The hidden curriculum in nursing education: a scoping study

Gender inclusive and affirming practices across undergraduate nursing curriculum: A scoping review

OBJECTIVES

There are increasing calls for gender affirming care, yet there remains uncertainty as to how nursing education is preparing students. The purpose of this scoping review was to map gender inclusive and affirming practices across the three levels of curriculum (formal, informal, and hidden) in the education of undergraduate nursing students. This novel approach allows consideration of transgender and gender diverse nurses (students and educators).

DESIGN

Scoping review as per Arksey and O'Malley and Levac et al. DATA SOURCES: Four databases (Medline, Embase, CINAHL, and Scopus) were searched for literature that addressed transgender and gender diversity, discussed at any level of curriculum. In addition, we searched key schools of nursing websites for inclusion of gender inclusive and affirming practices in documents and faculty profiles. We limited our search of peer-reviewed articles and websites to those in English, from Canada and the USA.

REVIEW METHODS

The article search and extraction were conducted by two independent reviewers while the school of nursing websites were searched by the lead author.

RESULTS

Forty-seven articles were included and categorized as either (a) Doing (n = 32) (formal, intervention-based) or (b) Thinking (n = 15) (discussion- or evaluation-based) gender inclusive and affirming practices. Twenty-five of the intervention-based articles were single-instance occurrences of learning, primarily by simulation (n = 17). Recommendations at each level of curriculum are offered. Of the 22 schools of nursing websites searched, less than 2 % of faculty profiles list pronouns.

CONCLUSIONS

While there has been an uptake of formal interventions on gender affirming care there remains a gap in addressing gender inclusive and affirming practices at the informal and hidden curriculum levels. Gender inclusive and affirming practices across all levels of nursing education can help advance culturally safe practices for TGD patients and experiences for TGD nurses and students.

The influence of supervisory support on clinical learning as experienced by Czech Nursing and health professional students in the context of patient safety events: A qualitative study

AIM

To explore the influence of supervisory and mentoring relationships on the clinical learning experiences of Czech Nursing and health professional students in the context of patient safety events BACKGROUND: Clinical experience is integral to healthcare education, shaping skills, behaviours, values and professional identity. During clinical placements, students may encounter memorable patient safety events and experience varied reactions from mentors/supervisors/others. Some research has highlighted challenges faced by students on clinical placement. Few studies involve multiple professions, most emanating from Western Europe, the UK, the USA and Australia with little relating to central European countries such as the Czech Republic.

DESIGN

Two stage interpretivist qualitative study based in social constructionism METHODS: Convenience sample across 13 undergraduate and 18 postgraduate health professions courses. Stage 1 (2022): using SLIPPS Learning Event Recording Tool translated into Czech. 20 students' (Midwifery=11, Nursing=1, Paramedic=1, Occupational therapy =7) submitted 21 patient safety learning event narratives. Stage 2 (2022): Focus group with 2 nursing and nine midwifery students. Phased thematic analysis involving multiple researchers.

RESULTS

Three themes illustrate the circumstances and impact of placement mentoring/supervision experiences, conceptualised as: 'Clinical and Emotional Companionship', 'Clinical and Emotional Abandonment' and 'Sense of agency - Professional and personal growth'. 'Companionship' reflected the students' feelings of being welcomed, respected, heard, trusted and supported. Conversely 'abandonment' emerged from feelings of being unheard, vulnerable, humiliated, afraid, leaving students feeling abandoned, lonely and 'useless'. Notwithstanding these conditions, students showed the ability to identify patient safety issues with agency evident in reactions such as stepping-in to try to ameliorate a situation, rather than speaking-up. Professional and personal growth was also apparent in their narratives and a conceptual diagram illustrates the students' learning journeys in a patient safety context.

CONCLUSION

The findings and new conceptualisations around abandonment and companionship emerging from this study expand the evidence base regarding the profound impact of clinical experience and mentorship/supervision on learning and students' emotional wellbeing. A sense of companionship appears to play a buffering role even in challenging circumstances of involvement in or witnessing compromised patients' safety. Allowing students a sense of belonging, to vent, grow, feel supported and safe to ask/learn - contributing to 'emotional safety for learning', promotes students' behaviour that may prevent/minimize hazards or ameliorate the aftermath. However, we must not simply blame mentors/supervisors, staff, or the students themselves- they are simply part of a much larger complex environment of professional education encompassing hidden curriculums, power dynamics and professional socialisation.

Knowledge and training among nursing students regarding the conspiracy of silence in palliative care: A participatory action research

AIM

To develop and implement specific training based on the knowledge and management of conspiracy of silence among nursing students.

BACKGROUND

Conspiracy of silence refers to the concealment of information from a patient on the family's request, under the influence of a paternalistic culture that seeks to protect the patient.

DESIGN

Participatory action research.

METHODS

Was conducted in the following stages: reconnaissance (focus groups); planning, action and observation (theoretical sessions); and reflection (analysis of care plans). The focus group consisted of six fourth year and eight second-year students. The intervention was conducted with 42 s-year students and a total of 93 s-year students participated in the resolution of the clinical case. The study was conducted between October 2022 and June 2023 at the Faculty of Nursing, University of Valencia. For data analysis, the process described by Carrillo et al. (2011) was followed, involving coding and the creation of categories and subcategories.

RESULTS

The focus group deficiencies were detected in the students' learning of palliative care competence, breaking bad news and the conspiracy of silence (reconnaissance stage). Therefore, an intervention was conducted to reinforce these knowledge areas, specifically addressing the conspiracy of silence (planning, action and observation stages). The resolution of the case showed how students with training approached the situation more comprehensively, including the family and proposed activities that were consistent with managing the situation (reflection stage).

CONCLUSIONS

An active feedback process was successfully established, where the students' feedback helped create specific training on oncological palliative care and provided the students with tools to manage the conspiracy of silence. The results underscore the importance of providing students with training in palliative care and managing conspiracy of silence, through therapeutic communication training, active training or enhancing emotional intelligence. This training is essential for cultivating the attitudes and skills required to deliver high-quality palliative care.

Decolonizing nursing education: Reflecting on Paulo Freire's pedagogy of the oppressed

Historically, nursing education's foundation has been framed by colonial practices of whiteness, which serves as a fulcrum for oppression, Western epistemic ideology, racial injustice, and health inequity. As a microcosm of the broader academy, nursing education must pivot to dismantle practices impeding the advancement of the profession and move to decolonize processes of professional edification. Decolonization is not a metaphor; it requires unlearning the deep socialization of Eurocentric perspectives embedded in nursing education and relearning in a new, inclusive manner that embraces historically marginalized knowledge systems and experiences. This paper aims to operationalize what this decolonization process would look like for nursing education while reflecting on Paula Freire's Pedagogy of the Oppressed. The authors will highlight the interrelationship of the main concepts of Paulo Freire's critical pedagogy, including liberation, critical consciousness, dialog, humanization, dehumanization, problem posing, and banking education.

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.

Psychiatric nurse and educator perspectives on professional boundaries in nursing education: An interpretive description study

BACKGROUND

Psychiatric nurses are responsible for maintaining professional boundaries. However, professional boundaries are as described as unclear and psychiatric nursing students are at risk of crossing these boundaries. Educational instruction regarding professional boundaries within psychiatric nursing often lacks foundational structure placing students at risk of transgressions.

PURPOSE

The purpose of the study was to describe boundaries in psychiatric nursing practice, identify strategies effective in teaching professional boundaries, and inform curriculum development in psychiatric nursing education.

METHOD

Interpretive description was utilized to answer: How do psychiatric nurse educators interpret and explain professional boundaries in psychiatric nursing undergraduate education? Psychiatric nurse educators and psychiatric nurses were recruited from an academic institution in western Canada. Twenty participants engaged in semi-structured interviews. Eight of those participants also attended a focus group.

RESULT

Participants reported that 'textbook' definitions of boundaries were insufficient in illustrating the complexities of the construct. Rather, relational forms of learning such as educators sharing clinical stories, role play activities, clinical supervision, and clinical debriefing were described as helpful strategies.

CONCLUSION

Foundational knowledge regarding professional boundaries in psychiatric nursing practice appears to be incorporated in the formal curriculum. However, learning is enhanced through the informal and hidden curriculum.

The Lived Experience of Play and How It Relates to Psychological Wellbeing: An Interpretive Phenomenological Analysis (IPA) Study Amongst Undergraduate Students from Medicine, Nursing, and Allied Health Professions' Programmes in the United Kingdom

Current literature acknowledges that undergraduate students undertaking programmes in medicine, nursing, and allied health professions experience occupational stress which presents as a detriment to mental health, psychological wellbeing (PWB), and burnout. Strategies to improve the wellbeing of students have been slow to embed and have had limited impact, indeed the issue of declining wellbeing amongst this group is escalating. Studies from the business literature suggest that organisations that foster a playful environment reap benefits in terms of employee wellbeing. This interpretive phenomenological analysis (IPA) study explored the lived experiences of play amongst undergraduate students from medicine, nursing, and allied health professions' programmes in the clinical practice setting. The resultant findings offer some unique empirical insights into the types of play that the students engaged in, ranging from informal banter with peers and patients to artful, sophisticated, cocreated play. The study also revealed insights about the factors which facilitate play, notably the "big personalities" on the ward. The factors which limited play are related to the tension between being a health professional and the enactment of play as well as hierarchical factors. Crucially, the study found that the practice of play induced key hedonic and eudaimonic PWB benefits to the students, ranging from positive affect to improved relationships, a sense of meaning, and a positive learning environment, offering original empirical insights. These findings have not been observed previously and shine a conceptual light on a previously unknown phenomenon.

Ethnic inequalities during clinical placement: A qualitative study of student nurses' experiences within the London National Health Service

AIM

To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups.

DESIGN

A qualitative thematic analysis with an inductive approach.

METHODS

Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement.

RESULTS

Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as "ward culture") providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS.

CONCLUSION

These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity.

IMPACT

Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.

Learning to provide humanistic care and support in the context of chronic illness: Insights from the narratives of healthcare professionals in hemato-oncology

PURPOSE

To document the process by which healthcare professionals (HCPs) support people living with and beyond hematological cancer and detail how they learned from their personal and clinical experience.

METHOD

Using a narrative approach, we conducted nine semi-structured interviews with HCPs, including nurses, from a specialized care centre who support patients with hematological cancer. Interviews aimed to capture experiential learning gained from their practice. We performed a hybrid inductive/deductive content analysis on data using a framework based on sociological and educational models of experiential learning.

RESULTS

Among healthcare professionals, analysis revealed the need to provide care and support that is 'humane' and adapted to each patient. Learning to provide this type of care proved to be challenging. Over the course of their clinical experience, healthcare professionals learned to adapt the support they provided by straddling a boundary between sympathy and empathy. Learning outcomes were associated with personal-professional development among participants.

CONCLUSION

Our findings bring to light an overlooked facet of patient support in the context of cancer care, which is the acquisition of the soft skills required to deliver humanistic care and support. This learning process requires time and involves navigating between the realms of sympathy and empathy. Experiential learning is intertwined with the complexity of the often long-term patient-professional relationship that characterizes hemato-oncology. This unique relationship offers rewards for healthcare professionals on both personal and professional fronts.

Nursing Students' Perceptions About the Culture of Nursing: A Focused Ethnography Study

AIM

The aim of this study was to gain students' perspectives on the culture of nursing and their enculturation to this professional culture.

BACKGROUND

Newly graduated registered nurses (NGRNs) experience identity shock when transitioning to practice, at great costs to themselves and health care organizations. Understanding how nursing students view their professional culture and the enculturation process can foster professional identity formation and ameliorate NGRN identity shock.

METHOD

This focused ethnography study used focus groups for data collection and Leininger's method of data analysis.

RESULTS

Two themes emerged: 1) descriptors of the culture of nursing and 2) influence of formal and informal learning.

CONCLUSION

Nursing students struggle to define the culture of nursing, contributing to challenges with the enculturation process and leading to identity shock. Intentionally addressing these challenges can help decrease identity shock, promote stronger professional nursing identity formation, and improve the transition to nursing practice.

Pre-registration nursing students' perceptions of a district nursing career: a qualitative descriptive study

District nursing vacancies are recognised as high in comparison to many other nursing specialities. The role is often considered as an option for nurses after a period of registration as a nurse, which may be informed by multiple factors. The objectives of the study were to explore barriers to district nurse employment from the perspective of undergraduate nurses. A descriptive qualitative design was employed using focus groups as the method of data collection in accordance with study approval reference no: 21/NAH/006, 30/03/23. Participants were recruited from the current undergraduate nursing programme (n=60). Thematic analysis was chosen as a flexible method of qualitative data analysis. The study produced themes relating to role ambiguity, personal preferences, educational opportunities and recruitment and employer engagement. The experiences provided an insight into the barriers to recruitment of student nurses into district nursing on qualification. Increased engagement from community nurse providers is required to inform the role and incentivise entering this career option. Educational strategies that support community career pathways are required to ensure a balanced view of nursing roles among undergraduates.

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.

Symbolic access: medical students' awareness of institutional culture and its influence on learning, a phenomenographic study

BACKGROUND

The discussion of access in medical education has its focus largely on physical and epistemological access, leaving a qualitative gap regarding sociocultural factors which enable access in this context. This study introduces and defines symbolic access, a concept with a specific lens on sociocultural inclusion, and the influence it has on student learning within the South African medical education landscape.

METHODS

A phenomenographic design was used to explore students' conceptions of symbolic access and its impact on learning. One-on-one exploratory interviews were conducted with fifteen final year medical students at the University of Witwatersrand in Johannesburg. Interviews were analysed using Sjöström and Dahlgren's seven-step phenomenography model.

RESULTS

Four categories of description were induced, which described students' understanding of symbolic access, these were rejection, disregard, invalidation, and actualization. Four dimensions of variation were discovered expressing the diversity of events which informed the collectives' understanding of the phenomenon. These dimensions were; interactions with educators, peer relationships, educational environment, and race. Categories of description and dimensions of variation formed the Outcome Space, a visual representation of the student experience of symbolic access. The outcome space had a double narrative related to symbolic access; exclusion (major) and actualization (minor). Medical student's chief experience within the medical community was exclusion, however clinical immersion, meaningful participation, peer-relationships, and clinical skills lessons facilitated community enculturation, and impacted learning.

CONCLUSION

Despite deeply exclusionary experiences throughout their programme, medical students articulated a paradox of both awareness and no awareness of symbolic access. The awareness of symbolic access was predominantly influenced by clinical experiences and clinical immersion during the pre-clinical and clinical years of study. Further, descriptions of valuable learning experiences were connected to clinical events and the involvement with patient care. This study suggests that the actualization of symbolic access and description of meaningful learning experiences are linked. Medical educationalists should design undergraduate curricula with early clinical immersion at the fore and explore symbolic concepts pertaining to access, as they are linked to transformative learning experiences for the medical student.

Development of a humanistic care digital storytelling programme for intensive care unit nursing students: Feasibility and satisfaction analysis

BACKGROUND

Humanistic care has become an essential quality for modern nurses. However, previous studies have revealed that nursing students lack adequate preparation to meet the needs of patients in intensive care units using a humanistic care approach.

OBJECTIVES

To develop a humanistic care digital storytelling programme for intensive care nursing students and assess its acceptance and satisfaction among participants through a satisfaction survey.

METHODS

The development of the programme was based on the SHARE framework (S: sense patient's needs; H: help patient out; A: acknowledge patient's feelings; R: respect patient's dignity and privacy; E: explain what is happening) and involved three steps. Content analysis and narrative adaptation were used to develop a series of digital stories illustrating humanistic stories from clinical practice. The preliminary draft of the programme was modified based on Delphi consultation. Finally, the programme was piloted with nursing students and their satisfaction was evaluated using questionnaires. All statistical analyses were performed using Excel 2016 and SPSS 26.0.

RESULTS

Four digital stories were successfully selected and a total of 16 questionnaires were distributed and collected in two rounds of expert consultation. The effective Delphi rate was 100 %. The expert authority coefficients in rounds 1 and 2 were 0.82 and 0.875, respectively. The coefficient of variation for round 1 was 0-0.23, and for round 2, it was 0-0.14. The Kendall's coordination coefficient was 0.119 for round 1 and 0.054 for round 2. The nursing students highly evaluated the programme, with 100 % of participants reporting that the digital stories successfully evoked emotional responses and that they were satisfied with the course duration.

CONCLUSION

A scientifically valid, credible, and satisfactory humanistic care digital storytelling programme was developed for intensive care unit nursing students. The programme provides valuable guidance for nurse educators and scholars seeking to develop effective digital storytelling training programmes.

Barriers to providing quality care for patients with substance use disorders from the perspective of baccalaureate nursing students: A descriptive qualitative study

BACKGROUND

With Iran facing an epidemic in substance use disorders, nursing students are increasingly encountering people impacted by substance misuse. Providing care for this group brings with it many barriers and challenges. These serious barriers have not been a priority in Iranian nurse education.

OBJECTIVES

To describe barriers to providing quality care for people with substance use disorders from the perspective of nursing students.

DESIGN

A descriptive qualitative study, using content analysis was used to address the study aim.

SETTING AND PARTICIPANTS

Purposive sampling was used to recruit participants. Participants were 34 baccalaureate nursing students from different academic semesters studying at two medical sciences universities in Iran.

METHODS

Data were collected using semi-structured interviews from July 2022 to October 2022. Granheim & Lundman's method for qualitative content analysis was used to analyze data.

RESULTS

The barriers to providing quality care for people with substance use disorders were described through the major theme: "lack of communication skills and difficulty finding language for therapeutic communication with people with substance use disorders". Based on nursing student perspectives, a lack of communication and language for therapeutic communication was described through the three barriers of: 1. "possessing or witnessing prejudiced attitudes and stereotypes", 2 "negative role models", and 3. "Knowledge deficit in self or others".

CONCLUSION

The result of this study showed that nursing students interact with people with substance use disorders through prejudiced attitudes, negative stereotypes, and knowledge deficits. Academic education should include practical techniques to reduce negative stereotypes and moral distress among nursing students as well as strategies to manage tough ethical situations and decrease prejudiced attitudes. Nurses and clinical educators must be attentive to their power to influence nursing students and should model appropriate unbiased behavior and language.

Representation of dark skin tones in foundational nursing textbooks: An image analysis

PURPOSE

This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts.

BACKGROUND

The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice.

METHODS

Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone).

RESULTS

Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks.

CONCLUSIONS

Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark.

RELEVANCE TO CLINICAL PRACTICE

All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.

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.

Factors triggering the progressive detachment of nurses toward the fundamental needs of patients: findings from a qualitative study

The progressive desensitization of nurses in relation to fundamental needs (FNs) has been documented in anecdotical, scientific, and policy literature with nurses spending limited time at the bedside, thus affecting the quality of care and clinical outcomes. A potential reason that has been recognized is the limited nursing staff available in the units. However, other cultural, social, and psychological factors which have not been investigated to date may have a role in triggering the phenomenon. To investigate nurses' perceptions of the reasons that progressively detach clinical nurses from the FNs of patients, was the main intent of the study. In 2020, a qualitative study based on grounded theory following the Standards for Reporting Qualitative Research guidelines was performed. Purposeful sampling was adopted, by including 22 clinical nurses designated as 'good nurses' according to the perception of nurses working in executive and academic position. All agreed to be interviewed face-to-face. The detachment of nurses from the patients' FNs has been explained by three main factors that are interconnected: namely 'Being personally and professionally convinced regarding the role of FNs', 'Being progressively detached from the FNs', and 'Being forced to be detached from FNs'. Nurses also identified a category including strategies aimed at preventing detachment and 'Rediscovering the FNs as the core of nursing'. Nurses are personally and professionally convinced about the relevance of the FNs. However, they distance themselves from the FNs due to: (a) factors mainly attributable to internal personal and professional forces, such as the emotional fatigue that daily work entails; and (b) external forces related to the work environment where nurses work. To prevent this detrimental process that may result in negative outcomes for patients and their relatives, several strategies at the individual, organizational, and educational levels should be implemented.

A qualitative exploration of undergraduate nursing students' experience of emotional safety for learning during their clinical practice

BACKGROUND

During their clinical practice, nursing students learn to manage patient safety through their experiences, emotions, and interpersonal relationships.

OBJECTIVES

To explore contextual and mechanistic factors that facilitate a sense of emotional safety for learning in nursing students, particularly regarding patient safety events experienced during their placements.

DESIGN

A descriptive qualitative study using narratives and thematic analysis.

SETTINGS

A university in Northern Italy.

PARTICIPANTS

Undergraduate nursing students recruited through purposive sampling.

METHODS

Twenty cases relevant to the present study were selected from the "Sharing LearnIng from Practice for Patient Safety" (SLIPPS) project database containing 100 narratives collected using the patient safety learning Event Recording Tool. The data were analysed using thematic analysis according to Braun & Clarke's methodology. The themes that emerged from the thematic analysis were rearranged in Context-Mechanism-Outcomes.

RESULTS

Students identified clinical practice experiences as important occasions for their personal and professional development. Emotional safety and tutoring were the elements that effectively "govern" the students' learning and development process.

CONCLUSIONS

Emotional safety is key for nursing students because it enables them to constructively overcome any relational and emotional tensions that may develop during their clinical placements.

Learning through Teaching: Peer Teaching and Mentoring Experiences among Third-Year Medical Students

PHENOMENON

Classroom studies of peer-led teaching and mentoring report benefits for students both as teachers and learners. Such benefits include both improved content mastery and personal and professional development. While benefits of peer-led teaching in the clinical setting have been well characterized among other health professions, less is known within undergraduate medical education. In this study, we explored medical students' perceptions and experiences relevant to peer teaching and mentoring in outpatient clinical clerkships.

APPROACH

Third-year medical students enrolled in two different longitudinal primary care clerkships, Education Centered Medical Home (ECMH) or Individual Preceptorship (IP), participated in semi-structured interviews in 2018. Students were asked to describe their peer teaching experiences during the clerkship and to reflect on their experiences serving as role models or mentors. We analyzed transcripts utilizing a two-cycle team-based inductive approach.

FINDINGS

Thirty-three students completed interviews. We derived three main themes: (1) diversity of peer teaching and mentoring opportunities, (2) transitioning one's role from learner to teacher, and (3) personal and professional development. While participants from both clerkships participated in peer teaching and mentoring experiences, ECMH students described more opportunities to interact with students across all years of medical school training, noting that "getting that guidance and in turn being able to teach is a valuable experience." ECMH students further perceived the responsibility of creating a comfortable learning environment for others. Students from both clerkships reflected on 'learning through teaching,' that teaching served as a reaffirmation of the knowledge they gained, and that teaching experience contributed to their personal and professional growth.

INSIGHTS

Students perceived their participation in peer teaching and mentoring experiences in the clinical setting as contributing positively to personal and professional development. Students from both clerkships reflected on their teaching and mentoring opportunities as a facilitator of growth in their own teaching skills; ECMH students further described a heightened sense of self-confidence and fulfillment. These findings highlight the importance of creating learning environments that foster peer teaching and mentoring, as such opportunities may lead to further growth as a learner and as a physician.

Learning From Student Experience: Development of an International Multimodal Patient Safety Education Package

BACKGROUND

Patient safety is a global concern. Learning to provide safe, high-quality care is core to nursing education.

PROBLEM

Students are exposed to diverse clinical practices, and experiences may vary between placements and across countries. Student experience is seldom used as an educational resource.

APPROACH

An international, European Union-funded project, Sharing Learning from Practice for Patient Safety (SLIPPs), aimed to develop an innovative online educational package to assist patient safety learning. Based on student reported data and educational theory, multiple elements were iteratively developed by a multicountry, multidisciplinary group.

OUTCOMES

The educational package is freely available on the SLIPPs Web site. Materials include a student reporting and reflection tool, virtual seminars, student reports data set, pedagogical game, high-fidelity simulation scenarios, scenario development and use guidelines, debriefing session model, and videos of simulations already performed.

CONCLUSIONS

E-learning enables removal of physical barriers, allowing educators, professionals, and students from all over the world to collaborate, interact, and learn from each other.

Student nurses' views on shift patterns: What do they prefer and why? Results from a Tweetchat

Aim

The main aim of the study was to understand student nurses’ views around shift patterns.

Design

Qualitative study.

Method

We held a Tweetchat in May 2019, where we asked questions around the frequency of 12‐hr shifts working on placement; schedule flexibility while on placement; which shift patterns they preferred and why. Data from the Tweetchat were analysed using reflexive thematic analysis to generate themes from initial codes.

Results

Seventy‐three nursing students participated in the Tweetchat. The majority reported that they work 12‐hr shifts on placements, particularly when based in a hospital. We identified three themes: ‘Achieving a personal equilibrium’; ‘Meeting the needs of the care environment’; ‘Factors affecting negotiation capacity’. Data highlighted a conflict for most students, where they preferred 12‐hr shifts because of more time off for study, paid work and leisure, while acknowledging 12‐hr shifts negatively affected their fatigue, exhaustion and led them to follow a poor diet and neglect exercise and sleep.

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.

Positive consequences of the hidden curriculum in undergraduate nursing education: An integrative review

Background:

Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education.

Materials and Methods:

A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology.

Results:

Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity.

Conclusions:

Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.

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.

Scoping reviews in medical education: A scoping review

OBJECTIVES

Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities.

METHOD

The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review.

RESULTS

One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal.

CONCLUSIONS

Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.

Writing activities and the hidden curriculum in nursing education

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric-driven competency-based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper-focus on "figuring out" the teacher with minimal focus on the act of writing. Students used a form of behavioral "code-switching" to maximize their grade while considering how their "valuing" of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment.

Nursing students' perspectives of dance movement therapy to learn relational skills: A qualitative description study

BACKGROUND

Nursing students are expected to develop communication and relational skills during their undergraduate education, and the literature on art-based methods for teaching these skills is growing. Art-based education seems to be a promising method for teaching relational skills, especially embodied and performing arts. Dance Movement Therapy has been used previously to learn relational skills, but never in undergraduate nursing students.

AIM

To describe how first-year undergraduate nursing students experienced the learning of communication and relational skills through a Dance Movement Therapy workshop.

SETTINGS & PARTICIPANTS

First-year undergraduate nursing students who completed a two-session Dance Movement Therapy workshop.

DESIGN & METHODS

This study utilised a Qualitative Description design. Data were gathered from students' reflective journals (n = 226 journals, 113 students) and analysed with a thematic analysis approach.

RESULTS

Three themes were identified: learning happens through the experience of competences, learning happens through corporeality, and learning takes time. The first theme describes how students experienced theoretical concepts through workshop games. "Learning happens through corporeality" focuses on the role of the body during Dance Movement Therapy games as a medium for learning. "Learning takes time" describes students' evolution during the workshop, both within and between sessions, and the graduality of comprehension and learning.

CONCLUSIONS

The findings of this study suggest that Dance Movement Therapy can be an applicable methodology for nursing students to learn communication and relational skills. Most of the relational skills and non-verbal communication components were explored and strengthened during the workshop. Students were also able to create links between theoretical concepts and nursing practice. Nurse educators may want to consider using Dance Movement Therapy to teach communication and relational skills.

Developing a measurement tool for evaluating the hidden curriculum in nursing education

BACKGROUND

The investigation of affective awareness in nursing students is important insofar as the results can serve to improve the quality of education provided to them and enhance nursing undergraduate education programs.

OBJECTIVES

This study aims to develop a valid and reliable measurement tool for use in determining and evaluating the hidden curriculum of institutions providing nursing education at the level of bachelor's degree.

SETTING

University Faculty Nursing.

PARTICIPANTS

Nursing students.

METHODS

This study was a methodological scale development study. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted for the construct validity of the measurement tool of which content validity and a pilot study were conducted. For predictive validity, Pearson correlation coefficient between total scale and its subdimensions was calculated and the compliance between them was examined. Time invariance of the scale was tested using the test-retest method (test-retest reliability was estimated). Internal consistency reliability of the scale was calculated using Cronbach's alpha internal consistency coefficient.

RESULTS

Factor analyses showed that Hidden Curriculum Evaluation Scale in Nursing Education (HCES-N) included 43 items and three subdimensions and 13 reverse scored items. Cronbach's alpha reliability coefficient of the scale was found to be 0.912.

CONCLUSIONS

Institutions that provide nursing education should recognize their own hidden curriculum and the institution's hidden curriculum. Formal program outcomes should correspond with each other to ensure nursing students' graduation outcomes as intended. This study in which a measurement tool was developed to determine and evaluate the hidden program in nursing education is thought to facilitate the process. The Hidden Curriculum Evaluation Scale in Nursing Education (HCES-N) is a measurement tool providing psychometric characteristics to be used in accordance with its purpose.

A multi-method exploratory study of health professional students' experiences with compliance behaviours

BACKGROUND

Research in healthcare, including students as participants, has begun to document experiences with negative compliance, specifically conformity and obedience. There is a growing body of experimental and survey literature, however, currently lacking is a direct measure of the frequency at which health professional students have negative experiences with conformity and obedience integrated with psychological factors, the outcomes of negative compliance, and students' perceptions.

METHODS

To develop empirical knowledge about the frequency of negative compliance and student perceptions during health professional education a multi-methods survey approach was used. The survey was administered to health professional students across ten disciplines at four institutions.

RESULTS

The results indicated students regularly experience obedience and conformity and are influenced by impression management and displacement of responsibility. Moral distress was identified as a consistent negative outcome. Student self-reported experiences aligned with the empirical findings.

CONCLUSIONS

The findings of the present study demonstrate the pervasiveness of experiences with negative compliance during health professional's education along with some attendant psychological factors. The findings have educational and practical implications, as well as pointing to the need for further integration of social and cognitive psychology in explaining compliance in healthcare. The results are likely generalizable to a population level however replication is encouraged to better understand the true frequency of negative compliance at a health professional population level.

The Hidden Curriculum Challenges in Learning Professional Ethics Among Iranian Medical Students: A Qualitative Study

BACKGROUND

Medical ethics is a vital quality for the doctors which has been seriously taken into consideration in recent years. Identifying the factors affecting medical ethics may help to develop more effective ways to promote this quality in medical education. This study was aimed to explain the challenges of hidden curriculum in learning the professional ethics among Iranian medical students.

MATERIALS AND METHODS

This qualitative study was performed on 15 medical interns of Kermanshah University of Medical Sciences in 2019 using grounded theory (GT). Sampling was started by purposive sampling and continued through theoretical sampling until complete data saturation. Data collection and analysis were done simultaneously. Data were interpreted by the constant comparative method according to Strauss and Corbin's approach.

RESULTS

The results showed that the challenges of hidden curriculum for learning the professional ethics by medical students included a number of key concepts. Analyzing these concepts and taking into account the commonalities, we obtained six subthemes using a reduction inductive method, the main theme of which was "the challenge of hidden curriculum in learning the professional medical ethics". The subthemes included "decreased interest in medicine", "false beliefs", "curriculum weakness", "materialism and economic problems", "avoidance of responsibility", and "underlying problems of the medical profession".

CONCLUSION

The findings indicated six challenges in the hidden curriculum for learning the professional medical ethics. These challenges can be considered a threat or an obstacle to achieving the goals of professional ethics. Therefore, curriculum planners, education policymakers, and teachers should plan and implement the professional ethics curriculum based on these factors.

Unpacking the hidden curriculum in nursing education: clinical placements abroad

Many Canadian nursing programs endorse clinical placements abroad. We critically examined the hidden curriculum embedded in clinical placements seeking to provide a 'global' experience. Using purposeful sampling, we interviewed a total of 18 participants, including eight faculty, eight students and two placement coordinators. Data were analyzed using initial and focused coding, supported by NVivo. After generating themes from the coded data, we adapted Hafferty's (1998) framework to further analyze the theme of the hidden curriculum. The findings illuminate how policies sustained international experience as a privileged endeavour, with restricted access based on grades. Placements incorporated little evaluation of benefits for local communities. Few resources were allocated to students for such placements, as many students paid for their placement. The institutional terms 'international and global experience' denoted interactions with cultural "Others". We recommend that nursing programs attend to hidden practices that sustain clinical placements abroad as prestigious, commodified experiences.

The hidden curriculum: Undergraduate nursing students' perspectives of socialization and professionalism

BACKGROUND AND AIM

Nursing students form a professional identity from their core values, role models, and past experiences, and these factors contribute to the development of their professional identity. The hidden curriculum, a set of ethics and values learned within a clinical setting, may be part of developing a professional identity. Nursing students will develop a professional identity throughout school; however, their identity might be challenged as they attempt to balance their core values with behaviors learned through the hidden curriculum. The purpose of this project was to educate students on the hidden curriculum in the development of their professional identity.

MATERIALS AND METHODS

A sample of 112 senior nursing students was recruited from a northeastern university in the United States for this study. Pre-post survey design was used, and an educational session was administered prior to the post-survey. Descriptive statistics and a valid percentage were used to describe the data within the surveys.

ETHICAL CONSIDERATION

Study was approved by the author's University Institutional Review Board.

FINDINGS

A significant finding was for advocacy as students would speak up if witnessing inappropriate behavior toward patients or families with a mean score increase from 2.50 (pre-survey) to 1.45 (post-survey). Also, over 95% (n = 106) found the educational session beneficial as they learned they had the ability to advocate and speak up for their patients.

CONCLUSION

Students were able to use their core values and advocate for their patients and families which allows for safer patient care.