Opportunity to discuss ethical issues during clinical learning experience.

BACKGROUND: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. RESEARCH AIMS: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. RESEARCH DESIGN: An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much'). PARTICIPANTS AND RESEARCH CONTEXT: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. ETHICAL CONSIDERATIONS: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. FINDINGS: Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. CONCLUSION: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice.

Multilevel National Analysis of Nursing Students' Perceived Opportunity to Access Evidence-Based Tools During Their Clinical Learning Experience.

BACKGROUND: Easy-to-access tools have been demonstrated to improve evidence-based practice (EBP) competences among nursing students. However, students' perception of access to EBP tools (e.g., clinical practice guidelines [CPGs], protocols) is unknown. AIMS: To explore: (1) nursing students' opportunity to access EBP tools during their education, and (2) associated factors. METHODS: A national cross-sectional study including all Italian nursing programs. Nursing students were deemed eligible according to the following inclusion criteria: Those who (1) were attending or just ended their practical rotation lasting at least 2 weeks at the time of the survey, and (2) expressed through written informed consent their willingness to take part in the study. Participants were asked about their perceived opportunity to access EBP tools during their most recent clinical learning experience (from 0 - not at all to 3 - always). A set of explanatory variables was collected at the individual, nursing program, and regional levels by using a questionnaire. RESULTS: Nine thousand six hundred and seven (91.6%) out of 10,480 nursing students took part in the study. Overall, 4,376 (45.6%) students perceived not at all or only a small opportunity to access EBP tools during their most recent clinical rotation. In the multilevel analysis, factors promoting access were mainly set at the clinical learning environment level (high safety and nursing care quality, high self-directed learning opportunities, high quality of the learning environment, and being supervised by a clinical nurse). In contrast, male gender and lower academic class were associated with a lower perception of accessibility to EBP tools. A consistent variability in the perceived opportunity to access EBP tools emerged across regions. LINKING EVIDENCE TO ACTION: Evidence-based decision-making is increasingly expected from nurses. Therefore, nursing faculties should safeguard and continuously improve students' competence regarding EBP, by implementing strategies mainly at the nursing program and regional levels.

[The involvement of patients in the assessment of nursing students during their practical training: a scoping review]. / Il coinvolgimento dei pazienti nel processo di valutazione dello studente di Infermieristica in tirocinio: una scoping review.

. The involvement of patients in the assessment of nursing students during their practical training: a scoping review. INTRODUCTION: In health care education, several experiences of patient involvement in students' assessment are documented internationally: this represents a challenge for nursing education. OBJECTIVE: To analyze user involvement experiences in nursing student assessment in order to identify: a) potential benefits and challenges, b) assessment methods and tools, c) assessed skills. METHODS: A scoping review was conducted according to the methodology proposed by the Joanna Briggs Institute. Methods and findings have been reported according to the PRISMA-ScR (Systematic reviews and Meta-Analyses extension for Scoping Reviews) statement. RESULTS: The results of the 22 included studies, published between 1995 and 2021, mainly in the United Kingdom and Europe, indicate that user' engagement is an experience that can be useful and meaningful. However, it is not without challenges such as the difficulty of providing critical feedback, student anxiety, and the investment of time and resources required. Assessments can be collected through scales, questionnaires, or interviews, focusing on interpersonal skills such as listening and respect, allowing tutors to gather surprising details about students' performance. CONCLUSIONS: Patients can provide original insights into nursing student's caring behaviors and can be a source of learning based on valuing the point of view of care receivers. Implementing patient participation in this process requires clarity, commited adherence and rigorous planning.

[Health projects managed by Nursing Coordinators: an analysis of contents and degree of success]. / I progetti gestiti dai Coordinatori: analisi del loro profilo e successo.

AIM: To describe the evolution and results of health projects run in hospitals and managed by Nursing Coordinators. METHODS: A convenience sample of 13 north Italian hospital, and a sample of 56 Nursing Coordinators with a permanent position from at least 1 year, was contacted. The following information was collected with a structured interview: projects run in 2009, topic, if bottom up or top down, number of staff involved and state (ended, still running, stopped). RESULTS: In 2009 Nursing Coordinators started 114 projects (mean 1.8±1.2 each): 94 (82.5%) were improvement projects, 17 (14.9%) accreditation, and 3 (2.6%) research. The projects involved 2.732 staff members (73.7%; average commitment 84 hours); 55 (48.2%) projects were still running, 52 (45.6%) completed, for 5 (4.4%) there was no assessment and 2 (1.8%) had been stopped. CONCLUSIONS: Nurses are regularly involved in several projects. A systematic monitoring of the results obtained and stabilization strategies are scarce. Due to the large number of resources invested, a correct management and the choice of areas relevant for patients' problems and needs are pivotal.

[The implementation of a District Clinic to overcome the shortage of general practitioners in the Basso Vicentino area]. / Attivazione del Presidio Territoriale di Assistenza Primaria per affrontare la carenza di medici di medicina generale nel territorio del Basso Vicentino.

. The implementation of a District Clinic to overcome the shortage of general practitioners in the Basso Vicentino area. INTRODUCTION: The demographic and epidemiological changes of Western societies lead to the implementation of new organizational models based on prevention and health promotion interventions mainly oriented to chronic patients. This approach promotes people's living places as the privileged place of care. AIM: To guarantee, in a rural area, the care of patients without a general practitioner, through the activation of the Primary Care District Clinic. METHODS: After having mapped the main chronic health problems of the catchment area, an outpatient care service based on an integrated medical-nursing approach was implemented. The Family and Community Nurse was responsible for the stratification of subgroups of patient according to their health problem, ensuring an integrated care of patients with chronic diseases or frail conditions, by education and symptoms monitoring. A convenience sample of 100 patients was selected, to analyze the degree of satisfaction with the care offered, by administering a questionnaire. RESULTS: Six months after its implementation, 4,000 patients accessed to the District Clinic. Those who answered the questionnaire declared high levels of satisfaction for the care received. The main needs were requests for repeated prescriptions and prescriptions for specialist examinations or visits for acute symptoms. CONCLUSIONS: The implemented model is promising, the patients were satisfied with the care received but would prefer to have contacts with the same nurse over time.

A Nationwide Italian Cross-sectional Study on Nursing Students' Perceived Workplace Safety During Clinical Practice.

BACKGROUND: Nursing students' perception of a safe clinical working environment may impact the development of professional skills and progression in the profession. PURPOSE: The aims of this study were to describe to what extent nursing students perceive the working environments as safe during their most recent clinical rotation and to explore factors associated with their perception of a safe workplace environment. METHODS: A nationwide Italian cross-sectional study involving 9607 students in 27 universities across 95 three-year nursing programs was performed in 2015-2016, and secondary analyses were run in 2019. RESULTS: The workplace environment was perceived by students as only a little (n = 2598 [27.0%]), to some extent (n = 4048 [42.1%]), and always (n = 2555 [26.0%]) safe; 406 (4.2%) students reported to have never felt that the workplace as safe. At the multivariate level, factors promoting students' perception of a safe clinical environment were a setting offering higher (a) learning opportunities, (b) safety and nursing care quality, (c) quality of tutorial strategies, and (d) self-directed learning opportunities. CONCLUSIONS: Nursing faculty should assess the quality of clinical settings before deciding on environments for students' learning experience.

Nursing students' experience of the mental health setting as a clinical learning environment: Findings from a national study.

PURPOSE: To explore nursing students' perceptions of their clinical learning experiences in the mental health (MH) setting. DESIGN AND METHODS: Secondary analysis of data collected within an Italian national cross-sectional study involving students (N = 9607) who were attending 95 3-year baccalaureate nursing programs. FINDINGS: Students in MH settings scored the quality of the learning environment overall significantly higher (P = .008) compared to those who rotated in other clinical settings, specifically with respect to (a) the tutorial strategies' quality; (b) the learning opportunities; and (c) the learning environment's quality. PRACTICE IMPLICATIONS: MH settings emerged as a worthy clinical environment where less pressing rhythms allow preceptors to provide students more learning opportunities that, in turn, affect the perceived degree of competence achieved and the desire to work in these contexts after graduation.

The Lived Experience of Nursing Students with Culturally and Linguistically Diverse (CALD) Backgrounds in Italy: A Descriptive Phenomenological Study.

Introduction: In recent decades, Italy has been exposed to significant migrant flows resulting from political and economic instability in neighbouring countries. As a result, there has been an increased amount of cultural and linguistic diversity (CALD) among nursing students. The aim of this study was to explore the experience of CALD nursing students as lived in the Italian nursing programmes. Method: A descriptive phenomenological method was used in 2017 with the involvement of a purposeful sample of 21 CALD nursing students in five Italian Bachelor of Nursing Science campuses. Data were collected using semistructured interviews; the subsequent content analysis was conducted by two independent researchers. Results: CALD nursing students reported having lived a transformative experience based on seven themes, from "living in the middle, between belonging and detachment" to "acquiring cultural awareness and cultural sensitivity." Discussion: Dealing with linguistic and cultural differences can affected CALD students' academic success, but also encourages them to develop awareness and cultural sensitivity by influencing their peers and the environment of the nursing programme. Therefore, having CALD students is a great value for nursing programmes. Nursing programmes should embody the values of cultural sensitivity and acceptance, including them as a nursing care value and as a concrete strategy to support CALD students. They should also develop strategies to promote the knowledge and responsibilities of nurses among CALD students and increase cultural sensitivity among faculty members at different levels.

Nursing students' involvement in shift-to-shift handovers: Findings from a national study.

BACKGROUND: Effective performance of clinical handovers should be one of the priorities of nursing education to promote efficient communication skills and ensure patient safety. However, to date, no studies have explored to what extent nursing students are involved in handovers. OBJECTIVE: To explore nursing students' handover involvement during their clinical rotations and associated factors. METHOD: This was a secondary analysis of a large national cross-sectional study that involved 9607 undergraduate nursing students in 27 universities across 95 three-year Italian baccalaureate nursing programs. The involvement in the clinical handovers was the end point (from 0, never, to 3, always). A path analysis was performed to identify variables directly and indirectly affecting students' handover involvement. RESULTS: Handover involvement was reported as 'only a little', 'to some extent', and 'always' by 1739 (18.1%), 2939 (30.6%), and 4180 (43.5%) students, respectively; only 749 (7.8%) of students reported never being involved. At the path analysis explaining the 19.1% of variance of nursing students' involvement, some variables emerged that directly increased the likelihood of being involved in handovers. These were being female (ß = 0.115, p < 0.001); having children (ß = 0.107, p = 0.011); being a 3rd-year student (ß = 0.142, p < 0.001) and being a 2nd-year student as compared to a 1st-year student (ß = 0.050, p = 0.036); and having a longer clinical rotation (ß = 0.015, p < 0.001) in units with high 'quality of the learning environment' (ß = 0.279, p < 0.001). Moreover, students who were supervised by the nurse teacher (ß = -0.279, p < 0.001), or by a nurse on a daily basis (ß = -0.253, p = 0.004), or by the staff (ß = -0.190, p < 0.001) reported being less involved in handovers as compared to those students supervised by a clinical nurse. Variables with indirect effects also emerged (model of student's supervision adopted at the unit level, and number of previous clinical rotations attended by students). Moreover, handover involvement explained 11.5% of students self-reported degree of competences learned during the clinical experience. CONCLUSIONS: Limiting students' opportunity to be involved in handover can prevent the development of communication skills and the professional socialization processes. Strategies at different levels are needed to promote handover among undergraduate nursing students.

[Back to units for nursing students' education? The Dedicated Education Units (DEU)]. / Un ritorno ai "reparti scuola"? Le unità dedicate alla formazione (DEU).

. Back to units for nursing students' education? The Dedicated Education Units (DEU). INTRODUCTION: The reorganization and rationalization of resources and cost containment in health care put a strain on the sustainability of practical training of student nurses. The Dedicated Education Units (DEU), where ward staff, in collaboration with university teachers, receive large numbers of students, integrating the caring and teaching missions, are a possible answer. AIM: To describe the main characteristics of DEUs. METHODS: A literature search was conducted in Pubmed with the following key-words Dedicated Education Unit, Education Unit and Nursing Education, up to January 30, 2017. RESULTS: Several models of DEU were identified with differences in contexts, professional roles involved, type of organizations (number of students, length of practical training). The students perceive a welcoming climate that promotes learning and allows time and space for reflection; they develop a professional group identity and learn to recognize and implement the presponsibilities related to the professional role. The students express satisfaction for the relationship with professionals involved in their education due to the clear definition of roles and responsibilities, of their learning needs and feel supported in the connections of theory and practice. The DEU, receiving large number of students optimize the use of resources. CONCLUSIONS: The DEU represent one of the possible models of organization of the practical training, able to ensure a high quality learning environment. The practical implications of its implementation in the italian context on skills acquisition and sustainability need a thorough assessment.

[The Italian instrument evaluating the nursing students clinical learning quality]. / Lo strumento italiano di misurazione della qualitàdell'apprendimento clinico degli studenti infermieri.

. The Clinical Learning Quality Evaluation Index for nursing students. INTRODUCTION: The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool. AIM: A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students. METHODS: A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students. RESULTS: 9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment. CONCLUSIONS: The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.

[Validation of the Italian Clinical Learning Environment Instrument (SVIAT):study protocol]. / Strumento di Valutazione Italiano degli Ambienti di Tirocinio per gli studenti infermieri (SVIAT): protocollo di validazione.

UNLABELLED: . Validation of the Italian Clinical Learning Environment Instrument (SVIAT): study protocol. INTRODUCTION: Nursing students obtain most of their university credits in internship environments whose quality can affect their clinical learning. Several tools are available to measure the quality of the clinical learning environment (CLE) as perceived by students: these instruments developed in other countries, were validated in Italian but do not discriminate those CLEs capable (or not) to promote significant clinical learning. AIM: To validate an instrument to measure the capability of the CLE to generate clinical learning; the secondary aim is to describe the learning environments as perceived by nursing students according to individual course site and tutorial models adopted. METHODS: The study will be developed in three phases: a) instrument development and pilot phase, b) validation of the psychometric properties of the instrument and c) description of the CLEs as perceived by the students including factors/item confirmed in the validation process. Expected outcomes. A large validation, with more than 8,000 participating students is expected; the construct under lying will be confirmed through exploratory and confirmatory factor analysis and will report high internal consistency; the instrument will report also a high test-retest and inter-rater reliability; in addition, the instrument will demonstrate predictive ability by discriminating those units able (or not) to activate effective learning processes.