Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

Interprofessional education in nursing: The impact of collaboration between physical and mental health care professionals

ObjectivesInterprofessional collaboration in the training of nursing and psychology students helps provide students of both disciplines with the ability and competences they need to best attend to their patients. This study implemented and analyzed a method for developing the competences of each discipline in a scenario of joint clinical simulation that incorporates mental and physical health simultaneously, and measured the caring ability of the participating students.MethodsParticipants took a self-applied survey measuring their own caring ability. After, a clinical simulation was performed where nursing students performed clinical interviews on psychology students, who acted as standardized patients. Caring abilities were measured in the nursing students, and the psychology students implemented an intervention service measuring caring ability and brief - debrief simulation by coaching to nursing students.ResultsThe results indicated that the self-applied questionnaire of caring ability resulted in scores significantly higher than what was measured by observers.ConclusionsThe results contribute to the development of protocols, training and collaborative work practices in interprofessional education, which allow the scaling of these competences.     

Collaboration between first year undergraduate nursing students – A focused ethnographic study

AimThe aim was to explore collaboration between first year undergraduate nursing students in a three-year bachelor program during clinical skills lab practices.BackgroundThe ability to collaborate is important in the nursing profession to ensure patient safety. Thus, efforts supporting nursing students with learning activities emphasizing this ability is crucial in nurse education as a preparation for the requirements of the nursing profession. Collaborative learning models are described as ways that support the students’ interaction during education. However, collaboration between students has shown to have challenges such as negative competition and confrontations. This stresses the need to explore the collaboration between students to find ways to support the interaction.DesignThe study was conducted with a focused ethnographic approach.MethodData were generated by participant observations during one semester, involving 70 h observation of 87 first year nursing students for 6 months and 24 training sessions in clinical skills lab practices. Two focus group discussions were used to elaborate students’ views of collaboration and to provide an opportunity for follow up questions and interpretations from the observations. Field notes and focus group discussions were interpreted as one unit of analysis conducted with thematic network analysis. A global theme were synthesized from organizational and additional basic themes presenting the overall metaphor of the students’ collaboration.ResultThe global theme, Between adaptation and non-conformity, revealed a field of tension in the nursing students’ collaboration. One the one hand, the global theme involved the students’ ability to adopt to new knowledge and to being a nursing student in a clinical skills lab and to others’ perspective. On the other hand, non-conformity creates a collaboration with less reflection between the students and non-synchronized and time-consuming laboratory work.ConclusionCollaborative activities in nurse education fosters and challenges nursing students’ collaboration required for clinical practices and later in the nursing profession. By the presented scaffolding efforts, nurse educators can arrange a learning environment that can support the collaboration between students and facilitate the transition into the profession.     

The impacts of faculty caring on nursing students’ intent to graduate: A systematic literature review

ObjectivesTo examine the current studies about the impacts of faculty caring on nursing students’ intent to graduate and provide recommendations. The nursing profession continues to face nursing shortages. One of the solutions recognized to alleviate the shortage is increasing the number of students graduating from nursing schools. It lacks a literature review synthesizing the current research about the impacts of faculty caring on nursing students’ intent to graduate and indicate areas for future research.MethodsThis is a systematic literature review. The search of the literature was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, and ProQuest Search. Search terms included ‘attrition,’ ‘dropouts,’ ‘graduation rate,’ ‘faculty,’ ‘instructor,’ ‘professor,’ ‘nursing,’ and ‘caring.’ResultsTen articles met the inclusion criteria. The articles were conducted in the Associate Degree of Nursing and the Bachelor of Science in Nursing programs. Nursing faculties played a significant role in students’ intent to graduate by building students’ confidence, creating a compassionate learning environment, and promoting students’ competence. Faculties’ caring behaviors, including respecting students, showing empathy, and using caring communication skills, were essential characteristics to affect students’ learning environments.ConclusionsThe findings indicate that students’ perceptions of faculty caring can affect their perceptions of the learning environment and sense of belonging, and therefore, impact their intent to graduate. Students’ perceptions of their instructors’ caring behaviors are instrumental in motivating them to continue learning. The capacity of faculty caring plays a significant role in students’ success.     

Percepción de los estudiantes del Grado en Enfermería sobre su entorno de prácticas clínicas: un estudio fenomenológico

AimTo explore the perception of fourth-year nursing students of the healthcare environment where their training process in clinical practices takes place.MethodsPhenomenological qualitative study based on the hermeneutical philosophy of Gádamer that included the development of focus groups and semi-structured interviews in a sample of fourth-year nursing students from the University of Almería. The collection period was in February 2016. The information obtained was transcribed and analyzed by inductive strategies in search of emerging categories.ResultsThe analysis revealed two main categories: (1) influence of the clinical environment on the healthcare and teaching performance of nurses and on student learning and (2) training and job prospects for the future professionals. Each of them showed two subcategories with their corresponding codes. The information collected showed the experiences and perceptions of Nursing students regarding the healthcare environment where their training process in clinical practices takes place.ConclusionsThis study enabled us to discover the perception of fourth-year nursing students of the environment where their training process in clinical practices takes place. Knowledge of this phenomenon helps to identify deficits in students’ clinical learning and to adapt university curricula to their training needs in order to guarantee their success as professionals facing future clinical-labour demands.     

Nursing students’ experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis

AimTo synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settingsBackgroundNurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.DesignA qualitative systematic review and meta-synthesisMethodsPubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012–25 Feb 2023. Qualitative studies of any design reporting nursing students’ experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso’s 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.ResultsThe review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.ConclusionsWhile caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.     

Effects of video-recorded role-play and guided reflection on nursing student empathy,caring behavior and competence: A two-group pretest-posttest study

AimThe study examined the differences in nursing student empathy, caring behavior and competence between the experimental and control groups before and after educational intervention and to predict the factors affecting their core competencies.BackgroundEducating nursing students in empathy and caring behaviors before entering clinical practice is challenging.DesignWe used a two-group pretest and post-test quasi-experimental design.MethodsFirst-year nursing students from medical schools in Taiwan participated in our study. Data were collected between March and May 2022. The learning method used with the intervention group was role-playing with videos and guided reflection. The control group was exposed to traditional curriculum. Empathy, caring behavior and competence were measured using the Jefferson Scale of Empathy- Healthcare Providers, the Caring Behaviors Scale and the Nursing Student Competence Scale.ResultA total of 72 participants (40 in the experimental group and 32 in the control group) were included in the final statistical analysis. The response rate was 92%. Statistically significant differences in nursing student empathy, caring behavior and competence were observed between the experimental and control groups (p < .05). The η² effect levels were 0.083, 0.223 and 0.270. Higher caring behavior scores were significantly associated with higher nursing student competence scores (β = 0.81, 95% CI:0.66–0.97).ConclusionsEducation based on video role-play and guided reflection improved empathy, caring behavior and nursing competence in first-year nursing students.     

护理专业学生关怀能力及其与教育环境的关系研究

目的调查护理专业学生关怀能力现状,并分析教育环境对关怀能力的影响。方法采用关怀能力量表和自设的教育环境问卷,对316名护理专业学生进行问卷调查。结果护理专业学生关怀能力得分为(179.38±20.88)分,低于国外常模(P<0.05)。分层回归结果显示,性别、寝室氛围、同辈关系、志愿者活动的开展对学生的关怀能力有显著影响。结论护理专业学生关怀能力偏低,建议护理教育者和管理者针对其影响因素,改进临床教学方法,改善学习和生活氛围,提高学生的关怀能力。     

临床护理教师的角色模范对学生人文关怀能力的影响

目的 探讨护理专业学生人文关怀能力与感知临床护理教师对患者关怀行为的关系,为培养和提高学生人文关怀能力提供依据.方法 采用"学生人文关怀能力量表"和"感知临床护理教师对患者关怀行为问卷"对83名本科学生进行问卷调查,并对两者进行相关性分析.结果 学生人文关怀能力得分(81.74±13.28)分,得分率78%;感知临床护理教师对患者关怀行为得分(2.93±0.46)分,得分率75%;两者之间存在正相关(r=0.620,P=0.000).结论 临床护理教师的角色模范是学生人文关怀能力的重要影响因素,护理教育者应重视临床护理教师对实习学生的潜移默化影响,为培养学生人文关怀能力创造良好的软性环境.     

Creating a Caring Learning Environment

This article discusses creating a caring learning environment for undergraduate nursing students. The purpose is to apply the results of a research study in which students described their lived experience with caring in the nursing environment. Students (N = 23) shared caring and uncaring stories about their curricula. The study identified two patterns: "The Power of the Faculty" and "Creating a Caring Learning Environment." The authors discuss the implications of these patterns for developing caring faculty practices and a caring learning environment.     

The relationship between professional values,ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach

AimTo examine the relationship between professional values, ethical sensitivity and caring behaviors among nursing students and determine whether professional values play a moderator role in the relationship between ethical sensitivity and caring behaviors among nursing students.BackgroundDeveloping professional nursing values, ethical sensitivity and caring behaviors is critical in nursing programs from the first year to graduation to prepare students for increasingly complex and diverse work environments.DesignA cross‐sectional study using structural equation modeling. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.MethodsThis study was conducted with 189 undergraduate nursing students. The study was conducted in a four-year nursing faculty in the Mediterranean region of Turkey from February to June 2022. Data were collected using a personal information form, the Nurses’ Professional Values Scale, the Moral Sensitivity Questionnaire and the Caring Behaviors Assessment Tool Nursing Version-Short Form.ResultsWe found that nursing students' perceptions of professional values and caring behaviors were high and their ethical sensitivity was moderate. Nursing students who are successful in high school have higher professional values. In addition, it was determined that nursing students who chose the nursing profession because of altruism had higher perceptions of caring behaviors. A positive relationship exists between professional values, ethical sensitivity (r = −0.258, p < 0.001) and caring behaviors (r = 0.431, p < 0.001) (p < 0.05). Professional values have a positive effect on ethical sensitivity and caring behaviors.ConclusionProfessional values, ethical sensitivity and caring behaviors are relationships and professional values positively predict nursing students' ethical sensitivities and caring behaviors. As the professional value perceptions of nursing students increase, their ethical sensitivity and caring behaviors increase. Improving the curricula in a way that will improve professional values may enable nursing students to increase their ethical sensitivity and caring behaviors. The research contributes to a broader understanding of nursing education curriculum content.     

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.     

护理本科学生人文关怀能力现状调查

目的 调查护理本科学生人文关怀能力,并分析不同性别和不同年级学生人文关怀能力的差异.方法 采用Nkongho关怀能力量表,对421名护理本科学生进行横断面问卷调查.结果 护理本科学生关怀能力各维度得分低于国际护理关怀能力评分标准(P＜0.001).女生的关怀能力高于男生(P＜0.001),低年级学生的关怀能力高于高年级学生(P＜0.05).结论 护理专业学生整体关怀能力偏低.护理院系应建立学生早期接触临床的机制,进一步改善护理人文课程教学,将人文关怀教育融入到护理专业课教学中,以提升学生的关怀能力.     

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.