Tensions in learning professional identities - nursing students' narratives and participation in practical skills during their clinical practice: an ethnographic study.

BACKGROUND: Clinical practice is a pivotal part of nursing education. It provides students with the opportunity to put the knowledge and skills they have acquired from lectures into practice with real patients, under the guidance of registered nurses. Clinical experience is also essential for shaping the nursing students' identity as future professional nurses. There is a lack of knowledge and understanding of the ways in which students learn practical skills and apply knowledge within and across different contexts, i.e. how they apply clinical skills, learnt in the laboratory in university settings, in the clinical setting. The aim of this study was therefore to explore how nursing students describe, and use, their prior experiences related to practical skills during their clinical practice. METHODS: An ethnographic case study design was used. Fieldwork included participant observations (82 h), informal conversations, and interviews (n = 7) that were conducted during nursing students' (n = 17) clinical practice at an emergency department at a university hospital in Sweden. RESULTS: The overarching theme identified was "Learning about professional identities with respect to situated power". This encompasses tensions in students' learning when they are socialized into practical skills in the nursing profession. This overarching theme consists of three sub-themes: "Embodied knowledge", "Divergent ways of assessing and evaluating knowledge" and "Balancing approaches". CONCLUSIONS: Nursing students do not automatically possess the ability to transfer knowledge from one setting to another; rather, their development is shaped by their experiences and interactions with others when they meet real patients. The study revealed different ways in which students navigated tensions related to power differentials. Reflecting on actions is a prerequisite for developing and learning practical skills and professional identities. This highlights the importance of both educators' and the preceptors' roles for socializing students in this process.

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.

Nursing students' socialisation into practical skills.

Socialisation is a significant factor that shapes nursing students' learning in clinical settings. Little is known about the ways in which students learn practical skills during their clinical practice and how they are socialised into these skills. This knowledge is important for creating an optimal environment for ensuring a high standard of care and patient safety. This study aims to address this knowledge gap. An ethnographic approach was used. Data were collected by participant observations during nursing students' clinical practice in an emergency department at a university hospital in Sweden, and during informal conversations with students and their preceptors. In the analysis, four themes emerged: A reflective approach based on a theoretical framing; Multitasking situations; Shifts in an active role as a nursing student; and Styles of supervision. Students' socialisation into practical skills was shaped by several factors where preceptors played a key role. Teaching and learning styles and interactions between the preceptor and the student shaped the learning situations. A dominant discrepancy regarding whether and how reflections took place between preceptors and students was identified. This highlights the need for creating continuity between the ways that experiences are organised across the settings of learning (university-based and clinically based learning) to enhance nursing students' learning and socialisation into practical skills.

Walking the bridge: Nursing students' learning in clinical skill laboratories.

Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified - walking the bridge - in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.

Use of technical skills and medical devices among new registered nurses: A questionnaire study.

BACKGROUND: One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way. OBJECTIVES: The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices. DESIGN: A cross-sectional study with descriptive and comparative design. PARTICIPANTS: RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1 year were included in the study (n=113, response rate 57%). METHOD: Data were collected by means of a postal questionnaire. RESULTS: Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon. CONCLUSIONS: This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed.