A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students

Abstract

Background: Narrative reasoning has been presented as a core component of the health professionals’ competencies.

Aim of the study: This study aimed to explore the students’ perspectives about the contribution of a narrative reasoning course to promote patient-centred practice.

Methods: An interpretative phenomenological analysis (IPA) was undertaken through focus groups. Eighteen volunteer final year students participated in three focus groups. Data analysis followed the IPA principles.

Findings: Three themes emerged: (1) “developing distinctive competencies”; (2) “shifting students’ focus” and (3) “challenging students’ professional identity”. In the first theme, students distinguished their capability to better understand patients’ experiences and needs and to be aware of the importance of a collaborative therapeutic relationship. In the second theme, students emphasized a shift from themselves as clinicians towards their patients. Finally, in the third theme participants shared the perspective that they have developed a different clinical profile, and that their reasoning and clinical actions have changed.

Conclusions: Students recognized the contribution of the course in developing competencies to facilitate patient-centred practice. Future research is needed to inform lecturers on how to best integrate narrative reasoning within the physiotherapy undergraduate curricula.     

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.     

Nursing students' first-time experiences in pediatric clinical practice in Taiwan: A qualitative study

BackgroundA pediatric nursing practicum is essential in equipping students with basic knowledge of theory, professional attitudes, and skills for the clinical setting. However, students often face multiple challenges in the practicum due to gaps between theory and practice.PurposeTo describe nursing students' first-time experiences in pediatric clinical practice in Taiwan.MethodsA phenomenological approach with purposive sampling was used. Twenty participants were interviewed individually, in person, within a month of completion of a pediatric nursing practicum. Interviews were semi-structured and digitally recorded. Data analysis followed Colaizzi's methods; epochs (bracketing) focused analysis on students' experiences and maintained objectivity.FindingsThree themes and related subthemes emerged: (a) orienting to the pediatric unit (becoming familiar with common treatments and surroundings in the pediatric unit; recognizing people in the unit); (b) encountering challenges in pediatric and family-centered care (navigating communication between child and families; student nurse-patient relationships: maintaining a good rapport with children and their families; being prepared for quick role changes); (c) translating knowledge into clinical practice thoughtfully (providing desirable and correct responses for children and their families; providing a safe and friendly environment for children and their families).ConclusionsStudent nurses engaged in a variety of care practices necessitated by patients' differing ages, developmental levels, and family needs. Ensuring students' successful completion of the demanding pediatric practicum, including innovative communication, technical skills, and role transitions, is challenging yet achievable.Clinical relevanceGaining a fuller understanding of nursing students' experiences in the pediatric nursing practicum can assist nursing professionals in preparing students to provide competent care for children and their families.     

Definition and identification of child abuse by Finnish public health nurses

The purpose of this study was to determine how public health nurses in Finland defined child abuse and how they assessed their capability to identify child abuse in the family. Public health nurses described child abuse as consisting of physical and emotional abuse. They described physical abuse as consisting of two categories, direct physical abuse towards children and other acts causing children physical harm. Emotional abuse included neglect, teasing the child, frightening the child, rejecting the child in the family, and forcing the child to assume an adult role. The nurses divided the identification of child abuse into two categories: tools for identifying child abuse and markers indicating child abuse. The tools for identifying abuse included knowledge acquisition and interactive skills, intuition, and the capacity of the nurse to handle problematic situations. Public health nurses identified child abuse in the child's behavior and appearance and in family behaviors. Public health nurses seem to be aware of child abuse, but further research is needed if they need more-specific skills regarding how to apply their theoretical knowledge to nursing practice to provide nursing care for abused children and their families.     

Invisibility of nurses and midwives in the public health response to child abuse and neglect: A policy review

BackgroundChild abuse and neglect need to be addressed through a public health approach that prioritises prevention and early intervention. Nurses and midwives are core to this public health response, yet little is known about how their roles are described in Australian policy.AimTo explore how nurses’ and midwives’ roles in a public health response to child abuse and neglect are described in Australian policies about child protection, health, welfare, or development.MethodsThis policy review used Internet searching to identify Australian policy documents relating to child protection, health, welfare, or development published from 2009 to 2021. Data were analysed using deductive coding and content analysis.FindingsNurses’ and midwives’ contributions to a public health response to child abuse and neglect were either absent or described in scant detail within Australian policy. The information that was available represented only a portion of nursing and midwifery practices from a limited range of practice contexts.DiscussionA lack of visibility and clarity of nurses’ and midwives’ roles in policy raises many challenges. This includes a lack of guidance for interdisciplinary collaboration, educational preparation of nurses and midwives, and appropriate resourcing for their interventions. Further research is urgently needed to guide future best-practice policy and practices for nurses’ and midwives’ contributions to a public health response to child abuse and neglect.ConclusionAn enhanced representation of nurses’ and midwives’ roles in Australian policy is required to guide a public health approach that promotes better outcomes for all children.     

Effectiveness of simulation-based education on nursing students’ professional knowledge,attitude and self-confidence in handling child abuse cases

AimThis study aimed to enhance nursing students’ professional knowledge, attitudes and self-confidence in handling child abuse cases through a Child Abuse Simulation-Based Education (CASE).BackgroundGiven that nursing students seldom learn about child abuse case management in textbooks, simulation-based education could assist them in appropriately handling child abuse cases when they become nurses.DesignUsing a quasi-experimental design.Methods190 nurses enrolled in a night school in-service program at a Taiwanese university were recruited for this study. Ninety-four nurses in the experimental group took a simulation-based education on child abuse while 96 nurses in the contrast group took a general nursing course. The pretest and posttest professional knowledge, attitudes and self-confidence of both groups were analyzed using generalized estimating equations in SPSS V22 software.ResultsFollowing the introduction of the CASE course, the experimental group’s posttest professional knowledge, attitudes and self-confidence in handling child abuse cases were higher than those of the contrast group (p < .001). Further analysis showed that professional knowledge increased with tenure, positivity in attitude increased with clinical ladder rating and male nurses were more confident than female nurses when handling child abuse cases.ConclusionsBased on the results, this study proposes recommendations for implementing child abuse simulation-based education for new nurses and those undergoing continuing education.     

“I Felt Alienated in the Operating Room”: A Phenomenological Qualitative Study

PurposeTo investigate the clinical practice experiences of nursing students in the operating room and to evaluate these experiences in terms of professional socialization.DesignThis study was designed as a qualitative study based on Heidegger's hermeneutic phenomenological approach.MethodsThe study was conducted with second-year nursing students who attended the operating room (OR) as an observer for 10 hours as part of the Surgical Nursing course. The study data were collected with a semistructured interview form on the day following this restricted and limited experience. This form included items that questioned the students' experiences of how they perceived the clinical experience and how they were ultimately affected. The data were analyzed using van Manen's thematic analysis.FindingsThe study was conducted with nine students, including four males and five females. The ages of the students ranged between 19 and 21 years. Two themes and seven subthemes were determined as a result of the data analysis. The themes of the study were (1) short and difficult experience and (2) very important for professional socialization.ConclusionsThe study provided important information about nursing students' experiences regarding the effect of OR practice on their professional socialization. It was understood that the students perceived OR practice as a short and difficult experience, felt worthless and alienated, and realized that there was no empathy in the OR. Additionally, they stated that the team members did their job very well and that they felt the importance of being the best. Moreover, they found OR practice important for guiding one's career goals, professional socialization, and gaining a professional identity.     

Experiences after international clinical placement as nursing students in a paediatric ward

AimThe aim of this study is to investigate nurses’ experiences after participating in an international clinical placement programme as nursing students while staying for one to three weeks in a paediatric ward.BackgroundStudent mobilisation is expected to increase the quality of education. Hence, offering international clinical placement programme in low- and high-income countries is a commonly used learning activity in bachelor programmes in nursing. Many studies have mainly examined the general experiences gained from international clinical placement programme but have not specifically focussed on the setting of paediatric wards in hospitals. Nursing students are required to acquire knowledge of paediatric nursing with children as patients.Design and methodIn this qualitative study, a hermeneutic, phenomenological approach was adopted. Data were collected through individual interviews with eight nurses after they participated in an international clinical placement programme as nursing students in a paediatric ward.ResultsMeetings with children’s destinies as patients were overwhelming, being an observer provided insights into and an overview of paediatric nursing, access to the resources required for treating children is limited, nurses had a different role and parents had an extended caring role.ConclusionAll participants gained knowledge of children as patients at a hospital and also gained knowledge of the parents’ and nurses’ roles and the treatment methods of various diseases that are relevant to paediatric nursing. This helped provide them with the cultural knowledge, awareness and sensitivity required, given the contrasting situation at their home country.     

Undergraduate nursing students' experiences and attitudes towards working with patients with opioid use disorder in the clinical setting: A qualitative content analysis

BackgroundWith the US facing an opioid epidemic, undergraduate nursing students are increasingly encountering patients with opioid use disorder in the clinical setting. Yet, nursing curriculums have not adapted to meet this need. Previous research indicates students are exposed to negative messages that might influence their views about patients with opioid use disorder.ObjectivesThe purpose of this study was to examine nursing students' experiences encountering patients with opioid use disorder in the clinical setting, their attitudes about their encounters, and their perceptions of their educational preparedness to care for this population.MethodPurposive sampling was used to identify participants. Semi-structured interviews were conducted until saturation. Krippendorff's method for qualitative content analysis was used to cluster units within the data to identify emergent themes.ParticipantsEleven senior nursing students from a public university in New England participated.ResultsAnalysis revealed six themes, including: navigating ethical dilemmas, gaining comfort with time and experience, avoiding the “elephant in the room,” learning from real-world scenarios, witnessing discriminatory care, and recognizing bias and stigma.ConclusionsStudents were most likely to experience bias and internal conflict in maternity clinical rotations. Education should include practical communication strategies to reduce avoidance behaviors among nursing students as well as techniques to manage difficult situations and reduce moral distress. Nurses must be mindful of their power to influence students and should model non-judgmental language and behavior. Students ultimately expressed a desire to provide informed and empathetic care.     

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.     

Transition experiences of nurses as students and new graduate nurses in a collaborative nurse residency program

BackgroundA small Midwestern college of nursing and an affiliate hospital partnered to design a nurse residency program where students are extended pre-hire job offers in a practice area of their choice and are then partnered with a preceptor who they will work with in a clinical immersion experience during the last semester of their nursing program and in their orientation period as new nurses.PurposeThe purpose of this qualitative, phenomenological study was to explore the lived experiences of a cohort of nurses as students and new graduate nurses during transition in this collaborative nurse residency program.MethodA transcendental phenomenological qualitative approach using Meleis' Transition Experience Theory as a theoretical framework is used for this study.ResultsThemes of feeling overwhelmed, supported, and confident were identified. A finding unique to the literature and this nurse residency program model is a theme of overwhelming support.ConclusionsThis information can be used to improve the nurse residency program and its outcomes and also further the advancement of nursing knowledge of the transition experience of new nurses.     

Immigrant parents' experiences of communicating with healthcare professionals at the neonatal unit: An interview study

BackgroundWhen newborn children of immigrants require care in a neonatal unit, parents frequently encounter not only a new language, but also a new healthcare organisation.AimTo examine parents’ experiences of communication with healthcare professionals in a neonatal unit when language barriers are present.MethodTwenty interviews were conducted with families who spoke Arabic and had a child who had been cared for at one of five neonatal care units, level II-III in western Sweden. The interviews were analysed using a phenomenological hermeneutic approach.ResultsThe main theme, having the opportunity to exercise one's parental role, included four themes encountering emotional warmth, feeling accepted, encountering a lack of understanding, and compensating for inadequate language skills.ConclusionIt is not only language barriers that affect communication between parents and healthcare professionals; different expectations and pre-understandings are also of importance.     

Protecting children from all forms of abuse and neglect

Nurses have a key role in safeguarding children from abuse and neglect. This article outlines nurses' responsibilities in child protection and general protocols for talking to children and reporting concerns about their welfare.     

Nursing Students' Experiences Related to Operating Room Practice: A Qualitative Study

PurposeThe purpose of this study was to examine the experiences of nursing students concerning operating room (OR) practice.DesignA qualitative design was used in this study.MethodsData were collected from second-year nursing students using the semistructured interview form including open-ended questions about their OR experiences. Perspectives of phenomenological approach including existentials of lived body, lived relations, lived space, and lived time were used in data analysis.FindingsThe study data regarding experiences of nursing students concerning OR practice were organized under three themes, namely, “OR environment,” “emotions,” and “career plans after graduation.” Nine subthemes emerged: educational experience, teamwork, and communication, excitement, enjoyment, anxiety, fear, different emotions, working as a surgical nurse, and working in departments other than OR.ConclusionsIn clinical environments, student nurses should be supported by staff and instructors to facilitate learning and create meaningful learning experiences.     

Undergraduate nursing students' attitudes towards incarcerated persons and their perceptions of clinical experiences

BackgroundIn 2019, an estimated 6.3 million persons were under the supervision of the United States adult correctional systems and one in 40 adult persons were under correctional supervision. At year-end of 2019, nearly seven in ten persons under correctional supervision were supervised in the community. A nurse's attitudes and beliefs about incarcerated persons may influence their behavior.PurposeThe purpose of this study was to examine nursing student's attitudes towards incarcerated persons and their perceptions of a clinical experience at a correctional facility.MethodsData from 137 nursing students were collected through a cross-sectional, electronic survey. The Attitude Towards Prisoners Scale (Melvin et al., 1985) was used. A post hoc analysis of perceptions of their clinical experience at a correctional facility was explored.ResultsThe mean scores of 93 and 94 (potential range of scores 0 to 144) suggest positive attitudes towards incarcerated persons exist, yet few nursing students report an interest in correctional nursing as a career. Although few (n = 5) students had a correctional nursing clinical experience, most perceived it as an effective clinical learning setting.ConclusionWith high rates of incarceration, the researchers recommend that baccalaureate nursing programs include educational teaching strategies that focus on incarceration, incarceration stigma, and explore clinical learning experiences.     

Baccalaureate nursing students' experiences with multi-patient,standardized patient simulations using telehealth to collaborate

BackgroundNurse faculty must utilize teaching strategies that promote student achievement of essential competencies, and simulation can provide experiential learning to help prepare students for professional practice.PurposeThe purpose of this phenomenological qualitative study was to explore baccalaureate nursing students' experiences with multi-patient, standardized patient simulations that used telehealth to provide opportunities to learn and practice intra- and interprofessional collaboration. Student perceptions of their ability to utilize lessons from the simulations in clinical practice were also examined.MethodsFocus group interviews were conducted with 27 final-semester baccalaureate nursing students after they had participated in two telehealth-enhanced simulations.ResultsAnalysis revealed five themes: Anxiety due to lack of experience, Improved clinical reasoning, Real world practice, How to communicate effectively, and Application to clinical practice.ConclusionThe use of telehealth helped overcome barriers to implementing collaborative simulations and provided students with experiential learning that addressed essential competencies for safe and effective professional nursing practice.