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.     

Using simulation to prepare neophyte nursing students to deliver intimate patient care

BackgroundPreparing neophyte nursing students to deal with the intimate aspects of patient care including nudity and body excretions is challenging. Traditional simulation approaches that have been used to teach these skills require examination in the context of considering more realistic ways. Mask-Ed™ is a high fidelity modality of simulation that enables the educator to transform into a patient by donning silicone props such as masks and body torsos inclusive of genitalia. The hidden educator is able to coach and direct the learner throughout the simulation.AimThe aim of this study was to identify if Mask-Ed™ simulation enhanced students learning in the context of providing intimate patient care when undertaking the skills of showering and toileting.MethodsFirst year undergraduate nursing students were tasked with showering and toileting a Mask-Ed™ patient in a simulated learning situation within a laboratory context. Following the simulation students were invited to participate in focus groups. Data was recorded, transcribed and analysed using an inductive thematic analysis approach.FindingsFrom class preparation to debrief, participants experienced a safe journey of discovery enabling them to provide intimate care. The realism of the learning environment combined with the confidence students had in their educator, allowed students to overcome their nervousness and anxiety, discover the vulnerable person at the centre of their care, gain confidence and find comrades.DiscussionSimulations that provide neophyte nursing students with an opportunity to face real to life intimate care experiences should be apparent in all undergraduate nursing programs. Nursing students need not only to be prepared to implement skills around safe practice when showering and toileting patients but they also need to feel safe and confident to practice themselves.ConclusionMask-Ed™ is an effective and efficient simulation modality to teach neophyte nursing students about intimate human care.     

Nursing degree students’ clinical placement experiences in Australia: A survey design

AimThis study aimed to evaluate Australian nursing students’ views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).BackgroundClinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.DesignA survey design was used with a contemporary survey tool– the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.MethodsA total of 1263 nursing students completed the Placement Evaluation Tool (PET) − 19 items (rated 1–5), one global rating (rated 1–10) − following placement in three Australian States (July 2019−February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.ResultsThe total PET mean score was 78.3% with 29.8% being ‘extremely satisfied’ (10 out of 10 – Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.ConclusionsWhilst students’ clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.     

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.     

Peer learning partnership: an innovative strategy to enhance skill acquisition in nursing students

The development of clinical skills for nursing students is a critical component of any undergraduate nursing program. Providing sufficient quality experience for students to develop competence has been recognised as a problem in skill acquisition. At the same time, peer learning has been identified as a valuable strategy for teaching and learning. Nurse academics at a Sydney university recognized these facts and implemented a peer learning strategy into existing first and third year nursing therapeutics units of study. This innovative approach linked the Australian Nursing Council Inc (ANCI) standards of practice to skills acquisition, resulting in third year students increasing their understanding of the relevance of these competency standards to practice. The peer learning strategy involved partnering first and third year students for clinical skills practice sessions. Evaluation of the peer learning approach indicated students valued the experience.     

Undergraduate nursing curricula: Numeracy and accreditation

BackgroundNumeracy skills are essential for patient safety; therefore, it is vital that registered nurses are proficient in performing calculations, notably medication calculations. However, the literature indicates that a large proportion of undergraduate nursing students and registered nurses are not competent in numeracy. The manifestation of numerical and calculation errors is thought to stem from failing to comprehend key mathematical principles from primary or secondary school, as well as the minimal admission requirements to enter nursing programs. Tertiary education providers teach and assess numeracy within nursing programs using a diverse range of pedagogical and instructional approaches. These programs of nursing study are underpinned by the Australian Nursing & Midwifery Accreditation Council standards, and lead to nursing registration in Australia. These accreditation standards do not incorporate numeracy, placing the onus on the tertiary education providers to design content and assessment types, as well as establish a benchmark to gauge the competence of the student prior to graduating.QuestionWhy the Australian Nursing & Midwifery Accreditation Council does not require graduates to demonstrate numeracy proficiency, and why there are no recommendations for undergraduate numeracy content and assessment in Australia.MethodAn exploratory sequential mixed methods design across 5 stages will be used.FindingsNo data has been collected to date.DiscussionNo discussion has been written to date.ConclusionTo contribute knowledge to improve the competence of undergraduate nursing students in relation to numeracy education, and ultimately the safety of Registered Nurses when calculating medications in practice.     

Validating the Nurse Professional Competence Scale with Australian baccalaureate nursing students

BackgroundProfessional competence is necessary to enhance patients’ quality of care and safety, however not much is known about nursing students’ perceptions of their professional competence at the point of graduation, particularly in the Australian context.AimTo validate the Nurse Professional Competence (NPC) Scale in the Australian context and explore graduating nursing students’ perceptions of their own competence and their suggestions to improve their learning experience.MethodA cross-sectional survey incorporating the NPC Scale was conducted with nursing students at the point of graduation at one large Australian University.ResultsFifty-six graduating nursing students completed the NPC Scale. Scale reliability measured via Cronbach’s alpha was 0.96. Almost 80% of students felt confident with their nursing skills and felt that the nursing program had prepared them for a graduate position as a registered nurse. Students reported their highest competence was in Value-based Nursing Care (m = 89.4) and Documentation & Administration of Nursing Care (m = 86.7), and the lowest were Development, Leadership & Organisation of Nursing Care (m = 80.9) and Care Pedagogy (m = 83.0). Students’ most common suggestion to improve the learning experience was to provide additional clinical workplace experience.DiscussionThe NPC Scale demonstrated excellent reliability in the Australian context. The areas that scored highest and lowest on the NPC were congruent with findings using this instrument in other countries.ConclusionFurther validation of the NPC Scale should include a larger sample that includes both graduating nursing students from multiple universities as well as registered nurses and incorporates confirmatory factor analysis.     

Preparing the nursing student for internship in a pre-registration nursing program: Developing a problem based approach with the use of high fidelity simulation equipment

AimThis paper aims to explore the development and evaluation results of a simulated skills package designed using a problem based learning approach with general nursing students.BackgroundInternationally, the use of high fidelity simulated learning environments has escalated. This has occurred as a result of growing concerns relating to patient safety, patient litigation, lack of clinical opportunities for student nurses to gain experience and integration of new teaching methods into nursing curricula. There are however both proponents and opponents to the value of simulation and high fidelity simulation within nursing education.MethodsThis study was conducted in an Irish school of nursing. A simulated learning support package was developed by nurse educators and piloted with 134 third year nursing students. This was evaluated using a questionnaire in which 87 students responded.FindingsStudents generally found the simulation sessions realistic and useful in developing clinical skills, knowledge and confidence for clinical practice. However student issues regarding support with preparation for the session were highlighted. Also, the need for a more formalised structure for debriefing following the simulation sessions were identified.ConclusionIt is hoped that this paper will provide nurse educators with some guidance to aid future development of innovative and interactive teaching and learning strategies.     

Nursing students collaborating to develop multiple-choice exam revision questions: A student engagement study

BackgroundNursing students find bioscience subjects challenging. Bioscience exams pose particular concerns for these students, which may lead to students adopting a surface-approach to learning.ObjectivesTo promote student collective understanding of bioscience, improve their confidence for the final exam, and improve deeper understanding of bioscience.DesignIn order to address exam anxiety, and improve student understanding of content, this student engagement project involved nursing students collaborating in small groups to develop multiple-choice questions and answers, which became available to the entire student cohort.SettingsThis study was conducted at two campuses of an Australian university, within a first year bioscience subject as part of the undergraduate nursing programme.ParticipantsAll students enrolled in the subject were encouraged to attend face-to-face workshops, and collaborate in revision question writing. Online anonymous questionnaires were used to invite student feedback on this initiative; 79 respondents completed this feedback.MethodsStudents collaborated in groups to write revision questions as part of in-class activities. These questions were made available on the student online learning site for revision. An online feedback survey was deployed at the conclusion of all workshops for this subject, with questions rated using a Likert scale.ResultsParticipants indicated that they enjoyed the opportunity to collaborate in this activity, and almost all of these respondents used these questions in their exam preparation. There was strong agreement that this activity improved their confidence for the final exam. Importantly, almost two-thirds of respondents agreed that writing questions improved their understanding of content, and assisted in their active reflection of content.ConclusionsOverall, this initiative revealed various potential benefits for the students, including promoting bioscience understanding and confidence. This may improve their long-term understanding of bioscience for nursing practice, as registered nurses' bioscience knowledge can impact on patient outcomes.     

Implementing and evaluating the effectiveness of an oral health module for the bachelor of midwifery program at an Australian university

ObjectiveAlthough guidelines recommend antenatal care providers such as midwives promote oral health during pregnancy, oral health training is not routinely provided in undergraduate midwifery curricula. The aim of this study was to implement an oral health module into an Australian undergraduate midwifery program, and evaluate its effectiveness in improving the oral health knowledge and confidence of midwifery students.DesignPre-test post-test study (2015–2017).SettingAn undergraduate midwifery program within an Australian university.ParticipantsAll first-year undergraduate midwifery students enrolled in two core units at the above university (N = 56).MethodsOral health modules were implemented into each of the two core units within the first year of the Bachelor of Midwifery course. Changes in knowledge and confidence were measured using a standardised questionnaire, administered at baseline, immediately following module completion, and at 2 and 3 years following module completion.Results44 students participated in the baseline survey (79% response rate), of which 41 completed the first post-module questionnaire, 21 completed the second post-questionnaire, and 24 completed the third post-questionnaire. Knowledge scores significantly increased from baseline (mean 13.12) to follow-up (mean 17.78, p < 0.001), with increases being retained through to the 3-year mark (mean 18.29, p < 0.001). Confidence scores also showed a sustained increase following the module, particularly regarding introducing oral health in the first antenatal appointment (62.1% increase, p < 0.001) and referring pregnant women to a dentist (48.2% increase, p < 0.001). However, the 48.2% increase (p < 0.001) in confidence in conducting a visual mouth check on a pregnant woman following the module was not sustained at subsequent time points, reducing to a 31.5% increase (p = 0.118) by the third year post-module.ConclusionsThe module is effective in improving and sustaining the knowledge and confidence of midwifery students to promote maternal oral health. Ongoing updates may be required to keep confidence high regarding visual mouth checks.     

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

AimTo explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.BackgroundThe World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.DesignCross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.MethodsA cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.ResultsOf 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.ConclusionsStudents were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.     

Innovations in interprofessional learning and teaching: providing opportunities to embed patient safety within the pre-registration physiotherapy curriculum. A Pilot Study

Abstract

Background: Despite recognition of the need to embed patient safety within undergraduate healthcare education, there are limited examples of how this has been achieved within physiotherapy. The purpose of this regional initiative was to develop a course and teaching resources to support Higher Education Institutions in the United Kingdom (UK) when embedding the World Health Organization (WHO) multiprofessional patient safety curriculum into undergraduate healthcare education.

Objectives: In this pilot study, researchers assessed the impact of the interprofessional simulation-based education (IPSE) course on students’ perceptions of interprofessional learning and patient safety post-course, and explored the participants’ perceived application of knowledge and skills 3 months later.

Methods: A sequential mixed-methods evaluation was conducted, including pre- and post-course Readiness for Interprofessional Learning Scale (RIPLS) questionnaires and two course evaluation questionnaires featuring open and closed items (administered immediately post-course and 3 months later). Participants included undergraduate physiotherapy, medical, nursing, and pharmacy students.

Results: The IPSE course enabled students to develop an appreciation of each other’s professional roles and particularly their individual and collaborative practices that may positively impact upon patient safety. Post-course students reported being able to influence patient safety through an increased application of their ability to identify errors and influence their colleagues’ practices, thus impacting directly upon patient safety.

Conclusion: This paper provides an evaluation of an innovative method of providing interprofessional patient safety learning and teaching opportunities within undergraduate healthcare curricula.     

Contextualising numeracy skill development and assessment in a first year undergraduate nursing subject: A mixed methods research study

BackgroundUndergraduate nursing students continue to perform poorly on clinically-related numeracy tasks, making errors that betray fundamental misconceptions about the underlying mathematics. Graduate nurses are also prone to error in this area but they have the benefit of performing their calculations in a real-world setting with the assistance of colleague nurses if required. These conditions are difficult to simulate in a classroom environment, but when effort is made in this direction the effects can be rewarding for students and educators.ObjectivesTo investigate the effect on undergraduate nursing students' learning experience and test performance of a practical, clinically contextualised numeracy workshop featuring individual and collaborative modes of assessment.DesignA mixed methods study using pre and post tests and a survey.SettingsClinical practice classrooms at an Australian university.ParticipantsFirst year undergraduate nursing students undertaking a subject whose curriculum features medication safety and clinically-related numeracy.MethodsAdministration of individual and collaborative short-answer pre and post tests, a survey, and facilitation of team-based, clinically-related numeracy activities over a 1.5 h workshop. All test marking, data collection and analysis were performed by the authors.ResultsPositive responses to survey questions probing students' judgement of the effect of contextualised learning on their confidence, engagement and proficiency in nursing numeracy, as well as the value of working in a clinical setting. Significant improvement in students' performance in pre/post tests.ConclusionsContextualised, practical and collaborative learning and assessment of nursing numeracy is valued by students and has a positive effect on their experience and performance in the content area.     

Effects of multiepisode case-based learning (CBL) on problem-solving ability and learning motivation of nursing students in an emergency care course

BackgroundMeeting the learning needs and developing the thinking skills of nursing students in caring for injured patients with complex, emergency, and unpredictable conditions is essential.PurposeThe present study aimed to compare the effects of case-based learning (CBL) with multi-episode case studies and lecture-based learning (LBL) on the perceived problem-solving ability and learning motivation of undergraduate nursing students in an emergency care course.MethodsThis study was conducted with a quasi-experimental, within-subjects, pretest-posttest design. Forty-three third-year undergraduate nursing students (as a single cohort) enrolled in the fall semester were selected using convenience sampling. The theoretical course of emergency nursing was taught to them using the LBL method (control group) during the first six weeks of the semester and then using the CBL method (intervention group) during the second six weeks of the semester through multi-episode cases in five steps. Outcomes including perceived problem-solving ability and learning motivation were measured using the Problem-Solving Inventory (PSI) and the Instructional Materials Motivation Scale (IMMS).ResultsThere was a significant difference (P < 0.001) between the changes in the total mean score of perceived problem-solving ability and its subscales on the three measurement points, i.e. before lectures (pre-test), after lectures (mid-term test) and after CBL (final test). There was a significant difference between the LBL and CBL groups in terms of the students' total learning motivation score (t = 16.91, P = 0.000) and all its subscales after the CBL intervention.ConclusionThe study suggests that the CBL method applied through multi-episode cases is an effective approach to improving the perceived problem-solving ability and learning motivation of nursing students.     

‘Speaking up for safety’: A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis

BackgroundThe international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement.Study aimsTo elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement.DesignThe study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks.SettingSchool of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia.ParticipantsOf the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data.MethodsAn evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach.ResultsFive major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning.ConclusionsFindings indicate that teaching assertiveness skills and establishing a preparatory framework for ‘speaking up for safety’ early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.