An investigation into the impact of approaches to learning on final-year student nurses’ clinical decision-making

This research aimed to investigate whether a correlation exists between students' approach to learning and clinical decision-making and to determine whether an educational learning intervention would impact on clinical decision-making outcomes. Tait, Entwistle and McCune's Approaches to Study Skills for Students (ASSIST) and Jenkins' Clinical Decision Making Nursing Scale (CDMNS) was administered to a convenience sample of adult nursing students (n = 78) at a university in central London, UK, at the beginning of the final year of their nursing course and, following the learning intervention, again at the end of the year. Pre-intervention, 38% of participants predisposed to the surface approach to learning; post-intervention, less than 8%. Clinical decision-making scores were statistically significantly higher for students adopting the strategic approach at the pre-intervention point and significantly higher for those adopting the deep approach at the post-intervention point. At both pre- and post- intervention data collection points there was a negative correlation between the surface approach and clinical decision-making scores. Findings indicate a statistically significant relationship exists between participants' approach to learning and their clinical decision-making. Changing from the surface to either the strategic or deep approach to learning is shown to impact positively on clinical decision-making outcomes.     

Undergraduate nursing students’ experiences of online education: A cross-sectional survey

During the coronavirus pandemic, UK Academics were required to adjust their learning and teaching environment and pedagogical approaches, with little guidance or time. Feelings of frustration and uncertainty around student engagement were commonplace across Higher Education Institutions. This was heightened in professionally regulated courses, such as nursing. The shift to online learning created a situation where academics were frequently faced with a ‘sea of black screens’ and unable to ascertain student engagement.This study investigated undergraduate nursing students’ experience of online education during the COVID-19 pandemic. An anonymous survey was distributed to each year of the undergraduate nursing programme and data subsequently analysed. Responses from 54 students revealed that engagement varied between different year groups. There were significant differences between those with pre-COVID (traditional face-to-face) teaching experience (years 2 and 3) and those without (year 1) in regard to self-reported engagement with online learning. The findings from this study revealed some powerful and emotional insights into the experience of online learning amongst UK students undertaking an undergraduate nursing programme during the COVID-19 pandemic.     

Strategies to promote nurses’ health: A qualitative study with student nurses

Developing strategies to support student nurses' health is a global priority for healthcare organisations and governments. This is because emerging international evidence indicates that improvements in student nurses' health are required to increase the longevity of careers and reduce the loss of time, skill and financial cost of sickness absence and workforce exit. However, we do not know what intervention strategies student nurses think would support their health. The study aim was to explore student nurses' views on factors that influence health-related behaviours and strategies that could improve health. Data were collected through participatory activities during focus groups with student nurses in Scotland. Analysis was theoretically informed and involved mapping to the Behaviour Change Wheel framework. Students identified several factors that influenced health-related behaviours. Four were ranked most important: knowledge, culture, time constraints, and stress. Strategies student nurses thought should be prioritised to improve nurses' health-related behaviours were: stimulating a health-promoting environment by reviewing shift work, improving workplace support, increasing staffing levels, subsidising and role-modelling of healthy food and exercise; and creating applied health-promoting curricula by integrating time and stress management training and lifestyle advice into nursing education. Educational and environmental interventions are needed to support student nurses’ health.     

Implementation of a Registered Undergraduate Student of Nursing (RUSON) program: The nurses’ perspective

ProblemUndergraduate nursing students remain an underutilised workforce within healthcare. This paper explores the establishment of a Registered Undergraduate Students of Nursing (RUSON) model through a university and healthcare partnership.BackgroundNursing continues to adapt to increasingly complex patient populations. Initiatives are needed to enable nurses to focus on patients’ care needs amidst increasing healthcare costs. This study identifies opportunities and strategies for engaging undergraduate nursing students as part of the healthcare workforce through the RUSON model, from the perspective of nurse leaders.AimThis project aimed to explore nurse leaders’ perspectives surrounding implementation of a RUSON model.MethodA qualitative exploratory design was employed for this study. Thematic analysis from a focus group with the nurse leaders was undertaken.FindingsTwo key themes were identified from the analysis, i) Establishing the RUSON; with sub-themes: “Who are RUSONs?”, “You are not on clinical placement” and “The importance of inclusivity” and ii) Benefits of the RUSONs; with sub-themes: “Addressing patient care needs”, “Value to the nursing team” and “Creating future ready employees”. Participants identified barriers that were overcome, subsequently leading to the model being considered advantageous to the clinical environment.DiscussionThe establishment of a RUSON workforce in acute care settings brings with it benefits to the nursing staff and the RUSONs themselves. In order to successfully embed a RUSON model in an organisation, it is important to collaborate with the nursing leadership team in the implementation process.ConclusionA RUSON workforce is an appropriate human resource strategy, both at the immediate point of implementation and longitudinally, as a recruitment strategy for future employment. Successful implementation of a RUSON model requires engagement and collaboration with nursing leaders.     

Understanding new nurses’ learning experiences in intensive care

ObjectivesRecruitment and retention of nurses in intensive care units (ICU) has been challenging over the last few years. Rising demand is now exacerbated by the ongoing Covid-19 pandemic. Transition to ICU from other clinical areas is stressful resulting in significant nurse retention issues. This study therefore aimed to illuminate and explore new nurses’ learning experiences in one large intensive care unit in the United Kingdom.Methodology/MethodsExploratory qualitative case study utilising two data collection methods: one to one interview with six new ICU nurses and focus groups with six senior/clinical education ICU nurses.SettingA large major trauma centre in London with over ninety ICU beds.FindingsFindings indicate that ICU is a challenging learning environment for new nurses due to the large number of skills which must be developed in a short period of time. Forming supportive social relationships proved important in helping new ICU nurses learn and adapt to this complex clinical environment. The high-risk culture of ICU makes it harder to learn particularly for internationally educated nurses. Frequently changing shift patterns also impacts learning.ConclusionSenior ICU nurses should be aware of the issues affecting new nurses and where possible alleviate the stress of working in this challenging environment. They should also consider individual circumstances whilst maintaining high quality education. Social support should be facilitated where possible and new nurses need to be aware of the realities of ICU work.     

Assisting nurses to facilitate student and new graduate learning in practice settings: What ‘support’ do nurses at the bedside need?

The behaviours of nurses in the community of practice that new graduates and students participate directly contribute to learning. These behaviours are becoming more important with increasing numbers of students and graduates learning in health care contexts. Nurses, whether they assume the role of preceptor, buddy or mentor are pivotal in identifying appropriate learning opportunities for students and graduates, and assimilating these learners into the team. As nurses at the bedside have a designated caseload they need to be supported to perform this important role while delivering health care. The literature reports a number of constraints for nurses when facilitating the learning of others, namely, inadequate preparation about how to foster learning in this context, poor planning at the ward level, lack of reward or recognition for the role, lack of understanding about the specific learning needs of students and new graduates. This discussion paper provides direction for leadership and management teams to effectively support nurses who assume the role of preceptor, buddy or mentor to assist others' learning in the workplace. The recommendations suggest management teams provide for adequate preparation of nurses, effective planning of workload and organisation of work in the clinical area, and mechanisms for timely and specific feedback to maintain nurses interest and motivation in performing the role. Furthermore, senior leadership personnel need to establish a culture where the value of teaching and learning in practice is recognised and fostered by the entire team.     

Understanding the impact of mental health placements on student nurses’ attitudes towards mental illness

Student nurses maintain unfavorable views of people with mental health issues. Many continue to perpetuate common stereotypes, are fearful and believe people with mental health problems are in some way dangerous. The impact of placements greatly affects these views. A pre-post survey of 85 student nurses was conducted to establish the opinions and attitudes of student nurses regarding mental health. Groups were allocated to either community or hospital placements. Each group received the same educational preparation prior to placement. Both community and hospital placed students had improved clinical confidence when working with people experiencing mental health problems. Community placed students demonstrated greater positive attitudes towards people experiencing mental health issues across a number of domains. Students in hospital settings demonstrated more confidence when working with people with mental health issues yet had less attitudinal change about mental health. The approach taken by clinical facilitators also influenced student attitudes. It is suggested that offering community opportunities along with exposure to positive instructor beliefs about mental illness will both improve student attitudes prior to the completion of their nursing studies and may encourage entry into mental health as a nursing option post-education.     

Public health nurses’ views on quality measures: A cross-sectional study

BackgroundThe quality indicators program has intended and unintended consequences that may affect nurses’ professional performance and organisational outcomes.AimsTo explore public health nurses’ knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother–child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication.MethodsA cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables.FindingsThe structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses’ knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes.Discussion and conclusionPublic health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.     

How do psychiatric nurses learn?: Modes of learning and learning self-directedness

Houle's typology of continuing professional learning was used to investigate the phenomena of continuing professional learning and learning self-directedness in psychiatric nurses. Five research questions guided the study that was the first to examine the learning styles and preferences of psychiatric nurses. The results have relevance for those planning educational opportunities and programs for psychiatric nurses and for those psychiatric nurses interested in insight into the dynamics of their own continuing learning.     

Can effective teaching and learning strategies help student nurses to retain drug calculation skills?

Student nurses need to develop and retain drug calculation skills in order accurately to calculate drug dosages in clinical practice. If student nurses are to qualify and be fit to practise accurate drug calculation skills, then educational strategies need to not only show that the skills of student nurses have improved but that these skills have been retained over a period of time. A quasi-experimental approach was used to test the effectiveness of a range of strategies in improving retention of drug calculation skills. The results from an IV additive drug calculation test were used to compare the drug calculation skills of student nurses between two groups of students who had received different approaches to teaching drug calculation skills. The sample group received specific teaching and learning strategies in relation to drug calculation skills and the second group received only lectures on drug calculation skills. All test results for students were anonymous. The results from the test for both groups were statistically analysed using the Mann Whitney test to ascertain whether the range of strategies improved the results for the IV additive test. The results were further analysed and compared to ascertain the types and numbers of errors made in each of the sample groups. The results showed that there is a highly significant difference between the two samples using a two-tailed test (U=39.5, p<0.001). The strategies implemented therefore did make a difference to the retention of drug calculation skills in the students in the intervention group. Further research is required into the retention of drug calculation skills by students and nurses, but there does appears to be evidence to suggest that sound teaching and learning strategies do result in better retention of drug calculation skills.     

Systematic review of interventions to enhance preceptors’ role in undergraduate health student clinical learning

AimEvaluate interventions to prepare preceptors for their role in undergraduate health student clinical education.BackgroundPreceptor training and development are crucial to quality clinical learning experiences for undergraduate health students. The efficacy of education interventions designed for preceptors and use of reliable, valid outcome measures are unclear.DesignA systematic literature review informed by PRISMA Guidelines.MethodsMajor databases CINAHL, Medline and Google Scholar were searched between January 2010 and November 2021. 1253 articles were initially retrieved. Removal of duplicates and screening by title, abstract and keywords yielded 156 papers. Twenty-one papers fulfilled the inclusion criteria and were assessed using an adapted ‘Critical Appraisal Checklist for Reports of Educational Interventions’ and the New World Kirkpatrick Model.ResultsMost interventions were developed for the nursing profession and evaluated using pre-post-test (86%) or post-test only (5%). Two studies were considered high quality. Most studies (81%) reported positive short-term impact on preceptor knowledge, skills, attitudes and confidence. Two thirds (62%) of included studies measured preceptor behaviour change. No study measured impact related to quality of health care. Small sample sizes limited inferential analyses. Psychometric testing of tools to measure preceptor outcomes was inconsistent and validity and reliability were not reported in most studies.ConclusionsStructure and content of interventions were diverse and lacked rigour in outcome measurement. Most interventions demonstrated some positive impact on preceptor development. Objective measures determining longer term impact or how enhanced preceptor development translated into quality clinical student learning support was lacking. Future research should consider how best to measure the impact of educational interventions on broader outcomes such as quality of client care.     

Oncology patients’ and oncology nurses’ views on palliative chemotherapy: A cross-sectional comparison

BackgroundPalliative chemotherapy may be offered to patients with incurable cancer with the goal of extending life and improving quality of life. However, the adverse effects that may be associated with chemotherapy can negatively impact patients’ quality of life. Oncology nurses have an integral role in caring for patients during the decision-making process and may understand the potential implications of treatment options being offered to patients.Objectives(1) To compare the views of medical oncology outpatients and oncology nurses about palliative chemotherapy near the end of life. (2) To examine the reasons oncology nurses gave for choosing not to receive palliative chemotherapy.DesignCross-sectional comparison study.Settings and participantsA total of 194 patients, aged 18 years or over with a confirmed diagnosis of cancer who were attending a medical oncology outpatient clinic for their second or subsequent appointment completed a pen and paper survey between September 2015 and January 2016. One hundred and seven nurses who were members of an oncology nursing society or employed in an oncology setting in a participating metropolitan hospital completed an online survey between May 2018 and July 2019.Outcome measuresParticipants were presented with data derived from the Coping with Cancer study comparing six quality of life and care outcomes for patients who received, or did not receive, palliative chemotherapy in the last 6 months of life. Participants were asked to consider the data and indicate what option they would choose if they were in the same situation. Choices included: have chemotherapy; do not have chemotherapy; and unsure. Participating nurses were also asked to provide reasons for their choices.ResultsThree-quarters of participating nurses indicted they would not have palliative chemotherapy if it was offered to them, compared to just over one-third of people with cancer (p < 0.001). The top three reasons participating nurses gave for not having palliative chemotherapy were: wanting to make the most of their remaining time; increasing the chance of dying in the location of their choice; and the limited benefit of palliative chemotherapy in the last 6 months of life.ConclusionNurses in this study were significantly less likely than patients to indicate a willingness to have palliative chemotherapy if they were in the last 6 months of life. Further research is needed to examine how nurses’ knowledge and experience can help patients to make informed decisions about their care with the goal of achieving an end-of-life experience that best aligns with their wishes.     

Undergraduate College Students’ Perceptions of Psychiatric Nurses

We surveyed undergraduate students’ perceptions of psychiatric nurses’ effectiveness and analyzed other sources of data. Students reported that psychiatric nurses’ strengths include helping in situations that involve psychiatric symptoms, mental health evaluation, and drug abuse. Psychiatric nurses also were said to be effective when helping an individual with psychiatric symptoms, such as delusions and hallucinations. Friends or associates, common knowledge, school and education, and movies are some sources by which students learn about psychiatric nurses. Sources that provided less influential information include insurance carriers, newspapers, and personal experience.