Defining Foundational Competence for Prelicensure and Graduate Nursing Students: A Concept Analysis and Conceptual Model

AimTo define the concept of foundational competence as it pertains to prelicensure and graduate nursing students during their educational program, thereby informing pedagogical and assessment practices.BackgroundCompetence has many definitions and uses, however a lack of consensus of a clear and useful definition in nursing persists. Without shared language, competence remains open for interpretation across and among groups and impedes the ability to teach and assess it in a competency-based education framework.MethodUsing the Walker & Avant method of concept analysis, literature was reviewed and synthesized to define and explain the concept of foundational competence in nursing using evidence and practice from various disciplines.FindingsAntecedents, attributes, empirical referents and consequences of foundational competence were identified.DiscussionThe components and uses of the concept of foundational competence are presented to guide pedagogical and assessment practices necessary for competency-based education in nursing.     

Clinical placement anxiety in undergraduate nursing students: A concept analysis

ObjectiveThe primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education.Design & methodsWe utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students.Data sourcesA review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety.ResultsThe literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted.ConclusionsInsights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.     

Ethical global health in nursing education: An integrative review

AimThe purpose of this integrative review is to provide a comprehensive review of ethical considerations for host communities and nursing programs in planning, implementing and evaluating global health experiences for nursing students.BackgroundGlobal health experiences for nursing students are proliferating rapidly across university settings while at the same time decreasing the average time spent in the host country engaged with local communities. Global health experiences are an area where students can experience ethics as it is applied across varied contexts including resource limited international settings. As nursing education expands its global programming, exploring the ethical implications of designing, implementing and evaluating GHEs becomes pivotal to build respectful, sustainable relationships with global partners and best prepare nursing students for ethical professional practice in an interconnected world.DesignWe conducted an integrative review to examine ethical considerations in development of ethical global health experiences that benefit, rather than harm, host communities and participating nursing student guests.MethodsThe search included articles published in English language, peer-reviewed journals between 1998 and 2021 that discussed ethics in the context of nursing students traveling internationally for global health experiences. Eighteen articles met criteria for review.ResultsOverall, findings demonstrate relatively little research specific to ethical engagement in global health experiences. The articles in this integrative review discussed a range of ethical attributes including reciprocity or collaboration, respect, sustainability or commitment, justice and openness. Recommendations based on research and non-research articles are provided.ConclusionsEthical comportment in global health experiences requires careful planning, implementation and evaluation to assure an equitable and sustainable partnership between host community, faculty and nursing student guests.     

Graduating nurses' self-efficacy in palliative care practice: An exploratory study

BackgroundEducational institutions and the health care industry agree that graduates from professional programs need to be “work ready” and capable of delivering competent and confident nursing care. One measure of program success is the student's self-efficacy in meeting expected graduate capabilities. In this study student's self-efficacy is related to palliative care graduate capabilities.AimTo explore graduating Bachelor of Nursing Science (BNSc) students' self-efficacy in caring for palliative care patients.DesignA qualitative design using semi-structured face-to-face interviews.SettingA regional Australian university.ParticipantsA purposive sample of 10 students in their final semester of study in a Bachelor of Nursing Science degree program.MethodSemi-structured face-to-face interviews were conducted. Interview questions were informed by published palliative care graduate capabilities. Interview data were transcribed verbatim and coded by capability. The coded data were then analysed to determine evidence of self-efficacy in caring for palliative care patients.ResultsAll participants had experiences in caring for palliative care patients. However, the responses did not consistently reflect high degrees of self-efficacy in four documented palliative care graduate capabilities required to care for persons with a life-limiting illness.ConclusionsThe findings support others that have identified gaps between curriculum and health care industry requirements in terms of students' beliefs about their empowerment to deliver nursing care as graduates. Education interventions and approaches to program evaluation require further development to better support students' growth of self-efficacy in undertaking their graduate roles.     

Effect of the dedicated education unit on nursing student self-efficacy: A quasi-experimental research study

Although the Dedicated Education Unit (DEU) has shown initial promise related to satisfaction with the teaching/learning environment, few studies have examined student outcomes related to the use of the DEU as a clinical education model beyond student satisfaction. The purpose of this quantitative, quasi-experimental study was to compare student outcomes from the traditional clinical education (TCE) model with those from the DEU model. Participants were students enrolled in a four-year baccalaureate program in nursing (n = 193) who had clinical education activities in one of three clinical agencies. Participants were assigned to either the DEU or a TCE model. Pre-clinical and post-clinical self-efficacy scores were measured for each group using an adapted Generalized Self-Efficacy Scale (Schwarzer and Jerusalem, 1995). Both groups experienced a significant increase in self-efficacy scores post clinical education. The increase in self-efficacy for the DEU students was significantly greater than the increase in self-efficacy for the traditional students. Self-efficacy is considered an important outcome of nursing education because high self-efficacy has been linked to making an easier transition from student to nursing professional. This study supports the quality of the DEU as a clinical education model by examining student self-efficacy outcomes.     

Program evaluation: A concept analysis

BackgroundProgram evaluation is critical for continuous quality improvement in nursing programs to achieve programmatic goals. The purpose of this concept analysis was to clarify the concept of program evaluation in nursing education.MethodUtilization of Walker and Avant's concept analysis methodology guided the process.ResultsThe identification of approximately 17 nursing education articles and three textbooks related to program evaluation in nursing education transpired through the search process. A program, a systematic process of collecting data and information, and judgments were the defining attributes of program evaluation in nursing education. The author defined program evaluation as a systematic process of data collection by which nurse educators make programmatic judgments based on predetermined program goals, benchmarks, and accreditation standards for pedagogical revisions and programmatic improvements to transpire.ConclusionLimited scholarship on program evaluation in nursing education supports future research regarding the concept, especially at the graduate program level.     

Graduate students as preceptors: Effects on clinical teaching outcomes of medical nursing

PurposeTo explore the feasibility of using graduate students as preceptors in the clinical education of medical nursing students.MethodsFive second-year graduate nursing students were recruited to participate in the clinical teaching of medical nursing for 38 undergraduates in the first semester of the 2010–2011 academic year, divided into two groups. The first group first received clinical teaching in caring for respiratory diseases from graduate preceptors for six weeks followed by clinical teaching in caring for circulatory diseases from nurse preceptors for six weeks. The second group received clinical teaching in the reverse order, from the nurse preceptors followed by the graduate student preceptors. Following training, all students were examined with a written test and scores were compared. In addition, review meetings were held to evaluate the teaching outcomes.ResultsNo significant differences in test scores were observed between the two teaching groups. Undergraduate student feedback indicated that the training provided by the graduate students was satisfactory, and the medical nursing course leader was satisfied with the teaching outcome with a few exceptions.ConclusionThese data indicate that graduate students are capable of training undergraduates in medical nursing, although some areas can be improved.     

Nurse practitioner students as an essential workforce: The lessons of coronavirus disease 2019

BackgroundThe coronavirus disease 2019 (COVID-19) disrupted the education and clinical training of nursing students. Clinical sites shut out students over low equipment supplies, physical distancing requirements, and redeployment of staff.Purpose and MethodsThe purpose of this paper is to highlight a progressive solution to engage nurse practitioner students as part of the COVID-19 response given the disruption of their traditional clinical training environments so that student could continue to matriculate and graduate in a timely manner.FindingsNurse practitioner students swiftly responded and were deemed an essential part of the nursing workforce.DiscussionPolicy implications for advanced nursing practice and education for telehealth and simulation research moving forward is also provided.     

Clinical teacher self-efficacy: A concept analysis

Self-efficacy is a well-researched concept and a key component of Bandura's Social Cognitive Theory. Teacher self-efficacy is widely researched within education; it affects student achievement and motivation as well as teacher performance and commitment. Minimal information exists on teacher self-efficacy within clinical settings of practice professions which likely affects patient outcomes. This paper provides background on self-efficacy and teacher self-efficacy; it then addresses clinical teacher self-efficacy using the Walker and Avant (2005) method for concept analysis. Assumptions, definitions, characteristics, antecedents and consequences of the concept of clinical teacher self-efficacy are discussed and represented visually, and exemplified as cases within nursing education. Implications and recommendations are suggested for the applicability of clinical teacher self-efficacy within clinician education and practice.     

The effect of an interprofessional simulation-based education program on perceptions and stereotypes of nursing and medical students: A quasi-experimental study

BackgroundInterprofessional education is intended to train practitioners to collaboratively address challenges in healthcare delivery, and interprofessional simulation-based education (IPSE) provides realistic, contextual learning experiences in which roles, responsibilities, and professional identity can be learned, developed, and assessed. Reducing negative stereotypes within interprofessional relationships is a prime target for IPSE.ObjectivesWe sought to understand whether perceptions of interprofessional education and provider stereotypes change among nursing and medical students after participating in IPSE. We also sought to determine whether changes differed based on the student's discipline.DesignThis was a quasi-experimental pretest-posttest study.SettingThe study took place at a large mid-Atlantic public university with a comprehensive health science campus.Participants147 senior Bachelors of Science in Nursing students and 163 fourth-year medical students participated.MethodsStudents were grouped into interprofessional teams for a two-week period and participated in three two-hour simulations focused on collaboration around acutely ill patients. At the beginning of the first session, they completed a pretest survey with demographic items and measures of their perceptions of interprofessional clinical education, stereotypes about doctors, and stereotypes about nurses. They completed a posttest with the same measures after the third session.Results251 students completed both the pretest and posttest surveys. On all three measures, students showed an overall increase in scores after the IPSE experience. In comparing the change by student discipline, medical students showed little change from pretest to posttest on stereotypes of doctors, while nursing students had a significant increase in positive perceptions about doctors. No differences were noted between disciplines on changes in stereotypes of nurses.ConclusionsThis study demonstrated that a short series of IPSE experiences resulted in improved perceptions of interprofessional practice and changes in stereotypical views of each profession even when the experience was not directly designed to address these issues. Differences observed between nursing and medical students should be explored further.     

Patients’ involvement in nursing students’ clinical education: A scoping review

BackgroundActual contacts with patients are crucial in developing the skills that students need when working with patients. Patients are accustomed to the presence of students. The concept of learning from patients has emerged recently, shifting the focus from learning from professionals as role models to the relationship between the student and patient.AimWith focus on patients’ perspective in clinical practice placements, this scoping review aims to review and summarize the existing empirical literature regarding patients’ involvement in nursing students’ clinical education.Design and methodA broad search without time limitations was performed in the databases CINAHL, Medline, PsycINFO and ERIC. A manual search was also performed. Only empirical studies describing aspects of patient involvement in nursing education from the patient’s perspective were taken into account. Thirty-two studies published from 1985 to June 2016 met the selection criteria and were analysed using inductive content analysis.ResultsThe perspective of real patients focused on their role in students’ learning and assessment processes. In general, patients appreciated the opportunity to contribute to a student’s learning process and thus enhance the quality of patient care. However, the patients’ approaches varied from active to passive participants, comprising active participants contributing to students’ learning, followers of care and advice, and learning platforms with whom students practiced their skills. Some patients perceived themselves as active participants who facilitated students’ learning by sharing knowledge and experience about their own care and wellbeing as well as assessed students’ performance by providing encouraging feedback.ConclusionThe state and degrees of patient involvement in nursing students’ clinical education were made explicit by the literature reviewed. However, the number of studies examining the involvement of real patients in students’ education in clinical settings is very limited. To understand this untapped resource better and to promote its full realization, recommendations for nursing education and future research are made.     

Nursing handoff education: An integrative literature review

AimThis integrative review aimed to identify nursing students' experiences of handoff practices and the effects of handoff education in the curriculum on nursing student learning outcomes.BackgroundAppropriate handoff communication skills are essential for nursing students to maintain patient safety and prevent adverse events.MethodA systematic literature search was conducted with keywords related to nursing, student, and handoff in April 2020. Articles should focus on nursing students' handoff education published in English in 2015–2020. Eight articles met the inclusion criteria and were included in this review.ResultsNursing students reported discrepancies in handoff experiences; diverse factors influenced their handoff experiences, such as knowledge, anxiety, confidence, and type of student supervision. Various handoff educations were implemented across studies. Some handoff educations significantly improved nursing students' attitudes toward other disciplinary providers, satisfaction, confidence, quality, and clarity in handoff communication; some did not substantially affect their selected outcomes.ConclusionThis review identified that there are still limited handoff experiences among nursing students and many factors affecting opportunities for their handoff experience. Some handoff education (e.g., structured handoff formats, role-play, simulated scenarios) effectively improved students' communication clarity, confidence levels, and handoff education satisfaction. More handoff education is needed for nursing students to learn safe and quality handoff practices.     

An Online Educational Intervention to Influence Medical and Nurse Practitioner Students’ Knowledge,Self-Efficacy,and Motivation for Antepartum Depression Screening and Education

ObjectiveTo evaluate nurse practitioner and medical students’ knowledge, self-efficacy, and motivation for antepartum depression screening and education before and after an online educational intervention.DesignQuasi-experimental study design.Setting/Local ProblemThe University of South Florida, College of Nursing and College of Medicine. Historically, nursing and medical school curricula have a focus on postpartum depression. Testing nurse practitioner and medical students regarding maternal depression throughout pregnancy may give insight into curriculum preparedness.ParticipantsMedical and nurse practitioner students were recruited by convenience sampling. In total, 71 participants completed the study. There were 52 (73%) nurse practitioner students and 19 (27%) medical students.Intervention/MeasurementsParticipants used a self-directed learning activity in the form of a slide presentation on the virtual platform REDCap. Knowledge was tested before and after the intervention using the “Speak Up When You’re Down”—Postpartum Depression Awareness Campaign examination. Self-efficacy and motivation were measured before and after the intervention by using the Physician/Nurse Practitioner Student Teaching Self-Efficacy Questionnaire and the Physician/Nurse Practitioner Student Teaching Motivation Questionnaire.ResultsNurse practitioner and medical students exhibited a mean increase in scores for knowledge, self-efficacy, and motivation. Both groups performed similarly from before to after the intervention, and student profession did not moderate the increase from before to after the intervention.ConclusionAn intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.     

“Who has been here that looks like me?”: A narrative inquiry into Black,Indigenous, and People of Color graduate nursing students' experiences of white academic spaces

Canadian Schools of Nursing rest upon white, colonial legacies that have shaped and defined what is valued as nursing knowledge and pedagogy. The diversity that exists in clinical nursing and is emerging within the graduate student population is not currently reflected within nursing faculty and academic leadership. Black, Indigenous, and People of Color (BIPOC) nurse leaders, historically and presently, are repeatedly left unacknowledged as knowers and keepers of nursing knowledge. This lack of diversity persists across nursing knowledge generation, research, and healthcare practices that ultimately aim to serve the increasingly diverse Canadian population. This narrative inquiry study examined the experiences of eight BIPOC graduate nursing students as they navigated white academic nursing spaces. The findings are presented to reflect their experiences of entrenched in whiteness, erasure of identity, and navigating belonging. These study findings highlight the importance of surfacing academic nursing history shaped by colonialism and racism, the need to diversify nursing faculty and the graduate nursing student population, and implementing nursing curricular and syllabi audits to ensure that they reflect the multitude of ways of knowing to expand dominant Eurocentric and Western knowledge in nursing education.