Opening up to learning spiritual care of patients: a grounded theory study of nursing students

Aim. To determine undergraduate nursing students’ perspectives on spiritual care and how they learn to assess and provide spiritual care to patients. Background. Nursing is concerned with holistic care. Systematic teaching and supervision of students to prepare them to assist patients spiritually is a growing focus. However, there is limited consensus about the competences students need to develop and little is written related to students learning processes. Design. Grounded theory was used to identify students’ main concern and develop a substantive grounded theory. Method. Data collected during semi‐structured interviews at three Norwegian University Colleges in eight focus groups with 42 undergraduate nursing students were analysed through constant comparison of transcribed interviews until categories were saturated. Results. The participants’ main concern was ‘How to create a professional relationship with patients and maintain rapport when spiritual concerns were recognised’. Participants resolved this by ‘Opening up to learning spiritual care’. This basic social process has three iterative phases that develop as a spiral throughout the nursing programme: ‘Preparing for connection’, ‘Connecting with and supporting patients’ and ‘Reflecting on experiences’. Conclusion. Nurses need a wide range of competences to fulfil the nursing focus on holistic patient care. Nursing education should prepare students to recognise and act on spiritual cues. A trusting relationship and respectful and sensitive communication assist students to discover what is important to patients. An educational focus on spiritual and existential themes throughout the nursing programme will assist students to integrate theoretical learning into clinical practice. Relevance to clinical practice. Study participants reported seeing few role models in clinical settings. Making spiritual assessment and interventions more visible and explicit would facilitate student learning in clinical practice. Evaluative discussions in clinical settings that include spiritual concerns will enhance holistic care.     

Clinical facilitator learning and development needs: Exploring the why,what and how

This study explores the practice experiences of clinical facilitators providing a voice for nurses undertaking the role, a group who up until now has been silent. Seven clinical facilitators from acute care areas within Tasmania participated in the interpretive and participatory study. Three core aspects of clinical facilitation identified were the why, what and how of facilitation. The study identified why nurses became clinical facilitators, what their experiences involved – both positive and negative; and enabled exploration as to how the role could be better supported in the future, through addressing ongoing professional development learning needs.Results of this study have provided in depth insight into the world of the clinical facilitator. The importance of key strategies to implement ongoing professional development through mentorship, provision of feedback and the development of communities of practice are seen as imperative to ensure the role of clinical facilitator reaches its full potential to bridge the gap between theory and practice experienced by undergraduates during clinical placements. Such strategies will help ensure quality clinical placements for undergraduate nursing students.     

Clinical Coaching – An innovative role to improve marginal nursing students' clinical practice

In order for undergraduate nursing students to demonstrate their ability to achieve the required level of competency with practice they must be able to integrate both the clinical skills and knowledge that are pivotal to safe and competent nursing practice. In response to ongoing concerns about students' level of competency expressed by the supervising clinical staff, one School of Nursing and Midwifery created a Clinical Coach (CC) role. The purpose of this paper is to present the data collected including outcomes achieved and the coaching strategies used when a CC role was implemented to support and develop nursing practice for the marginal performer or ‘at risk’ student. A literature review of the application of coaching to nursing, a detailed analysis and discussion of the outcomes identified from auditing of collected data and the specific coaching strategies that resulted in successful outcomes for students is presented. This model of Clinical Coaching for nursing students could readily be adopted by other Schools of Nursing and Midwifery. This account of the regime of coaching practices may also offer a transferable, adaptable and flexible approach for other health professions who require their undergraduate students to complete clinical placements in preparation for professional practice.     

“It's not their fault”: Clinical facilitators' experiences supporting English as second language students

BackgroundInternational nursing students in Australia are faced with additional stress and challenges during clinical placements due to language and cultural differences. These factors can significantly impact their learning experience and personal wellbeing.AimThis study aimed to explore the clinical facilitators’ perspectives of the experiences of international nursing students and the potential strategies for improving their learning experiences during clinical placements.MethodsAn exploratory qualitative study was designed. Semistructured interviews with 14 participants were conducted and analysed using thematic analysis.FindingsThe findings were categorised into two categories. (1) Clinical facilitators’ perspectives on the international nursing students’ experiences during the clinical placements, and (2) Clinical facilitators’ perspectives on strategies for improving the learning experience of international nursing students. Category 1 consisted of three themes: (i) Reduce self-confidence when communicating in English, (ii) Lowered perceived self-efficacy, and (iii) Looking for a sense of belonging. Category 2 consisted of five themes: (i) Nurture a supportive environment, (ii) Use validating and understanding communications, (iii) Promote acceptance of the cultural and language diversities, (iv) Use strength-based approaches, and (v) Create opportunities for transcultural socialisation.DiscussionClinical facilitators are well-positioned to support international nursing students to achieve positive learning experiences during clinical placements. More support from the university and hospital may be needed to enable clinical facilitators to effectively implement the identified potential strategies.ConclusionThe study findings provided the background for future research to upskill clinical facilitators and support them to facilitate positive experiences for international nursing students during clinical placements.     

Mental health stigma and undergraduate nursing students: A self-determination theory perspective

BackgroundClinical placements are essential in preparing students for professional practice. Given the serious negative impact of stigma on people with lived experiences of mental illness, it is essential to explore whether the educational setting of a clinical placement can influence mental health stigma.AimsUsing a Self-Determination Theory lens, this study aimed to examine whether the educational setting of a clinical placemen influences the stigma of undergraduate nursing students toward people with lived experiences of mental illness.DesignQuasi-experimental; pre-test post-test.MethodsNinety-nine undergraduate students enrolled in an accredited nursing program within Australia completed two surveys pre- and post-clinical placement. The surveys measured the educational setting (learning climate) and mental health stigma (social distance).FindingsStudents who partook in an Autonomy-Supportive mental health clinical placement reported a significant decrease in stigma from pre-to-post placement, whereas the Balanced/Neutral group reported a significant increase in stigma from pre-to-post-placement.DiscussionThe findings of this research have considerable implications for nursing facilitators and preceptors. Those that support autonomy amongst future nursing professionals are more likely to positively influence students’ mental health stigma. Those who do not promote an autonomy-supportive setting may actually worsen mental health stigma.ConclusionThe educational setting in which a clinical placement occurs can influence nursing students’ mental health stigma.     

Teaching spiritual care – a grounded theory study among undergraduate nursing educators

Aims and objectives. To explore teachers’ understanding of spirituality and how they prepare undergraduate nursing students to recognise spiritual cues and learn to assess and provide spiritual care. Background. Nursing education addresses patient care in all domains of the person. Systematic teaching and supervision of students to prepare them to assist patients spiritually is an important part of holistic care. However, few role models for spiritual care are seen in clinical practice, and limited research addresses necessary student competencies or how teachers can best facilitate this process. Design. Grounded theory was used to identify teachers’ main concern and develop a substantive grounded theory. Methods. Data collected during semi‐structured interviews at three Norwegian University Colleges in five focus groups with 19 undergraduate nursing teachers were conducted from 2008 to 2009. Data were analysed through constant comparison of transcribed interviews until categories emerged and were saturated. Results. The participants’ main concern was ‘How to help students recognize cues and ways of providing spiritual care’. Participants resolved this by ‘Journeying with Students through their Maturation’. This basic social process has three iterative phases that develop throughout the nursing programme: ‘Raising Student awareness to Recognize the Essence of Spirituality’, ‘Assisting Students to Overcome Personal Barriers’, and ‘Mentoring Students’ Competency in Spiritual Care’. Conclusion. Nursing education should prepare students to recognise and act on spiritual cues. Making spiritual assessment and interventions more visible and explicit throughout nursing programmes, in both classroom and clinical settings, will facilitate student maturation as they learn to integrate theoretical thinking into clinical practice. Relevance to clinical practice. Nursing students need role models who demonstrate spiritual care in the fast‐paced hospital environment as well as in other clinical practice settings. To model spirituality as part of nursing care can assist students to overcome their vulnerability and to safeguard ethical issues and promote patient integrity.     

The student experience of clinical supervision across health disciplines – Perspectives and remedies to enhance clinical placement

Effective clinical practice supervision for health students is essential prior to commencing their respective professions. Students require adequate preparation before their clinical practice event with an experienced clinical supervisor able to impart professional ‘know how’ and skills to students. The purpose of this study was to describe final year health students' perspectives and experiences of clinical supervision, and to develop an interprofessional model of clinical supervision. Focus groups and semi-structured interviews were conducted with undergraduate health students across a range of disciplines. Some students provided email comments. Qualitative data was analysed thematically using NVivo (V11). Six key themes and their various sub-themes (refer Table 1) were identified: (1) undergraduate learning valued by the CP provider; (2) effective connections (communications) between student, CS, CP provider and university; (3) undergraduate student learning not being valued; (4) ineffective connections; (5) mitigating factors for students; and (6) the impact of increasing student numbers. Undergraduate health student clinical placement requires careful educational preparation, structuring and adequate support for both the student undergoing the practice event and for the clinical supervisor stewarding the undergraduate health professional. A prospective plan to ensure an excellent experience is required (Fig. 1).     

Practice nurses experiences of mentoring undergraduate nursing students in Australian general practice

Internationally, the delivery of health services has shifted from secondary to primary care, necessitating an exponential growth of the nursing workforce and expansion of the nursing role in general practice. This growth, and the subsequent need to develop this workforce, has created a need to expose undergraduate nurses to general practice nursing as a viable career option. Concurrently, universities are struggling to find sufficient clinical places for their undergraduate students to gain clinical experience. It is logical, therefore, to increase the number of undergraduate nursing student placements in general practice. Through qualitative research methods, this paper seeks to explore the experiences of practice nurses mentoring undergraduate students on clinical placements within the general practice setting. Findings are presented in the following three themes: (1) Promoting Practice Nursing: We really need to get students in, (2) Mentoring future co-workers: Patience and reassurance, and (3) Reciprocity in learning: It's a bit of a two way street, which show the benefits of such placements. Clinical placements in general practice settings can be mutually beneficial in terms of providing quality teaching and learning experiences for students. Conversely, the experience provides an impetus for practice nurses to maintain currency of their clinical skills and knowledge through mentoring student nurses.     

Nursing educators’ and undergraduate nursing students’ beliefs and perceptions on evidence-based practice,evidence implementation,organizational readiness and culture: An exploratory cross-sectional study

AimsTo describe the undergraduate nursing students’ and nursing educators' evidence-based practice beliefs, their extent of evidence-based practice implementation and their perspectives regarding organizational culture for evidence-based practice. To identify any relationship between the mentioned variables.BackgroundThe integration of evidence-based practice in nursing curricula is crucial to educate nursing students to incorporate evidence-based practice in their future clinical practice. Therefore, to promote its integration within nursing education, it is important to deeply understand how prepared academic institutions are for teaching about and supporting evidence-based practice integration.DesignCross-sectional study.MethodsNursing educators and undergraduate nursing students from nine Portuguese nursing schools were invited to participate in this study through an electronic survey comprising socio-demographic questions and the scales.ResultsSixty-eight nursing educators replied to the survey. Most were female, have PhD and have evidence-based practice training. They showed mean scores of 88.92 ± 8.18 for evidence-based practice beliefs, 40.20 ± 18.93 for evidence-based practice implementation and 80.59 ± 17.52 for evidence-based practice organizational culture and readiness. Concerning nursing educator sample, there were moderate and statistically significant relationship between: evidence-based practice beliefs and implementation; and evidence-based practice beliefs and organizational culture and readiness for school-wide integration of evidence-based practice. Between evidence-based practice implementation and organizational culture and readiness for school-wide integration of evidence-based practice, there was a small relationship.One hundred and sixty-seven undergraduate nursing students answered the survey. Mostly, they were female and were in third or fourth year of their nursing degree. Similarly, to educators, students showed mean scores of 58.69 ± 6.92 for evidence-based practice beliefs, 32.37 ± 16.97 for evidence-based practice implementation and 84.20 ± 23.48 for evidence-based practice organizational culture and readiness. Regarding undergraduate nursing student sample, there were moderate and statistically significant relationship between the different variables.ConclusionsBoth nursing educators and undergraduate nursing students had strong evidence-based practice beliefs, but low levels of evidence-based practice implementation. In nursing educators’ and undergraduate nursing students’ perspectives, there were opportunities in their schools for the development of an evidence-based practice culture. Based on results, support for development and testing of interventions, specifically tailored for promoting evidence-based practice implementation in nursing educational contexts, is recommended.     

Advancing clinical facilitator capability to support graduate nurses: Outputs from social learning processes embedded in action research cycles

AimThis study in the first instance, seeks to identify encounters that commonly occur between graduates, facilitators and others; and second, to explicate skills and behaviours needed by facilitators to effectively guide graduates to perform at expected standards.BackgroundIn Australia, nursing graduates are expected to assimilate quickly and adapt to workplace practices within short timeframes. Clinical facilitators are provided to support transition to the workplace. However, providing support is only understood in broad terms.DesignTwo consecutive action research cycles informed by extended Vygotskian learning concepts guided the study. The first cycle recorded and categorised critical encounters with graduates which were subsequently subjected to a thematic analysis to identify common circumstances where clinical facilitators are required to provide support to graduates. The second cycle articulated behaviours useful to clinical faciltators to foster graduate nurse learning, for optimal management of challenges experienced in routine daily practice.MethodRegistered nurses involved in graduate clinical facilitation at a large (780 bed adult facility) and a medium (448 bed adult, paediatric, maternity) acute hospital participated in the study. This graduate facilitation team through situated learning and a series of joint activity designed an EXCEL spreadsheet on which they recorded their observations and experiences with faciltating graduates transition to practice.ResultsFrom 1615 reported challenging interactions in the first cycle, saturation of emerging themes was reached with a random subset of 142. Six common areas of intensive needs for graduates were recorded, namely, resilience, technical support, emergent need, time management, advocate for graduate and catastrophe. The second cycle articulated processes for managing identified need areas in the form of flow charts. In practice, the flow charts provide a means for ‘scaffolding’ supervision and suggest conversations useful to facilitators to successfully support graduate nurses.ConclusionThis research has successfully explicated a largely ‘undefined’ area of nursing work, that is, making the invisible work of clinical facilitators ‘visible’ through the construction of flow charts. Specifically, advances have been made in articulating contextual, constructive support that nurses who facilitate the assimilation of graduates need to bring to interactions with graduates.     

Nursing students learning transfer from classroom to clinical practice: An integrative review

AimThe aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice.BackgroundAs nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students’ learning transfer has not yet been synthesized.DesignThis integrative review was conducted using the Whittemore and Knafl framework.Review methodsEight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute’s critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsTwenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students’ ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators.ConclusionsThe information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students’ learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.     

Perspectives and experiences of nurses as facilitators within a Practice Development program

Background

Health services are challenged to change and adapt to meet the changing needs of the populations they serve. To support this, the ‘Essentials of Care’ Practice Development program was developed in Australia. Local facilitators play a key role in its delivery and achievements.

Clinical nurses as teachers: insights from students of nursing in their first semester of study

This paper reports the findings of a study which sought to gain insights about the role of clinical nursing staff in the planned clinical experience of undergraduate nursing students. This study differs from others in that the perspectives of students of nursing in their first year of the undergraduate programme are sought, and the role of clinical nurses rather than clinical teachers is of particular interest. Using a story-telling approach, an exploration of students' perspectives on the role of clinical nursing staff in their clinical learning was undertaken. Analysis allowed findings to be grouped into helpful and unhelpful behaviours, Helpful behaviours included understanding and being friendly, showing interest and explaining. Behaviours that students found unhelpful to their learning were often passive rather than active, but they made students feel acutely aware of being unwelcome in the clinical area. Several students described feeling intrusive, uncomfortable and even unwelcome in clinical areas because o the attitudes and behaviour of clinicians. Findings of this study highlight the importance of clinicians and academic nurses working together to ensure that students of nursing, who represent the future of the profession, are provided with the best possible opportunities for clinical learning.     

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.