A year and a half later: Clinical experiences of intern nursing students in the COVID-19 Pandemic: A constructivist grounded theory

AimsThe aim of this study is to develop a theory to explore the clinical experiences of interns in clinical practice during the COVID-19 pandemic.BackgroundThe COVID-19 pandemic is a serious public health problem influencing the healthcare systems worldwide. Nursing students were excluded from clinical practice for a long time due to the pandemic. However, the prolonged and uncertain pandemic conditions required the inclusion of fourth-year nursing students in clinical practice.DesignA qualitative research design based on the Constructivist Grounded Theory approach was used in this study.MethodsThe research data were collected from fourth-year nursing students doing an internship at a university hospital in Turkey. Fourteen nursing students (12 females and 2 males) in the clinical practice during the COVID-19 pandemic with a mean age of 22.64 ± 0.225 were included in the study. In the collection of data, firstly, the purposeful sample selection method, then the theoretical sample selection method was used. On the online interview platform, the data were collected through individual interviews with those agreeing to participate in the study between July 2021 and August 2021 using a semi-structured interview form. The results were analyzed with initial, focused and theoretical coding. The research was reported based on the Consolidated Criteria for Reporting Qualitative Research guide.ResultsA core category and five main categories emerged in the study. The core category is a lonely bird and the main categories are emotions, challenges, coping methods, nursing experiences and solution suggestions.ConclusionsThis research can help create a conceptual framework of clinical practice experiences of intern nursing students during the COVID-19 pandemic. It is thought that intern nursing students need to be supported by reliable authorities before and during the internship. Intern students stated that they experienced many emotions together and felt alone. Our study results revealed that intern nurses need more psychological support, especially during the pandemic period. A remarkable finding of the research is that interns now think of themselves as professional nurses. For interns to develop effective coping methods, intensive and regular training should be organized in cooperation with the hospital and school administration.     

Nurses’ experiences of ICU diaries following implementation of national recommendations for diaries in intensive care units: A quality improvement project

ObjectivesTo evaluate critical care nurses’ experiences of ICU diaries following the implementation of national recommendations for the use of diaries for critically ill patients.DesignA quality improvement project describing the development and implementation of national recommendations (2011), as well as the assessment of the use of diaries in intensive care nursing practice (2014).SettingNorwegian intensive care units (ICUs).ParticipantsThirty-nine Norwegian ICUs took part in the study.InterventionA multi-component process for developing national recommendations for the use of diaries in Norwegian ICUs, including recommendations for the target group, when to start, health professionals as authors, diary content, structure, language, use of photographs, handover, access and storage within patient medical records.Main outcome measureA questionnaire asking about experiences of implementing national recommendations on diaries in Norwegian ICUs, as well as their impact and how they are used.ResultsThree years after the implementation of the national recommendations, diaries were provided in 24 (61.5%) of the responding ICUs. Fifty-six per cent of the ICUs had revised their routines, of which 62% had updated and 38% had developed new protocols. Most ICUs kept the diary along with other medical information describing patient care, but only 50% of the ICUs scanned handwritten diaries into the electronic medical records before handing them over to patients or the bereaved. ICU nurses reported that implementing national recommendations had increased their awareness and knowledge on patient and family needs, as well as the long-term effects of critical illness.ConclusionThe results of this quality improvement project indicate that access to national recommendations on the use of diaries for critically ill patients have a potential of changing routines and increase standardisation.     

Experiences of nursing students during clinical education in mental health clinics: A phenomenological qualitative study

AimNursing students have both positive and negative experiences during clinical education. This study was conducted to identify experiences of nursing students during clinical education in mental health clinics.DesignThis phenomenological qualitative design study was conducted with 4th year undergraduate nursing students from a university in Turkey to identify their experiences specifically in mental health clinics.MethodsThe data were collected using focus groups interviews with 40 nursing students and assessed with the 7-stage phenomenological analysis method described by Colaizzi.ResultsThree main themes were determined: (i) the need for supportive interventions to cope with negative emotions; (ii) difficulty in translating theoretical knowledge into practice; and (iii) the lack of role model nurses and teaching staff.ConclusionsThe results of this study indicate that supportive interventions should be given to nursing students before clinical education. Also, the duration of clinical education, the teaching methods to be used and role model nurses and teaching staff effectiveness in clinical education should be planned carefully.     

Development of the professional competence and professional self-concept of undergraduate nursing students during the clinical practice period: A cross-lagged panel analysis

AimTo explore the relationship of the development of professional competence and professional self-concept of undergraduate nursing students during the clinical practice period.BackgroundClinical practice is one of the most important aspects of nursing education. Nursing students combine theoretical knowledge, psychomotor skills and emotions in a professional socialization process through clinical practice sessions.DesignA two-time point longitudinal design was performed. A cross-lagged model was employed to analyze the relationship between the development of professional competence and professional self-concept of undergraduate nursing students during their clinical practice period.MethodsA total of 210 undergraduate nursing students were included in this study. The questionnaire was distributed two months and six months after their clinical practice started. Professional Self Concept of Nurses Instrument and Professional Competence Scale for Undergraduate Nursing Students were the two main instruments.ResultsBoth the professional competence and professional self-concept of Undergraduate nursing students increase at the end of the sixth month compared with the end of the second month after their clinical practice started. The results of the cross-lagged analysis showed that the professional self-concept was partially responsible for the development of professional competence. The effect of professional competence on the development of professional self-concept, in contrast, was not found in this study.ConclusionsClinical nursing educators should pay greater attention to the development of the professional self-concept of undergraduate nursing students. More attention should be paid to creating a supportive clinical learning environment to facilitate the improvement of undergraduate nursing students’ professional self-concept and professional competence.     

34名男护生临床实习期间压力源与应对方式的调查

目的调查与了解男护生在临床实习过程中的主要压力源和常采用的应对方式，以采用有效的管理措施，引导学生采取有效的应对方式，减少或有效应对各种压力，以保持身心健康和提高学习效果。方法采用问卷调查方法，对在临床实习的34名男护生的压力源及应对方式进行调查。结果70．59％的男护生有中等水平的压力，5．88％的男护生有高水平的压力。压力来源依次为：社会的传统观念、工作的着落、出现差错的可能、处理病人紧急情况的能力、人际关系、接触传染疾病。结论男护生存在多种心理压力源，护生管理者应予以足够的重视．建立支持系统，减轻或消除心理压力。     

Factors associated with the patient privacy protection behaviours of nursing interns in China: A cross-sectional study

AimTo explore the associated factors of patient privacy protection behaviours among nursing interns.BackgroundThe patient privacy protection behaviours of nursing interns are closely related to information security incidents and the quality of clinical practice. However, little is known about the associated factors of patient privacy protection behaviours among nursing interns.DesignA cross-sectional study.SettingA comprehensive hospital in Hunan Province, China.ParticipantsNursing interns in a comprehensive hospital from 30 different nursing schools were recruited using convenience sampling.MethodsData on general information, patient privacy protection cognition, moral sensitivity, empathy and patient privacy protection behaviours were collected with a general information questionnaire and corresponding scales with good psychometric properties. U-test, spearman correlation analysis and multiple linear regression were used to determine the associated factors of patient privacy protection behaviours among nursing interns.ResultsThis study showed that nursing interns in a college programme had better patient privacy protection behaviours than those nursing interns in a baccalaureate programme. Nursing interns who have more knowledge of privacy laws and whose clinical nursing teachers excelled in patient privacy protection might show better patient privacy protection behaviours. Nursing interns with better patient privacy protection cognition, higher moral sensitivity and greater empathy might have better patient privacy protection behaviours.ConclusionStrengthening nursing interns’ knowledge of privacy laws and patient privacy protection cognition, improving their moral sensitivity and empathy and standardising the patient privacy protection behaviours of clinical nursing teachers may can improve the patient privacy protection behaviours of nursing interns. Also, clinical teachers should pay close attention to nursing interns in baccalaureate programmes who are likely to have a lower level of patient privacy protection behaviours and act as role models for them in protecting patient privacy in clinical nursing education.     

Nursing workforce deployment and intensive care unit strain during the COVID-19 pandemic in Victoria,Australia

BackgroundThe COVID-19 pandemic demanded intensive care units (ICUs) globally to expand to meet increasing patient numbers requiring critical care. Critical care nurses were a finite resource in this challenge to meet growing patient numbers, necessitating redeployment of nursing staff to work in ICUs.ObjectiveOur aim was to describe the extent and manner by which the increased demand for ICU care during the COVID-19 pandemic was met by ICU nursing workforce expansion in the late 2021 and early 2022 in Victoria, Australia.MethodsThis is a retrospective cohort study of Victorian ICUs who contributed nursing data to the Critical Health Information System from 1 December 2021 to 11 April 2022. Bedside nursing workforce data, in categories as defined by Safer Care Victoria’s pandemic response guidelines, were analysed. The primary outcome was ‘insufficient ICU skill mix’—whenever a site had more patients needing 1:1 critical care nursing care than the mean daily number of experienced critical care nursing staff.ResultsOverall, data from 24 of the 47 Victorian ICUs were eligible for analysis. Insufficient ICU skill mix occurred on 10.3% (280/2725) days at 66.7% (16/24) of ICUs, most commonly during the peak phase from December to mid-February. The insufficient ICU skill mix was more likely to occur when there were more additional ICU beds open over the ‘business-as-usual’ number. Counterfactual analysis suggested that had there been no redeployment of staff to the ICU, reduced nursing ratios, with inability to provide 1:1 care, would have occurred on 15.2% (415/2725) days at 91.7% (22/24) ICUs.ConclusionThe redeployment of nurses into the ICU was necessary. However, despite this, at times, some ICUs had insufficient staff to cope with the number and acuity of patients. Further research is needed to examine the impact of ICU nursing models of care on patient outcomes and on nurse outcomes.     

PBL教学法联合工作坊在肿瘤内科专科实习生护理临床带教中的应用

[目的]研究问题引导(PBL)教学法联合工作坊在肿瘤内科专科实习生护理临床带教中的应用效果。[方法]将肿瘤内科实习的60名护理专科实习生按照进入科室的批次分为对照组及观察组,每组30人,对照组采取PBL教学,观察组采取PBL教学法联合工作坊教学,在入科第1天及实习1个月后采用迷你临床演练评量表(Mini-CEX)对两组带教效果进行评估,并对两组实习生理论知识和操作技能进行考核。[结果]两组实习生教学后临床演练评量表(Mini-CEX)各维度评分均较教学前升高(P<0.05),且观察组教学后评分高于对照组(P<0.05);两组实习生教学后理论知识考核及操作技能考核成绩均较教学前升高(P<0.05),且观察组教学后成绩高于对照组(P<0.05)。[结论]在肿瘤内科专科实习生护理临床带教中采取PBL教学法联合工作坊模式进行教学,有助于教学效果及实习生综合能力的提升。     

Nursing students' learning dynamics with clinical information and communication technology: A constructive grounded theory approach

BackgroundThe learning of nursing students can be facilitated through direct and/or indirect experiences of using clinical information and communication technology during clinical placements. However, nursing students experience difficulties in using technology for learning. Despite the difficulties, nursing students' learning dynamics with technology in real clinical contexts is poorly understood.ObjectivesTo develop a theoretical model by identifying nursing students' learning dynamics with clinical information and communication technology and the factors influencing the dynamics.DesignA constructivist grounded theory approach was employed in order to develop the theoretical model.SettingsThis research was conducted by recruiting nursing students from four universities in Seoul, South Korea.ParticipantsSixteen fourth year nursing students were recruited by purposive sampling.MethodsThis research collected qualitative interview data in up to four rounds of interviews using open-ended and semi-structured interview questions. A total of 23 interviews were conducted. The data were transcribed verbatim. All interview data were analysed using three coding methods; initial, focused, and theoretical coding. NVivo 11 was used for data management.ResultsThis research developed a theoretical model of nursing students' learning dynamics with clinical information and communication technology. The model explains three dynamics that influence nursing students' use of clinical information and communication technology (interpersonal, organisational and emotional dynamics) and the students' responses regarding the dynamics for learning in clinical contexts.ConclusionsNursing educators can use the theoretical model to understand how best to support nursing students in navigating their clinical environments to build competency in using clinical information and communication technology.     

Percepción de los estudiantes del Grado en Enfermería sobre su entorno de prácticas clínicas: un estudio fenomenológico

AimTo explore the perception of fourth-year nursing students of the healthcare environment where their training process in clinical practices takes place.MethodsPhenomenological qualitative study based on the hermeneutical philosophy of Gádamer that included the development of focus groups and semi-structured interviews in a sample of fourth-year nursing students from the University of Almería. The collection period was in February 2016. The information obtained was transcribed and analyzed by inductive strategies in search of emerging categories.ResultsThe analysis revealed two main categories: (1) influence of the clinical environment on the healthcare and teaching performance of nurses and on student learning and (2) training and job prospects for the future professionals. Each of them showed two subcategories with their corresponding codes. The information collected showed the experiences and perceptions of Nursing students regarding the healthcare environment where their training process in clinical practices takes place.ConclusionsThis study enabled us to discover the perception of fourth-year nursing students of the environment where their training process in clinical practices takes place. Knowledge of this phenomenon helps to identify deficits in students’ clinical learning and to adapt university curricula to their training needs in order to guarantee their success as professionals facing future clinical-labour demands.     

Self-reflection during first clinical practice: The experiences of nursing students

BackgroundSelf-reflection can be used as a tool for describing student experiences and have a significant impact on their learning. It enables nursing students to develop the ability to identify and analyse their problems and find possible solutions.ObjectiveTo present students' self- reflection in their first clinical practice as their first stage of our nursing study program.MethodologyThe research was based on a naturalistic philosophical paradigm using a qualitative methodological approach. The research took place at one of the Slovenian universities with an undergraduate nursing education program. Purposive sampling was chosen. The data were obtained through written self-reflection diary entries collected between March and June 2016. A thematic analysis was selected for data analysis. Ensuring that all ethical considerations were covered, seventeen students in the first clinical practice were included.FindingsThree main thematic themes were identified that define the experience of students in their first clinical practice: (1) emotional experience, (2) interpersonal relationships, (3) learning.ConclusionsThe research has found that the experiences and the perceptions of students in the first clinical practice are mainly expressed emotionally. Self-reflection helps students to express emotions and feelings to reliving and to identifying problems and also, to understanding themselves better. Further research should be focused on the importance of the students' self-reflections in their professional and personal growth.     

Capacity of intensive care units in Ghana

PurposeTo document the equipment, resource and bed capacity of Intensive Care Units (ICUs) in the Republic of Ghana.Materials and methodsCross-sectional observational study of all operating ICUs in Ghana. Sixteen operating ICUs in 9 hospitals were identified and surveyed (13 adult and 3 pediatric ICUs).ResultsThere were a total of 113 adult and 36 pediatric ICU beds for a population of 30 million, (0.5 ICU beds per 100,000 people). The median number of staffed ICU beds and ventilators were 5 (IQR 4–6), and 4 (IQR 3–5) respectively. There were 2 pediatric and 6 adult intensivists practicing in the country. About half of the ICUs (56%) were staffed solely by non-intensivist providers. While there is adequate nursing support and availability of essential critical care medications, the current financing model for critical care delivery creates a significant barrier for most patients.ConclusionGhana has a significant shortage of critical care beds that are inequitably distributed across the country and a shortfall of intensivists to staff ICUs. A holistic approach that focuses on the key bottlenecks to quality improvement would be required to improve the capacity and quality of critical care delivery.     

Seeking autonomy: Grounded theory of clinical reasoning processes during simulation based experiences

AimTo conceptualize how undergraduate nursing students’ reason and think during Simulation-Based experiences (SBE) and explore the indicators of sound clinical judgment.BackgroundNursing students’ clinical reasoning processes during Simulation Based Experiences (SBE) are not well understood and underexplored. The purpose of this study is to conceptualize how undergraduate nursing students’ reason and think during SBE.DesignA constructivist grounded theory methodology was used to explore nursing students’ clinical reasoning during SBEMethodA grounded theory methodology was used to explore nursing students’ clinical reasoning during SBE. A purposive sample was used to recruit participants including 32 third-year nursing students. Data collection using semi-structured interviews conducted over 9 months in 2020–2021. The interviews were recorded and transcribed verbatim and the data were analyzed using the logic of constant comparison supported by memoing, theoretical sampling and conceptual mapping.ResultsSeeking autonomy is the core category that emerged from the participants’ responses that conceptualizes the students' reasoning process during SBEs.ConclusionEvidence from this grounded theory study adds validation to the practice of using SBEs to support students’ clinical reasoning process and prepare them to be competent in clinical practice.     

Nursing students’ experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis

AimTo synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settingsBackgroundNurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.DesignA qualitative systematic review and meta-synthesisMethodsPubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012–25 Feb 2023. Qualitative studies of any design reporting nursing students’ experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso’s 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.ResultsThe review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.ConclusionsWhile caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.     

The process of learning and professional development according to nursing students’ experience during Covid-19: A constructivist grounded theory study

AimThis study explored the experiences of nursing students with respect to learning processes and professional development during internships with COVID-19 patients to build a novel theoretical model.BackgroundThe COVID-19 outbreak had a profound impact on the worldwide learning system and it interrupted the internship experiences of nursing students. After the second wave of COVID-19, to balance academic activities with COVID-19 containment, some Italian universities allowed nursing students’ internships in COVID-19 units. This new experience may have influenced nursing students’ learning processes and professional development, but this is yet to be investigated.DesignA qualitative study using a constructivist grounded theory (CGT) approach.MethodsNursing students were recruited from two hospitals in northern Italy between January and April 2021. Data are gathered from interviews and a simultaneous comparative analysis were conducted to identify categories and codes, according to Charmaz’s (2006) theory.ResultsThe sample consisted of 28 students. The results suggested the core category, that is the ‘Students’ sense of belonging to the nursing profession’ and four main categories: (1) From knowledge to know-how, (2) A new relationship modality, (3) Sharing and socialisation and (4) Responsibilization. Finally, a premise and a corollary, respectively (5) Motivation and the (6) Circularity of the process, were identified.ConclusionOur study proposed a new theory of nursing students’ learning processes in clinical contexts during internships with COVID-19 patients. Despite significant difficulties, the nursing students developed a unique learning process characterised by motivation. Therefore, our study provided insight into the learning process during a pandemic and investigated the support needed for nursing students to continue their internships.     

Measuring professional nursing value development in students participating in international service learning: A quasi-experimental study

BackgroundInternational service learning is becoming widely used in nursing education as a means to provide global learning opportunities as well as part of a clinical learning experiences. Concrete outcomes for these experiences have not been clearly supported in previous research. Professional nursing values are an important learning outcome for nursing students and development of professional nursing values has been found to occur through various learning experiences. Determining if international service learning experiences facilitate the development of professional nursing values can support the use of international service learning as a viable pedagogy.ObjectiveThe purpose of the study was to determine if there was a difference in professional nursing values development in students who participate in international service learning as part of their clinical experiences compared to those who do not.DesignThe research was a quasi-experimental study with a pre-test, post-test design.Setting/participantsUndergraduate students participating in one week international service learning as part of their clinical hours were compared with students who did not participate in international service learning.MethodsComparison of professional nursing values development between the experimental and control group was completed using the Nurses Professional Values Scale.ResultsThe study showed the use of international service learning as part of clinical was at least equivalent in the development of professional nursing values as traditional clinical. In addition, it supported the development of professional nursing values through clinical learning overall.ConclusionThe use of international service learning is a viable option for clinical experiences as a means to develop professional nursing values.