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.     

Nursing students’ perceived stress and clinical learning experience

BackgroundStressors among nursing students arise from both academic activities and clinical placement. Understanding how nursing students perceive academic and clinical stressors and the clinical learning environment could help develop useful approaches to reducing levels of stress and contribute to the maintenance of a good learning environment. There is a paucity of studies that investigated associations between the clinical learning environment and the stress of nursing students.ObjectivesTo investigate the relationship between the perception of the clinical learning environment and stress in nursing students; to compare the perception of the clinical learning environment and stress in terms of the year and terms of the organization of supervision.DesignCross-sectional correlation studySettingsUniversityParticipantsThe sample consisted of 155 nursing students in the bachelor's degree program. During the four academic years, students of individual years of the bachelor's study program were included in the study after completing all clinical placements in a given academic year.MethodsThe following instruments were used for the data collection: Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Perceived Stress Scale; Physio-Psycho-Social Response Scale and Coping Behaviour Inventory. Correlation analysis and multiple linear regression analysis using stepwise methods were used to determine the relationships between the variables.ResultsThe clinical learning environment is a strong predictor of students' perceptions of stress related to teachers and nursing staff. Types and degrees of stressful events during clinical practice varied between years of study. The experience with supervision was related to the overall perception of the clinical learning environment, but not to the students' physio-psychosocial status, types of stressful events during clinical practice and coping behaviors. Also, the differences in the students' physio-psychosocial status were not significant in terms of individual years of study and method of supervision.ConclusionsThere is a significant relationship between the clinical learning environment and the perception of academic stress. The attitude of the teacher and the medical staff can thus be important in influencing the level of stress in nursing students.     

Constrained nursing: Nurses’ and assistant nurses’ experiences working in a child and adolescent psychiatric ward

The role of nurses and nursing in CAP inpatient care is unclear, and nurses are at risk of moral distress due to having to deal with complex demands while lacking organizational support. This study aimed to describe nurses’ and assistant nurses’ experiences working in child and adolescent psychiatric inpatient care. Eight nurses and seven assistant nurses working in a child and adolescent ward in Sweden participated in the study. Data were collected in 2019 using semi-structured qualitative interviews and subject to qualitative content analysis. Results describe nurses’ and assistant nurses’ experiences of child and adolescent psychiatric inpatient care in one theme, Constrained nursing, and four categories: Striving to be there for children and parents; Finding a way to manage work; Depending on others; Lacking nursing leadership. Findings suggest that good, person-centred and recovery-oriented nursing practice can exist in CAP inpatient care but remain unrecognized and lacking support due to unclear roles and responsibilities and lack of nursing leadership. This study is reported in accordance with the COREQ guidelines.     

Effect of Indoor Air Pollution from Biomass and Solid Fuel Combustion on Prevalence of Self-Reported Asthma among Adult Men and Women in India: Findings from a Nationwide Large-Scale Cross-Sectional Survey

Objectives. Increasing prevalence of asthma in developing countries has been a significant challenge for public health in recent decades. A number of studies have suggested that ambient air pollution can trigger asthma attacks. Biomass and solid fuels are a major source of indoor air pollution, but in developing countries the health effects of indoor air pollution are poorly understood. In this study we examined the effect of cooking smoke produced by biomass and solid fuel combustion on the reported prevalence of asthma among adult men and women in India. Methods. The analysis is based on 99,574 women and 56,742 men aged between 20 and 49 years included in India’s third National Family Health Survey conducted in 2005–2006. Effects of exposure to cooking smoke, determined by the type of fuel used for cooking such as biomass and solid fuels versus cleaner fuels, on the reported prevalence of asthma were estimated using multivariate logistic regression. Since the effects of cooking smoke are likely to be confounded with effects of tobacco smoking, age, and other such factors, the analysis was carried out after statistically controlling for such factors. Results. The results indicate that adult women living in households using biomass and solid fuels have a significantly higher risk of asthma than those living in households using cleaner fuels (OR: 1.26; 95%CI: 1.06–1.49; p = .010), even after controlling for the effects of a number of potentially confounding factors. Interestingly, this effect was not found among men (OR: 0.98; 95%CI: 0.77–1.24; p = .846). However, tobacco smoking was associated with higher asthma prevalence among both women (OR: 1.72; 95%CI: 1.34–2.21; p < .0001) and men (OR: 1.35; 95%CI: 1.49–2.25; p < .0001). Combined effects of biomass and solid fuel use and tobacco smoke on the risk of asthma were greater and more significant in women (OR: 2.16; 95%CI: 1.58–2.94; p < .0001) than they were in men (OR: 1.34; 95%CI: 1.04–1.72; p = .024). Conclusions. The findings have important program and policy implications for countries such as India, where large proportions of the population still rely on polluting biomass fuels for cooking and heating. Decreasing household biomass and solid fuel use and increasing use of improved stove technology may decrease the health effects of indoor air pollution. More epidemiological research with better measures of smoke exposure and clinical measures of asthma is needed to validate the findings.     

Expenditure on forestry and forest products research in Australia 2007–2008

Total expenditure on forestry research and forest products research in 2007–2008 in Australia was $87.8 million. This comprised $61.0 million on forestry research and $26.8 million on forest products research and was estimated using the same methods as in the several previous assessments (Quick and Booth 1987; Lambert and Turner 1992; Turner and Lambert 1997,2005). When some peripheral expenditure such as support, administration and surveys were included, the total expenditure increased to about $105.8 million. The total expenditure represents an annual average increase of about 3% since 1982 but a slow decline (0.45% per annum) in adjusted terms (1982 dollars). About 50 organisations reported undertaking forestry and or forest products research, while other organisations provided funding for research. The expenditure was attributed to four broad sectors undertaking research—Commonwealth, state, university and private—and also to broad research areas (native forests, exotic species plantations, native species plantations and environment). Research on native forests and exotic species plantations generally declined, whereas that on surveys in native forests and native species in plantations increased from 2001–2002 to 2007–2008. Similarly, research capacity declined in traditionally strong research areas such as pests and diseases and fire behaviour, and increased in energy areas such as carbon and forest bio-energy. About 600 full-time-effective researchers and technicians were involved in research in 2007–2008, plus support and management staff. The staffing numbers of individual organisations ranged from single individuals to more than fifty.

In 2007–2008, about 52% of the research funds were provided directly or indirectly by the Commonwealth Government, 28% by state governments and 20% by private companies. Total expenditure on forestry and forest products research ($87.8 million) averaged $5.78 ha^?1 of managed forest. The forestry research expenditure according to forest type comprised $14.80 ha^?1 on exotic species plantations, $36.90 ha^?1 on native species plantations and Total expenditure on forestry research and forest products research in 2007–2008 in Australia was $87.8 million. This comprised $61.0 million on forestry research and $26.8 million on forest products research and was estimated using the same methods as in the several previous assessments (Quick and Booth 1987; Lambert and Turner 1992; Turner and Lambert 1997,2005). When some peripheral expenditure such as support, administration and surveys were included, the total expenditure increased to about $105.8 million. The total expenditure represents an annual average increase of about 3% since 1982 but a slow decline (0.45% per annum) in adjusted terms (1982 dollars). About 50 organisations reported undertaking forestry and or forest products research, while other organisations provided funding for research. The expenditure was attributed to four broad sectors undertaking research—Commonwealth, state, university and private—and also to broad research areas (native forests, exotic species plantations, native species plantations and environment). Research on native forests and exotic species plantations generally declined, whereas that on surveys in native forests and native species in plantations increased from 2001–2002 to 2007–2008. Similarly, research capacity declined in traditionally strong research areas such as pests and diseases and fire behaviour, and increased in energy areas such as carbon and forest bio-energy. About 600 full-time-effective researchers and technicians were involved in research in 2007–2008, plus support and management staff. The staffing numbers of individual organisations ranged from single individuals to more than fifty.

In 2007–2008, about 52% of the research funds were provided directly or indirectly by the Commonwealth Government, 28% by state governments and 20% by private companies. Total expenditure on forestry and forest products research ($87.8 million) averaged $5.78 ha^?1 of managed forest. The forestry research expenditure according to forest type comprised $14.80 ha^?1 on exotic species plantations, $36.90 ha^?1 on native species plantations and $0.99 ha^?1 on native forests (including ecological and environmental research, and hydrological studies and fauna-flora research). Additionally, there was expenditure of about $0.45 ha^?1 on land-based surveys (mainly biodiversity), primarily in native forests. Total expenditure on forestry and forest products research equated to an average of $3.90 m^?3 of harvested timber. This comprised $1.02 m ³ on timber removals from exotic species plantations, $7.38 m^?3 from native species plantations and $1.90 m^?3 from native forests.     

A DECADE INDECADENT

This paper attempts to analyse the relationship between the pulp and paper industry in Australia, and State forestry. Victorian conditions are taken as an example.

The industry has an interest, at least equal to the State forestry authorities, in sustained yield forestry, and at the same time it can play an important role in assisting the State to work towards management for sustained yield. In many of the forests which have been cut for mill logs during the past decade, the volume of cull wood, both standing and on the ground, has often presented a serious obstacle to the establishment and development of satisfactory regeneration. The ability of the pulp and paper industry to utilize much of this material is of great potential value to State forestry.

The amount and type of this logging residue that can be used is limited by the economic conditions and disadvantages which handicap the Australian industry. Recent work shows that wood quality in relation to the quality of the finished product also exercises an economic, as well as a technical influence.

Because of these factors it is essential for the industry to have a substantial amount of high quality wood in its raw material furnish, and this introduces the novel concept of management of State forests primarily for pulpwood production. At first sight, this prospect may appear most undesirable to many State foresters, but there are several considerations which make it at least worth thinking about, if not attractive.     

Effect of hospital noise on patients' ability to hear,understand, and recall speech

Speech intelligibility and recall were examined in normally hearing and hearing‐impaired hospitalized patients. Fifty‐two participants completed testing in a sound‐attenuated booth. While listening to a recorded male speaker talking at conversational level, participants were asked to identify and remember the last (key) word in each of a series of five sentences presented in hospital noise with or without voices at three decibel levels (59, 64, and 69 dBA). Noise level and sentence context had the largest impact on key word identification (p < .001). Noise level had the largest impact on key word recall (p < .001). Type of hospital noise and hearing loss also significantly influenced performance on both measures. These findings have implications for healthcare providers communicating with hospitalized patients. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36:228–241, 2013     

Complexities during transitions to adulthood for youth with disabilities: person–environment interactions

Abstract

Purpose: The purpose of this qualitative study was to explore the experiences of youth with different disabilities from across Canada during their transitions from adolescence to adulthood. Methods: Qualitative methods, using a phenomenological tradition, explored the meaning of the lived experiences of youth with disabilities in transition to adulthood. Purposeful sampling was used to select people with a range of experiences, background, location and demographic characteristics. Individual interviews with key informants and a focus group with an “expert panel” of participants were the methods of data collection. Data analysis was iterative and followed established practices of phenomenology. Results: Over 50 people, including youth with different disabilities, parents/caregivers and service providers from different organizations and systems across Canada participated in individual and/or focus group interviews. An overarching theme of “complexities” emerged from the data analysis. Complexities were related to the interactions between person and environment during transition experiences. Six subthemes about complexities were explored in depth to describe the primary person–environment interactions that were identified by study participants. Conclusions: The complexities involved in the interactions between person and environment during transitions to adulthood appear to be similar for youth with different types of disabilities. Recommendations are provided to address these complexities using holistic and collaborative approaches in service delivery and future research.

• Implications for Rehabilitation

• The complexities involved in transitions to adulthood appear to be similar for youth with different types of disabilities.

• Rehabilitation service providers can address these complexities using holistic, strengths-based and collaborative approaches.

• Service providers and researchers in rehabilitation need to acknowledge the interactions between person and environment rather than addressing each component separately.

• Future research should include youth, families and community members on research teams to ensure that complexities are adequately addressed.

     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

Participation-based environment accessibility assessment tool (P-BEAAT) in the Zambian context

Purpose: The purpose of this study was to describe the preliminary development and validation of a potential measure for assessing the accessibility of the built environment in Zambia. It was designed to identify environmental features that present barriers to participation for people with mobility limitations (PWML) using mobility devices such as wheelchairs or crutches.Method: The Participation-Based Environment Accessibility Assessment Tool (P-BEAAT) was developed through focus group discussions and personal interviews with 88 PWML from five provinces of Zambia regarding the accessibility of their built environment. The content validity of the P-BEAAT checklist was accomplished through three phases of development with data gathered from 11 focus groups and nine personal interviews. Results: Participants described accessibility barriers which affect their participation in daily life. This information generated the P-BEAAT with 66 items describing eight environmental features with potential for identifying environmental barriers. The P-BEAAT has shown good homogeneity with Cronbach’s α score of 0.91. Conclusion: The P-BEAAT was constructed grounded in the reality of people’s experiences in Zambia for use in assessing environmental features important in the participation of daily life of PWML pertinent to developing countries. Further clinimetric testing of the properties of the P-BEAAT to establish reliability should be conducted next.

Implications for Rehabilitation

• Identification of barriers in the built environment is a critical element in the process of eliminating obstacles to participation by people with mobility limitations.

• Accessible built environment facilitates the enhancement of participation of people with mobility limitations.

• The process of identifying obstacles requires audit/assessment tools to evaluate and measure the presence or absence of barriers to accessibility of the built environment.

• This study shows that the Participation-Based Environment Accessibility Assessment Tool provides a preliminary checklist to be used in identifying environmental barriers in the process of promoting lifelong participation for people with mobility limitations using wheelchairs or crutches in Zambia.