Teaching spiritual care – a grounded theory study among undergraduate nursing educators

Aims and objectives. To explore teachers’ understanding of spirituality and how they prepare undergraduate nursing students to recognise spiritual cues and learn to assess and provide spiritual care. Background. Nursing education addresses patient care in all domains of the person. Systematic teaching and supervision of students to prepare them to assist patients spiritually is an important part of holistic care. However, few role models for spiritual care are seen in clinical practice, and limited research addresses necessary student competencies or how teachers can best facilitate this process. Design. Grounded theory was used to identify teachers’ main concern and develop a substantive grounded theory. Methods. Data collected during semi‐structured interviews at three Norwegian University Colleges in five focus groups with 19 undergraduate nursing teachers were conducted from 2008 to 2009. Data were analysed through constant comparison of transcribed interviews until categories emerged and were saturated. Results. The participants’ main concern was ‘How to help students recognize cues and ways of providing spiritual care’. Participants resolved this by ‘Journeying with Students through their Maturation’. This basic social process has three iterative phases that develop throughout the nursing programme: ‘Raising Student awareness to Recognize the Essence of Spirituality’, ‘Assisting Students to Overcome Personal Barriers’, and ‘Mentoring Students’ Competency in Spiritual Care’. Conclusion. Nursing education should prepare students to recognise and act on spiritual cues. Making spiritual assessment and interventions more visible and explicit throughout nursing programmes, in both classroom and clinical settings, will facilitate student maturation as they learn to integrate theoretical thinking into clinical practice. Relevance to clinical practice. Nursing students need role models who demonstrate spiritual care in the fast‐paced hospital environment as well as in other clinical practice settings. To model spirituality as part of nursing care can assist students to overcome their vulnerability and to safeguard ethical issues and promote patient integrity.     

Supervising nursing students administering medication: a perspective from registered nurses

Aims. To explore the attitudes, experiences and opinions of registered nurses regarding supervision of undergraduate nursing students while administering medication in the healthcare setting. Background. Medication errors present a considerable risk to safety in the healthcare setting. By virtue of their role in the administration of medication, registered nurses are considered as major contributors to this problem. Undergraduate nursing students administer medication in the clinical setting, but little attention has been paid to the implications for patient safety. Design. This research was conducted using exploratory qualitative methodology. Methods. Focus group interviews were conducted with 13 registered nurses. The participants were asked to describe their experiences and opinions regarding the supervision of undergraduate nursing students. Data were analysed using the framework approach. Results. Three main themes from this work are presented in this paper: ‘standard of supervision’, ‘a beneficial experience’ and ‘preparation’. Conclusions. The participants regarded supervision as an important process in fostering student learning and ensuring safety. Preparation on the part of the healthcare facility, students and the university were essential to maximise the benefits for all concerned. Relevance to clinical practice. The ability to administer medication safely is an important skill for all registered nurses. Nursing students need the opportunity to develop these skills as part of their undergraduate educational programme. Registered nurses must supervise students in a rigorous and supportive manner to enhance learning and to promote quality care.     

How can we maximize nursing students’ learning about research evidence and utilization in undergraduate,preregistration programmes? A discussion paper

Aim. This article presents a discussion on how to maximize nursing students’ learning about research for evidence‐based practice in undergraduate, preregistration programmes. Background. Evidence‐based practice may use information from many sources, including research. Research utilization concerns the translation of research findings into practice. Thus, while evidence‐base practice may not be solely research‐based and hence more than research utilization, research remains an important ingredient in ensuring quality and cost‐effective care and an academic requirement for nursing students undertaking a science degree‐level qualification. Nevertheless, how educators can best support research‐related learning and application remains uncertain and requires discussion. Data sources. MEDLINE, CINAHL, Social Science Citation Index, British Nursing Index, and Intute were searched for papers published 1980–2011 using the following search terms: research, research utilization, evidence‐based practice, learning, teaching, education, training, nursing, health, and social care. Discussion. Nursing students need to be able to value the relevance, authority, and utility of nursing research for patient care through embedding research learning in both academic and practice‐based settings. Students can be supported in learning how to access, understand, and appraise the authority of research through weaving these skills into enquiry‐based learning. Furthermore, encouraging students to undertake research‐based practice change projects can support research utilization and development skills. Conclusion. Research should be fully embedded throughout nursing curricula beyond the confines of ‘research classes’, integrating learning in academic and practice‐based settings. Although this requires synergistic and integrated support of student learning by nurse educators, managers, clinical practitioners, researchers and policymakers; nurse educators have a pivotal role.     

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.     

Student nurses' experiences of caring for infectious patients in source isolation. A hermeneutic phenomenological study

Aim. To illuminate issues central to general student nurses’ experiences of caring for isolated patients within the hospital environment, which may assist facilitators of learning to prepare students for caring roles. Background. Because of the development of hospital‐resistant micro‐organisms, caring for patients in source isolation is a frequent occurrence for supernumerary students on the general nursing programme. Despite this, students’ perceptions of caring for this client group remain under researched. Design and methods. Through methods grounded in hermeneutic phenomenology, eight students in the second year of the three‐year undergraduate programme in general nursing were interviewed using an un‐structured, open‐ended and face‐to‐face interview approach. Data analysis was approached through thematic analysis. Results. Four themes emerged: The organization: caring in context, Barriers and breaking the barriers, Theory and practice, Only a student. The imposed physical, psychological, social and emotional barriers of isolation dramatically alter the caring experience. Balancing the care of isolated patients to meet their individual needs while preventing the spread of infection has significance for students. Applying infection control theory to the care of patients in source isolation is vital for students’ personal and professional development. Perceptions of supernumerary status influence students’ experiences of caring for these patients. Relevance to clinical practice. Designating equipment for the sole use of isolated patients assists students in maintaining infection control standards. Balancing the art and science of caring for patients in source isolation is important to reduce barriers to the student–patient relationship and to promote delivery of holistic care. Staff nurses should consider using available opportunities to impart recommended isolation practices to students thereby linking the theory of infection control to patient care. Providing structured, continuing education for all grades of staff would acknowledge the interdependence of all healthcare workers in controlling hospital‐acquired infection.     

Undergraduate nurse students' perspectives of spiritual care education in an Australian context

BackgroundThe Australian Nursing and Midwifery Accreditation Council competency standards highlight the need to provide holistic care that is inclusive of spiritual care. Literature shows that internationally many nurses feel unsure of how to provide spiritual care which has been attributed to a lack of spiritual care education during undergraduate nursing programs.AimThis study explores the impact of a spiritual care subject in an undergraduate nursing program in an Australian tertiary institution.MethodQualitative research design using in-depth semi-structured interviews.SettingA tertiary institution with a Christian orientation in Sydney, Australia.ParticipantsSix undergraduate nursing students who had completed the spiritual care subject.Data ResultsTwo themes emerged from the data: Seeing the person as a whole and Being with the person.ConclusionsThe spiritual care subject had a positive impact on the perceptions of undergraduate nursing students. In particular students perceived themselves more prepared to provide holistic care that was inclusive of spiritual care.     

Spiritual care: implications for nurses' professional responsibility

Aim. This paper aimed to gain insight into the spiritual aspects of nursing care within the context of health care in the Netherlands and to provide recommendations for the development of care in this area and the promotion of the professional expertise of nurses. Background. International nursing literature suggests that caregivers are expected to pay attention to spiritual aspects of patient care. In Dutch nursing literature, the spiritual dimension is increasingly becoming a focus of attention. Despite this, there is a lack of empirical data from professional practice in the Netherlands. Method. Data were collected by means of focus group interviews. The sample was made up of the specialist fields of cardiology, oncology and neurology and divided into groups of patients, nurses and hospital chaplains. The interviews took place between May and December 2004. Data were qualitatively analysed using the computer programme Kwalitan. Results. Different spiritual themes emerged from the interviews. There were different expectations of the nurse's role with regard to spiritual aspects. The main themes derived from this research can be recognized as aspects of nursing competencies that are reported in the literature. However, the attention to spiritual aspects in the nursing process is not clear cut. It seems to be highly dependent on personal expression and personal commitment. Conclusions. The study raises questions about the nurse's professional role in spiritual care. The study shows that different factors (personal, cultural and educational) play a role in the fact that spiritual care is not structurally embedded in nursing care. Further research on the impact of that variable is recommended. Relevance to clinical practice. Nursing care implies care for the spiritual needs of patients. To provide this care, nurses need to be knowledgeable regarding the content of spiritual care and the personal, professional, cultural and political factors influencing it. They also need to be able to participate in policy and decision‐making discussions of spiritual care in clinical nursing practice.     

The diversity of Iranian nursing students' clinical learning styles: A qualitative study

BackgroundNumerous factors, including learning styles, affect the learning process of nursing students. Having insights about students' learning styles helps promoting the quality of education. The aim of this study was to explore the Iranian baccalaureate nursing students' learning styles in clinical settings.MethodsA qualitative design using a content analysis approach was used to collect and analyze data. Semi-structured interviews were conducted with fifteen Iranian baccalaureate nursing students selected using a purposive sample method.FindingsDuring data analysis, it was found that nursing students employed different clinical learning styles such as ‘thoughtful observation,’ ‘learning by thinking,’ and ‘learning by doing’.ConclusionStudents adopt different learning strategies in clinical practice. Designing teaching strategies based on students' learning styles can promote students' learning and maximize their academic and clinical practice success. Nursing educators, curriculum designers, and students can use the findings of this study to improve the quality of nursing education in both the classroom and clinical settings.     

Acute care teaching in the undergraduate nursing curriculum

Aim:  To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
Background:  Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
Practice development initiative:  An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
Conclusions:  Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
Relevance to clinical practice:  The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.     

Undergraduate student nurses’ perspectives of an integrated clinical learning model in the mental health environment

Providing nursing students with appropriate clinical practice during their undergraduate programme is critical to ensuring that graduates meet the competency requirements to gain registration as a nurse. In response to the predicted nursing workforce shortage, universities have been significantly increasing the enrolment of undergraduate nurses into Bachelor of Nursing courses. This has placed a demand on the availability of clinical placements and often universities struggle to find appropriate places. In this study, a Bachelor of Nursing course incorporated an Integrated Clinical Learning Model (ICLM) for the first time during a mental health placement. The model offered students the flexibility of attending their clinical placement over a 16‐week period instead of a traditional block of 4 weeks. The aim of this study was to evaluate the student perspective of this model and whether it prepared them for the nursing workforce. Focus groups were conducted with undergraduate nursing students following their mental health clinical placement at an acute and extended care inpatient unit. Data were analysed using thematic analysis. Main themes included preparedness for practice, maintaining a work–life balance, and perceiving they were part of a team. The ICLM deepened students’ knowledge and had a positive impact on their overall clinical learning.     

Using gaming workshops to prepare nursing students for caring for older people in clinical practice

mclafferty e., dingwall l. & halkett a. (2009)   Using gaming workshops to prepare nursing students for caring for older people in clinical practice. International Journal of Older People Nursing   5 , 51–60
doi: 10.1111/j.1748-3743.2009.00176.x
Background.  Older people are the least satisfied with the care they receive when they are acutely ill. Furthermore, within nurse education, nursing older people has been submerged rather than embedded in the acute focus of nursing curricula. Lecturers designed a 1-day gaming workshop to stimulate interest in nursing older people.
Aim.  To explore the influence of gaming workshops on undergraduate nursing students' learning about nursing older people.
Methods.  Both quantitative and qualitative methods were used. A survey questionnaire was distributed pre- and postgaming workshops to a cohort of second year nursing students ( n  = 100, 86% response rate). Students ( n  = 9) were invited to participate in a semi-structured interview on completion of their placement.
Findings.  Responses were significantly more positive for the questionnaire postworkshop when compared with the responses of preworkshop. Five themes were identified from the interviews, they included teacher interaction; level of student engagement with the topic; the effect of the teaching method; influence of the workshops on practice; working with older people.
Implications for practice.  Nursing students preferred this novel teaching method to lectures. They learned about appropriate and relevant care of older people, however, they seem to struggle to apply concepts related to caring for older people in the acute settings.     

Nursing students’ knowledge,attitude and readiness to work for clients with sexual health concerns

Aims. To investigate nursing students’ knowledge, attitude and readiness to work for clients with sexual health concerns and to identify strategies to help students develop as they take up their role in sexual health‐related care. Background. There is an increasing global demand for improving sexual health. A better understanding of nursing students’ attitude and readiness to work for clients with sexual health concerns is the beginning of this endeavour. The need to explore strategies for developing competent health care practitioners is timely. Design. A cross‐sectional survey. Methods. Nursing students (n = 377) studying in pre‐ and postregistration programmes were surveyed at a university in Hong Kong using a questionnaire with open‐ and closed‐ended questions about their knowledge, attitude and self‐perception on readiness to work for clients with sexual health concerns. Results. Students’ knowledge of sexual health was satisfactory. They were positive in acknowledging the nursing role in sexual health care, but hesitant in taking up an active role in practice. Students’ readiness to participate in related activities was below satisfactory. Their perception of inadequate knowledge, feelings of anxiety, worries about colleagues’ and clients’ possible adverse responses and inadequate exemplars were major factors affecting their readiness. This paper also highlighted some important learning areas and strategies that could help in enhancing students’ knowledge and confidence in sexual health care practices. Conclusion. Improving the educational programme and clinical practice for nursing students is necessary but may not be adequate. Valuing the affective aspect of education, formal recognition of this extended role and advancing related education to a postexperience level would also benefit the development of sexual health care. Relevance to clinical practice. Preparing more mentors as exemplars, inviting clinicians and managers as partners in sexual health‐related care would help nursing students to work efficiently for clients with sexual health concerns.     

Care home nursing: Co-creating curricular content with student nurses

BackgroundMeeting the complex care needs of an ageing population is a global issue and long term care settings, such as care homes, play an essential role. However, there is a crisis in the recruitment of registered nurses within care homes. Higher educational institutions have a critical part to play in addressing the crisis in recruitment in care homes and it is argued that student nurses can have a significant role to play in co-creating curricular content responsive to population need.ObjectiveTo co-create curricular content on care home nursing with student nurses.DesignCo-creation through collaborative enquiry and a three stage thematic analysis.SettingUndergraduate, preregistration nursing programme in a university in the United Kingdom.ParticipantsStudent nurses from Years One to Four undertaking a Bachelor in Nursing with Honours degree.MethodsSix focus groups and two one to one interviews.ResultsFindings revealed predominantly negative attitudes towards care home nursing. Teaching and practice placements appeared to play a minor role in shaping students' attitudes but rather, gave the unspoken message that for the acquisition of necessary knowledge and skills, care homes were less important than other settings. Most students were initially averse to care home nursing as a career choice. During focus groups/interviews, views shifted from seeing care homes as places where you ‘lose clinical skills’ to places where there is ‘a lot of responsibility’, and also a potentially rewarding career choice. From this attitudinal shift, students made suggestions for developing better curricular content and more positive learning opportunities.ConclusionsA co-creative framework can create a space for mutual learning between students and staff about challenges and opportunities for equipping nurses to meet the needs of ageing populations. Student nurses are open to learning about care home nursing as part of their education and keen to have a more positive exposure.     

本科实用型护理人才临床能力期望的调查研究

目的 调查不同群体对本科实用型护理人才临床能力的期望状况.方法 采用本科实用型护理人才临床能力期望问卷,对护理管理者、临床带教教师、本科学历护士、本科实习学生、护理院系专职教师、临床医生进行问卷调查,分析本科实用型护理人才应具备的临床能力,并比较不同群体的差异.结果 临床处置能力和沟通能力排在前两位,科研能力排在最后一位.不同群体对临床能力的重要性评价存在一定差异,护理管理者对管理能力和职业素养的评分较高,学生对观察病情、发现护理问题、制订护理方案等的评分低于带教教师.结论 临床处置能力和沟通能力是本科实用型护理人才被期望具备的首要能力,应引起护理管理者和护理教育者的重视.     

护生对生活护理情感体验的研究

目的了解护生对生活护理的情感认知情况及其心理体验。方法采用质性研究中的现象学研究方法,按照目的性抽样法选择福州市某三级甲等医院护理大专、本科实习生14名进行深入访谈,并用现象学分析法进行资料分析。结果得到2个主题:护生对生活护理认知不足,护生对生活护理体验具有多样性。结论护生执行生活护理,可提高临床实践动手能力、观察能力和培养职业情感,因此生活护理的专业教育和培训亟待开展,且要高度关注生活护理意识的养成。     

The impact of empirical studies of spirituality and culture on nurse education

Aims and objectives. The aim of this paper is to share reflectively how my empirical studies on spirituality and culture have had an impact upon nurse education. Background. Spirituality and cultural dimensions of care are considered to be integral to holistic care. The healing potentials of spiritual and cultural care are well documented. The commitment to the research programme came due to the concern within early literature on nursing that the provision of spiritual care for patients is inadequate. Methods. The research programme used action research comprising largely qualitative approaches. As the holistic and multiperspective nature of spirituality and culture requires a multidisciplinary approach and flexibility of methodology, various research techniques were used. Results. The findings from the research programme led to the development of theories, models and conceptual literature on spiritual and cultural care. In particular, two models evolved from the studies: the ASSET for spiritual cares education and training and the ACCESS for transcultural care practice. The critical incident studies provide insights into nurses’ roles in spiritual care interventions. The phenomenological study highlights that chronically ill patients use spiritual strategies in coping with their illness. Conclusion. Overall, the paper offers a body of evidence that has an impact upon curriculum development in nurse education and nursing practice. Relevance to clinical practice. The ASSET model offers a framework for spiritual care education. The ACCESS model offers a framework for transcultural care practice. The critical incident studies map out nurses’ roles in spiritual and cultural care with scope for development of care intervention models for the future. The coping mechanisms study highlights how patients use spiritual coping strategies such as prayer and other resources to cope with their chronic illnesses.     

Preparing nurses for practice: a phenomenological study of the new graduate in Australia

Aims. To explore the expectations of final year nursing students before they start employment and to describe the experiences of newly graduated nurses during their first six months of employment as registered nurses. Background. Nursing shortages are at crisis point world wide with registered nurses leaving the profession at a high rate and changing occupations. Thus, there is a need to reflect on new graduate nurses experiences in relation to retention and support. Design. Husserl’s phenomenological approach was used to gain insight and understanding into the lived experiences of new graduate nurses. Methods. Students enrolled in a Bachelor of Nursing programme at an Australian University were interviewed in their final semester and during employment in the hospital setting. Semi‐structured interviews were used to gather data from 13 participants. Data were collected at three intervals: prior to commencing employment, one month and six months postemployment and the results were analysed thematically. Results. As students, the participants held positive perceptions surrounding their impending role as a registered nurse and what it would encompass. However, after one month of employment, it became apparent that nursing comprised of a culture that embraced cliques which excluded them. The graduates were unprepared for ‘bitchiness’ and the limited amount of assistance with unfamiliar tasks they received from registered nurses. Participants also found rotating to different wards recreated the feelings they experienced on commencing employment. Conclusions. Nursing curricula should prepare new graduates for foreseeable stressors and oppressive practices so that graduates can become proactive in preventing and responding to factors such as silence and aggression. Moreover, nursing courses need to ensure that socialisation issues are addressed to assist in the eradication of oppressive practices. Finally, organisations need to address socialisation issues such as hostility within the workplace to address the attrition of new graduates from the profession. Relevance to clinical practice. Individuals in clinical practice settings need to be cognisant of the significant role that experienced registered nurses and nurse unit managers occupy in the socialisation of new graduate nurses. Additionally, there needs to be increased awareness that nursing culture can influence recruitment and retention of new graduates. Further, health care organisations need to evaluate the benefits of new graduates rotating through clinical areas in the first 12 months of employment.     

Strengthening the nursing and midwifery unit manager role: an interim programme evaluation

clarke e., diers d., kunisch j., duffield c., thoms d., hawes s., stasa h. & fry m. (2012) Journal of Nursing Management 20, 120–129
Strengthening the nursing and midwifery unit manager role: an interim programme evaluation Aims An interim evaluation was conducted on the professional development components of the New South Wales (NSW) Health ‘take the lead’ (‘ttl’) programme, an initiative aimed at enhancing nursing/midwifery unit managers’ (N/MUM) skills. Background Previous research has highlighted the importance of strong nurse leaders, and shown that training programmes may assist in improving leadership skills. The NSW Nursing and Midwifery Office (NaMO) developed the ‘ttl’ programme for N/MUMs with the intention of improving hospital quality by strengthening nurse leadership. The programme had three strands, with the professional development modules a key component. Method Semi-structured interviews were conducted with 17 participants who had completed components of the ‘ttl’ programme. The interviews explored participants’ perceptions of the programme, and suggestions for improvement. Qualitative analysis was conducted on the transcribed interviews. Results The N/MUMs reported feeling increasingly empowered, knowledgeable and supported as a result of attending the ‘ttl’ workshops. Conclusions The results suggest that the studied components of the ‘ttl’ programme may be effective in assisting nurse leaders gain new leadership skills and institute positive changes in the nursing work environment. Implications for Nursing Management Leadership programmes such as ‘ttl’ may provide an effective tool for improving N/MUM performance and role confidence.