A meta-study analysing the discourses of discourse analysis in health professions education

INTRODUCTION

Discourse analysis has been used as an approach to conducting research in health professions education (HPE) for many years. However, because there is no one 'right' interpretation of or approach to it, quite what discourse analysis is, how it could or should be used, and how it can be appraised are unclear. This ambiguity risks undermining the trustworthiness and coherence of the methodology and any findings it produces.

METHOD

A meta-study review was conducted to explore the current state of discourse analysis in HPE, to guide researchers engaging using the methodology and to improving methodological, analytical and reporting rigour. Structured searches were conducted, returns were filtered for inclusion and 124 articles critically analysed.

RESULTS

Of 124 included articles, 64 were from medical education, 51 from nursing and 9 were mutli-disciplinary or from other HPE disciplines. Of 119 articles reporting some sort of data, 50 used documents/written text as the sole data source, while 27 were solely based on interview data. Foucault was the most commonly cited theorist (n = 47), particularly in medical education articles. The quality of articles varied: many did not provide a clear articulation what was meant by discourse, definitions and methodological choices were often misaligned, there was a lack of detail regarding data collection and analysis, and positionality statements and critiques were often underdeveloped or absent.

DISCUSSION

Seeking to address these many lacunae, the authors present a framework to facilitate rigorous discourse analysis research and transparent, complete and accurate reporting of the same, to help readers assess the trustworthiness of the findings from discourse analysis in HPE. Scholars are encouraged to reflect more deeply on the applications and practices of discourse analysis, with the ultimate aim of ensuring more breadth and depth when using discourse analysis for understanding and constructing meaning in our field.

The relationship between professional values, ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach

AIM

To examine the relationship between professional values, ethical sensitivity and caring behaviors among nursing students and determine whether professional values play a moderator role in the relationship between ethical sensitivity and caring behaviors among nursing students.

BACKGROUND

Developing professional nursing values, ethical sensitivity and caring behaviors is critical in nursing programs from the first year to graduation to prepare students for increasingly complex and diverse work environments.

DESIGN

A cross-sectional study using structural equation modeling. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.

METHODS

This study was conducted with 189 undergraduate nursing students. The study was conducted in a four-year nursing faculty in the Mediterranean region of Turkey from February to June 2022. Data were collected using a personal information form, the Nurses' Professional Values Scale, the Moral Sensitivity Questionnaire and the Caring Behaviors Assessment Tool Nursing Version-Short Form.

RESULTS

We found that nursing students' perceptions of professional values and caring behaviors were high and their ethical sensitivity was moderate. Nursing students who are successful in high school have higher professional values. In addition, it was determined that nursing students who chose the nursing profession because of altruism had higher perceptions of caring behaviors. A positive relationship exists between professional values, ethical sensitivity (r = -0.258, p < 0.001) and caring behaviors (r = 0.431, p < 0.001) (p < 0.05). Professional values have a positive effect on ethical sensitivity and caring behaviors.

CONCLUSION

Professional values, ethical sensitivity and caring behaviors are relationships and professional values positively predict nursing students' ethical sensitivities and caring behaviors. As the professional value perceptions of nursing students increase, their ethical sensitivity and caring behaviors increase. Improving the curricula in a way that will improve professional values may enable nursing students to increase their ethical sensitivity and caring behaviors. The research contributes to a broader understanding of nursing education curriculum content.

Prediction of ethical decision making with professional values in senior nursing students

PURPOSE

This study investigated whether the professional values of nursing students can predict their ethical decision-making levels.

DESIGN AND METHODS

The study used a descriptive and cross-sectional research design. The study sample consisted of 130 senior nursing students. The data were collected from the Student Information Form, Nursing Professional Values Scale, and Nursing Dilemma Test (NDT). The data were evaluated using Pearson correlation analysis and multiple linear regression analysis.

FINDINGS

A significant correlation was found between students' professional values and their mean PLT total scores (p < 0.01). Also, a negative correlation was found between students' professional values and the total mean practical thinking scores (p < 0.01). Professional values of the students explained 21.2% of the total PLT score and 0.08% of the total practical thinking score.

CONCLUSION

The professional values of the students affect their principal and practical thinking skills in ethical dilemmas.

IMPLICATIONS FOR NURSING PRACTICE

It is recommended to discuss the ethical dilemmas observed or experienced by the students in their clinical practice in the field, increase the awareness of the students, and teach them how to deal with ethical dilemmas.

Nursing students' experience during their practicum in an intensive care unit: A qualitative meta-synthesis

Background

Clinical practicum provides nursing students with more opportunities to learn their professional knowledge and develop basic nursing skills. Intensive care unit (ICU) is often used as one of the clinical practicum departments for nursing students. Due to the characteristic fast-paced working environments, high acuity of patient care, and technical complexities of an ICU, nursing students are more susceptible to experiencing stress and lack of confidence in these settings, which hinders their professionalization and affects patient care.

Objective

The study aimed to summarize and evaluate the nursing students' experience in an ICU during their practicum and to provide a supportive ICU clinical practicum environment for them. One of the main objectives was to increase the ICU specialty nurse reserve and improve nursing care in the ICU.

Methods

The following databases were searched for related qualitative publications in Chinese and English by systematic searches across January 2022, including the nursing students' experience in ICU during their practicum: PubMed, Cochrane Library, Web of Science, and so on. The qualitative meta-synthesis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two reviewers independently selected these studies and carefully evaluated the quality of each study. Meta-synthesis was then used to summarize the results.

Results

Eleven sub-themes and 3 themes were revealed in 9 studies: challenges of clinical practicum in the ICU, the expectation of support from multiple sources, and the importance and necessity of practicum in the ICU.

Conclusion

Performing one's practicum in ICU was considered by the nursing students in this review as a beneficial practicum despite the challenges involved. The appropriate guidance and monitoring should be given by hospital managers and college educators.

Reliability and validity evaluation of the chinese version of the ethical sensitivity questionnaire for nursing students

BACKGROUND

Advances in technology and the expansion of nursing roles have led to complex ethical issues in nursing. Nursing students are the future clinical nursing workers and practitioners. The ethical sensitivity of nursing students is very important to the professional development of nursing students, which can strengthen the ethical cognition of nursing students, improve the ethical decision-making ability of nursing students, and is beneficial to the development of nursing students in the process of clinical practice and nursing education. However, there are no instruments to evaluate the ethical sensitivity of nursing students in China. Therefore, the purpose of this study is to evaluate the validity and reliability of the Chinese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS).

METHODS

After obtaining the authorization of the author of the original scale, the study used the Brislin back-translation method for translation. An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were performed to examine the underlying factor structure of the translated questionnaire. The Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation were calculated to verify the internal consistency of the scale.

RESULTS

The Chinese version of ESQ-NS retained 13 items. Exploratory factor analysis (EFA) extracts four common factors, and the cumulative variance contribution rate is 62.479%. The CFA reached the adaptive standard, and the discriminant validity of the scale was good. The Cronbach alpha coefficient of this scale was 0.821, and 4 dimensions were between 0.708 and 0.738. The results of the test-retest showed that Pearson's correlation coefficient of the overall ESQ-NS was 0.814. Corrected item-total correlation ranged from 0.337 to 0.542.

CONCLUSIONS

The Chinese version of the ESQ-NS has good reliability and validity, which can be used to evaluate the level of ethical sensitivity of nursing students in China.

The relationship between moral sensitivity and professional values and ethical decision-making in nursing students

BACKGROUND

More researchers have paid attention to the ethical decision-making in nursing worldwidely due to the increasing complexity of ethical issues and dilemmas. Ethical decision-making ability is regarded as one of the core competences of nursing practice and has the potential to resolve ethical issues. It is important to identify the key variables related to ethical decision-making and understand their relationship between them respectively. It is also helpful to design interventions to promote nursing students' ability to resolve ethical dilemmas.

OBJECTIVE

This study aims to examine the relationship between moral sensitivity, professional values and ethical decision-making respectively, and to explore whether professional values have mediating effect on the relationship between moral sensitivity and ethical decision-making among nursing undergraduates in Chinese nursing education context.

DESIGN

This study is a cross-sectional descriptive correlational design.

METHODS

263 nursing undergraduates from Nursing and Health School, Zhengzhou University in Henan province of China participated in the study and received the investigation. Their ethical decision-making, moral sensitivity and professional values were measured through the following three questionnaires, including the Judgement About Nursing Decision (JAND), Chinese Moral Sensitivity Questionnaire-Revised Version (MSQ-R-CV) and Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV). The data were processed and analysed by SPSS 23.0 and AMOS 24.0. The statistical methods included descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation analyses and structural equation modeling.

RESULTS

Moral sensitivity is positively correlated with ethical decision-making (P < 0.01). Professional values is positively correlated with ethical decision-making (P < 0.01) and also has a mediating effect on the relationship between moral sensitivity and ethical decision-making (P < 0.01).

CONCLUSION

The investigation contributes to a broader understanding of the factors that influence nursing students' ethical decision-making. Developing ethics education around nursing students' professional values and moral sensitivity can improve their ethical decision-making ability.

'Hello, my name is …': an exploratory case study of inter-professional student experiences in practice

BACKGROUND

The 'Hello my name is …' campaign emphasises the importance of compassionate care and focuses on health professionals introducing themselves to patients. Research has found that using names is key to providing individuals with a sense of belonging and can be vital in ensuring patient safety.

OBJECTIVE

To investigate the student experience of having 'Hello my name is …' printed on student uniforms and implement this campaign in practice.

DESIGN

A case study was used to capture the experiences of 40 multiprofessional healthcare students in practice. Participants were asked to complete a reflective diary during their first week in practice and attend a focus group with 4-8 other students.

SETTING

A higher education institution in the north east of England with students from adult, child and learning disability nursing, occupational therapy, physiotherapy and midwifery programmes, in a variety of clinical placements throughout the region.

FINDINGS

The implementation of the campaign and logo branding on the uniforms of students resulted in an increase in the number of times students were addressed by their name in practice. Participants reported that the study helped them to quickly develop a sense of belonging when on placement, and aided them in delivering compassionate care. Occasions when patient safety was improved were also reported.

CONCLUSION

The use of names is a key feature in human relationships and the delivery of compassionate care, and the authors advocate use of the 'Hello my name is …' campaign for all health professionals.

Nursing students' preparedness and practice in critical care settings: A scoping review

BACKGROUND

Due to the demanding nature of critical care settings, students are prone to experience stress and lack of confidence, which hinders their learning and affects patient care. Educators should be knowledgeable about students' roles, stressors, and challenges as well as strategies to enhance students' competence and confidence to efficiently practice in critical care.

PURPOSE

To map and analyze the literature about nursing students' placement, preparedness, and practice in critical care settings and identified areas for future research and practice.

METHODS

A scoping review using PRISMA guidelines. The literature was searched within eight databases using indexed terms. In total, 32 sources were selected for review. Literature summary tables, thematic synthesis, narrative summaries were used for data extraction and synthesis.

FINDINGS

Three themes and 12 sub-themes were generated. The themes included students' experiences and perspectives about critical care placements, strategies to enhance student learning, and the impact of clinical placements and teaching strategies on students.

CONCLUSIONS

Critical care placements allow students in understanding the care of complex patients, enhancing their observational skills, and improving their interpersonal relationships in critical care teams. To enhance student preparedness for effective practice, high fidelity simulations and course-based teaching have been demonstrated to be effective.