Feedback as a balancing act: Qualitative insights from an experienced multi-cultural sample of doctoral supervisors in nursing

AimTo better understand the views and experiences of experienced doctoral supervisors in nursing when providing feedback and critique to nursing doctoral students. Background: Feedback refers to information from a provider, intended to inform a receiver about the quality of their work in order for them to be able to see where improvements might occur and to signpost issues to be carried into future work. Feedback, particularly on student writing is central to successful doctoral supervision and is time consuming and labour-intensive for supervisors. Design: Qualitative. Methods: Following ethics approval and informed consent procedures, we gathered 962 min of interview data over a six-week period from 21 participants in four countries. During conversational-style interviews, participants shared their experiences of supervisionand elucidated on their experiences of providing feedback to doctoral students. Data were thematically analysed. Findings: Participants had more than 400 combined doctoral completions. As supervisors, participants aimed to strike a balance between helpful and empowering comments that motivated students to approach their work with renewed vigour and enthusiasm; and those that had the opposite effect of crushing and demoralising the student. ‘Feedback as a balancing act’ comprised four contributing themes with sub-themes. Findings reveal that feedback on student writing can remain a challenge for the duration of candidature. However, writing is an essential aspect of doctoral studies. It is through supervision that new nursing scholars are tutored and coached into the practices essential to creating disciplinary knowledge through writing. Our sample was drawn from multiple countries and included perspectives from various cultures. Despite the variation in countries and cultures, there was little variation in issues around feedback with all participants striving to provide clear, respectful feedback aimed at developing students and enhancing their skills. Conclusions: Supervision of doctoral student frequently involves working internationally and what while our sample was drawn from multiple countries and cultural perspectives, there was little variation in issues around provision of feedback to doctoral students. When considering feedback, our findings emphasise the importance of recognising feedback as a crucial educative process and one that is central to the production of a doctoral thesis. We argue that there is a need for nursing to move to developing and articulating meaningful and inclusive pedagogies of writing and doctoral supervision. We recommend universities support the development of such pedagogies and ensure that academic staff engaging in supervision are supported with the appropriate knowledge and skills to be optimally effective.     

Preserving writing in doctoral education: exploring the concernful practices of schooling learning teaching

Preserving writing in doctoral education: exploring the concernful practices of schooling learning teaching ¶Many contemporary scholars have challenged the current culture of graduate education and have suggested a need to reform nursing scholarship. The purpose of this study was to describe and analyse the common practices and shared lived experiences of nurses who are students or teachers in doctoral education. Participants recruited from across the United States included 15 nurses, five of whom were current faculty members in doctoral programmes in nursing and 10 who were currently enrolled as students in doctoral programmes. Data collected from extended, non-structured interviews were analysed hermeneutically using the interpretive phenomenology of Heidegger and Gadamer as the philosophical background. The results of this study reveal that the practices of scholarship, reading, writing, thinking and dialogue are inseparable and belong together. Analysing and describing how the practices of scholarship belong together will contribute to extending an understanding of how the practices of writing can be preserved in contemporary doctoral education. 'Preserving' refers to how teachers and students perpetuate and sustain these practices in ways that are meaningful and transformative and in ways that are oppressive. This study explores the experiences that are central to becoming a scholar and suggests how their meaningfulness can be sustained and extended into the next millennium.     

The learning experiences of international doctoral students with particular reference to nursing students: A literature review

One of the key challenges for the advancement of nursing globally is the development of doctorally prepared educators and leaders in a context where there is a shortage of provision of doctoral nursing programmes. For the short term future, many nurses wishing to undertake a doctorate will need to complete this education in the USA, the UK or Australia. Very little is known however about the nature of their learning experiences in these countries. This paper presents a literature review on the international doctoral student experience, with specific reference to nursing. A thorough review of the literature from 1990 to 2009 was undertaken which yielded only three empirical studies related to nursing. The review was then expanded to include subjects other than nursing which yielded 16 studies in total. This paper presents key themes that appear to be generic to international doctoral students, and draws out specific implications for nursing.The review found that international doctoral students’ learning experiences were strongly influenced by the extent to which they could engage with three key elements of doctoral programmes:

1.

pedagogical paradigms (specifically, self-directed learning and an emphasis upon criticality),

2.

pedagogical practices (specifically, understanding supervision styles and relationships and learning in a second language),

3.

academic environments (including the availability and accessibility of peer support and professional development opportunities).

The first months represented a critical time of transition and most international students seemed to want and expect considerable support and structured in-put during this period. Most studies concluded that there was a need for greater institutional support and supervisor training. The three nursing-specific papers were entirely consistent with these themes.The existing evidence is extremely heterogeneous and of variable methodological quality. In order to ensure that doctoral nursing students are getting a high quality and appropriate PhD experience, there is a need for more research specifically with this group. There is also a need to investigate the different stages of the doctoral process in nursing, including, for example, writing up and examination processes and post-doctoral career outcomes.     

Fostering scholarship in doctoral education: Using a social capital framework to support PhD student writing groups

The shortage of nurse scientists in the United States complicates nursing's ability to sustain research-intensive environments, build knowledge for translation, and advance nursing science. More emphasis is needed on the preparation of PhD doctoral students to better equip them for a career of scholarship. Four recent PhD graduates participating in a writing group, examined the influence of social capital on their ability to develop capacity for scholarship. They found that a strong social factor supported their efforts to engage as scholars, be accountable for their writing, and make contributions to the research community. Although the writing group provided a space to practice scholarly writing and increased scholarly productivity, the experience was transformative in building capacity for scholarship. This article includes recommendations for academic leaders to both create and support writing groups within doctoral nursing programs using a social capital framework. Strategies are provided using the three dimensions of social capital: structural, relational, and cognitive. Investing in strategies that build social capital within a community can directly impact the advancement of science by elevating capacity for scholarship.     

Do graduate entry nursing student’s experience ‘Imposter Phenomenon’?: An issue for debate

The recruitment of Graduates into the nursing profession is seen as advantageous in the academic literature. Conversely educated nurses are often portrayed in the media as “too posh to wash”. We would argue these conflicting discourses have a negative effect on graduate entry nurse education. Graduate nursing students may be particularly susceptible to “Imposter Phenomenon” a concept that describes an “internal experience of intellectual phoniness” exhibited by individuals who appear successful to others, but internally feel incompetent. We would like to encourage debate through the presentation of a small set of pilot data that established that 70% of the participants had frequent to intense experiences of Imposter Phenomenon. Students experienced feelings of failure despite consistent high achievement. Our findings and the prevalent negative rhetoric surrounding highly educated student nurses raise concerns regarding the impact of the anti-intellectualism on the Graduate entry student’s perception of self. Others may argue that this could simply be a ’natural’ or expected level of anxiety in a time of transition that has no lasting impact. We debate this issue in relation to the existing literature to encourage critical dialogue.     

中等护士专业增设护理写作课初探

目前我国中等护士专业学校的课程设置中仍然未设有专门的护理写作课，使培养出来的护士缺乏护理工作需要的专业应用写作能力。为此，作者提出构想：在中等护士专业课程设置中增设专门的护理写作课，使语文教学跳出旧的类似于普通中学的教学模式，更贴近专业。这样做不仅可以使教学内容更具有护理特色，而且可为护生毕业后的临床护理写作奠定基础。     

Swimming without the water: A critical perspective on mental health experience for adult nursing students

Adult nurses and adult field nursing students come into contact with a diverse range of other patient groups in their practice but perhaps none more so than those who have co-existing mental health issues. Consequently adult field student nurses must be equipped with the requisite knowledge and skills to competently care for their patients who also experience mental health problems. Given the pressure on placements many education providers have developed alternatives to direct mental health experiences. The authors review their own experience of some of the modalities that higher education institutes (HEI) use to instruct their students in this field. They argue that, ideally, there is no substitute for the practical experience of placements in the mental health sector, particularly if these include contact with mental health nursing. The paper concludes with some recommendations for nursing education and our professional body that could help equip adult field nursing students with the necessary experience and skills of mental health to support them into their future careers.     

What are our priorities? Addressing the looming shortage of nursing faculty

Let's get our priorities straight. As we continue the essential educational upgrading of the profession through research-focused doctoral programs, and through the new CNL and DNP programs, let's be sure that at least some of these programs attend to the critical need for well-prepared nursing faculty (i.e., provide opportunities for and encourage students to take advanced coursework in nursing education). Let's also pay attention to the reality of limited capacity in our research-focused doctoral programs and look to other viable approaches to having a cadre of well-prepared faculty. For example, let's recognize, value, and reward the important role master's-prepared nurses, especially those with advanced coursework in nursing education, can and must play in our basic programs. And let's be sure that we have faculty in our ranks who have the training, aptitude, and credentials to conduct the research so critical to progress in nursing education.     

The transitioning experiences of internationally-educated nurses into a Canadian health care system: A focused ethnography

Background

Educating nurses to doctoral level is an important means of developing nursing capacity globally. There is an international shortage of doctoral nursing programmes, hence many nurses seek their doctorates overseas. The UK is a key provider of doctoral education for international nursing students, however, very little is known about international doctoral nursing students' learning experiences during their doctoral study. This paper reports on a national study that sought to investigate the learning expectations and experiences of overseas doctoral nursing students in the UK.

Methods

Semi-structured qualitative interviews were conducted in 2008/09 with 17 international doctoral nursing students representing 9 different countries from 6 different UK universities. Data were analysed thematically. All 17 interviewees were enrolled on 'traditional' 3 year PhD programmes and the majority (15/17) planned to work in higher education institutions back in their home country upon graduation.

Results

Studying for a UK PhD involved a number of significant transitions, including adjusting to a new country/culture, to new pedagogical approaches and, in some cases, to learning in a second language. Many students had expected a more structured programme of study, with a stronger emphasis on professional nursing issues as well as research - akin to the professional doctorate. Students did not always feel well integrated into their department's wider research environment, and wanted more opportunities to network with their UK peers. A good supervision relationship was perceived as the most critical element of support in a doctoral programme, but good relationships were sometimes difficult to attain due to differences in student/supervisor expectations and in approaches to supervision. The PhD was perceived as a difficult and stressful journey, but those nearing the end reflected positively on it as a life changing experience in which they had developed key professional and personal skills.

Conclusions

Doctoral programmes need to ensure that structures are in place to support international students at different stages of their doctoral journey, and to support greater local-international student networking. Further research is needed to investigate good supervision practice and the suitability of the PhD vis a vis other doctoral models (e.g. the professional doctorate) for international nursing students.     

Students' voices: listening to their experiences in practice education

The experiences of the students in this pilot study demonstrate how students are learning to respond to the call of the patient amid the challenges of contemporary health care settings. Perhaps these experiences make teachers mindful of how students learn to respond, listen to, and know and connect with patients for whom they care. How would clinical courses be different if listening to and connecting with patients (as the basis for personalizing care) was given the same priority as completing particular interventions or demonstrating particular skills? What does it mean to students to encounter situations in which patients are not being listened to or in which nurses have not connected with patients? Research in nursing education is showing how new, student-centered pedagogies arise when teachers shift attention from content, and linking content to practice, to equally exploring narrative experiences and how students and teachers spend their time together (Diekelmann & Smythe, 2004). The voices of students gathered in this pilot study suggest that students are perhaps our brightest hope for envisioning what to preserve and what to overcome as we reform and create compelling, student-centered practice nursing education.     

Acute care nurses’ attitudes toward nursing students with disabilities: A focused ethnography

Discrimination towards individuals with disabilities is problematic within nursing. There have been calls to increase diversity in nursing and this includes embracing nurses with disabilities. Increasing diversity in nursing requires increasing diversity among nursing students; in this way, nurse educators are gatekeepers to the profession. Clinical education is a crucial element of nursing education, yet there have been very few studies related to the clinical education of nursing students with disabilities. There have been no studies of attitudes of acute care nurse preceptors toward students with disabilities in the United States. This gap is important as the majority of clinical experiences occur in the acute care environment. Utilizing a focused ethnography, semi-structured interviews were conducted with 20 acute care nurses with at least two years’ experience precepting students. While positive feelings about nursing students with disabilities were shared, thoughts and behavioral intentions remained negative. Six themes emerged: safety, barriers, otherness, communicating to meet needs, disclosure, and student versus colleague. Attitudinal barriers are the primary barriers faced by individuals with disabilities in becoming and practicing as nurses. Nurses in practice and education must embrace more inclusive attitudes towards individuals with disabilities.     

Professional doctorate and professional nursing practice

The professional doctorate degree in nursing is a novel approach to gaining a doctoral qualification other than the traditional Doctor of Philosophy (PhD) degree. This taught programme aims at linking theory and practice innovations in addressing clinical nursing problems. This paper outlines the evolution of the professional doctorate in the USA, the UK and Australia and its differences from the traditional PhD. I argue that nurses enrolled in this course work programme will not only have the opportunity to pursue studies at the doctoral level, but it will also facilitate nurses to challenge and share their experiences in solving practice problems in a collegial manner. By understanding the broader perspective of an environment dominated by scarce resources and intricate socio-political relationship, nurses will be able to influence policy decisions and ultimately improve the standard of health care and enhance the professional status of nursing. It may even reduce the antagonism of the anti-intellectual environment of the workplace through practice-oriented research.     

When TikTok Is Not Enough: Engaging Nurses at All Levels in the Advocacy Process

Nurses took to social media at the height of the pandemic. They leveraged the popular app TikTok to share their experiences with the pandemic, educate the public, combat misinformation, and used it as a tool to advocate for the nursing profession. Although many nurses leveraged this platform to educate, others used it as a platform to challenge the system and highlighted the great divide within the nursing profession. With 4.2 million nurses in the United States, it is estimated less than 10% are members of professional organizations. These professional organizations are the primary groups advocating on behalf of the profession. How are we developing legislative agenda’s that meet the need of the profession if less than 10% of nurses are engaging and speaking up? There are multiple ways nurse leaders can engage frontline staff in the advocacy process. Levels of engagement can range from within the organization to local, state, national, and global efforts. The opportunities to engage are endless. We are 4 million strong, yet we struggle to have an aligned collective voice. Our divide begins with unions versus non-unions, mandated staffing ratios versus other staffing models, associate degree versus bachelor’s degree, and so on. How do we ever expect to be heard if we are not aligning our voices and coming to consensus on what is best for the profession as a whole? Social media is not getting us in front of the right people. As leaders, we must role model what advocacy looks like and provide avenues for our nurses to engage in this process.     

The academic writing experiences of a group of student nurses: a phenomenological study

AIMS: To investigate the academic writing experiences of a group of preregistration nursing students. To explore issues surrounding how academic writing skills were developed, integrated and received into the student's educational programme and how these skills impacted on various aspects of their educational and clinical experience. BACKGROUND: The development of an academic writing style is seen to be an integral skill that the student must be willing to learn and undertake within higher education settings. Academic styles of writing have been imported into nursing education as a consequence of its integration into higher education. I wanted to investigate the experiences of learning an academic style of writing for students early on in their nursing career. There is little, if any, research that seeks to investigate or measure these experiences of nursing students. METHODS: A phenomenological approach to investigate the academic writing experiences of a group of preregistration students. FINDINGS: There is an expectation that preregistration students will quickly acquire academic writing skills when most will have had little or no prior experience. There appeared to have been little emphasis placed on facilitating the development of these skills in the educational programme. The lack of emphasis and support proved to be problematical for these nursing students. The emergence of a theory-practice divide also figured strongly. Students were, however, able to appreciate the need and place for academic writing skills and most were able to identify the structural processes that were integral to acquiring such skills. CONCLUSION: A plethora of anecdotal evidence, supported by the findings in this study, suggests that most nursing students' struggle with the demands placed upon them when writing academic assignments. The need for greater emphasis and support throughout the whole period of training are highlighted in the findings of this study. It is known that nursing loses large numbers of its students to the academic rigors of its educational programmes. Where this is the case, the findings of this study support the need for nurse educationalists and curriculum planners to revise and reform the way that they approach and deliver the demands of an academic style of writing with their students.     

Administrative substance. A mentoring experience

Leadership is an essential skill that must be passed on to the next generation of nursing leaders, if nursing is to continue to flourish. While some may argue that leadership ability is innate, certain acquired skills can enhance one's leadership abilities. Additionally, opportunities and appropriate experiences are essential to the development of effective leadership potential. The purpose of this article is to present a method of mentoring that allows the new academician to gain valuable leadership experience. This method encompasses an advanced doctoral student working with and under the leadership of an experienced nursing academic leader. The mentorship program attempts to fill the gap for needed leadership and administrative experiences in the academic setting among doctoral students and new doctoral graduates.     

Practice nurses experiences of mentoring undergraduate nursing students in Australian general practice

Internationally, the delivery of health services has shifted from secondary to primary care, necessitating an exponential growth of the nursing workforce and expansion of the nursing role in general practice. This growth, and the subsequent need to develop this workforce, has created a need to expose undergraduate nurses to general practice nursing as a viable career option. Concurrently, universities are struggling to find sufficient clinical places for their undergraduate students to gain clinical experience. It is logical, therefore, to increase the number of undergraduate nursing student placements in general practice. Through qualitative research methods, this paper seeks to explore the experiences of practice nurses mentoring undergraduate students on clinical placements within the general practice setting. Findings are presented in the following three themes: (1) Promoting Practice Nursing: We really need to get students in, (2) Mentoring future co-workers: Patience and reassurance, and (3) Reciprocity in learning: It's a bit of a two way street, which show the benefits of such placements. Clinical placements in general practice settings can be mutually beneficial in terms of providing quality teaching and learning experiences for students. Conversely, the experience provides an impetus for practice nurses to maintain currency of their clinical skills and knowledge through mentoring student nurses.     

Professionalism dilemmas experienced by health professions students: a cross-sectional study

ABSTRACT

Health professions students will invariably confront professionalism dilemmas. These early encounters significantly influence future professional attitudes and behaviours. Heretofore, studies concerning professionalism dilemmas experienced by health professions students across disciplines have been limited. To address this issue, we recruited 56 students with clinical experience from the National Taiwan University College of Medicine in the nursing, dentistry, pharmacy, medical technology, occupational therapy, and physiotherapy programs to participate in this research to compare health professions students’ understandings of professionalism and their experiences of professionalism dilemmas. We used group interviews to uncover students’ experiences of professionalism dilemmas. We identified the six most commonly reported professionalism dilemmas and found that interprofessional dilemmas were the dominant workplace professionalism dilemma for health professions students. We also identified significant disciplinary differences regarding dilemma types and frequencies. We employed the framework of dual identity development to better understand the role of professional and interprofessional identities in interprofessional dilemmas. The professionalism dilemmas that individual students encountered were shaped by disciplinary differences. Our findings suggest that the development of a sense of belonging to both their own profession and a broader interprofessional care team in health professions students can increase the effectiveness of interprofessional healthcare teams.     

Practices of caring for nursing students: A clinical learning environment

ObjectiveThe purpose of this study was to explore, describe and illuminate nursing students’ best encounters of caring in the clinical learning environment. Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment.MethodsQualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry (AI) methodology. Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council (SANC) were purposively sampled from 3 private hospitals within the Western Cape. Data was analysed using Giorgi’s method.ResultsThe main theme included the best and ‘least best’ caring practices embedded in the centrality of the heart. The subthemes comprised of the nursing students’ experiences of caring literacy and caring illiteracy. The second theme included the creation of best caring practices within a conducive clinical learning environment. Within this theme, the subthemes comprised of the caring attributes required in reflecting best caring practices, as well the creation of a clinical learning environment to optimise caring.ConclusionsThe significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants. Caring was equated to the heart as the core to the nursing students’ being. Recommendations for nursing education, management, practice and research were therefore specifically formulated to enhance caring towards nursing students.     

A guide to nursing students' written reflections for students and educators

Experiences from the clinical setting are ideal for building critical thinking skills if reflection is used as a teaching tool. Reflective writing is the purposeful and recurring inspection of thoughts, feelings, and occurrences that coordinate with experiences during practice. Reflecting on clinical experiences develops critical thinking ability, fosters self-understanding, facilitates coping, and leads to improvement in clinical practice (Kennison, 2006). Reflective writing allows students to combine clinical experiences and takeaways with didactic material to better understand both practice and instruction. Reflective writing is defined as an assignment that is focused on students’ experiences, like textbook readings, clinical experiences, or group activities, that highlights what the student has taken from the activity (McGuire et al., 2009). This study will explore reflective writing from the perspective of the nursing student and the nurse educator. The following questions will be answered: What are the benefits of reflective writing? Why would nurse educators want to use reflective writing in their nursing courses, both clinical and didactic? What are the barriers to using reflective writing for students and educators? What is the role of the nurse educator in student reflection?