Preparedness for a first clinical placement in nursing: a descriptive qualitative study.

BACKGROUND: A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students' perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students' emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience. METHODS: The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically. RESULTS: Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants' feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students' expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers. CONCLUSIONS: This unique study of first-year postgraduate entry-to-practice nursing students' perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students' narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Transition to Practice Programs in Nursing: A Rapid Review.

Background Transition to practice can be exceedingly stressful for newly qualified nurses as they grapple with the "reality shock" of everyday practice as an RN. Transition to practice programs were implemented as a support strategy to ease the transition from student to RN and are designed to increase graduates' confidence and competence, improve their professional adjustment, and increase their retention. Method This rapid review was framed by the Cochrane Methods Rapid Review, supported by the PRISMA statement checklist, aiming to identify and describe the benefits of transition to practice programs for newly graduated RNs and their impact on workforce retention. Results The literature revealed that mixed evidence exists regarding the value and benefits of graduate nurse transition programs to both the graduate and the health service. Conclusion There are multiple inconsistencies across clinical settings, organizations, and preceptor-ship/mentoring training, among others, particularly in relation to duration of the program and the amount of formalized contact/study days. [J Contin Educ Nurs. 2022;53(10):442-450.].

A new survey tool for evaluating pandemic preparedness in health services.

BACKGROUND: Rapid decision-making with limited resources and prior research to draw upon posed challenges for health service leaders globally when preparing for COVID-19. How do health services prepare for a pandemic and evaluate if the preparation has been effective? This study aimed to explore health workers' perceptions and knowledge regarding preparedness for COVID-19 at a regional health service in Australia. METHODS: A 32-item online survey was developed to evaluate preparedness across five scales: 1) Clinical, 2) Communication, 3) Environment, 4) Human Resources, and 5) General Preparedness. Data were analyzed using parametric and non-parametric statistics and qualitative content analysis. RESULTS: Ninety-three employees completed the survey, with most working in clinical roles (58.1%). Respondents largely felt the health service was well-prepared (84.0%) and they were personally prepared (74.4%) to respond to COVID-19. Clinical and communication scale scores varied by role type. Respondents faced personal risk and resource shortages impacted their sense of safety; others felt adequately supported. CONCLUSIONS: A coordinated "whole hospital response", accessible and inclusive communication, education, adequate resourcing, and employee wellbeing supports are necessary when preparing health services for sentinel events. This survey tool offers health services an approach to evaluating pandemic preparation. Continued advocacy for resources and wellbeing needs of health workers is paramount in future preparations.

Exploring the contribution of clinical placement to student learning: A sequential mixed methods study.

BACKGROUND: Increasing demand and limited supply of clinical placements in nursing underscore the need to better understand the role of clinical placements in students' learning. Identifying pedagogically rich activities that support work place learning alongside factors that influence educational outcomes has the potential to optimise professional placement experiences. OBJECTIVE: To explore student nurses perceptions of the value of nursing clinical placements to their learning. DESIGN AND METHODS: A descriptive research design was employed using a sequential mixed method approach. A cross-sectional student survey captured students' perceptions of work integrated learning based on the perceived contribution of a pre-determined list of activities undertaken on clinical placement. SETTING AND PARTICIPANTS: Four Australian universities took part. Participants included students undertaking entry to practice programs. RESULTS: Four hundred and sixty-nine students completed the survey. Thirty-eight students participated in 12 focus groups. Participants rated PRA including interacting and time with patients and performing assessments as the most useful activities. Less useful, were activities that took them away from the patient. CONCLUSIONS: To maximise workplace learning, consideration must be given to ensuring students are presented with goal directed activities that support learning and are focused on an expanding scope of practice with opportunities to discuss and engage with staff.

Transforming their lives: post-traumatic growth experience in Chinese women with breast cancer-a grounded theory study.

Our research sought to explore post-traumatic growth experience among Chinese women with breast cancer. Constructivist grounded theory methodology was utilised to understand Chinese women's post-traumatic growth experience. 24 women with breast cancer were recruited from China. Data was collected through semi-structured, interviews. Three categories were developed from the data: renewing self-perception, encountering changes in relationships, and altering philosophical values and beliefs. The unique manifestations of post-traumatic growth highlight the need for development and adaption of the post-traumatic growth inventory to reduce cultural biases within the assessment tool and incorporate new culturally appropriate items.

The development of nurses' foundational values.

BACKGROUND: In the ever-changing and complex healthcare environment, nurses encounter challenging situations that may involve a clash between their personal and professional values resulting in a profound impact on their practice. Nevertheless, there is a dearth of literature on how nurses develop their personal-professional values. AIM: The aim of this study was to understand how nurses develop their foundational values as the base for their value system. RESEARCH DESIGN: A constructivist grounded theory methodology was employed to collect multiple data sets, including face-to-face focus group and individual interviews, along with anecdote and reflective stories. PARTICIPANTS AND RESEARCH CONTEXT: Fifty-four nurses working across various nursing settings in Indonesia were recruited to participate. ETHICAL CONSIDERATIONS: Ethics approval was obtained from the Monash University Human Ethics Committee, project approval number 1553. FINDINGS: Foundational values acquisition was achieved through family upbringing, professional nurse education and organisational/institutional values reinforcement. These values are framed through three reference points: religious lens, humanity perspective and professionalism. This framing results in a unique combination of personal-professional values that comprise nurses' values system. Values are transferred to other nurses either in a formal or informal way as part of one's professional responsibility and customary social interaction via telling and sharing in person or through social media. DISCUSSION: Values and ethics are inherently interweaved during nursing practice. Ethical and moral values are part of professional training, but other values are often buried in a hidden curriculum, and attained and activated through interactions during nurses' training. CONCLUSION: Developing a value system is a complex undertaking that involves basic social processes of attaining, enacting and socialising values. These processes encompass several intertwined entities such as the sources of values, the pool of foundational values, value perspectives and framings, initial value structures, and methods of value transference.

Primary healthcare clinicians.

The objective of the study was to measure implementation of telehealth for client consultations from Allied Health and Community Health clinicians' perspectives during the COVID-19 pandemic. Purposeful sampling was used to invite allied and community health clinicians to complete the survey. An online survey design, underpinned by normalisation process theory, utilising the NoMAD tool, which consists of 19 implementation assessment items. Descriptive statistics are reported. A 66% (n=24) response rate was obtained. Fifty-two percent indicated they were using telehealth for the first time. Despite the rapid implementation of telehealth for client consultations due to the pandemic crisis, participants reported positive perceptions of the use of telehealth when measured using the NoMAD. Fifty-eight percent (n=14) of respondents agreed or strongly agreed that telehealth will become a normal part of their work. Despite unplanned and under-resourced implementation of telehealth, Allied Health and Community Health clinicians reported very positive perceptions. However, further education and training to ensure 'normalisation' of this model may be required.

Community health placements for junior medical and nursing students for interprofessional learning.

Health care is increasingly delivered in primary and community settings, yet undergraduate clinical education remains focused in hospitals. Interprofessional student placements in community health offer an alternative to traditional clinical education and extend the capacity for clinical education beyond hospital placements. This study sought to investigate the value of interprofessional clinical placements at a community health center for dyads of second year medical and nursing students. A mixed methods evaluation was used. Quantitative and qualitative feedback was collected using the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI). Students (n = 58) completed the ICPELI after observation of community health half day sessions, at one of three community health sites. Two focus group interviews were undertaken with the health care practitioners (n = 8) to explore their perception of the new interprofessional placements. The placements were rated highly by all participants with three themes identified: It takes a team, Bouncing ideas and Realities of Community Health. Innovative approaches to clinical education and learning are needed to prepare a healthcare workforce capable of working in a collaborative, interprofessional manner. Community health offers a promising location for interprofessional learning for junior medical and nursing student teams.

Emerging From the "Ku:" Fluctuating in Adjusting With Breast Cancer-A Post-Traumatic Growth Theory Situated Within Chinese Culture.

This purpose of the study was to construct a model (theory) to understand Chinese women's adjustment process in living with breast cancer. A constructivist grounded theory method was adopted in this study. A total of 24 women were recruited through purposive and theoretical sampling. Semi-structured, audio-recorded interviews were undertaken in Chinese and transcribed. Initial coding, focused coding, and theoretical coding approaches were used to identify subcategories and categories, and to construct the emergent theory. The basic social process these women used to deal with the breast cancer diagnosis was identified as: Emerging from the 'ku': Fluctuating in adjusting with breast cancer. Four categories were revealed following analysis: confronting challenges, orienting to reality, accommodating the illness, and transforming their lives, which encapsulated the main cognitive and emotional processes in which Chinese women engaged in their adjustment to living with their illness. The core process was influenced by a variety of contextual influences, which were identified as personal factors, social-environmental factors, and some specific cultural factors which emphasized positive changes. Chinese cultural values such as "Wuwei" coping strategies, familial primacy, and Chinese self-disclosure contribute to Chinese women's adjustment processes and post-traumatic growth experiences. Hence, there is a need to consider Chinese cultural features, in designing culturally tailored supportive programs in multi-cultural clinical settings.