Influencing nursing students' perceptions of community care with curriculum-redesign; a quasi-experimental cohort study

The influence of individual factors on the career preferences and specialty choices of final-year nursing students

BACKGROUND

Statistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints.

PURPOSE

The aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students' career decision-making process.

METHOD

A narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes.

RESULTS

Data analysis generated three main themes: demographic factors, social factors, and career goals. Participants' characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans.

CONCLUSION

Nursing students' career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may need formal career guidance to encourage nursing students' positive attitudes and career interests in different nursing specialties and make realistic career decisions.

An examination of the career decision-making self-efficacy of final-year nursing students

BACKGROUND

One in four newly graduated registered nurses leave their employment positions within the first year. To reduce this attrition, nursing stakeholders could focus on the final year of nursing education because students at this stage make professional career plans, including their practice destination for the graduate year and their commitment to the profession. Previous studies provide evidence of nursing students' career preferences and specialty choices. However, there is a dearth of data that focuses on the students' career decision-making process.

AIM

This study examined the self-efficacy or confidence of final-year nursing students in making career decisions and the factors that influence their career decision-making process.

SETTING AND PARTICIPANTS

Final year pre-registration nursing students (N = 222) at two public universities in Western Australia.

METHODS

An online survey was used to collect cross-sectional data. The Career Decision Self-Efficacy Scale - Short Form was used to investigate nursing students' confidence in making career decisions. Career decision-making self-efficacy refers to the confidence to successfully complete career decision-making tasks. Descriptive statistics were used to describe the participants' characteristics. The chi-square test was used to assess the significance of the difference between categorical data, and binary logistic regression was used to determine the odds of the factors that predict career decision self-efficacy.

RESULTS

Forty-seven percent of participants who answered all Career Decision Self-Efficacy Scale - Short Form questions had good confidence in making career decisions. Factors such as the setting of the final clinical placement, the intention to be employed in the specialisation or organisation of their final placement and the students' assessment of their clinical experience were associated with career decision-making confidence.

CONCLUSIONS

Most participants had low confidence in making career decisions. This study provides ideas for nursing stakeholders to implement measures to improve students' confidence to make informed career decisions.

Perceptions of community care among nursing students: A cross-sectional study with implications to nursing workforce

BACKGROUND

A shift of health care services towards community care has driven the need to develop the community care nursing workforce. However, challenges exist in attracting nursing graduates to a career in community care.

AIM

To examine perceptions of community care and placement preference among undergraduate nursing students across different years of study in a Singapore university.

METHODS

This study examined perceptions of community care and placement preference among undergraduate nursing students across different years of study. A cross-sectional study was conducted using the 'Scale on COmmunity care Perceptions' (SCOPE).

RESULTS

Only 31.3 % of the 501 nursing students who completed the survey preferred community care placement. They rated opportunities for advancement, work status and enthusiastic colleagues in community care with relatively lower scores in the SCOPE. Students' placement preferences and year of study were predictive factors of their perceptions of community care nursing. Students who indicated their placement preference in home-based care (p < 0.001) and intermediate long-term care (p < 0.05) reported significantly positive perceptions towards community nursing as compared to students who indicated acute care as their preferred placement. Despite pre-perceived ideas among the year 1 cohort, the community care placement within their course curriculum had an impact on year 2 to 4 students' perceptions of community care.

CONCLUSIONS

These findings identified key strategies to increase the community care nursing workforce which include promoting a better understanding of the role of a community nurse, providing quality community placement opportunities supported by preceptors who are good role models and fostering an optimistic career outlook and advancement in community nursing.

The impact of final-year clinical placements on nursing students' career planning for the graduate year and beyond

AIMS

This study had three objectives: 1) to determine final-year nursing students' career preferences and long-term career plans; 2) to investigate factors influencing nursing students' specialty choices following their final-year clinical placement(s); and 3) to understand how final-year clinical placements can be used to develop the career interests of nursing students to different nursing specialties.

BACKGROUND

Clinical placement provides an insightful experience that may influence students to feel inclined to work in certain specialties. Therefore, each clinical placement should promote students' learning and enhance positive experiences that could develop their career interests and encourage them to seek employment in the specialty on graduation.

DESIGN

A cross-sectional online survey.

METHODS

The survey was structured using the Career Decision Self-Efficacy Scale - Short Form. The questionnaire was distributed to final-year nursing students (N = 222) at two public universities in Western Australia. This study specifically reports on the Goal selection and Planning domains of the Career Decision Self-Efficacy Scale - Short Form, which were explored through additional questions prompting participants to explain their career preferences and reasons for their nursing specialty choices.

RESULTS

Most participants, fifty-three percent, had low confidence in making career decisions. The Goal Selection and Planning questions measured the students' confidence in choosing a suitable practice destination and preparing for their professional careers. Overall, participants prefer employment in hospital settings both in the short- and long-term aspects of their nursing career. The factors influencing the students' career decisions were classified into three main categories: the clinical environment, educational factors and individual factors.

CONCLUSIONS

The nursing curriculum may encourage nursing students to work in some specialties over others. This study provides insight into factors that may promote or inhibit students' career choices and how students may be motivated to pursue the less preferred nursing specialties.

Nursing students' perceptions on community care and placement preference in Saudi Arabian universities: A multicenter cross-sectional study

BACKGROUND

There is an increasing shortage of highly educated community nurses; only a small number of nursing students choose to work in the community.

OBJECTIVES

To understand the perception among nursing students in Saudi Arabia about working in the community and where they intend to pursue their careers.

DESIGN

A quantitative cross-sectional design.

SETTINGS AND PARTICIPANTS

A convenience sample of undergraduate students enrolled in their first to final years of a bachelor's degree program at three Saudi Arabian universities.

METHODS

Data were collected from September-December 2022 using the 'Scale on Community Care Perceptions', which included demographic questions and measures reflecting their impressions of a community care placement, a community care career, and their current placement preferences.

RESULTS

In total, 439 students completed the online questionnaire. Nursing students' community care feelings (affective component), expectations, and regards as a future profession were moderately positive with a mean of 6.68 (1-10 scale; negative-positive perceptions). Regarding placement preference, many students chose general hospitals (N = 212, 48.30 %); a small number chose community care (N = 77, 17.54 %). The positive choice of respondents was influenced by the various technical nursing skills required (N = 212, 10.6 %), enjoyable relationships with patients (N = 211, 10.5 %), and many opportunities for advancement (N = 169, 8.4 %). Furthermore, students' placement preferences were significantly predicted by their expectations of placement and future professions in community care (F = 95.24, p < 0.01, R2 = 0.30). A significant difference was also found among their preferences in terms of the level of education and the experience of family and friends working in the community (p < 0.01).

CONCLUSION

Community care is an undervalued career choice among nursing students in Saudi Arabia. To bolster nursing students to prefer this career path, nursing schools, in coordination with local authorities, must formulate and implement a clearly defined career development plan that allows them to fully immerse themselves in community care activities.

Community nurse lecturers' experiences of pre-registration nurse education: a phenomenological study

The aim of this study was to explore the lived experiences of community nurse lecturers in pre-registration nurse education and to gain insight into the nature of community nursing and its profile within pre-registration nursing. A qualitative phenomenological approach explored pre-registration, adult field nurse lecturers' experiences of being community nurses and subsequently their experiences of being community nurse lecturers. Three participants audio recorded answers prompted by three questions that allowed for storytelling and prompted memory recall. The results were analysed, and the themes identified were: community nursing is vastly different to hospital nursing, with a notable heightened sense of accountability, lone working and a recognition of experience needed to be a community nurse. When reflecting on their role as lecturers, research participants recalled responses that informed the second theme: the pre-registration adult nursing curriculum was acute care focused and this was also the expectation of students. Results identified tensions between community nursing and critical care nursing, and a loss of identity to which each of them embraced in different ways.

A district nurse's reflection on pre-registration nursing education: a troubling position

This article explores the author's observations as a qualified district nurse and senior lecturer in pre-registration nurse education. Perceived 'troubling' reflections suggest pre-registration nurse education appears very hospital focussed. Additionally, the role of the district nurse has become synonymous with the term 'community nurse', hiding the historical specialism it represents. Media representations of the term 'frontline' was particularly noted in relation to COVID-19, suggesting a heroism of nursing that only happened in hospital. More discussion will take place around how nursing is viewed within education by students, such as what we do to patients (catheterisation, blood sugars etc) rather than how we can work with them. All these areas appear to strengthen lingering historical myths around district nursing and student perceptions of this specialist profession.

Nursing Teaching Curriculum Setting by Introducing Postcompetency Model under the Vision of Internet Informatization

The nursing curriculum is to be modernized to improve the student's skills in meeting the recent trends in medical and healthcare fields. The curriculum improvements are based on expert recommendations, authors, and informative data from different web sources. The challenging task is to improve the readability and understandability of the curriculum to real-time standards. Considering the above facts, this article introduces a refined curriculum with Internet information analysis (RC-IIA) method. The proposed method incorporates the distributed Internet, journal, and previous curriculum information within the active nursing syllabus. This prevents repetitions and less-informative content within the active curriculum. Besides, classification learning for knowledge-based representations is used within the curriculum to improve competency. Based on the refined information, a recommendation-based curriculum is preferred for varying information across different standards. The proposed analysis method relies on existing and distributed information across multiple curriculum providers for leveraging the visibility and prolonging the stealth of the nursing curriculum.

The effect of a more community-oriented curriculum on nursing students' intervention choice in community care: A quasi-experimental cohort study

AIM

The aim of this study is to investigate the effect of a more 'community-oriented' baccalaureate nursing curriculum on students' intervention choice in community care.

BACKGROUND

Following a healthcare shift with increased chronic diseases in an ageing patient population receiving care at home, nursing education is revising its curricula with new themes (e.g., self-management) on community care. Although it seems obvious that students incorporate these themes in their nursing care interventions, this is unclear. This study investigates the effect of a redesigned curriculum on students' care intervention choice in community nursing.

DESIGN

A quasi-experimental quantitative study.

METHODS

This study with an historic control group (n = 328; study cohorts graduating in 2016 and 2017; response rate 83 %) and an intervention group n = 152; graduating in 2018; response rate 80 %) was performed at a University of Applied Sciences in the Netherlands. The intervention group experienced a curriculum-redesign containing five new themes related to community care (e.g., enhancing self-management, collaboration with the patients' social network, shared decision making, using health technology and care allocation). The primary outcome 'intervention choice in community nursing' was assessed with a specially developed vignette instrument 'Assessment of Intervention choice in Community Nursing' (AICN). Through multiple regression analyses we investigated the effect of the curriculum-redesign on students' intervention choice (more 'traditional' interventions versus interventions related to the five new themes). The control and intervention groups were compared on the number of interventions per theme and on the number of students choosing a theme, with a chi-square or T-test.

RESULTS

Students who studied under the more community-oriented curriculum chose interventions related to the new themes significantly more often, F(1461) = 14.827, p = <0.001, R² = .031. However, more traditional interventions are still favourite (although less in the intervention group): 74.5 % of the chosen interventions in the historic control group had no relation with the new curriculum-themes, vs. 71.3 % in the intervention group; p = .055).

CONCLUSIONS

Students who experienced a more 'community-oriented' curriculum were more likely, albeit to a limited extent, to choose the new community care themes in their caregiving. Seeing this shift in choices as a step in the right direction, it can be expected that the community care field in the longer term will benefit from these better skilled graduates.

Career Preferences among Nursing Students: A Cross-Sessional Study

Introduction

It is estimated that mores nurses are needed in the future, nursing students’ career preferences are important to contribute the shortage of nursing manpower in Macao. Little is known regarding the preferences for nursing students’ career preferences and related factors among nursing students.

Objective

To explore and investigate the career preferences and related factors among nursing students in Macao.

Methods

A descriptive, cross-sectional survey study design was adopted to assess career preferences and related factors among nursing students in Macao.

Results

In total, 217 nursing students completed surveys. The most favorite career preferences among nursing students were community health nursing, paediatric nursing, medical surgical nursing, and obstetric & gynecological nursing; while the least career preferences among nursing students were oncology and hospice nursing, mental health nursing, and ER nursing. Factors were related to “gender”, “education”, and “nursing is my first study preference” among Macao nursing students for career preferences.

Conclusion

The senior nursing students prefer working in community health nursing and the junior and female nursing students prefer working in pediatric nursing and obstetric and gynecological nursing. The more understandings of nursing students’ career preferences, the better nursing curriculum design and implication to promote nursing students’ intention for working in the least career preferences work.

Nursing Students' Willingness and Confidence to Volunteer in a Pandemic

Introduction

The current coronavirus disease 2019 pandemic may result in shortages of health care workers in some areas of the health care system. With adequate support, nursing students could potentially play a role in easing health worker shortages.

Objective

To describe and explore nursing students' willingness and confidence to contribute to the health care workforce during a pandemic.

Methods

A mixed-methods descriptive survey design was used to explore the perspectives of second-year nursing students at an Australian University. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using directed content analysis.

Results

A total of 280 nursing students were invited to complete the survey with a response rate of 32%. The majority of the participants showed moderate to high levels of willingness to volunteer in a pandemic. Of the participants, 50% reported slight confidence that their knowledge and skills would assist them during their volunteering. Reasons that influenced students' willingness to volunteer included perception of lack of personal protective equipment, need for incentives, fear of transmitting infection to family members, barriers to volunteering, inadequate knowledge and skills to handle a pandemic situation, study and clinical placement arrangements, and disease hazardousness.

Conclusion

Most nursing students have a level of willingness to volunteer but low confidence that their knowledge and skills would assist them while volunteering in pandemic situations. Universities and health care organizations can benefit from these findings by developing strategies to increase students' willingness to volunteer, as well as their confidence in their knowledge and skills.

'Do nurses really do that'? An exploratory mixed methods study of Students' willingness to lead

BACKGROUND

Health care needs are changing, requiring nurses to assume leadership roles and engage in political activism to impact health system transformation. Nursing education socializes students to the profession, as this is where they begin to develop their professional identity. For these reasons' educators must begin to explore student perceptions of the role of the registered nurse given the emphasis on leadership and health care transformation and question if students want to assume these roles.

OBJECTIVES

To identify first- and fourth-year baccalaureate nursing student perceptions of the role of the nurse and analyze their willingness to participate in roles that embody leadership and political action.

DESIGN

An exploratory mixed method design.

SETTING

Two western Canadian four-year baccalaureate nursing programs.

PARTICIPANTS

First- and fourth-year students.

METHODS

This study utilized a survey to collect demographic data and broad student perceptions of the registered nurse role and career aspirations. Focus groups followed with a sub-set of participants to further explore student opinions about the role of nurses.

RESULTS

Similar perceptions and views of nursing exist among cohorts (first- and fourth-year students) and between Baccalaureate programs. Students continue to choose nursing as a career for altruistic reasons. Validation of their role is in the form of personal affirmation of a job well done from their patients. While there is acknowledgement among first- and fourth- year students that nurses should be leaders and influence the overall health care system, student responses indicated that the 'other guy' should do it, not them.

CONCLUSIONS

The results identify the need to develop and implement strategies to prepare future nurses who are interested and willing to participate in a career based on leadership, political action, and healthcare transformation.

How nursing students' placement preferences and perceptions of community care develop in a more 'community-oriented' curriculum: a longitudinal cohort study

BACKGROUND

Extramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students' perceptions of community care and placement preferences develop over time in a more 'community-care-oriented' curriculum, to gain insights on which curriculum elements potentially influence career choices.

METHODS

A nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students' placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students' perceptions develop over time. Patterns of placement preferences at individual level were visualised.

RESULTS

Students' perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students' perceptions fluctuate between 6 and 7 (range 1-10). A placement in community care did not positively influence students' perceptions, and an intensive 1 week theoretical programme was only temporarily influential.

CONCLUSIONS

Although interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students' perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.

Being a real nurse: A secondary qualitative analysis of how public health nurses rework their work identities

Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self-identity, mandated identity, and identity as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. 'Being a real nurse' describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role.