Letters from the pandemic: Nursing student narratives of change, challenges and thriving at the outset of COVID-19

Student nurses' experiences of remote learning during Covid-19 pandemic: A qualitative evidence synthesis

AIM

To systematically synthesize undergraduate student nurses' experience of online, blended or distance learning during Covid-19 pandemic.

DESIGN

A qualitative evidence synthesis (QES).

REVIEW METHODS

A QES. Themes were organized using the 'best fit' framework approach. Methodological limitations and confidence in the review findings were informed by GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research).

DATA SOURCES

Qualitative literature from five databases including CINAHL, PubMed, Medline, Education Full Text (H.W. Wilson) and ERIC were searched from March 2020 to November 2021.

RESULTS

Nine qualitative and two mixed method studies were included in this 'best fit' framework using Chickering and Gamson's Seven Principles for Good Practice in Undergraduate Education. Importance of the social presence of the teacher through effective communication and interpersonal relationships is highlighted. Clinical placement and in-person practical skills training are needed for effective nursing education.

CONCLUSIONS

This review highlighted that online content can be developed into efficient and high-quality learner-centred education within blended undergraduate nursing programmes incorporating essential face-to-face and practical components. Various supporting measures are required for both students and faculty. We suggest an adaptation of a 'Blending with Purpose: The Multimodal Model' with key considerations for undergraduate nursing programmes where pedagogical objectives and activities drive the approaches to achieve intended learning outcomes and student satisfaction.

IMPLICATIONS FOR THE PROFESSION

Well-designed online programmes using digital tools that support interaction and teamwork are required for undergraduate nursing education.

IMPACT

Blended learning approaches offer more flexibility than online learning alone which leads to improved student engagement. Clinical placement and in-person practical skills training are needed for effective nursing education. REPORTING METHOD: 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) for QES.

NO PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Effects of the First Wave of the COVID-19 Pandemic on the Work Readiness of Undergraduate Nursing Students in China: A Mixed-Methods Study

Background

Newly graduated nurses with strong work readiness are more likely to smoothly transition from school to clinical settings. However, even before the pandemic, this transition from nursing graduate to clinical nurse was often challenging. Therefore, this study aims to investigate the impact of the initial wave of COVID-19 on the work readiness of nursing students.

Methods

A convergent mixed-method design was employed. For the quantitative study, an online cross-sectional survey was conducted among 500 graduating nursing students from four Chinese public higher education institutions. The questionnaire comprises three parts: socio-demographic information, the Chinese version of the Work Readiness Scale for Graduate Nurse, and a questionnaire on the socio-behavioral impact of COVID-19 on the general population. In the qualitative study, a semi-structured interview was carried out with 8 students who took part in the survey. The results from both parts were integrated using the "Pillar Integration Process".

Results

The study identified six key pillars: "Graduating nursing students possess fundamental knowledge, skills, and a preparedness in terms of attitude and psychology"; "Specialist knowledge and skills and soft skills for transition from nursing students to clinical nurses need to be strengthened"; "The most obvious impact of COVID-19 on nursing students are the adoption of preventive measures and the limitations in study and daily life due to household confinement"; "Growth in both personal and professional awareness"; "Negative effects of fear and anxiety"; and "Negative effects of household confinement".

Conclusion

Graduating nursing students require additional preparation in specialized nursing knowledge, skills, and soft skills to make a successful transition from students to clinical nurses. It is important to acknowledge that the impact of COVID-19 on students' work readiness has both positive and negative aspects. Therefore, whether during the pandemic or post-graduation, these students will benefit from increased support from universities and hospitals.

Nursing students' experiences of teaching and learning during the COVID-19 pandemic: a systematic review and meta-synthesis of qualitative studies

INTRODUCTION

During the COVID-19 pandemic, the sudden transition to virtual learning led to several challenges for nursing students. This study aimed to synthesis nursing students' experiences of teaching and learning during the COVID-19 pandemic.

CONTENT

A meta-synthesis of qualitative articles were conducted. Three online databases were searched from December 2019 to December 2022. Qualitative studies and qualitative sections of mixed method studies were included.

SUMMARY

Twenty-four qualitative studies and seven mixed-method studies were included in the review. The findings consisted of one main theme "educational transformation", and three categories "challenging face-to-face clinical training", "transition from face-to-face to virtual education", and "support continua". The evidence indicated that during this health-related crisis, most of the training was provided as distance learning in various forms. According to the findings, distance education alone cannot replace face-to-face education and is suggested to be considered as a supplementary learning method.

OUTLOOK

This study provides a comprehensive understanding of nursing students' experiences during the COVID-19 pandemic, offering practical implications for educators and institutions globally. The lessons learned can inform strategic decisions, policies, and practices to enhance the resilience and adaptability of nursing education in the face of unforeseen challenges.

Through the Lens of the Social Determinants of Learning™: Experiences of Online Prenursing Students During the COVID-19 Pandemic

BACKGROUND

Prenursing students represent the future pipeline of nursing students, yet their perceptions of how COVID-19 affected their experience as prenursing students are unknown.

METHOD

Short-answer data ( n = 289) in US prenursing students were collected in fall 2020. Deductive thematic analysis was applied according to the social determinants of learning (SDOL™) framework.

RESULTS

Participants verbalized fears of contracting COVID-19 (physical health) and difficulties with stress and anxiety (psychosocial health). Participants shared pandemic-related financial challenges (economic instability), changes in living situations (physical environment), and the lack of hoped-for social connections (social environment). Many struggled with focus; others confirmed their goals (self-motivation).

CONCLUSION

The SDOL framework can be utilized by educators to conceptualize the influence of the COVID-19 pandemic on the experiences of online prenursing students and leveraged to develop targeted interventions to improve students' well-being as they apply to nursing programs.

The effect of a distance-delivered mindfulness-based psychoeducation program on the psychological well-being, emotional intelligence and stress levels of nursing students in Turkey: a randomized controlled study

Nursing students who started university during the COVID-19 pandemic had to attend via distance education, which increased their stress. This study aimed to determine the effect of a mindfulness-based psychoeducation program on the psychological well-being, emotional intelligence and stress levels of young adults in their first year of an undergraduate nursing program at a university in Turkey. The sample consisted of 59 students (mean age 19.3 years) who were randomized to the intervention group (n = 29) and control group (n = 30). Those in the intervention group participated in a mindfulness-based psychoeducation program twice a week for 4 weeks via video conference. The Perceived Stress Scale (PSS-14), Psychological Well-Being Scale (PWB) and Revised Schutte Emotional Intelligence Scale (SEIS) were used as measurement tools. Between the pretest and posttest assessments, students in the intervention group showed a significant decrease in perceived stress scores and increases in emotional intelligence and psychological well-being scores. There were statistically significant differences in perceived stress, emotional intelligence and psychological well-being scores between the intervention and control groups in the posttest. Online mindfulness psychoeducation via video conferencing can be a useful intervention for nursing students to reduce stress and support psychological well-being and emotional intelligence.

Delayed sleep-wake rhythm due to staying at home during the COVID-19 pandemic and sleep debt after returning to campus among Japanese nursing university students: A longitudinal study

This study aimed to investigate sleep problems during staying at home due to the coronavirus disease 2019 (COVID-19) pandemic and after returning to campus among university nursing students. We analyzed data from self-reported sleep surveys conducted during a nursing course at a university in Tokyo between 2019 and 2021. During staying at home due to COVID-19, we observed delayed sleep-wake rhythm, prolonged sleep duration on weekdays, a decreased sleep debt, improved daytime sleepiness, and worsened insomnia, especially in terms of difficulty initiating sleep (Study 1; 18 paired data). After returning to campus, we found advanced wake-up time, shortened sleep duration, increased sleep debt, worsened insomnia, and increased daytime sleepiness (Study 2; 91 paired data). The association between advanced midpoint of sleep and commute time over an hour (aOR, 3.29; 95%CI: 1.24-8.72) was confirmed. Furthermore, sleep paralysis and nightmares were more prevalent among nursing students with an advanced midpoint of sleep, whereas nursing students whose midpoint of sleep was delayed had higher daytime sleepiness after returning to campus. To maintain regular sleep-wake rhythms and sufficient sleep duration, the educational environment surrounding nursing university students (e.g., curriculum, class schedule, style of class) should be established considering their age-dependent biological rhythm in addition to sleep hygiene education for students.

Facilitators and Inhibitors of LPN-to-RN Student Transition: A Cross-Sectional National Survey

AIM

The aim of the study was to describe the transition conditions (facilitators and inhibitors) encountered by licensed practical nurses in registered nurse educational programs (LPN-to-RN students).

BACKGROUND

LPN-to-RN students are important because they may increase diversity and numbers of RNs. However, no prior study has examined transition experiences of LPN-to-RN students across the United States.

METHOD

A cross-sectional survey of LPN-to-RN students was conducted using Meleis et al.'s transition theory.

RESULTS

Students (n = 873) from 131 nursing programs responded. The most common facilitators were personal motivation and believing the content taught was valuable; the most common inhibitors were juggling multiple responsibilities and personal stress levels. Several significant relationships between transition conditions and program/student characteristics were identified.

CONCLUSION

Faculty in LPN-to-RN programs can increase support for students by refining their own actions and addressing potential challenges when LPN and non-LPN nursing students share classes.

Alternative Clinical Practice During the COVID-19 Pandemic: A Qualitative Study of Nursing Students' Potential Loss of Experience

Introduction

During the COVID-19 pandemic, the lockdown of nursing institutions changed nursing students' learning conditions in clinical practice. They were removed from their ordinary clinical practice and isolated in their homes for one week before resuming an alternative clinical practice. Owing to the changed learning conditions, nursing students had to readjust and find new and different solutions to manage their own learning.

Objectives

This study aimed to investigate the impact of removing first-year nursing students from clinical practice during the COVID-19 pandemic on their perceived learning and development.

Methods

A qualitative descriptive and interpretative design based on group and individual interviews was used. Eleven first-year nursing students from a university college in Norway participated in the study. They were interviewed from their homes, after completing their first 10-week clinical practice. Three group interviews and two individual interviews were recorded using the digital live video aid Zoom and analyzed using systematic text condensation.

Results

The main theme "loss of experience," summarized how the nursing students experienced their first clinical practice during the COVID-19 lockdown. The nursing students shifted from a predictable to an unpredictable clinical practice without supervision from the nurse supervisor or the nurse educator. The organization and planning of the practice were left to the students, who bore the responsibility of achieving the learning outcomes. Three categories were identified: unpredictable learning situations, compensating learning activities, and achieving learning outcomes.

Conclusions

Nursing students faced difficulties in their first clinical practice during the COVID-19 lockdown, which made a challenging study situation. Too much autonomy and responsibility for their own learning reinforced a loss of experience. The uncertainty of the study situation potentially harmed their professional development, learning outcomes, and self-efficacy, especially concerning basic nursing skills.

Clinical experiences of final-year nursing students during the COVID-19 pandemic: A systematic review and meta-synthesis

OBJECTIVES

This systematic review aimed to qualitatively synthesise existing literature to examine the clinical nursing experiences of final-year nursing students during the COVID-19 pandemic and provide recommendations for the effective management of clinical placement of nursing students.

DESIGN

A qualitative systematic review was conducted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

DATA SOURCES

Five electronic databases were searched and qualitative studies were included for analysis if they focussed on the clinical nursing experiences of final-year nursing students during the COVID-19 pandemic.

REVIEW METHODS

Data synthesis was conducted by extracting all findings, developing categories, and producing synthesised findings.

RESULTS

Four synthesised findings were concluded: 1) facing the unknown and willingness to help, 2) challenging the clinical environment, 3) transition improving professional identity, and 4) finding ways out of the pandemic.

CONCLUSIONS

The transition of nursing students to clinical nursing practice during the pandemic is a personally and professionally challenging process, while nursing students try to adapt to the changing clinical environment and enhance their professional identity. Nursing managers and health policymakers should acknowledge the challenges encountered by nursing students during the pandemic and support the professional growth of future nursing teams by providing high-quality supervision.

Race, gender, and ethnicity differences of nursing students' experiences during the COVID-19 pandemic

Background

The coronavirosus disease caused physical, mental, and social stress to humans; however, the human impact was not balanced and proportionately distributed to all people; especially nurses. This study explored nursing students' lives affected by the pandemic.

Purpose

The purpose of this study was to investigate the effects of COVID-19 and the pandemic on students' experiences across different races, genders, and ethnicities.

Method

This cross-sectional study sought to investigate significant differences in reported experiences of nursing students during the COVID-19 pandemic based upon race, gender, and ethnicity classifications. A survey was developed to collect the data.

Results

A national sample of 616 student responses was analyzed. Significant differences were found in the pairwise comparisons. The differences found among the diverse student classifications revealed variations in survey responses to classes moved to on-line, interactions with peers, COVID-19 testing, fear/anxiety, and test performance.

Conclusion

The research adds knowledge about nursing students' experiences during the pandemic; especially unrepresented students from diverse backgrounds. The findings from this study suggested nursing students reacted differently based on race, ethnicity, and gender.

Trauma and survivance: The impacts of the COVID-19 pandemic on Indigenous nursing students

The COVID-19 pandemic has resulted in tremendous educational and health impacts for Indigenous peoples and communities. Yet, little is known about the impacts of the pandemic on Indigenous nursing students in Canada. Guided by an Indigenous conceptual framework and a qualitative sharing circle methodology, the interconnected personal, academic, and community impacts of the pandemic were explored with Indigenous nursing students (n = 17). Overall, the pandemic exacerbated and compounded prior traumas Indigenous students and communities have experienced across generations on Turtle Island. Participants suffered worsening psychological distress and significant losses during the pandemic, especially losses in learning and cultural safety. However, the pandemic also revealed silver linings including: the benefits of online learning; and demonstrations of posttraumatic growth, survivance, and community strength. These findings are relevant to informing culturally safe and trauma-informed strategies, policies, administrators, and educators in schools of nursing.

A Transformative Learning Experience for Senior Nursing Students

BACKGROUND

Research suggests that clinical practicums in hospital-based settings are important, even if condensed, to provide students with the opportunity for real-world learning experiences. Rational dialogue makes learning meaningful and empowers students to learn by reflecting on experiences.

PROBLEM

The COVID-19 pandemic minimized availability of traditional one-to-one mentorship practicums.

APPROACH

This article describes the use of critical reflection on experiences in an undergraduate senior mentorship course to assess student learning through the thematic analysis of writing assignments. Guided by Mezirow's transformative learning theory, students completed a traditional group clinical practice, written reflective journals and virtual seminars focused on role development, and reflection on concurrent learning in clinical and simulation experiences.

OUTCOMES

Transformative learning was evident in their writing. Student journals demonstrated themes of responding to change, discovering resilience, developing confidence, finding gratitude, embracing advocacy, and transforming and becoming.

CONCLUSIONS

Through critical reflection, students recognized the opportunities mentorship afforded them, despite challenges.

Nursing students’ clinical placement experiences during the Covid-19 pandemic: A phenomenological study

Aim

This study explored the clinical placement experiences of nursing students during the Covid-19 pandemic.

Background

The health emergency caused by Covid-19 required a rapid reorganisation of care settings. This reorganisation entailed revisiting the clinical placements settings and learning programs of Italian nursing faculties. Some Italian universities wanted to seize the health emergency as a learning opportunity enabling the nursing student to acquire additional knowledge and skills.

Design

We conducted a descriptive qualitative study employing a phenomenological approach. The study population was second and third-year nursing students. The students did their clinical placement in 5 Northern Italy hospitals, mainly in infectious diseases wards, intensive care and sub-intensive care units, emergency department, short-stay surgical units and internal medicine wards. In these departments, the inpatient wards were entirely converted into Covid-19 units. Ethical approval was obtained from the local ethics committee.

Methods

Semi-structured, open-ended interviews were conducted in March-April 2021 and analysed following a phenomenological approach.

Results

Twenty-one nursing students in their 2nd and 3rd academic year participated. Their average age was 24 years. 81% were female and 19% were male. Three main themes were generated: (i) Learning which surpasses technicalities; (ii) Confronting dignity issues; (iii) Feeling treated as an equal in the workspace. Students had to learn how to lower their fear and self-manage the emotional burden to be a caring presence for the patients who were intensely suffering from the disease and isolation. Attending a clinical practice placement in Covid-19 wards led them to focus on human dignity issues: participants realised how dignity was questioned and how they could become patients’ advocates. Students also described that they felt part of the team, with their student role almost fading.

Conclusions

This study describes that the most unpredictable public health emergency, such as Covid-19, can provide learning opportunities in the practice environment for nursing students. Students described feeling useful and capitalising on new competencies. Designing educational activities for nursing students concerning pandemic emergencies may be strategic for dealing with similar situations in the future.

Nursing Education and Zoom Fatigue in the Pandemic Process

Ülkemizde Covid-19’un Dünya Sağlık Örgütü tarafından bir pandemi olarak açıklanmasının ardından üniversitelerde yüz yüze yürütülen eğitime ara verilerek uzaktan eğitim sürecine başlanmıştır. Bununla birlikte, bu olanaklar bazı sorunları da beraberinde getirmektedir. Eş zamanlı sınıf oturumlarının genellikle uzun derslere dönüşmesi, çoklu görevleri ve dikkatin dağılmasını sebep olabilmektedir. Bireysel yaşantıya (ev ve iş hayatı, ikamet bölgesi) bağlı olarak derslere katılmaları zorlaşabilmektedir. Bu faktörler nedeniyle insanların tükenmesi ve yorgun hissetmeleri “Zoom Yorgunluğu” terimini ortaya çıkarmaktadır. Geleceğin sağlık profesyoneli adayı olan hemşirelik öğrencilerinin Covid-19 pandemisinde zoom yorgunluğuna ve uzaktan eğitim sürecinde stres kaynaklı biyopsikososyal bir takım sorunlar yaşadıkları, bu süreçte hayatlarının hem olumlu hem de olumsuz olarak etkilendiği ve öğrencilerin klinik uygulama yapmadan sadece teorik bilgiyi alması konuları çabuk unutmalarına sebep olmuştur. Bu problemler nedeniyle hemşirelik mesleğine ilişkin bazı negatif düşünceler oluştuğu belirlenmiştir. Öğrencilerin istenilen düzeyde cevap alamaması, kendilerini ifade etmede eksik olduklarını düşünmeleri ve anlatılan dersleri çabuk unutmaları uzaktan eğitimin dezavantajlarının bulunduğunu ve öğrenciler için kişisel ve mesleki gelişime engel olduğunu göstermektedir. Pandeminin yıkıcı ve yıpratıcı psikolojik etkilerini azaltmak amacıyla öğrencilerin, online (çevrimiçi) derslerin olası sorunları hakkında bilgilendirilmesi ve duygularını net ifade edilebilmeleri için imkân yaratılması, gerektiği zaman ruh sağlığı profesyonellerine başvurmaları konusunda desteklenmeleri; mesleki bilgi ve yeterliliklerini artırabilecekleri, gelişimlerine katkı sağlayabilecek mesleki topluluk veya derneklerle etkileşim içinde olmaları önerilmektedir.

Faculty perceptions of the impact of the COVID-19 pandemic on new graduate nurses' transition to practice: A qualitative study

BACKGROUND

The COVID-19 pandemic disrupted nursing education worldwide. Most studies have focused on how the pandemic affected students. With an alarming workforce shortage, a better understanding of the pandemic's impact on new nurses is vital to proactively develop strategies to promote success of the profession's newest members.

PURPOSE

This study explored faculty perceptions of the pandemic's impact on new nurses' practice preparedness and recommendations for promoting effective transition to practice.

METHODS

Using an exploratory-descriptive qualitative approach and convenience sampling, 116 nurse faculty from across North Carolina, United States responded to open-ended questions within an electronic survey. Data were analyzed with thematic analysis.

RESULTS

Four themes emerged: 1) Less Hands-On, 2) Transition-to-Practice Opportunities, 3) Key Role of Preceptors, and 4) Provide Additional Support.

CONCLUSIONS

Findings provide strategies clinical nurses and leaders can implement to meet the needs of new nurses entering professional practice during the ongoing pandemic. Due to less hands-on learning, pandemic graduates may benefit from extended time with a trained preceptor and opportunities to focus on clinical reasoning, managing multiple patients, effective communication, and safe skill performance. Upon entering the clinical environment, pandemic graduates' inexperience may increase the likelihood of transition shock, requiring multi-faceted approaches for providing support.

Are internship experiences during a pandemic related to students' commitment to nursing education? A cross-sectional study

BACKGROUND

The predominate role of internships on the retention of nursing students highlights the need to monitor internship experiences during a healthcare crisis like CoViD-19.

OBJECTIVES

To explore the relation between internships experiences during a pandemic and student nurses' commitment or intention-to-leave the nursing program; as well as the relation between internship experiences and commitment or intention-to-leave the nursing program.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study using a sample of 1.079 nursing students from18 nursing schools in Flanders, Belgium. Students from all study years were eligible to participate.

METHODS

Online self-reporting survey during the first CoViD-19 wave (April-May 2020). Regression analyses were used to explore the association with students' commitment or intention-to-leave.

RESULTS

Students reported high levels of study commitment (4.06; SD 0.66; range 1-5), and an overall low intention-to-leave (1.64; SD 0.83; range 1-5). No difference in commitment or intention-to-leave were seen between students who did or did not had internship experience during CoViD-19 period. Need-supportive experiences - indicating that students felt competent, related to the team, and could be themselves on internship - coincided with high commitment. Conversely, need-frustrating experiences - indicating that students felt insecure, unrelated, and controlled by the nursing team - increased intention-to-leave nursing education. Students who felt pressured for an internship during the first wave of the CoViD-19 crisis, had more doubts to continue nursing education, and an increased chance on drop-out.

CONCLUSIONS

We recommend nursing schools to assess student's motivation when making a substantiated decision concerning internships during a health crisis, as facing an imposed or subjective mandatory decision to go into clinical practice might lead to less commitment to the study program. For both teacher and staff mentors it is deemed important to discuss the internship climate with the student, in order to early identify need-frustrating issues during internship.

Prevalence of mental health problems and sleep disturbances in nursing students during the COVID-19 pandemic: A systematic review and meta-analysis

AIM

To identify the prevalence of mental health problems and sleep disturbances among nursing students during the COVID-19 pandemic.

BACKGROUND

As a future professional workforce, nursing students are expected to play a role in controlling the COVID-19 pandemic; however, physical and mental health problems may hinder their willingness to stay in the nursing profession. Evidence of the prevalence of the health problems among nursing students related to COVID-19 may allow educators to manage their students' health problems and make them feel more positive about their future careers.

DESIGN

Systematic review and meta-analysis. This study was prospectively registered with PROSPERO.

DATA SOURCES

Databases, including CINAHL, Embase, PubMed and Web of Science, were searched for all related journal articles, from database inception to June 29, 2021, published between 2020 and 2021.

METHODS

This review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a PICOS search strategy. A DerSimonian-Laird random-effects model was used to estimate the prevalence and potential heterogeneity among the selected studies using the Cochran Q statistic and I-square test. Publication bias was assessed using the Egger intercept test.

RESULTS

Seventeen studies were included in the meta-analysis, representing 13,247 nursing students. During the COVID-19 pandemic, the prevalence of four health problems and sleep disturbances were identified. The health problem with the highest prevalence in nursing students was depression (52%). Other COVID-19-related health problems were fear (41%), anxiety (32%) and stress (30%) and sleep disturbances (27%).

CONCLUSIONS

The findings from this study showed that strategies are necessary to manage nursing students' teaching and learning during the COVID-19 pandemic or similar future situations. Our results suggest that preparing modified distance learning might reduce the prevalence of health problems related to the educational process. In addition, providing regular mental health assessments or online mental health services to students may improve their mental health and increase their well-being. Nursing education policies regarding clinical practice remain to be formulated to ensure the achievement of competencies to support future careers while considering the mental readiness and safety of students.

Exploring the Intersection Between Academic and Professional Practice During the COVID-19 Pandemic: Undergraduate and Graduate Nursing Students' Experiences

Background

The coronavirus disease-2019 (COVID-19) pandemic has implications for students who are also nurses.

Purpose and Methods

This qualitative descriptive study used a practice development approach to explore the intersection between academic and professional work experiences for undergraduate Post-Diploma Registered Practical Nurses bridging to Registered Nurse Bachelor of Science in Nursing students and Master of Nursing graduate nursing students during the first wave of the COVID-19 pandemic. The study incorporated critical aesthetic reflections that focused on the personal and aesthetic ways of knowing, as a data collection approach and knowledge dissemination strategy.

Results

Analysis of the narrative component of participants’ reflections revealed the following themes: sensing a “call to duty,” experiencing a myriad of emotions, shifting societal and individual perceptions of nursing, and learning in an uncertain environment.

Conclusions

The results of the study can inform educational strategies and academic policies to support this unique nursing population, who are frontline practitioners as well as student learners.