Addressing a Critical Voice in Clinical Practice: Experiences of Nursing Students, Teachers, and Supervisors-A Qualitative Study.

AIM: Our goal was to explore how power asymmetry manifests within the relationships between students, teachers, and supervisors, and how it influences students' ability for critical reflection. DESIGN: This study has an explorative qualitative design. METHODS: Thirty in-depth interviews with nursing students (15), teachers (9), and supervisors (6) were conducted in addition to 16 observations of mid-term assessments during clinical practice. The analysis was conducted using Braun and Clarke's thematic analysis. RESULTS: The students described being a student as a balancing act between humility, conforming to the supervisor's expectations, and speaking their minds. The view expressed by the teachers and supervisors is that training for the nursing profession is closely linked to the students' ability to act independently. Due to the supervisors' hierarchical position, however, students are hesitant to voice any criticism regarding insufficient supervision or unsatisfactory performance of clinical tasks while at the same time being evaluated on their ability to critically reflect on their own and others' clinical performance. This study was prospectively registered with the Norwegian Centre for Research Data on the 15th of August 2017 with the registration number 54821.

Perspectives on self-directed learning in bioscience in nurse education - An integrative review.

OBJECTIVES: There is a lack of synthesized knowledge on nursing students self-directed learning in bioscience and how to best support students' learning in this subject. The purpose of this integrative review is to synthesize current literature on perspectives on self-directed learning among nursing students studying bioscience to guide further research aiming to support students' learning more effectively. METHODS: An integrative review in line with Whittemore & Knafl's modified framework containing five stages: problem identification, literature search, data evaluation, data analysis and presentation. A structured literature search was undertaken in the Web of Science, ERIC, Medline and CINAHL databases from November 2022 to January 2023. The inclusion criteria were nursing students enrolled in a bachelor programme, research addressing activities intended for learning bioscience, in addition to formal taught lectures and perspectives on self-directed learning in natural science subjects within nurse education such as views, actions, activities, habits and attitudes. Exclusion criteria were students in other education programs, research in formal learning contexts, and self-directed learning in other subjects than natural science subjects. Rigour of each included source was assessed using Whittemore & Knafl's suggested 2-point scale (high or low). A constant comparison method was used to synthesize results. RESULTS: Of the initial 1143 sources, 12 articles were included after abstract and full-text screening: one pilot study for randomized controlled trial, one qualitative study, two mixed methods studies and eight quantitative studies. The sample size was from 23 to 563 participants. DISCUSSION: This review identifies self-directed learning in bioscience understood as a continuum of teacher-directedness and self-directedness rather than as distinguished orientations. There seem to be no consistent definition of self-directed learning in bioscience, yet descriptions commonly imply metacognitive learning approaches. Nursing students value digital learning resources, yet technology might be secondary to the skill of self-directed learning.

Nursing leaders' perspectives on research in specialist health services: A descriptive study.

AIM: This study is to gain insight into how nursing leaders perceive their contribution to research-based knowledge in hospital settings. DESIGN: The study has a qualitative descriptive design. METHODS: Nine nursing leaders were interviewed. Data were analysed based on Braun and Clarke's thematic analysis. RESULTS: Three themes were developed: the primacy of management and practicalities, delegated responsibility and lack of research competence. Even though the nurse leaders wish to be professional leaders, they seem to prioritize the day-to-day management. The nurse facilitators have been delegated, by the nurse leaders, the responsibility for the departments and the employees' professional development. The participants reported that neither their own leaders, the nurses, nor they themselves had the necessary knowledge or the interest in engaging in research. CONCLUSION: There seems to be a lack of awareness, knowledge and priority of nursing research in nursing leadership and absence of a culture of research.

The paradox of an expected level: The assessment of nursing students during clinical practice - A qualitative study.

AIM: The aim of this study is to increase knowledge about the assessment of nursing students' clinical practice, particularly concerning how teachers and clinical supervisors identify and assess the expected level of competence in mid-term evaluations and students, teachers and supervisors' experiences of mid-term assessment. Assessment is important to assure the quality of students' clinical competence and studies show that further research on this topic is required. DESIGN: This study has an explorative qualitative design. METHODS: Thirty semi-structured interviews were conducted with nursing students, teachers and clinical supervisors along with 16 observations of mid-term assessments during clinical practice, as part of a bachelor's programme in nursing. RESULTS: Two main challenges concerning establishing an expected level of competence were identified from the analysis of the interviews and observations: 1) a general formulation of learning outcomes and 2) vague expectations of what is the expected level of achievements at different points in time. Both challenges were at institutional level. Furthermore, at performance level, certain patterns were identified related to these challenges, such as teachers and supervisors needing to concretise the general formulation of learning outcomes and their discretion to set the expected level. Additionally, non-verbal language during mid-term assessment seemed to affect how the assessment situation was perceived. CONCLUSION: We suggest that the institutional guidelines need to be critically reviewed to include greater focus on clarifying what students are expected to achieve, as well as what constitutes the expected level. We have emphasised that discretion is a necessary premise to identify an expected level of clinical competence at mid-term assessment, in particular when there is lack of a clear standard and the assessment form is vague, but also when there is no clear definition of the expected level of competence at different points in time. The consequences are that the student feel insecure about how the assessment ought to be perceived, what level they are at in their learning process, and subsequently, their level in the process of developing necessary clinical competence.

Teaching bioscience to nursing students-What works?

AIM: To compare the effects of flipped classroom and traditional auditorium lectures, on nursing students' examination results in bioscience. DESIGN: An educational intervention study. METHODS: All the first-year students in the bachelor programme (N = 493) were entered into a database and randomly assigned to the intervention or the control group in a course in bioscience. The outcome measures are the proportion of students who passed the examination, and the distribution of grades from A to E. Chi-square tests and Mann-Whitney Wilcoxon test were used. The odds to pass versus fail were modelled using binary logistic regression. RESULTS: The proportion of students who did not pass the final examination was very similar in the intervention and the control groups, 21.4% and 23.6% (p = .574). Our data did not reveal any statistically significant differences concerning the distribution of grades (p = .691). Students with biology and/or natural science had higher odds for passing.

The challenge of the biosciences in nurse education: A literature review.

AIMS AND OBJECTIVES: To review relevant literature that addresses the challenges of the biosciences in nurse education. More precisely, the review aims to explore the literature, concerning students' learning, learning contexts and methodological issues and identify any significant gaps. BACKGROUND: Knowledge of anatomy, physiology and biochemistry is essential for the understanding of human beings and for full appreciation of the concepts of illness and disease. The current status would seem to be that the required competencies within bioscience subjects are difficult to acquire and students have high rates of failure. DESIGN: Integrative review. METHODS: The research was performed on CINAHL, ERIC, Medline and British Nursing Index databases in a period from 2013-2017. Descriptive analytical methods were used for the initial research trawl. FINDINGS: The search strategy resulted in 23 papers. The results of this review shed light on certain deficiencies in the research field looking at the biosciences in nurse education. There is a distinct lack of intervention studies and, thereby, knowledge of how best to support students' learning in effective ways. Of note is that there are no field study approaches identified in the review sample. CONCLUSION: Many of the papers are single studies and course evaluations which may be seen as too narrow and inadequate as perspective. Students appear satisfied with the courses in the biosciences, but there seems to be no correlation between satisfaction and achievement. RELEVANCE TO CLINICAL PRACTICE: Understanding and being able to give coherent rationales for the bioscience content in the nursing curricula are crucial and must be established in relation to its relevance to the dynamic nature of patient care, technological advances and demographic realities. Only on that basis can the primacy of this content be seen as relevant to the aspiring student nurse.