A feasibility study of a cognitive behavioral based stress management intervention for nursing students: results, challenges, and implications for research and practice.

BACKGROUND: Stress related psychological problems are growing in nursing education and constitute an essential challenge for educators. This makes research about strategies and interventions to meet these problems important. Stress management interventions need to be tested for feasibility and acceptability, before conducting large scale RCTs. The objective of our study was to assess the feasibility and acceptability of a newly developed cognitive behavioral stress management intervention for nursing students. METHODS: Data were collected using a combination of standardized measurements and newly created questionnaires in combination with qualitative data. Our data included recruitment capability, sample characteristics, intervention acceptability and preliminary evaluation of participant psychological changes. RESULTS: Findings suggested that the feasibility of conducting a full-scale evaluation was confirmed for intervention acceptability, data collection procedures, and adherence. However, difficulties relating to recruitment capability and homework were identified. All aspects taken together, the intervention was found feasible and acceptable to nursing students, and thus a potential stress management intervention for the nurse education context. CONCLUSIONS: Overall, this study provides an insight into the challenges and complexities of developing and evaluating a new brief cognitive behavioral based stress management training intervention in a nurse education setting.

Self-assessed competence and need for further training among registered nurses in somatic hospital wards in Sweden: a cross-sectional survey.

BACKGROUND: Professional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses' self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (≤ 0,5 year, > 0,5-5 years, and ≥ 6 years). METHODS: A cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out. RESULTS: Registered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients' health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant. CONCLUSIONS: Although the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed.

Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study.

AIMS AND OBJECTIVES: To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway. BACKGROUND: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%-20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools. DESIGN: Qualitative interviews were conducted with 18 public health nurses working in the school health services. METHOD: A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist. RESULT: The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: "The formal structure has an impact on interprofessional collaboration"; "The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration"; and "The primary players are the teachers in collaboration." CONCLUSION: The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible. RELEVANCE TO CLINICAL PRACTICE: The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.

Value conflicts in perioperative practice.

BACKGROUND: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves. OBJECTIVES: This study describes operating theatre nurses' experiences of ethical value conflicts in perioperative practice. RESEARCH DESIGN: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation. ETHICAL CONSIDERATION: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee. FINDINGS: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient's care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient's best. This occurred when operating theatre nurses' competence was not taken seriously and was ignored in patient care. CONCLUSION: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations.

Clinical group supervision for integrating ethical reasoning: Views from students and supervisors.

BACKGROUND: Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students' education and especially the focus on ethical reasoning. AIM: The aim of this study was to explore and describe nursing students' ethical reasoning and their supervisors' experiences related to participation in clinical group supervision. RESEARCH DESIGN: The study is a qualitative interview study with interpretative description as an analysis approach. PARTICIPANTS AND RESEARCH CONTEXT: A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5). ETHICAL CONSIDERATIONS: The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden. FINDINGS: The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions. DISCUSSION AND CONCLUSION: Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice.

Work stress among newly graduated nurses in relation to workplace and clinical group supervision.

AIM: The aim was to investigate occupational stress among newly graduated nurses in relation to the workplace and clinical group supervision. BACKGROUND: Being a newly graduated nurse is particularly stressful. What remains unclear is whether the workplace and clinical group supervision affect the stress. METHOD: A cross-sectional comparative study was performed in 2012. Data were collected by means of a numerical scale measuring occupational stress, questions about workplace and clinical group supervision. One hundred and thirteen nurses who had recently graduated from three Swedish universities were included in the study. RESULTS: The stress was high among the newly graduated nurses but it differed significantly between workplaces, surgical departments generating the most stress. Nurses who had received clinical group supervision reported significantly less stress. The stress between workplaces remained significant also when participation in clinical group supervision was taken into account. CONCLUSIONS: Newly graduated nurses experience great stress and need support, especially those in surgical departments. Nurses participating in clinical group supervision reported significantly less stress. IMPLICATIONS FOR NURSING MANAGEMENT: It is important to develop strategies that help to adapt the work situation so as to give nurses the necessary support. Clinical group supervision should be considered as an option for reducing stress.

Making the invisible visible--operating theatre nurses' perceptions of caring in perioperative practice.

The aim of this study was to describe operating theatre nurses' (OTNs') perceptions of caring in perioperative practice. A qualitative descriptive design was performed. Data were collected with interviews were carried out with fifteen strategically selected operating theatre nurses from different operating theatres in the middle of Sweden. A phenomenographic analysis was used to analyse the interviews. The findings show that operating theatre nurses' perceptions of caring in perioperative practice can be summarised in one main category: To follow the patient all the way. Two descriptive categories emerged: To ensure continuity of patient care and keeping a watchful eye. The operating theatre nurses got to know the patient and as a result became responsible for the patient. They protected the patient's body and preserved patient dignity in perioperative practice. The findings show different aspects of caring in perioperative practice. OTNs wanted to be more involved in patient care and follow the patient throughout the perioperative nursing process. Although OTNs have the ambition to make the care in perioperative practice visible, there is today a medical technical approach which promotes OTNs continuing to offer care in secret.

Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education.

AIMS AND OBJECTIVES: To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. BACKGROUND: Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. DESIGN: A cross-sectional study with evaluative design. METHODS: Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. RESULTS: Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. CONCLUSIONS: The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. RELEVANCE TO CLINICAL PRACTICE: It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.

The clinical learning environment during clinical practice in postgraduate district nursing students' education: A cross-sectional study.

AIM: To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. DESIGN: Cross-sectional study design. METHODS: A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. RESULTS: The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.

Operating theatre nurses' with managerial responsibility: Self-reported clinical competence and need of competence development in perioperative nursing.

AIM: The aim of this study was to investigate operating theatre nurses (OTNs) with managerial responsibility, and their self-rated clinical competence and need for competence development in perioperative nursing. DESIGN: A cross-sectional study was applied using a modified version of Professional Nurse Self-Assessment Scale of Clinical Core Competence I. METHOD: Data were collected from 303 OTNs in Sweden, 80 of whom indicated that they had managerial responsibility. Statistics analysis was used to identify the relationships between background variables to compare OTNs with and without managerial responsibility and their need for competence development. RESULTS: OTNs with an academic degree and managerial responsibility self-rated their clinical competence higher compared with OTNs without an academic degree. It also turned out that OTNs with RN education and 1-year advanced nursing in theatre care, and master's 60 credits had a lower need for competence development in cooperation and consultation, professional development and critical thinking.

Not Just Tools to Handle It: A Qualitative Study of Nursing Students' Experiences From Participating in a Cognitive Behavioral Stress Management Intervention.

Background. Stress-related problems are an increasing challenge within nurse education since it affects learning, professional development, and mental health negatively. Despite this, knowledge is scarce regarding nursing students' experiences of being in stress management interventions. Aim. This study aimed to describe how nursing students experienced a preventive cognitive behavioral therapy-based stress management intervention. Method. Data were collected through 14 semistructured interviews with nursing students who had participated in a stress management intervention, and analyzed using inductive qualitative content analysis. Results. The analysis yielded one theme, Turning points, which consisted of four categories: (1) more in touch with reality, (2) increased self-confidence, (3) improved communication skills, and (4) a new way of reflecting. Discussion. Findings emphasize the importance of both theoretical and structural aspects when planning a stress management training intervention. A group format delivery in combination with a multicomponent cognitive behavioral intervention can be interrelated elements for positive stress-related changes. Conclusion. Our findings indicate that participants developed new and more adaptive coping strategies, which were attributed to the intervention. The participants expressed that they had increased their ability to reflect, which led to increased insight and self-reflection. The intervention constitutes an example of a contribution to stress management research and provides information for stress management training initiatives in nurse education.

Effects of a Cognitive Behavioral-Based Stress Management Program on Stress Management Competency, Self-efficacy and Self-esteem Experienced by Nursing Students.

Nursing students' exposure to stress negatively affects both academic and clinical performance and potentially their future as professional nurses. This pilot study measured the effects of a 10-week cognitive behavioral therapy-based stress management program, using a quasi-experimental design. Independent t tests showed positive effects of the training program compared with a control group. Students' perceived stress management competency, self-efficacy, and self-esteem were higher 1 year after the intervention.

Operating theatre nurses' self-reported clinical competence in perioperative nursing: A mixed method study.

AIMS: The aim of this study was to investigate how operating theatre nurses (OTNs) self-rated their clinical competence and describe their experience of important factors for the development of clinical competence in perioperative nursing. DESIGN: A cross-sectional study with a mixed-method approach was chosen. Data were collected through a modified version of the questionnaire Professional Nurse Self-Assessment Scale of Clinical Core Competence I, which was supplemented with an open-ended question. METHODS: Data were collected from 303 operating theatre nurses in Sweden. Statistics analysis was used to identify the relationship between the participants' background variables. The open-ended question was analysed by using a qualitative conventional content analysis. RESULTS: Academic degree and professional experience of perioperative nursing were significant for the development of clinical competence. Academic degree appeared to affect operating theatre nurses' leadership and cooperation in the surgical team, as well as how consultations took place with other professionals.

Experiences of supervision during clinical education among specialised nursing students in Sweden: A cross-sectional study.

BACKGROUND: The importance of the clinical learning environment in nurse education has gained increasing attention over the last decades. However, there is a lack of research on the learning environment, its significance and meaning in specialist nurse education. OBJECTIVE: The objectives of the study were to investigate specialised nursing students' experiences of supervision during clinical practice and to compare students who were satisfied with the supervision with those who were dissatisfied with respect to a) organisation of supervision and number of preceptors, as well as time allocated by preceptors for b) supervision, c) reflection, d) discussion of intended learning outcomes, and e) assessments of students' performance by preceptors. DESIGN: This study used a cross-sectional design. SAMPLE AND SETTINGS: A convenience sample of specialised nursing students was derived from five Swedish universities in the years 2016 and 2017. METHODS: Data were collected using a questionnaire. Statistical analyses and a qualitative conventional content analysis were performed. RESULTS: While almost all specialised nursing students reported that there had been time for discussion on their performance assessment, almost half of the students reported not getting time for supervision, or time for reflections and discussions on intended learning outcomes with the preceptor. Students reporting having time allocated for supervision by preceptors were found to be more satisfied with supervision. It was described as important that the preceptor(s) acknowledged the students previous work experiences. Even though being a registered nurse, reflections and feedback were described as valuable for the students learning. Several preceptors were described as positive allowing a broader picture and different views regarding working as a specialist nurse. CONCLUSIONS: This study indicates that supervision, in terms of discussions and reflections, of specialised nursing students is significant for learning experiences and satisfaction during clinical placement.

Responsibility for patient care in perioperative practice.

AIM: To obtain an understanding of operating theatre nurses' experiences of responsibility for patient care and safety in perioperative practice. DESIGN: A hermeneutic design were used. METHOD: Data were collected during 2012 from 15 operating theatre nurses who participated in individual interviews. The text was analyzed by hermeneutical text interpretation. FINDINGS: The texts revealed two main themes: A formal external responsibility and personal ethical value. Responsibility that the patient was not exposed to risks, protecting the patient's body, systematically planning and organizing work in the surgical team. The personal ethical value meant confirming the patient as a person, caring for the patient and preserving the patient's dignity. A new understanding emerged that the operating theatre nurse always have the patient in mind.

Nurse students learning acute care by simulation - Focus on observation and debriefing.

INTRODUCTION: Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings. AIM: To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing. DESIGN: The study was designed as an observational study inspired by an ethnographic approach. METHOD: Data was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis. RESULTS: Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity. CONCLUSION: High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety.

Nurse teacher models in clinical education from the perspective of student nurses--A mixed method study.

OBJECTIVES: The aim was to describe and compare the clinical teacher's role in different models of clinical practice from the perspective of student nurses. DESIGN AND SETTINGS: The study took place in collaboration with two Swedish universities that applied different educational models in clinical practice. A mixed method approach was used. The quantitative part had a comparative design and the qualitative part had a descriptive design. PARTICIPANTS: The study group consisted of 114 student nurses (response rate 87%). Fifty-three of them had met clinical teachers employed at the university and not participating in the daily clinical work (University Nurse Teachers, UNTs), whilst 61 had met clinical teachers dividing their time between teaching and nursing (Clinical Nurse Teachers, CNTs). Eight students participated in the qualitative part of the study. METHODS: A questionnaire including the CLES+T scale was used to ascertain the students' perception of the clinical teacher's role, complemented by interviews directed towards an enrichment of this perception. RESULTS: Students meeting CNTs agreed more strongly than those meeting UNTs that the teacher had the ability to help them integrate theory and practice. Whilst spontaneous meetings between students and CNTs occurred, students mostly met UNTs in seminars. Students meeting UNTs felt alone but did appreciate having someone outside the clinical environment to provide support if they did not get along with their preceptor. CONCLUSIONS: In the case of UNTs, it is important that they keep their knowledge of clinical issues updated and visit the clinical placement not only for seminars but also to give students emotional support. In the case of CNTs, it is important that they are members of the faculty at the university, take part in the planning of the clinical courses and are able to explain the learning goals to the students.

Student nurses' experiences of the clinical learning environment in relation to the organization of supervision: a questionnaire survey.

AIM: The aim was to investigate student nurses' experiences of the clinical learning environment in relation to how the supervision was organized. BACKGROUND: The clinical environment plays an essential part in student nurses' learning. Even though different models for supervision have been previously set forth, it has been stressed that there is a need both of further empirical studies on the role of preceptorship in undergraduate nursing education and of studies comparing different models. METHOD: A cross-sectional study with comparative design was carried out with a mixed method approach. Data were collected from student nurses in the final term of the nursing programme at three universities in Sweden by means of a questionnaire. RESULTS: In general the students had positive experiences of the clinical learning environment with respect to pedagogical atmosphere, leadership style of the ward manager, premises of nursing, supervisory relationship, and role of the nurse preceptor and nurse teacher. However, there were significant differences in their ratings of the supervisory relationship (p<0.001) and the pedagogical atmosphere (p 0.025) depending on how the supervision was organized. Students who had the same preceptor all the time were more satisfied with the supervisory relationship than were those who had different preceptors each day. Students' comments on the supervision confirmed the significance of the preceptor and the supervisory relationship. CONCLUSION: The organization of the supervision was of significance with regard to the pedagogical atmosphere and the students' relation to preceptors. Students with the same preceptor throughout were more positive concerning the supervisory relationship and the pedagogical atmosphere.

Nursing students' assessment of the learning environment in different clinical settings.

INTRODUCTION: Nursing students perform their clinical practice in different types of clinical settings. The clinical learning environment is important for students to be able to achieve desired learning outcomes. Knowledge is lacking about the learning environment in different clinical settings. AIM: The aim was to compare the learning environment in different clinical settings from the perspective of the nursing students. DESIGN: A cross-sectional study with comparative design was conducted. METHOD: Data was collected from 185 nursing students at three universities by means of a questionnaire involving the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. An open-ended question was added in order to ascertain reasons for dissatisfaction with the clinical placement. RESULTS: The nursing students' satisfaction with the placement did not differ between clinical settings. However, those with clinical placement in hospital departments agreed more strongly that sufficient meaningful learning situations occurred and that learning situations were multi-dimensional. Some students reported that the character of the clinical setting made it difficult to achieve the learning objectives. CONCLUSION: In the planning of the clinical placement, attention must be paid to whether the setting offers the student a meaningful learning situation where the appropriate learning outcome may be achieved.

The learning process of recently graduated nurses in professional situations--experiences of an introduction program.

An increased theoretical focus and decreased clinical training have resulted in sharp criticism from health care institutions of the content of the nursing education program. As a consequence of this criticism, employers offer introduction programs to recently graduated nurses after they have completed their nursing education. This study is part one of a larger research study. The aim of the present study was to analyze and describe how recently graduated nurses learn at the place of work and how they seek a meaning in their encounter with that environment. The research method was ethnographic, and the empirical material was based upon data from participant observations, interviews and field notes. The results disclosed that workplaces using the master-apprentice system as a model for supervising recently graduated nurses during the introduction program. The results also showed that the novices have acquired theoretical knowledge and know what action to take, but may have trouble assessing which part of their knowledge to use. The introduction program constitutes an obstacle in the professional development of the novices.