Pre-registration nursing students’ perceptions and experience of intentional rounding: A cross-sectional study

This paper examines pre-registration nursing students’ perceptions of the practice of intentional rounding and perceived benefits for nurses and patients.Intentional rounding was developed to ensure nursing staff regularly check on patients to ensure that all care needs are met. It has been linked to a reduction in falls and call bell use, and an increase in patient safety. No previous studies have examined pre-registration nursing students’ role in the practice of intentional rounding during clinical placements nor the perceptions of rounding practices, important from a future workforce perspective.A cross-sectional multisite study was undertaken, and pre-registration nursing students completed the Nurses’ Perceptions of Patient Rounding Scale between August 2017– June 2018, distributed using online education platforms and email. Strobe reporting guidelines were used to report findings.Participants perceived positive benefits in intentional rounding for nurses and patients. Mixed opinions surrounded the sufficiency of education received around the intervention. Previous nursing experience was linked to opposing opinions of intentional rounding, depending on education levels.Participants had a positive perception of intentional rounding practices overall. Education surrounding intentional rounding needs to be consistent, and introduced before students are expected to actively participate in the practice of rounding on clinical placement.     

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.     

Learning by chance. Student nurses’ conditions for learning in single-room hospital design. A realistic evaluation

AimThe aim of this study was to explore how a single-room hospital design influenced student nurses’ learning and competence development in clinical practice compared with shared-room accommodation, refining the programme theory: The student nurses’ conditions for learning in single-room hospital design are associated with the values of the patient room as the patient’s home during hospitalisation.BackgroundIt is evident that a hospital design with single-room accommodation influences several parameters for both the patients and staff. Furthermore, studies have shown that the physical as well as the psychological learning environment affects the learning outcome for student nurses. A premise for learning and education is that the physical learning space must promote person-centred and collaborative learning in order for the students to achieve their competence development goals.DesignThe study was conducted as a realistic evaluation that compares second and fifth-semester undergraduate nurses’ learning and competence development in clinical practice in shared accommodation (a pre-study) to single-room accommodation (a post-study).MethodsIn the data generation, we drew on an ethnographically inspired participant observation method. We gathered data during the period 2019–2021, covering the time before and approximately one year after relocation to all single-room accommodation. We undertook 120 h of participant observation for the pre-study and 146 h of participant observation for the post-study.ConclusionWe conclude that the learning environment in a single-room accommodation setting promotes task-oriented practices where the patient is often a mediator of activities related to nursing care. The learning environment in single-room accommodation places increased demands on the students’ ability to reflect on verbal instructions on nursing activities whenever the chance for reflection presents itself. We also conclude that in a single-room accommodation setting, stakeholders must focus on conscious planning and follow-up on the student nurses’ learning and educational activities which must support the students’ competence development. Hence, summing up to a refined programme theory developed through the realistic evaluation process: The student nurse’s conditions for learning in a single-room hospital design are associated with increased demands on the student’s ability to reach out for professional reflection when the chance presents itself. This is because the value of the patient room as the patient’s home during hospitalisation promotes a task-solving approach to nursing with the patient and the patient’s relatives as instructors.     

Using technology to enhance physical therapy students’ problem-solving skills around safe patient handling

Abstract

Background: Physical therapy students are at risk of musculoskeletal injuries during patient handling. Current guidelines recommend a risk management approach to reduce the likelihood of injury associated with patient handling.

Objectives: To determine the benefits of online scenarios using scenario-based learning interactive (SBLi^®) to enhance students’ confidence in making decisions around patient handling techniques, including equipment, and in practical patient handling skills.

Methods: Third year undergraduate and first year graduate-entry masters (GEM) students from the 2011 cohort of the physical therapy program at The University of Queensland received comprehensive training in patient handling. Only GEM students completed two SBLi patient scenarios. Students’ confidence in selecting patient handling techniques and equipment was assessed pre- and post-training with three statements scored on a 10-cm visual analogue scale anchored from strongly disagree to strongly agree. Patient handling skills were assessed with a practical skill assessment. Student satisfaction with SBLi as a learning platform was determined with three items and a focus group with eight students.

Results: Students’ confidence in performing a patient risk assessment and selecting appropriate patient handling technique and equipment improved with training. However, the online scenarios provided no additional advantage to the GEM students’ confidence in these tasks or in the practical skill assessment. GEM students were moderately satisfied with SBLi as a learning platform, reporting that it assisted their clinical preparation for the clinical environment and increased their awareness for safety of themselves and others.

Conclusions: The online interactive scenarios provided no additional benefit but may assist student preparation for the clinical environment.     

Proactive rounding: Perspectives and experiences of nurses and midwives working in a large metropolitan hospital

BackgroundRounding by the Rapid Response team (RRT) is an integral part of safety and quality care of the deteriorating patient. Rounding enables Intensive Care Units (ICU) liaison nurses to proactively identify deteriorating patients in the general wards and minimize the time spent by general nursing staff to call for assistance.ObjectiveThe study examined nurses’ and midwives’ experiences of proactive rounding by a RRT/ICU Liaison service, including the impact on workflow and patient care as well as enablers and barriers to utilization of the service.MethodA mixed method approach was used: an online survey and semi-structured interviews with nurses and midwives in an acute care setting.Results52 respondents completed the online survey and 6 participated in a semi-structured interviews. The majority of survey respondents found the service useful and indicated that rounding by the ICU Liaison service improves patient care. Participants also believed that pro-active rounding increases staff confidence and builds rapport when utilizing the ICU Liaison service. Barriers to use of the service included the lack of out of normal business hours support and obtaining prompt support.ConclusionProactive rounding was perceived by nurses and midwives to be beneficial for both themselves and patients, and ensured that deteriorating patients were identified.     

The invisible nature of learning: Patient education in nursing

BackgroundLearning for patients and their families within nurses’ patient- and family-education practice is an important part of person- and family-centred care. Patients and their families must master health promotional or management strategies to optimise their health outcomes. Support is often provided by nurses, but how nurses facilitate each patient’s and their family’s learning, using cognitive learning principles, seems invisible in the nursing literature.AimThis discussion paper examines the important role of cognitive learning within nurses’ patient- and family-education practice. How learning is enabled, the differences between teaching and learning and the role of learning principles are discussed. Shortcomings are identified and possible ways to address these within nurses’ practice are considered.MethodsThe discussion draws on the limited current literature surrounding cognitive learning principles in nurses’ practice and nurses’ awareness of learning principles. Readers are encouraged to question their current conceptualisation of learning and their perceptions and use of learning principles in their practice.Findings and discussionThe learning process within nursing is overshadowed by explanations of teaching strategies, determinants of learning and the learning principles of one specific theorist. The principles of cognitive learning and their role in patient- and family-education are poorly described and possibly poorly understood. This creates a fundamental knowledge gap in nursing practice.ConclusionA significant rethink about the role of learning principles within nurses’ patient- and family-education practice is overdue. These principles need to be explored further by involving nurses, patients and their families to identify how nurses are perceiving and using learning principles in their practice.     

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

An Australian mixed methods pilot study exploring students performing patient risk screening

Clinical placement shortages and rising costs have created demand to provide low‐resource, high value student learning opportunities. Malnutrition screening provides a vehicle for achieving this. A mixed methods explanatory sequential intervention study investigated time costs, and students’ perceptions of preparedness after performing routine patient screening tasks, as well as students’ overall views on their feelings of confidence and preparedness when commencing their first clinical placements. Pre‐clinical student dietitians commencing initial placements participated (n=58), with 16 of these forming a subgroup who performed malnutrition screening tasks while the others attended usual placement orientation. The time saved when students undertook screening tasks usually assigned to nurses was substantial. Questionnaires revealed that student perceived confidence increased in the screening group when compared with controls. Focus group themes included “anxiety and confidence,” “learning in the clinical learning environment,” “communication skill development,” and “the pre‐placement screening experience.” Students performing routine patient‐screening tasks prior to initial clinical placement has potential cost savings for healthcare organizations and was perceived to be valuable for learning.     

The implementation of intentional rounding using participatory action research

‘Intentional'/‘hourly rounding’ is defined as regular checks of individual patients carried out by health professionals at set intervals rather than a response to a summons via a call bell. Intentional rounding places patients at the heart of the ward routine including the acknowledgement of patient preferences and in anticipation of their needs. The aim of this study was to implement intentional rounding using participatory action research to increase patient care, increase staff productivity and the satisfaction of care provision from both patients and staff. Outcomes of the study revealed a drop in call bell use, no observable threats to patient safety, nursing staff and patient satisfaction with care provision. However, any future studies should consider staff skill mix issues including the needs of newly graduated nursing staff as well as the cognitive status of patients when implementing intentional rounding on acute care wards.     

Health care students experience of using digital technology in patient care: A scoping review of the literature

ObjectivesTo explore how undergraduate health care students use digital technology to deliver patient care during their clinical placements.DesignA scoping review of primary research was conducted using the extended PRISMA guidelines.Data sourcesA subject specialist librarian assisted in searching for the academic literature in four electronic databases: CINAHL, PubMed, Scopus and ERIC.Review methodsFour reviewers, working in pairs, independently reviewed a total of 332 potentially relevant articles according to set inclusion and exclusion criteria. Then, all included papers underwent an independent quality review by two reviewers.ResultsSeven studies involving medical or nursing/midwifery students were included in the review. Three studies evaluated the use of mobile learning devices in patient care with four studies evaluating the use of digital systems in practice. Due to the heterogeneity of studies, which used differing digital systems and instruments, the researchers decided the most suitable method of analysis was a narrative review. The results are explained using four key themes: student learning needs when using technology in practice; access to technology in placements; perceptions of using technology in placements; and impact of technology on patient care.ConclusionThe use of digital systems in clinical settings creates challenges and benefits to student learning in delivering patient care. When students are prepared and facilitated to use digital systems, a sense of confidence and belonging to the team is fostered. Lack of availability and access to these systems, however, may impede students’ ability to be involved in all aspects of patient care. Limitations of the current review included the relatively low quality of the educational research being conducted in this field of research. Further quality research is needed to explore how students in the health care professions are supported in digital environments and how higher education institutions are adapting their curricula to meet the digital learning needs of health care students.     

Practices of caring for nursing students: A clinical learning environment

ObjectiveThe purpose of this study was to explore, describe and illuminate nursing students’ best encounters of caring in the clinical learning environment. Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment.MethodsQualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry (AI) methodology. Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council (SANC) were purposively sampled from 3 private hospitals within the Western Cape. Data was analysed using Giorgi’s method.ResultsThe main theme included the best and ‘least best’ caring practices embedded in the centrality of the heart. The subthemes comprised of the nursing students’ experiences of caring literacy and caring illiteracy. The second theme included the creation of best caring practices within a conducive clinical learning environment. Within this theme, the subthemes comprised of the caring attributes required in reflecting best caring practices, as well the creation of a clinical learning environment to optimise caring.ConclusionsThe significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants. Caring was equated to the heart as the core to the nursing students’ being. Recommendations for nursing education, management, practice and research were therefore specifically formulated to enhance caring towards nursing students.     

Concerns of nursing students beginning clinical courses: A descriptive study

BackgroundStudents harbor fears related to the clinical environment that influence their participation and learning. Some studies have addressed general anxieties in undergraduate nursing students, but few have asked students to report their fears and concerns prior to entering the clinical environment. Therefore, this study examined the fears and concerns of undergraduate nursing students beginning clinical courses as well as their continued concerns upon completion of the first year of instruction. The study also assessed their confidence in physical assessment skills.MethodsNinety-six junior nursing students enrolled in a generic baccalaureate nursing program completed a survey, two items of which asked about their fears and concerns related to beginning clinical experiences and their confidence in physical assessment. A follow up survey was completed at the end of the junior year by 72 students.ResultsMaking a mistake, lack of course success, and not knowing how to do something were students' major concerns prior to the start of clinical experiences. Bad experiences with a nurse or instructor, freezing up, and uncomfortable patient/family experiences were also concerns. Not knowing how to do something persisted as a concern at the completion of the first year. Fears about being/feeling left alone in a clinical setting as well as concern about the senior year also emerged on the post survey. Confidence in physical assessment was a mean of 60.46 on a scale of 0–100 at the beginning of clinical instruction and 71.28 at the end of the junior year.ConclusionsFaculty should structure learning activities that decrease anxiety and enhance students' confidence prior to initial clinical experiences. Opportunities might include in-depth orientation to clinical settings and various simulations that allow practice of skills and communication. Awareness of predominant student fears and concerns can also guide staff nurses to provide a welcoming environment and enhance learning.     

Preparing the nursing student for internship in a pre-registration nursing program: Developing a problem based approach with the use of high fidelity simulation equipment

AimThis paper aims to explore the development and evaluation results of a simulated skills package designed using a problem based learning approach with general nursing students.BackgroundInternationally, the use of high fidelity simulated learning environments has escalated. This has occurred as a result of growing concerns relating to patient safety, patient litigation, lack of clinical opportunities for student nurses to gain experience and integration of new teaching methods into nursing curricula. There are however both proponents and opponents to the value of simulation and high fidelity simulation within nursing education.MethodsThis study was conducted in an Irish school of nursing. A simulated learning support package was developed by nurse educators and piloted with 134 third year nursing students. This was evaluated using a questionnaire in which 87 students responded.FindingsStudents generally found the simulation sessions realistic and useful in developing clinical skills, knowledge and confidence for clinical practice. However student issues regarding support with preparation for the session were highlighted. Also, the need for a more formalised structure for debriefing following the simulation sessions were identified.ConclusionIt is hoped that this paper will provide nurse educators with some guidance to aid future development of innovative and interactive teaching and learning strategies.     

Summative assessment of clinical practice of student nurses: A review of the literature

ObjectivesTo provide an overview of summative assessment of student nurses’ practice currently in use.DesignNarrative review and synthesis of qualitative and quantitative studies.Data sourcesWith the support of an information specialist, the data were collected from scientific databases which included CINAHL, PubMed, Medic, ISI Web of Science, Cochrane library and ERIC published from January 2000 to May 2014. Sources used in all of the included studies were also reviewed.Review methods725 articles concerned with student nurse clinical practice assessment were identified. After inclusion and exclusion criteria, 23 articles were selected for critical review.ResultsFindings suggest that the assessment process of student nurses’ clinical practice lacks consistency. It is open to the subjective bias of the assessor, and the quality of assessment varies greatly. Student nurses’ clinical assessment was divided into 3 themes: acts performed before final assessment, the actual final assessment situation and the acts after the final assessment situation. Mentors and students need teachers to provide them with an orientation to the assessment process and the paperwork. Terminology on evaluation forms is sometimes so difficult to grasp that the mentors did not understand what they mean. There is no consensus about written assignments’ ability to describe the students’ skills. Mentors have timing problems to ensure relevant assessment of student nurses. At the final interview students normally self-assess their performance; the mentor assesses by interview and by written assignments whether the student has achieved the criteria, and the role of the teacher is to support the mentor and the student in appropriate assessment. The variety of patient treatment environments in which student nurses perform their clinical practice periods is challenging also for the assessment of student nurses’ expertise.ConclusionsMentors want clinical practice to be a positive experience for student nurses and it might lead mentors to give higher grades than what student nurses in fact deserve. It is very rare that student nurses fail their clinical practice. If the student nurse does not achieve the clinical competencies they are allowed to have extra time in clinical areas until they will be assessed as competent.Further research needs to be carried out to have more knowledge about the final assessment in the end of clinical practice. Through further research it will be possible to have better methods for high quality assessment processes and feedback to student nurses. Quality in assessment improves patient safety.     

Caring in process: A 3-year qualitative longitudinal study of nursing students

AimThis paper aims to describe caring perceptions and behaviors among student nurses in Italy as they progress through their nursing education.BackgroundAs nursing students are potential nurses of the future, there is an expectation that in addition to appropriate academic qualifications, they will develop appropriate caring behaviors/attitudes. However, there has been some evidence that the educational process does not always modify their caring perceptions/behaviors or that the direction of the change is not always positive.DesignA qualitative longitudinal design with three data collection points, was performed from October 2013 to October 2016 at the University of Verona, Trento Campus.MethodsSemi-structured interviews were conducted at the time of entry into a 3-year bachelor’s degree program in nursing and at the end of the second and third years. Observation of the students during their clinical practice was carried out at the end of each of the three years of education. Thirty students commenced the study and 24 finished. Data were analyzed using a phenomenological approach.ResultsThe iterative process of analyzing interviews and observations resulted in nine themes collectively from all three stages: establishing a trusting relationship with the patient, satisfying the patient’s needs, paying attention, being respectful, being competent, giving time, being concerned with the emotional dimension, acting within context to facilitate caring actions and giving information.ConclusionsAt the end of the third year the students’ concept of caring was enhanced; their initial generic or lay view of caring turned into an intentional, competent, conscious, accountable and realistic caring approach.     

Nursing students' preparedness and practice in critical care settings: A scoping review

BackgroundDue to the demanding nature of critical care settings, students are prone to experience stress and lack of confidence, which hinders their learning and affects patient care. Educators should be knowledgeable about students' roles, stressors, and challenges as well as strategies to enhance students' competence and confidence to efficiently practice in critical care.PurposeTo map and analyze the literature about nursing students' placement, preparedness, and practice in critical care settings and identified areas for future research and practice.MethodsA scoping review using PRISMA guidelines. The literature was searched within eight databases using indexed terms. In total, 32 sources were selected for review. Literature summary tables, thematic synthesis, narrative summaries were used for data extraction and synthesis.FindingsThree themes and 12 sub-themes were generated. The themes included students' experiences and perspectives about critical care placements, strategies to enhance student learning, and the impact of clinical placements and teaching strategies on students.ConclusionsCritical care placements allow students in understanding the care of complex patients, enhancing their observational skills, and improving their interpersonal relationships in critical care teams. To enhance student preparedness for effective practice, high fidelity simulations and course-based teaching have been demonstrated to be effective.     

‘Speaking up for safety’: A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis

BackgroundThe international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement.Study aimsTo elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement.DesignThe study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks.SettingSchool of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia.ParticipantsOf the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data.MethodsAn evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach.ResultsFive major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning.ConclusionsFindings indicate that teaching assertiveness skills and establishing a preparatory framework for ‘speaking up for safety’ early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.     

Nurse anesthetists’ reflections and strategies when supervising master's students

ObjectiveThe objective was to describe registered nurse anesthetists’ reflections and strategies in relation to supervision of specialist nursing students in anesthetic care.BackgroundIn anesthesiology care, registered nurse anesthetists work with advanced care in a high-technology environment. The complexity of working with production requirements, time pressure and patient safety creates great challenges. Registered nurse anesthetists have a unique position and are responsible for the patient’s life during surgery. At the same time, they must supervise students without risking patient safety. Little research to date has focused on the clinical supervisory role in this context.DesignA qualitative design was used.MethodsThe data were collected in 2018 from qualitative interviews with a purposive sample of twelve student registered nurse anesthetists from a large hospital in Sweden. The data were analyzed using content analysis.ResultsThe results demonstrated that the dual role of registered nurse anesthetist and supervisor was experienced as satisfying, important and promoting development, although it also involved several challenges. Creating opportunities for supervision and learning in perioperative care improved supervisors’ prerequisites for supporting students and helping them develop. Being a supervisor was also rewarding, and given the interplay with students, supervision was viewed as a process of mutual growth.ConclusionBy focusing on students and their learning, we can help produce well-qualified registered nurse anesthetists who have positive experiences of the workplace and who want to stay in their profession.