Verbal abuse experienced by nursing students

Title. Verbal abuse experienced by nursing students Aim. This paper is a report of a study to describe the nature, severity, frequency and sources of verbal abuse experienced by nursing students while gaining clinical experience. Background. Verbal abuse of healthcare workers is currently receiving considerable attention and nursing students have been identified as a group vulnerable to experiencing workplace verbal abuse. Method. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre‐registration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73·0%. Findings. Experience of verbal abuse was reported by 45·1% of respondents, 34·5% had witnessed other students experiencing this and 65·5% reported that they were aware of other students experiencing verbal abuse. The incidents involved patients in 64·7% of cases, 15·7% involved visitors or relatives and 19·6% involved other healthcare workers. Students reported experiencing threats to kill them, racial abuse and sexually oriented verbal abuse, with the majority of incidents occurring in general medical, mental health and general surgical clinical areas. Conclusion. Education and healthcare providers should prepare students to manage negative verbal exchanges during nursing education, and policies and support networks relating to managing verbal abuse in clinical practice should be available to nursing students.     

Reporting behaviours of nursing students who have experienced verbal abuse

Title. Reporting behaviours of nursing students who have experienced verbal abuse. Aim. This paper is a report of a study exploring the reporting behaviours of nursing students who had experienced verbal abuse while gaining clinical experience. Background. Under‐reporting of incidents of verbal abuse has been identified internationally as a limitation leading to incomplete data collection when researching aggression in healthcare facilities. This can call into question conclusions, recommendations and policy initiatives based on the research. Method. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one preregistration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73·0%. Fifty‐one students (44·7%) reported verbal abuse and all of these gave details of the behaviours concerned. Results. Thirty‐two students (62·7%) of those reporting verbal abuse) stated that they had reported the incident and 19 (37·3%) of respondents stated that they had not. Only four incidents resulted in formal documentation. The most frequent feelings reported by respondents were embarrassment and feeling sorry for the abuser. Conclusion. Failure to document experiences of verbal abuse formally was prevalent and reporting practices were variable. Both higher education institutions and healthcare providers should consider establishing process for formal reporting and documenting of incidents of verbal abuse during nurse education, and students should have access to formal support services.     

Developing cultural competence in nursing students through their experiences with a refugee population

Nursing students in an urban university in southwestern Pennsylvania began visiting newly relocated Somali refugees as part of their community health nursing (CHN) clinical course-work. The purpose of this qualitative study was to relate the students' experiences in their clinical visits with the refugees to the development of cultural competence. Findings identify the many challenges confronted by students and present strategies for resolution. The level of skills needed for the care of vulnerable populations should be considered when assigning undergraduate students to the clinical setting.     

Nursing students' experiences with incivility in clinical education

This qualitative study aimed to explore the experiences of nursing students as targets of incivility in clinical settings, to describe their perceptions of specific uncivil and favorable behaviors by nurses, and to examine how nursing students think schools of nursing should address incivility in clinical settings. Four focus groups were conducted comprising 21 prelicensure nursing students. Data were collected with semi-structured interviews. Uncivil behaviors fell into three themes: exclusionary, hostile or rude, and dismissive. Positive experiences occurred when students felt included by the staff nurses in patient care. Schools of nursing should prepare students through discussion. Our research suggests that incivility occurs in clinical education. Further research on a larger scale is needed to provide qualitative and generalizable findings. All health care team members, including students, should be educated about the organization's code of conduct.     

Student contributions to clinical agencies: a comparison of adult health and psychiatric staff nurses' perceptions

Clinical rotations in acute medical and psychiatric inpatient facilities are an essential component of the education for undergraduate nursing students. The benefits students receive from these clinical experiences have been documented, but no data have been reported regarding the advantages that students may bring to agencies. This exploratory study, which used a mail-back survey, asked adult health/medical-surgical nurses and mental health/psychiatric nurses in acute care units about the effects undergraduate nursing students had on staff time, staff development, quality of care, staff's personal satisfaction, and unit standards and practices during their clinical rotations. Results indicated that students contribute to the personal and professional satisfaction of the staff by offering opportunities for mentoring and reciprocal learning and allowing nurses to participate in students' professional development. Students also contribute to patient care.     

Making it meaningful: Teaching public health nursing through academic-community partnerships in a baccalaureate curriculum

Because of the importance, and difficulty, of providing public health clinical experiences for baccalaureate nursing students, a small midwestern school of nursing offered students a three-year assignment to agencies serving vulnerable populations. The program allowed for long-term placement of students, instilling in them an understanding of community health as a prime aspect of nursing care. Students mentored students, which enhanced continuity in the agencies. More than 2,000 community members have been served, and students' responses have been overwhelmingly positive.     

Developing an evening clinical experience for baccalaureate community health nursing students

With the ever-changing directions in health care delivery, baccalaureate nursing instructors are being challenged with the task of seeking out innovative approaches to community health nursing clinical experiences. With the focus on "community as client," an evening clinical program was designed and piloted for nontraditional nursing students who, because of daytime employment, were in need of evening courses to further their nursing education. The pilot project incorporated family nursing care, community-centered practice, and observational experiences. The evening community health nursing clinical experience was found to be mutually beneficial to clients and students and served to fill a gap in health teaching within the community.     

Thinking in nursing education. Part I. A student's experience learning to think

Learning to think critically is a central commitment of nursing education. There is a substantial body of literature describing nursing educators' attempts to define critical thinking (1-3) to differentiate critical thinking from other kinds of thinking (1,4), and to measure students' ability (and changes in ability) to think critically (2,5-7). These efforts were facilitated when the National League for Nursing Accrediting Commission (NLNAC) identified critical thinking as an outcome criterion for the accrediation of undergraduate and graduate nursing programs. This change in accreditation led to the proliferation of framework (8,9) and strategies (10,11) for nursing educators to use in demonstrating compliance with this criterion. Describing strategies and frameworks for teaching critical thinking is helpful. However, explicating how teachers teach and students learn critical thinking in actual clinical situations illuminates the contextual aspects of practice that influence learning to think (12). Conventional strategies teachers use to assist students to learn critical thinking include individual and group activities, discussions and interactions between students and teachers, clinical simulations, and problem-solving encounters. Although such strategies are commonly thought to be effective in teaching critical thinking in classroom or laboratory situations, little research has been conducted to evaluate the relationship between specific teaching strategies and students' ability to think critically in specific situations (1). A further limitation of laboratory and classroom strategies is that they need to be supplemented with contextual experiences. Providing students with opportunities to practice critical thinking in actual clinical situations is difficult because the context of care is rapidly changing and schools of nursing continue to allocate limited resources to practice education. This two-year study, which was undertaken to reveal common contemporary approaches to teaching and learning critical thinking in clinical courses, analyzes the lived experiences of 45 students and teachers. Part I describes a typical student's experiences of learning "nurse thinking" in the context of clinical practice. Part II describes a typical teacher's experiences creating opportunities for students to learn and practice critical thinking in a community clinical course.     

Computer mediated conferencing - a hope or hype for healthcare education in higher learning?: A review of the literature

AIMS AND OBJECTIVES: In view of the increase use of computer mediated conferencing (CMC) by nurses with other health care professionals in health care education, this literature review provides insights into the experiences and issues surrounding the use of the technology by nursing students and their use with other health care students. It is an important initial step in designing and developing strategies in the use of CMC. This literature review also aims to structure the available research findings of needs and experiences of other health care students and students from disciplines other than health care to provide the best approximation of what nursing students will experience in diverse groups for inter-professional learning. METHOD: Literature review. RESULTS: The literature review indicates a substantial amount of students' experiences and expectations in CMC. The problems thus far, are more complex than access and use of the technology, and emerged as six different, but related issues associated with technology and reflective and collaborative online learning in a constructivist learning environment. RELEVANCE TO PRACTICE: Priority needs should be central in the preparation of student in the constructivist learning environment. Concerted efforts should not be just about increasing students' technological competence, but on addressing the socio-psychological dimensions in CMC.     

Clinical teachers' conceptions of nursing

Lack of knowledge exists about clinical teachers' understanding of nursing. A likely relationship between teachers' conceptions of nursing and what they focus on when teaching nursing students in the clinical setting means that the identification of different conceptions of nursing is important. This study investigated clinical teachers' experiences of nursing and clinical teaching of undergraduate nursing students. This article reports on clinical teachers' conceptions of nursing. Semistructured interviews of 20 nurses employed as clinical teachers in Australian universities were conducted. Data were analyzed using a phenomenographic approach. The findings suggest that nursing is conceived as performing tasks; providing appropriate care; providing individualized patient care aimed at achieving patient outcomes; or collaborating with health care team members to provide appropriate, individualized patient care aimed at achieving patient outcomes. Insights will assist with future preparation and support of clinical teachers, the education of nursing students, and improved curriculum design.     

"Making a connection": BSN students' perceptions of their reminiscence experiences with older adults

The projected increase in the diversity of the older adult population in the United States has generated a demand for nurses prepared to care for older adults from different cultural backgrounds. Nurse educators are challenged to develop innovative experiences to help prepare students who are competent in gerontological nursing and sensitive to cultural differences. The purpose of this study was to examine baccalaureate nursing students' perceptions of their reminiscence experiences with older adults. Forty-one nursing students who participated in a reminiscence education program during their clinical practicum completed an open-ended questionnaire. Data were analyzed, and three major themes emerged: "Making a Connection," "Seeing the World Through Their Eyes," and "Benefits of Reminiscence." Results indicate that implementing reminiscence education programs in clinical experiences can help students develop gerontological nursing skills, increase their cultural sensitivity, and improve their care of older adults.     

Pre-registration nursing students' experience of caring for cancer patients.

The preparation of nurses caring for cancer patients remains a topical subject. The recent emphasis on the preparation of an effective and informed workforce for cancer care at all nursing levels is significant, particularly as the majority of previous studies have traditionally focused on post-registration preparation of qualified nurses. Currently, there is limited information on the preparation of pre-registered nursing students and little is known about the experiences of these students, especially during their initial exposure to cancer patients. Recently, changes have also been made to the pre-registration nursing programmes in the UK in line with national recommendations leading to much earlier exposures to patient care in practice. This study provides information about nursing students' experiences of caring for cancer patients. Using self-report questionnaires each comprising of 21 Likert scale items, a survey was conducted on a total of 134 students (response rate: 88%) enrolled on the common foundation programme at the end of the first year of their undergraduate nursing programme. Data collected included information about the types of clinical settings where students were exposed to cancer patients, perceptions of their experiences with cancer patients and aspects of educational and clinical inputs perceived as helpful in preparing them to care for cancer patients. Additional insight into the students' experience was further obtained from semi-structured interviews conducted from a total of nine students drawn from the three categories of experiences they identified: positive, non-positive and mixed. The findings and implications for the preparation of pre-registration nursing students in caring for cancer patients were discussed in relation to the theoretical input, clinical support and the use of reflection in practice.     

Perceptions of graduating nursing students regarding life experiences that promote culturally competent care.

This article describes a qualitative study that explored the perceptions of graduating students from a northeast baccalaureate nursing program regarding their life experiences with cultural diversity. Thirteen students were interviewed using an interview guide, and interviews were recorded on audiotape. Information obtained included participants' cultural heritage, life experiences before entering a nursing program, educational and clinical experiences in the nursing program, knowledge about cultural competence, and the students' reflections on their ability to provide culturally competent care. Primarily qualitative methods were used to gather and analyze data. This article focuses on one of the major themes that emerged: defining life experiences related to cultural diversity. Data were reanalyzed focusing on this theme, and three life patterns emerged: positive, neutral, and conflicted. These patterns affected the students' interest and desire to provide culturally competent care. Implications for further research and nursing education are discussed.     

Place(ment) matters: students' clinical experiences and their preferences for first employers

BACKGROUND: Although a significant volume of nursing research has focused on students' experiences of clinical placements, to date, none has considered these experiences in the context of workforce recruitment and specifically how they may impact upon preferences for working for health care providers. METHODS: In this context, the research used a place-sensitive geographical perspective and a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) method to collect data on the complex range of clinical experiences which together impact upon the perceived attractiveness of different health care settings. FINDINGS: The data identified a range of experiential factors associated with mentorship, ward management, learning opportunities and racism. An important finding was that although students' experiences are obtained at the micro ward level, even if they may not necessarily reflect what happens throughout the hospital, they potentially impact, both positively and negatively, upon their broader perceptions of the hospital and the likelihood of seeking work there. IMPLICATIONS: The study highlighted a variety of issues that should be addressed by both higher education institutions and hospitals so that they may be able to provide a more consistent and positive experience for students. In the longer term, this may pay dividends through increased recruitment of new graduates.     

Enacting connectedness in nursing education: moving from pockets of rhetoric to reality

Nursing education research points to lack of faculty support as a factor in nursing students' voluntary or involuntary withdrawal from nursing education programs. Moreover, despite global trends toward educational processes grounded in humanism that foster egalitarian and liberating student-teacher relationships, nursing students continue to report that some nursing faculty struggle to enact the caring philosophy they espouse. This article showcases how a fourth-year nursing student, interviewed for a study of students who experienced failure or its threat in their nursing program, found strength as she navigated her way through nursing faculty abuse. An interpretative analysis of the student's experiences with a group of faculty whom she describes as intent on failing her calls for future research on student-teacher relationships.     

Nursing students’ experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis

AimTo synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settingsBackgroundNurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.DesignA qualitative systematic review and meta-synthesisMethodsPubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012–25 Feb 2023. Qualitative studies of any design reporting nursing students’ experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso’s 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.ResultsThe review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.ConclusionsWhile caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.     

Students' voices: listening to their experiences in practice education

The experiences of the students in this pilot study demonstrate how students are learning to respond to the call of the patient amid the challenges of contemporary health care settings. Perhaps these experiences make teachers mindful of how students learn to respond, listen to, and know and connect with patients for whom they care. How would clinical courses be different if listening to and connecting with patients (as the basis for personalizing care) was given the same priority as completing particular interventions or demonstrating particular skills? What does it mean to students to encounter situations in which patients are not being listened to or in which nurses have not connected with patients? Research in nursing education is showing how new, student-centered pedagogies arise when teachers shift attention from content, and linking content to practice, to equally exploring narrative experiences and how students and teachers spend their time together (Diekelmann & Smythe, 2004). The voices of students gathered in this pilot study suggest that students are perhaps our brightest hope for envisioning what to preserve and what to overcome as we reform and create compelling, student-centered practice nursing education.