Lost in translation: barriers to learning in health professional clinical education

Making sense of praxis within an evolving clinical context: A grounded theory of nursing student learning transfer

BACKGROUND

Nursing students are tasked with connecting theoretical knowledge with clinical practice to ensure patient safety and provide quality care. However, there is a distinct lack of research on nursing student learning transfer. More exploration and research are necessary to understand how nursing students apply their learning in complex and evolving clinical situations.

AIM

The objective of this study was to explore the processes and strategies nursing students use to transfer classroom learning to real-world clinical situations.

DESIGN

We utilized a classic grounded theory methodology developed by Glaser and Strauss to explore how fourth-year baccalaureate nursing students transfer classroom learning to clinical practice.

PARTICIPANTS AND SETTING

From March 2023 to February 2024, 19 fourth-year nursing students were recruited from six undergraduate nursing programs across Alberta, Canada, ensuring that the study population provided a fair representation within the province.

METHODS

Interviews were transcribed verbatim and analyzed through open coding, the constant comparative method, and memo writing. A core category emerged along with four related sub-categories. A substantive theory was developed through theoretical sampling, selective coding, the constant comparative method, and memo writing.

RESULTS

The research findings identified making sense of praxis as the core category, which represented the way students applied theory-to-practice connections in clinical settings. Four interconnected sub-categories were identified: experiencing the clinical environment, making it personal, recognizing connections, and working toward mastery by doing, culminating in the theory Making Sense of Praxis Within an Evolving Clinical Context.

CONCLUSIONS

The findings led to recommendations for nursing education programs, specifically nursing curriculum designers and clinical instructors, regarding the preparation of and support for nursing students in their developing clinical practice.

Evaluating an inquiry-based learning program

Inquiry-based learning (IBL) is a promising educational framework that is understudied in graduate medical education. To determine participant satisfaction and engagement with phases of an IBL postgraduate education program, a mixed-methods study collected data via survey statements and open-ended responses. The authors included participants attending an intensive care medicine (ICM) IBL program from May to November 2020. Quantitative outcomes included participants' satisfaction with the IBL format and impact of engagement with IBL on the learning experience. Qualitative outcomes explored determinants of engagement with IBL phases and the impact on the learning experience. Of 378 attendees, 167 submitted survey responses (44.2%). There was strong agreement relating to overall satisfaction (93.4%). Responses indicated engagement with "orientation" (94.6%), "conceptualization" (97.3%), "discussion" (91.1%), and "conclusion" (91.0%) but limited engagement with the "investigation" phase (48.1%). Greater engagement with IBL phases had positive impacts, with repeat attenders having clearer learning objectives (79.1% vs. 56.6%, P < 0.05) and enhanced learning through collaborative discussion (65.9% vs. 48.7%, P < 0.05). Qualitative analysis showed that ICM learners value active learning principles, clear objectives, and a safe environment to expand their "knowledge base." Sessions facilitated "clinically relevant learning," with application of theoretical knowledge. Learners transformed and "reframed their understanding," using the input of others' experiences. ICM learners were highly satisfied with the IBL format and reported valuable learning. Participants engaged strongly with all IBL phases except the investigation phase during the sessions. IBL facilitated learners' active construction of meaning, facilitating a constructivist approach to learning.NEW & NOTEWORTHY An inquiry-based learning (IBL) program was launched as part of a novel binational intensive care medicine education program. Postgraduate intensive care medicine practitioners participated in this education intervention, where facilitated group discussions explored core intensive care medicine concepts. Survey responses indicated overall satisfaction, engagement with the IBL format, and a constructivist approach to learning. This study provided new insights into the benefits and challenges of an IBL program in the context of practicing clinicians.

Nursing students learning transfer from classroom to clinical practice: An integrative review

AIM

The aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice.

BACKGROUND

As nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students' learning transfer has not yet been synthesized.

DESIGN

This integrative review was conducted using the Whittemore and Knafl framework.

REVIEW METHODS

Eight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute's critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.

RESULTS

Twenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students' ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators.

CONCLUSIONS

The information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students' learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.

The mediating role of professional commitment between the clinical learning environment and learning engagement of nursing students in clinical practice: A cross-sectional study

BACKGROUND

Previous studies have shown that learning engagement can significantly predict nursing students' academic achievement. Nursing educators put considerable effort into assessing and promoting students' engagement in school. However, nursing students' learning engagement in clinical practice has seldom been explored.

OBJECTIVES

To investigate nursing students' learning engagement and influencing factors in clinical practice and examine the effects of the clinical learning environment and professional commitment on learning engagement, specifically to verify the mediation effect of professional commitment.

DESIGN

A cross-sectional study.

SETTINGS

The participants were from five hospitals in Jining, Shandong, China.

PARTICIPANTS

A total of 318 nursing students who were at the end of clinical practice training (>8 months) were included in this study.

METHODS

The Utrecht Work Engagement Scale for Students, the Clinical Learning Environment for Nursing Scale, and the Professional Commitment Scale were used for data collection. Regression and mediating analyses were used to explore the influencing factors of clinical learning engagement and the potential mediating role of professional commitment.

RESULTS

The participants experienced moderate levels of engagement in clinical learning. The clinical learning environment indirectly affected nursing students' learning engagement in clinical practice through professional commitment. Night shifts and educational background also contributed to learning engagement.

CONCLUSIONS

The findings provide new perspectives on promoting nursing students' clinical learning engagement. Professional commitment might be an important mediating variable in nursing education. There is a need to take steps to improve professional commitment of nursing students.

Clinical Stress and Clinical Performance in Prelicensure Nursing Students: A Systematic Review

BACKGROUND

Stress within clinical learning environments often has been associated with nursing education. However, in the past decade, the perceived stress levels of prelicensure nursing students have not only been sustained, they have actually increased. Increased and sustained stress levels negatively affect nursing students' perceptions of their competence, confidence, and ultimately, their clinical performance.

METHOD

A systematic review of the relationship between nursing students' perceived clinical stress and perceived clinical performance was conducted following PRISMA guidelines.

RESULTS

The review highlighted what is currently known about the relationship between perceived clinical stress in prelicensure nursing students and perceived clinical performance, providing implications for future research in clinical education. Three main themes were identified: nursing student gender, academic year, and clinical skill preparation.

CONCLUSION

Future research with rigorous methodological designs is necessary to examine the relationship between perceived clinical stress in prelicensure nursing students and perceived clinical performance. [J Nurs Educ. 2023;62(1):36-41.].

Sources of the knowledge-practice gap in nursing: Lessons from an integrative review

BACKGROUND

The ultimate value of learning lies in the transfer of knowledge to real-life settings. The gap between knowledge and practice can be described as the disconnection between acquired knowledge, the skills learned in nursing school, and those skills needed to practice safely and independently. This is a concerning issue that needs to be investigated deeply to address all the circumstances and factors contributing to the gap.

OBJECTIVES

To reveal the full range of factors leading to the knowledge-practice gap in nursing by means of a thorough survey of the most recent evidence and updates.

METHODS

An integrative review design was selected. Three data bases (MEDLINE, CINAHL Plus and ERIC) were searched electronically for research articles from 2009 up to June 2020 on the gap between knowledge and practice. The 406 articles that appeared were appraised for inclusion or exclusion using the JBI Critical Appraisal Checklist for qualitative research.

RESULT

Eight qualitative studies were included in the review, which identified three major themes and subthemes. The first theme is personal factors, with the following subthemes: internal motivation, learning style and attitude. The second theme is educational structure, with the following subthemes: clinical instructor role, preceptor effect and curriculum. The third theme is organisational characteristics, with the following subthemes: resources, clinical setting features and staffing.

CONCLUSION

The review revealed that the knowledge-practice gap has deep roots in multiple factors. Considering all dimensions of these factors is the key to bridging the knowledge-practice gap.

'Everyone's nice, but …': A qualitative exploration of trainees' experiences of postgraduate geriatric medicine training in Australia

OBJECTIVE

To understand the experiences of trainees who undertake geriatric medicine advanced training in Australia.

METHODS

In this qualitative study, data were collected through semi-structured interviews with geriatric medicine advanced trainees. Data were analysed using a thematic analysis approach and data collection ceased when thematic saturation was achieved.

RESULTS

Thirteen trainees participated. Trainees enjoyed the training program, supported each other and felt prepared for independent practice as a geriatrician. However, they noted the variability of supervision and feedback practices, and educational opportunities afforded to them across different clinical learning environments. They felt unable to give feedback on their training. The research project and concerns about employment after training were also substantial sources of stress.

CONCLUSION

While geriatric medicine advanced trainees reported positively on much of their training, areas for improvement could include improved training for supervisors, improved support for research projects and more robust mechanisms for providing feedback.

Determinants of interprofessional collaboration in complementary medicine to develop an educational module "complementary and integrative medicine" for undergraduate students: A mixed-methods study

As use of complementary medicine (CM) is increasing, health professionals may require proper training in CM to offer evidence-based advice to their patients. The aim of this study was to explore interprofessional collaboration (IPC) in CM in order to gain a comprehensive overview of determinants and to facilitate the definition of objectives for an undergraduate interprofessional educational module. Pursuant to a sequential mixed-methods approach, focus groups and individual interviews with health professionals, who actively use CM in patient care, were conducted. All hospital employees at the University Hospital Lübeck, Germany, were asked to complete an online questionnaire that was based on the previously obtained qualitative results. The interviews with 20 participants revealed four main themes: profession-specific aspects, communication, health care system-associated factors, and the influence of CM on interprofessional dynamics. An analysis of the 157 responses in the online questionnaire showed that team meetings (n = 124, 79%) were most frequently stated as promoting IPC. In binary regression analyses, nursing (OR = 6.17 [2.02-18.84]) and medical professions (OR = 3.77 [1.27-11.18]) predicted evidence-based care as enabler for IPC. Hence, teaching professional competencies and an equal understanding of evidence-based medicine seems necessary to promote IPC within CM.

Hosting pre-registration physiotherapy students in Australian private practices does not change service and economic outcomes; an economic analysis

BACKGROUND

Despite perceived economic barriers to hosting physiotherapy students in private practice settings, no research to date has investigated the effect of hosting students on service delivery and income during clinical placements.

OBJECTIVES

The aim of this study was to determine the effect of student placement provision on service delivery and income in private practice settings.

METHODS

A retrospective economic analysis using a temporal synthetic control period was undertaken. Physiotherapy private practices who had hosted at least one pre-registration physiotherapy student with a matched control period in the subsequent or previous year were invited to participate. Direct service and economic comparisons were conducted across five-week periods and individual placement weeks.

RESULTS

No significant differences in occasions of service and income were found when students were hosted and not hosted, and this remained non-significant after controlling for practice-specific characteristics. The overall mean income per practice was higher for week one of the student placement (95% CI: 657.35 to 1240.95) as compared to week one of the control period, but this finding was not significant. Overall mean income per practice was significantly higher in weeks two to five of the student placement (95% CI: 29.03 to 1732.19) when compared to weeks two to five of the control period.

CONCLUSION

Hosting pre-registration physiotherapy students within private practice settings is not associated with a reduction in service and economic outcomes. Hosting physiotherapy students has a positive economic effect following their initial placement week.

The Reflection, Feedback, and Restructuring Model for Role Development in Nursing Education

An integral component of transitioning to the nursing practice setting is in assimilating and sometimes reformulating and reconceptualizing the knowledge gained in the classroom with what is seen and experienced in practice. An inability to do so may inhibit role development and result in difficult transitions to practice. A constructivist approach was utilized in the development of a new model that describes the process of learning and role development in the clinical and simulation setting. This approach involved reviewing the literature, reanalyzing themes, development of multiple schematics, continual review, personal observations of students in the clinical and simulation settings, and feedback from peer educators. The resulting reflection, feedback, and restructuring model describes an inductive, iterative process strongly influenced by feedback. This conceptual model may be a useful tool to guide nurse educators in facilitating role development and the transition from the classroom to the clinical setting for the nursing student.

The relationship between the undergraduate clinical learning environment and work readiness in new graduate nurses: A pre-post survey study

BACKGROUND

Due to projected nurse shortages, it is necessary that undergraduate programs optimise work readiness outcomes in new graduate nurses. Research that quantitatively evaluates characteristics of clinical nursing programs that predict increased work readiness is required.

OBJECTIVES

To explore the relationship between the undergraduate clinical learning environment and nurse perceptions of work readiness prior to and following, commencement as a new graduate nurse.

DESIGN

A pre-post follow-up study. Undergraduates were surveyed at the end of their Bachelor's degree (baseline) and at 8-10 weeks after commencement as a graduate nurse (Time 1).

SETTING

A multi-site, metropolitan private hospital in Victoria, Australia.

PARTICIPANTS

Nursing graduates who completed a university fellowship program (n = 26), or were undertaking their graduate year and had completed placement blocks within (n = 18) or outside (n = 31) the healthcare organisation.

METHODS

Participants self-completed the Clinical Learning Environment Inventory (CLEI) and Work Readiness Scale for Graduate Nurses (WRS-GN) at baseline and Time 1. Multiple regression analyses were performed.

RESULTS

CLEI scores significantly predicted work readiness outcomes (all p-values<.05), accounting for 16-36% and 17-28% of the variance of WRS-GN scores at baseline and Time 1, respectively. After adjusting for clustering due to clinical placement groups, CLEI Individualisation (p = .023) and Valuing Nurses Work (p = .01) predicted improved Time 1 WRS-GN Organisational Acumen. CLEI Innovative and Adaptive Culture scores predicted poorer Time 1 Organisational Acumen (p = .001).

CONCLUSIONS

Learning environments that offered high levels of individualised attention and valued nurses' work appeared to facilitate post-graduation engagement and identification with nursing practice. However, highly innovative and adaptive education may detract from optimal work readiness. Findings revealed that while important, the clinical learning environment only accounted for a small-to-moderate degree of nursing graduates' work readiness. To facilitate robust evidence-based improvement of clinical nursing education, future research should attempt to empirically establish the value of additional facilitators of work readiness.

"It's yours to take": generating learner feedback literacy in the workplace

Feedback can improve students' learning and performance on clinical placements, yet students are often dissatisfied with the process. Attempts to improve feedback frequently focus on faculty development programs without addressing learners' capabilities to engage with feedback. For feedback to be effective, students need to understand its processes and to translate this into practice. Developing student feedback literacy may enhance feedback engagement and, therefore, learning outcomes. This qualitative interview study aimed to problematise student feedback literacy in the healthcare setting, from the learner's perspective. Before commencing placements, 105 healthcare students at an Australian teaching hospital participated in a feedback literacy program. After their placements, 27 students engaged in semi-structured interviews to explore their feedback experiences. Informed by workplace learning theory, interview transcripts were analysed using the framework method of qualitative analysis. Students reported reframing feedback as a process they could initiate and engage in, rather one they were subjected to. When they took an intentional stance, students noted that feedback conversations generated plans for improvement which they were enacting. However, students had to work hard against orthodox feedback expectations and habits in healthcare. They privileged intraprofessional supervisor feedback over interprofessional practitioners, patients, or peers. Findings suggest that student engagement with feedback can be augmented with focussed retraining. However, further research examining the structural and cultural influences on students' capacity to be active in workplace feedback is warranted.

Does a socially-accountable curriculum transform health professional students into competent, work-ready graduates? A cross-sectional study of three medical schools across three countries

Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan.Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/or supervision of first year medical graduates from three SAHPE medical schools.Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group).Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies ('communication skills', 'teamwork', 'professionalism', 'work-readiness', 'commitment to practise in rural communities', 'commitment to practise with underserved ethnic and cultural populations'), as well as 'overall performance' and 'overall clinical skills'.Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs.

Changes in direct patient care from physiotherapy student to new graduate

Background: Clinical placements offer students an opportunity to provide direct patient care and are essential to develop safe and effective practitioners. It is unknown what changes in direct patient care activities are required as students transition to graduate physiotherapists. Objective: To determine the change in direct patient care activity from physiotherapy student to new graduate. Methods: Five hospitals provided clinical activity data from 412 physiotherapy students and 50 new graduate physiotherapists working in four physiotherapy clinical areas. Main Outcome Measures: Percentage of day spent in direct patient care, average occasions of service (OOS) per day and average length of one OOS (LOOS) for physiotherapy students and new graduates. Results: Students spent less time during their day providing direct patient care (24%, 95% confidence interval (CI) 19 to 29), performed fewer OOS (4.4, 95%CI 4.0 to 4.8) and had longer LOOS (18 min, 95%CI 13 to 23) compared to new graduates. This was consistent across all clinical areas. Conclusions: Physiotherapy student caseload is half that of a new graduate physiotherapist, with students taking longer to complete an OOS. Given this disparity in workload, active stakeholder engagement is essential to implement strategies that support and optimize the transition from student to graduate.

Authentic practice environments to support undergraduate nursing students' readiness for hospital placements. A new model of practice in an on campus simulated hospital and health service

This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-campus simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive sampling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.

Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

PURPOSE

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

METHOD

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

RESULTS

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

CONCLUSIONS

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

Comparison of manikin-based simulators and patient monitor simulators within paramedic education: the student perspective

Objective

Investigate the impact to paramedic students of patient monitor simulators, when compared with manikin-based simulators within an educational programme.

Design

An exploratory study using an online questionnaire to gain qualitative and quantitative data.

Setting

One London university delivering a paramedic science programme.

Participants

A total of 136 paramedic students sponsored by a UK ambulance service were approached for this study. Data were received from 43 respondents (32%).

Main outcome measures

Comparison of simulators and their effect on student development through the identification of the student's own perceived ability following use, perception of other's ability (fellow students studying same course) following use and perception of the two pieces of simulation equipment available.

Results

The majority of respondents identified that simulation both increased their confidence and ability to demonstrate new knowledge and skills during simulation (97%) and further increased their ability to manage real patients (95%). Respondents agreed that there were advantages and disadvantages of using simulation, but these were not in line with those identified in previous studies. Instead of the human factors and non-technical skills outlined, students were much more practically focused on how the equipment performed.

Conclusions

This study suggests that there is a clear link between simulation and increased student confidence, but any issues encountered with the simulator equipment can reduce this benefit, causing the student's learning environment to falter. Transitioning to monitor-based simulators is seen as a positive move, although the integration of manikins with this equipment is identified as being necessary.

Students' goal orientations, perceptions of early clinical experiences and learning outcomes

CONTEXT

Workplace learning is optimised when learners engage in the activities of the workplace; learner engagement is influenced by workplace affordances and learner agency. Learner agency can be operationalised through achievement goal theory, which explains that students can have different goal orientations as they enter learning situations: mastery (learn and improve), performance approach (demonstrate competence) or performance-avoid (avoid demonstrating incompetence). Mastery-orientated, compared with performance-orientated, students approach curricular experiences as opportunities for developing rather than demonstrating competence. This study explored the relationships among students' achievement goal orientations, workplace affordances and learning outcomes in the context of early clinical experiences.

METHODS

Students who completed their preclerkship curricula at four medical schools answered a questionnaire about their personal goal orientation and the perceived goal structure and workplace affordances of their preceptorship experiences. All items used a 5-point scale (1 = strongly disagree/not at all true, 5 = strongly agree/very true). Students were evaluated by their preceptors and completed standardised-patient exams at the end of their pre-clerkship curricula. Analyses included descriptive statistics and mediation analysis.

RESULTS

Of 517 students, 296 (57.3%) responded and 253 (85.5%) had linked performance data. Student goal orientation means were: mastery, mean = 4.27 (SD = 0.65); performance-approach, 2.41 (0.76); performance-avoid, 2.84 (0.88). Student goal orientation and performance on preceptor evaluations (PEval) or standardised-patient exams (SPExam) were not significantly related. Perceptions of a mastery-structured curriculum and inviting workplace were associated with higher SPExam (β = 0.28, p = 0.02) and PEval (β = 0.51, p = 0.00) scores, respectively. Student mastery goal orientation was positively associated with perceptions of a mastery-structured curriculum (β = 0.59, p = 0.00) and positive workplace affordances (β = 0.25-0.29, p ≤ 0.01).

CONCLUSIONS

Students held a predominant mastery goal orientation towards their early clinical experiences. Mastery-orientated students perceived preceptorships as mastery-structured with positive workplace affordances, and those perceiving a mastery-structured or inviting preceptorship performed better. Clinical experiences should be structured to emphasise learning rather than demonstration of skills to promote learning outcomes.

Students' and teachers' experiences of participating in the reflection process "THiNK"

OBJECTIVES

Reflective journal writing in clinical practice is used as a tool in bachelor programs in nursing. The reflection process THiNK was developed to enhance students' reflection processes. It was tailored to the needs of a nursing programme (in Norway) as former studies showed that many students had superficial level of reflection in their reflective journals, few students applied knowledge to their reflections and some met unprepared in the guided reflection groups. The teachers had inconsistent focus on the importance of reflection as a way of learning. This study aimed to describe students' and teachers' experiences of participation in reflection processes.

DESIGN AND METHOD

The development of THiNK is inspired by educational design research. This study used focus groups to gain insight into students' and teachers' experiences of the reflection processes. Data were analysed using qualitative content analysis.

PARTICIPANTS AND SETTING

The empirical sample included 5 focus groups with 28 students and 7 teachers in a bachelor nursing program at a University College in Norway.

RESULTS

The themes were as follows: stop and verbalise the experiences, stimulate and support the reflection processes and develop a conscious attitude. The students became aware of themselves and their own execution. The teachers and reflection groups were crucial in order to learn to see the complexity of a given situation and helped draw connection between the situation and the theoretical knowledge.

CONCLUSIONS

Enhancing students' professional development requires attention to facilitation skills as well as other contextual factors. Readiness in the culture can be ensured by tailoring frameworks of reflection that replies to students' and teachers' requests. Participating in reflection processes facilitates integration of modes of thinking when dealing with clinical situations.

The clinical learning environment in nursing education: a concept analysis

AIM

The aim of this study was to report an analysis of the clinical learning environment concept.

BACKGROUND

Nursing students are evaluated in clinical learning environments where skills and knowledge are applied to patient care. These environments affect achievement of learning outcomes, and have an impact on preparation for practice and student satisfaction with the nursing profession. Providing clarity of this concept for nursing education will assist in identifying antecedents, attributes and consequences affecting student transition to practice.

DESIGN

The clinical learning environment was investigated using Walker and Avant's concept analysis method.

DATA SOURCES

A literature search was conducted using WorldCat, MEDLINE and CINAHL databases using the keywords clinical learning environment, clinical environment and clinical education. Articles reviewed were written in English and published in peer-reviewed journals between 1995-2014.

METHODS

All data were analysed for recurring themes and terms to determine possible antecedents, attributes and consequences of this concept.

RESULTS

The clinical learning environment contains four attribute characteristics affecting student learning experiences. These include: (1) the physical space; (2) psychosocial and interaction factors; (3) the organizational culture and (4) teaching and learning components. These attributes often determine achievement of learning outcomes and student self-confidence.

CONCLUSION

With better understanding of attributes comprising the clinical learning environment, nursing education programmes and healthcare agencies can collaborate to create meaningful clinical experiences and enhance student preparation for the professional nurse role.

Reverse Engineering: Strategy to Teach Evidence-Based Practice to Online RN-to-BSN Students

This article describes an innovative approach to introducing RN-to-BSN students to nursing research and evidence-based practice (EBP). Reverse engineering updates an existing EBP project to better emphasize the role of research and evidence to practicing RNs enrolled in an RN-to-BSN program. Reverse engineering of a nursing practice guideline offers a method for teaching an appreciation of research and supporting nursing practice with best evidence.

Comparison of student experience with critical events during simulation and acute care hospital rotations

An exploratory study was conducted to determine critical events for adult patients and to verify critical events that nursing students experienced in their nursing programs. Sophomores and juniors were surveyed regarding frequency of exposure to critical events. Sophomores reported greater differences between simulation and clinical practice, with most in simulation. Juniors were more balanced in exposure to critical events, in both clinical practice and simulation. This information provides feedback on critical events, clinical experiences, and how to use simulation to lessen the experience gap.

Strengthening partnerships: The involvement of health care providers in the evaluation of authentic assessment within midwifery undergraduate education

Collaborative partnerships between health care providers and academics are essential in the provision of quality undergraduate midwifery programs. While health care providers often contribute to clinical assessment and teaching in midwifery programs, they are rarely involved in assessment design and evaluation. This paper describes the evaluation of an assessment task designed to develop critical thinking skills in final year undergraduate midwifery students. Health care providers' involvement sought to confirm the authenticity and validity of the assessment task and facilitate further engagement. A mixed method descriptive study design was used. After reviewing a sample of student work, health care providers completed a 20 item survey and participated in a focus group. Survey items were based on the domains of Educational Acceptability, Educational Impact and Preparation for Practice. Participants gave high scores for each domain and commented positively on the innovative nature of the assessment, students' ability to undertake in-depth analysis of complex cases, and development of student's critical thinking skills. Participants also reported greater confidence in students' competence and the program. Involving health care providers in evaluation of an assessment task validated the assessment, contributed to clinicians' perceptions of student credibility, and fostered strong links between the program and industry.

A contemporary examination of workplace learning culture: an ethnomethodology study

BACKGROUND

Creating and maintaining a sustainable workforce is currently an international concern. Extensive literature suggest that students and staff need to be 'engaged', that is they need to interact with the health team if they are to maximise learning opportunities. Despite many studies since the 1970s into what creates a 'good' learning environment, ongoing issues continue to challenge healthcare organisations and educators. A 'good' learning environment has been an intangible element for many professions as learning is hindered by the complexity of practice and by limitations on practitioners' time available to assist and guide novices.

OBJECTIVES

This study sought to explore the nature of the learning interactions and experiences in clinical nursing practice that enhance a 'good' workplace learning culture for both nursing students and qualified nurses.

DESIGN

An ethnomethodology study.

SETTING

A range of clinical settings in Victoria and Queensland, Australia.

PARTICIPANTS

Students and registered nurses (n=95).

METHODS

Fieldwork observations were carried out on student nurses and registered nurses, followed by an individual interview with each participant. An iterative approach to analysis was undertaken; field notes of observations were reviewed, interviews transcribed verbatim and entered into NVivo10. Major themes were then extracted.

RESULTS

Three central themes: learning by doing, navigating through communication, and 'entrustability', emerged providing insights into common practices potentially enhancing or detracting from learning in the workplace.

CONCLUSIONS

Students' and registered nurses' learning is constrained by a myriad of interactions and embedded workplace practices, which can either enhance the individual's opportunities for learning or detract from the richness of affordances that healthcare workplace settings have to offer. Until the culture/or routine practices of the healthcare workplace are challenged, the trust and meaningful communication essential to learning in practice, will be achievable only serendipitously.

Competence development as perceived by degree and non-degree graduates in Japan: a longitudinal study

BACKGROUND

A degree programme is believed to prepare graduates with a higher level of competence than their diploma counterparts. However, there have been inconsistent findings reported as to whether or not degree-graduates outperformed those who take diplomas.

OBJECTIVES

This study aimed to identify graduates' perceptions of competence development in their first year of employment, and to compare the competence levels of graduates with different educational backgrounds.

DESIGN

This study adopted a longitudinal design.

SETTINGS

This study has been performed in five hospitals in Japan.

PARTICIPANTS

122 Japanese graduates participated in this study.

METHODS

The self-assessed competence of the graduates was collected in the 3rd, 6th, 9th, and 12th months of their employment using a survey method. The data were analysed using a linear mixed model.

RESULTS

The results suggested that the graduates perceived their competence to be rapidly growing during the first half of the graduate year, and slowly later. The results also indicated that the graduates' perception of their competence showed a significant variation. The most striking finding of the study was that, on average, the non-degree graduates rated their competence higher than their degree counterparts.

CONCLUSIONS

The current university orientation on emphasising intellectual and theoretical components of education, with less focus on practical components might have led to the development of lower competence among the BN graduates. A fine balance between theoretical and practical components needs to be established in a university curriculum.

Toward creating an optimal acute care clinical learning environment: insights from staff, faculty, and students

Understanding how a clinical site impacts student learning was the focus for a participatory action research study in which three separate focus groups for students, faculty, and staff were convened. Participants were asked to identify what they enjoyed or liked about the clinical setting, what they disliked about the clinical setting, and what they would change about the clinical setting. Themes identified by a constant comparative method included experiences provided, attitudes, and expectations. Although the researchers anticipated that each group would have a unique and different perspective on the clinical experience, respondents were consistent in their beliefs both within and among groups. Of interest, each participant group attributed an ineffective clinical learning environment to external causes.

Third year nursing students' viewpoints about circumstances which threaten safety in the clinical setting

BACKGROUND

Evidence emphasizes that learners, educators, clinicians, programs, and organizations share the responsibility for establishing and maintaining safety throughout undergraduate nursing education. Increased knowledge about students' perceptions of threats to safety in the clinical setting may guide educators' efforts to promote the development of safe novice practitioners while preserving patient safety.

OBJECTIVE

The purpose of this study was to describe third year nursing students' viewpoints of the circumstances which threaten safety in the clinical setting.

METHODS

Using Q methodology, 34 third year Bachelor of Science in Nursing students sorted 43 theoretical statement cards. Each card identified a statement describing a threat to safety in the clinical setting. These statements were generated through a review of nursing literature and consultation with experts in nursing education. Centroid factor analysis and varimax rotation identified viewpoints regarding circumstances that most threaten safety.

RESULTS

Three discrete viewpoints and one consensus perspective constituted students' description of threatened safety. The discrete viewpoints were labeled lack of readiness, misdirected practices, and negation of professional boundaries. There was consensus that it is most unsafe in the clinical setting when novices fail to consolidate an integrated cognitive, behavioral, and ethical identity. This unifying perspective was labeled non-integration.

CONCLUSION

Third year nursing students and their educators are encouraged to be mindful of the need to ensure readiness prior to entry into the clinical setting. In the clinical setting, the learning of prepared students must be guided by competent educators. Finally, both students and their educators must respect professional boundaries to promote safety for students and patients.

Service users' perceptions regarding their involvement in a physiotherapy educational programme in the UK: a qualitative study

BACKGROUND

The impact of user involvement in allied healthcare education is complicated by a lack of understanding of this concept both practically and ideologically. It is important to analyse whether service users perceive taking part as an 'honour' or as 'agents of change'.

OBJECTIVE

This study explored service users' perspectives of their involvement in a UK college-based physiotherapy educational programme.

METHOD

A Grounded Theory approach utilising semi-structured interviews was conducted with eight of the service users who took part in the physiotherapy programme. The analysis of the interviews was carried out according to a grounded theory framework.

RESULTS

All the service users wished to foster a sense of a partnership and communicate what it was like on the 'other side'. Their personal agendas and possible motivation for taking part were to challenge the students assumptions regarding disability, to give something back for their healthcare and to communicate their dissatisfaction with present healthcare provision.

CONCLUSION

The participants felt that they could be instrumental in a process of change. One way to address this is to include this programme as an integral element of the current move towards life-long learning that supports their professional development in a range of authentic situations. Their reflexive dialogues with the service users can be documented as part of a reflexive portfolio with the service users as mentors.

Better knowledge, better health: piloting an education intervention in chronic condition self-management support

Chronic condition self-management and lifestyle risk modification education is paramount for General Practice registrars. A multi-dimensional learning package 'Better Knowledge, Better Health' was developed and piloted to improve General Practice registrars' understanding of their role in supporting chronic condition self-management in patients with osteoarthritis. This pilot study was supported by the Australian Better Health Initiative. Pre-training learning needs analysis with a new intake of General Practice registrars (n=40) indicated high levels of confidence in supporting patients in chronic condition management and lifestyle risk modification, and locating and interacting with local resources and allied health professionals. Conversely, interviews with General Practice Supervisors (n=13) found most would not identify chronic condition self-management skills as priorities for registrar learning. Supervisors were also not familiar with core principles of chronic condition self-management, in particular application of motivational interviewing to behaviour change. Disparities between General Practice Supervisors' perceptions of the importance of chronic condition self-management and lifestyle risk modification education and levels of access to learning opportunities in chronic condition self-management for registrars are discussed. Difficulties in implementing a pilot study within tight timeframes are also explored.

An evaluation of students' perceptions of a college-based programme that involves patients, carers and service users in physiotherapy education

BACKGROUND

There is little evidence of the integration of UK physiotherapy university education into clinical practice, and some students say that they are not adequately prepared for professional life. This was addressed by a college-based programme involving patients, carers and service users as facilitators of learning to enhance the partnership between health professionals and patients.

PURPOSE

This programme has been running for 2 years, and this paper is an evaluation of the students' perceptions of it, appraising the outcomes of their learning in order to discover the ways in which it can be enhanced, improved or changed.

METHODS

A grounded theory approach utilizing focus groups and semi-structured interviews was conducted. Three focus groups representing the higher educational levels 4-6 in pre-registration physiotherapy were carried out. Following the analysis of the focus groups, seven interviews reflecting the three educational levels were conducted in order to explore in greater depth the findings from the focus groups. The analysis of the focus groups and the subsequent interviews were carried out in accordance with a grounded theory framework.

RESULTS

The students perceived the programme as a context in which to think how their learning needs could be met within a 'real' framework but on their own territory. Equally, it created feelings of anxiety at being given such an open forum that created a challenge to their communication skills. Many expressed a wish for a more explicit mentoring-learning environment. They also perceived a tension between the technical-rational demands of academia and social practice and a need to view this as a basis for critical appraisal and self-awareness.

CONCLUSION

This programme appeared to be integral to the students' development as future physiotherapists.