Training healthcare professionals to be ready for practice in an era of social distancing: a realist evaluation.

BACKGROUND: Programme changes due to the COVID-19 pandemic have impacted variably on preparation for practice of healthcare professional students. Explanations for such variability need exploration. The aim of our study was to understand what clinical learning, whilst under socially distanced restrictions, worked and why (or why not). METHODS: We conducted a realist evaluation of the undergraduate healthcare programmes at one UK university in 2020-21. Initial programme theories to be tested in this study were derived from discussions with programme leads about the changes they implemented due to the pandemic. Study participants were students and teaching faculty. Online interview transcripts were coded, identifying why interventions had worked or not. This resulted in a set of 'context-mechanism-outcome' (CMO) statements about each intervention. The initial programme theories were refined as a result. RESULTS AND DISCUSSION: 29 students and 22 faculty members participated. 18 CMO configurations were identified relating to clinical skills learning and 25 relating to clinical placements. Clinical skills learning was successful whether in person, remote or hybrid if it followed the steps of: demonstration-explanation-mental rehearsal-attempt with feedback. Where it didn't work there was usually a lack of observation and corrective feedback. Placements were generally highly valued despite some deficiencies in student experience. Being useful on placements was felt to be good preparation for practice. If student numbers are to expand, findings about what works in distance learning of clinical skills and the value of various modes of induction to clinical workplace activity may also be relevant post-pandemic.

The creation of a confidence scale: the confidence in managing challenging situations scale.

Background: Self-confidence and self-efficacy are vital psychological constructs that can affect a student's performance. Aims: To measure the level of confidence in nursing students in managing challenging situations in clinical practice settings. Methods: In order to develop the scale three focus groups were conducted: with registered nurses, third year student nurses and service users. Focus group frameworks included: challenging behaviours, managing challenging situations and preparing students to manage challenging situations. Themes in relation to challenging situations that emerged from the focus groups, in conjunction with Nursing and Midwifery Council standards and expert discussions were used to create the confidence scale. The Confidence in Managing Challenging Situations Scale consists of two parts with 21 items in total. Both parts were measured by way of a five-point Likert scale. The scale was utilised to determine the level of confidence of students both pre and post a teaching intervention. Results: The confidence in managing challenging situations scale had good internal consistency, with a Cronbach's alpha coefficient reported of 0.86. Exploratory factor analysis was used to support the scale validation process. Conclusions: The Confidence in Managing Challenging Situations Scale is a successful measure of confidence for nursing students in healthcare settings. It can be applied in alternative healthcare settings for the identification of confidence levels in those student nurses learning in care settings.

Learning and teaching approaches promoting resilience in student nurses: An integrated review of the literature.

Undergraduate nursing students face challenges that can result in stress leading to impaired performance, physical illness, high turnover and sickness absence (Kinman and Jones 2001). Students therefore require skills and knowledge to help them cope with the challenges of learning professional practice. This paper explores the concept of resilience, with an emphasis on how educational programmes can foster resilient practices among student nurses. Educators can facilitate resilience by incorporating resilience teaching and training that includes, the core concepts of resilience: self-efficacy, reflective ability and self-confidence. Critical appraisal and synthesis of the literature resulted in the identification of three themes: attributes, programmes and transition. The following five key learning and teaching methods were identified as supporting the development of resilience: peer activities; reflective practice; directed study; problem based learning/enquiry based learning and experiential learning Having resilience and resilient qualities is an integral part of nursing, having a positive impact upon the health and well-being of the nurse as practitioner. Resilient qualities and behaviours can be developed through the facilitation of appropriate learning and teaching interventions.