Promoting stigma self-awareness in nursing students through brief unconventional clinical experiences

Background: Literature reflects nursing student bias toward stigmatized groups. This article describes nursing students’ clinical experiences at a human immunodeficiency virus (HIV) community clinic, a state maximum-security carceral facility, and an HIV service-learning university campus project. Approach: Brief and unconventional experiences focused on linking cultural diversity concepts to stigma self-awareness in clinical settings and improving patient-centered care. The faculty implemented current recommendations to promote awareness of bias and stigmatizing behavior. Students’ experiences were first-person, participatory, and interactive. Students completed reflections and clinical evaluations focusing on thoughts, feelings, and awareness of bias, thereby bridging the gap of stigmatized populations and nursing practice. Conclusion: Associate degree nursing students participated in clinical learning environments with stigmatized populations. Students rated the clinical learning experiences as positive and meaningful in addressing stigma and bias. The brief clinical experiences align with the current National League for Nursing best practices to reduce stigma and promote bias awareness.     

Lived experience of medical veterans transitioning from military service to civilian nursing education

BackgroundMany veterans take advantage of the educational benefits afforded them after service. As veterans, students in higher education are a special population with subsequent needs.PurposeThe purpose of this study was to explore the lived experience of medic student veterans attending a full-time Bachelor of Science in Nursing (BSN) program.MethodThis study used the hermeneutic phenomenology research approach to explore the lived experiences of student veterans with military medic experience enrolled in a Bachelor of Science in Nursing (BSN) program.ResultsWhile our study revealed diverse student experiences among these veterans, common themes included staying true to military training, normal life, and fitting in as a university student.ConclusionsFindings in this study substantiate medic student veterans attending nursing school represent a unique cohort which can benefit from customized services from the university.     

“Everybody’s Scrutinizing You”: Perspectives of Inclusion among Black and Hispanic Nursing Students

BackgroundDespite increased focus on diversity and inclusion in nursing education, there remains an underrepresentation of Black and Hispanic nurses in the United States.PurposeThe purpose of this qualitative study was to explore student perceptions of the School of Nursing's diversity and inclusion recruitment/retention initiatives and the perceived impact of exclusion on their academic success.MethodsPhenomenological methodology was employed to elicit Black/Hispanic student lived experiences/perceptions of inclusion. Participants were recruited from the SON in a large public university using a snowball approach. Participant interviews were conducted via telephone and recorded.Data AnalysisThe thematic analysis of the interviews revealed three key themes: being singled out; importance of representation; and importance of curriculum integration.ConclusionThis study highlighted the need for teaching strategies to promote inclusivity among marginalized diverse nursing students to improve recruitment and retention in the profession.     

Nursing Students' Experiences Related to Operating Room Practice: A Qualitative Study

PurposeThe purpose of this study was to examine the experiences of nursing students concerning operating room (OR) practice.DesignA qualitative design was used in this study.MethodsData were collected from second-year nursing students using the semistructured interview form including open-ended questions about their OR experiences. Perspectives of phenomenological approach including existentials of lived body, lived relations, lived space, and lived time were used in data analysis.FindingsThe study data regarding experiences of nursing students concerning OR practice were organized under three themes, namely, “OR environment,” “emotions,” and “career plans after graduation.” Nine subthemes emerged: educational experience, teamwork, and communication, excitement, enjoyment, anxiety, fear, different emotions, working as a surgical nurse, and working in departments other than OR.ConclusionsIn clinical environments, student nurses should be supported by staff and instructors to facilitate learning and create meaningful learning experiences.     

Choosing Midwifery − The perceptions and experiences of Black,Asian and Minority Ethnic applicants to midwifery programmes: A mixed methods study

Aimto explore recruitment to UK midwifery programmes from the perspective of applicants from Black, Asian and Minority Ethnic (BAME) groups and describe the perceptions and experiences of the application process for these applicants and those from white backgrounds.BackgroundMidwifery in the Global North is an overwhelmingly white profession. This lack of diversity has been cited as a factor in the poorer outcomes experienced by women from non-white backgrounds. There is a need for midwifery programmes to recruit and support more ethnically and racially diverse cohorts if this situation is to be addressed. Very little is currently known about the recruitment experiences of midwifery applicants.DesignA mixed methods study comprising a survey and individual interview or focus group. The study was conducted between September 2020 and March 2021 in three universities in South East England. Participants comprised 440 applicants to midwifery programmes and 13 current or recently qualified BAME midwifery students.FindingsAlthough many survey findings in respect to choosing a midwifery programme were broadly similar between candidates from BAME and non-BAME backgrounds, some trends were noted. More BAME applicants cited school/college rather than family as encouraging. More BAME applicants also indicated that they would consider issues of diversity when selecting a place of study, and BAME respondents appeared less likely to consider location and university life. Survey and focus group findings combined may indicate deficits in social capital available to BAME midwifery applicants. Focus group findings in particular suggest multiple experiences of challenge and inequity at all stages of the application process, together with a perception that midwifery is a niche and white profession. Applicants value proactive support from universities and would appreciate increased diversity, opportunities for mentorship and an individualised approach to recruitment.ConclusionsBAME applicants to midwifery can face additional challenges which have an impact on their ability to secure a place. There is a need to reposition midwifery as an inclusive and welcoming option for people from all backgrounds and to develop equitable recruitment processes that value a range of skills and life experiences.     

Impact of rubric weight on holistic admissions for underrepresented students in nursing

IntroductionRecommendations to address US health inequities include increasing nursing workforce diversity. Holistic admissions review (HAR) is a strategy to increase underrepresented student admission. This study's purpose was to evaluate HAR's effect on the cohort's racial composition and the effect of adjusting criteria weight on overall rubric scores.MethodsA retrospective design was used to evaluate data for three admission cycles for an associate degree in nursing program. Racial groups were compared on individual criterion, domain, and overall scores before and after weight adjustment.ResultsStudents who identified as Asian had the highest admission rate (50%), followed by White (40%), Filipino (30%), Latino/a/e (26%), and Black (10%). However, when criterion weight was adjusted, there were no significant racial differences.DiscussionIntegrating imbalanced HAR criteria produced admissions outcomes similar to non-HAR. Qualified underrepresented students are often disqualified when biased academic metrics are used as the primary basis for admissions selection.     

Giving while grieving: Racism-related stress and psychological resilience in Black/African American registered nurses

BackgroundStudies have found race-related stress psychologically and physiologically harms members of stigmatized racial groups. However, the stressor is racism, not race.PurposeThis study examined the relationship between racism-related stress and psychological resilience in Black/African American nurses.MethodThis study used a cross-sectional, quantitative, correlational design with two instruments, an investigator-developed demographic questionnaire and a convenience sample.FindingsParticipants perceived they have low psychological resilience in stressful situations. With racism-related stress, in particular, participants perceived they are affected by both lived and vicarious racism – ruminating over past occurrences, and expecting/worrying that racism will happen to them or other Black/African American people. There was a significant positive correlation between participants’ perceived psychological resilience, their ability to assess the nature of the racism-related stressor and their ability to mitigate its harmful effects by identifying and utilizing their coping resources. There was a negative correlation between racism-related stress and psychological resilience.DiscussionThere is a need for continued research on racism-related stress among Black/African American nurses. Further, healthcare organizations, advisably through their diversity, equity and inclusion (DEI) programs, must develop systemic approaches to meeting the unique needs of the Black/African American workforce.     

Chiropractic and osteopathic students' perceptions of readiness for transition to practice: The educational value of university clinic vs community and private clinics*

ObjectiveThe objective was to determine final-year students'' self-perceptions of readiness for transition to practice, professional identity, and experiences of interprofessional clinical practice. Findings will inform the clinical education curriculum.MethodsWe used repeated measures individual case studies with a self-selecting sample from the total final-year student population at 2 chiropractic and 2 osteopathic programs offered by Australian universities. Cases were not compared. Amalgamated data are presented.ResultsThere were interviews with students in 2 chiropractic programs (n = 15) and 2 osteopathic programs (n = 13). Perceptions indicate that clinical education in university health clinics prepares them for transition to practice through scaffolded supervision of their consultations with reasonably healthy patients. Students perceived that other clinics (community clinics or private practices) prepared their readiness for transition to practice substantially better. Community clinics and private practices allowed students to consult people from diverse socioeconomic and cultural backgrounds and treat complex health care issues, and the model of supervision allows students a degree of autonomy. Students lacked a clear understanding of the behaviors that demonstrate their professionalism. Interprofessional learning activities were ad hoc and opportunistic.ConclusionUniversity health clinics, private practices, and community clinics prepare students for transition to practice in different ways. Most students feel prepared. There is a clear indication that a focused discussion related to the development of students'' understanding of competencies related to professionalism and another related to interprofessional clinical education in curriculum are needed.     

Us and them: The experience of international nursing students engaged in team based learning: A qualitative descriptive study

BackgroundInternational students report multiple challenges adjusting to educational settings. Instructional strategies such as Team Based Learning (TBL), could provide international students with opportunities that promote academic success, language skills and social connectedness. However, little is known about international students' experience of TBL. The aim of this study was to explore culturally and linguistically diverse (CALD) students' experiences of TBL.MethodsThis paper reports on a qualitative study that explored the experiences of 15 international students enrolled in an Australian university nursing program, where TBL is used.ResultsFindings indicate that TBL promotes language proficiency and respectful intercultural connections. It also uncovered an unintentional benefit of TBL in interrupting racism towards international students from domestic students. However, it is not enough to rely on TBL to mitigate the impact of racial and cultural power dynamics in educational settings.ConclusionTo improve international student experiences, educators must actively engage students in dialogue about privilege and structural racism as it relates to international students and other people of colour.     

Nurse educators’ experiences of fostering undergraduate students’ ability to manage stress and demanding situations: A phenomenological inquiry

AimTo understand the lived experience of nurse educators when mitigating nursing students’ stress and fostering their ability to manage demanding situations.BackgroundSupporting and advocating for nursing students during their stressful and challenging times is one of the core competencies of nurse educators. Much of the research has focused on understanding nursing students' views and experiences of managing their stress. No research could be found to have explored the role and contribution of nurse educators in managing student well-being and supporting them during demanding situations.DesignA hermeneutic phenomenology was conducted in Pakistan. The COREQ guidelines were followed for reporting.MethodsSemi-structured interviews were conducted from February to May 2021 with a purposive sample of 13 nurse educators with atleast a bachelor's degree in nursing or a three-year diploma with one-year specialization and at least three months of teaching experience in educational or clinical settings. Data were analyzed using Ricoeur’s interpretation theory. The three steps included: (a) explanation, (b) naïve understanding and (c) in-depth understanding.ResultsSix themes captured educators’ experience: Sharing personal experiences, developing a trustworthy relationship, creating a stress-sharing culture, demonstrating stress management, encouraging to speak up and confront and prompting management to address student issues. Policymakers and management should collaborate with educators to strengthen existing mechanisms and revisit the policies directed toward supporting students in managing their clinical and academic stress.ConclusionsNurse educators should continue to play their part by creating a stress-sharing culture, sharing personal experiences and enhancing student stress management abilities by teaching through demonstration and building their courage to speak up for their issues. Nursing institutions should develop policies to expand nurse educators’ role in supporting student stress management. Institutions also need to collaborate with educators to establish mechanisms and resources to mitigate student stress.     

How organisational processes influence assessors’ experiences of marginal students’ performances in clinical assessments

BackgroundCompetence assessment has become the accepted modality of assessing practice based disciplines, such as nursing. However, assessment of clinical competence remains a challenge for assessors.AimThis study sought to describe assessors’ experiences of grading undergraduate students’ performances in clinical courses when that performance is marginal; not a clear pass or fail.MethodsFourteen semi-structured interviews and two focus groups were undertaken with university employed assessors from a pre-registration bachelor of nursing programme at a multi-campus Australian university.FindingsThematic analysis identified two distinct theme themes from the textual data: ‘human influences’ and ‘organisational processes’. The first theme of human influences was reported elsewhere. ‘Organisational processes’, including three emerging themes:time demands and pressures; assessment processes and learning and teaching practices, were identified as key impacts on assessors’ experiences of grading student clinical performances and is addressed in this paper. The impact of organisational policies and processes on the assessor around workload, teaching and learning practices and assessment processes were significant to assessors.DiscussionTertiary assessment processes were found to significantly influence, both in a positive and negative manner, assessors’ experiences of grading student performances in clinical courses. Provision of a holistic approach to clinical assessment that includes robust assessor support measures should be developed and implemented to enhance student success and assist assessors to meet their professional responsibilities.ConclusionTertiary institutions play a key role in supporting effective and meaningful assessment of clinical programme components. Through understanding the significance of the organisations’ role, key stakeholders can start to examine and enact measures to bolster the enabling factors and reduce the barriers to assessing student performances that are not a clear pass or fail.     

Implementing service improvement projects within pre-registration nursing education: A multi-method case study evaluation

BackgroundPreparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations.AimThe study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum.MethodA multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach.ResultsStudents were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff.ConclusionService improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential.     

Discourse tensions: Professional socialisation into nursing within the university education system

Starting university brings expectations of new experiences and a good social life (Morton and Tighe, 2011), however student nurse experience may not mirror these expectations. The aim of this study was to identify any indications of ‘differentness’ expressed in students talk, track development and changes in student language over the duration of their programme, and explore how language might situate lecturers and students within a professional socialisation process.Using Discourse Analysis (Potter and Wetherell, 1987), interviews (n = 17) were conducted with 8 lecturers and 7 volunteer student nurses multiple times over 3 years (April 2013 – August 2016). Analysis uncovered three discourse tensions, each showing resonance with students and their lecturers: The university student and the student nurse; The Nursing and Midwifery Council registrant and the lecturer; Student nurses as consumers of their university education.Students did not appear to align themselves with the university after experiencing clinical practice, and lecturers' language attempted to position students away from traditional student experiences to protect professional standards.     

Effects of weight bias training on student nurse empathy: A quasiexperimental study

AimThis study aimed to identify the efficacy of weight bias training on the empathy skills of student nurses when working with a person with obesity.BackgroundWeight bias with nurses harboring negative attitudes towards patients with obesity results in inferior care and patients' reluctance to seek medical care. Empathy is a communication skill used in nursing to build trust and rapport with patients to provide optimal patient-centered care.MethodsThis study used a quasi-experimental design with 121 undergraduate nursing students in their first semester of the nursing program. The students completed learning activities on weight bias, including reading an article on weight bias, watching a video showing an individual with obesity's experiences in the healthcare setting and participating in a group discussion and reflection on the article and video. In addition, students completed the Jefferson Scale of Empathy-Health Professions Students’ version before and after the learning activities. Following the learning activities, students participated in a simulation activity with a standardized patient wearing an obesity suit. The standardized patient completed the Jefferson Scale of Patient Perceptions of Nurse Empathy to rate the patient's perception of the nursing student's level of empathy based on their interactions in the simulation scenario.ResultsA comparison of the scores on the Jefferson Scale of Empathy-HPS showed there was not a significant difference in the scores before learning activities (M = 15.45, SD = 12.7) and post-learning activities (M = 15.94, SD = 11.5); t(120) = 0.476, p = .635. Data analysis identified significant changes in empathy scores on the Jefferson Scale of Empathy-HPS in the accelerated second-degree cohort with differences in scores before learning activities (M = 113.7, SD = 10.5) and post-learning activities (M = 116.5, SD = 13.4); t(50) = 2.02, p = .049. The traditional cohort did not have a significant change in empathy scores. Empathy scores and the patient's perception of empathy scores showed no relationship. Most (79 %) of the patient's perception of empathy scores was moderate. Student comments in this study support the findings that some nursing students harbor weight bias towards individuals with obesity.ConclusionThere is a need to identify learning activities that eliminate weight bias in the nursing student population and result in the student's ability to demonstrate appropriate communication skills and nursing behaviors in a nondiscriminatory manner to the patient with obesity. To improve empathy behaviors, students should practice communication skills throughout the nursing curriculum.     

Self-efficacy and concerns of nursing students regarding clinical experiences

BackgroundIt is important for nurses to provide safe, high-quality care for patients, and clinical experiences allow nursing students to integrate theory into practice. However, many students have anxiety about clinical rotations.ObjectivesThe concerns of nursing students about clinical experiences and factors relating to self-efficacy in a rural Bachelor of Science in Nursing (BSN) program were examined.DesignThis was a mixed-methods study, and students were surveyed prior to and at the end of their clinical experiences.SettingThe study location is a public liberal arts university in the rural, southeast United States.ParticipantsJunior level students (first and second semester) and senior level students (first and second semester) levels of BSN students participated in this project.ResultsQualitative themes were identified, including concerns regarding clinical competence, expectations of learning, aspects of patient/peer/instructor interactions, as well as learning strategies and preferences. The student's level of confidence regarding communication to patients and physicians, assessment of heart and lung sounds, interview skills, documentation, and discussion of nursing procedures increased significantly from pre to post-survey. Confidence levels in physical assessment skills rose significantly after the clinical experience (t′ = −6.3718 with 140 df, p < .001).ConclusionStrategies that nurse educators can use prior to, during, and after the clinical experience to address student concerns about clinical experiences include the use of caring, competent clinical instructors, orientation to clinical sites, laboratory and simulation days, self-reflection, peer-support, and debriefing.