To belong or not to belong: nursing students' interactions with clinical learning environments - an observational study

Evaluating a Shared Reflective Practice to Develop Nursing Student Clinical Judgment

BACKGROUND

Self-reflection is a valuable method that nurse educators can use to develop clinical judgment skills among prelicensure nursing students. Little research exists on improving clinical judgment in second-degree nursing students in the clinical setting.

PURPOSE

To determine the implications of increasing clinical judgment skills in prelicensure nursing students using a shared structured reflection teaching innovation within a required baccalaureate clinical course.

METHODS

This educational innovation used qualitative descriptive methods to evaluate its effectiveness in the clinical setting among students in the final semester of an accelerated prelicensure nursing program.

RESULTS

Students reported increased accountability for their learning, a sense of intentionality with their nursing practice, and a deeper sense of community with their peers.

CONCLUSIONS

Shared reflective practices in the clinical setting show promise for increasing clinical judgment and supporting a competency-based curriculum.

Addressing a Critical Voice in Clinical Practice: Experiences of Nursing Students, Teachers, and Supervisors-A Qualitative Study

AIM

Our goal was to explore how power asymmetry manifests within the relationships between students, teachers, and supervisors, and how it influences students' ability for critical reflection.

DESIGN

This study has an explorative qualitative design.

METHODS

Thirty in-depth interviews with nursing students (15), teachers (9), and supervisors (6) were conducted in addition to 16 observations of mid-term assessments during clinical practice. The analysis was conducted using Braun and Clarke's thematic analysis.

RESULTS

The students described being a student as a balancing act between humility, conforming to the supervisor's expectations, and speaking their minds. The view expressed by the teachers and supervisors is that training for the nursing profession is closely linked to the students' ability to act independently. Due to the supervisors' hierarchical position, however, students are hesitant to voice any criticism regarding insufficient supervision or unsatisfactory performance of clinical tasks while at the same time being evaluated on their ability to critically reflect on their own and others' clinical performance. This study was prospectively registered with the Norwegian Centre for Research Data on the 15th of August 2017 with the registration number 54821.

Investigating the processes and influences involved in the transformational journeys of Registered Nurse Degree Apprentices: A realist informed qualitative study

AIM

This study aimed to investigate students' learning journeys across the duration of a new registered nurse degree apprenticeship programme and to develop an understanding of the contextual factors, mechanisms and outcomes involved.

BACKGROUND

Registered nurses are the largest group of healthcare workers globally, but shortages exist. To encourage existing UK healthcare employees into nursing, national investment was made into Registered Nurse Degree Apprenticeships. In 2018 a UK health service organisation and a university collaboration led to development of a nursing degree apprenticeship programme. Research into these novel undergraduate programmes in nursing is lacking, with scarce evidence or understanding of processes and experiences involved in such programmes.

DESIGN AND METHODS

An exploratory qualitative design informed by realistic evaluation was employed. Three sequential semi-structured interviews were conducted with an entire cohort (n=8) across the 18-month programme (24 interviews). Focused interviews were also undertaken with practice assessors (n=8) involved in the apprentices' journey. Initial thematic analysis was followed by application of Realist Evaluation principles and a temporal lens to move beyond qualitative description.

RESULTS

Analysis identified four interrelated temporal themes, each comprising contextual factors, mechanisms and outcomes acting to inhibit or facilitate transition across the apprenticeship journey: (1) Starting out (Latent Ambition, enhanced motivation and expectations): programme availability and conditions enabled enactment of ambitions to become qualified nurses, preconceived assumptions regarding roles influenced expectations. (2) Initial stages (Identity dissonance, transition to academia, becoming a student nurse) related to changing identity and re-conceptualisation of their role to student nurse, alongside transitioning into higher education. (3) Travelling through (Being an apprentice, social capital, self-efficacy and confidence) facilitated confident integration into placements, although over confidence could be risky. Academic struggles prompted some episodes of emotional dissonance. (4) Moving beyond to become registered nurses (Confidence, empowerment and loyalty in the transition to becoming a nurse) saw apprentices transform, with revised understandings of nursing, increased empowerment and self-efficacy. All expressed gratitude and loyalty for the apprenticeship opportunity, with all securing jobs in their employing organisation.

CONCLUSION

This study is one of the first of its kind, providing detailed insight into processes experienced by students over the duration of a novel apprenticeship programme. Analysis identified several factors that facilitated and inhibited progress in participants' 'learning journeys', mapping context, mechanism, outcome configurations which came into play at various stages. These were influential in successful completion of the programme by all apprentices, resulting in the development of competent Registered Nurses.

How workplace learning is put into practice: contrasting the medical and nursing contexts from the perspective of teaching and learning regimes

Health professions education places significant emphasis on learning in the clinical environment. While experiences of workplace learning have been extensively investigated, practices of workplace learning explored through field work have been less utilized. The theoretical framework of teaching and learning regimes acknowledges aspects of power and conflict in its consideration of what guides teachers and learners in their practice of workplace learning. This study aimed to explore practices of workplace learning in the two adjacent healthcare professions; medicine and nursing. We adopted an ethnographic qualitative design. Field observations and follow-up interviews were performed in three clinical departments and the data set comprised 12 full days of observations and 16 formal follow-up interviews. Thematic analysis was performed deductively according to the theoretical framework. Four teaching and learning regimes were found in the data. In the medical context, workplace learning was either practiced as reproduction of current practice or through stimulation of professional development. In the nursing context, workplace learning was either based on development of partnership between student and supervisor or on conditional membership in a professional community. The medical and nursing contexts demonstrated varying underpinnings and assumptions relating to teaching and learning. The respective practices of workplace learning in the medical and nursing context appear to hold substantial differences which might have implications for how we understand practices of workplace learning. We further conclude that the theoretical framework of teaching and learning regimes in this study proved useful in exploring workplace learning.

Veterinary Nursing Students' Experience in the Clinical Learning Environment and Factors Affecting their Perception

Student veterinary nurses (SVNs) spend a significant proportion of their training time within the clinical learning environment (CLE) of a veterinary practice. These clinical experiences are vital for building practical and professional skills. To evaluate the current satisfaction of SVNs in the CLE, a cross-sectional survey design was used incorporating a previously validated instrument. To provide understanding of factors that may affect the SVN satisfaction, additional validated tools were added across factors, including resilience, wellbeing, personality, and work place belonging. A total of 171 SVNs completed the survey. In addition, two open questions were included to provide greater depth of understanding of the SVN experiences. Results showed that 70.76% of respondents were satisfied/very satisfied with the CLE. Significant factors that affected the satisfaction scores included, depression, anxiety, and stress (p ≤ .001), psychological sense of organizational membership (p ≤ .001), agreeableness (p = .022), and emotional stability (p = .012). The qualitative data demonstrated shared SVN factors that are considered to contribute to clinical learning and those that detract from clinical learning. Educational facilities and training veterinary practices can support the SVN within the CLE by creating a greater sense of belonging, considering the SVN individual personality and wellbeing, and including the SVN in discussions around learning support needs.

Senior nursing students' reflections on deviations from guideline adherence regarding venous blood specimen collection practice: A qualitative study

BACKGROUND

Venous blood specimen collection is a common procedure within healthcare and both diagnoses as well as treatment evaluation, are often based on results from these analyses. However, studies among both students and staff have demonstrated suboptimal adherence to venous blood specimen collection practice guidelines which in turn might jeopardize patient safety.

OBJECTIVES

This study aimed to describe final semester nursing students' experiences of deviations from venous blood specimen collection practice guidelines during clinical training.

METHODS

This study adopted a qualitative design. Twentysix final (6th) semester nursing students were recruited through purposive sampling at a Swedish university. Data were collected through semi-structured, face-to-face, focus group interviews in September 2015. The transcribed interviews were analyzed using qualitative content analysis.

RESULTS

The students' experiences generated two categories; 1) Striving to blend in (subcategories Feeling uncomfortable and Adapting to the prevailing practice culture) and 2) Diminished confidence (subcategories Being confused due to inconsistency and Being uncertain about guideline usefulness) forming the overall theme Being a copycat.

CONCLUSION

The research concludes that nursing students adapt to the prevailing practice culture encountered during clinical training, often at the expense of guidelines adherence. Since the students are being assessed during clinical training, the eagerness to belong to the team and be well-liked might be stronger than the ambition to follow guidelines. As a consequence, nursing students in clinical training might become copycats by aligning themselves with the prevailing practice culture which in turn might jeopardize adherence with VBSC guideline practice and thereby patient safety. With the ambition to support nursing students' learning in clinical training, facilitators of learning to comprise both students and supervisors need to be further addressed.

TWEETABLE ABSTRACT

Nursing students adapt to the prevailing venous blood sample collection practice culture and become copycats.

Sense of Belonging and Evidence Learning: A Focus Group Study

A sense of belonging is a prerequisite for the professional and clinical success of nursing students. The objective of this study was to elucidate whether students’ participation in projects oriented toward translating knowledge into clinical practice promoted a sense of belonging and assisted with their integration into clinical practice services. Fifteen students were distributed into two focus groups, and the study was carried out by means of a semi-structured interview script using the research question as a starting point for directing the discussion toward more specific topics. Qualitative analysis followed a predefined protocol. WebQDA® software was used to organize and analyze the findings, as well as to increase their rigor. The study design was approved by an ethics committee. Three categories related to belongingness emerged from the data analysis: integration, participation, and collaborative work. Belongingness was a central element for integrating students into services, and it influenced their clinical education, their motivation, and the quality of their experience. It also allowed them to learn about evidence, communicate science, carry out evidence-based practice, and develop competencies. Concurrently, student integration was facilitated by the sharing of knowledge between professors and nurses, and the existence of ongoing work with clinical practice services.

Learning in the Third Room-A Way to Develop Praxis by Embracing Differences Between Theoretical and Practical Knowledge

Contradictions between theory and practice are well known in nursing. To this end, this article discusses a learning strategy that might facilitate the capture of the dialectic between theory and practice, equally valid components of a nurse's competence, giving the 2 forms of knowledge equal relevance. Using a virtual platform (ie, the "third room") decreases the power order between different forms of knowledge. Nurses, students, and teachers all contribute to a seminar using nonhierarchical structures and concepts to capture the knowledge that enables to learn the praxis of nursing.

The influence of a self-determination theory grounded clinical placement on nursing student's therapeutic relationship skills: A pre-test/post-test study

For undergraduate nursing students, an integral mode of learning is their clinical placements. Learning within the clinical setting is influenced by factors such as the facilitators, peers, unit, or department the student is placed on. What is not known is the role of a social context that is grounded in Self-Determination Theory and how this influences the development of therapeutic relationship skills among undergraduate nursing students. The aim of this study was to examine the role of autonomy support in the professional learning of undergraduate nursing students. This study employed a two-group pre-test and post-test design, with undergraduate nursing students placed in either an autonomy-supportive group or a comparison group in an Australian context. Therapeutic relationship skills were assessed at the beginning and end of their compulsory mental health clinical placement. Participants were 210 (n = 210) Australian undergraduate nursing students. Using a tertile split, 140 students were placed into one of two groups based on their perception of autonomy support at the post-test time point. Pre- and post-test therapeutic relationship data were collected for both groups. A repeated measures analysis of variance was used to examine whether engagement in different clinical placements would illicit significant differences in therapeutic relationship skills. Undergraduate nursing students who were engaged in the autonomy-supportive setting had significantly higher scores associated with the therapeutic relationship subscales: Positive Collaboration and Positive Clinical Input. The importance of the social context is underscored, which is strongly influenced by the educational leader, typically referred to as a nurse facilitator.

Modification, Translation, and Psychometric Testing of the Arabic Version of the Belongingness Scale-Clinical Placement Experience (BES-CPE)

BACKGROUND

This paper aimed to describe the modification, translation, and psychometric testing of the Arabic version of the Belongingness Scale-Clinical Placement Experience (BES-CPE).

METHODS

This study included the following phases: modification of the original BES-CPE based on the qualitative findings from a previous study; translation and back-translation of the scale; evaluation of the content validity by experts from Saudi Arabia; evaluation of the internal consistency reliability; and other psychometric properties of the Arabic BES-CPE.

RESULT

The results demonstrated acceptable psychometric properties. The Cronbach's alpha ranged from 0.68 to 0.92.

CONCLUSION

The Arabic BES-CPE is a promising tool that can be used to assess Saudi nursing students' sense of belonging. However, testing the tool with other undergraduate nursing students in a different context is recommended.

Moral intelligence, clinical placement experience and professional behaviors among Iranian undergraduate nursing students in a baccalaureate nursing program: A descriptive correlational study

AIMS

This study was intended to examine the relationship of both moral intelligence (MI) and Clinical Placement Experience (CPE) with the level of nursing students' professional behaviors (PB).

BACKGROUND

The foundation of belief, belonging and ethical values develop PB as a meaningful attribute during the period students and caring for patients.

DESIGN

A descriptive correlational study was conducted.

METHODS

Descriptive data were derived from the Belongingness Scale-Clinical Placement Experience (BES-CPE), the Moral Intelligence Questionnaire (MIQ) and the Nursing Students Professional Behaviors Scale (NSPBS) including 200 students (response rate 94.5%).

RESULTS

We found a statistically strong positive correlation between NSPB, MI and CPE. The regression model accounted for 57.8% of the variance in NSPB; CPE and MI were significant explanatory variables of NSPB. Moreover, the non-employed dormitory students had a significant statistical difference in the scores of all three variables. Female students had significantly higher CPE and MI (p˂0.05).

CONCLUSIONS

According to our findings, preventive and mediation endeavors for nursing students can explicitly target their behavioral skills to reduce perceived rejection and improve morality. As a result, an optimal plan to improve the quality of professional training courses for students should be designed based on the comprehension of clinical belonging and moral intelligence.

Successful instillation of professionalism in our future doctors

This article was migrated. The article was marked as recommended. Dynamic approaches are required in teaching professionalism to medical students. Awareness of this issue has both arisen from and generated by a dramatic increase in publications relating to professionalism teaching in medical education. This report explores the current state of defining professionalism and shows that current literature reveals a strong proclivity to adopting "Communities of Practice" as the learning paradigm most likely to successfully instil professional values. This pedagogy is then critiqued with regards to the requirement of an undergraduate curriculum with the conclusion that Communities of Practice should be pertinent to successfully empowering medical students' professionalism.

Moving beyond solutionism: Re-imagining placements through an activity systems lens

INTRODUCTION

Clinical placements are central to the process of preparing future health professionals for practice. Health care environments are increasingly complex and demanding with clinical placements often being perceived as a burden on busy health professionals giving rise to a service-education tension. This tension creates a situation ripe for simplistic solutionist approaches. For example, characterising the problem of clinical placements as students negatively impacting on service productivity results in a reductionist solution such as universities compensating health services for student education. Challenges faced by placement seekers and placement providers are multifaceted and complex requiring a more sophisticated understanding and response to the challenges of involving students in the workplace to prepare them for the future workforce.

RE-CONCEPTUALISATION

We argue that the health and education systems have become de-coupled. Learning and working are seen as distinct activities that are at odds with one another. Re-imagining the purposes and practices of clinical placements for the mutual benefit of patients, health services and students may fruitfully address this disconnect.

WORKED EXAMPLE

We present a worked example using the conceptual and analytical tools of cultural-historical activity theory to articulate what we have learnt about this health-education disconnect. Our worked example draws on research involving a series of clinical education case studies within acute care contexts.

CONCLUSION

Through the lens of cultural-historical activity theory, we highlight that solutionist approaches are entrenched in a de-coupling of health from education where the shared object of preparing the future workforce is fragmented. Successful re-coupling requires a partnership that is founded on a shared commitment to preparing the future workforce; recognises that learning and practice are inseparable; and understands that both activity systems are fluid and that collaboration to stay focused on the shared object of preparing the future workforce is complex, challenging and ongoing work.

Call the On-Call: a study of student learning on an interprofessional training ward

Interprofessional training wards are designed to train students' team and communication competences. Such wards are generally highly valued clinical placements by undergraduate students; however, evidence in the literature suggests that medical students experience a lack of profession-specific tasks on these wards. Moreover, students lack structured training in the complexities of everyday communication where different health professions rarely are present together in stable teams. This paper reviews one strategy to train students in interprofessional communication while letting students perform profession-specific tasks. A qualitative study with ethnographically-collected data was conducted among three interprofessional student teams over three two-week periods, mixing field observations (75 h), interviews (n = 16), and field notes (45 pages). The findings show that students gained insights into new aspects of their professional roles and an appreciation of clear and open interprofessional communication over the telephone. Learning was facilitated through being confronted with new situations and discussing these experiences with each other over time. Call the On-Call as a pedagogic activity provided not just medical students, but also nursing students with new types of profession-specific tasks on the interprofessional training ward.

Percepciones de los estudiantes sobre sus vivencias en las prácticas clínicas

Introducción: Los estudiantes de enfermería deben adquirir conocimientos, habilidades, actitudes y valores, para proporcionar cuidados de calidad. Las prácticas clínicas son el contexto ideal para lograr algunas de las competencias requeridas. Objetivo: Explorar las percepciones de los estudiantes sobre sus vivencias durante sus prácticas clínicas. Método: Abordaje metodológico descriptivo de tipo cualitativo y con un encuadre sociocrítico. Se analizaron los 45 portafolios de estudiantes de 4º curso de la Escuela Universitaria de Enfermería (EUE) Cruz Roja, donde explican sus vivencias en prácticas. Se optó por un portafolio semiestructurado en función de la competencia a demostrar definiendo previamente las tareas o evidencias Se realizó un análisis de contenido que comprendía las siguientes fases: reducción de los datos; categorización-codificación, presentación de datos y conclusiones/verificación de los datos. Se alcanzó saturación en la información sobre las categorías presentadas. Resultados: Del análisis de los datos emergen distintas unidades de significado que se engloban en tres categorías: aprendizaje en prácticas, dificultades del entorno, crecimiento personal y profesional. Conclusiones: El estudio evidencia la importancia de las prácticas clínicas para los estudiantes dentro del plan de estudios, ya que es donde aplican lo que han aprendido en el aula y son conscientes de la realidad a la que se enfrentan. El entorno clínico y la relación que se establezca entre este y el estudiante determina en muchas ocasiones el aprendizaje. Queda patente que los estudiantes durante sus prácticas clínicas toman conciencia de aquellos conocimientos del saber, saber hacer y saber estar.

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.

On learning in the clinical environment

INTRODUCTION

The clinical environment has been increasingly acknowledged as an important setting for learning within healthcare professional education. In particular, researchers have highlighted the need to advance the knowledge on the social nature of learning in the workplace setting. The aim of the thesis was to explore workplace learning among undergraduate medical and nursing students.

METHOD

The thesis adopted a socio-cultural perspective on learning and employed a qualitative approach embedded in an interpretative tradition of inquiry. Four consecutive studies were included in the thesis, the first one designed according to qualitative description whereas the other three had an ethnographic approach. Data were collected through individual interviews and field observations. Content analysis and thematic analysis were employed.

RESULTS

For the medical students, workplace learning entailed access to a variety of activities in the role of a marginal member of the healthcare team. Medical students demonstrated an adaptive approach to workplace learning. For the nursing students, workplace learning involved being entrusted to hold responsibility for patient care and the need to negotiate their basic values with those of the workplaces. Nursing students showed a hesitant approach to workplace learning.

DISCUSSION

Workplace learning was built upon varying theoretical perspectives of learning in the medical and nursing contexts respectively. The main message in the thesis argued for an upgrading of students as a powerful and active stakeholder in workplace learning, so as not to view students as passive consumers of clinical education.

Belongingness and its implications for undergraduate health professions education: a scoping review

Belongingness is well recognised within higher education to have an important influence on the performance and well-being of learners. There appears to be little awareness of its importance in undergraduate health professions education. To identify how belongingness has been defined and measured, its impact on the performance and well-being of learners, and how it can be fostered in educational settings. A scoping review to map the published research in the wider higher education literature (including undergraduate health professions education). PubMed and ERIC were used. Only peer-reviewed articles in the English Language between 1996 and 2016 were included. Fifty-one relevant articles were identified with 16 related to nurse clinical education. No studies were found in undergraduate medical education or in primary care educational settings. Common features were identified within the several definitions of belongingness. A thematic analysis of articles revealed that belongingness has an important role in student motivation and learning identity formation and in facilitating positive mental health. The scoping review highlighted the importance of belongingness in higher and undergraduate health professions education, with implications for future practice and policy. Further research is recommended. There are important implications for curriculum development and delivery, including clinical placements; within secondary and primary care health professional education.