An integrative literature review of pre-registration nursing students’ attitudes and perceptions towards primary healthcare

BackgroundThere is a renewed focus on the role of primary healthcare within the health system due to an ageing population, increasing cost of acute healthcare services, and an emphasis on developing healthier communities. Associated with this focus is the need for an increase in primary healthcare workforce capacity. Despite this, primary healthcare is rarely prioritised within the pre-registration nursing curricula. By understanding the perspectives and experiences of student nurses regarding clinical placement in primary healthcare, educators and industry will be better informed to support the student nurse within this setting.AimThe aim of this integrative literature review was to identify the established knowledge regarding the attitudes, perceptions and experiences of student nurses attending clinical placement within primary healthcare.MethodsA search of electronic databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pubmed, Proquest, Informit, Scopus, Clinical Key and Google Scholar was undertaken. The review included papers over a 10 year period; January 2007 to December 2017. Quality evaluation was undertaken using a Mixed Methods Appraisal Tool and the selected papers were then analysed thematically.FindingsAnalysis identified two interrelated themes. The first theme primary healthcare clinical experience is comprised of three sub themes; learning on placement, context of care, and support on placement. This theme discusses students understanding of primary healthcare practice and learning. The second theme attitudes towards primary healthcare also comprises three sub themes including focus on acute care, usefulness of placement, and autonomy in practice. This theme highlights the varied perspectives and attitudes pre-registration student nurses hold towards nursing within primary healthcare and their clinical placement experience.ConclusionStudent nurses are reported to have both positive and negative attitudes towards primary healthcare nursing. Despite this, clinical placement within primary healthcare is generally well received by the student nurse. To support student nurses in their learning within primary healthcare, it is essential to offer both theoretical content and clinical experiences which address preconceptions and attitudes towards the setting.     

A thematic literature review of innovative strategies to prepare nursing students for aged-care

BackgroundThe exponential rise in people living longer but requiring residential care is adding pressure to already overstretched aged care nurses. Consequently, a person-centred care culture in residential care remains aspirational, rather than a reality. For nursing students in Australia and elsewhere, clinical placements in aged care facilities are under-utilised due to negative perceptions about the likelihood for learning. Creative strategies to engage students to safely challenge ageist thinking and to inspire enthusiasm for learning in this context are needed.ObjectivesThe purpose of this thematic review of the literature is to better understand challenges related to learning in aged care settings and identify innovative strategies to enhance nursing student learning experiences in residential aged care placements.Review methodsA literature review was undertaken in 2019 using CINAHL, PUBMED, Elsevier, Medline, ProQuest and Google Scholar. The search was limited to papers that were peer reviewed, in English, and published between 2001 and the date of review (mid-2019) in order to situate the review in the new millennium.Results47 articles and books were included in the review that introduce solutions and innovative strategies that could be used to improve students' attitudes to learning in aged care and from older people. The literature review was categorized into three main themes, including: barriers to working with older people; the need for pedagogical change to foster empathy; and innovative strategies to address barriers.ConclusionThese themes are useful to consider in designing engaging learning and teaching for nursing students to be effective in working in aged care.     

Exploring undergraduate nursing students' perceptions of working in aged care settings: A review of the literature

ObjectivesTo explore undergraduate nursing students' perceptions of working in the aged care setting through a review of the literature.DesignA review of available literature relating to undergraduate nursing students' attitudes, perceptions and experiences in the aged care setting, or in the care of older adults.Data sourcesCINAHL Plus with Full Text was the primary database used. Other databases include PsycINFO and Health Source: Nursing/Academic Edition.Review methodsStudies focused on undergraduate nursing students and their experiences in the aged care setting and on the perceptions and attitudes of nursing students toward older adults, were included. Studies that did not present an original study or those that did not meet the aim of the study were excluded from the review.ResultsFollowing removal of duplicates and exclusion of articles not meeting the aim of this paper, 24 articles remained. Three main themes emerged from the review of the literature: perceptions of aged care placement, attitudes to working in aged care, and experiences in aged care.ConclusionThe experiences of nursing students employed as undergraduate AINs in the aged care setting can provide an immersive clinical learning experience in preparation for their new graduate (NG) year. Furthermore, it is an opportunity to challenge ageist attitudes and instil core nursing values in novice nurses such as promoting compassionate care.     

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.     

Undergraduate community health nursing education in a neighborhood settlement house.

Undergraduate community health nursing faculty are continually challenged to find appropriate clinical placements. Prior to using an inner-city neighborhood settlement house as a clinical site, traditional public health and home-care agencies provided clinical placements for senior baccalaureate nursing students. The settlement house had several programs but did not have a traditional nursing department. A 14-item questionnaire was developed to examine student (N = 30) perceptions of the opportunities for course objectives to be met and student attitudes and beliefs regarding the settlement-house placement. The majority of the students agreed that the learning experiences at the settlement house provided opportunities to meet course objectives. Findings indicated that students who considered the neighborhood safe are more apt to recommend the clinical placement to other students (p < .01). Those students who believe that professional nursing services can help improve the health of people who live in the inner city are more apt to say, "This experience changed my beliefs regarding people who live in an inner-city neighborhood" (p < .01).     

Undergraduate nursing students' attitudes towards incarcerated persons and their perceptions of clinical experiences

BackgroundIn 2019, an estimated 6.3 million persons were under the supervision of the United States adult correctional systems and one in 40 adult persons were under correctional supervision. At year-end of 2019, nearly seven in ten persons under correctional supervision were supervised in the community. A nurse's attitudes and beliefs about incarcerated persons may influence their behavior.PurposeThe purpose of this study was to examine nursing student's attitudes towards incarcerated persons and their perceptions of a clinical experience at a correctional facility.MethodsData from 137 nursing students were collected through a cross-sectional, electronic survey. The Attitude Towards Prisoners Scale (Melvin et al., 1985) was used. A post hoc analysis of perceptions of their clinical experience at a correctional facility was explored.ResultsThe mean scores of 93 and 94 (potential range of scores 0 to 144) suggest positive attitudes towards incarcerated persons exist, yet few nursing students report an interest in correctional nursing as a career. Although few (n = 5) students had a correctional nursing clinical experience, most perceived it as an effective clinical learning setting.ConclusionWith high rates of incarceration, the researchers recommend that baccalaureate nursing programs include educational teaching strategies that focus on incarceration, incarceration stigma, and explore clinical learning experiences.     

Examining the impact of virtual clinical on prelicensure nursing students’ pediatric knowledge

BackgroundClinical site closure during a pandemic along with the already limited pediatric clinicalplacements challenged educators to develop virtual pediatric clinical experiences. This paper aims toshare a pediatric virtual clinical innovation and retrospectively evaluate its impact on undergraduatepediatric nursing student knowledge.MethodA quasi-experimental natural design was used to retrospectively evaluate a virtual clinicaleducational innovation at one mid-sized, Midwest university. The first half of a student cohortcompleted traditional face-to-face clinical experiences. Simulation and commercially available productswere used to create a 100% pediatric virtual clinical experience for the other half of a student cohort. Course and standardized exam scores were used to measure student learning across the two groups.ResultsFindings suggest virtual clinical, as a replacement for traditional clinical, did not negatively impact students pediatric nursing knowledge.ConclusionsThe results of this natural experiment can support future discussions about pediatric nursing clinical education.     

An international exploration of blended learning use in pre-registration nursing and midwifery education

AimTo explore international experiences of using blended learning in preparing nursing and midwifery students for initial professional registration to inform future education policy.BackgroundThe global nursing and midwifery skills shortage and need for an expanded nursing workforce that is fit for contemporary care delivery is widely acknowledged. The immense pressure the profession was already under because of austerity, staff shortages and increasingly complex healthcare needs has been worsened by the Covid-19 pandemic. The UK is extending and evaluating the use of blended learning programmes for pre-registration nursing and midwifery students to help address these issues. This study sought to explore relevant nursing and midwifery experiences from outside the UK to help inform future health professional education policy here and elsewhere.DesignCross-sectional, sequential, mixed methods studyParticipants/settingsNursing/nurse education leaders from across International Council of Nurses regionsMethodsExploratory online survey (n = 32) and three follow-up case studies (March-May 2021). Participants’ knowledge and experiences of blended learning were examined along with any perceived benefits for workforce development and successful strategies for addressing the challenges blended learning presents in this context. Case studies were developed inductively from survey responses and follow up telephone calls to provide more detailed information about reported successes.ResultsParticipants reported flexibility, cost effectiveness, increased student/tutor and student/student communication and interaction as benefits of blended learning. Challenges included the design and use of interactive learning resources, appropriate preparation and support for staff and students, the potential of blended learning to exacerbate otherwise hidden disadvantage and the need for multi-stakeholder cost/benefit evaluation.ConclusionsBlended learning is used globally in the pre-registration education of nurses, midwives and other healthcare professionals. These results broadly mirror the literature regarding the benefits blended learning offers healthcare students, staff and organisations and the strategies employed to mitigate risk. As the deployment of blended learning nursing and midwifery programmes expands, further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach. These concern adequate preparation and support of students and staff, ensuring access to appropriate equipment and connectivity, exploration of student perceptions that online learning is of lesser value and comprehensive multi-stakeholder, exploratory evaluation to uncover any hidden factors and impact.Tweetable abstractBlended learning plays an effective part in the education of pre-registration nursing and midwifery students to help tackle global workforce shortages, but further work is needed to address gaps in the current evidence base regarding the practice and impact of this approach.     

Virtual reality simulation: using three-dimensional technology to teach nursing students

The use of computerized technology is rapidly growing in the classroom and in healthcare. An emerging computer technology strategy for nursing education is the use of virtual reality simulation. This computer-based three-dimensional educational tool simulates real-life patient experiences in a risk-free environment, allows for repeated practice sessions, requires clinical decision making, exposes students to diverse patient conditions, provides immediate feedback, and is portable. The purpose of this article was to review the importance of virtual reality simulation as a computerized teaching strategy. In addition, a project to explore readiness of nursing faculty at one major Midwestern university for the use of virtual reality simulation as a computerized teaching strategy is described where faculty thought virtual reality simulation would increase students' knowledge of an intravenous line insertion procedure. Faculty who practiced intravenous catheter insertion via virtual reality simulation expressed a wide range of learning experiences from using virtual reality simulation that is congruent with the literature regarding the barriers to student learning. Innovative teaching strategies, such as virtual reality simulation, address barriers of increasing patient acuity, high student-to-faculty ratio, patient safety concerns from faculty, and student anxiety and can offer rapid feedback to students.     

Interprofessional education as a method to address health needs in a Hispanic community setting: A pilot study

Abstract

The Hispanic population in and around Richmond, Virginia, USA, has grown rapidly since 2000. The Richmond City Latino Needs Assessment emphasized this growth and also reported concerns regarding healthcare access. Schools of medicine, pharmacy, and nursing at Virginia Commonwealth University have partnered together with community organizations to develop and implement an interprofessional student service learning pilot program to meet community needs and provide an opportunity for enhanced learning. Community events allowed students to work on interprofessional teams to provide healthcare screenings and education to the Hispanic community. The program was evaluated by the use of a community service survey. Results indicated improved perceptions of student comfort with working with diverse patients, working on teams, and patient-centered care, as well as statistically significant improvements in student understanding of health care access and barriers, community needs, and social determinants of health. Results suggest that this community-based service-learning interprofessional experience was critical in student learning.     

Integrating technology in skills lab: Using smartphones for urinary catheter validation

Nurse educators are challenged to promote student success in all learning environments. Historically, students had increased anxiety associated with poor outcomes for indwelling urinary catheter skill validation. Faculty were looking for alternative ways to reduce stress, improve learning, and achieve successful student skill validations.The purpose of this process change project was to implement and evaluate an innovative teaching strategy of a psychomotor skill. Specifically, the integration of smartphone technology, self-evaluation, and peer feedback on indwelling urinary catheter skill validation was implemented and student perceptions of this strategy were evaluated. Throughout two, four-hour skills lab sessions, 81 students in the second semester of a baccalaureate program in nursing participated in peer pairs where they used smartphones to video and refine their indwelling urinary catheter skills through self-reflection and peer feedback.Students reported the utilization of technology and peer feedback positively enhanced learning and “decreased anxiety”. However, students agreed integrating technology into a psychomotor skill validation was not without challenges. However, the benefits outweighed the challenges providing implications for nursing education to use smartphones to evaluate a psychomotor skill as a strategy to integrate technology, self-reflection, and peer feedback into a clinical skills lab environment.     

Nursing students' reflections on the learning experience of a unique mental health clinical placement

IntroductionThere exists a need for innovative thinking to identify new clinical placement opportunities for nursing students. Recovery-based clinical placements for mental health nurse students remain unique and require investigation.AimTo examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp.DesignThis study incorporated qualitative analysis of written reflections. Using Braun and Clarke's (2006) six phases of thematic analysis the corpus of student reflections were reviewed by three members of the research team independent to each other.FindingsFour themes emerged. The theme of Pre-placement Expectations incorporates participant foci on pre-conceptions of Recovery Camp. The theme of Student Learning incorporates the ways in which participants recognised the experience of Recovery Camp influenced learning. Reflections themed under the title Placement Setting include discussion of the Recovery Camp as a clinical placement. The theme of Future Practice incorporates students' reflections on how they plan to practice as nurses as a result the learning experiences of Recovery Camp.ConclusionsAn immersive clinical placement such as Recovery Camp can influence students' perceptions of people with mental illness, have a positive impact on student learning and influence students' decisions about future practice. The learning experience of nursing students whom attend unique, recovery-orientated clinical placements can be both positive and educative.     

"Me and my computer": emotional factors in online learning

This study focused on nursing student perceptions of sense of community in the online classroom. Using qualitative analysis of data gathered from five student focus groups, themes related to the affective domain in online learning were identified: aloneness, anonymity, nonverbal communication, trepidations, and unknowns. This article provides detailed examples of student experiences under each theme and suggests that greater attention to the affective domain is needed, particularly in asynchronous online learning. Pedagogical strategies that foster a sense of community in online courses between students and faculty enhance cognition through affective engagement of students. Strategies for instructors are given.