Effective clinical nursing leadership in hospitals: barriers from the perspectives of nurse managers.

AIM: The purpose of this study was to identify barriers to effective clinical nursing leadership in Jordanian hospitals from the perspectives of nurse managers (NMs). BACKGROUND: Clinical leadership is about expertise in specialised fields and involving professionals in clinical care. Even though leadership terminology has been used in nursing and healthcare business literature, clinical leadership is still misunderstood, including its barriers. METHOD: This study adopted a qualitative narrative approach and recruited a purposive sample of 19 NMs and two associate executive directors of nursing from two hospitals. Data were collected through two focus group discussions and in-depth interviews and were analysed using content analysis. The study was guided by the 'Consolidated Criteria for Reporting Qualitative Research'. RESULT: Four themes emerged regarding barriers to effective clinical nursing leadership: (1) power differential, (2) inconsistent connectedness with physicians, (3) lack of early socialisation experiences and (4) clinical practice reform is a mutual responsibility. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Barriers are detrimental to effective clinical leadership; they are associated with interdisciplinary and professional socialisation factors. Managers and academicians at all levels should immediately consider these barriers as a priority. Innovative clinical leaders should identify barriers to effective clinical leadership at the early stages. Thus, innovative clinical leadership programmes are warranted.

Experiences of nursing students under the unprecedented abrupt online learning format forced by the national curfew due to COVID-19: A qualitative research study.

BACKGROUND: The unprecedented abrupt shift to remote online learning (OL) within the context of the national lockdown due to the 2019 coronavirus disease (COVID-19) highlights the importance of addressing students' preparedness in managing their first experiences with OL. PURPOSE: To investigate the experiences of undergraduate nursing students during their first uses of OL to increase the understanding of their encountered opportunities and challenges. DESIGN: A descriptive qualitative design guided by a phenomenological approach was used. METHODS: The study used a purposive sampling technique to recruit 18 undergraduate nursing students from two universities. Data were collected using two focus group discussions, and the discussions with participants were audio/video recorded through the online platform Zoom due to the national imposed curfew. Content analysis employed Colaizzi's steps to derive the themes/categories. RESULTS: The study revealed four themes: experience of helplessness, burdens, and burnout; the need for social and technical support to manage OL; the propensity to consider OL as a positive opportunity; and the deficiency of OL in fulfilling the educational outcomes of clinical courses. CONCLUSIONS: Abrupt remote OL was a challenge to clinical encounters. This format was very stressful; however, it was also useful. The current study highlighted the need for further research on the effectiveness of remote OL platforms in regard to the achievement of the intended learning outcomes of clinical courses.

Roles and responsibilities of nurse preceptors: Perception of preceptors and preceptees.

In this study setting, preceptors, who were clinical teaching assistants and hospital employed nurses assist through an interactive process preceptees, who were nursing students, in developing clinical skills and integration into the culture of the clinical area. Therefore, roles and responsibilities of preceptors should be clear and meet the expectations of preceptors and preceptees. This study aimed at comparing similarities and differences of perception to roles and responsibilities as held by nurse preceptors and their preceptees in relation to how important such roles and responsibilities are, and how frequently preceptors attend to the role. A self-administered questionnaire using Boyer's (2008) roles and responsibilities was completed by a convenience sample of 87 preceptee and 62 preceptors amounting to 66.9% and 77.5% response rate respectively. The questionnaire included 43 items and two 4-points Likert-type scales: "Importance of", and "frequency of attendance to roles". Two versions were developed: one for preceptors and the other for preceptees. The reliability (Alpha values) was .944 for the importance and .973 for the frequency of attendance scales. Mean scores indicated agreement among the two groups in relation to importance of, but to disagreement in relation to frequency of attendance to certain roles and responsibilities. Both groups perceived roles and responsibilities as important but varied with significant difference in rating preceptors' frequency of attendance to their roles as educators and facilitators.

Perception of nursing students to two models of preceptorship in clinical training.

PURPOSE: This descriptive survey aimed at exploring nursing students' perception of two models of preceptorship: Model A requires intensive mentorship while Model B requires increasing students' independence and self directed learning. METHODS: Convenience sample of 110 nursing students were recruited for this study. Fifty seven who were in courses of adult I and adult II were engaged in Preceptorship Model A, while 53 who were in courses of maternity and pediatric nursing were engaged in Preceptorship model B. Moore's (2009) reliable "Preceptorship Evaluation Survey" was used for data collection. It consists of three dimensions: preceptor's performance, preceptorship support at the practice site, and preceptee satisfaction with the clinical training experience. t-test, independent samples, was used for data analysis. RESULTS: The findings showed that participants' mean scores on each dimension: preceptee satisfaction, program support, as well as preceptor's performance domains (teacher, facilitator, role model, provider of feedback, adept with adult learning, advocate, and socializer) were significantly (p < .05) in favor of Model A. CONCLUSIONS: Participants perceived the preceptorship model which incorporates intensive mentoring as more satisfactory than the preceptorship model where increasing students' independence and self directed learning is required.

Nursing students coping with English as a foreign language medium of instruction.

AIM: To explore the strategies used by nursing students in coping with English as a foreign language medium of instruction. METHOD: A descriptive repeated-measure design was used. A convenience sample of 78 students completed the assessment tool at three different times. Coping was measured with Folkman and Lazarus' (1988) Ways of Coping Questionnaire. In addition, a Free Response Questionnaire was designed to elicit possible solutions for the participants' limited competency in the English language. Changes in mean scores from time 1 to time 2 and from time 2 to time 3 were examined using paired t- test independent samples. RESULTS: The study showed that positive reappraisal, planful problem-solving, self-controlling, and seeking social support have decreased significantly (p<.05) from time 1 to 2, whereas confrontive coping and distancing have increased significantly from time 2 to 3, (p<.05). Further, while analyzing the free responses (Part 2), two themes emerged: language-related solutions; and accountability related solutions. CONCLUSIONS: This study provides evidence that nursing students utilize a variety of strategies, which change over time. The responsibility for coping with English rests with the collective efforts of the student, faculty, and management.

The relationship between learning styles, emotional social intelligence, and academic success of undergraduate nursing students.

BACKGROUND: Feelings or emotions and thinking have been identified as forces that may affect one's learning styles (D. A. Kolb, 1984), emotional social intelligence, and success (R. Bar-On, 2004). This study on the relationship between academic success and the two variables of learning abilities or styles and emotional social intelligence was conducted at two colleges of nursing in Saudi Arabia. Both offer conventional and accelerated undergraduate nursing education programs. PURPOSE: This study was designed to explore the preferred learning abilities or styles of Saudi nursing students in conventional and accelerated programs, the difference in emotional social intelligence between the two, and the relationships between academic success and learning styles and emotional social intelligence. METHODS: A convenience sample was recruited, consisting of a total of 98 students, 50 and 48 of whom were enrolled, respectively, in conventional and accelerated programs. Self-administered instruments including the Kolb learning style inventory and the Bar-On emotional quotient inventory (EQ-i) were used to collect data, which were analyzed quantitatively. RESULTS: Both groups were found to favor a diverger style of learning, with total EQ-i scores showing no statistical difference between the two (t = 1.251, p =.214). "Self-regard" and "problem solving" earned the highest EQ-i content subscale scores for both groups. Pearson's correlation coefficient showed no significant relationship between learning abilities or styles and emotional social intelligence and academic success. CONCLUSIONS: The findings suggest that either no actual relationship exists or that emotional social intelligence may be confounded with factors such as professional and cultural values.

Applying Watson's nursing theory to assess patient perceptions of being cared for in a multicultural environment.

BACKGROUND: J. Watson's (2002) caring theory addresses caring relationships among humans and the deep experiences of life itself. M. Leininger (1988) noted that caring is a universal phenomenon, which is likely to be perceived differently by patients and nurses if they come from different cultural backgrounds. Little is known about the patients' perception of "being cared for" in the Kingdom of Saudi Arabia, where most nurses in the workforce come from cultural backgrounds different from their patients. PURPOSE: This study was designed to explore Saudi patient perceptions of important caring behaviors and those most frequently attended to by staff nurses in a multicultural environment. METHODS: A questionnaire survey was used to explore discrepancies between the perceived importance of caring behaviors and how frequently those caring behaviors were attended to by staff nurses. A probability sample of 393 patients was drawn from three hospitals in three different regions of Saudi Arabia. The Caring Behaviors Assessment instrument of S. N. Cronin and B. Harrison (1988) was used in data collection. RESULTS: Patients rated overall caring behaviors as important (97.2%) and frequently experienced (73.7%). The discrepancy between the importance of and frequency of attendance to caring behaviors by nurses was statistically significant (t = -4.689, p = .001). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The caring behaviors based upon Jean Watson's theory were valued by Saudi patients irrespective of their cultural differences with the caregiver. However, the frequency of caring attended to by nurses in teaching/learning and helping/trust behavior subcategories were rated lower. Such is most likely the result of culture differences and language barriers existing between patients and nurses in Saudi Arabia. Results showed that the carative factors in Jean Watson's theory were also applicable to patients in Saudi Arabia and that nursing professionals should base their care on such theory to meet patient needs.

Leadership styles of nurse managers in a multinational environment.

This is a descriptive study conducted at a multinational working environment, where 1500 nurses representing 52 nationalities are employed. The study aimed at exploring the predominant leadership style of nurse managers through self-evaluation and staff nurses' evaluation and the impact of working in a multinational environment on their intention to stay or quit. The value lies in its focus on leadership styles in an environment where national diversity among managers, staff, and patients is very challenging. The study included 31 nurse managers and 118 staff nurses using Bass and Avolio's (1995) Multifactor Leadership Questionnaire. The results showed that nurse managers and staff nurses reported transformational leadership as predominant with significant difference in favor of nurse managers. Participants' nationality and intention to stay or quit affected their perception of transformational leadership as a predominant style. The implications highlight the need for senior nursing management to set effective retention strategies for transformational nurse managers who work at multinational environments.

Critical thinking, self-esteem, and state anxiety of nursing students.

This study aimed at exploring the existing predominant critical thinking disposition(s) of baccalaureate nursing students and the relationship among their critical thinking (CT), self-esteem (SE), and state anxiety (SA). Cross-sectional correlational design was utilized to achieve the said aim. A voluntary convenient sample consisted of first year (n=105) and fourth year (n=60) nursing students. The California Critical Thinking Disposition Inventory, Rosenberg Self-Esteem Scale, and Spielberger State Anxiety Inventory were used for data collection after their translation to Arabic language and test for validity and reliability. Descriptive and inferential statistics were used to analyze data. Results showed that both groups overall CT was marginal indicating no serious deficiency, their SE was average, and their SA was relatively high; they reported analyticity, open-mindedness, systematicity, inquisitiveness, and truth seeking as predominant critical thinking dispositions with no significant difference between them. However, the two groups were weak with significant difference on CT self-confidence (t=-2.053, df=136.904, p=.042) with beginning students reporting poorer level of CT self-confidence. Significant correlation results showed that critical thinking is positively correlated with SE, negatively correlated with SA, and SE is negatively correlated with SA; however, all correlations were actually quite low.