Transformative learning theory applications in health professional and nursing education: An umbrella review.

OBJECTIVES: This review intended to synthesise existing evidence on the application of transformative learning theory in nursing education. DESIGN: An umbrella review, or review of reviews. DATA SOURCES: Six databases were systematically searched: CINAHL, Cochrane Reviews, Ebscohost, OVID, ProQuest Central, and PubMed. The structured framework of PCC: Population/Concept/Context was employed to identify relevant literature, published in English between 2012 and March 1st, 2022. REVIEW METHODS: Elements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this review. A modified version of the Johanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Synthesis was applied to determine final inclusions. RESULTS: Sixteen (16) reviews were included. Most reviews were scoping reviews. Nursing featured in 10 of the 16, medicine in half (8/16) and various allied health disciplines were reported in seven reviews. Studies reported on differing scholarly approaches to transformative learning theory. Curricula design and evaluation, developing leadership skills and a professional identity were common applications. Critical reflection and learning experiences that challenge students' and professionals' existing ideologies also featured. Few reviews reported on studies of models and tools for educators to guide them in applying the theory in lesson design and teaching practice. CONCLUSION: Applying transformative learning theory in curriculum design, program evaluation and healthcare professional education can be beneficial. There were reported successes and some critiques. Researchers should design more rigorous studies to evaluate the theory in practice and to develop and test frameworks that guide educators in teaching with transformative learning theory.

Choirs in end-of-life care: a thematic literature review.

BACKGROUND: Choirs are an important source of wellbeing for people experiencing palliative and end-of-life care. Threshold choirs are an innovation that could be more widely introduced, as hospital and palliative care settings have become more open to community input. AIMS: Before such choirs are recommended and encouraged, evidence for their effectiveness and implementation barriers need to be known. METHODS: A literature review was undertaken in 2019 and 2020 using CINAHL, PUBMED, Medline, ProQuest, Google Scholar and an internet manual search. FINDINGS: The review identified a total of 26 research and discussion papers relevant to the topic of choir in palliative care settings. CONCLUSION: Following the review, guidelines were developed that may be useful to assist choirs and service providers to effectively introduce this valuable initiative. Choirs may be a creative, and uplifting arts-based activity to augment and enrich the culture of person-centred care during palliative care processes.

Exploring resilience and workplace adversity in registered nurses: A qualitative analysis.

The aim of this study was to explore New Zealand registered nurses' experiences of resilience and workplace adversity. Resilience research in nursing has concentrated on quantitative and individual aspects. Contextual factors have been largely ignored. This study addresses this gap by qualitatively researching and documenting nurses' experiences of resilience and workplace adversity. An online survey of New Zealand registered nurses was conducted in 2018. Qualitative responses were analyzed using Braun and Clarke's thematic analysis method. Three themes emerged: (i) perseverance; (ii) how the past influences my present resilience; and (iii) things I do to stay strong. Nurses rely on personal resilience to overcome workplace adversity. Health service organizations must implement policies and procedures that (i) reduce workplace adversity, and (ii) encourage and develop strategies for nurses to individually and collectively face adversity with resilience. Future research needs to explore how healthcare organizations can modify existing systems and structures to align with nurses' efforts to sustain and develop resilience.

Exploring Online Mentorship as a Potential Strategy to Enhance Postgraduate Mental Health Nursing Education through Online Delivery: A Review of the Literature.

The value of mentorship to professional development in nursing education has been consistently demonstrated in the literature. The benefits for mental health nursing are particularly noted for attracting nursing students and new graduates into this area of practice. The proliferation of online delivery of mental health nursing programs poses particular issues in providing mentorship to students. Despite changes to the mode of educational delivery, the mentorship literature primarily addresses face-to-face processes. The aim of this paper is to present a review of the literature pertaining to online mentorship. A literature search of the CinAHL, Medline, ProQuest and Google Scholar databases was undertaken to identify relevant literature. Hand searches of reference lists were also conducted. The findings demonstrate the paucity of literature addressing this topic. Evaluation of online mentorship programs are particularly scarce, small scale and usually conducted at one site only. Few descriptions of the content and structure are provided meaning that program development cannot benefit from existing knowledge and expertise. There is an urgent need for online mentorship accompanied by rigorous and systematic evaluation frameworks to maximize the benefits of mentorship to an online environment.

Rituals, ghosts and glorified babysitters: A narrative analysis of stories nurses shared about working the night shift.

Working the night shift can be fraught and experienced as demanding and, yet, is often dismissed as babysitting. Few researchers have explored the social and cultural meanings of night nursing, including storytelling rituals. In 2019, a narrative study was undertaken. The aim was to explore the stories recalled by nurses about working night shifts. Thirteen Australian nurses participated. Data were gathered using the Biographical Narrative Interview Method, and narrative analysis produced forty stories and three themes: strange and challenging experiences; colleagues can be mentors (or not); and textbook knowledge is only part of what is needed on night shift. Nursing students who engage with these stories may come to understand the challenges of the night shift, and the valuable work that nurses engage in throughout a 24-hr period, work that involves adept psychosocial and interpersonal skills alongside technical and physical competence.

Nursing education, virtual reality and empathy?

An empathic approach to patient-centred care is a core of nursing practice. One of the methods to develop empathy, which is gaining currency is the use of virtual reality simulations in education. This paper posits some questions, does it simply reinforce a 'type' of patient, neglecting caring for the patient as unique, is empathy what results or is it pity, does it result in a greater distance being created between the patient and the health care provider? Can we ever really know what it is like to walk in a patient's shoes when what we experience through virtual reality provides a small snapshot of the vicissitudes of living with an illness or disability. We suggest that what matters most in simulations using virtual reality is how the student exits the experience and if they leave knowing just what patients 'like that' feel, or whether they leave with humility and curiosity.

Australian clinical facilitator professional development needs: A cross-sectional study.

BACKGROUND: Registered Nurses are recruited from clinical positions to work as clinical facilitators, supervising nursing students' clinical learning. Few studies have reported on the capabilities of the group, nor offered clinical facilitators validated tools to support their professional development. OBJECTIVE: To test the validated Capabilities of Nurse Educator (CONE) questionnaire with expert clinical facilitators. To use the modified CONE to investigate the Australian clinical facilitator capability for the role. DESIGN: Cross-sectional survey design. PARTICIPANTS: A purposive sample of 235 Australian clinical facilitators. METHOD: Face validity testing was completed with five members of the target group. The modified CONE was emailed to the 235 Australian nurses with a link for the CONE to complete online. Appropriate statistical analysis was applied to the aggregate data. RESULTS: All 93 items and six subscales remained in the modified CONE following minor rewording, of some items. Eight-one (n = 81) participants responded. Clinical facilitators are committed to supporting students to learn, and to their own life-long learning, however the survey results identified gaps in leadership and research capabilities. CONCLUSION: The modified CONE is suitable for use with clinical facilitators as both a self-assessment tool and for understanding group professional development needs. The results of this study will be beneficial in the design of future professional development for clinicians working with students in clinical settings.

Borders in clinical teacher professional development: A concept analysis.

Background: A career in nursing academia offers clinicians a new challenge. Academic nursing and clinical nursing are two separate worlds with different social and cultural borders, foci and ways of working. It is possible to imagine this space as a kind of borderland, a new frontier that is simultaneously exciting and perilous. Aim: A concept analysis explored the borders as a site of meaning for professional development. Method: This study employed a four step concept analysis. Results: The analysis revealed four attributes of borders that are useful for clinical teachers to understand; liminality, border crossing, border work, and inhabiting a new world. Conclusion: As a liminal space, clinical teaching can be a site where uncertainty and ambiguity arises. This can create anxiety but also opportunities to think about both worlds differently, so that clinical teachers may discover new insights and applications for their work.

Illuminating nursing's shadow side through a Jungian analysis of the film Fog in August.

Fog in August is a German film based on Robert Domes' historical novel of the same name. The film provides a fictionalized account of the institutionalization and eventual killing of children and adults labelled as a burden on the State and unworthy of life. On one level, this is a story of good versus evil, where innocent patients are manipulated by callous doctors and nurses. At a deeper level, however, it is possible to read the characters as more complex and such a reading gives an insight into the paradox of how a genocidal policy was able to be systematically implemented by health care professionals who had previously taken an oath to provide care to all people. Carl Jung argued that powerful stories, told across generations, contain mythical archetypes that help drive the plot and convey beliefs about humanity. The aims of this paper are to explore Jungian ideas within Fog in August that help the historical story it is based on resonate with viewers today, and demonstrate how the application of these insights can help health care professionals more fully understand morally distressing events and, as a result, support and improve the safety of patients.

Professional development in clinical teaching: An action research study.

OBJECTIVE: Clinical supervisors, who support and assess health students' clinical learning, encounter many challenges. Professional development opportunities for clinical supervisors to overcome the challenges are available but are often designed to meet organisational and tertiary provider administrative needs, rather than the needs of intended target groups. DESIGN: A qualitative action research study was designed to include a group of Australian nursing clinical supervisors in the design and implementation of meaningful professional development activities. PARTICIPANTS: Ten clinical supervisors, from one organisation, participated in three meetings to explore shared challenges and create solutions to resolve these challenges. RESULTS: Over a seven-month period in 2018-2019 data revealed clinical supervisors in this study experienced a variety of tensions. Participants prioritised three opposing tensions that were of shared concern; Doing and Thinking; Educator and Clinician and Negotiating and Challenging. Being able to visualise and articulate these tensions helps to empathise with the role complexity that clinical supervisors experience, and this led to the production of solutions which validate and advocate for the role and the values. CONCLUSION: The group created innovative solutions such as podcasts, posters, banners and flyers to assist them to harmonise the tensions and work more effectively in their role.

Addressing Self-Injury in Schools, Part 1: Understanding Nonsuicidal Self-Injury and the Importance of Respectful Curiosity in Supporting Youth Who Engage in Self-Injury.

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the first of two parts, this article provides school nurses with a better understanding of NSSI and the distinctions between NSSI and suicidal behaviors, discusses the role of nurses' knowledge and attitudes on their ability to care for their patients' mental health needs, and discusses approaches for developing a respectful, empathic manner for working with and supporting youth who engage in self-injury. Part 2 will offer a strategy for brief assessment of NSSI and reflect on two case studies and their implications for school nursing practice.

Addressing Self-Injury in Schools, Part 2: How School Nurses Can Help With Supporting Assessment, Ongoing Care, and Referral for Treatment.

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the second of two parts, this article offers a strategy for brief assessment of NSSI, as well as reflection on two case studies and how to offer support, ongoing care, and referral for treatment to youth who engage in self-injury.

Narrative research methods with vulnerable people: sharing insights.

BACKGROUND: Families with hereditary illnesses have complex and unique experiences that are important for nurses to understand. In New Zealand, a Maori family predisposed to an aggressive gastric cancer recently participated in research to explore their healthcare experiences. The family constituted a vulnerable group, so the methodology needed to be inclusive and respectful. The authors chose to use narrative research. AIM: To share insights from conducting narrative research with a vulnerable family. DISCUSSION: Narrative research aligns well with nursing values. Numerous aspects of the methodology help to reduce power imbalance, enhance openness and explore wide-ranging experiences. These include: cultural humility; use of conversational cues rather than scripted research questions; the adoption of an empathic, curious stance; and working in partnership. Each of these aspects helps to foster an environment conducive to full exploration of experiences. People's stories are their own, and so researchers need to exercise humility and meticulous safe-keeping of data so that the whole experience is collaborative. When stories are conveyed to others, effort needs to be applied so that lessons are compelling for others and have generative, change-making potential. CONCLUSION: Narrative research is a fitting methodology for nurses researching the experiences of vulnerable populations. Illness can be disempowering, but recounting stories may help participants with healing, adaptation and coping. IMPLICATIONS FOR PRACTICE: New knowledge about illness, recovery and nursing care can be generated using a critical approach to analysis. By gaining a deeper understanding of people's experiences of illness, nurse researchers can co-create and share compelling narratives that may create empathy and change.

Evaluation of a professional development experience designed to equip school support staff with skills to facilitate youth mental health promotion.

Background: Public policy across the world is increasingly focusing on the role of mental health promotion in whole of health strategies. There is a growing evidence-base that mental health promotion, delivered by trained facilitators, is effective in promoting self-awareness and self-care to prevent the damaging effects of ongoing stress in one's life and to promote early detection of any possible emerging mental health problems. Within Australia, however, few clinicians or school staff are confident or trained in mental health promotion.Aims: This paper reports the results of a two-day training designed for facilitators of a mental health program for secondary-school students. The goal was to develop facilitators' knowledge and understanding of best practice in youth mental health promotion and to increase their confidence in delivering the program.Design: A mixed methods evaluation assessed the impact that a solution-focused training program had on participating facilitators.Methods: A questionnaire was created and included eight quantitative items and one open ended, qualitative question. Twenty-seven nurses and guidance officers from central Queensland were recruited via convenience sampling and data were analysed using descriptive statistics and thematic analysis.Results: The evaluation revealed that participants' perception of their ability to facilitate a youth mental health program significantly improved after completing the training. Qualitative data indicated that participants found the professional development experience to be valuable, provide useful and transferable skills, and believed it to be necessary for mental health promotion work.Conclusion: By providing detailed description of the program's content and processes, other mental health professionals may be inspired to further develop effective learning experiences.

Incivility behaviours exhibited by nursing students: clinical educators' perspectives of challenging teaching and assessment events in clinical practice.

Background: The increase in the frequency and severity of student incivility and unprofessional behaviours in clinical education is of concern. Aim: To determine the types and frequency of incivility and unprofessional student behaviours, triggers for disruptive behaviour and situations that clinical educators find challenging.An exploratory study using online surveys and interviews investigated perspectives of 71 respondents from two Schools of Nursing within Australia and one in the United States.Results: Almost all participants had experienced student incivility and unprofessional behaviours in the previous 12 months. A significant antecedent for these behaviours was students receiving feedback perceived to be negative. Clinical educators with experience and qualifications in education reported more incidents and frequency of student incivility and unprofessional behaviour.Conclusions: Incivility and unprofessionalism is commonly reported. It is recommended that students and faculty act proactively to prevent these behaviours, and that focused training and support to prevent, reduce and manage incivility and unprofessionalism is implemented.

Psychological resilience in New Zealand registered nurses: The role of workplace characteristics.

AIM: To investigate the impact of workplace factors on psychological resilience in registered nurses. BACKGROUND: Nursing is characterized by persistent workplace adversity. Psychological resilience has been postulated as a means to mitigate the effects of workplace adversity. There is little research that examines the role of workplace factors (i.e., practice environment and bullying) in shaping resilience. METHODS: A cross-sectional survey was conducted among 480 registered New Zealand nurses. Psychological resilience was self-reported using the CD-RISC-10, while practice environment and workplace bullying were self-reported using PES-NWI and NAQ-R, respectively. RESULTS: For every point increase in PES-NWI and NAQ-R, there was an increase of 2.84 points (95%CI = 1.79, 3.89; p-value = <0.001) and a decrease of 0.07 points (95% CI = -0.12, -0.03; p-value = 0.002) in resilience, after controlling for demographic and job-related characteristics. These two factors explained for 12.6% of the variation in resilience. About 25.8% of registered nurses experienced bullying. CONCLUSION: Workplace factors are associated with psychological resilience in registered nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are key to transforming health care work environments to promote positive outcomes for nurses, the organisation and patient outcomes. Future efforts to promote psychological resilience in registered nurses need to enhance the practice environment and reduce workplace bullying.