Skills,community, and rapport: Prelicensure nursing students in the virtual learning environment

IntroductionThe coronavirus-19 (COVID-19) pandemic forced changes in program delivery across nursing education. This article describes the innovative virtual lab sessions designed and implemented for Foundations and Pediatrics courses in an Accelerated Baccalaureate Science in Nursing program. The objectives of this quality improvement project were to (1) ascertain student perceptions of learning in virtual lab environment (2) identify benefits and barriers to planning and implementing virtual learning experiences, and (3) explore student attitudes and perceptions regarding group dynamics and the sense of community provided by virtual lab sessions.MethodsA cross-sectional approach was employed with two cohorts (Cohort 1, n = 71; Cohort 2, n = 86). Students completed a survey and responded to open-ended questions regarding their virtual clinical lab experiences.ResultsThe four themes of small group dynamics, resource availability, hands-on activities, and sense of community emerged as the characteristics students liked most about virtual lab sessions with 95% of students reporting the virtual lab sessions were engaging. Overall student survey responses were favorable to the virtual labs.DiscussionThis project demonstrates that nursing educators were able to design and implement innovative teaching and learning strategies in a virtual environment to promote knowledge, skills, and attitudes while nurturing a sense of community.     

An integrative literature review of pre-registration nursing students’ attitudes and perceptions towards primary healthcare

BackgroundThere is a renewed focus on the role of primary healthcare within the health system due to an ageing population, increasing cost of acute healthcare services, and an emphasis on developing healthier communities. Associated with this focus is the need for an increase in primary healthcare workforce capacity. Despite this, primary healthcare is rarely prioritised within the pre-registration nursing curricula. By understanding the perspectives and experiences of student nurses regarding clinical placement in primary healthcare, educators and industry will be better informed to support the student nurse within this setting.AimThe aim of this integrative literature review was to identify the established knowledge regarding the attitudes, perceptions and experiences of student nurses attending clinical placement within primary healthcare.MethodsA search of electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pubmed, Proquest, Informit, Scopus, Clinical Key and Google Scholar was undertaken. The review included papers over a 10 year period; January 2007 to December 2017. Quality evaluation was undertaken using a Mixed Methods Appraisal Tool and the selected papers were then analysed thematically.FindingsAnalysis identified two interrelated themes. The first theme primary healthcare clinical experience is comprised of three sub themes; learning on placement, context of care, and support on placement. This theme discusses students understanding of primary healthcare practice and learning. The second theme attitudes towards primary healthcare also comprises three sub themes including focus on acute care, usefulness of placement, and autonomy in practice. This theme highlights the varied perspectives and attitudes pre-registration student nurses hold towards nursing within primary healthcare and their clinical placement experience.ConclusionStudent nurses are reported to have both positive and negative attitudes towards primary healthcare nursing. Despite this, clinical placement within primary healthcare is generally well received by the student nurse. To support student nurses in their learning within primary healthcare, it is essential to offer both theoretical content and clinical experiences which address preconceptions and attitudes towards the setting.     

Clinical decision-making in senior nursing students in Iran

Clinical decision-making is the basis for professional nursing practice. This can be taught and learned through appropriate teaching and clinical experiences. Unfortunately, it has been observed that many graduates are unable to demonstrate suitable clinical decision-making skills. Research and study on the process of decision-making and factors influencing it assists educators to find the appropriate educational and clinical strategies to teach nursing students. To explore the experience of nursing students and their view points regarding the factors influencing their development of clinical decision-making skills. An exploratory qualitative approach utilizing grounded theory methods was used; focus group interviews were undertaken with 32 fourth year nursing students and data were analysed using constant comparative analysis. Four main themes emerged from the data: clinical instructor incompetency, low self-efficacy, unconducive clinical learning climate and experiencing stress. The data indicated that students could not make clinical decisions independently. The findings of this study support the need to reform aspects of the curriculum in Iran in order to increase theory-practice integration and prepare a conductive clinical learning climate that enhances learning clinical decision-making with less stress.     

Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature review

Providing quality clinical experiences for nursing students is vital to the development of safe and competent professional nurses. However, clinical educators often have difficulty identifying and coping with students whose performance is unsatisfactory. The purposes of this integrative review were to examine the extent and quality of the literature focusing on unsafe nursing students in clinical settings and to describe the characteristics of nursing students considered unsafe in clinical settings. A structured literature search yielded 11 relevant articles: five theoretical articles and six research studies. Analysis of findings revealed three themes: ineffective interpersonal interactions, knowledge and skill incompetence, and unprofessional image. The themes reflected the attitudes, actions, and behaviors that influenced students' ability to develop a safe milieu for client care. The findings provide clarity for early identification of students in need of increased support and facilitate clinical educators in meeting students' learning needs to ensure patient safety.     

The value of reflective journaling in undergraduate nursing education: a literature review

OBJECTIVES: The purpose of this literature review was to ascertain the evidence for the use of reflective journaling as a tool to promote the pedagogical strategy of reflection for the purpose of learning from practice for practice in undergraduate nursing education. DESIGN: Concept-centric. DATA SOURCES: The literature review involved structured searches of all OVID gateway databases, EBSCO host databases, and Blackwell Synergy. Qualitative and Quantitative Studies from 1992 to 2006 were included if they focused on reflective journaling in undergraduate clinical education. REVIEW METHODS: Due to the vast plethora of literature on reflection, keywords were utilized to focus the search. Approximately 150 abstracts were reviewed for primary sources of research. A total of nine studies met the inclusion criteria. The review subsequently divided the literature into four content themes allowing for appraisal and analysis of the findings, followed by summary and key recommendations for nursing education and research. RESULTS: There was evidence that educators struggle to incorporate reflective processes into education; however, the research provided rationale and support for engaging undergraduate students in the reflective process. Researchers found reasonable levels of reflection in undergraduate students' journaling and educators reported students' learning as a result of reflective journaling. Further to this, there was evidence that writing reflectively improved over time; a learned skill also dependent on a good facilitator and trust. Unfortunately, there was a paucity of research that explored the undergraduate nurses' experiences with the process of having to create written communication, with a critical reflective focus on practice. CONCLUSION: Nursing educators are correct in pursuing the teaching and learning of the reflective process in undergraduate nursing education. Nurse educators need to utilize various tools and strategies for facilitating the growth of undergraduate students into reflective practitioners. Indeed there was only limited evidence to support reflective journaling as an appropriate tool to promote reflection for the purpose of learning from practice for practice in undergraduate nursing education. Research that provides insight into the undergraduate student experience and perceptions of reflective journaling is needed to facilitate the structuring and use of reflective journaling as a tool in undergraduate nursing education.     

Integration tutorials and seminars: examining the integration of academic and fieldwork learning by student occupational therapists

This paper, the second of two companion papers, describes a collaborative research study conducted by academic and fieldwork educators of an undergraduate educational programme in occupational therapy. The study examined the perception of student occupational therapists' ability to integrate and apply academic and theoretical knowledge in fieldwork education sites following the introduction of Integration Tutorials and Seminars to the curriculum. The literature review supports the need to develop educational strategies to improve this integration process. The qualitative research design consisted of guided interviews with preceptors and students during two consecutive fieldwork education experiences. Inductive data analysis revealed three themes that contribute to understanding students' ability to integrate academic learning during their fieldwork education: the fieldwork learning environment; preceptor influence on student learning; and the student learning process over time. The discussion section raises implications for academic and fieldwork education approaches.     

Research Informed Teaching Experience in Diagnostic Radiography: The Perspectives of Academic Tutors and Clinical Placement Educators

IntroductionThis small scale, qualitative research study investigated the perceptions by both academic tutors and clinical placement educators of integrating the research-informed teaching experience (RiTe) within an undergraduate radiography curriculum to support the learning and practice of image quality and dose optimization.MethodA purposeful sampling approach was used to recruit participants and two asynchronous online focus groups (OFG) were used for data collection. An inductive thematic approach was taken to analyse both sets of OFG data.Results and discussionFive academic tutors and four clinical placement educators participated in the research. Three overarching themes common to both sets of OFG data were identified. Findings confirmed that both OFGs felt that the RiTe supported student learning of image quality and dose optimization as well as the development of research skills. However, the clinical placement educators did identify that students may find it difficult to transfer and apply this knowledge into practice (theory-practice gap).ConclusionResults from both OFGs support RiTe with regard to the teaching and practice of image quality and dose optimization. However, greater involvement by clinical placement educators may help to overcome issues with the translation of RiTe by students into the clinical environment (theory-practice gap) and support its continued development within the curriculum. It was also identified that RiTe could be developed for qualified staff for continued professional development.     

Understanding Clerkship Student Roles in the Context of 21st-Century Healthcare Systems and Curricular Reform

ABSTRACT

Phenomenon: Preclerkship medical education has undergone extensive reform, and the clerkship years are growing targets for curricular innovation. As institutions implement new preclerkship curricula to better prepare medical students to practice medicine in the context of modern healthcare systems, the perspective of clerkship leaders regarding clerkship student roles and potential for change will facilitate redefining these roles so that preclerkship educational innovations can continue into clerkships. Approach: In this qualitative exploratory study, authors conducted semistructured interviews with clerkship and site directors for eight core clerkships from April to May 2016. Questions addressed how clerkship leaders perceive current student roles and the potential for change. Through iterative consensus building, authors identified themes describing current ideal clerkship student roles applicable to future roles. Findings: Twenty-three of 24 (96%) directors participated. Findings fell into four themes: factors influencing the clerkship role, clerkship student role archetypes, workplace authenticity and value, and potential for change. Student, supervisor, and context factors determine the clerkship student role. Three role archetypes emerged: the apprentice (an assistant completing concrete patient care tasks), the academic (a researcher bringing literature back to the team), and the communicator (an interdisciplinary and patient liaison). Each archetype was considered authentic and valuable. Positive attitudes toward preclerkship curricular changes were associated with openness to evolution of the clerkship students' role. These emerging roles mapped to the archetypes. Insights: Clerkship leaders perceive that student, supervisor, and context factors result in varying emphasis on role archetypes, which in turn lead to different types of learning. Medical educators can use the archetypes to articulate how expanded student roles align learning with clinical needs, particularly as they relate to health systems science and inquiry.     

Students' experiences of blended learning across a range of postgraduate programmes

The article describes the students' experiences of taking a blended learning postgraduate programme in a school of nursing and midwifery. The indications to date are that blended learning as a pedagogical tool has the potential to contribute and improve nursing and midwifery practice and enhance student learning. Little is reported about the students' experiences to date. Focus groups were conducted with students in the first year of introducing blended learning. The two main themes that were identified from the data were (1) the benefits of blended learning and (2) the challenges to blended learning. The blended learning experience was received positively by the students. A significant finding that was not reported in previous research was that the online component meant little time away from study for the students suggesting that it was more invasive on their everyday life. It is envisaged that the outcomes of the study will assist educators who are considering delivering programmes through blended learning. It should provide guidance for further developments and improvements in using Virtual Learning Environment (VLE) and blended learning in nurse education.     

Student perceptions of incivility in nursing education: implications for educators

This study explored the phenomenon of incivility in nursing education from the perspective of undergraduate nursing students and compared it to perspectives of educators as found in the literature. The sample consisted of 24 undergraduate junior and senior nursing students from four universities in the mid-Atlantic states. Data from four focus groups were transcribed and content analyzed to reveal themes and subthemes. Students perceived that incivility in nursing education exists. They shared a common view with findings in the literature regarding incivility from the faculty perspective. Notably, an emerging student view was that faculty may contribute to the escalating incivility in nursing education, and that student incivility is justified when faculty are seen as uncivil. The implications for educators, consistent with the literature, are that students want professors to maintain classroom decorum and set the example for civility.     

Mental Health Education and Virtual Learning Environments (VLEs) in Pre-registration Nursing Degrees: Follow the Leaders?

Virtual learning environments (VLEs) are now commonly used, worldwide, as teaching and learning platforms for pre-registration nursing education. However, there is only limited evidence in the research literature to suggest that VLEs are employed to support the education of student nurses about mental health and illness. This article describes the work of mental health nurse educators who have taken the lead by providing case-based simulations on VLEs, thereby enabling students to acquire knowledge and develop the clinical skills required for practice in mental health settings. Benefits of VLEs include their flexibility and accessibility, and also the opportunity they provide for students to engage with Web 2.0 technologies. Leadership in education must include the utilization of the most current pedagogical tools and strategies, as well as staying abreast of contemporary evidence-based practices in clinical settings, to support the knowledge acquisition and practice-based learning of the registered nurses (RNs) of the future.