Reflect and learn together - when two supervisors interact in the learning support process of nurse education

berglund m., sjögren r. & ekebergh m. (2012) Journal of Nursing Management 20, 152–158
Reflect and learn together – when two supervisors interact in the learning support process of nurse education Aim To describe the importance of supervisors working together in supporting the learning process of nurse students through reflective caring science supervision. Background A supervision model has been developed in order to meet the need for interweaving theory and practice. The model is characterized by learning reflection in caring science. A unique aspect of the present project was that the student groups were led by a teacher and a nurse. Method Data were collected through interviews with the supervisors. The analysis was performed with a phenomenological approach. Results The results showed that theory and practice can be made more tangible and interwoven by using two supervisors in a dual supervision. The essential structure is built on the constituents ‘Reflection as Learning Support’, ‘Interweaving Caring Science with the Patient’s Narrative’, ‘The Student as a Learning Subject’ and ‘The Learning Environment of Supervision’. Conclusion The study concludes that supervision in pairs provides unique possibilities for interweaving and developing theory and practice. Implications for nursing management The supervision model offers unique opportunities for cooperation, for the development of theory and practice and for the development of the professional roll of nurses and teachers.     

Developing a collaborative preceptor program involving registered nurses, student nurses and faculty.

This paper addresses a collaborative preceptorship program involving a group of undergraduate nursing students, their registered nurse preceptors employed on the paediatric ward of an acute care hospital, and academic staff from a university school of nursing. The project utilised a fourth generation evaluation model, adapted from action research methods, which comprised a series of parallel focussed group discussions with a registered nurse preceptor group and a student nurse group. During the project, members of the two groups explored the issues around the supervision of students in practice in an acute paediatric context. This resulted in the development of innovative approaches to the supervisory practices utilised by preceptors. It also highlighted the benefits of collaboration between universities and hospital staff in developing preceptorship programs which respond appropriately to the needs of both preceptors and students.     

‘Teaching on the Run’ with Australian midwives in a tertiary maternity hospital

Teaching On The Run (TOTR) is an Australian program for health professionals involved in clinical supervision. An amended TOTR program was evaluated with midwives acting as preceptors assisting learners integrate theory with clinical practice. A mixed method study was employed to compare midwives' perceived skills and confidence before and after completion of TOTR workshops. A secondary aim explored midwifery learners' (students and new graduates) perceptions of support from preceptors during the implementation of TOTR. Sixty five midwives completed the TOTR workshops with 46 providing data before program enrolment and 1–3 months after completion of the final TOTR workshop. Significant improvements were found for midwifery preceptors with before and after comparisons using Preceptor Self-Efficacy and Self-Evaluation Questionnaires. Using the Nursing Facilitator Clinical Questionnaire, preceptees or midwifery learners (n = 49) scored the ‘qualities of their preceptors’, ‘their clinical practice’, ‘clinical learning’ and ‘how feedback was provided’ highly with no changes between 2013 and 2014. Nineteen students then participated in three focus group interviews, analyzed using a six step systematic process. One overarching theme, ‘Guiding me through’ emerged with four themes: ‘Getting to know each other’; ‘Willingness to share knowledge’; ‘Leading by example’; and ‘The system acknowledging and valuing the preceptor role’.     

Continuing education for urology nurses: harnessing the potential of e‐learning

The module ‘Living with cancer of the lower urinary tract' was developed to address the learning needs of specialized urology nurses working in hospitals and generalist nurses caring for urology patients in practice settings. The module is also offered to oncology nurses undertaking specialist postgraduate education. The module is delivered by a ‘blended learning’ approach and supported by the technology offered on the Blackboard Learning System (Version 9·1), a virtual learning environment that facilitates the delivery of on‐line and flexible learning. While a number of challenges were faced during the module development and delivery, the positive benefits of collaborative working between university and expert nurse clinicians, and shared learning between urology and oncology nurses was evident.     

Caring behaviours and stress perception among student nurses in different nursing programmes: A cross-sectional study

Caring is central to providing high-quality nursing. Little research exists concerning the relationship between caring behaviours and stress perception among student nurses. This study aimed to explore this relationship among student nurses in different nursing programmes. A sample of 792 student nurses from three nursing education programmes in one academic institution completed Chinese versions of the Caring Behaviors Scale and the Nurse Stress Checklist to assess participants' caring behaviour and psychosocial responses to work-related stress, respectively. We found a statistically significant negative correlation between caring behaviour and stress perception among participants. The three most frequently reported caring behaviours were related to ‘knowing the patient’: (a) recognising that each patient holds unique values, (b) taking a patient's chief complaints seriously, and (c) stating that the family's best interests should be respected regarding health decisions. Completion of work, time limitations, and lack of personal interactions were sources of stress. Nursing education curricula involve the fundamentals of caring and the preparation of nursing students for clinical practice. The study recommends that nursing faculty and administrators should educate students in stress management in order to foster, support, and promote caring behaviours among nursing professionals.     

Existential aspects of living with addiction - part II: caring needs. A hermeneutic expansion of qualitative findings

Aim. This paper aims to describe caring needs associated with existential aspects of living with addiction. Background. Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing. Design. Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction. Method. This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background. Results. The themes presented are: meaning – meaninglessness, connectedness – loneliness, life – death, freedom – adjustment, responsibility – guilt, control – chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability. Conclusions. When caring for patients suffering from addiction nurses should address patients’ spirituality. The caring communion is vital, as it is the foundation for meeting the patients’ needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others. Relevance to clinical practice. Understanding and being able to identify patients’ caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient’s recovery.     

Plugging a hole and lightening the burden: a process evaluation of a practice education team

Aim. To investigate the perceptions of clinical and senior managers about the role of practice educators (PEs) employed in one acute hospital in the UK. Background. Producing nurses who are fit for practice, purpose and academic award is a key issue for nurse education partnership providers in the UK. Various new models for practice learning support structures and new roles within health care institutions have been established. To sustain funding and policy support for these models, there is a need for evaluation research. Design. A process evaluation methodology was employed to determine the current value of a practice education team and to provide information to guide future direction. Methods. Data were collected through semi‐structured telephone interviews using a previously designed schedule. All senior nurse managers (n = 5) and a purposive sample of Clinical Managers (n = 13) who had personal experience of and perceptions about the role of PEs provided the data. Interview notes were transcribed, coded and a thematic framework devised to present the results. Results. A number of key themes emerged including: qualities needed for being a successful practice educator; visibility and presence of PEs; providing a link with the university; ‘plugging a hole’ in supporting learning needs; providing relief to practitioners in dealing with ‘the burden of students;’ alleviating the ‘plight of students;’ and effects on student attrition. Conclusions. Findings provided evidence for the continued funding of the practice educator role with improvements to be made in dealing with stakeholder expectations and outcomes. Relevance to clinical practice. In the UK, there still remain concerns about the fitness for practice of newly Registered Nurses, prompting a recent national consultation by the professional regulating body. Despite fiscal pressures, recommendations for further strengthening of all systems that will support the quality of practice learning may continue to sustain practice learning support roles.     

Supporting bachelor of nursing students within the clinical environment: Perspectives of preceptors

Student learning in the clinical environment is a cornerstone of pedagogy for students undertaking a Bachelor of Nursing in Australia.MethodThis paper presents the results of a survey that was conducted with registered nurses who preceptor students for universities in Australia.FindingsFindings reveal that some preceptors do not hold the qualification they are preceptoring students to obtain, that university involvement in preparation of preceptors is scant and that resource provision and communication from universities to preceptors is considered problematic. Registered nurses choose to act as preceptors for reasons that are both altruistic and professional. They are often employed in senior positions and as such find it difficult to manage time and resolve role conflict.ConclusionThis paper concludes that the registered nurses who preceptor students generally have a positive experience but require greater involvement by universities in their preparation, particularly when they are responsible for the direct assessment of students. The paper posits this may be best achieved by universities creating effective lines of communication and ongoing support. This will sustain collaborative and meaningful engagement with registered nurses who preceptor undergraduate students.     

Nurses' use of tuition waivers: one university's experiences.

Although the nursing literature documents the benefits of collaboration between academic and practice settings, the benefits of rewarding clinical preceptors and their organizations has not been examined. In Fall 1996, a large urban public university in New England implemented a program awarding tuition waivers to individual preceptors and clinical agencies who had made significant contributions to the education of nursing students. Three years after implementation, the program was evaluated to determine the extent nurse preceptors and clinical agencies used tuition waivers to assist nurses to enroll in a degree-granting program. Slightly more than one third (36.6 per cent) of the 82 vouchers awarded for a course waiver of tuition and fees were used by 24 nurses. Of the 24 nurses, 12 (50 per cent) were matriculating in the University degree-granting program when they used the voucher. Only one nurse, however, who took her first course on the campus with a voucher, subsequently enrolled in the graduate nursing program during the study period. J Prof Nurs 17:147-150, 2001.     

Nursing the clinic vs. nursing the patient: nurses' experience of a day hospital chemotherapy service

Aims and objectives. This study sought to explore the nurses’ experience of a day hospital chemotherapy service in an acute general hospital in Northern Ireland and how this compared with their experience of working in an inpatient setting. Background. Despite the many changes taking place in cancer care delivery, little research has been conducted on nurses’ experience of working in more acute cancer treatment settings. Research conducted to date has tended to focus on the role of nurses in wards, hospices and palliative care settings. Design. This Heideggerian hermeneutic phenomenological study explored nurses’ lived experience of day hospital chemotherapy service. Method. Face‐to‐face focused in‐depth interviews were conducted with the total population of nurses who worked in the day hospital at the time of data collection (n = 10). Data analysis involved a two‐staged approach, the analysis of narratives and narrative analysis, based on the work of Polkinghorne (1995) . Conclusions. The nurses’ viewed their experience of the chemotherapy day hospital as having both positive and negative dimensions. The positive dimensions included an increased sense of autonomy and the challenge of developing new skills, while the negative dimension included a perceived decrease in their caring role: (i) The individual characteristics of the nurse were seen to have a key influence on caring experience; (ii) Role changes led to a perceived dichotomy between their actual and aspired role and their caring and clinical role. Relevance to clinical practice. There is a need to achieve a balance between delivering a clinical role (administering chemotherapy) while maintaining the centrality of the nurse–patient relationship. This can be likened to achieving a balance between ‘nursing the clinic’ alongside ‘nursing the patient’. These findings have implications for the discourse on caring within other outpatient type clinics and discourse on cancer nursing as therapy and the culture of the cancer clinic.     

Nursing students’ evaluation of clinical learning environment and supervision in a Norwegian hospital placement – A questionnaire survey using CLES+T scale

AimThe clinical learning environment and supervisor-student relationship play vital roles in the learning outcomes of nursing students. The aim of this study is to evaluate nursing students’ experiences with the clinical learning environment and supervision in a hospital placement organised with a dual preceptor team – preceptors holding dual positions both in the clinic and the nursing faculty in addition to the standard one-to-one supervision by a clinical preceptor.DesignThe study is a paper-based survey based on a validated questionnaire developed and tested in hospital settings in various European countries, including Norway.MethodThe Norwegian version of the CLES+T Evaluation Scale, was distributed to all second-year students in three different years (2015–2017) at a nursing faculty.ResultsA total of 61% students (n = 261) returned the questionnaire. Overall, the students considered that their hospital placement provided a good clinical learning environment. The results suggest that the dual preceptor team on top of one-to-one supervision did not interfere negatively with the clinical learning environment Nevertheless, the dual preceptor model did not compensate for a poor relationship with the clinical preceptor. Thus, the association between a reported ‘strained relationship’ with the clinical preceptor and low scores on the CLES+T, reported on by other studies, remained in our data.ConclusionsTo better grasp the complexity in this area, various methods are needed, such as in-depth interviews with students, nurse teachers and clinical preceptors. Further studies need to elaborate on students’ experiences of clinical learning environment according to how supervision is organised.     

Embodied reflection in practice—‘Touching the core of caring’

Ranheim A, Kärner A, Arman M, Rehnsfeldt AW, Berterö C. International Journal of Nursing Practice 2010; 16 : 241–247
Embodied reflection in practice—‘Touching the core of caring’ A study was performed with the aim of clarifying the integration of the caring act of touch with reflection on caring theory. Seven participant nurses in elderly care volunteered as ‘coresearchers’ and performed a caring act called Rhythmical Embrocation, together with reflective dialogues on caring theory. The project lasted for 6 months and at the end qualitative interviews with participants were used to evaluate the study. The findings showed an opening of awareness, embodied moments of presence and an extended ability to act creatively in caring. In this study, the movement between theory and practice was the integration of the caring act with reflection on basic caring concepts. Implications for praxis development are that implementation and reflection by teams over certain caring acts might open the door to an expanded view of one's own caring ability that in the long run will benefit the patient.     

Revisiting caring science: some integrative ideas for the ‘head,hand and heart' of critical care nursing practice*

Aim: This paper introduces the notion of ‘Caring science’ as a way to delineate and develop particular kinds of knowledge relevant to caring practices in critical care. Relevance for practice: Firstly, one particular development of person centred care, lifeworld led care is offered. Its relevance for critical care nursing is analysed by pointing to examples of studies which describe temporality, spatiality, intersubjectivity and embodiment and how they may manifest with reference to the person as ‘body object/body subject' and the matter of technology in critical care environments. Secondly, by use of an imagined practice scenario, the challenge of expanding our traditional notions of evidence to encompass ways of knowing that are more intimately embodied and practice related is discussed. Such knowledge, referred to as ‘embodied relational understanding’ is particularly relevant to a conception of caring for persons' in a holistic way. Conclusion: The paper concludes by pointing to the potential for caring science, grounded in lifeworld led care, to offer some integrating ideas that legitimate the full range of resources, ‘head’, ‘hand’ and ‘heart’, that nurses can draw upon in everyday holistic critical care practice.     

Expectations and experiences of group supervision: Swedish and Norwegian preceptors’ perspectives

Aim The aim of the present study was to describe preceptors’ expectations and experiences of participating in group supervision (GS). Background The challenging role of preceptors and their need for support is well known. Therefore, a collaborative project was carried out, providing GS to preceptors to strengthen them in their role. Method Data were collected from 48 preceptors by means of study-specific forms and field notes, and analysed using qualitative content analysis. Results Both positive and negative expectations and experiences of group supervision were found, but the positive experiences exceeded the expectations. The group in itself had a significant meaning for the preceptors; their pedagogical and personal competence increased and they became aware of their role as ‘bridge-builders’. Conclusions Using GS to strengthen preceptors in their role was found to be successful. The findings provided new arguments for this model as a reflection tool. Implications for nursing management Strengthened preceptors can have an impact on nursing students’ learning, and thereby also on future nurses’ competence, which is a great concern of nurse managers. By using nurse lecturers as group leaders, the collaboration between the clinical placements and the nursing faculties can be improved.     

Readiness to Practice Indicators: Accelerating New Graduate Nurses Toward Independent Practice

Academic institutions and hospitals want the same outcomes: safe, practice-ready nurses, but each use different tools to evaluate practice-readiness. Successful transition-to-practice programs aimed at closing the academic gap require thoughtful and actionable collaboration between academic and practice settings with consideration of using mutual evaluation tools. Readiness to Practice Indicators (RPIs) are an evidence-based tool intended as a determinant for independent practice that synthesizes the scope and standards of nursing practice with a focus on how to manage a patient assignment. RPIs have been used with new graduate nurses since 2016 and now are being used as the performance evaluation tool shared by academic and hospital organizations in a new Student Readiness to Practice Program. Participating academic institutions, hospitals, and community organizations have agreed to use the RPI evaluation tool across settings. Future research will evaluate whether early exposure to RPIs in the senior practicum accelerates the transition of new graduate nurses into productive staffing and increases retention and satisfaction among new nurses and preceptors.