Diversity, contradictions, and distinction - A scoping review of honours programmes in nursing

BACKGROUND

There is a long-standing tradition of honours education in the field of nursing, dating back to the early 1960s in the United States. However, its adoption in European and particularly Scandinavian egalitarian educational contexts is relatively recent.

PURPOSE

This scoping review aims to provide an analysis of the global utilisation and distribution of honours education within the field of nursing.

METHOD

In this scoping review, we conducted an extensive examination of the existing literature to assess the worldwide implementation of honours education in nursing. We employed a systematic approach to identify key trends, patterns, and commonalities in the use of the honours concept across different regions.

RESULTS

Our review reveals three predominant approaches to honours education, primarily concentrated in the Anglo-Saxon world: distinction programmes, add-on-year programmes, and embedded programmes. Regardless of the approach, our findings highlight a consistent lack of robust theoretical foundations, limited documentation supporting the educational impact, and a noticeable absence of standardisation. Instead, honours education appears to serve a symbolic and distinct purpose rather than a purely pedagogical one.

CONCLUSION

As the prevalence of honours education continues to rise within continental education systems, it becomes imperative to prioritize further research to ensure the optimal allocation of resources. Addressing the lack of evidence, especially in terms of educational value and theoretical foundations, is crucial for refining and maximizing the potential benefits of honours education in nursing. A more strategic and cohesive approach to developing honours programmes is essential to enhance their effectiveness and alignment with global educational goals.

New Graduate Nurses' Experiences and Challenges during a One-Year Clinical Rotation Programme in the Volta Region of Ghana: Implications for Nursing Management and Nursing Workforce Retention

Background

To help improve the standards and quality of nursing practice, newly graduated nurses and midwives are required after passing the Nursing and Midwifery Council's Licensing Examination to undertake a one-year mandatory clinical rotation at health facilities before registration. However, there is a lack of scientific studies to explore new graduate nurses' experiences and challenges during the one-year mandatory clinical rotation programme.

Aim

This study is aimed at exploring newly qualified nurses' experiences and challenges during the one-year mandatory clinical rotation in health facilities in the Volta Region of Ghana.

Methods

This qualitative exploratory study used a combination of focus group discussions (FGDs) and individual interviews. Thirty (30) newly qualified nurses were selected from two secondary and one tertiary health facilities, where newly qualified nurses are posted for a clinical rotation programmes to participate in the study. A total of two focus group discussions (FGDs) were conducted, comprising five (5) members in each group. Moreover, twenty (20) newly qualified nurses were interviewed individually, and their data were added to what was obtained from the focus group discussions. This study adopted the thematic analysis approach to analyze the data.

Results

The results of this study showed that newly qualified nurses experienced the following during the one-year clinical rotation programme: acquisition of more knowledge and competencies to assume professional nursing roles; lack of knowledge of the objectives of the clinical rotation programme by hospital staff; experience of frustration during the clinical rotation programme; inadequate supervision and support; accommodation and financial challenges.

Conclusion

The study revealed important challenges experienced by new graduate nurses during the clinical rotation programme, including hospital staff's lack of knowledge regarding the objectives of the rotation programme, inadequate supervision and support, and accommodation and financial challenges. There is a need for the Nursing and Midwifery Council to develop guidelines for the one-year mandatory clinical rotation for newly graduated nurses and midwives to make the programme more effective.

Evaluation of the Allied Health Rural Generalist Program 2017-2019

OBJECTIVE

To evaluate the development and implementation of the Allied Health Rural Generalist Program, a two-level online post-graduate education program, which includes Level 1, an entry-level non-award pathway program, and Level 2, a Graduate Diploma in Rural Generalist Practice.

DESIGN

A convergent mixed methodology evaluation in two overlapping stages: a process evaluation on quality and reach, together with a mixed method case study evaluation on benefits, of the program.

SETTING

Rural and remote Australia across ten sites and seven allied health professions: dietetics; occupational therapy; pharmacy; physiotherapy; podiatry; radiography; speech pathology.

PARTICIPANTS

Process evaluation included 91 participants enrolled in all or part of the Rural Generalist Program. Case study evaluation included 50 managers, supervisors and Rural Generalist Program participants from the ten study sites.

INTERVENTIONS

The Allied Health Rural Generalist Program.

MAIN OUTCOME MEASURES

Process evaluation data were derived from enrolment data and education evaluation online surveys. Case study data were gathered via online surveys and semi-structured interviews. Quantitative and qualitative data were collected concurrently, analysed separately and then integrated to identify consistency, expansion or discordance across the data.

RESULTS

The Rural Generalist Program was viewed as an effective education program that provided benefits for Rural Generalist Program participants, employing organisations and consumers. Key improvements recommended included increasing profession-specific and context-specific content, ensuring Rural Generalist Program alignment with clinical and project requirements, strengthening support mechanisms within employing organisations and ensuring benefits can be sustained in the long term.

CONCLUSION

The Rural Generalist Program offers a promising strategy for building a fit-for-purpose rural and remote allied health workforce.

Supervised internship in undergraduate nursing courses in the State of São Paulo, Brazil

Objective:

to analyze how nursing courses in the State of São Paulo, Brazil have operationalized the supervised curricular internship and to identify those that approach the recommendations proposed by the National Curriculum Guidelines.

Method:

a quantitative, descriptive-exploratory study. The sample consisted of 38 course coordinators. The data collection instrument was developed based on the Curricular Guidelines. Data collection took place electronically and, for data analysis, descriptive and inferential statistics were used.

Results:

the undergraduate schools have developed internships for a mean of 860.4 hours in primary and tertiary care settings, with learning based on professional practice being the main teaching method. Formative assessment is the predominant mode of assessment, and nurses from health institutions participate in 44.7% of courses. The mean score obtained was 3.1 points (scale from 1 to 5), with the evaluation processes used being the most influential factor (p<0.001).

Conclusion:

the courses have partially met the educational legislation regarding the hours and participation of professionals from health institutions granting internship field, which can compromise the quality of training and the safety of care.

Graduate Nurses' Perception of the Effect of Simulation on Reducing the Theory-Practice Gap

Graduate nurses employed in high-acuity areas can experience a deficit in integrating theoretical concepts in the clinical environment, which is known as the theory-practice gap; this may result in a risk to patient safety with the potential for negative outcomes. Most existing literature address the existence of the theory-practice gap and the benefit of simulation from a faculty perspective. The purpose of this study was to explore the theory-practice gap from the perspectives of graduate nurses based on their experiences and to determine their perceptions of simulation in prelicensure programs as a strategy to address and reduce the gap prior to entry to practice. Cognitive constructivism was the conceptual framework that guided this study. A qualitative phenomenological design was used to explore the lived experiences of 13 graduate nurses with 2 years of less clinical experience by engaging in semistructured interviews. Data analysis revealed that all the graduates experienced the theory-practice gap on their transition to independent clinical practice with variations in degree. In addition, the graduates voiced aspects of their programs which contributed to reducing the challenges experienced during the transition period. The crucial finding was graduate nurses perceived the theory-practice gap could be reduced through the use of high-fidelity simulation utilizing scenario-based learning exercises in prelicensure programs prior to entry to practice.

Nurse graduates' experiences and support needs: A qualitative systematic review of South Africa's community service programme

BACKGROUND

The student-to-nurse graduate transition is a pivotal phase in the professional development of nurses. In South Africa, this transition is part of a compulsory community service programme, which requires newly graduated nurses to work in rural and/or underserved areas for a period of 1 year.

OBJECTIVES

The aim of this study was to review nurse graduates' experiences and support needs during their transition in the compulsory community service programme.

METHODS

A qualitative systematic review of experiences was conducted. Qualitative research studies that addressed nurses' experience in South Africa (2008-2017) were identified in Cochrane, Joanna Briggs Institute (JBI), Academic Search Complete, CINAHL, PubMed, SABINET, Science Direct, SCOPUS and Google Scholar databases. The systematic review methods included searching, sifting, abstracting and quality assessment of relevant qualitative studies by two reviewers and cross-checking by a third reviewer. Two reviewers independently performed blinded data extraction and quality assessment using the confidence in qualitative synthesis findings (ConQual) approach.

RESULTS

A total of 1257 studies were identified of which 12 met the inclusion criteria. Seven of the 12 studies were published articles and six were theses. The quality of the studies was found to be of high standard based on the ConQual rating. Four main themes emerged from the analysis: (1) rich developmental experiences through practice exposure, (2) difficulties in reconciling theory and practice, (3) contextual challenges in the workplace and (4) need for professional support structures, educational measures and public guidelines.

CONCLUSION

Although positive experiences were reported, various challenges emerged, indicating the need for more systematic support mechanisms during transition.

A Comparative Study of Newly Licensed Registered Nurses' Stressors: 2003 and 2015

BACKGROUND

Newly licensed nurses are overwhelmed and feel stressed as they transition from student to professional nurse. Health educators are making strides in improving the work environment, yet these nurses continue to feel stressed. Little has been done to track stress-ors to see whether they have changed over time.

METHOD

A descriptive qualitative research method was used to identify the stressors of newly licensed nurses. The first focus group interviews were conducted in 2003 with 21 nurses. In 2015, the study was replicated using another group of 22 recently graduated nurses.

RESULTS

There were fewer stressors noted in the 2015 group compared with the 2003 group. Six major stress-ors were identified in the 2003 group, and only three of these were noted in the 2015 group.

CONCLUSION

The decline in work-related stressors could be attributed to changes in health care organizations and in state policies. Nurse educators and leaders should refine orientation and educational programs based on ongoing changes in stressors expressed by newly licensed nurses. J Contin Educ Nurs. 2018;49(3):132-140.

Clinical supervision and ward orientation predict new graduate nurses' intention to work in critical care: Findings from a prospective observational study

INTRODUCTION

Clinical supervision and transitional support programs are important in supporting the successful transition and retention of new graduate nurses and their intention to work in specialty settings. However, little is known about which elements of support programs influence this intention. This study aimed to examine new graduate nurses' perceptions of clinical supervision and the practice environment, and how these influenced their intention to stay in critical and non-critical care areas following their transitional support program.

METHODS

Between May 2012 and August 2013, new graduate nurses (n = 87) were surveyed towards the end of their 12-month transitional support program. In addition to demographic and ward details, participants completed the Manchester Clinical Supervision Scale (MCSS) and the Practice Environment Scale Australia (PES-AUS). The 'Intention to Stay in a Clinical Specialty' survey was used to measure new graduate nurses' intention to remain working in their current ward or unit.

RESULTS

Predictors of new graduate nurses' intention to stay in their current ward/unit were not having to practise beyond personal clinical capability (AOR: 4.215, 95% CI: 1.099-16.167) and working in a critical care specialty (AOR: 6.530, 95% CI: 1.911-22.314). Further analysis of those nurses who indicated an intention to remain in critical care revealed that high satisfaction with clinical supervision (AOR: 3.861, 95% CI: 1.320-11.293) and high satisfaction with unit orientation (AOR: 3.629, 95% CI: 1.236-10.659) were significant predictors.

CONCLUSION

While this study identified that new graduates who worked within their scope of practice were more likely to report their intention to remain in their current ward, new graduates assigned to critical care were six times more likely to indicate their intention to remain than new graduates in other wards/units. Ensuring new graduate nurses assigned to critical care areas receive good unit orientation and clinical supervision increases their intention to remain in this setting.

New graduate nurses' experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support

BACKGROUND

Given the increasing complexity of acute care settings, high patient acuity and demanding workloads, new graduate nurses continue to require greater levels of support to manage rising patient clinical care needs. Little is known about how change in new graduate nurses' satisfaction with clinical supervision and the practice environment impacts on their transitioning experience and expectations during first year of practice. This study aimed to examine change in new graduate nurses' perceptions over the 12-month Transitional Support Program, and identify how organizational factors and elements of clinical supervision influenced their experiences.

METHODS

Using a convergent mixed methods design, a prospective survey with open-ended questions was administered to new graduate nurses' working in a tertiary level teaching hospital in Sydney, Australia. Nurses were surveyed at baseline (8-10 weeks) and follow-up (10-12 months) between May 2012 and August 2013. Two standardised instruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS) were used. In addition to socio-demographic data, single -item measures were used to rate new graduate nurses' confidence, clinical capability and support received. Participants were also able to provide open-ended comments explaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent themes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential statistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content analysis (CCA). The study was approved by the relevant Human Research Ethics Committees.

RESULTS

Eighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The median age was 23 years (Range: 20 to 53). No change was seen in new graduate nurses' satisfaction with clinical supervision (mean MCSS-26 scores: 73.2 versus 72.2, p = 0.503), satisfaction with the clinical practice environment (mean PES-AUS scores: 112.4 versus 110.7, p = 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus 7.8, p = 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6, p = 0.541), unit orientation (mean: 4.4 versus 4.8, p = 0.081), confidence levels (mean: 3.6 versus 3.5, p = 0.933) and not practising beyond personal clinical capability (mean: 3.9 versus 4.0, p = 0.629). Negative responses to the open-ended questions were associated with increasing workload, mismatch in the level of support against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and Transitional Support Program as a foundation for success; and ii) developing clinical competence.

CONCLUSIONS

While transitional support programs are helpful in supporting new graduate nurses in their first year of practice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nurses' experiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to better support new graduate nurses' and promote confidence and competence to practice within their scope.

Partnerships of the Future

OBJECTIVES

To explore how partnerships among private, nonprofit, and public organizations can be instrumental in addressing 21st century health care challenges.

DATA SOURCES

Peer-reviewed studies and guidelines, journal articles, books, websites, and personal communication.

CONCLUSION

Given the complexity of the health care environment and the need to transform the system, individuals and organizations will need to form partnerships that result in improved quality of care and decreased cost. Some recent initiatives have been successful and are included in this article.

IMPLICATIONS FOR NURSING PRACTICE

In many communities and at the national level, there are agencies and organizations that are working independently, yet they have overlapping goals and the same intent. They compete for the same financial and human resources whether in academia, the care delivery sector, or non-profit associations. In the cancer care world, interprofessional teams are essential, yet much care is still delivered in silos. There are redundant patient advocacy organizations even for some of the less common cancers. Partnerships and collaboration will take new forms and require new skill sets in the future.