Nurses new to intensive care: perceptions of their clinical learning environment

Newly undergraduate nurses and intensive care in units of non-critical patients

OBJECTIVE

To identify the social representations of newly undergraduate nurses on the intensive care of Nursing to critical patients hospitalized in non-critical patient units.

METHOD

Qualitative and descriptive research. Twenty-six newly undergraduate nurses from a private university participated. An in-depth interview was conducted with semi-structured script. The analysis was of lexical type with the help of Alceste 2012 software.

RESULTS

The social representations were built according to the image of the intensive care unit, although patients were out of this environment. Care is understood as complex and specialized, requiring graduate training. Therefore, undergraduation training was considered insufficient to provide this type of care, creating fear and insecurity in the newly undergraduate nurses.

FINAL CONSIDERATIONS

Intensive care confronts newly undergraduate nurses with feelings of unpreparedness to care for, but it mobilizes to broaden the knowledge to provide care. There is evidence of a theory-practice dichotomy and weaknesses in teaching-learning experiences in undergraduate education.

How the context of ambulance care influences learning to become a specialist ambulance nurse a Swedish perspective

OBJECTIVES

Ambulance emergency care is multifaceted with extraordinary challenges to implement accurate assessment and care. A clinical learning environment providing opportunities for mastering these essential skills is a key component in ensuring that prehospital emergency nurse (PEN) students acquire the necessary clinical competence.

AIM

The aim is to understand how PEN students experience their clinically based training, focusing on their learning process.

METHOD

We applied content analysis with its qualitative method to our material that consisted of three reflections each by 28 PEN students over their learning process during their 8 weeks of clinical ambulance practice. The research was carried out at the Center for Prehospital Care, University of Borås, Sweden.

RESULTS

The broad spectrum of ambulance assignments seems to awaken great uncertainty and excessive respect in the students. Student vulnerability appears to decrease when the clinical supervisor behaves calmly, knowledgeably, confidently and reflectively. Early traumatic incidents on the other hand may increase the students' anxiety. Each student is offered a unique opportunity to learn how to approach patients and relatives in their own environments, and likewise an opportunity to gather information for assessment. Infrequency of missions seems to make PEN students less active in their student role, thereby preventing them from availing themselves of potential learning situations. Fatigue and hunger due to lack of breaks or long periods of transportation also inhibit learning mode.

CONCLUSION

Our findings suggest the need for appraisal of the significance of the clinical supervisor, the ambulance environment, and student vulnerability. The broad spectrum of conditions in combination with infrequent assignments make simulation necessary. However, the unique possibilities provided for meeting patients and relatives in their own environments offer the PEN student excellent opportunities for learning how to make assessments.

Associations between baccalaureate nursing students' perceptions of educational environment and HESI scores and GPA

BACKGROUND

Students' perceptions of their educational environment have been found to be related to their approaches to learning and learning outcomes. Educational environment is just beginning to be researched in nursing education with the vast majority of studies focusing on the clinical educational environment. Perception of educational environment has been shown to influence student implementation of a specific learning style and influences educational outcomes such as program completion and GPA. There is a need for sound research that explores the relationship, if any, between perceptions of environment and outcomes.

OBJECTIVE

To explore the relationship between baccalaureate nursing student (BSN) perception of educational environment (SPEE) and objective learning outcomes.

DESIGN

Retrospective correlational descriptive study.

SETTING

Private School of Nursing in the Southwest.

PARTICIPANTS

Convenience sample of 62 graduating baccalaureate students.

METHODS

All graduating BSN students were invited to complete the Dundee Ready Education Environment Measure (DREEM) through the online survey application Qualtrics. A total of 62 students completed the DREEM survey. These results were compared with each student's GPA and HESI score.

RESULTS

A total of 62 students completed the survey for an overall response rate of 57%. There was no correlation between total SPEE and nursing grade point average (NGPA) or HESI exit scores.

CONCLUSIONS

Based on this study at this institution, it appears that students' performance was not influenced by SPEE. One of the major implications of this study is the possibility that an "acceptable" SPEE (one that is neither exceptional nor terrible) may not significantly influence student outcomes. Exploring this relationship has theoretical as well as practical implications as educators seek to determine the effectiveness of educational interventions. Student perception of learning environment is measured in various ways at the majority of institutions. It has been assumed that an educational environment that is ranked high by students result in increased learning. However, as the science of nursing education advances, educators need to determine if and how these perceptions relate to actual learning outcomes. As academicians, we need to be concerned with the relationship between learning outcomes and environment in order to create the most effective learning environment.

Education of ICU nurses regarding invasive mechanical ventilation: findings from a cross-sectional survey

BACKGROUND

Continuing education for intensive care unit nurses on invasive mechanical ventilation is fundamental to the acquisition and maintenance of knowledge and skills to optimise patient outcomes.

PURPOSE

We aimed to determine how intensive care unit nurses perceived current education provided on mechanical ventilation, including a self-directed learning package and a competency programme; identify other important topics and forms of education; and determine factors associated with the completion of educational programmes on invasive mechanical ventilation.

METHODS

A cross-sectional, 30-item, self-administered and semi-structured survey on invasive mechanical ventilation education was distributed to 160 intensive care nurses. Analysis included descriptive statistics and logistic regression was used to determine factors associated with current education completion, reported as adjusted odds ratios (AOR) and 95% confidence intervals (CIs).

FINDINGS

Eighty three intensive care unit nurses responded and the majority (63%) reported not receiving education about mechanical ventilation prior to working in intensive care. Using a Likert rating scale the self-directed learning package and competency programme were perceived as valuable and beneficial. Hands-on-practice was perceived as the most important form of education and ventilator settings as the most important topic. Multivariate analysis determined that older age was independently associated with not completing the self-directed learning package (AOR 0.20, 95% CI 0.04, 0.93). For the competency programme, 4-6 years intensive care experience was independently associated with completion (AOR 17, 95% CI 1.7, 165) and part-time employment was associated with non-completion (AOR 0.23, 95% CI 0.08, 0.68).

CONCLUSION

Registered nurses are commencing their ICU experience with limited knowledge of invasive MV therefore the education provided within the ICU workplace becomes fundamental to safe and effective practice. The perception of continuing education by ICU nurses from this research is positive regardless of level of ICU experience and may influence the type of continuing education on invasive MV provided to ICU nurses in the future, not only in the ICU involved in this study, but other units throughout Australia.

Student nurses in critical care: benefits and challenges of critical care as a learning environment for student nurses

AIM

This article is a literature view of student nurses' experiences of critical care and the value of their experience to the nursing community. To explore the literature in relation to the value of critical care as a learning environment, the experiences and perceptions of student nurses in critical care and the impact of mentors on the experience.

BACKGROUND

The shortage of critical care nurses and increasing numbers of acutely ill patients being cared for outside critical care areas has highlighted the importance of nurses being equipped with appropriate knowledge and skills to care for such patients. Student nurses have been experiencing critical care for many years and though it is accepted that it can be a stressful environment, there has been little empirical evidence of this. As anxiety has been said to interfere with learning, how much of an impact can this have and can anything be done about it?

SEARCH STRATEGY

Using Medline, CINAHL and British Nursing Index (BNI) and search terms including nursing students or student nurses, critical or intensive care and perceptions, expectations or pre-conceptions, a literature search was carried out. Some articles explored registered nurses experiences, despite the titles, so this was set as an exclusion criteria.

CONCLUSIONS

Critical care offers a wealth of learning opportunities which are only available in high acuity areas. Though students can be very anxious before commencing their placements, mentors and higher education play an important part in helping them overcome this. The challenge is how to work together to provide effective support systems for the benefit of the students.