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

Keep quiet or act? Challenges in integrating ethical theory into gerontological nursing care during students' first clinical rotation: A discussion paper

AIM

The aim of the paper is twofold: 1. To present observations based on first-year nursing students' narratives during clinical rotation in gerontological nursing care; and 2. Explore a nursing educator's reflections on these observations in relation to the didactic and ethical challenges that occurred.

BACKGROUND

The teaching of ethics is included in nurse education worldwide. Students are in their first clinical placement in residential care of older persons confronted with the moral complexities of gerontological care, where they get little possibility to share emotions and thoughts about ethically challenging nursing situations with a supervising registered nurse.

DESIGN

A critical discussion paper.

METHOD

The educator's reflections in this discussion paper are based on a narrative assignment in ethics where first-year nursing students reflect on and describe a nursing situation during their clinical rotation in the residential care of older persons.

RESULTS

Most students were acting as mere spectators in the described nursing situation where an older person, ethical standards, or evidence-based care was violated. Some students acted as advocates to the older person and intervened in the situation and a few as inspirers showing alternative ways of handling ethically challenging situations.

CONCLUSIONS

Educators in nursing programs at the undergraduate level require time for student-centered formative guidance to foster moral courage and practice. During first-year students' clinical rotation, the learning goals in long-term residential care of older persons are focused on evidence-based basic nursing care. In this, students are confronted with ethically challenging situations, where the possibility to learn from a critical reflective practice is rare. When observing situations where an older person is subjected to unethical or unsafe nursing care it is common that the students take the spectators' role, not knowing how to deal with what is observed. Some students are taking an intervening role by trying to alleviate the vulnerability of the older person. A few are showing moral courage by directly intervening when experiencing unethical or unsafe nursing care or conduct. In this the student can inspire fellow students or staff during their clinical rotation in alternative ways of handling ethically challenging situations. As older persons are the largest demographic group that nurses will experience, educators need a sound knowledge of ethics as well as gerontological care to be able to meet and nurture students' ethical reflections during clinical practice and to foster practical wisdom in nursing.

Development and psychometric evaluation of the hidden curriculum assessment scale in nursing education: A validity and reliability study

AIMS

The study aimed to develop and psychometrically evaluate a measurement scale for identifying and assessing the hidden curriculum in undergraduate nursing education.

BACKGROUND

The hidden curriculum is a general term for educational information that exists outside of the teaching program and mainly affects students' knowledge, emotions, behaviors, beliefs, values and professional ethics. However, a specific instrument to comprehensively define and assess the hidden curriculum in nursing education has not yet been developed in China.

DESIGN

A descriptive and explorative study design was used.

METHODS

We developed the initial scale through a literature review, focus group discussion, Delphi expert consultation and pre-survey. From February to April 2023, the data were collected from a convenient sample of 512 nursing students enrolled in five medical universities in China to conduct exploratory factor analysis and confirmatory factor analysis for validity testing. In addition, reliability analysis was conducted by calculating Cronbach's alpha coefficients, split-half reliability and test-retest reliability. The nursing students' responses were evaluated using a five-point Likert scale.

RESULTS

The Hidden Curriculum Assessment Scale in Nursing Education (HCAS-NE) was formulated, consisting of 4 dimensions and 35 items. Exploratory factor analysis extracted four factors, with a cumulative variance contribution rate of 66.863 % and confirmatory factor analysis indicated that the fit indices values of the scale structure model met the criteria for an ideal level. the Cronbach's α coefficient of the scale was 0.965, the Guttman split-half was 0.853 and the test-retest reliability was 0.967.

CONCLUSION

This study demonstrated that the Hidden Curriculum Assessment Scale in Nursing Education (HCAS-NE) has ideal reliability and validity, which provides a valid and reliable tool for identifying and assessing the hidden curriculum in nursing education.

An interview study about how nurses and physicians talk about the same concepts differently

BACKGROUND

How healthcare professionals understand and use concepts of social and cognitive capabilities will influence their behaviour and their understanding of others' behaviour. Differing understandings of concepts might lead to healthcare professionals not acting in accordance with other healthcare professionals' expectations. Therefore, part of the problem concerning errors and adverse incidents concerning social and cognitive capabilities might be due to varying understandings of concepts among different healthcare professionals. This study aimed to examine the variations in how educators at the Copenhagen Academy for Medical Education and Simulation talk about social and cognitive capabilities.

METHODS

The study was conducted using semi-structured interviews and directed content analysis. The codes for the analysis process were derived from existing non-technical skills models and used to show variations in how the participants talk about the same concepts.

RESULTS

Educators with a background as nurses and physicians, talked differently about leadership and decision-making, with the nurses paying greater attention to group dynamics and external factors when describing both leadership and decision-making, whereas physicians focus on their individual efforts.

CONCLUSION

We found patterned differences in how the participants described leadership and decision-making that may be related to participants' professional training/background. As it can create misunderstandings and unsafe situations if nurses and physicians disagree on the meaning of leadership and decision-making (without necessarily recognising this difference), it could be beneficial to educate healthcare professionals to be aware of the specificity of their own concepts, and to communicate what exactly they mean by using a particular concept, e.g. "I want you to coordinate tasks" instead of "I want better leadership".

Navigating the pathway to advanced practice: A grounded theory of nurse practitioner role transition in a fellowship

BACKGROUND

Greater attention to the transitional period for advanced practice nurses has urged health care organizations and employers to implement fellowships. Currently, the theoretical process of nurse practitioner (NP) role transition from the essential perspectives of NP fellows does not exist.

PURPOSE

The purpose of this study was to construct a middle-range theory grounded in reality of an NP fellowship environment that explains how NPs transition to their new role.

METHODOLOGY

Following Charmaz's constructivist methodology, 11 NPs who transitioned to practice in a fellowship were interviewed.

RESULTS

"Navigating the Pathway to Advanced Practice: A Grounded Theory of Nurse Practitioner Role Transition in a Fellowship" emerged from the data and is composed of through five phases: (1) mapping a path, (2) stepping onto the trailhead, (3) navigating the trailway, (4) gaining traction, and (5) summiting.

CONCLUSIONS

The resulting middle-range theory is the first in the nursing literature that conceptualizes meaning about NP role transition in a fellowship. This process occurs in the contextual factor of a realm of support that includes growth, value, lifelong learning, and readiness. Throughout this process, NPs build competence and confidence that advances them to summit, or transition, to their NP role at the completion of an NP fellowship.

IMPLICATIONS

This discovery will fill the research gap pertaining to best practice interventions in support of NPs during role transition in fellowships. Understanding how NPs transition to their new advanced practice roles may inform organizations on how to structure fellowships that support learning, encourage confidence, and enhance competence.

Student nurse retention. Lived experience of mature female students on a UK Bachelor of Nursing (Adult) programme: An interpretative phenomenological analysis

AIMS

To explore the lived experiences of mature female students undertaking a Bachelor of Nursing (Adult) programme in the UK, to gain insight into the challenges and barriers faced by students and investigate the factors that support students who have considered leaving, to stay and continue with their studies.

BACKGROUND

There is a global shortage of nurses and challenges exist in ensuring that enough nurses are available to provide care in the complex and rapidly changing care environments. Initiatives introduced to increase the number of Registered Nurses (RN), include increasing the number of students enrolled on pre-registration nursing programmes. However, the success of this intervention is contingent on the number of students who go on to complete their course.

DESIGN

This qualitative study employed Interpretative Phenomenological Analysis (IPA), which provided a methodological framework and analytical approach to enable an exploration of participants' individual and shared lived experiences.

METHODS

Eight female, mature students at the end of their second year of a Bachelor of Nursing (Adult) programme at a Higher Education Institution in South Wales participated in semi-structured, face-to-face interviews, which were analysed idiographically before group-level analysis was undertaken.

FINDINGS

The analysis revealed three superordinate themes: 'Ambition to become a Registered Nurse'; 'Jugging Roles' and 'Particular Support Needs for a Particular Student'.

CONCLUSION

Each student had a unique history, their past and present social and psychological experiences were multifaceted and complex. These differences resulted in varying degrees of resilience and motivations to continue their studies. These findings are important for ensuring that services develop and provide effective support to maximize retention and, ultimately, increase the number of students entering the RN workforce.

PATIENT OF PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT STATEMENT

This research expands on current literature regarding the needs of mature female students, a growing student nurse demographic. Every student had a dynamic set of circumstances and demonstrated that the identification of 'at-risk' students, purely based on demographics or information on a Curriculum Vitae, is problematic and potentially futile. This knowledge could be used to tailor University support systems and inform curriculum development and support systems for maximizing student retention. These findings are important for ensuring that services continue to develop and provide effective support to maximize retention and completion and, ultimately, increase the number of students entering the Nursing and Midwifery Council register.

Valuation of the cultural adaptation and psychometric properties of the Chinese version of the hidden curriculum evaluation scale in nursing education

BACKGROUND

The hidden curriculum in baccalaureate nursing programs is a means of moral education. Evaluation of the curriculum by students and faculty can increase awareness of its characteristics, which could be useful for planning and further development.

OBJECTIVES

This study's aim was to translate the Hidden Curriculum Evaluation Scale in Nursing Education (HCES-N) to Chinese, adapt the scale to the Chinese culture and evaluate its validity and reliability in a sample of undergraduate nursing students.

DESIGN

Psychometric assessment of a tool using two cross-sectional surveys.

SETTINGS

University-based schools of nursing in seven provinces and cities of China.

PARTICIPANTS

Undergraduate nursing students in a baccalaureate program.

METHODS

The English version of the HCES-N was translated to Chinese using the Brislin translation model. The test-retest, internal consistency and split-half reliabilities of the HCES-N were examined in a sample of 1016 undergraduate nursing students. Exploratory factor analysis and confirmatory factor analysis were conducted to examine the scale's content validity.

RESULTS

The exploratory factor analysis of the final 44-item HCES-N revealed three common factors and a cumulative variance contribution rate of 73.535%. The results of the confirmatory factor analysis showed that the final 44-item, 3-factor model was adequate for the s cale's structure (Chi-square/df = 6.59, RMSEA = 0.074, SRMR = 0.040, CFI = 0.911 and TLI = 0.905). The results confirmed that the Chinese version of HCES-N had good internal consistency (Cronbach α = 0.945); the scale's split-half-reliability was 0.794 and its test-retest reliability after two weeks was 0.894.

CONCLUSION

The Chinese version of the HCES-N has good reliability and validity and it can be used to assess the hidden curriculum in baccalaureate nursing programs.

Professional nurses supporting learners during professional socialisation in Limpopo province

Background

Professional nurses play a significant role in the professional socialisation of learner nurses during clinical placement. Clinical placements are areas of experiential learning as learner nurses come in contact with real-life experiences. Professional nurses are custodians of learners and need to offer them support.

Aim

The study sought to explore the role of professional nurses in supporting learner nurses during professional socialisation.

Setting

Four clinical health facilities in Limpopo province at different levels of care were purposely sampled to obtain information from different levels of care.

Methods

An ethnonursing approach and qualitative, explorative design was used. Non-probability purposive sampling was used to select 25 professional nurses. The criteria were professional nurses with 3 years of experience in professional socialisation and working in institutions accredited for clinical placement of learner nurses registered in the undergraduate programme. Data were collected through a face-to-face interview until data saturation was reached. Tesch's open coding system was used to analyse data.

Results

Professional nurses acknowledged that their responsibilities in supporting learners during professional socialisation are mentoring, teaching and being competent practitioners. Professional nurses were aware of their role in transferring ethical skills and knowledge to learners through professional socialisation.

Conclusion

The effectiveness of professional socialisation of learner nurses depends on the support offered during clinical placements.

Contribution

The study adds to the body of knowledge in nursing education and practice because when learners are offered support in the clinical areas, their learning journey will be of positive experience leading to competent practitioners.

Nursing students' processes of taking role models and being role models: A descriptive phenomenological study

BACKGROUND

Role models are frequently viewed as a means of motivating people to adopt new behaviors and inspiring them to establish ambitious targets. Role models play a significant role in the characters of individuals and can be effective in shaping their career choices, education, and identities. Within the nursing profession, role models are integral to nursing students' journey towards understanding the nursing role and professional responsibility. For this reason, it is very important for nursing students to identify role models that support the development of students growth and development.

OBJECTIVES

This study aimed to investigate the qualities of nurses who serve as role models for senior undergraduate nursing students in shaping their professional attitudes and behaviors, identify the motivations behind selecting these individuals as role models.

DESIGN

A descriptive phenomenological research method was used.

SETTINGS

The research was conducted at a state university nursing school.

PARTICIPANTS

The study was conducted with the participation of 16 senior nursing students.

METHODS

Data collected from one-on-one interviews. A thematic analysis was used to analyze the data.

RESULTS

Student nurses mostly took clinical nurses and lecturers as professional role models. They were most impressed by their role models' knowledge, strong communication skills, and respect for human beings. To imitate their role models, students were willing to work in the clinic to improve their communication and psychomotor abilities and engaged in research and inquiry in areas where they felt insufficient. However, they also reported that most clinical nurses were not positive role models. They avoided taking nurses as role models because they had low communication skills, did not guide the student, and did not value human beings.

CONCLUSIONS

The study's findings indicated that student nurses were primarily influenced by clinical nurses and viewed them as both positive and negative role models, and they aspired to emulate the qualities of the nurses they considered positive role models while actively avoiding behaviors and traits associated with those seen as negative role models. Clinical nurses, who are in contact with prospective nurses the most, have an important role in guiding them.

A comparison of perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students

BACKGROUND

The population of women in homelessness in Europe is increasing and women in homelessness experience multiple healthcare needs. However, there is insufficient understanding about how perceptions of caring behaviours compare between women in homelessness as patients and nurses in their clinical practice.

AIM

This study aimed to investigate perceptions of caring behaviours among women in homelessness, Registered Nurses and nursing students.

METHODS

A cross-sectional design was used with convenience sampling to recruit groups of women in homelessness (n = 37), Registered Nurses (n = 92) and nursing students (n = 142) in Stockholm, Sweden. Between August 2019 and December 2020, data were collected through face-to-face interviews or online, using the Caring Behaviours Inventory-24 instrument. Data were analysed using descriptive statistics and group-comparing hypothesis tests.

RESULTS

Overall, women in homelessness' perceptions of caring behaviours were significantly lower than nursing students (p < 0.001), who in turn scored significantly lower than Registered Nurses (p < 0.001). The Knowledge and Skill domain had the highest score, and the Connectedness domain had the lowest score in all three groups. The ranking of the individual items according to score varied between the groups. However, all three groups had the highest score for the Knowing how to give shots, IVs, etc., item and the lowest score for the Helping the patient to grow item.

CONCLUSION

Healthcare providers and nurse educators should consider incongruences and congruences in caring behaviours to better prepare Registered Nurses and nursing students to contribute to increased health equity, and more targeted clinical practice for women in homelessness.

Is nurses' clinical competence associated with their moral identity and injury?

BACKGROUND

The enhancement of nursing care quality is closely related to the clinical competence of nurses, making it a crucial component within health systems.

OBJECTIVE

The present study investigated the relationship between nurses' clinical competence, moral identity, and moral injury during the COVID-19 outbreak.

RESEARCH DESIGN

This cross-sectional study was carried out among frontline nurses, using the Moral Identity Questionnaire (MIQ), the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP), and the Competency Inventory for Registered Nurse (CIRN) as data collection tools.

PARTICIPANTS

and research context: The research population for this study consisted of all frontline nurses (n = 251) employed in a hospital in southern Iran. Sampling was conducted between May 1, 2021 and September 30, 2021, during the COVID-19 outbreak.

ETHICAL CONSIDERATIONS

The present study received approval from the research ethics committee of Rafsanjan University of Medical Sciences, with project No. 99267 and code of ethics ID No. IR. RUMS.REC.1399.262, dated 15.02.2021.

RESULTS

According to the study findings, 42.2% of the nurses demonstrated high clinical competence, while 51.4% exhibited moderate clinical competence. The results indicated a positive correlation between moral identity and clinical competence but a negative correlation between moral injury and clinical competence. Furthermore, the variables of moral identity and moral injury were found to predict 10% of the variance in clinical competence.

CONCLUSION

According to the results, moral identity and moral injury had an impact on the clinical competence of nurses. Therefore, implementing a program aimed at enhancing moral identity and providing training strategies to address moral injury during crises like the COVID-19 pandemic can lead to improvements in nurses' clinical competence and the overall quality of care they provide.

Nurses' Perception of Professionalism in Practice: A Review of Qualitative Studies

Professionalism is a fundamental concept in nursing and a central aspect of nursing care. The review aimed to synthesize evidence presented in qualitative studies related to the perception of professionalism in nursing practice. Six main analytical themes were generated from primary studies included in the literature review: everyday practice, ethical aspects of nursing care, nurses' identity, nurses' professional growth, achieving autonomy, complexity of relationships. Presented themes are considered key elements of nursing professionalism, are closely interconnected, and support the multidimensional structure of professionalism in nursing. Nursing professionalism means providing high-quality care while upholding the values of integrity, accountability, and respect.

A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers, patients and families

This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.

Strategies to improve hidden curriculum in nursing and medical education: a scoping review

BACKGROUND

The importance of hidden curriculum cannot be neglected in education. Despite much research in the field, there have been limited studies on HC improvement in nursing and medical education. This scoping review aimed to determine the scope of strategies to improve HC in nursing and medical education.

METHOD

PubMed, EBSCO/Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Web of Science, Proquest and Persian-language databases of Magiran and SID were searched in January 2023 without a time filter. According to the PRISMA flow diagram, two independent reviewers selected the records that fit the inclusion and exclusion criteria via title and abstract screening. Next, the reviewers studied the full texts of the related articles. The data extracted from the selected articles were tabulated and ultimately synthesized.

FINDINGS

Out of the eight examined studies, published from 2017 to 2022, only one was in the field of nursing and seven were in medicine. The central strategies were implementing new curricula to replace the previous ones, utilizing team-based clinical clerkship, proposing a HC improvement model, implementation a case-based faculty development workshop, implementation longitudinal and comprehensive educational courses, and incorporating an educational activity into a small group program.

CONCLUSION

Students and faculty members familiarization on the topic of HC, implementing new curricula, utilizing team-based clerkship, and using comprehensive models were among the HC improvement strategies. Focusing on upgrading the learning environment, particularly the clinical settings, can also be helpful in HC improvement.

Senior nurses' expectations and support of new graduate nurses' adjustment in hospitals: A qualitative descriptive study

Aim

This study aimed to identify senior nurses' expectations and support of new graduate nurses' adjustment to their work environment.

Background

New graduate nurses have difficulties in adjusting to their work environment because they are not well prepared for clinical nursing practice upon graduation. Hospitals support their adjustment to their work environment through residency/transition programs. Although such support exists, new graduate nurses are expected to learn the expected behavior and attitude themselves. Thus, identifying senior nurses' expectations and support of new graduate nurses' adjustment may facilitate smooth adjustment to the work environment.

Design

This was a qualitative descriptive study.

Methods

Fourteen nurses who teach new graduate nurses in Japanese hospitals were interviewed face-to-face individually. The data were analyzed using qualitative inductive content analysis, which was coded and sorted to identify categories.

Results

Regarding senior nurses' expectations of new graduate nurses' adjustment, six categories emerged: trying to fit in with people in their ward, behaving by following the unspoken rules of their ward, having attitudes compatible with learning, addressing their situations using their initiative, showing a willingness to learn, and obtaining necessary information by themselves. Senior nurses' support of new graduate nurses' adjustment consisted of four categories: watching over and speaking to them, trying to create a good working environment, encouraging them to have attitudes compatible with learning, and teaching them how to learn.

Conclusions

Senior nurses need to understand and express what they expect from new graduate nurses at the stage of hospital adjustment. If senior nurses understand their expectations for adjustment, they can help new graduate nurses effectively. Furthermore, understanding the expectations of senior nurses may facilitate new graduate nurses' adjustment. These findings may contribute to good working relationships between senior and new graduate nurses.

Do professional nurses practice what they preach? A qualitative study on professional socialisation of student nurses in the clinical learning environment

While working alongside professional nurses, student nurses develop professional identity and learn the professional nursing role, a process known as professional socialisation. Professional nurses should model professional behaviour to be emulated by student nurses. We used a qualitative exploratory design to explore if professional nurses behave in a manner that supports professional socialisation of student nurses in a clinical learning environment. According to our observations, two main categories emerged regarding professional nurses' behaviour. The first category was unprofessional conduct with sub-categories that included disrespect, infringed patient privacy, breached confidentiality, inappropriate dress code and lack of punctuality. The second category was ward disorganisation which was related to delegating duties and structured orientation programmes for student nurses. In this study, professional nurses did not behave in a manner consistent with professional socialisation in the clinical learning environment. Student nurses may struggle to develop professional identity, leading to reduced confidence and poor patient quality care. Student nurses need to be professionally socialised in a clinical learning environment and professional nurses need to be empowered on how to carry out this process.

Success factors in adaptation of newly graduated nurses: a scoping review

BACKGROUND

Difficulties in adapting to the workplace can affect newly graduated nurses' transition. Such nurses must adapt quickly, as it can affect their future career prospects. Therefore, this review aimed to identify the success factors that promote newly graduated nurses' effective transition and adaptation.

METHODS

The Joanna Briggs Institute scoping reviews methodology was used. Data were extracted from MEDLINE, Scopus, EBSCOhost, and Web of Science publications published between 2011 and 2020. A total of 23 articles were included in this review, which comprised qualitative, quantitative, and mixed methods primary research studies focusing on the contributing factors that aided newly graduated nurses' adaptation to the work environment during their transition period. Key emerging themes were identified with thematic analysis.

RESULTS

Three main themes were identified: (1) organisational contribution (social development, organisational culture, work characteristics, work readiness, work commitment, professional role), (2) personality traits (self-embodiment, personality masking, being proactive and confident), and (3) academic institutions (pre-entry knowledge and role of nursing faculty). Newly graduated nurses' adaptation should begin during nursing education, be supported by the workplace organisation, and driven by the nurse's personality. We determined that that the role of nursing education in aiding the provision of the required knowledge and actual clinical experiences to students profoundly affected developing nurses' self-confidence levels in delivering nursing care effectively. Additionally, a warm environment supported nurses emotionally and physically.

CONCLUSIONS

While organisations and educational institutions have undertaken numerous efforts to ensure that newly graduated nurses are adequately supported, the nurse's personality and values are also equally important to ease adaptation during the transition process. Academic and workplace programs designed for newly graduated nurses should apply and emphasise this knowledge to develop and strengthen their personalities and values, especially to increase confidence and promote proactive values that facilitate newly graduated nurses' rapid and effective adaptation to their new employment.

Characteristics and processes of registered nurses' clinical reasoning and factors relating to the use of clinical reasoning in practice: a scoping review

OBJECTIVE

The objective of this review was to examine the characteristics and processes of clinical reasoning used by registered nurses in clinical practice, and to identify factors reported to relate to the use of clinical reasoning by registered nurses in clinical practice.

INTRODUCTION

Significant variability in the clinical reasoning of graduate registered nurses has been identified in research, with underdeveloped and unsafe clinical reasoning being linked to failure-to-rescue and sentinel events in the clinical setting. The identification of characteristics and processes of clinical reasoning, and factors relating to registered nurses' clinical reasoning when engaged in clinical practice, will increase understanding of the clinical reasoning requirements for undergraduate registered nurses and of potential factors that may affect their clinical reasoning.

INCLUSION CRITERIA

Studies including registered nurses who met the criteria for registered nurse registration in Australia and who used clinical reasoning to engage with health care consumers in all practice environments were eligible for inclusion.

METHODS

Eight databases were searched, with articles identified through CINAHL, MedNar, PubMed, Science Direct, ERIC, PsycINFO, Scopus, and ProQuest Dissertations and Theses. Database searches were conducted on December 31, 2020, and updated August 20, 2021, with primary qualitative and quantitative research studies in English from 2000 onwards considered for inclusion. Opinion papers, text, and reports were not included. Data were extracted based on the draft charting tool from the scoping review protocol, with results presented in tabular format and in a narrative summary.

RESULTS

The 29 qualitative and 5 quantitative research studies included in the scoping review utilized exploratory descriptive, descriptive rationalist, narrative, ethnography, correlational, observational, and grounded theory methodologies in their research designs. Observation, think-aloud sessions, questionnaires, surveys, interviews, and focus groups were used to collect data from the 1099 participants in 9 countries. Multiple concepts related to the characteristics (n=35) and processes (n=30) of clinical reasoning were detected in the research studies, with 5 categories identified: i) situation management, ii) data management, iii) interpreting, iv) implementing and evaluating, and v) professional practice, with an additional processes category identified (decision-making processes). The factors (n=26) reported to relate to clinical reasoning were categorized into environment of care, care requirements, professional practice, experience, knowledge, and decision-making processes. Connections between the various concepts were evident throughout the review.

CONCLUSIONS

The scoping review identified characteristics and processes of clinical reasoning, as well as factors reported to relate to clinical reasoning in all studies. The concepts that comprise the clinical reasoning of registered nurses in clinical practice must be considered in undergraduate registered nurse education. Registered nurses must complete their baccalaureate program with well-developed clinical reasoning to ensure safe clinical practice. Understanding the characteristics and processes of registered nurses' clinical reasoning in clinical practice, and the factors reported to relate to clinical reasoning, supports the creation of targeted resources for development and assessment of clinical reasoning.

Newly qualified graduate nurses' experiences of workplace incivility in healthcare settings: An integrative review

AIM

To explore, identify and integrate the existing knowledge to categorise the characteristics, likelihood, and consequences of workplace incivility among newly qualified graduate registered nurses. A particular focus of this review is on the experiences of new nurses related to these negative workplace behaviours and the strategies employed by these nurses and their organisations to manage workplace incivility.

BACKGROUND

Workplace incivility has been widely recognised as a global problem in healthcare settings and is known to affect nurses in all facets of their professional and personal life. This might be particularly harmful for newly qualified graduate nurses, as they are unprepared to deal with this uncivil culture.

DESIGN

An integrative review of the global literature, conducted according to the Whittemore and Knafl framework.

METHODS

Database searches (CINAHL, OVID Medline, PubMed, Scopus, Ovid Emcare and PsycINFO), and manual searching generated an aggregate of 1904 articles, which were further screened based on inclusion criteria and eligibility using the Mixed Methods Appraisal Tool (MMAT). Peer-reviewed empirical studies that explored the workplace incivility experiences of new graduate nurses were included in this review. Extracted data were grouped to develop themes and sub-themes.

RESULTS

This review included 14 studies in total with seven quantitative and seven qualitative studies. The data collected from these studies were categorised according to the research questions into a) expectations of civility, b) experiences and exposure to workplace incivility, c) forms and characteristics of incivility, d) sources of incivility, e) consequences of incivility, and f) managing and coping with incivility. Across studies, graduate nurses' views about the prestige and power of the nursing profession are conflicted due to experiences of incivility in clinical practice. New graduate nurses experienced a high but variable prevalence of incivility from their co-workers (25.6-87 %), with manifestations of incivility varying greatly, including eye rolling, yelling, exclusion and sexual harassment. Included studies primarily focused on professional and organisational effects and their outcomes relative to the physical and psychological effects on new nurses.

CONCLUSION

Findings from the literature demonstrate that incivility directed toward newly qualified graduate nurses is prevalent and can have significant negative impact on their self-esteem and confidence, which may ultimately impact on their workforce participation decisions and the quality of patient care. Supportive and empowering work environments are vital not only for improved nurse health and well-being, but also to retain new graduate nurses. The current nursing shortage emphasises the need for such conditions.

Evaluating the use of reflective cafés in Specialist Community Practitioner and Specialist Community Public Health Nurse programmes

Background: Specialist Community Practitioner (SCP) and Specialist Community Public Health Nurse (SCPHN) students are required to evidence their competency by the use of reflective practice as part of the NMC proficiencies. A reflective café trilogy comprising of three reflective teaching sessions was developed and introduced into a university programme to support and encourage alternative methods for deeper reflection within this student group. Aim: It was important for educators to evaluate if a reflective café met the student's needs and understand the usefulness of a 'reflective café' as a technique to support the process of reflecting on practice. Methods: Evaluation was undertaken using an online questionnaire. Findings: Students evaluated if the reflective café was useful for their own development and identified that the number of sessions met their developmental needs. Conclusion: The potential to develop alternative methods to reflect was recognised and the team plan to develop other reflective processes to support students in the future.

DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE SENSE OF BELONGING IN NURSING SCHOOL SCALE

Background and Purpose: While sense of belonging is essential for human motivation, impaired belonging among nurses can impact the care and safety of patients. This article reports the development and psychometric testing of the Sense of Belonging in Nursing School (SBNS) scale to assess nursing students' sense of belonging in three different environments: Clinical, classroom, and among the student cohort. Method: Principal component exploratory factor analysis with varimax rotation was used to determine the construct validity on the 36-item SBNS scale with a sample of 110 undergraduate nursing students. Cronbach's alpha was used to determine the scale's internal consistency. Results: The scale was reduced to 19-items with high internal consistency (α = 0.914). Principal component analysis then identified four factors (sub-scales) with high internal consistency: Clinical staff (α = 0.904), clinical instructor (α = 0.926), classroom (α = 0.902), and classmates/cohort (α = 0.952). Conclusion: The SBNS scale is a reliable and valid tool to measure sense of belonging across three environments among nursing students. Further research is needed to determine the scale's predictive validity.

Socialization in professional reality integration for nursing student transition (SPRINT) to improve professional competence: A quasi-experimental study

Background

Professional socialization could support competency achievement and assist the transition phase. It is rare to find quantitative studies examining the effects of professional socialization for nursing students (NS).

Objectives

To investigate the effects of a socialization in professional reality integration for nursing student transition (SPRINT) to improve the professional competence of undergraduate NS in Indonesia.

Design

A quasi-experimental study non-equivalent control group pre-test post-test design was conducted using convenience sampling.

Participants

One hundred twenty NS (60 participants in the experimental group and 60 participants in the control group) from two nursing departments in private universities in Indonesia.

Methods

The SPRINT educational intervention consisted of professional socialization training using several learning methods and activities. Meanwhile, the control group received conventional socialization. The Nurse Professional Competence short-form (NPC-SF) scale was evaluated prior to the participants' internship program, lasting from 6 to 12 weeks after clinical education in both groups.

Results

SPRINT intervention significantly increased overall professional competence scores of the experimental groups higher than the control group. By comparing the mean scores in three times measurement, the six competency areas mean score increased significantly for the experimental group while, for the control only three areas of competence increased in twelve week post-test.

Conclusion

A "SPRINT" as an innovative educational program developed in collaboration with academia, clinical preceptors, could improve professional competence. It is recommended to implement SPRINT program to assist the smooth transition from academic into clinical education.

New Nurses' Perceptions on Transition to Practice: A Thematic Analysis

BACKGROUND

New nurses' transition to the workforce is often described as challenging and stressful. Concerns over this transition to practice are well documented, with the hypothesis that transition experiences influence the retention of new nurses in the workforce and profession.

METHODS

In a cross-sectional survey (N = 217) to assess new nurse transition in the province of Ontario, Canada, an open-ended item was included to solicit specific examples of the transition experience. The comments underwent thematic analysis to identify the facilitators and barriers of transition to practice for new nurses.

RESULTS

Comments were provided by 196 respondents. Three facilitator themes (supportive teams; feeling accepted, confident, and prepared; new graduate guarantee) and four barrier themes (feeling unprepared; discouraging realities and unsupportive cultures; lacking confidence/feeling unsure; false hope) to new nurse transition emerged.

CONCLUSIONS

Concerns of nursing shortages are heightened in the current COVID-19 pandemic, reinforcing the priority of retaining new nurses in the workforce. The reported themes offer insight into the contribution of a supportive work environment to new nurses' transition. The recommendations focus on aspects of supportive environments and educational strategies, including final practicums, to assist nursing students' development of self-efficacy and preparation for the workplace.

Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study

AIMS AND OBJECTIVES

To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship.

BACKGROUND

Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills.

DESIGN

The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions.

METHODS

Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study.

RESULTS

Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork.

CONCLUSIONS

This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services.

RELEVANCE TO CLINICAL PRACTICE

Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.

Validating an Instrument for Measuring Newly Graduated Nurses' Adaptation

A long-established approach, Confirmatory Factor Analysis (CFA) is used to validate measurement models of latent constructs. Employing CFA can be useful for assessing the validity and reliability of such models. The study adapted previous instruments and modified them to suit the current setting. The new measurement model is termed NENA-q. Exploratory factor analysis (EFA) revealed the instruments of the NENA-q model formed a construct of the second order with four dimensions, namely organizational contribution (OC), academic institution contribution (AIC), personality traits (PT), and newly employed nurses' adaptation (NENA). Researchers administered the questionnaires to a sample of 496 newly employed nurses working in hospitals under the Ministry of Health (MOH) for the confirmation of the extracted dimensions. The study performed a two-step CFA procedure to validate NENA-q since the model involves higher-order constructs. The first step was individual CFA, while the second step was pooled CFA. The validation procedure through confirmatory factor analysis (CFA) found the model achieved the threshold of construct validity through fitness index assessment. The model also achieved convergent validity when all average variance extracted (AVE) exceeded the threshold value of greater than 0.5. The assessment of the composite reliability (CR) value indicates all CR values exceeded the threshold value of 0.6, which indicates the construct achieved composite reliability. Overall, the NENA-q model consisting of the OC construct, AIC construct, PT construct, and NENA construct for CFA has met the fitness indexes and passed the measurements of the AVE, CR, and normality test. Once the measurement models have been validated through CFA procedure, the researcher can assemble these constructs into structural model and estimate the required parameter through structural equation modelling (SEM) procedure.

Belonging in high acuity settings: What is needed for newly graduated registered nurses to successfully transition? A qualitative systematic review

BACKGROUND

A worldwide shortage of nurses providing clinical care, coupled with an increase in severity of illness of hospitalised patients has led to newly graduated Registered Nurses being placed into high acuity settings, such as the emergency department, intensive care unit and operating theatre. The feeling of belonging in these settings impacts on successful transition of newly graduated Registered Nurses, their learning, and may lead to high attrition rates.

OBJECTIVE

To comprehensively synthesise qualitative research on newly graduated Registered Nurses' experiences of belonging, while working in high acuity clinical settings.

DESIGN

Elements of the Joanna Briggs Institute (JBI) systematic review protocol were utilised. The Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to conduct the review. Data were analysed using thematic analysis.

DATA SOURCES

Ovid Emcare, PsychInfo, CINHAL, Proquest and Scopus.

METHODS

The PICo (population, interest and context) strategy was used as a guide to develop search terms. Published literature from January 2007 to April 2021 was searched. Screening, selection and data extraction were performed by two authors independently. All discrepancies were resolved through discussion with a third reviewer.

RESULTS

A total of 506 studies were identified following the systematic search; after duplicates were removed, 440 were screened by title and abstract and 29 by full text. Six articles were included in this systematic review. Methodological quality was assessed utilising the JBI critical appraisal checklist, and discrepancies ratified through team consensus. The themes; emotional lability, structured program design, preceptors' influence and acceptance were identified.

CONCLUSIONS

Newly graduated Registered Nurses in the high acuity setting feel emotionally insecure related mainly to their educational unpreparedness. They have need for a structured program, inclusive of both theory and supported practice. The role of the preceptorship team is vital in enabling a feeling of belonging, as is acceptance by nursing staff of the learning journey.

The impact of university-based education on nursing professional identity: a qualitative examination of students' experiences

OBJECTIVES

To examine graduate students' perceptions of their nursing professional identity within the university-based educational system.

METHODS

A qualitative phenomenological approach was adopted involving the completion of in-depth interviews and focus groups among master's degree students in Morocco.

RESULTS

The shift to university-based nursing education system was associated with the development of a positive self-image, sense of empowerment, and attachment to professional values in addition to role extension and involvement in research.

CONCLUSIONS

The perceived external barriers such as negative social image, role ambiguity, and unsupportive work environments, limit the reach of the positive influence of the educational shift and may lead to doubts in integrating the clinical workspace.

Experiences of socialization in clinical education among Indonesian nursing students: A phenomenology study

BACKGROUND

Professional socialization is an essential process of the nursing profession to internalize the values into behavior, resulting in professional identity. However, research into students' experience of professional socialization in clinical nursing education remains limited.

AIM

To explore Bachelor nursing students' (NS) experience of professional socialization in clinical education in Indonesia.

DESIGN

This study used a descriptive phenomenology qualitative approach. Four sessions of focus group discussions (FGD) were conducted with ten final-year NS from five teaching hospitals using the purposive sampling technique. Data were analyzed using Colaizzi methods and NVivo 12 Plus.

RESULTS

The analysis identified two themes and four-subthemes in this study. The first theme is the facilitators of the socialization experience, consisting of "being a professional nurse" and "Islamic culture". The second theme hinders the socialization experience, including "inadequacy of socialization" and "nurses' unprofessional behavior."

CONCLUSION

Bachelor NS experience is challenging in Indonesia in both a positive and negative way, which facilitates or hinders professional socialization. Thus, the role of a nurse educator in establishing a comprehensive professional socialization program for new NS to assist their transition from the academic setting into clinical education needs to be reassessed.

Australian chiropractic and osteopathic graduates' perceptions of readiness for transition to practice

OBJECTIVE

This is the second phase of a project. The aim was to explore Australian chiropractic and osteopathic new graduates' readiness for transition to practice concerning their clinical skills, professional behaviors, and interprofessional abilities. Phase 1 explored final year students' self-perceptions, and this part uncovered their opinions after 6 months or more in practice.

METHODS

Interviews were conducted with a self-selecting sample of phase 1 participant graduates from 2 Australian chiropractic and 2 osteopathic programs. Results of the thematic content analysis of responses were compared to the Australian Chiropractic Standards and Osteopathic Capabilities, the authority documents at the time of the study.

RESULTS

Interviews from graduates of 2 chiropractic courses (n = 6) and 2 osteopathic courses (n = 8) revealed that the majority had positive comments about their readiness for practice. Most were satisfied with their level of clinical skills, verbal communication skills, and manual therapy skills. Gaps in competence were identified in written communications such as case notes and referrals to enable interprofessional practice, understanding of professional behaviors, and business skills. These identified gaps suggest that these graduates are not fully cognizant of what it means to manage their business practices in a manner expected of a health professional.

CONCLUSION

This small study into clinical training for chiropractic and osteopathy suggests that graduates lack some necessary skills and that it is possible that the ideals and goals for clinical education, to prepare for the transition to practice, may not be fully realized or deliver all the desired prerequisites for graduate practice.

Transforming an educational ecosystem for substance use disorders: A multi-modal model for continuous curricular improvement and institutional change

Health professions curricula are created to prepare learners to effectively address health issues affecting individ uals and their communities. Ideally, curricula emphasize the predominant biopsychosocial influences impacting the health of diverse populations. However, despite decades of investment and advances in educational research and design, we have failed to create a health professional workforce capable of equitably meeting the health care needs of the public. Particular communities, geographic regions, and patients with stigmatized diagnoses continue to be underserved, and the potential contributions of multidisciplinary health professionals and advanced practice providers continue to be unrealized within a predominantly physician-centric health care model. Genuine educational transformation requires multidimensional, iterative strategies used to meaningfully evolve traditional classroom curricula, break from the implicit and "hidden" curricula, and enrich the educational ecosystem in which all operate. This manuscript elaborates the construct and process of "educational ecosystem transformation" as a tool for the evolution of the educational ecosystem and its situated curriculum that will eventually drive the enrichment of the healthcare workforce. Drawing from traditional models of curriculum development, recent work on transforming the hidden curriculum, the clinical learning environment, and change management strategies, this new approach uses a health equity and structural competence lens to interrogate and deconstruct a learning system in order to identify opportunities to change, strengthen, and deepen a learner's experience around a specific topic. This process requires an in-depth, multidimensional assessment followed by the identification of key change targets and a stepwise, iterative plan for improvement and transformation. The topic area of substance use disorders (SUD) is used to illustrate how this complex process might be employed to improve the quality of care, realize and amplify the contributions of the entire healthcare team, stimulate interest in addiction medicine as a career, and reduce the stigma and disparities patients with SUDs often experience.

The experience of meaningful rehabilitation as perceived by people with chronic pain: A phenomenological study

BACKGROUND: People with chronic pain may seek rehabilitation to reduce pain and restore productivity and valued roles. Theoretically, a biopsychosocial approach makes rehabilitation more meaningful, however, the limited research on meaningful rehabilitation predominantly describes the perspective of therapists and researchers. The client’s perspective of meaningfulness in rehabilitation is lacking. OBJECTIVE: To investigate the experience of meaningfulness in rehabilitation from the perspective of people with chronic pain. METHOD: Qualitative, semi-structured interviews were conducted with Australian adults who had chronic pain and recent experience of occupational therapy or physiotherapy. Sampling continued until thematic saturation occurred. Transcripts were coded and analyzed using theory-driven and data-driven thematic analysis. RESULTS: Ten participants (four males; six females) were interviewed. Pain histories ranged from nine months to 20+ years, with conditions such as fibromyalgia or trauma. Three themes from a prior concept analysis were upheld, and a further three data-driven themes emerged. Results indicate that people with chronic pain seek a “genuine connection”; from a therapist who is “credible”; and can become a “guiding partner”, and they find rehabilitation meaningful when it holds “personal value”; is “self-defined”; and relevant to their sense of “self-identity”. CONCLUSIONS: The genuine connection and guiding partnership with a credible therapist, that is sought by people with chronic pain, may be at odds with aspects of contemporary rehabilitation. Client-defined meaningfulness is an important construct to engage clients in treatment and improve work and other occupational outcomes for people with chronic pain.

The relationship between attitudes to homelessness and perceptions of caring behaviours: a cross-sectional study among women experiencing homelessness, nurses and nursing students

Background

Women experiencing homelessness have complex and multifaceted healthcare needs and yet they are an underserved population across healthcare services. Nurses are trained to perform an integral role in the provision of equitable healthcare and their attitudes towards homelessness may therefore influence the care that women experiencing homelessness receive. This study aimed to examine correlations between attitudes towards homelessness and caring behaviours, and to test if these correlations differed between the groups of women experiencing homelessness, registered nurses, and nursing students.

Methods

A cross-sectional design using convenience sampling was used to recruit women experiencing homelessness (n = 37), registered nurses (n = 90), and nursing students (n = 138) in Stockholm, Sweden between August 2019 and December 2020. The participants answered two questionnaires: the Attitudes Toward Homelessness Inventory and the Caring Behaviours Inventory-24. Correlations between ordinal variables were calculated using Spearman’s rank correlation ρ. Tests of equality between two independent correlations were performed using a Z-test applied to Fisher’s z-transformed correlations. An advisory board of women with lived experience of homelessness supported the interpretation of the results.

Results

Weak, negative correlations were identified between the Attitudes Toward Homelessness Inventory and Caring Behaviours Inventory-24. The Attitudes Toward Homelessness Inventory mean total scores (SD) were 4.1 (0.6), 4.2 (0.6), 4.1 (0.5) points for the women experiencing homelessness, registered nurse, and nursing student groups, respectively, with the corresponding scores for the Caring Behaviours Inventory-24 being 4.1 (1.1), 5.2 (0.5), 4.8 (0.7) points, respectively.

Conclusions

To promote equitable health for women experiencing homelessness, healthcare providers and nurse educators should consider the role of stigmatising attitudes in relation to caring behaviours.

The relationship between social media usage by undergraduate nursing students and development of their professional identity: A correlational study

BACKGROUND

How nursing students perceive themselves as potential nurses in the future is defined as their nursing professional identity. Many undergraduate nursing students present positive attitudes regarding the use of social media. However, the influence of social media usage by undergraduate nursing students on the development of their professional identity is yet to be determined.

OBJECTIVE

To determine the relationship between social media usage by undergraduate nursing students and the development of their professional identity.

DESIGN

Descriptive, correlational, cross-sectional study.

SETTING(S)

Two universities in western Saudi Arabia.

PARTICIPANTS

Undergraduate nursing students who used social media.

METHODS

An online questionnaire was designed, and its contents were validated. It was then distributed via a Qualtrics link to students' email addresses and via social media between 4th September 2019 and 28th October 2019. Descriptive analysis including frequencies, percentages, medians, and interquartile ranges were reported. Additionally, a number of non-parametric tests were conducted to investigate the relationships in question.

RESULTS

In total, 484 questionnaires were included in the analysis. The participants who used social media for educational (p = 0.004), or for professional purposes (p = 0.015) had high scores on the PI scale. The professional identity scores were also positively associated among the participants who followed nurses (p < 0.001), shared their nursing experiences (p < 0.001), and acted as societal educators about the nursing profession (p < 0.001) on social media platforms.

CONCLUSIONS

Engagement with social media positively influenced undergraduate nursing students in the development of their professional identity. However, it is notable that the pedagogy of nursing education has been slow to adopt social media into nursing curricula. Nursing students require guidance in terms of how to use social media for their professional development.

Effectiveness of a professional identity promotion strategy for nursing students during the COVID-19 pandemic: A quasi-experimental study

Aim

To evaluate the effectiveness of a professional identity promotion strategy (PIPS) on nursing students' professional identity and resilience.

Methods

This study was a quasi‐experimental study with a random cluster sample of 103 sophomore undergraduate nursing students. One hundred students answered the questionnaires at both baseline and follow‐up (51 of 53 in the intervention group and 49 of 50 in the control group). Intervention and control groups underwent 5 months PIPS and standard professional education from May 2 to September 27, respectively. Participants completed the professional identity questionnaire for nursing students (PIQNS) and Connor–Davidson resilience scale (CD‐RISC). Data were collected at baseline (T0), after the intervention (T1) and 3 months after the intervention (T2), and analyzed using the Chi‐squared test, Fisher's exact test, and repeated‐measures analysis of variance.

Results

There were no significant differences between the two groups (p > .05) regarding demographic questions, professional identity, or resilience at baseline (p > .05). Significant differences were found in professional identity between groups (p < .001), measurement times (p = .026), and in the interaction between groups and measurement times (p = .018) from T0 to T2. Significant differences were found in resilience between groups (p < .001), measurement times (p = .007), and in the interaction between groups and measurement times (p = .035) from T0 to T2.

Conclusions

The PIPS program improved nursing students' professional identity and resilience. Further long‐term effectiveness of the program needs to be tested with implementation through various forms of mobile technology.

Cross-sectional Study of the Relationship between Experiences of Incivility from Staff Nurses and Undergraduate Nursing Students’ Sense of Belonging to the Nursing Profession

AIM

This study examined the frequency of incivility for undergraduate nursing students and the relationship between staff nurse incivility and nursing students' sense of belonging. Factors between program semester and students' body mass index (BMI) to staff nurse incivility and students' sense of belonging were assessed.

BACKGROUND

Sense of belonging enhances belonging development to the profession. However, no studies address the relationship between incivility and nursing students' sense of belonging.

METHODS

A cross-sectional design assessed the relationship between staff nurse incivility and undergraduate nursing students' sense of belonging to the nursing profession. An online survey was administered to 123 pre-licensure junior and senior undergraduate nursing students from February 1, 2021, to May 5, 2021. Correlation coefficient, descriptive statistics, Fisher r-to-z transformation, 95% confidence intervals were calculated.

RESULTS

Staff nurse incivility inversely correlated with undergraduate nursing students' sense of belonging (rs=-.358; p <.001). American Indian or Alaskan Native students reported the highest mean frequency of incivility (1.25 ± .421). There were no significant differences in correlations based on semester or BMI.

CONCLUSION

Staff nurse incivility is inversely associated with sense of belonging in students. Further research is needed to test interventions mitigating the effects of incivility on belonging.

A vulnerable journey towards professional empathy and moral courage

Background: Empathy and moral courage are important virtues in nursing and nursing ethics. Hence, it is of great importance that nursing students and nurses develop their ability to empathize and their willingness to demonstrate moral courage. Research aim: The aim of this article is to explore third-year undergraduate nursing students’ perceptions and experiences in developing empathy and moral courage. Research design: This study employed a longitudinal qualitative design based on individual interviews. Participants and research context: Seven undergraduate nursing students were interviewed during or immediately following their final clinical placement. Ethical considerations: The Norwegian Social Science Data Services (NSD) approved the study. Participants were informed that their participation was voluntary and were assured confidentiality. They were informed that they could withdraw from the study at any time, without providing reasons. Findings: Affective empathy seemed to be strong among third-year undergraduate nursing students. However, they tried to handle the situations in a ‘professional’ way, and to balance their emotions. At the same time, they expressed how difficult it can be to show moral courage when confronted with poor patient care. In addition, they spoke about a lack of role models during clinical practice and supervision. Conclusions: Undergraduate nursing students are in a vulnerable position throughout their journey to become professional and to develop empathy and moral courage. The professional socialisation and forming of professional empathy and moral courage among nursing students, may be seen as a complex interaction of formal and hidden curriculum, where role models play an important role. We argue that the main theme ‘Vulnerable students – a journey towards professional empathy and moral courage’ may cover the longitudinal project as a whole. This vulnerability is something both teachers and supervisors should be aware of when following up with students in their clinical placements.

Facilitators of professional socialisation of learners in the clinical learning areas: A qualitative systematic review

Background

Professional socialisation is significant in nursing as it involves immersing learners in the profession so that they adopt the ethical values and conduct of the profession. It is in the clinical learning areas where learners observe and practise those values. The objective of the review was to explore the factors that promote professional socialisation of learners in the clinical learning areas. The problem is the inadequate support for learner nurses in the clinical learning areas. The South African community has lost trust in nurses and that was even acknowledged in the national nursing summit in 2011.

Objectives

To present a review of the factors that facilitate professional socialisation among undergraduate nursing learners.

Method

A systematic review was conducted on literature from 2008 to 2018. The literature search focused on factors that facilitate professional socialisation of learner nurses. A search of databases was conducted in CINAHL, MEDLINE, Google Scholar and Science Direct. The search focused on literature on professional socialisation of learner nurses published from 2008 to 2018. The search resulted in 3035 articles which were further reduced to 13 after further synthesis. Critical appraisal skills programme was used to assess the quality of the studies.

Results

Three main themes emerged. Learner factors, factors in the clinical learning areas and interpersonal factors were identified as the factors that facilitate professional socialisation of learners.

Conclusion

Learners should have self-motivation and be supported and assisted to develop a positive professional identity. The clinical learning environment should have effective communication that fosters learning. Professional nurses should act as exemplary role models so that learners can emulate the conduct and practice. The review brought to light that the professional socialisation of learners is affected by the learner factors, clinical learning areas and personal factors.

Unobserved Observers: Nurses' Perspectives About Sharing Feedback on the Performance of Resident Physicians

PURPOSE

Postgraduate training programs are incorporating feedback from registered nurses (RNs) to facilitate holistic assessments of resident performance. RNs are a potentially rich source of feedback because they often observe trainees during clinical encounters when physician supervisors are not present. However, RN perspectives about sharing feedback have not been deeply explored. This study investigated RN perspectives about providing feedback and explored the facilitators and barriers influencing their engagement.

METHOD

Constructivist grounded theory methodology was used in interviewing 11 emergency medicine and 8 internal medicine RNs at 2 campuses of a tertiary care academic medical center in Ontario, Canada, between July 2019 and March 2020. Interviews explored RN experiences working with and observing residents in clinical practice. Data collection and analysis were conducted iteratively. Themes were identified using constant comparative analysis.

RESULTS

RNs felt they could observe authentic day-to-day behaviors of residents often unwitnessed by supervising physicians and offer unique feedback related to patient advocacy, communication, leadership, collaboration, and professionalism. Despite a strong desire to contribute to resident education, RNs were apprehensive about sharing feedback and reported barriers related to hierarchy, power differentials, and a fear of overstepping professional boundaries. Although infrequent, a key stimulus that enabled RNs to feel safe in sharing feedback was an invitation from the supervising physician to provide input.

CONCLUSIONS

Perceived hierarchy in academic medicine is a critical barrier to engaging RNs in feedback for residents. Accessing RN feedback on authentic resident behaviors requires dismantling the negative effects of hierarchy and fostering a collaborative interprofessional working environment. A critical step toward this goal may require supervising physicians to model feedback-seeking behavior by inviting RNs to share feedback. Until a workplace culture is established that validates nurses' input and creates safe opportunities for them to contribute to resident education, the voices of nurses will remain unheard.

The best of both worlds - entering the nursing profession with support of a transition programme

BACKGROUND

Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition.

AIM

The phenomenological study aimed to describe newly graduated nurses' expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers.

METHOD

The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology.

FINDINGS

"Expectations of transition into the nursing profession via the Clinical Nursing Introduction Programme" is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge.

CONCLUSION

Transitioning into the nursing profession via the Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers

PURPOSE

The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment.

DESIGN/METHODOLOGY/APPROACH

Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis.

FINDINGS

Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles.

PRACTICAL IMPLICATIONS

Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care.

ORIGINALITY/VALUE

This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.

Student nurse socialization: A model of professional discourse adoption

AIM/OBJECTIVE

Through an exploration of student nurses and lecturers' professionalism discourses, this study illuminates influences on professional socialization and offers an appreciation of the processes of language (discourse) adoption involved.

BACKGROUND

Professionalism is a complex concept to define. Nursing research has predominantly explored professionalism in clinical practice; however, the time spent university is key to professional socialization and identity development. Previous research focused on socialization in the clinical area only. This study examined how student nurses and their lecturers construct their talk regarding professionalism while at university.

DESIGN

A social constructionism approach was adopted, where it is assumed that we jointly construct our world on shared assumptions and that language is central to this process.

METHODS

Employing a Discourse and Social Psychology (DASP) approach to discourse analysis, seven nursing students (Adult, Child, and Mental Health fields) and eight lecturers participated in a total of 16 interviews.

RESULTS

The findings indicated participants drew on several interpretative repertoires. These changed over the 3 year degree. Analysis led to development of a Model of Professional Discourse Adoption, illustrating a three phased process, resonating with theories of professional socialization in nursing.

CONCLUSIONS

The study offers insights into how education strategies may support learning and teaching, and professionalism communication.

Professional identity, wellness, and future hope among nurse interns in Egypt

Objective

Since nursing is a performance-based profession, clinical learning environments play an important role in the acquisition of professional abilities and train nursing students to enter the nursing profession and become a registered nurse. The study aimed to investigate the relations among professional identity, wellness, and future hope in nurse interns.

Methods

A cross-sectional, analytic, descriptive, correlational study design was used to test these relations in the study where 210 nurse interns’ students were selected using a convenience sampling from Zagazig University hospitals and Suez Canal University hospitals in Egypt. The questionnaires consisted of 4 parts, namely demographic characteristics, Professional Identity Scale for Nursing Students (PISNS), Holistic Health and Wellness Survey, and Hope scale.

Results

Less than half of the study sample had chosen nursing specialty by own will (43.8%), while slightly more than half of them had a “very good” graduation level, and had no nursing role model. The lowest mean professional identity score was for independence in career choice while the highest was for social modeling. The reported physical wellness mean-score was the least, while social wellness was the highest. Professional identity, wellness, and future hope scores differed significantly based on nurse interns’ personal characteristics. There were statistically significant, positive, weak-to-moderate correlations among the scores of professional identity, wellness, and future hope; however, the “choice of nursing study by own will” was a statistically significant independent positive predictor of the scores of professional identity, wellness, and future hope.

Conclusions

Nurse interns’ professional identity, wellness, and future hope were positively inter-correlated. However, nurse interns’ wellness was the lowest, and it should be fostered as it was the main predictor for future hope. The internship programs should be modulated to improve nurse interns’ professional identity, particularly regarding independence, and should foster their well-being in the clinical environment.

A discursive study exploring the professional identities of registered nurses employed in older person residential care settings

BACKGROUND

The phenomenon of an ageing population is being experienced globally requiring the ongoing provision of residential care services. A large number of registered nurses work in these settings; however, many challenges exist in their recruitment and retention.

OBJECTIVES

To explore professional identities and emerging discourses of registered nurses working in older person residential care settings.

METHODS

This study employed a discursive-based research methodology with a central focus on the role language, and discourses play in identity construction. Fourteen in-depth narrative interviews were completed with registered nurses in residential care settings in the Republic of Ireland. Thematic analysis was underpinned by a critical discursive psychology framework.

RESULTS

Four key identities and related discourses emerged: 'skilled professional identity', 'person-centred identity', 'subordinate identity' and 'product of healthcare reform identity'. Discourses presented contrasting professional identities held by nurses in residential care settings; on the one hand, they employed positive professional and person-centred discourses, while on the other hand, tensions associated with healthcare reform and a subordinate identity exist.

CONCLUSIONS

This study presents unique insights into how registered nurses in residential care construct their professional identity and in doing so, enhances opportunities to promote recruitment and marketing in this setting. Equally, the challenges and opportunities of healthcare reform require sensitive management so that the professional identity of nurses working in residential care is enhanced and protected.

IMPLICATIONS FOR PRACTICE

How registered nurses working in residential care settings view their professional identity directly impacts on attitudes and behaviours and the subsequent delivery of care. Greater understanding and insight into how they construct their professional identity may enhance recruitment and retention initiatives. Study results also provide an opportunity for policymakers and service providers to create more positive working environments that promote professional identity development for this nursing group.

Graduate Nurse Transition Programs Pivotal Point of Participants' Practice Readiness Questioned During the COVID-19 Pandemic Crisis: A Scoping Review

BACKGROUND

The COVID-19 pandemic requires an accessible, practice-ready nursing workforce to assist with the increase in health service delivery. Graduate nurse transition programs are the entry point for most graduates into professional practice, and this review focused on both empirical studies and gray literature to identify at what point practice readiness occurs and what can assist graduate nurses' transition to become practice ready.

METHOD

A scoping review was conducted using the Joanna Briggs Institute scoping review framework.

RESULTS

Consensus purports supportive environments, ideally in formal structured graduate transition to practice programs, to enhance graduate nurses' clinical skills and confidence development. With nursing confidence and competence gained through professional practice experience, it is apparent that for a sustainable nursing workforce, greater access for graduating nurses to transition programs is imperative.

CONCLUSION

Recommendations include restructuring transition programs with possible time reductions, limited rotations, comprehensive orientations inclusive of preceptorship, and dedicated educators to increase and enhance supportive graduate nurse transitions. [J Contin Educ Nurs. 2021;52(8):392-396.].

Unprofessional practice and student professionalism dilemmas: What can radiography learn from the other health professions?

OBJECTIVE

Professionalism in radiography is a complex, multidimensional concept seldom investigated. During clinical placements, students may observe or be involved in unprofessional practice/professionalism lapses which result in professionalism dilemmas. Establishing what constitutes a professionalism dilemma and what action to take may be challenging for students and also practitioners. This is due to unclear reporting pathways and fear of retribution, both deterrents to raising concerns. The aim of this integrative literature review was to investigate how and why professionalism dilemmas occur. In addition, to explore the types of dilemma students experience during clinical placement and to contextualise and reflect on these findings within radiography. Ovid MEDLINE, PubMed, Google Scholar and the grey literature were reviewed, analysed and themed.

KEY FINDINGS

Twenty-eight papers (published between 2004 and 2020) were analysed and summarised. Four themes emerged, and were discussed within the radiography context; the nature of professionalism lapses (mistreatment, verbal abuse, exclusion and intimidation), reasons for professionalism lapses (burnout and poor role modelling), student response at the time of the professionalism dilemma (accept, resist or report) and long-term impacts on students (moral/emotional distress, professional development and choice of career).

CONCLUSION

Professionalism dilemmas are not reported in the radiography literature but are cited in radiology and other health professions studies. Student experiences of such dilemmas can be profound and long lasting. Thus, research is required to investigate specifically the professional dilemmas experienced by radiography students in the unique environment in which they develop their clinical skills.

IMPLICATIONS FOR PRACTICE

The literature review findings can be used to support the development of strategies to enhance future teaching and modelling of professionalism and develop related research in radiography.

The development of nurses' foundational values

BACKGROUND

In the ever-changing and complex healthcare environment, nurses encounter challenging situations that may involve a clash between their personal and professional values resulting in a profound impact on their practice. Nevertheless, there is a dearth of literature on how nurses develop their personal-professional values.

AIM

The aim of this study was to understand how nurses develop their foundational values as the base for their value system.

RESEARCH DESIGN

A constructivist grounded theory methodology was employed to collect multiple data sets, including face-to-face focus group and individual interviews, along with anecdote and reflective stories.

PARTICIPANTS AND RESEARCH CONTEXT

Fifty-four nurses working across various nursing settings in Indonesia were recruited to participate.

ETHICAL CONSIDERATIONS

Ethics approval was obtained from the Monash University Human Ethics Committee, project approval number 1553.

FINDINGS

Foundational values acquisition was achieved through family upbringing, professional nurse education and organisational/institutional values reinforcement. These values are framed through three reference points: religious lens, humanity perspective and professionalism. This framing results in a unique combination of personal-professional values that comprise nurses' values system. Values are transferred to other nurses either in a formal or informal way as part of one's professional responsibility and customary social interaction via telling and sharing in person or through social media.

DISCUSSION

Values and ethics are inherently interweaved during nursing practice. Ethical and moral values are part of professional training, but other values are often buried in a hidden curriculum, and attained and activated through interactions during nurses' training.

CONCLUSION

Developing a value system is a complex undertaking that involves basic social processes of attaining, enacting and socialising values. These processes encompass several intertwined entities such as the sources of values, the pool of foundational values, value perspectives and framings, initial value structures, and methods of value transference.

Perceptions and experiences of nurses transitioning to primary care: A qualitative study

BACKGROUND

Transitioning to primary care is a highly stressful process for nurses due to the diverse roles and responsibilities required. Despite the global shift of health services requiring more nurses in primary care, there is a dearth of literature regarding their transition experiences.

AIM

To explore the perceptions and experiences of nurses transitioning to primary care.

METHODS

A qualitative descriptive design was used. Nineteen nurses from five primary care clinics in Singapore participated in the semi-structured interviews. These interviews gathered the experiences of nurses transitioning to primary care. Interviews were analysed using thematic analysis through an inductive and theoretical approach. Rigour was established through an audit trail, peer examination and member checking.

FINDINGS

Three themes of Idealistic assumptions, Role realignment and Seeking enlightenment emerged. These themes described the nurses' initial disorientation to the unfamiliar primary care setting; their attempts to fit in by embracing the new environment and suppressing their true emotions; and the support received coupled with their ownership to learn.

IMPLICATIONS FOR NURSING POLICY

The findings highlight the importance for nurse managers to promote positive transition experiences through the modification of existing support programmes and organizational cultures. To further enhance the nurses' retention within primary care, it is imperative for nurse educators and policy makers to revise the nursing curricula, primary care nursing career framework and recruitment campaigns at the national level. This brings clarity to the misconceptions in the roles and expectations required of nurses in primary care.

Clinical teachers' perceptions of role modeling: a qualitative study

BACKGROUND

Role modeling has been significantly considered in medical education in recent decades. In the clinical course, students learn necessary skills and accordingly their professional identity is formed by observing and working among clinical educators. Given the importance of the role modeling in medical education, in the present study, it was attempted to explore the clinical teachers' perceptions of being a role model for medical students using a qualitative method.

METHODS

A qualitative design, based on the content analysis approach, was used to analyze the perspectives of 15 clinical teachers. Participants were chosen by purposeful sampling. Data were collected using reflection paper writing.

RESULTS

During the data analysis, five main categories emerged: influencing others, developing different dimensions of student, situational self-awareness, feedback and continuous effort.

CONCLUSIONS

This study will be useful to form role modeling educational programs. Encouraging clinical teachers to make continuous efforts to improve role modeling and educating time management and self-control skills can help reduce the challenges of role modeling for clinical teachers.

Being and becoming a nurse: Toward an ontological and reflexive turn in first-year nursing education

In this paper, we call for an ontological and reflexive turn in first-year nursing education. An ontological turn focuses on formation, the 'being' and 'becoming' of a nurse, and emphasizes the value of nursing knowledge. First-year nursing students often possess romanticized ideals about being a nurse that devalues the knowledge and expertise of nurses. We posit a thoughtful ontological orientation within nursing education that shifts the emphasis toward becoming skillful nurses, with expertise grounded in nursing perspectives. A focus on formation includes discussions regarding ideologies, dominant perspectives, and reflexive explorations of students' views of nursing juxtaposed with the realities of nursing practice. We propose ontologic reflexivity as an approach to consider what perspectives are prioritized (or not) within the nursing classroom. Within pedagogical dialogic spaces, ontologic reflexivity calls on educators to create opportunities for students to learn the value of nursing knowledge along with other forms of knowledge. We consider ways in which an ontological and reflexive turn within the first year of nursing education may contribute to the formation of nursing students who value nursing knowledge, are open-minded to various forms of knowledge, and possess an intentional reflexive way of being.

Solidarity in a Community of Nursing Colleagues

Introduction

Several concepts have been used to describe the qualities of communities of nursing colleagues. Nonetheless, few studies have shed light on nursing communities by drawing on the concept of solidarity.

Objective

To explore solidarity among a community of nursing colleagues.

Methods

A qualitative research design with a reflective life world approach was selected. This study reused data from a larger Norwegian empirical study. The data from the original study consisted of qualitative interviews and follow-up interviews with 13 nurses (RNs). The research context was municipality and specialist health services. A secondary data analysis was conducted. The study was based on the SRQR reporting guidelines.

Results

The results were formulated under two themes: 1) having indispensable relationships and 2) encountering a relative absence of sympathy.

Conclusion

A sense of community among nursing colleagues seems to rely on solidarity: whatever affects one nurse affects another. The solidarity that arose from the content of commonalities involved maintaining indispensable relationships with nursing colleagues by supporting and aiding them and simultaneously enduring a relative absence of sympathy. Solidarity among the community in this study was not a peripheral concept of the general notion of solidarity, implying that the commonalities within the collegial relationships were ambiguous and could shift from something good to something relatively good and vice versa. Such a shift was evidenced by nurses’ experiences of their community.