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.     

Professional role synthesis for nursing faculty: a redefinition of faculty practice

Nursing faculty role is the synthesis of theory, education, practice, and research within a school of nursing environment. This model of nursing faculty role presents a synthesis and implementation of professional nurse role that nursing faculty might use to systematically meet the goals of developing nursing theory based on clinical practice, redefining and evaluating this theory through research, and educating students.     

质控表格在临床教学管理应用中的效果分析

目的:探讨质控表格在临床教学管理中的应用效果。方法:选择2011年3月~2013年4月我院带教老师和护生为研究对象,将2011年3月~2012年3月的带教老师和护生设为对照组,2012年4月~2013年4月带教老师和护生为观察组。对照组按常规方法带教,观察组在教学过程中使用16项教学质控表格,比较两组护生专科理论考试合格率、实践操作考核合格率、护生对带教老师满意率。结果:观察组护生专科理论考试合格率、实践操作考核合格率、护生对带教老师满意率明显高于对照组,差异均具有统计学意义(P0.05)。结论:教学质控表格能提高教学质量、护生学习效果以及对带教老师满意率,值得在临床教学管理中推广。     

Seeking autonomy: Grounded theory of clinical reasoning processes during simulation based experiences

AimTo conceptualize how undergraduate nursing students’ reason and think during Simulation-Based experiences (SBE) and explore the indicators of sound clinical judgment.BackgroundNursing students’ clinical reasoning processes during Simulation Based Experiences (SBE) are not well understood and underexplored. The purpose of this study is to conceptualize how undergraduate nursing students’ reason and think during SBE.DesignA constructivist grounded theory methodology was used to explore nursing students’ clinical reasoning during SBEMethodA grounded theory methodology was used to explore nursing students’ clinical reasoning during SBE. A purposive sample was used to recruit participants including 32 third-year nursing students. Data collection using semi-structured interviews conducted over 9 months in 2020–2021. The interviews were recorded and transcribed verbatim and the data were analyzed using the logic of constant comparison supported by memoing, theoretical sampling and conceptual mapping.ResultsSeeking autonomy is the core category that emerged from the participants’ responses that conceptualizes the students' reasoning process during SBEs.ConclusionEvidence from this grounded theory study adds validation to the practice of using SBEs to support students’ clinical reasoning process and prepare them to be competent in clinical practice.     

建立学生导师制提高护理本科生临床实习质量

目的评价在本科护生临床实习中建立学生导师制提高护理本科生的临床实习质量。方法选取临床实习的护理本科生,选择讲师以上的专业临床护理教师作为导师,将循证护理引入实习教学,导师负责本科生的课题研究,采用新式“全程考试”模式,加强临床实习的管理。结果此方法激发了护理本科学生的学习兴趣和求知欲,提高了科研能力和综合素质,有利于临床工作能力的培养。结论在护理本科生实习中实行导师制可以普遍提高护理本科生的临床护理质量。     

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.     

Implementing reflection: insights from pre-registration mental health students

Reflection and reflective practice continues to be contentious issues in nursing. The focus of this article is the use of reflection by pre-registration mental health students. The broad aim of this preliminary study was to discover student mental health nurses' perceptions of reflection as a learning strategy during clinical placement. Using a constructivist grounded theory methodology [Charmaz, K., 2000. Grounded theory: Objectivist and Constructivist Methods. In: Denzin, N., Lincoln, Y. (Eds.), Handbook of Qualitative Research, second ed. Sage, Thousand Oaks, California], five students were interviewed individually in their clinical placements. Data analysis revealed three major categories: understanding the process of reflection, using reflection in clinical practice, and needing support and guidance. Findings indicated that students were primarily using reflection-on-action, but to varying extents. Overall, students felt that reflection facilitated their learning. Factors were discovered that both helped and hindered students' use of reflection. These included level of preparation to reflect, a limited culture of reflection and the level of support from preceptors, clinical staff, clinical placement co-ordinators, and lecturers. In conclusion, it appears that a collaborative approach between students, Health Service Providers and institutes of nursing is vital for the successful development and implementation of reflective learning strategies in clinical placement. Suggestions are made as to how a collaborative approach may be developed to enhance this process.     

Development of the professional competence and professional self-concept of undergraduate nursing students during the clinical practice period: A cross-lagged panel analysis

AimTo explore the relationship of the development of professional competence and professional self-concept of undergraduate nursing students during the clinical practice period.BackgroundClinical practice is one of the most important aspects of nursing education. Nursing students combine theoretical knowledge, psychomotor skills and emotions in a professional socialization process through clinical practice sessions.DesignA two-time point longitudinal design was performed. A cross-lagged model was employed to analyze the relationship between the development of professional competence and professional self-concept of undergraduate nursing students during their clinical practice period.MethodsA total of 210 undergraduate nursing students were included in this study. The questionnaire was distributed two months and six months after their clinical practice started. Professional Self Concept of Nurses Instrument and Professional Competence Scale for Undergraduate Nursing Students were the two main instruments.ResultsBoth the professional competence and professional self-concept of Undergraduate nursing students increase at the end of the sixth month compared with the end of the second month after their clinical practice started. The results of the cross-lagged analysis showed that the professional self-concept was partially responsible for the development of professional competence. The effect of professional competence on the development of professional self-concept, in contrast, was not found in this study.ConclusionsClinical nursing educators should pay greater attention to the development of the professional self-concept of undergraduate nursing students. More attention should be paid to creating a supportive clinical learning environment to facilitate the improvement of undergraduate nursing students’ professional self-concept and professional competence.     

Learning strategies of public health nursing students: conquering operational space

Aim. To develop understanding of how public health nursing students learn in clinical practice and explore the main concern for the students and how they acted to resolve this main concern. Background. How professionals perform their work directly affects individuals, but knowledge is lacking in understanding how learning is connected to clinical practice in public health nursing and in other professions. Design. Grounded theory. Method. Grounded theory was used in gathering and analysing data from 55 interviews and 108 weekly reports. The participants were 21 registered nurses who were public health nursing students. Results. The grounded theory of conquering operational space explains how the students work to resolve their main concern. A social process with three identified phases, positioning, involving and integrating, was generated from analysing the data. Their subcategories and dimensions are related to the student role, relations with a supervisor, student activity and the consequences of each phase. Public health nursing students had to work towards gaining independence, often working against ‘the system’ and managing the tension by taking a risk. Many of them lost, changed and expanded their professional identity during practical placements. Conclusion. Public health nursing students’ learning processes in clinical training is complex and dynamic and the theory of ‘Conquering operational space’ can assist supervisors in further developing their role in relation to guiding students in practice. Relationships are one key to opening or closing access to situations of learning and directly affect the students’ achievement of mastering. Relevance to clinical practice. The findings are pertinent to supervisors and educators as they prepare students for practice. Good relationships are elementary and supervisors can support students in conquering the field by letting students obtain operational space and gain independence. This may create a dialectical process that drives learning forward.     

Criteria used by nurses to evaluate practice-related information on the World Wide Web

Existing criteria used to evaluate information on the World Wide Web often are not related to nursing, especially in relation to clinical and evidence-based practice. Published criteria have been found orientated to the health-consumer, medicine, or general information. In this study, the process by which nurses evaluate practice-related information and the associated evaluative nursing criteria were investigated using a grounded theory approach. In the first stage of this ongoing investigation, semistructured interviews were used to collect data from UK postregistration nursing students. The findings from this initial study provided indications of the process and the criteria for evaluating information on the World Wide Web. Participating students identified intuition as part of the evaluative process. They identified some criteria similar to existing standards, but critically, with additional criteria that are nursing practice related. Because these new criteria are significant for evaluating nursing information, further refinement of these findings is being undertaken through the next stage of the research program.     

An emancipatory praxis study of nursing students on clinical practicum in New Zealand: pushed to the peripheries

The purpose of this qualitative study was to gain a better understanding of the learning experiences of nine nursing students on clinical placement in New Zealand. The students were in their third and final year of their baccalaureate nursing degree. The study specifically examined what impinged upon their learning experience in the clinical venue. Data was obtained from interviewing the students, initially individually and finally in a focus group. Themes emerged through words and concepts as the data was analysed. The themes included powerlessness; marginalization; the move from a holistic to a reductionist approach in care; the exploitation of minority students and the myth of praxis. Clinical practice was a time for nursing students to apply their knowledge to their practice, and to gain experience and confidence. Their clinical practice was normally a positive experience, but, each student spoke of the occasional negative episode. These left them with feelings of powerlessness and marginalization. The Maori students felt exploited. The students were concerned about the lack of time to debrief at the end of the day, and to share their experiences with their educator and colleagues. The students' negative experiences were often the result of a clinical practitioner's high workload, under resourcing and the nurse educator's unavailability. An emancipatory praxis methodology was used to guide the research and hence Habermasian critical theory underpinned this study. It has demonstrated within this research the necessityfor strategic action, by exposing the current situation to create an awareness for favourable change. The findings from this research will enable educators and clinical practitioners to have a clearer understanding of the needs of nursing students in clinical practice. Recommendations from this study included the need for further research into nursing students clinical supervision models, and the identication of the special learning needs of indigenous nursing students.     

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'.     

Using portfolios for clinical practice learning and assessment: the pre-registration nursing student's perspective

Portfolios have been introduced to help to integrate theory and practice and thereby address the issue of the theory-practice divide. Although there has been much theoretical discussion about portfolio use in clinical placements, few studies have focused on the students' perceptions regarding their use. To obtain adult branch pre-registration nursing students' perspectives on using portfolios for their clinical practice learning and assessment, postal questionnaires were sent to 253 diploma of nursing students with a reminder to all students three weeks later. The response rate was 69% (174/253). This paper reports on the qualitative findings of the study, which employed both quantitative and qualitative methods. Although students stated that portfolios helped them in their development of self-awareness and independent learning, they indicated that portfolios do not sufficiently address the assessment of their clinical skills and the integration of theory and practice. They considered that portfolios could be greatly improved in three areas, namely in the conflict between using portfolios for both assessment and learning, the amount of support and guidance students feel they receive with their portfolio use and the portfolio design.     

Nursing students' intentions to use research as a predictor of use one year post graduation: A prospective study

BackgroundGraduating nursing students are expected to have acquired the necessary skills to provide research-based care to patients. However, recent studies have shown that new graduate nurses report their extent of research use as relatively low. Because behavior intention is a well-known predictor of subsequent behavior, this gives reasons to further investigate graduating nursing students’ intentions to use research in clinical practice after undergraduate study.ObjectivesTo investigate graduating nursing students’ intentions to use research in clinical practice and, furthermore, to investigate whether intention in itself and as a mediating variable can predict subsequent research use behavior in clinical practice one year post graduation.DesignA follow-up study was performed of graduating nursing students in their final semester of undergraduate study (2006) and at one year post graduation (2008). Data were collected within the larger national survey LANE (Longitudinal Analysis of Nursing Education).ParticipantsA sample of 1319 respondents was prospectively followed.MethodsGraduating nursing students’ intentions to use research instrumentally were studied as a predictor of their subsequent instrumental research use one year post graduation. A statistical full mediation model was tested to evaluate the effects of intention and factors from undergraduate study on subsequent research use in daily care.ResultsThirty-four percent of the nursing students intended to use research on more than half or almost every working shift in their future clinical practice. Intention showed a direct effect on research use behavior. In addition, significant indirect effects on research use were shown for capability beliefs (regarding practicing the principles of evidence-based practice) and perceived support for research use (from campus and clinical education), where intention acted as a mediating factor for those effects.ConclusionsStudents rated a modest level of intention to use research evidence. Intentions close to graduation acted as an essential predictor of subsequent research use behavior, both through a direct effect and as a mediating variable. These findings give support for designing future interventions aiming at influencing students’ intention to use research to improve subsequent behavior. Focusing on strengthening students’ capability beliefs and providing support for research use appear as promising target activities.     

Integrating what is taught with what is practised in the nursing curriculum: a multi-dimensional model

The discrepancy between nursing as it is taught in the classroom (theory) and nursing as it is experienced by students in the clinical setting (practice) has long been a source of concern to teachers, practitioners and learners This paper provides an overview of the literature on the theory-practice gap, exploring some of the many reasons cited for its existence as well as suggested ways of bridging the gap Drawing upon the findings, a comprehensive and multidimensional model designed to integrate theory and practice of nursing is proposed for use by curriculum planners Fundamental to the model is the notion of collaboration between education and service staff at all stages of the curriculum process The model highlights eight key areas for the curriculum team to consider the curriculum model to be used, sequencing of taught content and clinical practice, the content of the course, teaching methods to be used, assessment criteria, the role of tutors in the learning process, the contribution of service staff, and the influence of the hidden curriculum It is argued that only through such a comprehensive model can integration of theory and practice within the curriculum be achieved Adoption of the model, however, will require considerable individual and organizational commitment     

Clinical environment as a learning environment: student nurses' perceptions concerning clinical learning experiences

The aim of this study is to describe student nurses' perceptions of clinical learning experiences in the context of the clinical learning environment. We use the phenomenological approach by Colaizzi. The data was collected by unstructured interviews. Altogether 16 student nurses were asked to describe the significance of clinical learning experiences and good and bad learning experiences. Four elements sum up these clinical learning experiences: the appreciation and support the students received, the quality of mentoring and patient care, and students' self-directedness. Student nurses valued clinical practice and the possibilities it offered in the process of growing to become a nurse and a professional. A good clinical learning environment was established through good co-operation between the school and the clinical staff. It was concluded that the school should be able to provide a suitable clinical learning environment at the right time, so that theory and practice would complement each other. The teacher was the expert on nursing education, the aims set for each practice, as well as student nurses and their skills, but then again the nurse mentor knew the ward on which students were practicing. This was why collaboration between nurse mentors and nurse teachers was considered very necessary.