Are nurses recognised,prepared and supported to teach nursing students: Mixed methods study

BackgroundThe requirement for clinical teaching and supervision of undergraduate nursing students is a continual high volume, high impact essential requirement of registered nursing staff. Nurses are integral in facilitating the learning of nursing students in the practice environment to deliver quality safe care. However nurses engaged in teaching and supervising nursing students have unique challenges.ObjectiveTo understand how well recognised, prepared, and supported nurses perceive they are to teach and supervise undergraduate nursing students in the practice environment?MethodsNurses from 12 different wards of two hospitals were invited to participate in the study. A sequential mixed methods approach comprising hard-copy questionnaires, completed by 59 nurses, and six focus groups. Four feedback sessions verified findings.ResultsA low level of recognition and support for the amount of time available to nurses to teach and supervise was reported from both survey and focus group data. Four themes emerged from focus groups. Nurses recognised their role to teach and supervise students; The role in teaching and supervision was not recognised at a system level; Nurses could be more prepared to teach and supervise students; and Nurses required more support for their role in teaching and supervising students. A major challenge was the low level of support nurses perceived from the education sector in preparing students for placements. The nurses reported a disconnection of components of the student placement system, which was difficult to negotiate when undertaking this teaching and supervision role.ConclusionThe complex practice environment, where nursing student numbers are increasing and nurses have to navigate an often disconnected student placement system, requires a rethink of the precentorship or buddy one-to-one model of clinical placement. Addressing these challenges will be an essential step in protecting the interests of the public, nurses and nursing profession.     

Shifting supervision: implications for safe administration of medication by nursing students

Background. Medication errors made unintentionally by nurses continue to be a major concern in hospitals, medical centres and aged care facilities throughout Australia. While there is a plethora of literature available, which has identified factors that contribute to nurses making errors, few studies have reported on factors that may contribute to errors made by nursing students. Design. A grounded theory approach. Methods. In‐depth interviews with final‐year undergraduate nursing students (n = 28) to explore their experiences of administering medication. Constant comparative analysis was used to identify categories from the data. Results. The central category was identified as ‘shifting levels of supervision’. This describes the process of supervision students received when administering medication. Four levels were identified: ‘being with’, ‘being over’, ‘being near’ and ‘being absent’. The findings suggest that nursing students do not always receive the level of supervision that is legally required. Less than satisfactory levels of supervision were identified by participants as leading to medication errors or near misses. Conclusion. Apart from ‘Being with’, the levels of supervision described by participants have major implications for the safe administration of medication by nursing students and represent the actual or potential cause of error. Relevance to clinical practice. The potential for medication errors pose a major safety issue. Healthcare services have a responsibility to protect patient safety. Appropriate supervision of nursing students when administering education therefore requires urgent attention to ensure best practice is executed.     

A “Co-CREATES” framework to foster a positive learning environment for nursing students’ professional development in Rwanda

AimThe future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment.DesignA focused ethnographic approach was used.MethodsNursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews.ResultsFive key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a “Co-CREATES” framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in “cocreating” conditions that build positive practice environments which are conducive to preparing students as professional nurses.ConclusionThe positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.     

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.     

The diversity of Iranian nursing students' clinical learning styles: A qualitative study

BackgroundNumerous factors, including learning styles, affect the learning process of nursing students. Having insights about students' learning styles helps promoting the quality of education. The aim of this study was to explore the Iranian baccalaureate nursing students' learning styles in clinical settings.MethodsA qualitative design using a content analysis approach was used to collect and analyze data. Semi-structured interviews were conducted with fifteen Iranian baccalaureate nursing students selected using a purposive sample method.FindingsDuring data analysis, it was found that nursing students employed different clinical learning styles such as ‘thoughtful observation,’ ‘learning by thinking,’ and ‘learning by doing’.ConclusionStudents adopt different learning strategies in clinical practice. Designing teaching strategies based on students' learning styles can promote students' learning and maximize their academic and clinical practice success. Nursing educators, curriculum designers, and students can use the findings of this study to improve the quality of nursing education in both the classroom and clinical settings.     

Teaching spiritual care – a grounded theory study among undergraduate nursing educators

Aims and objectives. To explore teachers’ understanding of spirituality and how they prepare undergraduate nursing students to recognise spiritual cues and learn to assess and provide spiritual care. Background. Nursing education addresses patient care in all domains of the person. Systematic teaching and supervision of students to prepare them to assist patients spiritually is an important part of holistic care. However, few role models for spiritual care are seen in clinical practice, and limited research addresses necessary student competencies or how teachers can best facilitate this process. Design. Grounded theory was used to identify teachers’ main concern and develop a substantive grounded theory. Methods. Data collected during semi‐structured interviews at three Norwegian University Colleges in five focus groups with 19 undergraduate nursing teachers were conducted from 2008 to 2009. Data were analysed through constant comparison of transcribed interviews until categories emerged and were saturated. Results. The participants’ main concern was ‘How to help students recognize cues and ways of providing spiritual care’. Participants resolved this by ‘Journeying with Students through their Maturation’. This basic social process has three iterative phases that develop throughout the nursing programme: ‘Raising Student awareness to Recognize the Essence of Spirituality’, ‘Assisting Students to Overcome Personal Barriers’, and ‘Mentoring Students’ Competency in Spiritual Care’. Conclusion. Nursing education should prepare students to recognise and act on spiritual cues. Making spiritual assessment and interventions more visible and explicit throughout nursing programmes, in both classroom and clinical settings, will facilitate student maturation as they learn to integrate theoretical thinking into clinical practice. Relevance to clinical practice. Nursing students need role models who demonstrate spiritual care in the fast‐paced hospital environment as well as in other clinical practice settings. To model spirituality as part of nursing care can assist students to overcome their vulnerability and to safeguard ethical issues and promote patient integrity.     

A clinical supervision model in bachelor nursing education – Purpose,content and evaluation

BackgroundCollaboration between universities and clinical placements has been highlighted as a weak point of the nursing education. To facilitate a good academic learning environment a clinical supervision model had been developed. The aim of this study was to evaluate to what extent the goals of the model were met after one and a half years of utilisation.MethodsA questionnaire was responded to by 30 head nurses, 12 main preceptors, 193 personal preceptors, and 11 clinical nurse lecturers.ResultsMost of the participants perceived that the quality criteria in the model were met to a large extent, the students' individual goals were achieved, and the supervision model contributed to fulfilment of goals, and assessment of the students. The nurse lecturers scored highest and the personal preceptors lowest in most of the questions. The conditions stated in the model were not always fulfilled. The deficiencies found were especially related to education level, time for supervision, and support to the personal preceptors.ConclusionsDespite some shortcomings the supervision model was considered by most participants as a valuable tool to be used in an academic nursing education. Improvements of the model in regard to the findings were suggested.     

Extended immersive simulation to develop nontechnical skills: Content analysis of students' views

BackgroundThe purpose of undergraduate nursing education is the preparation of graduates for clinical practice. Despite this focus, graduates are often unprepared for independent practice, particularly in the use of skills such as time management, delegation and critical thinking in clinical situations. This paper reports on students’ views of using extended, immersive simulation to consolidate the use of both technical and nontechnical skills in preparing them for independent nursing practice.AimTo investigate students’ views on the value of extended, immersive simulation in preparing them for independent practice as registered nurses.MethodsCross-sectional research involving content analysis of open-ended survey questions. The study involved comments from 287 final year nursing students conducted at a university in Western Australia.FindingsThemes related to critical thinking, the role of the registered nurse, communication, time management, teamwork and leadership were identified through the content analysis. Students believed exposure to extended simulation facilitated development of the essential skills required to practise independently and helped them prepare for the role of a registered nurse. Many expressed the wish for this type of simulation to be included throughout all years of the nursing curriculum.DiscussionStudents need experience in clinical situations where they are challenged to use multiple skills simultaneously to develop the expertise required of registered nurses. The ability to practise independently, and take responsibility for decisions made in complex ward conditions, is not currently required of students on clinical placements. Simulation is a way to fill this void in nursing education to enable students to experience the full role of a registered nurse.ConclusionBased on our findings nursing students believed that extended, immersive simulation was an effective method of supporting students as they undertake the full responsibilities of registered nurses to enable them to be safe and effective practitioners on commencement of the registered nurse 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.     

My role as a clinical coach in veterinary practice

ABSTRACT:

I have had the role of ‘teacher’ in many forms over the years. I have seen the training scheme for veterinary nurses evolve from the days of the ‘green book’, through the editions of the Portfolio with the NVQ qualification, and now to the Nursing Progress Log (NPL) with the Level 3 Diploma in Veterinary Nursing.

Over the years, I have been a trainer, a lecturer in veterinary nursing at Berkshire College of Agriculture, D32/33 Unit assessor, A1 assessor and now a clinical coach. Although the qualifications have changed, my role as a clinical coach still involves what it always has done – to provide a high standard of practical training of nursing skills to student veterinary nurses, while delivering this in a supportive way that encourages the students to be self-directed and enjoy learning for themselves.     

Triage education in rural remote settings: A scoping review

BackgroundTriage is a complex nursing task to prioritise patient care, based on acuity. Triage decisions can affect patient safety and must employ critical thinking. Graduate registered nurses are expected to triage in rural facilities, which is in contrast to current guidelines. The purpose of this review was; to discover how effective education support programs were in developing clinical decision-making skills for graduates at triage; and to determine what is known about triage education support programs for graduate or novice registered nurses undertaking triage in rural and remote settings.MethodA scoping review was undertaken to identify and analyse primary research articles following PRISMA guidelines, sourced from four electronic databases.Results6158 retrieved articles were found, after duplicate removal and screening against inclusion/exclusion criteria; fourteen articles were included. Themes included ‘variability of triage accuracy and assessment’; ‘education qualifications and experience’; and ‘training and supervision’.ConclusionThis review demonstrates significant gaps in the literature reporting on this topic area, particularly in the rural context. Common recommendations include standardised triage education strategies, and strategies that account for differences in resourcing levels. Further research is required to attempt to link education strategies in rural contexts to acceptable triage outcomes like triage accuracy.     

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

Experiences of nursing students during clinical education in mental health clinics: A phenomenological qualitative study

AimNursing students have both positive and negative experiences during clinical education. This study was conducted to identify experiences of nursing students during clinical education in mental health clinics.DesignThis phenomenological qualitative design study was conducted with 4th year undergraduate nursing students from a university in Turkey to identify their experiences specifically in mental health clinics.MethodsThe data were collected using focus groups interviews with 40 nursing students and assessed with the 7-stage phenomenological analysis method described by Colaizzi.ResultsThree main themes were determined: (i) the need for supportive interventions to cope with negative emotions; (ii) difficulty in translating theoretical knowledge into practice; and (iii) the lack of role model nurses and teaching staff.ConclusionsThe results of this study indicate that supportive interventions should be given to nursing students before clinical education. Also, the duration of clinical education, the teaching methods to be used and role model nurses and teaching staff effectiveness in clinical education should be planned carefully.     

Teaching nursing students about spiritual care – A review of the literature

AimThis paper examines that examines content, process and outcome of spirituality teaching programmes for nursing students.BackgroundIncreased secularisation in Europe and resulting ambivalent attitude towards spirituality and religion is contrasted with increased professional and public interest in this topic. Additionally there are concerns that patient's spiritual needs are not being met and nurses are often ill equipped to provide this care. Nurses while positively disposed towards spiritual care delivery, and often carrying out spiritual care in practice, do so with little preparation. While teaching spiritual care to nursing students is advocated there is little research on this topic.MethodA search was conducted using CINAHL database spanning the years 2007–2012 using the key words ‘spirituality’ and ‘education’.FindingsThree papers were identified that examined teaching approaches with nurses and nursing students. Due to methodological issues such as small sample sizes and limited testing generalising from these studies is difficult. Approaches used were firmly rooted in a religiosity framework.ConclusionFurther research is required, using rigorous approaches, examining the benefits of teaching approaches. Analysis of the need for spiritual education is also required. Issues that are of concern to educators are the definitions and understandings of spirituality, assessment and how, best to teach this topic.     

Practices of caring for nursing students: A clinical learning environment

ObjectiveThe purpose of this study was to explore, describe and illuminate nursing students’ best encounters of caring in the clinical learning environment. Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment.MethodsQualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry (AI) methodology. Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council (SANC) were purposively sampled from 3 private hospitals within the Western Cape. Data was analysed using Giorgi’s method.ResultsThe main theme included the best and ‘least best’ caring practices embedded in the centrality of the heart. The subthemes comprised of the nursing students’ experiences of caring literacy and caring illiteracy. The second theme included the creation of best caring practices within a conducive clinical learning environment. Within this theme, the subthemes comprised of the caring attributes required in reflecting best caring practices, as well the creation of a clinical learning environment to optimise caring.ConclusionsThe significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants. Caring was equated to the heart as the core to the nursing students’ being. Recommendations for nursing education, management, practice and research were therefore specifically formulated to enhance caring towards nursing students.     

Caring in process: A 3-year qualitative longitudinal study of nursing students

AimThis paper aims to describe caring perceptions and behaviors among student nurses in Italy as they progress through their nursing education.BackgroundAs nursing students are potential nurses of the future, there is an expectation that in addition to appropriate academic qualifications, they will develop appropriate caring behaviors/attitudes. However, there has been some evidence that the educational process does not always modify their caring perceptions/behaviors or that the direction of the change is not always positive.DesignA qualitative longitudinal design with three data collection points, was performed from October 2013 to October 2016 at the University of Verona, Trento Campus.MethodsSemi-structured interviews were conducted at the time of entry into a 3-year bachelor’s degree program in nursing and at the end of the second and third years. Observation of the students during their clinical practice was carried out at the end of each of the three years of education. Thirty students commenced the study and 24 finished. Data were analyzed using a phenomenological approach.ResultsThe iterative process of analyzing interviews and observations resulted in nine themes collectively from all three stages: establishing a trusting relationship with the patient, satisfying the patient’s needs, paying attention, being respectful, being competent, giving time, being concerned with the emotional dimension, acting within context to facilitate caring actions and giving information.ConclusionsAt the end of the third year the students’ concept of caring was enhanced; their initial generic or lay view of caring turned into an intentional, competent, conscious, accountable and realistic caring approach.     

Trying on the professional self: nursing students' perceptions of learning about roles,identity and teamwork in an interprofessional clinical placement

AimThis study aims to describe how senior nursing students viewed the clinical learning environment and matured their professional identity through interprofessional learning in a student-led hospital ‘ward’.BackgroundUndergraduate nursing and medical student teams participated in a trial of ward-based interprofessional clinical learning, managing patients over 2 weeks in a rehabilitation ward.MethodsQualitative and quantitative program evaluation was conducted using exit student focus groups and a satisfaction survey.ResultsTwenty-three nursing and medical students in three placement rounds provided positive feedback. Five main themes emerged describing their engagement in ‘trying on’ a professional role: ‘experiencing independence and autonomy’; ‘seeing clearly what nursing's all about’; ‘altered images of other professions’; ‘ways of communicating and collaborating’ and ‘becoming a functioning team’.ConclusionsWard-based interprofessional clinical placements offer senior students authentic ideal clinical experiences. We consider this essential learning for future interprofessional collaboration which should be included in senior nursing students' education.     

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.     

临床护理教学基地建设的优化及成效

目的优化临床护理教学基地建设,持续强化医院临床教学与学校教育的有效衔接。方法以丰富的教学资源及充足经费为保障,从组织架构、管理制度、师资队伍、教学实践模式、质量监督体系等方面优化临床护理教学基地建设:构建"请进来、送出去、强内训"三位一体的师资队伍建设体系,培养带教教师;基于"三阶段""五特色"临床护理教学培养模式,提升护理实习生综合素质;建立教研室、教师、学生三方互评的教学质量监督体系,保证教学质量持续改进。结果教学质量持续改进,师资队伍结构较前优化,综合素质得到提升,护理实习生对我院临床护理教学工作满意度逐年增高。结论临床护理教学基地优化建设举措是帮助医院教学改革、加强临床教学和学校教学紧密衔接的有效途径。     

Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing

BackgroundConducting mental status examination and suicide risk assessment is an important skill required of nurses when they are in the clinical setting. With nursing students often expressing the anxiety and lack of confidence in doing so, the use of standardized patients provide an excellent opportunity to practice and become proficient with this skill in a simulated environment.ObjectivesTo explore the learning experience of undergraduate nursing students using standardized patients while practising their mental status examination and suicide risk assessment skills in mental health nursing module.DesignA pre- and post-test, single group quasi experimental design was used in this study. A standard didactic tutorial session and a standardized patient session was conducted to evaluate the learning experience of undergraduate nursing students learning mental status examination and suicide risk assessment. Outcome measures for this study include Student Satisfaction and Self-Confidence in learning scale.Qualitative comments in the form of open-ended questions were also collected in this study.SettingsA University offering nursing program from undergraduate to postgraduate level.ParticipantsA convenience sample of Year 2 undergraduate nursing students undertaking the mental health nursing module was included in this study.ResultsThe use of standardized patient session had significantly increased students' satisfaction and confidence level before they are posted to a mental health setting for their clinical attachment. There was a significant difference on students' self-confidence level for those who have taken care of a patient with mental illness after adjusting for pre-test on score in learning. Qualitative feedback obtained from students showed a positive outlook towards the use of standardized patient as an effective tool in augmenting didactic learning into practical skills.ConclusionsUsing standardized patient in mental health nursing education enhanced the integration of didactic content into clinical setting allowing students to practice their assessment skills learned in classroom and transfer it to the clinical area. The benefits of using standardized patient include allowing students to practice their communication skills and improving their confidence level in conducting mental status examination and suicide risk assessment by reducing anxiety as compared with traditional classroom and textbook-based pedagogy.