Fourth year nursing students' perceptions of their educational preparation in medication management: An interpretative phenomenological study

BackgroundMedication safety is an integral aspect of patient safety. Nurses, as advocates of patient safety, actively consider medication safety in the course of their daily work. Hence, it is important to consider the educational preparation of nursing students in medication management, as future caregivers. There are inherent links between nurses' undergraduate educational preparation in medication management and patient safety.ObjectiveThis research study identifies fourth-year nursing students' perceptions of their educational preparation in medication management.DesignAn interpretative phenomenological methodological approach underpinned this research study.SettingThis study was conducted at a University in the West of Ireland.ParticipantsParticipants were final year students of three undergraduate nursing programmes, Bachelor of Science in Nursing (General), Bachelor of Science in Nursing (Intellectual Disability) and Bachelor of Science in Nursing (Mental Health).MethodsFourteen semi-structured, face-to-face interviews were conducted with students on a one-to-one basis. Data were analysed using thematic content analysis.ResultsThe voices and interpretations of the participants in this study were fundamental to understanding nursing students' perceptions of their preparation in medication management and provided the foundation for this research. These perceptions were captured in the format of four themes: developing an understanding, embedding knowledge in practice, engaging in practice and accepting professional responsibility.ConclusionsFindings point to the important role of the university and the clinical placement settings in nursing students' medication management education and the need for further collaboration and development across both settings. Teaching and learning strategies which promote the integration of theory and practice throughout the four years of the undergraduate degree programme should be encouraged, such as technology enhanced learning and simulation.     

Medical and pharmacy students shadowing advanced practice nurses to develop interprofessional competencies

AimThis article describes a job-shadowing project that partnered second-year medical and third-year pharmacy students with an advanced practice nurse (APN) for a four-hour job- shadowing experience.BackgroundIn order to address the Interprofessional Education Collaborative (IPEC) Expert Panel core competencies of interprofessional communication, teamwork, and roles/responsibilities, this project implemented a job-shadowing experience to increase students' knowledge of APN roles and interprofessional collaborative team practices.MethodsForty volunteer medical and pharmacy students were paired together and completed the job-shadowing activity with an APN. Assessment of knowledge was measured by pre- and post-project surveys.ResultsPre- and post-job-shadowing differences demonstrated statistical significance in the interprofessional domains of role awareness, collaboration and communication. These results suggest that an APN job-shadowing experience is effective in developing medical and pharmacy students' competencies in interprofessional collaborative practice.ConclusionSpecific recommendations include creating enhanced job-shadowing experiences within the curriculums of medicine, pharmacy, and nursing students, and assessing for evidence of enhanced IPEC competencies as a result of these learning experiences.     

Undergraduate registered nursing students working as assistants in nursing within the acute care environment: Program development and discussion

BackgroundMost pre-registration nursing students require employment during their studies which may entail undertaking another qualification.This paper describes how one university developed a program whereby undergraduate nursing students complete the national vocational education – HLT33115 Assistant in Nursing qualification through recognition of prior learning, a self-directed education package and completion of an objective structured clinical examination.ObjectiveTo discuss the development of an ‘Assistant in Nursing’ in the acute care environment program for pre-registration undergraduate nursing degree students using the national vocational education framework.DesignThis program maps the national ‘Assistant in Nursing- Acute Care’ vocational qualification to the pre-registration registered nurse degree. Upon successful completion of this program students can work as Assistants in Nursing within the acute care environment.ConclusionsThis program enables student nurses to work as Assistants in Nursing within the acute care environment. This provides employment in a health facility and opportunities for students to immerse themselves in the clinical environment whilst continuing their studies. This may assist students to gain a deeper insight into their future role as a nurse, build networks within the nursing community and assimilate into the clinical environment. This program design may prove useful as a template for other nursing faculties wishing to implement a similar program.     

Lived experience of medical veterans transitioning from military service to civilian nursing education

BackgroundMany veterans take advantage of the educational benefits afforded them after service. As veterans, students in higher education are a special population with subsequent needs.PurposeThe purpose of this study was to explore the lived experience of medic student veterans attending a full-time Bachelor of Science in Nursing (BSN) program.MethodThis study used the hermeneutic phenomenology research approach to explore the lived experiences of student veterans with military medic experience enrolled in a Bachelor of Science in Nursing (BSN) program.ResultsWhile our study revealed diverse student experiences among these veterans, common themes included staying true to military training, normal life, and fitting in as a university student.ConclusionsFindings in this study substantiate medic student veterans attending nursing school represent a unique cohort which can benefit from customized services from the university.     

Graduating nurses' self-efficacy in palliative care practice: An exploratory study

BackgroundEducational institutions and the health care industry agree that graduates from professional programs need to be “work ready” and capable of delivering competent and confident nursing care. One measure of program success is the student's self-efficacy in meeting expected graduate capabilities. In this study student's self-efficacy is related to palliative care graduate capabilities.AimTo explore graduating Bachelor of Nursing Science (BNSc) students' self-efficacy in caring for palliative care patients.DesignA qualitative design using semi-structured face-to-face interviews.SettingA regional Australian university.ParticipantsA purposive sample of 10 students in their final semester of study in a Bachelor of Nursing Science degree program.MethodSemi-structured face-to-face interviews were conducted. Interview questions were informed by published palliative care graduate capabilities. Interview data were transcribed verbatim and coded by capability. The coded data were then analysed to determine evidence of self-efficacy in caring for palliative care patients.ResultsAll participants had experiences in caring for palliative care patients. However, the responses did not consistently reflect high degrees of self-efficacy in four documented palliative care graduate capabilities required to care for persons with a life-limiting illness.ConclusionsThe findings support others that have identified gaps between curriculum and health care industry requirements in terms of students' beliefs about their empowerment to deliver nursing care as graduates. Education interventions and approaches to program evaluation require further development to better support students' growth of self-efficacy in undertaking their graduate roles.     

Palliative care: a suitable setting for undergraduate interprofessional education

Effective delivery of high-quality palliative care requires effective interprofessional teamworking by skilled health and social care professionals. Palliative care is therefore highly suitable for sowing the seeds of interprofessional teamworking in early professional education. This paper describes experiences of running undergraduate interprofessional workshops in palliative care for medical, nursing, social work, physiotherapy and occupational therapy students. These workshops are unusual in three respects: first, the involvement of family carers mean that these learning experiences are rooted in clinical reality; secondly, there is no attempt to 'tidy up' the story for the students; thirdly, unlike many undergraduate interprofessional programmes, these workshops have been sustained over several years. Evaluation of these workshops demonstrate that students value and enjoy the opportunity to work together; they find the experience moving, informative and interesting. Feedback from carers showed that they appreciated the opportunity to present their real-life experiences to students. Our evidence suggests that palliative care is a suitable subject for undergraduate interprofessional education.     

The effect of an interprofessional simulation-based education program on perceptions and stereotypes of nursing and medical students: A quasi-experimental study

BackgroundInterprofessional education is intended to train practitioners to collaboratively address challenges in healthcare delivery, and interprofessional simulation-based education (IPSE) provides realistic, contextual learning experiences in which roles, responsibilities, and professional identity can be learned, developed, and assessed. Reducing negative stereotypes within interprofessional relationships is a prime target for IPSE.ObjectivesWe sought to understand whether perceptions of interprofessional education and provider stereotypes change among nursing and medical students after participating in IPSE. We also sought to determine whether changes differed based on the student's discipline.DesignThis was a quasi-experimental pretest-posttest study.SettingThe study took place at a large mid-Atlantic public university with a comprehensive health science campus.Participants147 senior Bachelors of Science in Nursing students and 163 fourth-year medical students participated.MethodsStudents were grouped into interprofessional teams for a two-week period and participated in three two-hour simulations focused on collaboration around acutely ill patients. At the beginning of the first session, they completed a pretest survey with demographic items and measures of their perceptions of interprofessional clinical education, stereotypes about doctors, and stereotypes about nurses. They completed a posttest with the same measures after the third session.Results251 students completed both the pretest and posttest surveys. On all three measures, students showed an overall increase in scores after the IPSE experience. In comparing the change by student discipline, medical students showed little change from pretest to posttest on stereotypes of doctors, while nursing students had a significant increase in positive perceptions about doctors. No differences were noted between disciplines on changes in stereotypes of nurses.ConclusionsThis study demonstrated that a short series of IPSE experiences resulted in improved perceptions of interprofessional practice and changes in stereotypical views of each profession even when the experience was not directly designed to address these issues. Differences observed between nursing and medical students should be explored further.     

Interprofessional socialization as a way to introduce collaborative competencies to first-year health science students

Abstract

Interprofessional education (IPE) is the cornerstone of preparing future health care providers but remains to be a challenge for many health science programs. We aimed to develop and evaluate an interprofessional conference for first-year health science students with goals to provide students with interprofessional socialization opportunity and introduce IPE principles. A half-day conference was based upon core competencies for health professionals and involved 277 first-year health sciences, nursing, pharmacy, physical therapy, and speech language pathology and audiology students. Alcohol and substance misuse was chosen as a topic for its relevance to college students and health professionals. Results from program evaluation revealed that the conference was successful in exposing students to core interprofessional competencies and provided useful information about alcohol and substance misuse. This study advocates for early inclusion of IPE in the health professions curricula in the form of interprofessional socialization.     

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.     

Interprofessional education: Lessons learned from conducting an electronic health record assignment

Abstract

Ineffective collaboration and communication contribute to fragmented patient care and potentially increase adverse events, clinical errors, and poor patient outcomes. Improving collaboration and communication is essential; however, interprofessional education (IPE) supporting this cause is not a common practice. Most often healthcare profession students are educated in profession-centered silos limiting opportunities to develop effective communication and collaboration practices. Students from nursing, health informatics, and radiologic technology collaboratively populated an academic electronic health record (AEHR) using fictitious case study data. The assignment was designed to address the Quality and Safety Education for Nurses and IPE Collaborative competencies. The objective was to evaluate students’ informatics competency, teamwork behaviors, and communication skills while exploring the different roles and responsibilities for collaborative practice after participating in an interprofessional case study assignment. Students gained experience using the AEHR for data entry, analysis, and application increasing their informatics competency. The assignment required students to communicate and actively collaborate as an interprofessional team to achieve the assignment objectives. Clinical errors often occur during care transitions, so simulating this process in the assignment was essential. Nursing and radiologic technology students had to analyze patient data and develop a hand-off communication template supporting patient safety and optimizing outcomes. The assignment required students to work as an interprofessional team and demonstrate how communication and collaboration is an essential component to quality and safe patient care.     

Interprofessional education using simulation of an overnight inpatient ward shift

Abstract

In healthcare it is rare for professionals to practice together before they practice together. Nightmare Night Care is an annual interprofessional voluntary event for health sciences students in nursing, medicine and pharmacy to come together for a simulated hospital overnight ward shift. The purpose of this study was to investigate the interprofessional knowledge, skills and attitudes the students learn from this experience. Students responded to surveys before (n?=?45) and after the event (n?=?11) regarding their understanding of the goals of interprofessional education (IPE), roles and responsibilities of other professions, and what they learned from this event. Responses demonstrated that students are eager to learn in interprofessional settings and that IPE events may aid in building understanding and communication between professions. IPE events are an opportunity to allow students to learn about each other; however, they must occur frequently, and must include an orientation on role clarification if they are to have an effect on changing preconceived stereotypes of the other professions.     

Implantación del nuevo modelo de formación práctico-clínica en Andalucía: una evaluación cualitativa en las titulaciones de Enfermería y Fisioterapia

ObjectiveThe design of new Bachelor degree courses, together with the agreement reached between the Regional Government of Andalusia and Andalusian universities shape the new clinical training model for Health Science students. The aim of this project is to present a qualitative evaluation of the implementation of the new model in Nursing and Physiotherapy degrees at the University of Almeria and the Andalusian Public Health System.MethodAn exploratory qualitative study using document content analysis techniques, by analyzing 12 reports from teachers and those responsible for Practicum in Nursing and Physiotherapy degrees at the University of Almeria. The reports included opinions and proposals from university and clinical placement teachers, healthcare professionals or clinical placement tutors, students, and those in positions of responsibility as regards clinical placements.ResultsThree categories emerged in the data analysis: Health system organization, with sub-categories of disparity between shifts, difficulties with supervisor coordination, feelings of a lack of control, disparities in evaluation criteria and geographic distribution; academic organization, with sub-categories of short rotations, a lack of information received by the clinical placement tutor, and carrying out placements without studying the theory; and management of the work agreement, with sub-categories of being discouraged by what is received in return, extra work for those in charge, and delays in evaluations.ConclusionThe study suggests a need to support and guide clinical tutors, to increase coordination between the university and health services, to organize the students’ theoretical and practical training and to provide the management of the model with flexibility and transparency.     

Indigenous women's experiences of diabetes in pregnancy: A thematic synthesis

BackgroundIndigenous women's voices are largely silent in the literature because of a lack of opportunity to share their experiences and understandings of diabetes in pregnancy (DiP).AimTo synthesise qualitative literature describing the experiences of Indigenous women with DiP.MethodsA librarian assisted, systematic search was conducted across CINAHL, EMBASE, Global Health, Medline, ProQuest, PubMed, Scopus and the Web of Science databases. International, peer reviewed studies published in English, between the years 1999 and 2019 that explored Indigenous women's experiences of DiP were sought. Thirteen papers were coded for recurring patterns and conceptual overlaps and synthesised into themes.FindingsAnalysis revealed four themes: ‘Poverty and Vulnerability: Colonisation's Legacy’; ‘Contradictions and Confusion: Understandings of DiP’; ‘Shame and Blame: Experiences with Health Professionals’; and, ‘Community and Care: Cultural Constructions of Health’.DiscussionThis review has revealed similar concerns and experiences of DiP among Indigenous women across communities in Canada, Alaska, the United States and Aotearoa New Zealand. To work with and effectively engage with Indigenous women, requires a shift from focusing on individual behaviours, to recognising and including cultural strengths, and addressing structural inequity in relation to healthcare.ConclusionThis review has resulted in a call to action for researchers to work collaboratively with Indigenous communities to co-design culturally safe, appropriate, and relevant policies, programs, models of care and educational materials with Indigenous women.     

Enhancing student understanding of nursing inherent requirements using assessment for learning

ProblemWhere misperceptions and a lack of understanding of the realities of the Nursing profession exist, this can result in students entering into Nursing degrees without understanding the academic knowledge, behavioural and physical attributes and other inherent requirements necessary to undertake and succeed in their studies and subsequent career.QuestionCan an ‘Assessment for Learning’ approach result in enhanced student understanding of inherent requirements and their relationship to registered nurse attributes?MethodsThis interpretive study analysed students’ written reflections on two Bachelor of Nursing inherent requirement statements using latent content analysis. Purposive sampling of all 165 students enrolled in an introductory professional nursing unit was undertaken with 162 (98.2%) consenting to provide demographic data and have their reflections analysed following completion of their unit.FindingsFour themes were identified: Eye opening, responding to self-examination, setting goals and effecting change, and affirming beliefs and attributes.DiscussionAnalysis of the students’ reflections on the nursing inherent requirements showed they exhibited enhanced awareness, understanding and acknowledgement of personal areas to be addressed, as well as goal setting and the beginnings of acculturation and movement along the pre-professional identity to professional identity continuum.ConclusionAn assessment for learning approach enhanced beginning students understanding of requirements inherent in undertaking a Bachelor of Nursing degree, enabling them to set goals for their development as they linked the BNIRs to the attributes required of a registered nurse.     

A mixed-methods evaluation of an interprofessional clinical education model serving students,faculty, and the community

ABSTRACT

The clinical learning environment significantly affects students’ preparedness to enter practice. Nursing programs may struggle securing relevant clinical sites necessary for student learning and meeting accreditation standards. Programs must be creative in developing community-based experiences that facilitate students’ learning. However, authentic interprofessional practice is often missing. We evaluated how an interprofessional clinical education model provided preventive health services through a faculty-student-led clinic and delivered an effective avenue to educate health profession students while serving the community. The model was implemented as a pilot project over the course of one semester. We used mixed-methods to analyze data from pre/post-instruments and focus groups to gain a comprehensive understanding of the effect of the model on students, faculty, and the community. Student growth in interprofessional competencies, measured with the Interprofessional Education Collaborative Self-Assessment Tool and the Interprofessional Socialization and Valuing Scale, indicates significant difference pre/post-participation. Four themes were identified from the focus groups highlighting the impact of the clinical education model: interprofessional teamwork, an unorthodox learning environment, delivery of primary and secondary prevention in the community, and reaching underserved populations. This clinical education model has promising utility in providing an interprofessional clinical learning environment while serving the community.     

Self-efficacy and concerns of nursing students regarding clinical experiences

BackgroundIt is important for nurses to provide safe, high-quality care for patients, and clinical experiences allow nursing students to integrate theory into practice. However, many students have anxiety about clinical rotations.ObjectivesThe concerns of nursing students about clinical experiences and factors relating to self-efficacy in a rural Bachelor of Science in Nursing (BSN) program were examined.DesignThis was a mixed-methods study, and students were surveyed prior to and at the end of their clinical experiences.SettingThe study location is a public liberal arts university in the rural, southeast United States.ParticipantsJunior level students (first and second semester) and senior level students (first and second semester) levels of BSN students participated in this project.ResultsQualitative themes were identified, including concerns regarding clinical competence, expectations of learning, aspects of patient/peer/instructor interactions, as well as learning strategies and preferences. The student's level of confidence regarding communication to patients and physicians, assessment of heart and lung sounds, interview skills, documentation, and discussion of nursing procedures increased significantly from pre to post-survey. Confidence levels in physical assessment skills rose significantly after the clinical experience (t′ = −6.3718 with 140 df, p < .001).ConclusionStrategies that nurse educators can use prior to, during, and after the clinical experience to address student concerns about clinical experiences include the use of caring, competent clinical instructors, orientation to clinical sites, laboratory and simulation days, self-reflection, peer-support, and debriefing.     

A scoping review of safety management during clinical placements of undergraduate nursing students

BackgroundThe abundant knowledge on nursing students’ competencies in clinical safety, and the multiple approaches adopted make it difficult to obtain an overview of the current status of this question.PurposeTo review the literature on undergraduate nursing students' safety competencies during their clinical placements.MethodA scoping review was carried out. Searches were executed in PubMed, CINAHL, WOS, MEDES, and websites of relevant organizations. The framework proposed by the Joanna Briggs Institute was adopted.FindingsA total of 43 studies were selected for the final sample. The review identified four major topics: the presence of adverse events in clinical placements, the acquisition of competencies in clinical safety, student experiences regarding clinical safety, and pedagogical approaches for clinical safety.DiscussionNursing students encounter adverse events and clinical safety incidents throughout their clinical training. Faculties should assign the highest priority to this question, due to its importance in the creation of a culture of safety.     

The Virtual Learning Environment: An alternative,flexible and accessible method of neonatal nurse education

The purpose of this paper is to propose that an alternative method of providing neonatal nurse education makes it more accessible, flexible and tailored to individual nurses personal and professional needs. The Virtual Learning Environment (VLE) is identified as the method of delivery and a module in Scientific Foundations for Neonatal Practice (incorporating examination of the newborn) is used as an example to illustrate this. The VLE enables nurses to develop their skills and knowledge in Contemporary and Advanced Neonatal Nursing practice leading to recognised awards such as a Diploma, Bachelor of Science Neonatal Nurse Practitioner or Master of Science in Advanced Health and Social Care (Neonatal Practice). The aim is to provoke neonatal nurses to challenge their own boundaries and develop clinical practice within a supportive network that respects individuality and professionalism. Neonatal nurses can thus enhance their practice in any area of neonatal practice by choosing modules that are focused on the skills they need to achieve as individuals, whether that be developmental care, pain management or nutrition to name but a few.