Using clinical skills laboratories to promote theory-practice integration during first practice placement: an Irish perspective

Aims and objectives. This aim of this study was designed to investigate how a select cohort of nursing students experienced their first practice placement in a large Irish teaching hospital. The objectives of this study were to investigate whom do students learn from, what skills they learnt during their first practice placement and to identify if the use of clinical skills laboratories before their first practice placement helped students relate theory to practice during their first practice placement. The aim of this paper is to discuss if the sessions taught in the clinical skills laboratory prior to the first placement helped students integrate theory to practice during their first practice placement. Background. The debate regarding theory–practice integration has been ongoing in nursing for decades. Many studies across Europe have consistently demonstrated that the use of clinical skills laboratories have helped students integrate theory to practice during practice placements. Others have identified the difficulty students have relating theory to practice. However, as there appears to be a gap in current literature, from an Irish perspective, it is essential to highlight if Irish students can integrate theory to practice during their first practice placement. Design. A qualitative method incorporating the Heideggarian approach of phenomenology was utilized. Methods. A purposeful sampling technique was used to select six participants from all first year students. Interviews were conducted using a semi‐structured interview schedule. Data were analysed using the Giorgi method of analysing phenomenological data. Results. The participants identified that sessions taught in the clinical skills laboratory before the first practice placement, which they identified as ‘basic nursing skills such as taking and recording vital signs and hygiene needs of patients were useful and helped them to integrate theory to practice during their first practice placement. These results are relevant to this paper as they identify the use of teaching sessions in the clinical skills laboratories, enabling students to link theory to practice during practice placements. Conclusions. Nursing students must be adequately prepared to carry out clinical skills competently and efficiently. Educators and practitioners must display the knowledge and skills required to promote theory–practice integration, to enhance nursing students education, which in turn will optimize high standards of patient care. Relevance to clinical practice. Clinical skills laboratories are essential to help students develop the collaborative skills required for a profession like nursing. It is essential that students are adequately prepared to carry out clinical skills during their first practice placement, and have the ability to link theory to practice.     

Implementing advanced practice: identifying the factors that facilitate and inhibit the process

? This paper reports the preliminary results of research investigating the factors that help or hinder advanced nurse practitioners as they attempt to implement new roles in clinical practice. ? Multiple facilitating and inhibiting factors are identified, the majority of which are shared across various clinical settings. ? Factors fall into three categories: re-negotiating relationships; becoming an advanced practitioner; and the clinical context and deployment. ? Whilst the results of this case study research are not necessarily generalizable, they provide evidence of the lived experience of advanced nurse practitioners attempting to implement new roles in a variety of clinical settings following their graduation from a Master's degree programme.     

护生专业自我概念与社会支持相关性研究

目的:调查护生专业自我概念与社会支持状况,并了解二者的相关性,为培养护生积极的专业自我概念提供依据。方法:采用护理专业自我概念量表、社会支持评定量表,对185名护生进行调查。结果:护生专业自我概念总分为(2.83±0.46)分,其中灵活性得分最高,为(2.94±0.53)分,满意度得分最低,为(2.73±0.51)分。护生的社会支持总分为(39.35±5.37)分,与国内常模得分比较差异有统计学意义(t=11.66,P<0.01)。护生专业自我概念与社会支持评分呈正相关(P<0.01)。多元回归分析显示,客观支持和支持利用度是护生专业自我概念的主要影响因素。结论:护生社会支持水平对其专业自我概念有影响,医院和学校应建立良好的社会支持系统,培养护生积极的专业自我概念,为护理学科的发展奠定基础。     

实习护生骨质疏松症知识的调查与分析

目的了解实习护生骨质疏松症知识现状，分析影响骨质疏松症知识水平的相关因素。方法采用便利抽样的方法，抽取北京市某三级甲等医院的164名实习护生作为研究对象，运用自行设计的骨质疏松症知识问卷调查。结果实习护生骨质疏松症知识得分（14．71±3．66）分，属于中等水平，其中运动知识答对率最低（49．86％），危险因素知识答对率最高（61．55％）；不同学历实习护生骨质疏松症知识得分差异具有统计学意义（F=4．394，P=0．014）；临床实习时间与骨质疏松症知识得分呈正相关。结论实习护生骨质疏松症知识不足，提示护理管理人员和教育者在学校应积极开展有关骨质疏松症的教育，使护生能够掌握相关知识，并能在实习期间加以强化，从而更好地进行自身预防，为患者提供相关的健康教育。     

Comparison of the clinical practice satisfaction of nursing students in Korea and the USA

The objective of this research was to compare the clinical practice satisfaction of nursing students in South Korea and the United States. A self-report questionnaire on 'Satisfaction of clinical nursing practice of undergraduate students' was used to survey 131 nursing students of the Yonsei University in South Korea and 109 nursing students of the Colorado Christian University in the USA. Findings indicate that American nursing students had significantly higher clinical practice satisfaction levels than the Korean students. Two factors were identified to explain the differences. One is the different motivation for choosing a nursing major and the second is the different clinical practice environment. Although different countries utilize clinical practice differently, it is beneficial to understand the factors that influence students' satisfaction levels by comparing countries' nursing education system.     

Perceived barriers and facilitators to implementing research findings in the Irish practice setting

Background. Studies have consistently demonstrated that nurses are increasingly recognizing the role research has to play in their daily practice. Despite this recognition the actual application of research findings in the practice setting is still poor. To date, the barriers to implementing research findings in the Republic of Ireland's practice setting have not been explored empirically. This study sought to address this gap. Aims. The aims of this study were to ascertain what Registered Nurses practising in the Republic of Ireland perceive as barriers to the implementation of research findings in the practice setting and to explore what they perceive would facilitate them in using research findings in their daily practice. Design. Cross‐sectional survey. Methods. A non‐probability strategy was employed with all Registered Nurses who commenced a nursing‐focused academic course accredited by the University of Dublin, Trinity College, between September 2001 and February 2002 invited to participate. The ethical rights of the participants in terms of anonymity, privacy and informed consent were assured through a number of mechanisms. Data were collected via the Barriers scale. Findings. Eight of the top 10 ranked barriers were organization centred. The top barrier was a perception of insufficient authority to instigate change in the practice setting. The perceived key facilitators to implementing research findings included protected time for retrieval and evaluation of research findings, instrumental support from management, informed supportive personnel in the practice settings and accessible educational opportunities to augment critical reading skills. Relevance to clinical practice. The Irish Government is committed to provide the people of Ireland with an evidence‐based health service. From a nursing perspective the findings of this study indicate that a number of strategies have to be introduced or enhanced in the practice settings before this commitment can be realized.     

Clinical practice characteristics of gerontological nurse practitioners: a national study

PURPOSE: To determine the clinical practice characteristics of gerontological nurse practitioners (GNPs) in the United States and ascertain whether length of employment, geographic region of practice, work setting, and educational preparation influence GNPs' delivery of advanced clinical services and clinical procedures. DATA SOURCES: The Gerontological Nurse Practitioner Practice Profile was mailed to a stratified random sample of 1000 GNPs certified by the American Nurses Credentialing Center. CONCLUSIONS: Despite the growing demands for GNPs, of the 472 GNPs who responded to the survey, only half were working full-time as a GNP. Although the role was established over 30 years ago, 56% of the respondents indicated that they were the first GNP in the position. There was a statistically significant positive relationship between being the first GNP in his or her practice and the percent of primarily medical advanced clinical services performed. GNPs who worked in multiple clinical setting performed more advanced clinical services and medical procedures than GNPs who only worked in one setting. IMPLICATIONS FOR PRACTICE: This study provides insight into the complex practice characteristics of GNPs. GNPs are combining the nursing skills so necessary to care for older adults with advanced clinical services and clinical procedures deemed medical acts. Various factors influence how GNPs practice, including geographic location, type of practice, and whether the GNP was the first person to be employed as a nurse practitioner at the practice.     

Clinical judgement and decision-making in nursing - nine modes of practice in a revised cognitive continuum

Title. Clinical judgement and decision‐making in nursing – nine modes of practice in a revised cognitive continuum Aim. This paper is a report of an evaluation of cognitive continuum theory and identification of revisions required for application to clinical judgement and decision‐making in nursing. Background. The importance of nurses’ developing and applying sound clinical judgement is reflected in an international classification of nursing practice. Cognitive continuum theory synthesizes rival and complementary approaches to decision theory in an accessible format, which has been applied in medicine, and various nursing scholars have advocated its use to enhance the effectiveness of nurses’ clinical judgement and decision‐making. Method. Parse’s structure and process criteria are applied in critiquing the relevance of cognitive continuum theory to nursing. Findings. Cognitive continuum theory illustrates how different judgement tasks are suited to different thought processes and how matching the two can optimize decision‐making. However, existing modes of inquiry applied to medicine emphasize experimental research, ignoring many alternative approaches used in nursing. A revised version of the cognitive continuum is developed, incorporating examples of nursing judgements and decisions, a broader evidence base, an ethical dimension, and evaluative competence criteria. Conclusion. The revised cognitive continuum promotes awareness of the nature and the variety of patient‐centred judgement tasks and decisions in nursing, how to select the most suitable intervention tactic from available options, and the fallibility of all forms of human judgement from intuitive/experiential to analytic/rational. Hence, it is recommended for use as an educational tool and practice guide to facilitate theory development and the practice of judgement and decision‐making in nursing.     

护理专业高职高专学生预见习活动的实施

目的探讨护理专业高职高专学生预见习活动的实施方法与效果。方法一年级学生利用假期在当地医院进行10d的预见习,并上交预见习活动手册,以PPT形式在班级和系部层面进行汇报,并采用问卷调查和座谈会的方式了解他们在预见习中的收获。结果学生预见习的主要收获包括不再惧怕护理工作(90.3%),了解了护士工作职责(85.3%),了解了交班事项(72.7%),熟悉了护士工作流程(65.5%),了解了护理基本操作(59.7%),掌握了与患者的沟通技巧(43.7%)。结论预见习活动能促进学生对护理工作的了解,是实践教学中的重要部分。     

Creating a culture of caring: A collaborative academic‐practice approach to clinical education

Strong academic and practice partnerships are needed in the ever‐changing health care environment. Sometimes an invisible barrier exists between clinical practice and academia; academic‐practice partnerships are a way to bridge this barrier. Since 2008a team‐based model of clinical education known as the Culture of Caring (COC) has brought together three academic institutions with a large hospital system to develop a unified clinical experience and curriculum that improves the student, provider, and patient experience. In the COC model the team consists of academic‐practice leaders, clinical instructors, staff nurses, and students. Together they engage in a structured curriculum that is integrated into both the clinical environment and the academic setting. Each week of clinical the students focus on a topic that is paired with journal articles and learning activities that allow the team to engage in learning that is applicable to the clinical practice environment. The learning activities allow students to engage in learning about evidence‐based practice and quality improvement initiatives that are taking place on the unit. The implementation of this collaborative approach to a clinical nursing education model has had a positive impact on the working relationships between the academic partners and clinical practice leaders.     

Supporting Clinical Practice at the Bedside Using Wireless Technology

OBJECTIVES: Despite studies that show improvements in both standards of care and outcomes with the judicious application of clinical practice guidelines (CPGs), their clinical utilization remains low. This randomized controlled trial examined the use of a wirelessly networked mobile computer (MC) by physicians at the bedside with access to an emergency department information system, decision support tools (DSTs), and other software options. METHODS: Each of ten volunteer emergency physicians was randomized using a matched-pair design to work five shifts in standard fashion (desktop computer [DC] access) and five shifts with a wirelessly networked MC. Work pattern issues and electronic CPG/DST use were compared using end-of-shift satisfaction questionnaires and review of a CPG/DST database. Repeated-measures analysis of variance was used to examine between-shift differences. RESULTS: A total of 100 eight-hour shifts were evaluated; 99% compliance with postshift questionnaires was achieved. Using a seven-point Likert scale (MC values first), MCs were rated as being as fast (5.04 vs. 4.54; p=0.13) and convenient (5.08 vs. 4.14; p=0.07) as DCs. Overall, physicians rated MCs to be less efficient (3.18 vs. 4.30; p=0.02) but encouraged more frequent use of DSTs (4.10 vs. 3.47; p=0.03) without impacting doctor-patient communication (2.78 vs. 2.96; p=0.51). During the study period, physician use of an intranet Web application (eCPG) was more frequent during shifts assigned to the MC when compared with the DC (eCPG uses/shift, 3.6 vs. 2.0; p=0.033). CONCLUSIONS: The MC technology permitted physicians to access information at the bedside and increased the use of CPG/DST tools. According to physicians, patients appeared to accept their use of information technology to assist in decision making. Development of improved computer technology may address the major limitation of MC portability.     

The development of clinical leadership through supported reflective practice

• ? The notion of clinical leadership is significant in current nursing practice, particularly since recommendations made by the Department of Health in ‘The Strategy for Nursing’. However, while it is a concept that many nurses aspire to implement, in reality the operationalizing of such a concept is fraught with difficulty.
• ? This paper aims to explore the issue of clinical leadership through a collegiate model developed in a particular practice area.
• ? The development of this collegiate relationship is articulated through the mediums of reflective practice and clinical supervision.
• ? A model of collegiality is offered as an approach to the integration of the spheres of clinical leadership.
• ? If reflective practice is to be a reality then it is essential that both clinical leaders and practitioners engage in such processes within a supportive culture.

     

Assessing and developing the written reflective practice skills of speech-language pathology students

Purpose: Written reflective practice aims to support critical thinking and problem solving skills in speech-language pathology (SLP) clinical education programmes. Yet, there has been limited investigation of students’ development of written reflective practice skills over time and during a real-time clinical experience. The purpose of this study was to investigate students’ development of breadth and depth of written reflective practice across a six-week clinical experience.

Method: Participants were 59 undergraduate and 14 postgraduate SLP students. Participants wrote critical reflections describing an interaction with a client/s at the conclusion of weeks two, four and six of their clinical experience. Formative feedback was provided after each submission. Breadth and depth of reflection were coded using a modification of Plack et al.’s coding schema.

Result: There was a statistically significant association between time and likelihood of development of breadth of reflection for the elements process and content. Depth of reflection improved significantly across time. The majority of participants were classified as "reflectors" or critical reflector at the conclusion of the study.

Conclusion: SLP students can make significant improvements in both breadth and depth of written reflective practice over a six-week period. Implications for clinical teaching are discussed.     

Supporting learners in clinical practice: capacity issues

Aim. The aim of this paper is to report a study exploring, from the perspective of key stakeholders (mentors of nurses, managers of nurses, and modern matrons) in one English acute sector hospital, how decisions are made on how many learner nurses can be supported in clinical practice. The objective was to identify what factors are taken into consideration in making these decisions. Background. Supporting increasing numbers of students is a demand of current service provision in the English National Health Service, as part of an expansion in the numbers of all healthcare professionals. This is particularly the case in nursing, where the government announced a required increase in numbers of qualified nurses of 20 000. This expansion of numbers has implications for the quality of placement learning in clinical placements. Methods. Data were collected using three focus group interviews with a total of 12 participants in 2003/04. Recruitment was on a purposive basis. Subsequent analysis identified themes, which were compared across groups. A short questionnaire was also used to establish participants’ biographical details prior to the focus groups. Findings. Three key themes were identified: ‘capacity issues’, ‘enhancing support in practice’ and ‘issues impacting on learning in practice’. ‘Capacity issues’ identified factors that impact on the capacity of placements to support learners. ‘Enhancing support in practice’ identified necessary roles and strategies to enhance learning in practice. Finally, ‘issues impacting on learning in practice’ identified learner groups where support could be enhanced through structured management of the placement experience. Conclusions. Decisions on learner numbers to be supported at any one time are complex, with a multitude of dimensions. These include identification of types of learners and numbers of mentors available to support them and other operational issues. ‘Educational staff’ are needed at operational and strategic levels to support learning in practice. Timely and appropriate audit information to support allocation decisions and identify strategies to enhance the quality and support of learning in practice, are also required. Relevance to clinical practice. Increases in learner numbers and National Health Service modernization have had an impact on clinical placements’ capacity to support learning, and potentially, on learners’ achievements in practice. Findings from this study are thus important in evaluating the impact of these policy initiatives.     

护理专业本科实习学生临床决策能力的现状调查

目的了解护理专业本科学生临床决策能力。方法对在重庆市5所三级甲等医院实习的护理专业学生253人进行临床决策能力测量。结果护理本科实习学生临床决策能力总分为（81．60±9．85）分,临床环境适应性、临床思维、知识结构、护患沟通能力、综合基础素质得分较低。结论护理专业学生临床决策能力水平偏低,提示应采取针对性干预措施,不断提高其临床决策能力。     

Iranian nurses' perceptions of theoretical knowledge transfer into clinical practice: a grounded theory approach

Since nursing education was transferred to universities in Iran, the public and health administrators have criticized Iranian nurses because of poor-quality patient care. It seems that nurses are not able to transfer the taught theoretical knowledge in academia into practice. This paper attempts to provide an insider view of why the taught theoretical knowledge in academia might be difficult to enact in the clinical setting. Using the grounded theory approach, individual in-depth interviews and participant observation were undertaken with a purposive and theoretical sample of 26 participants in Tehran University of Medical Sciences. The data were analyzed using the constant comparative method. The findings showed that, in spite of increased academic input into nursing education, clinical behaviors in both the education and practice settings were perceived as "traditional routine-based".