Creating walking tracks to success: A narrative analysis of Australian Aboriginal and Torres Strait Islander nursing students’ stories of success

Australian Aboriginal and Torres Strait Islander people have higher rates of morbidity and mortality than other Australians. One proposed strategy to improve this situation is to increase the participation of Aboriginal and Torres Strait Islander people, including Aboriginal and Torres Strait Islander nurses, in the health workforce. Although the numbers of Aboriginal and Torres Strait Islander students undertaking tertiary nursing courses have increased, completion rates have not kept pace. The study aimed to describe Aboriginal and Torres Strait Islander nursing students’ experiences of enablers for successful course completion and to develop a narrative of student experience. A qualitative study using a strengths-based approach with a narrative analysis of semi-structured interview data was conducted across four schools of Nursing in Queensland, Australia. Eight final-year Aboriginal and Torres Strait Islander nursing students volunteered to participate in the study. A collective story with the overarching plotline Creating walking tracks to success was developed. Six threads of experience emerged: Making a difference, Valuing Indigeneity, Healing strength of connections, Resisting racism, Embracing support, and persevering towards completion. Key success factors included resilient attributes, building supportive connections and having positive expectations of the future, along with sustained institutional support from Aboriginal and Torres Strait Islander nurse academics and clinicians. Development of tailored resilience-building training for Aboriginal and Torres Strait Islander nursing students and appointment of Aboriginal and Torres Strait Islander academics in Schools of Nursing that include such students may facilitate future successful completions in other programs.     

The importance of clinical experience in aboriginal communities

The importance of preparing nurses adequately to meet the health needs of Aboriginal people cannot be understated. Much of the reason for negative attitudes among nurses is a lack of knowledge and understanding of cultural differences. Clinical practice in an Aboriginal community can assist in the development of cross-cultural skills among student nurses. In recent times it has been accepted that nursing curricula in Australia must reflect an understanding and awareness of cultural perspectives, diversity and sensitivity. Exposing students to Aboriginal health workers has been found to result in a positive change in attitude among students (Hayes et al. 1994). Providing clinical experiences in Aboriginal communities can increase students' awareness of Aboriginal health status, the socio-cultural and historical influences involved, and the nurse's role in relation to Aboriginal health. Nurses are a major provider of health care within Aboriginal communities throughout Australia. Culturally diverse clinical placements challenge students to become aware of their own health beliefs, attitudes, and values, which can facilitate bridging cross-cultural gaps with clients and also facilitate the delivery of quality nursing care.     

Nursing students' experiences with incivility in clinical education

This qualitative study aimed to explore the experiences of nursing students as targets of incivility in clinical settings, to describe their perceptions of specific uncivil and favorable behaviors by nurses, and to examine how nursing students think schools of nursing should address incivility in clinical settings. Four focus groups were conducted comprising 21 prelicensure nursing students. Data were collected with semi-structured interviews. Uncivil behaviors fell into three themes: exclusionary, hostile or rude, and dismissive. Positive experiences occurred when students felt included by the staff nurses in patient care. Schools of nursing should prepare students through discussion. Our research suggests that incivility occurs in clinical education. Further research on a larger scale is needed to provide qualitative and generalizable findings. All health care team members, including students, should be educated about the organization's code of conduct.     

Of Lillian Wald, Community Health Nursing Education, and Health Care Reform

Abstract A pilot project is described that was initiated to provide a comprehensive clinical experience for community health nursing (CHN) students despite local cutbacks in field nursing services. The project, entitled the Nursing Elementary Education Outreach Project (NEEOP), is used as a basis for discussion on the CHN role in community-focused health care reform. One-third of the CHN students in one school of nursing during one academic year ( n = 16) participated in the NEEOP. One salaried CHN faculty member assumed primary responsibility, and equipment funding was granted by a local corporation. Collaboration was established with the county's proactive school nurses' association. CHN students developed and conducted health education presentations in elementary schools, worked with school nurses, and participated in other community health activities. Three levels of evaluation were utilized: elementary students to nursing students, nursing students to nursing faculty, and school nurses to nursing faculty. The NEEOP was a success by all evaluation criteria, and plans are currently in progress to expand its focus. Innovative clinical placements such as the one described can promote student understanding of CHN practice with its broad-based emphasis on the promotion of healthier communities.     

Nurses' experiences of the encounter with elderly patients in acute confusional state in orthopaedic care

The aim of this study was to illuminate nurses' experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n=26) or licensed practical nurses (n=22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses' actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses' experiences showed that the nurses found it difficult to reach the patients' reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients' situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients' irritation and anger. The results were more successful when the strategies were derived from the nurses' interpretation of the patients' situation and the nurses paid attention to the patients and confirmed them.     

Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review

kokko r. (2011) Journal of Nursing Management 19, 673–682
Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review Aim This article describes the development of cultural competence among nursing students. The focus is on illuminating the learning experiences of nursing students during their exchange. Background As the world gets smaller, the demand for culturally competent nurses increases. Future nurses need to be open-minded towards international cooperation and willing to develop the quality of care from a cultural point of view. Nursing education in many countries provides an option for students to learn nursing in different cultures while taking part of their studies abroad. Methods A systematic literature search was conducted. Inductive content analysis was applied to the data consisting of empirical studies (n = 7) describing nursing students’ studies abroad. Results The process of developing cultural competence among nursing students on exchange was found to consist of three main themes, namely: (1) an increased cultural knowledge base, (2) personal growth and (3) the impact of exchange experiences on the nursing student’s own practice. Conclusions Studies abroad are a beneficial strategy for the development of future nurses’ cultural competence. Implications for nursing management Nursing is facing a crucial challenge to recruit culturally competent nurses, because an increasing number of patients are from different cultures. Nurses with experiences of studying abroad can offer employers a resource through their preparedness for culturally competent nursing.     

Perceptions of nursing: confirmation, change and the student experience

Research has identified a number of negative societal perceptions of nursing related to gendered stereotyping, subordination to doctors, low academic standards, limited career opportunities and poor pay and conditions, and importantly how these perceptions may affect levels of recruitment into nursing. Focusing specifically on nurses, research has also considered the extent to which these societal perceptions are realities in their workplaces, and the direct experiences that contribute to attrition from both nursing courses and jobs. However, to date, few research has actually bridged the above approaches and considered the perceptions that nursing students hold as they first enter their education and how these change, or are confirmed, as a result of their experiences. In this context, the current study uses a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) methodology to investigate the experiences of students based at two British Universities. The findings suggest that many students were surprised, yet not overwhelmed, by the high academic standards required of them and came to recognize and value the tremendous knowledge, skills set and responsibilities of nurses as they acquired them. However, their experiences reinforced both society's and their own image of an underpaid, overworked profession that lacks respect and has low morale. The findings support media initiatives that emphasize nurses' skills in order to influence public opinion. They also support a range of subtle changes in nurse education at the institutional level to make student life easier. Nevertheless, it is acknowledged that these may have a limited impact unless pay and conditions are adequately addressed at the national level.     

Nursing students' career preferences: a Norwegian study

AIM: This paper is a report of a study to identify Norwegian undergraduate nursing students' career preferences at the beginning and end of their nursing education programme, together with their reasons for these preferences. BACKGROUND: International studies have shown that recruitment and retention of nurses in areas such as aged care and psychiatric nursing is difficult. It is important to know why some working areas are popular whilst others are not, so that nursing schools produce graduates who meet the needs of the community. METHODS: All students starting their nursing education programme in 2001/2002 in five Norwegian university colleges were invited to complete questionnaires at the beginning and end of their nursing education programme. In phase 1, 620 of 782 commencing students completed questionnaires (response rate 79.2%). In their third year, phase 2, 473 questionnaires were distributed (response rate 82.6%, n = 386). The questionnaire included closed questions about career preferences and open-ended questions seeking the reasons for the preferences. RESULTS: The study revealed changes in preferences between the beginning and the end of the nursing education programme. In phase 1, midwifery and paediatric nursing were ranked highest and in phase 2 working in medical/surgical ward, midwifery and psychiatric nursing were preferred. Working in aged care institutions remained unpopular throughout. Clinical experiences and professional challenges were often given as reasons for preferences. CONCLUSION: Nursing educators, clinical nurses and policymakers must reconsider their priorities and improve working conditions for nurses in aged care in order to meet society's need for nurses.     

Registered nurses' expectations and experiences of first year students' clinical skills and knowledge

BACKGROUND: Clinical education is a fundamental component of nurse education. In theory, this aspect involves integrated input from registered nurses, clinical educators and university lecturers. Registered nurses are important contributors to this process and play a major role in influencing and shaping undergraduate nursing students' early clinical experiences. Despite this important function, their voice has been somewhat neglected. Little is known about registered nurses' expectations and experiences of first year aduate nursing students undertaking their first clinical placement. AIM: The aim of this study was to explore registered nurses' expectations and experiences of first year undergraduate students' levels of knowledge and clinical skills. METHOD: Three consecutive focus groups were conducted with a purposive sample of 16 registered nurses. Interviews were audiotaped and transcribed and thematic analysis applied to the data to identfy themes imbedded in the data sets. FINDINGS: Three main themes emerged: (1) Clinical nursing skills (2) Knowledge requirements and (3) Experiences of reality shock. The findings highlight that registered nurses' expectations of first year students' clinical skills and knowledge were not consistently met. Registered nurses placed significant emphasis upon a range of basic skills, but acknowledged that some aspects of nursing knowledge can only be learned through experience. Furthermore, they demonstrated a considerable degree of empathy surrounding the reality shock that students might experience during early clinical placement. CONCLUSION: Findings from this study suggest that registered nurses and academics differ in their perceptions surrounding the level of clinical skills first year students should have during their first clinical placement. There appears to be a two way theory practice gap between registered nurses in clinical practice and academics in tertiary institutions. Improved communication between registered nurses and providers of nurse education may assist in addressing some of the issues raised by this study and reduce the theory practice gap, which remains 'alive and well'.     

运用现象学方法对护士和护生健康促进和健康教育实践的研究

目的运用Husserlian现象学方法,探讨护士和护生对健康促进和健康教育概念的理解和实践体验。方法分别对8位实习护生和8位注册护士进行半结构性访谈,访谈资料用MP3记录,整理后采用Giorgi的分析法对资料进行分析。结果研究发现除几点明显不同外,此研究和欧美等国家的类似研究结果大致相同,即护士从事着相似的健康促进实践活动。研究还给出了参与者对健康促进实践的共同而明确的看法。结论虽然中国的医疗卫生体制和文化背景与国际上其他国家不同,但护士对健康促进和健康教育的经验体会却与欧美等国家相似。这表明地域环境对护士理解和运用全球性的健康相关概念没有影响。     

Tjirtamai--'to care for': a nursing education model designed to increase the number of Aboriginal nurses in a rural and remote Queensland community

In 2009, a nursing education model was locally designed and delivered to support the interest of a group of Aboriginal community members living in a rural and remote town in Queensland, specifically to prepare for entry into further nursing education. Named 'Tjirtamai' by the traditional owners of the area, the program was offered in recognition of the challenges faced by Aboriginal people when they enter nursing education courses and as a way to increase the local number of Aboriginal nurses. This program, while funded by the Government, had unprecedented support and involvement from both the local Aboriginal and wider community. The model offered multiple exit points, assistance with financial and other known challenges for Aboriginal and Torres Strait Islander students, and included contextualised literacy and numeracy. Of the 38 Aboriginal students who enrolled in the course, 26 students completed. Of those students, 18 have since enrolled in a bachelor degree in nursing while another 4 enrolled in a diploma of nursing. This paper provides an overview of the course and its outcomes.     

Older nurses and employment decisions

AIM: To investigate the options, decisions and outcomes for nurses aged over 50 in terms of remaining in, retiring from, or returning to, work in the NHS. METHOD: Interviews were conducted with 18 employers, advisers and policy makers linked to the nursing labour market. They were conducted by telephone (n = 14) or face to face (n = 4), recorded (with consent), transcribed and analysed thematically. Interviews were also held with 84 older nurses who were remaining in nursing, had retired or had returned to nursing. One focus group was held with older nurses who 'remained' in Scotland (n = 11) and the rest of the data were collected in face-to-face and telephone interviews (n = 73). Again, interviews were recorded (with consent), transcribed and analysed thematically. RESULTS: There is a gap between the rhetoric of policy and the implementation of practice in the employment of older nurses. CONCLUSION: Older nurses could continue to make a valuable contribution to the NHS, especially in light of the shortage of nurses, but their value is not always recognised. If older nurses are to continue making a contribution then they need good advice about employment, retirement and pension options.     

Faculty practice and roles of staff nurses and clinical faculty in nursing student learning.

The perceptions of staff nurses and clinical nurse faculty on the roles they play in nursing student learning were examined. The study also sought to explore how faculty practice status affected these perceived roles. Nursing schools with generic baccalaureate nursing programs in the middle Atlantic region composed the study population. A convenience sample of two schools that expected their undergraduate clinical faculty to engage in faculty practice and two schools that did not expect faculty practice participated in the study. Clinical faculty members (15) and nursing education administrators (4) from each school participated, as well as staff nurses (22) and nursing service administrators (4) from each school's related hospital. Focus groups and individual interviews were conducted. Manifest and latent content analyses were used to examine the issues. Staff nurses who worked with practicing faculty reported fewer instances of role overload, conflict, and ambiguity than when they worked with nonpracticing faculty. Lack of clear communication and delineation of expectations among administrators, staff, faculty, and students were cited as major factors in perceived role problems. Administrators, faculty, and staff nurses viewed high student/faculty ratios as a causative factor in the faculty's inability to meet all teaching objectives with students.     

Diagnostic reasoning strategies of nurses and nursing students

This study described and compared the cognitive strategies of diagnostic reasoning used by junior nursing students (n = 15), senior nursing students (n = 13), and practicing nurses (n = 15). Verbal responses to three videotaped vignettes provided the data. Findings suggested that diagnostic reasoning processes of both nurses and nursing students can be described by a general model developed from studies of physicians. Subjects activated diagnostic hypotheses early in the encounter and used systematic information gathering to rule in and rule out hypotheses. With increased levels of knowledge and experience, there was a trend toward more systematic data acquisition and greater accuracy in diagnosis. The number of hypotheses activated, the earliness with which they were activated, and their diagnostic accuracy were task-specific components of the process, but selection of data-acquisition strategies appeared to be more generalizable across cases.     

Socio-demographic characteristics and opinions of basic and post-basic nursing students in Nigeria

In attempting to describe the socio-demographic characteristics and opinions of Nigerian nurses, a random selection of 293 students was made in three schools offering basic and post-basic programmes. Most of the students were from the lower socio-economic background; they entered nursing to ‘help’ people, and were enthusiastic about their training and exposure to new experiences. For most basic students, first job expectation was bedside nursing after graduation; it was administrative and/or teaching duties for those in the post-basic programme. The students showed similarities with their counterparts elsewhere.     

Evaluation of a multischool collaborative COVID-19 vaccination project

To describe experiences of student nurses and faculty who participated in COVID-19 vaccine delivery through a multischool collaboration. Cross-sectional survey. Student nurses and faculty members from five university schools and colleges of nursing who participated in one or more COVID-19 vaccination or education events in 2021. Surveys were designed for students and faculty to document process and outcome experiences associated with project participation. Surveys were administered through an online survey platform. Overall, 648 students and 68 faculty members participated in the project. The evaluation survey was completed by 115 students (18%) and 58 faculty members (85%). Students valued increasing their clinical skills and reported the experience influenced their perspectives on nursing, fueling their passion and informing future career choices. Students reported that it was personally important to contribute to the vaccination effort. Few students reported challenges in participating in the project. Faculty reported positive experiences including gaining knowledge about public health and their communities, fueling their passion for nursing education, feeling a deeper connection with students, and experiencing personal satisfaction from contributing to the pandemic response. This project resulted in meaningful student learning opportunities, enhanced capacity for the public health emergency response, and strengthened partnerships among nursing programs and between academia and public health community partners.     

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.     

The impressions of a sample of British and overseas student nurses of some social aspects of their training.

As part of a larger study, female student nurses from overseas and Britain in four training schools for the general nursing register were interviewed to obtain their perceptions of their reception at the hospital, their later welfare, and some of their general reactions to their training. Differences between the British and overseas student nurses were mainly related to experience before training and their reception at the hospital. Many similarities between the two groups were also found with respect to their later experiences and attitudes toward nursing. A proportion of the overseas students had experienced expressions of racial prejudice from patients.