Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis

OBJECTIVES

To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements.

DESIGN

Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar.

REVIEW METHODS

Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed.

RESULTS

14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence.

CONCLUSIONS

Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

A supportive clinical learning environment for undergraduate students in health sciences: An integrative review

BACKGROUND

The clinical learning environment is a platform where theory and practice should be integrated in a safe environment. However, many students experience the clinical learning environment as "stress provoking", because this environment is not always supportive.

OBJECTIVE

The aim of the article is to report on a study that synthesized the evidence on strategies for providing a supportive clinical learning environment for undergraduate students in health sciences.

DESIGN

The integrative review followed the methodology of Whittemore and Knafl (2005).

DATA SOURCES AND REVIEW METHODS

We searched MEDLINE with Full Text, CINAHL with Full Text, Academic Search Ultimate, PsycINFO, Health Source: Nursing/Academic Edition, ERIC, Africa-Wide Information, OpenDissertations, CAB Abstracts, MasterFILE Premier, SocINDEX with Full Text, SPORTDiscus with Full Text and PsycARTICLES. Other data sources included grey literature and reference lists. The filtering process, quality appraisal and data extraction were carried out by at least two independent reviewers. Thematic analysis was used to analyse the data.

RESULTS

The search yielded 500 studies, of which nine studies met the inclusion criteria. The generated data culminated in a clinical learning environment mindmap that highlights, firstly, a network of carefully selected supporters who may have specific clinical responsibilities while supporting undergraduate students in clinical learning. Secondly, the relationship between the student, student supporter and clinical staff should create a sense of belonging, self-efficacy and self-directedness. This relationship is influenced by the roster, the ratio of students to student supporters, and appropriate learning opportunities. Thirdly, higher education institutions and healthcare providers should support students and student supporters through formal partnerships.

CONCLUSIONS

The synthesis of the evidence provided new insights regarding creating and maintaining supportive clinical learning environment strategies for undergraduate students in health sciences. These strategies may be implemented in innovative ways to provide students with the best clinical learning opportunities.

The relationship of sleep quality among internship nurses with clinical learning environment and mental stress: a cross-sectional survey

BACKGROUND

Previous evidence has supported an association between sleep quality and psychological stress. However, the association between internship nurses' sleep status and its relevant factors is poorly understood.

OBJECTIVE

The aim of this study was to investigate sleep quality and its related factors in clinical learning environment and mental stress.

METHODS

A cross-sectional survey was conducted by three instruments: Clinical Learning Environment, Supervision, and Nurse Teacher Evaluation Scale (CLES + T), Stress Rating Scale for practicing nurses (SRS) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

A total of 508 (91.86%) of 553 students experienced poor sleep quality. The structural equation model showed a correlation of the PSQI with the CLES + T (r = -0.21, p < 0.001), a correlation of the PSQI with the SRS (r = 0.32, p < 0.001), and a correlation of the SRS with the CLES + T (r = -0.22, p < 0.001). Linear regression analysis showed that education (B = -0.56, p < 0.001), willingness to engage in nursing after graduation (B = -0.75, p < 0.001), pedagogical atmosphere in the ward (B = -0.05, p < 0.001) measured by the CLES + T, workload (B = 0.11, p = 0.01), interpersonal relationships (B = -0.12, p = 0.03), and conflicts between study and work (B = 0.12, p < 0.001) on the SRS were significant factors influencing the PSQI.

CONCLUSIONS

Poor sleep quality is common among internship nurses and it's affected by clinical environment and mental stress. It's necessary to apply more tailored education programs to promote nursing development.

Integrating Peer Learning Activities and Problem-Based Learning in Clinical Nursing Education

INTRODUCTION

The implementation of nursing clinical learning in Indonesia has several challenges that require innovation in the learning method strategy. The method that has been used so far focuses on the hierarchical relationship between lecturers/preceptors and students, so that there are many shortcomings in learning outcomes. The application of the method of active learning with Peer Learning (PL) and Problem Based Learning (PBL) techniques has proven effective in classroom learning, but its rarely found in clinical learning.

OBJECTIVE

The purpose of this study was to determine the effectiveness of the PL and PBL towards the achievement of clinical learning in nursing students.

METHODS

The research method used a true experiment with a posttest only control group design, the sampling technique was taken by randomize control trial. An instrument for clinical learning achievement using AssCE.

RESULTS

The analysis was carried out as descriptive and bivariate. The results showed the mean in the experimental group was 7.059 and the control group was 6.325. Further statistical test results were obtained p-value = 0.001 (p < 0.05) which showed that the average score there were differences in clinical learning achievement development scores.

CONCLUSION

Clinical learning using peer learning and PBL methods can directly improve various aspects of student competency achievement.

Peer-mentees' challenges in an undergraduate peer-group clinical mentoring programme in a nursing education institution

Background

Clinical competency and professional growth amongst nursing students is the cornerstone of a nursing education programme. The demanding and complex training of nursing students requires various clinical teaching and learning strategies such as peer-group clinical mentoring.

Aim

The objective of this research was to explore and describe the challenges that peer-mentees experience in an undergraduate peer-group clinical mentoring programme in one-specific nursing education institution in the North West Province.

Setting

The study was conducted at a nursing education institution in North West Province.

Methods

A qualitative, retrospective case study research design was used. Two separate World Café sessions following a semi-structured schedule based on Gibbs Reflective Cycle were conducted with 51 peer-mentees who were mentored in clinical practice. Four levels of qualitative thematic data analyses were employed to analyse the data.

Results

Five themes emerged from the findings of the study, namely, poor implementation of the peer-group clinical mentoring programme, ineffective undergraduate peer-group clinical mentoring programme, undesirable attitudes of the mentors, mentors unprofessional conduct as well as communication challenges. Ten sub-themes emerged from the findings. Literature control was done to support the findings.

Conclusion

The findings showed that undergraduate nursing students faced a diversity of challenges in the effective learning and teaching of peer-mentees in a clinical context. Limitations and recommendations of the study were given. Recommendations were given for nursing practice, education and research.

Practices of caring for nursing students: A clinical learning environment

OBJECTIVE

The purpose of this study was to explore, describe and illuminate nursing students' best encounters of caring in the clinical learning environment. Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment.

METHODS

Qualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry (AI) methodology. Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council (SANC) were purposively sampled from 3 private hospitals within the Western Cape. Data was analysed using Giorgi's method.

RESULTS

The main theme included the best and 'least best' caring practices embedded in the centrality of the heart. The subthemes comprised of the nursing students' experiences of caring literacy and caring illiteracy. The second theme included the creation of best caring practices within a conducive clinical learning environment. Within this theme, the subthemes comprised of the caring attributes required in reflecting best caring practices, as well the creation of a clinical learning environment to optimise caring.

CONCLUSIONS

The significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants. Caring was equated to the heart as the core to the nursing students' being. Recommendations for nursing education, management, practice and research were therefore specifically formulated to enhance caring towards nursing students.

Undergraduate nursing students' experience of clinical supervision

BACKGROUND

 Clinical supervision plays a major role in the undergraduate nursing programme. There have been some local studies addressing clinical supervision; however, there still remains a lack of knowledge and understanding how to improve quality supervision of undergraduate nursing students. This article is based on the authors' original thesis.

OBJECTIVES

 The objective of the study was to explore the experiences of undergraduate nursing students on clinical supervision.

METHOD

 A descriptive design with a qualitative approach using focus group interviews was used to explore the experiences of undergraduate nursing students regarding clinical supervision. Purposive sampling was used for selection of 36 participants. The participants needed to be enrolled at the institution under study, at the time of the study, as undergraduate nursing students in order to meet the inclusion criteria. The participants also needed to have worked at clinical facilities where they received clinical supervision. Nine (n = 9) students were purposively selected from each year level to participate in focus group interviews. The interviews were analysed using content analysis.

RESULTS

 The findings indicated both positive and negative experiences regarding clinical supervision. The results were tabulated in which the positive experiences were grouped together and were separated from the negative experiences of the undergraduate students. Positive experiences included the support that was received from supervisors. These were, however, overshadowed by many comments on negative experiences concerning the behaviour and competencies of the supervisors. The findings also confirmed that the students experienced differences in the clinical procedures demonstrated by various supervisors. Negative experiences that relate to abusive behaviour such as misuse of power were also found, as well the incongruence amongst clinical supervisors regarding clinical procedures. Recommendations were proposed to enhance clinical supervision and the learning experiences of student nurses.

CONCLUSION

 The study findings suggest a need for continuous professional development for clinical supervisors by means of in-service training as well as to maintain congruence by clinical supervisors when demonstrating clinical procedures.