitate student placements in an environment that supported learning. Conclusion: The introduction of the DEU model has supported increasing numbers of students in the clinical area and provided an improved environment for learning.

Collaborative Learning in Practice (CLIP): Evaluation of a new approach to clinical learning

BACKGROUND

There are challenges in creating positive clinical learning environments. A new model of practice learning for pre-registration nurse education was pilot-tested in the East of England. The Collaborative Learning in Practice model (CLIP) was developed from a similar model of practice learning used in the Netherlands.

OBJECTIVES

We undertook an evaluation of a new approach to clinical learning. The aims of the project were to consider the challenges of implementation; consider the perception of gains and losses of students and stakeholders experiencing the new model of practice learning; and consider the sustainability of the new model in the context of service delivery.

METHODS

Mixed methods were used. Data were collected in three forms: (1) a survey of students undertaking the CLIP model and those learning within the existing mentorship model to assess the supervisory relationships and pedagogical atmosphere experienced; (2) student focus groups; and (3) qualitative one-to-one interviews with key stakeholders in the provision of practice learning environments.

RESULTS

A total of 607 questionnaires were returned out of the 738 distributed, five focus groups of a total of 30 students were undertaken, and 13 stakeholders were interviewed. Students who had experienced CLIP reported lower supervisory relationship scores compared with those without experience (mean difference = -0.24 points, 95% CI -0.21 to -0.094, p = 0.001). There was no difference in pedagogical atmosphere scores (mean difference -0.085 points, 95% CI -0.21 to 0.040, p = 0.19). Analysis of qualitative data produced two themes: 'Adapting the environment' illustrated the importance of learning context and 'learning to fly' highlighted the process of students gaining greater autonomy.

CONCLUSION

Our findings suggest that collaborative learning in practice offers many benefits as an approach to clinical learning but with important caveats. Attention needs to be paid to particular aspects of the model such as sufficient numbers of students, and an acknowledgement of perceived losses as well as gains.

Attitude of Nursing and Midwifery students towards clinical practice and its associated factors in Northwest Ethiopia: a cross-sectional study

OBJECTIVE

The aim of this study was to assess the attitude of Nursing and Midwifery students towards clinical practice and its associated factors at University of Gondar, Northwest Ethiopia. 2018.

RESULT

The prevalence of a favorable attitude towards clinical practice was found to be 42.9% in this study. The odds of having favorable attitude were found to be 2 times higher among students who prepared well for clinical practice [AOR = 2.07, 95%, CI (1.25, 3.44)] compared with counterparts. Similarly students who communicate well with clinical staffs [AOR = 1.89, 95%, CI (1.05, 3.41)], practiced in well-equipped hospital [AOR = 1.76, 95%, CI (1.01, 3.06)], and accompanying frequently by a clinical supervisor [AOR = 1.69, 95%, CI (1.02, 2.81)] were more likely to have favorable attitude compared with counterparts.

Role-modelling and the hidden curriculum: New graduate nurses' professional socialisation

AIMS AND OBJECTIVES

To explore new graduate nurses' experiences of professional socialisation by registered nurses in hospital-based practice settings, and identify strategies that support professional identity development.

BACKGROUND

Professionalism is reinforced and stabilised in the clinical environment through the "hidden curriculum", with major learning coming from practice role-models. New graduates observe attitudes, behaviours, decision-making and skills, and gain feedback from registered nurses, which they translate into their own practice. Professional socialisation occurs through encounters with desirable and undesirable role-modelling; both are significant in professional identity formation.

DESIGN

Qualitative descriptive design.

METHOD

Data collection was undertaken through semistructured interviews with five new graduate nurse participants. A general inductive approach guided analysis. The meaningful descriptions gained provided insight into their experiences.

RESULTS

Three main themes identified from the data include: "Lessons from the wilderness"; "Life in the wild"; and "Belonging to a wolf pack". The data set highlighted the major transitional process from student identity to registered nurse.

CONCLUSIONS

New graduates' rethinking of beliefs and professional nursing identities were influenced by organisational pressures and experienced nurses' role-modelling practices contrary to professional values. Despite encountering a range of professional behaviours, attitudes and dilemmas, new graduates were capable of moral agency and critical thinking. However, they rapidly acculturated and described compromises to cope. To promote high morale and a sense of belonging, a concerted effort is required by all nurses to facilitate the socialisation process to encourage self-authorship.

RELEVANCE TO CLINICAL PRACTICE

A well-developed professional identity enhances nursing as a profession, contributing towards better healthcare delivery and outcomes. It is critically important how professional values are learnt within the culture of nursing. Tensions in clinical practice need to be understood better to avoid moral distress caused by dissonance between expectation and experience. It is advantageous to increase early positive socialisation.

A dietetic clinical educator enhances the experience and assessment of clinical placement

AIM

The aim of this study was to evaluate the impact of a Clinical Educator model on the learning experience and environment for students, preceptors and managers.

METHODS

A Clinical Educator position was established for the 10-week dietetic clinical placement at Edith Cowan University. The Clinical Educator was responsible for overseeing the placement and assisting in the supervision of students. A qualitative descriptive approach using focus groups with purposive sampling explored the research question. Students (n = 10), preceptors (n = 21) and managers (n = 3) participated in separate focus groups. Data were thematically analysed with consideration given to participant and focus group commonalities and differences.

RESULTS

The findings revealed that the Clinical Educator (i) reduced the logistical burden of student placements and improved time efficiency; (ii) facilitated student assessment within a programme of assessment; (iii) was uniquely positioned to provide support and enhance student confidence; and (iv) enhanced capacity to manage underperforming and challenging students.

CONCLUSIONS

The Clinical Educator model increased student confidence, facilitated quality assessment and supported the management of underperforming students. This was achieved by reducing the burden of clinical placements, facilitating effective and timely communication between stakeholders and supporting the establishment of meaningful relationships which enriched learning. The results highlight the importance of the people involved in placement to facilitate a positive student learning environment and high quality assessment.

An interprofessional learning experience for trainee general practitioners in an academic urban minor injuries unit with advanced nurse practitioners (Emergency)

BACKGROUND

There is a body of empirical literature indicating that interprofessional education (IPE) not only enriches students' understanding of their own discipline but of other disciplines. However, giving the on-going emphasis on the importance of IPE to healthcare processes and outcomes, on-going attention is needed to advancing the research evidence related to the emergency department setting. The aim of this qualitative descriptive study was to determine the clinical learning experiences of GPs who rotated through an academic urban minor injuries unit as part of their training, led by advanced nurse practitioners (emergency).

METHODS

Data were drawn from semi-structured interviews of sixty to ninety minutes duration with 5 general practitioners (GPs) who completed the trainee rotation practicum in an academic urban minor injuries unit led by advanced nurse practitioners (ANPs) emergency.

STUDY FINDINGS

The GPs indicated that their knowledge translation of minor injuries to practice was connected to their utilisation of algorithm rules and case management processes modelled by ANPs (emergency). The outcome of this process reported by GPs brought notable reductions to their referral of patients with minor injuries to emergency departments.

CONCLUSION

Interprofessional learning in clinical practice with ANPs (emergency) was seen as a valuable role making model for the trainee GPs who are now employed in primary care.

The influence of workplace culture on nurses' learning experiences: a systematic review of qualitative evidence

BACKGROUND

A healthy workplace culture enables nurses to experience valuable learning in the workplace. Learning in the workplace enables the provision of evidence-based and continuously improving safe patient care, which is central to achieving good patient outcomes. Therefore, nurses need to learn within a workplace that supports the implementation of evidence-based, professional practice and enables the best patient outcomes; the influence of workplace culture may play a role in this.

OBJECTIVES

The purpose of this review was to critically appraise and synthesize the best available qualitative evidence to understand both the nurses' learning experiences within the workplace and the factors within the workplace culture that influence those learning experiences.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Registered and enrolled nurses regulated by a nursing and midwifery board and/or recognized health practitioner regulation agency (or their international equivalent).

PHENOMENA OF INTEREST

This review considered studies that described two phenomena of interest: the nurses' learning experience, either within an acute healthcare workplace or a workplace-related learning environment and the influence of workplace culture on the nurses' learning experience (within the workplace or workplace-related learning environment).

CONTEXT

This review considered studies that included nurses working in an acute healthcare organization within a Western culture.

TYPES OF STUDIES

This review considered studies that focused on qualitative evidence and included the following research designs: phenomenological, grounded theory and critical theory.

SEARCH STRATEGY

Published and unpublished studies in English from 1980 to 2013 were identified using a three-step search strategy, searching various databases, and included hand searching of the reference lists within articles selected for appraisal.

METHODOLOGICAL QUALITY

For studies meeting the inclusion criteria, methodological quality was assessed using a standardized checklist from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

DATA EXTRACTION

Qualitative data were extracted from articles included in the review using the standardized data extraction tool from the JBI-QARI.

DATA SYNTHESIS

Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument (JBI-QARI). This involved the aggregation and synthesis of findings to generate a set of categories, which were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that could be used as a basis for evidence-based practice.

RESULTS

Fourteen articles were identified following appraisal and a total of 105 findings (85 unequivocal and 20 credible) were extracted from included studies and grouped into eight categories based on similarity of meaning. Subsequently, categories were grouped into two synthesized findings. The two synthesized findings were as follows: ORGANIZATIONAL INFLUENCES: Enabling nurses to demonstrate accountability for their own learning, along with clear organizational systems that provide resources, time, adequate staffing and support, demonstrates encouragement for and the value of nurses' learning and education.

RELATIONAL DYNAMICS

Nurses value their peers, expert nurses, preceptors, mentors and educators facilitating and encouraging their learning and professional development.

CONCLUSION

An optimal workplace culture is central for nurses to experience valuable and relevant learning in the workplace. To emphasize the importance of nurses' learning in the workplace, working and learning is understood as an integrated experience. Consequently, a dual system that enables nurses to demonstrate accountability for their own learning, along with clear organizational and educational systems, is required to demonstrate the value in nurses' learning and education.

A comprehensive literature review of guidelines facilitating transition of newly graduated nurses to professional nurses

Literature shows that successful transition of newly graduate nurses to professional nurses is imperative but does not always take place, resulting in difficulty in performance, cognizance or behaviour of a role as a nurse, affecting the quality of patient care negatively. No integrative literature review could be found to summarize available guidelines facilitating transition of final year nursing students to professional nurses. An extensive search of the literature by means of an integrative literature review was conducted in 2014 and updated in June 2017, following a five-step process. All relevant studies were subsequently appraised for rigour and quality using the AGREE II tool by two independent reviewers. Eight (n = 8) guidelines on transitions were independently extracted. After thematic analysis was done, three factors to facilitate transition of final year nursing students to professional nurses were found: 1) support for new graduates, 2) the graduate's need for socialization and belonging, and 3) a positive clinical learning environment. The availability and implementation of guidelines on transition of final year nursing students by educational institutions and healthcare facilities could ease the transition from being final year nursing students to becoming professional nurses as well as improve retention of newly qualified professional nurses.

Work-based learning in health care organisations experienced by nursing staff: A systematic review of qualitative studies

The aim of this review is to systematically summarise qualitative evidence about work-based learning in health care organisations as experienced by nursing staff. Work-based learning is understood as informal learning that occurs inside the work community in the interaction between employees. Studies for this review were searched for in the CINAHL, PubMed, Scopus and ABI Inform ProQuest databases for the period 2000-2015. Nine original studies met the inclusion criteria. After the critical appraisal by two researchers, all nine studies were selected for the review. The findings of the original studies were aggregated, and four statements were prepared, to be utilised in clinical work and decision-making. The statements concerned the following issues: (1) the culture of the work community; (2) the physical structures, spaces and duties of the work unit; (3) management; and (4) interpersonal relations. Understanding the nurses' experiences of work-based learning and factors behind these experiences provides an opportunity to influence the challenges of learning in the demanding context of health care organisations.

A peer learning intervention for nursing students in clinical practice education: A quasi-experimental study

BACKGROUND

Studies of peer learning indicate that the model enables students to practice skills useful in their future profession, such as communication, cooperation, reflection and independence. However, so far most studies have used a qualitative approach and none have used a quasi-experimental design to study effects of nursing students' peer learning in clinical practice.

OBJECTIVES

To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance.

DESIGN

Quasi-experimental.

SETTING

The study was conducted during nursing students' clinical practice.

PARTICIPANTS

All undergraduate nursing students (n=87) attending their first clinical practice were approached. Seventy students out of 87 answered the questionnaires at both baseline and follow-up (42 of 46 in the intervention group and 28 of 39 in the comparison group).

METHODS

During the first two weeks of the clinical practice period, all students were supervised traditionally. Thereafter, the intervention group received peer learning the last two weeks, and the comparison group received traditional supervision. Questionnaire data were collected on nursing students' self-rated performance during the second (baseline) and last (follow-up) week of their clinical practice.

RESULTS

Self-efficacy was improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. For the other self-rated variables/tests, there were no differences in changes over time between the groups. Studying each group separately, the intervention group significantly improved on thirteen of the twenty variables/tests over time and the comparison group improved on four.

CONCLUSIONS

The results indicate that peer learning is a useful method which improves nursing students' self-efficacy to a greater degree than traditional supervision does. Regarding the other self-rated performance variables, no interaction effects were found.

Clinical Growth: An Evolutionary Concept Analysis

Clinical growth is an essential component of nursing education, although challenging to evaluate. Considering the paradigm shift toward constructivism and student-centered learning, clinical growth requires an examination within contemporary practices. A concept analysis of clinical growth in nursing education produced defining attributes, antecedents, and consequences. Attributes included higher-level thinking, socialization, skill development, self-reflection, self-investment, interpersonal communication, and linking theory to practice. Identification of critical attributes allows educators to adapt to student-centered learning in the clinical environment. These findings allow educators to determine significant research questions, develop situation-specific theories, and identify strategies to enhance student learning in the clinical environment.

Transitions into practice: First patient care experiences of baccalaureate nursing students

An essential component of the learning process for nursing and other disciplines in health professions education is the structuring of successful clinical experiences for beginning students. The purpose of this research study was to explore and describe first patient care experiences of baccalaureate nursing students in order to better understand student perspectives and perceptions. Data were collected from three cohorts of baccalaureate nursing in two university settings in the first semester following completion of first patient care experiences. A basic, exploratory qualitative approach with overtones of grounded theory was used for data collection and analysis. Three clear themes emerged from the data analysis. Participants experienced emotional responses of Anticipation, including fear, nervousness, and anxiety. The clinical experiences allowed Processing ∼ Working Through, which was impacted by actions of instructors, nurses and patients. Participants developed Awareness as a result of their experiences.

Requirements for reflection in the critical care environment

BACKGROUND

Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear.

OBJECTIVES

To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses.

METHOD

A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment.

RESULTS

The themes that emerged from the focus group were buy-in from stakeholders -management, facilitators and critical care nurses, and the need to create an environment where reflection can occur.

CONCLUSION

Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatory practice development.

The sum of all parts: an Australian experience in improving clinical partnerships

AIM

To create a collaborative partnership between the education provider (University) and the placement provider (Hospital) to facilitate the identification and development of strategies to improve capacity and capability for nursing clinical placements. This partnership was labelled (TULIP) to identify the two partners and it purpose as a learning investment project.

BACKGROUND

The quality of clinical learning is interdependent on the collaborative clinical health partnerships between Hospital, University, preceptors/facilitators and students. Success is dependent on communication between all key stakeholders within the partnership, to meet capacity and capability demand.

DESIGN

Collaborative quality assurance project in combination with two research projects.

METHOD

Quantitative and qualitative measurements of student perceptions, preceptor understanding and organisation partnership capacity and capability over a three year period in an acute care hospital.

RESULTS

Qualitative and quantitative data from students and preceptors, and hospital quality assurance data linked to become the TULIP framework for a clinical placement development model that addresses the key components of strategic communication, resourcing and staff acknowledgement between stakeholders.

CONCLUSIONS

The outcomes achieved demonstrated student engagement, clinical leadership from registered nursing staff, and the establishment of a collaborative partnership between hospital executives and staff, and the university resulting in an increased capacity. The TULIP project has provided both partners with a sustainable plan for growth in student placements, improved strategies to develop clinical leadership practice in individual nurses and a better clinical learning environment for staff that uses a framework that is transferrable to other health settings.

Exploring ward nurses' perceptions of continuing education in clinical settings

BACKGROUND

Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care.

OBJECTIVES

To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward.

DESIGN

A case study approach was utilized.

SETTING

A major teaching hospital in Melbourne, Australia.

PARTICIPANTS

A range of clinical nursing staff (n=23).

METHODS

Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data.

RESULTS

Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace.

CONCLUSIONS

Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong learning and a culture conducive to learning.

Importance of public health nurses precepting students in clinical practice: a qualitative study

BACKGROUND

Preceptors' working environment, support and competence affect how they perform the preceptor role, are therefore important for developing students and can influence students' roles as students and future professionals. Previous research has focused on precepting student nurses and not so much on public health nurses or other postgraduate students. Knowledge in this field is therefore lacking.

OBJECTIVE

The article aims to present a grounded theory of the role of public health nurses as student preceptors in Norway.

DESIGN

We conducted 20 interviews with public health nurses in addition to a focus group with four participants. We used classical grounded theory method to gather and analyze data.

FINDINGS

The preceptors were strongly concerned about invisibility and lack of recognition of the preceptor role. This main concern was resolved by the strategy of being obligated and included three patterns: optimistic, ambivalent and reluctant performance, all with differing motivation for being obligated. All stakeholders involved in clinical practice seem to contribute to making the preceptors' role invisible and thereby contribute to the lack of recognition, support and reward, which again seem to self-reinforce invisibility.

CONCLUSION

The study highlights the obligation of public health nurses in precepting students and increases the understanding of the challenges of this role. Ensuring education of a high academic standard requires paying more attention to developing effective support for the people involved.

How undergraduate nursing students learn to care for patients spiritually in clinical studies--a review of literature

AIM

To gain knowledge about what is known about how undergraduate nursing students learn to care for patients spiritually in their clinical studies.

BACKGROUND

Spirituality is related to meaning, hope and comfort and spiritual care is part of nurses' responsibility. Clinical studies are vital for students to integrate knowledge, clinical reasoning and formation. However, nurses are important in role modelling.

METHOD

A literature search was undertaken using international databases from 1980 to 2012. Articles were thoroughly evaluated and 10 papers reviewed for this article.

RESULTS

Four main areas emerged as essential for learning spiritual care in clinical studies: (1) the importance of learning in real-life situations with repeated exposure to patients in diverse placements; (2) use of pedagogical methods that assist students to understand, work with and reflect on patients' spirituality; (3) to be aware of and overcome conditions prohibiting spiritual care learning; and (4) to see spiritual care learning in connection with how students are prepared and how they are followed up after clinical studies.

CONCLUSION

Clinical studies are fundamental to students' learning of spiritual care in nursing.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders play a key role in keeping holistic care a nursing focus and creating a good learning environment.

The influence of the learning climate on learning outcomes from Marte Meo counselling in dementia care

AIM

  To identify factors that affected the learning outcomes from Marte Meo counselling (MMC).

BACKGROUND

  Although MMC has shown promising results regarding learning outcomes for staff working in dementia-specific care units, the outcomes differ.

METHOD

  Twelve individual interviews and four focus group interviews with staff who had participated in MMC were analysed through a qualitative content analysis.

RESULTS

  The learning climate has considerable significance for the experienced benefit of MMC and indicate that this learning climate depends on three conditions: establishing a common understanding of the content and form of MMC, ensuring staff's willingness to participate and the opportunity to do so, and securing an arena in the unit for discussion and interactions.

CONCLUSION

  Learning outcomes from MMC in dementia-specific care units appear to depend on the learning climate in the unit. Implication for nursing management  The learning climate needs attention from the nursing management when establishing Marte Meo intervention in nursing homes. The learning climate can be facilitated through building common understandings in the units regarding why and how this intervention should take place, and by ensuring clarity in the relationship between the intervention and the organization's objectives.

Nursing students' perspectives on the patient and the impact of the nursing culture: a meta-synthesis

AIM

To explore and interpret how nursing students develop their understanding of the patient as a human being.

BACKGROUND

Understanding the patient is the main characteristic of good, caring performance. In addition, nurse leaders play an active role in creating a culture in which nursing students can flourish and improve.

METHOD

This meta-synthesis was based on Noblit and Hare's meta-ethnography.

RESULTS

The overarching metaphor was interpreted as the nursing students' capacity for compassion. Two central metaphors were revealed, based on how nursing students developed their understanding of the patient as a human being. These central metaphors were labelled 'The open door', comprising seven key metaphors and 'The closed door' based on two key metaphors.

CONCLUSION

During practical training, the students observed both virtuous and unkind nurses. Virtue is a skill that can be taught, but not all students were able to learn it. Some students acquired the ability to reflect on ethical issues, while others did not. Therefore, good role models are of major importance.

IMPLICATION FOR NURSING MANAGEMENT

The nurse leader should function as a facilitator in the students' efforts to gain the capacity to face the suffering patient and to develop an understanding of the patient's situation.