Accommodating and supporting students with disability in the context of nursing clinical placements: A collaborative action research

Aim/objectiveTo examine issues and challenges encountered by university and clinical milieus in addressing the needs of students with disability during their clinical placements; and to identify existing or potential accommodation and support measures to address the challenges encountered.BackgroundThe influx of students with learning disabilities, attention deficit disorder [with or without hyperactivity], mental health disorders or on the autism spectrum has caused an increase in the number of students with disabilities of more than 900% in universities in the past decade. This increase is causing added pressures to both the academic services providing student assistance and the personnel responsible for these students’ clinical placements. While several studies have focused on measures designed to accommodate students with disabilities during their theoretical courses, only a small number worldwide have focused on student accommodation and support in the context of clinical placements. In the current paper, strategies highlighted in these studies were grouped under three categories: prior, during and post clinical placements.DesignCollaborative action research conducted amidst three learning communities.MethodsThe larger study included learning communities from three disciplines: education, social work and nursing. Three tools helped guide the discussions: 1) brainstorming and classification tool; 2) contribution and feasibility tool; and 3) carrousel tool. The current study focusses solely on the findings from the five meetings of the nursing learning community (n = 14 participants).ResultsSix categories of challenges were documented: 1) Poor writing skills; 2) Difficulty adapting to clinical milieus; 3) Difficulty linking theory with practice and setting priorities; 4) Difficulty managing specific and situational needs; 5) Issues with interpersonal skills and overall attitude; and 6) Challenges pertaining to students’ professional responsibility to disclose their condition. Several accommodation and support measures were identified for each set of challenges and were also grouped under three categories: prior, during and post clinical placements.ConclusionsOur study revealed that the issues identified could in fact be faced by any students, albeit their impact and complexity increased considerably when dealing with students with disability. It brought to light that the implementation of some of the measures identified will require changes to the structure of nursing programs. It also highlighted the ever-growing complexity of the clinical instructor role and the fact that clinical instructors do not always feel adequately prepared to support students with disability.     

Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions

Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements.Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool.     

护理本科生自我效能感与临床能力的相关性分析

目的 调查护理本科生临床能力、自我效能感的现状,探讨两者之间的相关性,为临床教师帮助学生提高临床能力提供参考依据.方法 采用一般自我效能感量表及临床能力自评量表对在三级甲等医院实习的128名护理本科生进行问卷调查.结果 护理本科生自我效能感均分为(2.58± 0.85)分,临床能力均分为(4.16±0.53)分.护理本科生临床能力总分及各因子和自我效能感呈显著正相关.结论 了解护理本科生临床能力的现状及与自我效能感的关系,有助于临床带教教师有针对性的采取措施,从而提高学生总体临床能力.     

客观结构化临床考试在护理本科毕业生临床能力评价中的应用研究

目的探讨客观结构化临床考试（OSCE）在本科毕业生临床能力评价中的应用。方法在探讨护理临床能力内涵的基础上,构建OSCE考核方案,并对33名2004级护理本科毕业生进行考核及成绩分析。结果本次考试方案难度适中,区分度指数较高,有较好的信度和效度。结论OSCE能够客观有效地评价护生的临床能力,但应根据存在的问题进行进一步完善改进。     

护理本科生临床实习前期能力培养的探讨

探讨护理本科生在实习前期所需培养的各项能力,对本科生的临床实习具有指导意义,使学生在高效率完成实习任务的同时．增强评判性临床思维能力、科研能力、专业英语交流能力及职业道德修养等综合素质,为培养出实用型护理人才打下坚实的基础。     

两种学制和教学模式护理本科生临床综合能力评价的比较

目的 比较两种学制和教学模式护理本科生的临床综合能力，为我国四年制护理本科课程体系改革提供参考依据。方法采用问卷调查法，调查了95名2006届四年制和五年制护理本科生的临床综合能力，并收集了50名临床带教老师的评价，内容包括思想、实践、操作3个方面素质的19项评价标准。结果①护生临床综合能力的自评综合评价值为（87．64±6．11）分，他评综合评价值为（92．60±3．48）分。②护生的思想素质、实践素质、操作素质综合评价值均〉85分，自评与他评结果呈正相关（r=0．22-0．48．P〈0．01）。③在他评结果中，四年制护生的思想素质总分高于五年制护生（P〈0．05），操作素质总分低于五年制护生（R〈0．01）。结论①两种学制和教学模式护理本科生的临床综合能力评价结果完全符合学校的培养目标。②四年制教学更注重培养护生的综合素质，但需加强护理操作技能。③四年制课程体系的教学改革是比较科学、合理、可行的。     

Doing the right thing: nursing students, relational practice, and moral agency

Registered nurses and nurse educators are often unaware of how nursing students experience the nursing profession. In the current practice climate of increased workloads, reduced funding, and higher patient acuity, nurse educators are likely to hear from colleagues how unprepared newly qualified nurses are for the needs of practice. It is difficult for many nursing students to see value in their practice because they become preoccupied with their perceived lack of knowledge and technical skills. Nurses and nurse educators should be aware of how this brands new graduates and informs their sense of developing professional identity. Despite their feelings of deficit in terms of skills and knowledge, it is clear that many nursing students are, in fact, effectively negotiating relational ethics. This article presents a collaborative account of the important relational work being undertaken by one group of nursing students in New Zealand.     

我国护理硕士研究生临床能力培养的重要性

临床能力是护理专业学生在临床实践中应该掌握相关知识和获取相关技能的能力。护理学是培养从事某一特定职业实际能力的应用型人才．我国护理硕士研究生（以下简称护理硕士）的培养目标是：不仅培养教学型、科研型、管理型的高层次人才。而且要培养更多参与临床实践的学术型、专科型护理人才及临床护理专家．以提高临床护理质量和护理队伍的整体素质。因此．临床能力是护理硕士最基本的必备能力,不仅是专业本身的要求,也是进一步做好护理研究、护理教育和护理管理的要求。     

Responding to responsive behaviours: A clinical placement workshop for nursing students

As our population ages, it is important for the next generation of nurses to feel prepared to care for people with dementia. Communicating with a person with dementia who is experiencing responsive behaviours can be challenging. Furthermore, new graduate nurses may experience a phenomenon called reality shock when they do not feel prepared for the reality of nursing. Reality shock can lead to nurse turnover and poor retention rates. This study evaluated a workshop for first-year practical nursing students focusing on applying a person-centered communication framework when caring for people with dementia experiencing responsive behaviours. The results suggested that training students during their clinical placements on dementia communication may be effective in helping prepare nurses to care for this patient population.     

Improving the quality of nursing students' clinical placements in nursing homes: An evaluation study

The aim of this study was to explore students' experiences during their clinical placements in five nursing homes after implementing measures to improve the learning environment.It is vital to stimulate more future nurses to consider a career within geriatric wards and nursing homes. One way to achieve this, is to enhance nursing students' learning experiences during clinical placements in these settings.Measures to improve the learning environment were implemented as a result of a joint effort between a university college and five nursing homes. An explorative design was developed to collect empirical data concerning the students' experiences expressed through questionnaires and logs.The results generally conveyed more positive than negative experiences. Students expressed most satisfaction with peer collaboration, the placement's contribution to awareness of future nursing role and described the learning arena as exciting and interesting. They expressed less satisfaction with supervision from preceptor and how the practice site was prepared for and organized students' placements.Clinical placement arenas and educational institutions should collaborate closely to explore and develop models of supervision appropriate for the nursing home context, to build on existing potentials and resolve the issues that represent barriers for creating interesting and effective learning environments.     

住院患者对学生临床学习态度及影响因素的现象学研究

目的探讨住院患者对学生临床学习的态度及影响因素。方法采用现象学研究法,以半结构式深入访谈法对20名住院患者进行访谈,对访谈资料采用阅读、编码、分析、分类、提炼主题。结果促使患者对学生临床学习持反对态度的因素包括患者的疾病性质、既往不良经验、家庭和社会的影响、个人维权意识以及学生动手能力差;而学生良好的礼仪素质和护患沟通是促使患者持支持态度的因素。结论住院患者对学生临床学习的态度主要取决于学生的动手能力、沟通能力和礼仪素质,建议加强学校教育,加强学生礼仪修养、提高动手能力和沟通能力,以取得患者对学生临床学习的支持和合作。     

Making power visible: Doing theatre-based status work with nursing students

As part of a senior leadership class in an undergraduate baccalaureate nursing program in the northeastern United States, we conducted an experiential, theater-based workshop designed to increase student awareness of the micro-dynamics of power and the enactment of status in their day-to-day lives. These exercises allowed student participants to embody status and power and understand it in ways that they did not after simply completing assigned readings. At the conclusion of the workshop the participants were asked to reflect on their status habits and the consequences of these habits in a single hand-written page. The participants' reflections showed two interesting trends. The first is that a relatively short workshop dramatically increased participants' awareness of power and status as ever present, including a substantial normative move from seeing using power as being a generally bad thing that can be justified in the interests of the organization's mission to a more neutral stance that power and status are at work in all of our interactions. The second trend that emerged was the tendency for participants to focus on agency-based explanations of power dynamics.     

以能力为核心的临床护理教学模式的构建与实践

目的探讨以能力为核心的临床护理教学模式。方法编写《临床护理教学手册》,制订分阶段目标教学计划,将实习分为基础护理阶段、专科护理阶段和整体护理阶段．由带教老师对274名实习学生实施以能力为核心的临床护理教学模式的带教。结果学生临床护理能力得到提高,学生和带教老师对教学模式的满意度均较好（P〈0．01）。结论以能力为核心的临床护理教学模式能提高学生临床护理能力,有利于提高临床教学质量。     

以学生为主体设计情景模拟教学病例的效果评价

将2007级57名护理本科生分为12组,以学生为主体设计情景模拟教学病例。采用流程图的形式,评价学生在模拟情景中运用、分析和整合知识的能力;通过对设置的情景教学病例的演示,评价学生的技能掌握及运用情况;采用自制的以学生为主体进行情景教学病例设计的效果评价表,了解学生对情景教学模拟效果的评价。结果学生完成了12个重点疾病的流程图,并对重点疾病的发生发展过程有了全面、深入、形象的认识;学生通过观看模拟过程的录像进行自我评价,对自身护理技能操作中存在的问题有了清晰的认识;学生认为以学生为主体设计情景模拟教学病例加深了对相关疾病知识的了解,培养了临床思维能力等。     

A scoping review of safety management during clinical placements of undergraduate nursing students

BackgroundThe abundant knowledge on nursing students’ competencies in clinical safety, and the multiple approaches adopted make it difficult to obtain an overview of the current status of this question.PurposeTo review the literature on undergraduate nursing students' safety competencies during their clinical placements.MethodA scoping review was carried out. Searches were executed in PubMed, CINAHL, WOS, MEDES, and websites of relevant organizations. The framework proposed by the Joanna Briggs Institute was adopted.FindingsA total of 43 studies were selected for the final sample. The review identified four major topics: the presence of adverse events in clinical placements, the acquisition of competencies in clinical safety, student experiences regarding clinical safety, and pedagogical approaches for clinical safety.DiscussionNursing students encounter adverse events and clinical safety incidents throughout their clinical training. Faculties should assign the highest priority to this question, due to its importance in the creation of a culture of safety.     

Violence experienced by undergraduate nursing students during clinical placements: An online survey at a Scottish University

AimTo assess the prevalence of violence and experiences of violence during clinical placements, among nursing students at a Higher Education Institution (HEI) in Scotland.DesignCross-sectional survey, using an opt-in online questionnaire.ParticipantsAll 950 undergraduate nursing students aged 18 + years were eligible.MethodsThe survey, with 24 open and closed format questions, was advertised over a 6-week period via the students’ virual learning platform. Potential participants were provided with study information before giving (electronic) informed consent. The questionnaire used was adapted from two other surveys and piloted prior to administration. Open-ended questions were fully transcribed and categorised and data analysed using SPSS.ResultsThere were 138 completed questionnaires (approx. 15% response rate); respondents were mainly female (92%). 77% had experienced verbal violence directed at them while on placement, most commonly swearing, shouting and insults. 70% of respondents had experienced physical violence, most commonly hitting, grabbing, kicking and spitting. By the fourth year of study, all 10 students who responded (out of 17 enrolled) had experienced violence. In general, patients (with a mental illness) were perceived to be the most likely perpetrators. The five most commonly reported feelings by respondents during the incident were: anxious (65), understanding (58), vulnerable (54), unsafe (50) and scared (45) and those after the incident were understanding (70), anxious (59), guilty (37), vulnerable (36), incompetent (34). 55 (47.8%) respondents felt supported during this ‘significant’ incident, 23 (20.0%) were unsure and 28 (24.3%) did not feel supported. There was a trend towards younger respondents and those with fewer years of care experience experiencing more violence.ConclusionThis study indicates that there is a high prevalence of violence experienced by student nurses that can have significant emotional consequences. There is scope to provide more training and support for them to deal with frequent incidents of violence.