Perceived clinical constraints in the nurse student–instructor interactions: A qualitative study

Effective student–instructor interactions impact the quality of nursing clinical education. There are a myriad of different factors related to clinical settings that affect these interactions and they have received less attention in nursing studies. Identifying clinical constraints that impact the nursing student–instructor relationships will help nursing instructors to manage clinical learning situations in a more effective manner.ObjectiveThe goal of this study was to identify the primary factors that influence the student–instructor interactions within clinical settings.MethodsA purposeful sampling strategy was applied to recruit 18 nursing students and instructors to participate in qualitative, semi-structured interviews. In order to identify relevant themes of transcribed interviews, qualitative content analysis was utilized.ResultsData analysis resulted in the development of five main themes that represent essential interaction constraints in clinical contexts. These themes include: outsiders' eyes, dominance of act, close contact, clinical workplaces' disputes, and instability and uncertainty.ConclusionsThe results of this study can serve to improve the understanding and practice of international clinical nursing instructors within the clinical education context. The behaviors that emerged were based on clinical constrains and an awareness each can serve to enhance the instructor–student relationship.     

Education of nurse practitioners in academic nurse-managed centers: student perspectives

Clinical experiences for advanced practice nurses are increasingly a challenge. Finding settings that demonstrate primary care nursing practice in its finest form can be difficult. This article reports on nurse practitioner (NP) student feedback on clinical placements in the academic nurse-managed centers (ANMCs) associated with four Michigan schools or colleges of nursing. Student feedback was solicited over three years through site and preceptor evaluation tools and focus groups. Students were overwhelmingly satisfied with their experience in ANMCs. Being mentored by an NP preceptor in an ANMC was a valuable experience for students. They valued the role modeling of the NP and the quality of their preceptors' instruction. Students stated that the nursing model of care to which they were exposed was congruent with classroom learning. They reported learning to apply an understanding of their patients' economic, social, and cultural situations to treatment decisions and patient-education efforts and learning to understand the role of community-based care. One limitation of ANMCs from the students' perspective was a relatively low volume of patients, particularly in the initial years. However, the benefit of having time to spend with clients and to reflect on clinical practice was also articulated.     

Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views

Background

There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients’ views about their consultations with a nurse prescriber.

Objective

To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management.

Design

A qualitative study involving semi-structured interviews and thematic analysis.

Setting

Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009.

Participants

Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers.

Results

Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment.

Conclusions

The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses’ interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients’ requirements.     

Student nurses' views of a learning model – a multi-method research study

The aim of this study is to describe students' perceptions of various assignments within a specific learning model. In particular the study focuses on how the students perceived and reacted to the assessment processes used. A learning model was developed in which the learning of nursing theory and practice was integrated with the overall aim of motivating students to integrate their cognitive, affective and psychomotor skills. A multi-methods design was applied using a questionnaire and qualitative interviews. Two hundred and eighty four students were asked to complete the questionnaire. Fifteen of the 252 students who returned the questionnaires were interviewed. The main findings were that the students constructed their own learning depending on how they understood the specific assignment and there was diversity in the students' interpretation of the assignments. They focused on the assignments in accordance to the demands they expected to face as registered nurses and their interpretations of the demands differed between them. The way the individual student understands the paradigm of nursing must therefore be challenged; what does the student intend to achieve and why. Dialogues in which students and teachers share their understandings of the meaning of various aspects of nursing must be emphasised in nursing education.     

Service user involvement in nurse education: a report on using online discussions with a service user to augment his digital story

Service user involvement is a key element within current pre- and post-registration nurse education in the U.K. but achieving this is challenging. Most service user involvement is through classroom visits. Digital stories, film and audio are alternatives but lack the interactivity and development of reflection that can be achieved through face-to-face contact. This report reviews the background to service user involvement in healthcare professional education then provides a reflective account of a novel initiative whereby a spinal-injured patient was involved in creating a digital story around some of his in-hospital experiences and then engaged in online discussions with post-registration nursing (degree) and practice educator (masters) students. These discussions provided a richer experience for the students enabling them to reflect more deeply on how nursing care is delivered and perceived by service users. The report concludes that digital stories can be used with repeated groups to inspire discussion and reflection. Augmenting such digital stories with online discussions with the service user whose story is told helps practitioners develop greater empathy, insight and understanding which are beneficial for improving service delivery and nursing care.     

Student feedback delivery modes: A qualitative study of student and lecturer views

BackgroundStudent feedback on assessment is fundamental for promoting learning. Written feedback is the most common way of providing feedback yet this has been criticised by students for its ineffectiveness. Given the wide range of feedback modes available, (written, audio, video, screencast, face-to-face, self and peer-feedback) a better understanding of student and lecturer preferences would facilitate recommendations for optimising feedback delivery. The aim of this study was to explore the experiences and preferences for summative feedback modes of physiotherapy students and lecturers.MethodsA sample of convenience was used to recruit participants from one undergraduate physiotherapy programme in the UK. A total of 25 students were recruited for three focus groups and five lecturers for semi-structured interviews. Focus groups and individual interviews were guided by a semi-structured interview guideline and carried out by a research assistant who was not involved in teaching on the programme and therefore unknown to participants. Data were analysed using inductive thematic analysis.ResultsThree themes were developed in relation to student and lecturer experiences of feedback to date: the importance of dialogue; the value of feed forward; and feedback disparity. From the student perspective, three themes were identified supporting their feedback preference: the importance of human connection; added information from non-verbal communication; valuing the lecturer view. From the lecturer perspective, two themes were identified around feedback preferences: challenges of spoken feedback and the importance of self-assessment.ConclusionsThis study identifies challenges around selecting optimal feedback modes due to the lack of student-lecturer consensus. Students preferred lecturer-led modes, providing the highest quality personal interaction with lecturers (face-to-face, screencast, video, audio). Lecturers most often advocated for student led feedback modes (peer or self-assessment) as a means to students valuing the feedback and developing reflective skills.     

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.     

Curriculum development through understanding the student nurse experience of suicide intervention education – A phenomenographic study

Suicide remains a global public health issue and a major governmental concern. The World Health Organisation argues for continued investment in education for front-line professionals, with a particular focus on nurses, to address the rising suicide levels. Considering this rate, it could be argued that suicide has impacted on the lives of many, including the student nurse population. Understanding the psychological impact, and influence on learning, whilst developing suicide intervention knowledge is crucial. However, little is known of the student experience in this complex and challenging area of skills development. This phenomenographic study examines the experiences of second year Bachelor of Nursing (mental health) students who participated in the Applied Suicide Intervention Skills Training (ASIST). Experiences were illuminated through two focus groups, Experiences were distilled and categorised through hierarchically relationships to construct a group experiential field to illustrate understandings of the impact this approach has on learning Students found ASIST to be emotionally challenging yet an extremely positive experience through bonding, peer learning, and class cohesion. The supportive workshop facilitation was essential allowing for full immersion into role simulation thus developing student confidence. Appropriate pedagogy and student support must be considered whilst developing suicide intervention in the pre -registration curricula.     

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.