Concept analysis of professional socialization in nursing

"I feel like this is an area where one can feel a lot of satisfaction": Physiotherapy students' preferences for their prospective area of practice

OBJECTIVES

To identify physiotherapy students' preferences about their prospective area of practice and the reasons for their choices.

METHODS

Tel-Aviv University physiotherapy students participated in a cross-sectional survey and three open-ended questions that comprise the qualitative component of the study. At the very beginning of their studies, and at the end of the first to fourth years, participants were asked about their area of preference, the factors that shaped their choice, and the reasons for prospective changes in their preference.

RESULTS

In total, 289 students filled out the survey. Response rate was 68%. Interest in some areas of practice such as pediatrics remained stable throughout years of physiotherapy studies. In contrast, interest in other areas such as sports declined and interest in others such as rehabilitation increased. The open-ended questions yielded 1,616 codes sorted into five categories that shaped the students' preferences: "I/Me /My" the largest category, followed by "the physiotherapy studies program" and then the relational focused "physiotherapy practice." The number of codes for "working conditions" and "work-life balance" increased steeply with the progression of the studies and the age of the students.

CONCLUSIONS

The choice for areas of practice of physiotherapy students vary during their professional formation. During their professional development, their preferences are shaped by their personal feelings, interest in and past experience with the specific areas of practice, as well as their practical exposure, experiences in practicums, and theoretical studies. Millennial physiotherapists prefer areas of practice in which personal as well as relational considerations are core.

Our New Normal: Pediatric Nurse Residents' Experiences with Transition to Practice during the COVID-19 Pandemic

This phenomenological qualitative study examined the lived experience of pediatric nurse residents' transition to practice during the COVID-19 pandemic. The purposive sample included nine pediatric nurses, participating in a nurse residency program, who entered the nursing profession during the first year of the pandemic. The setting was a free-standing, Magnet-recognized, pediatric academic medical center in the Northeastern U.S. Individual interviews were audio recorded and transcribed. Narratives were analyzed using a hermeneutic phenomenological approach. Five themes emerged from the data: Our New Normal; The Rules Keep Changing; I'm Not Ready for This (transition to practice); The Toll of COVID; and Shattered Family-Centered Care. Sub-themes emerged in The Toll of COVID theme: COVID and the Nursing Care Environment, Emotional Toll of COVID, Burnout: A Universal Truth, and The Pandemic within the Pandemic. The nurse residents' narratives uncovered the essence of their uncertainty, sorrow, growth, and resilience. Through the eyes of pediatric nurse residents, this study illuminated the experiences of these novices as they entered the nursing profession amid a pandemic.

The threshold of rural placement frequency and duration: A repeated cross-sectional study examining rural career aspirations among student nurses

AIM

This study aimed to explore what changes rural placement had on the perceptions of nursing students and the impact of placement frequency and duration on student considerations for rural practice.

BACKGROUND

A strong rural healthcare workforce is a global concern and has led countries to look for creative ways to address this challenge. One approach is to train more health professionals, however, nursing students who grew up or lived in metropolitan or urbanised areas are suggested to be less inclined to pursue a rural career. As such it is posited that recurrent exposure to rural settings may exert a positive impact on future intention for rural practice. However, there is a need to explore the specific thresholds related to both the frequency and duration of rural placement exposure, as well as the cumulative impact multiple rural placements may have on the intention to engage in rural practice.

DESIGN

A repeated cross-sectional design.

METHODS

All nursing students from an Australian regional university were invited to complete an online questionnaire between 2019 and 2023. Demographic and placement specific questions were included. A modified version of the Nursing Community Apgar tool also measured the importance of key variables in rural career decision-making. Data were analysed using independent sample t-tests and one-way ANOVAs. Significance was determined at two-tailed p≤.05.

RESULTS

Among the 835 respondents (response rate 15.4%), the average number and duration of rural placements was 2.45 placements and 3.01 weeks respectively. Rural placements did not have an impact on students who resided rurally or regionally. However, among metropolitan students who had experienced more than three rural placements, or more than sixteen cumulative weeks of placement, were significantly more likely to consider rural employment. Greater number of rural placements and longer cumulative duration had the greatest impact.

CONCLUSION

Issues related to the nursing rural workforce are dynamic and complex. Understanding the unique drivers that improve the rural experiences among students, particularly metropolitan students, can have an impact on decision-making to pursue employment in rural environments. Importantly, whilst professional and clinical motivation and experiences are influential factors, the socialisation, environment and community features are essential elements that influence students' decisions to pursue a career in rural practice. Undertaking a nuanced approach that facilitates rural practice understanding among students may help shape future employment decision-making.

Socialized to care: Nursing student experiences with faculty, preceptors, and patients

Effective socialization of nurses has led to positive outcomes for both hospitals and nurses, including higher retention and greater job satisfaction. The importance of faculty, preceptors, and patients in the socialization of nursing students has been documented extensively in the literature. The research presented in this article examines data from qualitative, longitudinal interview transcripts of 15 students as they progressed through a 2-year nursing program to determine how these three types of influence socialize nursing students, and at which points in their education. Using multiple perspective qualitative longitudinal interviews, I interviewed participants every semester of nursing school about their experiences. From the data, these three parties have an impact at different points in their socialization, starting with faculty who socialize students to nursing school by helping them think like nurses. Next, preceptors can be barriers or facilitators of learning by demonstrating how to act like nurses and providing insight about how and why nurses may act the way that they do. Finally, patients help students put everything together by applying classroom lessons to clinical settings. The research concludes with implications for research, practice, and policy.

Health promotion roles shaped by professional identity: an ethnographic study in the Netherlands

How frontline care professionals interpret and fulfill their health promotion roles is of great importance for the health of the vulnerable clients they work with. While the literature on health promotion is limited to describing the roles of healthcare professionals, this study examines the health promotion roles held by various frontline professionals when working with clients with combined psychosocial problems and how this is associated with professional identity. Based on ethnographic data from Dutch frontline professionals in social welfare, general healthcare and mental healthcare, this article shows how various frontline professionals promote health by reframing and customizing health problems and that this is associated with how they identify as pragmatic or holistic professionals.

Preparedness to assume professional roles: experiences of recently qualified radiographers: A qualitative study

INTRODUCTION

Recently qualified health workers including radiographers struggle with workplace integration. Similarly, in our local context, undocumented complaints were received from the various heads of departments and radiologists regarding recently qualified radiographers' ability to fully assume their professional roles. In light of the complaints, this study sought to explore and describe the lived experiences of recently qualified radiographers from one local University on their readiness to assume their professional roles.

METHODS

A qualitative, descriptive research design with a phenomenological approach was used to conduct the study. Ten (10) diagnostic radiographers who graduated between 2018 and 2020 from the local university were sampled using the snowball sampling technique. Telephonic interviews were conducted using a semi-structured interview guide. Data were analysed using Tesch's open coding method.

RESULTS

The findings of this study have shown a combination of positive and negative experiences by recently qualified radiographers. The positive experiences (satisfactory work engagement) emanate from increased confidence and creativity, responsibility consciousness and teamwork. Negative experiences (reality shock and professional role conflict) emanated from excessive workload, patient care impediments, the burden of student supervision and lack of professional trust.

CONCLUSION

Though the recently qualified radiographers from our local University experienced some contextual challenges upon assuming their professional roles, they appeared well-prepared for their clinical roles. Standardised induction and mentorship programmes should be implemented to facilitate the transition process from student to qualified radiographer.

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.

Workplace discrimination and its relationship with organizational commitment among the surgical technologist: A national cross-sectional study in Iran

Background

Discrimination in healthcare centers can reduce care quality and job satisfaction, weaken the morale of the personnel and increase the cost of health care and finally lead to turnover intention. Discrimination in hospitals can affect the work outcomes and performance indicators of nurses such as their organizational commitment. Due to the vital role of surgical technologists in surgery and justice as the basis of effective performance, as well as the role of organizational commitment in care quality, the present study was conducted aimed to determine the level of workplace discrimination from viewpoint of the surgical technologists and its relationship with the organizational commitment.

Methods

This cross-sectional study was conducted on 615 surgical technologists in 8 metropolises of Iran in 2022. The sampling method in this study was multi-stage. The data collection tools included three questionnaires (demographic information, workplace discrimination, and Allen and Meyer's organizational commitment). Data were collected within 2 months and analyzed by SPSS version 22. Descriptive and inferential analyzes including independent t-test and analysis of variance were used for data analysis. p-value ≥ 0.05 was considered significant.

Results

The average age of the participants in the study were 29.90 ± 5.83 years with the participation of 464 women. The results of the data analysis showed an inverse and significant correlation between workplace discrimination and organizational commitment (r = -0.149, p-value < 0.001). The mean and standard deviation for workplace discrimination was 108.20 ± 11.53, which is average. Also, the mean and standard deviation for total organizational commitment was 100.56 ± 19.14, which is higher than the average.

Conclusion

According to the results of this study, managers need to pay attention to reduce discrimination in the operating room and establish organizational justice, to improve the motivation of surgical technologists and the quality of their performance. It is also suggested that operating room managers and supervisors, by creating a safe, confidential, and fearless environment to encourage the personnel to express what they understand about discriminatory conditions.

Professional socialization of hospital nurses: A scale development and validation study

BACKGROUND

Tools currently available to measure professional socialization are outdated or could not reflect various properties of professional socialization of nurses. Thus, the objective of this study was to develop and validate a professional socialization measurement instrument for hospital nurses.

METHODS

Fifty-two items were initially extracted from literature reviews and in-depth interviews with 32 nurses. After content validity testing, 48 items remained. They were used to survey 881 hospital nurses in Korea in the testing phase for construct validity and reliability.

RESULTS

Four factors (21 items) were extracted: ethical practice and reflection, perception of respect and recognition, clinical competency based on leadership, and desires and motivation for professional development. These factors demonstrated good construct validity and reliability. Correlation coefficients of professional socialization with professional value, compassion satisfaction, secondary traumatic stress, and burden were 0.58 (p < 0.001), 0.70 (p < 0.001), - 0.08 (p = 0.014), and - 0.56 (p < 0.001), respectively. Reliability had a Cronbach's alpha of 0.95. Test-retest reliability intraclass correlation coefficient was 0.90.

CONCLUSIONS

The four professional socialization scale factors in this study reflected attributes of knowledge, skills, values, and professional roles. Professional socialization of nurses can be continuously developed by emphasizing elements of the professional socialization scale in nursing education programs. Nursing managers should help nurses go through the professional socialization process. The professional socialization scale will serve as a tool for developing careers of hospital nurses.

Strengthening Professional Values of Doctoral-Level Nursing Students

Introduction

Multiple recent critical societal/world events have impacted nurses' beliefs and emphasized the importance of the standards of behavior that frame nurses' professional values.

Objectives

This study focused on the professional values of students in a Doctor of Nursing program (DNP), including the relationship between professional values, time in program, and intentions to participate in professionalism-focused activities.

Methods

From fall 2019 through Spring 2021, 227 participants were invited to participate in this study through the completion of an online survey at several points in time. The survey contained various demographic variables, items from the Nurses Professional Values Scale-3 representing the dimensions of caring, activism, and professionalism, and Likert scale items that measured intentions to participate in professionalism-focused activities.

Results

The overall mean NPVS-3 score was 118.30 (out of a possible range of 28-140). The highest mean score among the three dimensions was for caring (45.38), followed by activism (40.20) and then professionalism (32.71). Students indicated high intentions to participate in activities focused on professionalism (5.77 on a scale of 1 to 7). A moderate correlation between intentions and professionalism (r = .44, p < .0001) was noted. The association of intentions to caring and activism was weaker but significant (r = 0.26; p = .012) and (r = 0.37; p = .0003), respectively.

Conclusion

DNP curricular efforts can strengthen nurses' professional values by focusing on the development of critically important professional attributes. Nurses, especially those who have a doctoral-level education, need to have strong professional values and understand the importance of their voice and impact as a leader in the profession.

Fourth year intellectual disability student nurses' journey and future work intention: a qualitative study

BACKGROUND

The aim of this qualitative study is to explore the views and experiences of final year BSc intellectual disability nursing students' journey, future work plans and examine factors influencing their migration intentions following graduation.

METHODS

A qualitative component of a mixed methods study where a focus group interview was conducted with final year BSc intellectual disability nursing students (n = 10) from one University in Ireland in June 2019. A topic guide was utilised, and participant's were interviewed about their programme, future work plans and migration intentions. An inductive approach was utilised, and data were analysed using a pre-existing framework for initial coding and thematic development. Duffy's conceptual model of identity transformation provided a structure to analyse the data and map themes onto the conceptual framework.

RESULTS

The findings were mapped onto the five stages of Duffy's (2013) conceptual model of identity transformation: Pre-Entry; Reaffirming; Surmounting; Stabilising and Actualising. Findings indicate that further work is required to promote intellectual disability nursing and address professional esteem issues, support for education and professional development, such as providing career guidance opportunities prior to course completion, development of clinical skills within their education programme and support for the professional development of new graduates. Participant's identified uncertainty about career opportunities and saw scope for future professional development opportunities particularly in community-based work.

CONCLUSION

This study has identified that final year intellectual disability nursing students are uncertain about career options and opportunities for intellectual disability nurses in other country's. There is an urgent need for the intellectual disability nursing profession to articulate their practice and advocate for their role and contribution to the care of people with intellectual disability. This study identified a clear need for direction and information regarding intellectual disability nursing roles and career opportunities.

Clinical judgement in nursing - An evolutionary concept analysis

AIMS

The aim of this concept analysis was to develop a contemporary operational definition of Clinical Judgement in nursing.

DESIGN

Concept analysis.

METHODS

Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist.

RESULTS

This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion.

CONCLUSION

The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.

Teams Model of Clinical Nursing Education: An Innovative Approach

The need for registered nurses has never been greater. Only through thoughtful academic-practice partnerships will it be possible to align the current and future demands of the workplace with the knowledge, attitudes, and skills that are required. Outdated nursing education models that treat practice partners as "real estate" and try to expose all students, in the same way, to the full array of patient populations, most often in acute care settings, do not serve the profession well. Attending to the heightened expectations for nurses to lead complex, interprofessional teams across an array of settings led to the development of the Teams Model of clinical nursing education. In this model, students match to practice partner facilities where they complete the majority of their clinical hours. They do not rotate through various settings, they do not spend precious practice time reorienting to new facilities, and they are not relegated to the periphery of the interprofessional team when in the student role. They become expected and valuable members of the care delivery team. They focus on developing depth as a nurse rather than breath across patient populations. The Teams Model is predicated on advancing academic-practice partnerships that provide a pipeline for workforce development and prepares the new graduate as a work-ready hire. Ongoing evaluation of the students' development and their knowledge acquisition is linked to practice partner assessments and provides support for this model as an innovative alternative to preparing the next generation of nurses. This partnership program builds confidence through immersion experiences in a consistent, welcoming, and prepared clinical environment, with opportunities to advance the priorities of the practice setting in addition to promoting positive patient outcomes. Benefits include student exposure to nontraditional fields of nursing and areas of critical shortage as well as the ability to pivot quickly as workforce needs shift.

Exploring the role of reflection in nurse education and practice

Reflection is an essential element in every nurse's practice and is embedded in the Nursing and Midwifery Council's code of conduct - the UK nursing regulatory body's code of professional standards of practice and behaviour. The application of reflection to practice has clear advantages, for example it enables nurses to learn from clinical events and adapt and enhance their skills. This article explores the role of reflection in nursing practice, considers the use of reflective models and explores how nurses can overcome barriers to reflection in their everyday practice. These barriers include psychological stress or discomfort when revisiting challenging clinical experiences, which may have been exacerbated during the coronavirus disease 2019 (COVID-19) pandemic.

[Interprofessional socialization and collaboration on an interprofessional training ward - a reconstructive analysis]

Interprofessional education has gained relevance in German-speaking countries, and interprofessional training wards (IPTW) can contribute to the acquisition of interprofessional competencies and thereby improve interprofessional collaborative practice and patient care. Professional socialization and identity development have proven to be critical for future clinical practice in addition to competency development. According to Khalili (2013) socialization through interprofessional education can result in a dual identity, i. e., a sense of belonging to one's own profession as well as to the interprofessional health care team. The aim of this study was to analyse to which extent interprofessional socialization takes place on the Interprofessional Training Ward in Heidelberg (HIPSTA) and how medical students in their practical year and nursing trainees in their third year of training experience their placement there. For this purpose, five semi-structured group discussions were conducted with undergraduates at the end of their placement on HIPSTA and analysed using the documentary method. Typification resulted in two types that differ with regard to interprofessional socialization. The type interprofessional responsiblepersons is characterized by the joint assumption of responsibility for patient care, open communication with each other and joint structuring of collaboration, which contributed to a removal of barriers and interprofessional role learning; the type interprofessional learners is characterized by their focus on learning processes and their anticipation of barriers between the professional groups, which would be relevant for future collaboration. All groups experienced a sense of belonging to their peer-student/learner group, regardless of their different professional background. Their professional identity underwent further development. These results show that placement on an IPTW does not warrant interprofessional socialization processes and the development of a dual identity. However, it can be a first step in the right direction.

Impact of exemplar education program on the professional commitment of nursing students: A quasi-experimental study

BACKGROUND

High attrition rate and nursing workforce shortage have been a prevailing world challenge. Professional commitment is a known key factor for attracting and retaining the nursing workforce.

OBJECTIVE

To design, implement and evaluate the impact of a one-week structured education program, underpinned by the exemplar education strategy, on the professional commitment of undergraduate nursing students.

DESIGN

A quasi-experimental study was designed with pre- and post-intervention measurements. The intervention was a structured, four module education program underpinned by the exemplar education strategy.

SETTING

Department of Nursing, Qianjiang College, Hangzhou Normal University, Zhejiang, China.

PARTICIPANTS

152 third-year nursing students who attended the education program and consented to participate were enrolled in the research.

METHODS

The intervention, the education program, was delivered over 16 h in one week of an 18-week semester. It was sequenced in four modules: expert lectures (3 h each), visiting a hospital (3 h), alumni salon (3 h), and submitting a reflection report (4 h). Professional commitment was measured by the Nursing Professional Commitment Scale (NPCS) administered both pre- and post-intervention.

RESULTS

The total professional commitment measurement score was significantly improved after the intervention. There were statistically significant differences before and after intervention in the four dimensions of professional commitment, namely, belief in goals and values, willingness to make an effort, desire to stay in the profession, and intrinsic positive value of work.

CONCLUSION

The one-week professional education program underpinned by the exemplar education strategy effectively improved the level of professional commitment of the undergraduate nursing students. The program can be transferred into the curriculum to improve nursing students' professional commitment. The methodology can be applied in other aspects of nursing professional development.

Professional values and role socialization of new NPs

ABSTRACT

This cross-sectional study focuses on assessing factors related to role socialization of new NPs. Participants identified caring as the most important professional value, followed by activism and professionalism. Role socialization factors including a sense of belonging and forming professional identities were higher for experienced NPs.

Stigmatization in nursing: Theoretical pathways and implications

Stigmatization of patients exists in nursing and results in less than optimal nursing care and poor patient outcomes. It is also a violation of our code of ethics. In order to eliminate stigmatization from nursing practice, it is necessary to understand how it develops. Two possible theoretical pathways are proposed to explain the development of stigmatization in nursing. These pathways are informed by a conceptual understanding of stigma and theories of professional socialization, professional formation, symbolic interactionism, and social cognitive theory. Re-labeling and role-taking and moral disengagement are proposed as two possible processes that may lead to stigmatization of patients. Both proposed pathways have implications on professional socialization, formation, and the development of professional identity. Devoting attention to and reframing normative behavioral expectations, eliminating labeling, developing empathy, focusing on relationships, and cultivating ethical comportment and moral maturity during nursing formation may reduce the stigmatization of patients by nurses.

“I Internalize Islamic Values”: Bachelor Nursing Students’ Perception and Experience of Professional Identity in Indonesia

BACKGROUND: Professional identity is the primary goal of nursing education institutions that shaped professional nurse’s identity. However, final-year bachelor nursing students’ perception and experience of professional identity remain limited to explore. AIM: This study aims to analyze final-year bachelor nursing students’ perception and experience toward professional identity in Indonesia. METHODS: A descriptive qualitative study with a drawing exercise was conducted with a convenience sample of final-year bachelor nursing students to explore how they viewed the nursing profession. Thirteen nursing students were recruited from four academic hospitals of Universitas Muhammadiyah Yogyakarta. Data were analyzed thematically using Colaizzi methods and NVivo 12 Plus. RESULTS: The analysis showed five themes identified, namely, “Islamic nurse is my identity,” “I follow Islamic sharia,” “I internalize Islamic values,” “I practice professional roles,” and “I obey professional regulation.” CONCLUSION: Nursing students perceived the identity of Islamic nurses into their identity. Developing a strong professional identity is essential for the students to enhance a sense of belonging and career choice in the nursing profession.

Social culture and the bullying of midwifery students whilst on clinical placement: A qualitative descriptive exploration

The context within which midwifery students are professionally socialised is thought to impact upon the development of their sense of belongingness, their attitudes and values, and their commitment to the midwifery profession. Negative forms of socialisation are known to lead to undesirable outcomes including desensitisation about humanistic needs. This has potential to extend to an acceptance of workplace bullying and unfair treatment of others, including midwifery students whilst on clinical placement. This study aimed to explore how the social culture of the maternity setting influences midwifery students' experiences of being bullied whilst on clinical placement. One hundred and twenty midwifery students from Australia and the United Kingdom completed a qualitative online survey and the data was thematically analysed. One main overarching theme and four sub themes were identified. These were: 'the organisational culture of acceptance: "in front of"', 'brazen expression', 'group buy-in', 'suppression of dissent', and 'collateral damage'. Each of these factors enabled replication of the problem and led to perpetuation of the bullying cycle. This study illuminated that an entrenched culture of acceptance exists which impacts the students educational experience, the care received by mothers and babies, and the reputation of the midwifery profession.

Approaches used to enhance transition and retention for newly qualified nurses (NQNS): A rapid evidence assessment

AIM

To undertake a rapid evidence assessment of approaches used to enhance nurse transition and retention for newly qualified nurses and to evaluate the strength of the evidence for specific approaches to nurse transition and retention.

DESIGN

A rapid evidence assessment was undertaken. Electronic databases were searched, and the full texts of relevant papers were retrieved. Studies were appraised using relevant Critical Appraisal Skills Programme and Mixed Methods Assessment Tools and a single descriptor of quality: high; medium; or low was assigned to each output. Given the disparity in methods, the lack of randomised trials, results could not be combined; therefore, a descriptive approach was used to synthesise and present the data.

DATA SOURCES

The search was undertaken using: specific database searching; and secondary searching of relevant websites. Electronic databases (CINAHL complete, Academic search premier, Open Grey, ERIC* (Education), Web of Science-Social Science Citation Index and PubMed) were searched during February 2018.

RESULTS

Orientation and creating supportive environments were frequently reported as being effective in enhancing transition across a range of studies. A range of methods: quasi-experimental, survey and qualitative were used. Generally, the quality of most studies was poor.

CONCLUSIONS

Despite decades of research into the experiences of newly qualified nurses and development of schemes and frameworks to support them during this period, there is little substantive or robust evidence in terms of impact on retention. Further research into the longer-term retention of newly qualified nurses is recommended. Longitudinal studies would be beneficial in assessing the efficacy of approaches to enhancing retention.

Towards abandoning the master's tools: The politics of a universal nursing identity

Healthcare environments continue to prove discriminatory and marginalizing towards patients and healthcare workers themselves, which contributes to inequitable health outcomes across lines of socially constructed difference. This content and discourse analysis of nursing identity scholarship asks whether there is a connection between nursing identity and oppressive behaviour by examining the construction of nursing identity and the foundational discourses, sometimes in absentia, that support such a construction. Bourdieu's concepts of social fields and Audre Lorde's concept of the master's house are applied as a framework towards understanding the constructs of power and status in healthcare. The analysis identifies a gap in nursing identity literature where social constructs of difference are not considered. In the reviewed literature, nursing identity has been co-opted by the professionalization project in effort to stabilize a conceptualization of nursing's contribution to healthcare towards gaining professional and societal status. This leads to a monolithic, apolitical representation of nursing identity that erases difference, denies historical influence, universalizes nursing work and further marginalizes marginalized identities. The oppressive and hegemonic nature of a universal nursing identity may contribute to a lack of disciplinary reflexivity about the ongoing influences of foundational discursive constructs of gender, epistemology, power and professional status.

Conflict, confusion and inconsistencies: Pre-registration nursing students' perceptions and experiences of speaking up for patient safety

There is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under-explored, especially in the Australian context. This two-phased qualitative study used Interpretive Description to explore 53 pre-registration nursing students' perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students' decisions to speak up or remain silent. Understanding students' perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up.

Developing and sustaining nurses' service improvement capability: a phenomenological study

BACKGROUND

Service improvement to enhance care quality is a key nursing responsibility and developing sustainable skills and knowledge to become confident, capable service improvement practitioners is important for nurses in order to continually improve practice. How this happens is an under-researched area.

AIM

A hermeneutic, longitudinal study in Northern England aimed to better understand the service improvement lived experiences of participants as they progressed from undergraduate adult nursing students to registrants.

METHOD

Twenty year 3 student adult nurses were purposively selected to participate in individual semi-structured interviews just prior to graduation and up to 12 months post-registration. Hermeneutic circle data analysis were used.

FINDINGS

Themes identified were service improvement learning in nursing; socialisation in nursing practice; power and powerlessness in the clinical setting; and overcoming service improvement challenges. At the end of the study, participants developed seven positive adaptive behaviours to support their service improvement practice and the 'model of self-efficacy in service improvement enablement' was developed.

CONCLUSION

This study provides a model to enable student and registered nurses to develop and sustain service improvement capability.

Professional socialization: an analytical definition

Professional socialization is defined as a process through which a person becomes a legitimate member of a professional society. This will have a great impact on an individual’s professional conduct and morality. The aim of this study was to clarify this concept and reduce the ambiguities around it.

This was a qualitative research through which the concept of professional socialization was analyzed using Walker and Avant’s eight-step approach. The review of literature for this concept was done using electronic database without any time limitation. The overall search produced about 780 articles, and after reviewing these articles, 21 were selected purposefully.

Based on concept analysis, we propose the following analytical definition: Professional socialization is a nonlinear, continuous, interactive, transformative, personal, psychosocial and self-reinforcing process that is formed through internalization of the specific culture of a professional community, and can be affected by individual, organizational and interactional factors. This definition is in accordance with the interactionism perspective. Existence of a particular profession and getting involved in a community of practice are the antecedents of this process, and formation of professional identity and professional development are its consequences. A case model, as well as borderline and related cases, has been introduced for this concept. The results of this study can be used to design useful educational interventions to conduct and facilitate the process.

Challenges and facilitators of professional socialization: A systematic review

AIMS

This current study aimed to present a review of the challenges and facilitators of professional socialization among undergraduate nursing students.

DESIGN

Systematic review.

METHODS

A literature search was conducted in Embase, Google Scholar, PubMed and Scopus in April and May 2018 for studies published in the English language. Four thousand three hundred fifty-two articles were retrieved. We conducted further screening for full-text articles after discarding duplicates and irrelevant studies. Finally, eight studies were included. The Joanna Briggs appraisal tools were used to appraise and evaluate study quality. The PRISMA guidelines were followed and a narrative synthesis used for data analysis.

RESULTS

Challenges and facilitators of professional socialization were identified and categorized into two major themes. Under each theme, results were grouped into three sub-themes: professional, personal and educational challenges/facilitators.

The 'values journey' of nursing and midwifery students selected using multiple mini interviews: Evaluations from a longitudinal study

Values-based practice is deemed essential for healthcare provision worldwide. In England, values-based recruitment methods, such as multiple mini interviews (MMIs), are employed to ensure that healthcare students' personal values align with the values of the National Health Service (NHS), which focus on compassion and patient-centeredness. However, values cannot be seen as static constructs. They can be positively and negatively influenced by learning and socialisation. We have conceptualised students' perceptions of their values over the duration of their education programme as a 'values journey'. The aim of this hermeneutic longitudinal focus group study was to explore the 'values journey' of student nurses and midwives, recruited through MMIs, across the 3 years of their education programme. The study commenced in 2016, with 42 nursing and midwifery students, originally recruited onto their programmes through multiple mini interviews. At the third and final point of data collection, 25 participants remained. Findings indicate that students' confidence, courage and sense of accountability increased over the 3 years. However, their values were also shaped by time constraints, emotional experiences and racial discrimination. We argue that adequate psychological support is necessary as healthcare students embark on and progress through their values journey, and propose a framework for this.

Nursing profession and nurses' contribution to nursing education as seen through students' eyes: A qualitative study

The behavior of clinical instructors, as observed by students, deeply influences their professional development. When instructors behave unprofessionally, they risk undermining the professional growth students gain from their clinical placement experience. Clinical instructors need to be aware of how their behavior can affect the students' learning process and the contributions they make to clinical nursing education. A qualitative study was performed to describe the nursing profession as perceived by students who observed their clinical instructors' behaviors during the clinical experience. In-depth interviews of nursing students were conducted until data saturation was attained. Sixteen interviews were analyzed using an inductive content analysis methodology. The nursing profession was described by the participants through five themes as follows: the helping relationship, technical role, professional growth, working group, and contradictions and conflicts. Several examples of unprofessional behaviors on the part of the clinical instructors were reported by the respondents. The nursing profession, as perceived by nursing students, does not always reflect their expectations and their ideas related to professionalism. Universities and schools of nursing should ascertain that clinical instructors are prepared to educate students. Faculty should clearly state to students what they can expect from the clinical experience, namely, preparing students to face real working environments that do not always reflect educational philosophies.

Musculoskeletal symptoms in nursing students: concept analysis

ABSTRACT Objective: to analyze the musculoskeletal symptomatology concept in undergraduate nursing students through Rodgers' evolutionary method. Method: An integrative review of the literature was performed for the identification and selection of ten articles. A concept analysis was performed according to Rodgers' evolutionary method. Article search was performed using the EBOSCO Host platform, Virtual Health Library and Google scholar for the years from 2004 to 2018. Results: Based on the 3 elements of Rodgers model we found: 1) substitute terms and related concepts, where musculoskeletal disorders and musculoskeletal symptoms were highlighted; 2) as essential attributes of the concept we highlight pain and discomfort, as well as, measurement using the Nordic Musculoskeletal Questionnaire; and 3) risk factors were identified as antecedents, and the consequences were the impact on students' lives. Conclusions: This study contributes to the knowledge and clarification of the concept of musculoskeletal symptomatology in nursing students.

Nurturing the Virtues: Upholding Professionalism in the Midst of Busy Medical Practice

Tom L. Beauchamp and James F. Childress' (B&C) book Principles of Biomedical Ethics is well known for its four-principle approach to biomedical ethics. However, the authors also emphasize the importance of the virtues of health care personnel. After a short overview of virtue ethics, the five "focal virtues" described by B&C are discussed and applied to a chronic pain example. The question of how virtues are learned in the health care setting is addressed, and it is argued that virtues such as the ones defended by B&C are acquired when health care personnel are socialized in an environment dedicated to the continuous upholding of practices that aim at the telos of medicine. Viewed from this perspective, professional isolation can be considered to be dangerous; the upholding of medical professionalism throughout a whole career largely presupposing the existence of a community where virtues relevant to the practice of medicine are embodied and kept alive. The concept of professional socialization is important in that respect. Finally, some potential general implications of this view for continuing professional development are proposed.

Nurses' Lived Experience of Working with Nursing Students in Clinical Wards: a Phenomenological Study

Introduction: Despite being aware of the importance of nurses’ role in providing clinical training to nursing students, studies show that sufficient research has not yet been conducted on the experience of clinical nurses who are engaged in training nursing students outside their normal working hours. The present study aim to describe the experience of these nurses who are training outside their routine working hours.

Methods: This study was conducted using descriptive-phenomenology method. Twelve nurses was participated in this research. Data were collected using purposive sampling method and face to face interviews based on nurses’ real life experience of students’ learning in clinical settings through answering open-ended questions. Spiegel burg analysis method was used to analyze the data.

Results: The result of data analysis was the derivation of four themes and eight sub-themes. Themes included "nurses as teaching sources", "changes in the balance of doing routine tasks", "professional enthusiasm", and "nurses as students' professional socialization source of inspiration". Sub-themes included "efficient education", "poor education", "support", "interference in the role," "self-efficacy development", "inner satisfaction", "positive imaging" and "being a model".

Conclusion: It is necessary that academic centers plan for teaching nurses working on a contractual basis in the field of the evaluation method and various methods of teaching. The findings also suggested the development of individual self-efficacy in clinical nurses who train students.

Learning Situations in Nursing Education: A Concept Analysis

Background and purpose:

The nursing student requires opportunities to learn within authentic contexts so as to enable safe and competent practice. One strategy to facilitate such learning is the creation of learning situations. A lack of studies on the learning situation in nursing and other health care fields has resulted in insufficient knowledge of the characteristics of the learning situation, its antecedents, and consequences. Nurse educators need to have comprehensive and practical knowledge of the definition and characteristics of the learning situation so as to enable their students to achieve enhanced learning outcomes. The aim of this study was to clarify the concept of the learning situation as it relates to the education of nurses and improve understanding of its characteristics, antecedents, and consequences.

Methods:

The Bonis method of concept analysis, as derived from the Rodgers’ evolutionary method, provided the framework for analysis. Data collection and analysis were undertaken in two phases: “interdisciplinary” and “intra-disciplinary.” The data source was a search of the literature, encompassing nursing and allied health care professions, published from 1975 to 2016.

Results:

No agreement on the conceptual phenomenon was discovered in the international literature. The concept of a learning situation was used generally in two ways and thus classified into the themes of: “formal/informal learning situation” and “biologic/nonbiologic learning situation.” Antecedents to the creation of a learning situation included personal and environmental factors. The characteristics of a learning situation were described in terms of being complex, dynamic, and offering potential and effective learning opportunities. Consequences of the learning situation included enhancement of the students’ learning, professionalization, and socialization into the professional role.

Implication for Practice:

The nurse educator, when considering the application of the concept of a learning situation in their educational planning, must acknowledge that the application of this concept will include the student’s clinical learning experiences. More studies are required to determine factors influencing the creation of a successful learning situation from the perspectives of nurse educators and nursing students, clinical nurses and patients.

Nurse Educator Attitudes Toward People With Disabilities

AIM

As educators strongly influence the attitudes of their students, the purpose of this study was to determine nurse educator attitudes toward people with disabilities.

BACKGROUND

Inadequate education of health professionals is a known barrier to care for people with disability. Continuing calls for improved education of health professionals compel an assessment of nurse educator attitudes.

METHOD

This was a cross-sectional, correlational web-based survey of nurse educators (n = 126). Nurse educator attitudes were analyzed using descriptive statistics, analysis of variance, and multiple regression analysis.

RESULTS

Nurse educators held discriminatory attitudes toward people with disabilities, though most preferred a biopsychosocial model of disability. Forty-four percent lacked knowledge of disability-related aims, objectives, or outcomes within the curriculum.

CONCLUSION

To advance equity in health care, nurse educators must confront personal bias and teach competent care of people with disabilities.

Nursing students' learning dynamics and influencing factors in clinical contexts

Clinical placements are essential for students to develop clinical skills to qualify as nurses. However, various difficulties encountered by nursing students during their clinical education detract from developing clinical competencies. This constructivist grounded theory study aims to explore nursing students' experiences in clinical nursing education, and to identify the factors that influence the clinical education students receive. Twenty-one individual and six group semi-structured interviews were conducted with sixteen fourth year nursing students and four registered nurses. This research identified six factors that influence nursing students' clinical education: interpersonal, socio-cultural, instructional, environmental, emotional and physical factors. The research has developed a dynamic model of learning in clinical contexts, which offers opportunities to understand how students' learning is influenced multifactorially during clinical placements. The understanding and application of the model can improve nursing instructional design, and subsequently, nursing students' learning in clinical contexts.

Professional Socialization of Iranian BSN Students: A Grounded Theory Study

Introduction: Professional socialization is a critical aspect of nursing students’ development, which begins with entry into the nursing program and continues when their professional practice begins. The aim of this study was to explore the socialization of Iranian BSN students in the nursing profession.

Methods: An exploratory qualitative approach utilizing Straussian version of the grounded theory (1998) method was used. Individual in-depth semi-structured interviews were undertaken with 14 participants chosen from two large nursing schools in an urban area through purposive and theoretical sampling. The data were analyzed, using the constant comparative method.

Results: Five main categories and eleven subcategories emerged and integrated around one core category. Professional metamorphosis as the core variable was a complex and interrelated process (consisting of three stages: dependence, disintegration, and integration) with dynamic, ongoing, and personal features influenced by professional and extra-professional context. The students assumed a passive role in the initial of their studies. However, during the last year of the educational program, they gradually involved actively in dealing with own personal and professional issues.

Conclusion: This study introduced "professional metamorphosis of BSN students" as a substantive grounded theory in the socio-cultural context of the health care system in Iran. During this process, students move from outsider personal position to insider professional position. The nurse educators and administrators may develop effective educational interventions to promote professional socialization of students with an understanding of the promoting and driving forces influencing socialization.

Professional Socialization: A Grounded Theory of the Clinical Reasoning Processes That RNs and LPNs Use to Recognize Delirium

Delirium is an acute disorder of attention and cognition. It affects half of older adults in acute care settings and is a cause of increasing mortality and costs. Registered nurses (RNs) and licensed practical nurses (LPNs) frequently fail to recognize delirium. The goals of this research were to identify the reasoning processes that RNs and LPNs use to recognize delirium, to compare their reasoning processes, and to generate a theory that explains their clinical reasoning processes. Theoretical sampling was employed to elicit data from 28 participants using grounded theory methodology. Theoretical coding culminated in the emergence of Professional Socialization as the substantive theory. Professional Socialization emerged from participants' responses and was based on two social processes, specifically reasoning to uncover and reasoning to report. Professional Socialization makes explicit the similarities and variations in the clinical reasoning processes between RNs and LPNs and highlights their main concerns when interacting with delirious patients.

A concept analysis of professional commitment in nursing

BACKGROUND

The concept of professional commitment is being widely studied at present. However, although it is considered an indicator for the most human part of nursing care, there is no clear definition for it, and different descriptors are being used indiscriminately to reference it.

OBJECTIVE

The aim of this study is to clarify the concept of professional commitment in nursing through the Rodgers' evolutionary concept analysis process.

DESIGN

Systematic search using English and Spanish descriptors and concept analysis. Studies published between 2009 and June 2015, front-to-back analysis of the Nursing Ethics journal and manual check of articles cited in studies related to the Nijmegen Professionalism Scale.

RESEARCH DESIGN

The procedure of concept analysis developed by Rodgers was used.

ETHICAL CONSIDERATIONS

Although the topic was not labeled as sensitive and subject to ethical approval, its realization was approved by the Ethical Committee of Clinical Research of Aragon (CEICA) approved the study on 18 March 2015 and also careful procedures have been followed according to ethics expressed in the Declaration of Helsinki.

FINDINGS AND DISCUSSION

A total of 17 published studies. A clear definition of the concept was made, and surrogate terms, concept dimension, differential factors related to the concept, sociocultural variations and consequences for nursing practice were identified.

CONCLUSION

There is a need for continuous advancement in the development of the concept, specific actions to encourage this and the improvement of evaluation methods for its study.