Opening up to learning spiritual care of patients: a grounded theory study of nursing students

Aim. To determine undergraduate nursing students’ perspectives on spiritual care and how they learn to assess and provide spiritual care to patients. Background. Nursing is concerned with holistic care. Systematic teaching and supervision of students to prepare them to assist patients spiritually is a growing focus. However, there is limited consensus about the competences students need to develop and little is written related to students learning processes. Design. Grounded theory was used to identify students’ main concern and develop a substantive grounded theory. Method. Data collected during semi‐structured interviews at three Norwegian University Colleges in eight focus groups with 42 undergraduate nursing students were analysed through constant comparison of transcribed interviews until categories were saturated. Results. The participants’ main concern was ‘How to create a professional relationship with patients and maintain rapport when spiritual concerns were recognised’. Participants resolved this by ‘Opening up to learning spiritual care’. This basic social process has three iterative phases that develop as a spiral throughout the nursing programme: ‘Preparing for connection’, ‘Connecting with and supporting patients’ and ‘Reflecting on experiences’. Conclusion. Nurses need a wide range of competences to fulfil the nursing focus on holistic patient care. Nursing education should prepare students to recognise and act on spiritual cues. A trusting relationship and respectful and sensitive communication assist students to discover what is important to patients. An educational focus on spiritual and existential themes throughout the nursing programme will assist students to integrate theoretical learning into clinical practice. Relevance to clinical practice. Study participants reported seeing few role models in clinical settings. Making spiritual assessment and interventions more visible and explicit would facilitate student learning in clinical practice. Evaluative discussions in clinical settings that include spiritual concerns will enhance holistic 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.     

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.     

Learning strategies of public health nursing students: conquering operational space

Aim. To develop understanding of how public health nursing students learn in clinical practice and explore the main concern for the students and how they acted to resolve this main concern. Background. How professionals perform their work directly affects individuals, but knowledge is lacking in understanding how learning is connected to clinical practice in public health nursing and in other professions. Design. Grounded theory. Method. Grounded theory was used in gathering and analysing data from 55 interviews and 108 weekly reports. The participants were 21 registered nurses who were public health nursing students. Results. The grounded theory of conquering operational space explains how the students work to resolve their main concern. A social process with three identified phases, positioning, involving and integrating, was generated from analysing the data. Their subcategories and dimensions are related to the student role, relations with a supervisor, student activity and the consequences of each phase. Public health nursing students had to work towards gaining independence, often working against ‘the system’ and managing the tension by taking a risk. Many of them lost, changed and expanded their professional identity during practical placements. Conclusion. Public health nursing students’ learning processes in clinical training is complex and dynamic and the theory of ‘Conquering operational space’ can assist supervisors in further developing their role in relation to guiding students in practice. Relationships are one key to opening or closing access to situations of learning and directly affect the students’ achievement of mastering. Relevance to clinical practice. The findings are pertinent to supervisors and educators as they prepare students for practice. Good relationships are elementary and supervisors can support students in conquering the field by letting students obtain operational space and gain independence. This may create a dialectical process that drives learning forward.     

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.     

A qualitative exploration of nursing students’ perceptions of the homeless and their care experiences

The health care needs of the homeless are more complex than those of the population at large. The purpose of this qualitative study was to explore undergraduate nursing students’ perceptions of the homeless. Thematic content analysis of responses from 19 undergraduate nursing students yielded four themes describing student experiences with the homeless, their perceptions of homelessness and the health care of the homeless, and their suggestions for best teaching strategies. Students in this study had varying amounts of experience with and knowledge of the homeless. While our participants strongly believed that homeless people deserved compassionate, equitable nursing care, many of their statements suggested an implicit bias toward the homeless. This suggests that student nurses need more comprehensive education concerning the homeless and the health care needs of this vulnerable population. Few interventions aimed at educating student nurses about homelessness and changing their attitudes to mitigate bias are based on research, particularly research conducted from the perspective of the homeless, and few explore the impact of civil interactions on health outcomes. The findings of this study may assist nurse educators in developing education interventions to improve students’ knowledge of homelessness.     

Coping with uncertainty within the preceptorship experience: the perceptions of nursing students

A substantial amount of time and resources are channelled into supporting clinical practicum in nursing education programmes. Attention is targeted at the most effective models to achieve this aim. The provision of sound support models regardless of specific clinical setting is recognized as integral to student development and transition periods throughout nurses’ careers. Within the mental health setting, this situation is compounded by the negative attitudes nursing students tend to hold towards people experiencing a mental illness. Preceptorship has been widely used both nationally and internationally for clinical practicum. Although this model seems to have been endorsed by virtue of its increasing use, additional examination is necessary to assess efficacy and effectiveness across clinical practicum, including those in mental health settings. In utilizing a grounded theory approach, this study addresses the question: what is the experience of preceptorship for undergraduate nursing students in the mental health setting? The major themes identified include: ‘fear of the unknown’, ‘reconciling difference between general acute health and mental health settings’ and ‘supporting practice’.     

A study on development of a scale to assess nursing students’ performance in clinical settings

Aims. To develop a valid and reliable scale to assess nursing student performance in clinical settings. Background. In nursing education, clinical evaluation is important for students, teachers and patients and there is a need to evaluate with valid and reliable scales. Design. Instrument development. Methods. Data were collected at 2002–2003 and 2003–2004 academic years and 350 evaluations of third and fourth year students formed the study population. In the light of the literature and our experiences, we determined clinical responsibilities of nursing students and wrote 77 items accordingly. These items were discussed twice by 17 teachers at a University School of Nursing and then the items were decreased to 28. Each item was scored between 1 and 10. The structure validity of the scale was evaluated with factor analyses and reliability of the scale with Cronbach’s alpha and item‐to‐total correlation. Results. The item‐to‐total correlation coefficient was 0·40 and items were excluded with item‐to‐total correlation coefficient of lower than 0·40. Cronbach’s alpha was 0·97. Three factors with an eigenvalue greater than one were extracted. These factors were ‘nursing process’, ‘professionalism’ and ‘ethical principles’ and their Cronbach’s alpha values were 0·97, 0·94 and 0·87, respectively. Conclusion. This scale can be used to evaluate nursing students’ performance in clinical settings. Relevance to clinical practice. A valid and reliable tool may allow an objective evaluation of nursing students’ performance in clinical settings.     

Incorporating evidence-based practice education in nursing research curriculum of undergraduate nursing students: A quasi-experimental study

AimTo examine the effect of incorporating evidence-based practice (EBP) in Nursing Research curriculum on undergraduate nursing students.BackgroundThe competence of EBP is essential for nurses and it is an essential task for educators to implement EBP education in nursing students.DesignA quasi-experimental study.MethodsBased on Astin’s Input-Environment-Outcome model, the study was conducted among 258 third-grade students of a four-year nursing bachelor’s program between September through December 2022. The students were divided into two groups. Students in the intervention group received innovative teaching where EBP elements were incorporated in Nursing Research course in a natural, gradual and spiral way, while students in the control group attended conventional teaching. Effect of EBP teaching was examined in terms of students’ EBP competence, learning experience and satisfaction and score of team-based research protocol assignment.ResultsCompared with conventional teaching, the innovative teaching characterized by EBP improved students’ EBP competence in terms of attitudes and skills and enhanced student’s comprehensive ability in nursing research. Students’ learning experience and satisfaction were similarly favorable between the two groups.ConclusionsFor undergraduate nursing students, the teaching strategy characterized by EBP is an appropriate and effective way to improve their EBP competence of attitudes and skills, as well as their nursing research ability.     

Development of the professional competence and professional self-concept of undergraduate nursing students during the clinical practice period: A cross-lagged panel analysis

AimTo explore the relationship of the development of professional competence and professional self-concept of undergraduate nursing students during the clinical practice period.BackgroundClinical practice is one of the most important aspects of nursing education. Nursing students combine theoretical knowledge, psychomotor skills and emotions in a professional socialization process through clinical practice sessions.DesignA two-time point longitudinal design was performed. A cross-lagged model was employed to analyze the relationship between the development of professional competence and professional self-concept of undergraduate nursing students during their clinical practice period.MethodsA total of 210 undergraduate nursing students were included in this study. The questionnaire was distributed two months and six months after their clinical practice started. Professional Self Concept of Nurses Instrument and Professional Competence Scale for Undergraduate Nursing Students were the two main instruments.ResultsBoth the professional competence and professional self-concept of Undergraduate nursing students increase at the end of the sixth month compared with the end of the second month after their clinical practice started. The results of the cross-lagged analysis showed that the professional self-concept was partially responsible for the development of professional competence. The effect of professional competence on the development of professional self-concept, in contrast, was not found in this study.ConclusionsClinical nursing educators should pay greater attention to the development of the professional self-concept of undergraduate nursing students. More attention should be paid to creating a supportive clinical learning environment to facilitate the improvement of undergraduate nursing students’ professional self-concept and professional competence.     

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.     

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.     

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.     

Conducting clinical post-conference in clinical teaching: a qualitative study

Aim and objective. The aim of this study was to explore nurse educators’ perceptions regarding clinical postconferences. Additional aims included the exploration of interaction characteristics between students and faculty in clinical postconferences. Background. Nursing students are challenged to think and learn in ways that will prepare them for practice in a complex health care environment. Clinical postconferences give students the opportunity to share knowledge gained through transformative learning and provide a forum for discussion and critical thinking. Faculty members must guide students as the latter participate in discussions, develop problem‐solving skills and express feedings and attitudes in clinical conferences. Methods. The study used qualitative research methods, including participant observation and an open‐ended questionnaire. Participant observers watched interaction activities between teachers and students in clinical postconferences. A total of 20 clinical postconferences, two conferences per teacher, were observed. The Non‐Numerical Unstructured Data Indexing Searching and Theory‐building qualitative software program was used in data analysis. Conclusions. Research findings indicated that, of the six taxonomy questions, lower‐level questions (knowledge and comprehensive questions) were mostly asked by faculty members’ postclinical conferences. The most frequently used guideline was task orientation, which is related to practice goals and was found in discussions of assignments, reading reports, discussions of clinical experiences, role plays, psychomotor skill practice, quizzes and student evaluations. Relevance to clinical practice. It is an essential responsibility of nurse educators to employ postconferences to assist students in applying their knowledge in practical situations, in developing professional values and in enhancing their problem solving abilities.     

Educating nurses to deliver optimum care to military veterans and their families

The aim of the project was to help prepare the future nursing workforce to provide optimum care for the Armed Forces Community.Structured evidenced-based educational sessions were designed and then delivered at two Universities in England. This educational model included a flipped approach, didactic classroom teaching, blended learning, and information technology.Educational sessions were provided to 468 first year Bachelor of Nursing undergraduate students in 2017 and 2018. A mixed methods evaluation included a quasi-experiential design with pre and post-test data followed by research interviews conducted by student nurses and analysed using a modified Grounded Theory.Post session evaluation demonstrated a significant improvement in students' knowledge. 93% agreed that the training was useful, 95% felt that nurses should be aware of the healthcare needs of the Armed Forces Community, and 89% indicated that the subject matter should be included in the undergraduate curriculum. A qualitative theoretical model was built from four major clusters: the military community; student's identity, clinical engagement, and future practice.These educational sessions are being introduced into a growing number of United Kingdom Universities to create future nursing leaders with a better insight into the large and diverse Armed Forces Community.     

Students' ideals for nursing older people in practice

Aim. Drawing on research exploring nursing students’ experiences of working with older people, this paper aims to demonstrate how context and culture can impact on the realization of their ideals. Background. The principles underpinning individualized and person‐centred approaches to care resonate with those focal to gerontologic nursing. Restrictive contexts of care and pervasive workplace cultures render nurses unable to deliver care in accord with these. Design and method. This interpretive study was informed by phenomenological–hermeneutic theory. A purposive sample (n = 10) was recruited from a single educational institution. Data were generated in two phases using loosely structured interviews and supplementary activity. Themes explicating their experiences were identified via systematized detailed analysis and issues pertaining to nursing students’ orientation towards older people cut across these. Findings and discussion. Students perceived that older people were prone to depersonalization and marginalization, so sought to show respect by coming to know individuals, form human connections with them and personalize care accordingly. Giving respect, promoting personhood, asserting reciprocal identity and maintaining dignity were prominent features of this but were often frustrated by practices and cultures encountered in mainstream settings. Conclusions. Nursing students’ approaches to older people are contextual and reflect elements of person‐centred ideology. Their attempts upholding their ideals are liable to be subverted by workplace norms. Preparatory education should address these, assist students to learn how to attend to personhood in restrictive environments and offer targeted placements in age‐specific and non‐acute services. Relevance to clinical practice. Demographic trends mean that working with older people has increased significance for nurses in most settings. Person‐centredness is seen as beneficial for older people but contemporary service imperatives and enduring practices are inhibitory, preventing entrants to nursing from developing related skills.