Preparedness for a first clinical placement in nursing: a descriptive qualitative study.

BACKGROUND: A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students' perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students' emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience. METHODS: The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically. RESULTS: Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants' feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students' expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers. CONCLUSIONS: This unique study of first-year postgraduate entry-to-practice nursing students' perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students' narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Transition to Practice Programs in Nursing: A Rapid Review.

Background Transition to practice can be exceedingly stressful for newly qualified nurses as they grapple with the "reality shock" of everyday practice as an RN. Transition to practice programs were implemented as a support strategy to ease the transition from student to RN and are designed to increase graduates' confidence and competence, improve their professional adjustment, and increase their retention. Method This rapid review was framed by the Cochrane Methods Rapid Review, supported by the PRISMA statement checklist, aiming to identify and describe the benefits of transition to practice programs for newly graduated RNs and their impact on workforce retention. Results The literature revealed that mixed evidence exists regarding the value and benefits of graduate nurse transition programs to both the graduate and the health service. Conclusion There are multiple inconsistencies across clinical settings, organizations, and preceptor-ship/mentoring training, among others, particularly in relation to duration of the program and the amount of formalized contact/study days. [J Contin Educ Nurs. 2022;53(10):442-450.].

Transforming their lives: post-traumatic growth experience in Chinese women with breast cancer-a grounded theory study.

Our research sought to explore post-traumatic growth experience among Chinese women with breast cancer. Constructivist grounded theory methodology was utilised to understand Chinese women's post-traumatic growth experience. 24 women with breast cancer were recruited from China. Data was collected through semi-structured, interviews. Three categories were developed from the data: renewing self-perception, encountering changes in relationships, and altering philosophical values and beliefs. The unique manifestations of post-traumatic growth highlight the need for development and adaption of the post-traumatic growth inventory to reduce cultural biases within the assessment tool and incorporate new culturally appropriate items.

Community health placements for junior medical and nursing students for interprofessional learning.

Health care is increasingly delivered in primary and community settings, yet undergraduate clinical education remains focused in hospitals. Interprofessional student placements in community health offer an alternative to traditional clinical education and extend the capacity for clinical education beyond hospital placements. This study sought to investigate the value of interprofessional clinical placements at a community health center for dyads of second year medical and nursing students. A mixed methods evaluation was used. Quantitative and qualitative feedback was collected using the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI). Students (n = 58) completed the ICPELI after observation of community health half day sessions, at one of three community health sites. Two focus group interviews were undertaken with the health care practitioners (n = 8) to explore their perception of the new interprofessional placements. The placements were rated highly by all participants with three themes identified: It takes a team, Bouncing ideas and Realities of Community Health. Innovative approaches to clinical education and learning are needed to prepare a healthcare workforce capable of working in a collaborative, interprofessional manner. Community health offers a promising location for interprofessional learning for junior medical and nursing student teams.

Emerging From the "Ku:" Fluctuating in Adjusting With Breast Cancer-A Post-Traumatic Growth Theory Situated Within Chinese Culture.

This purpose of the study was to construct a model (theory) to understand Chinese women's adjustment process in living with breast cancer. A constructivist grounded theory method was adopted in this study. A total of 24 women were recruited through purposive and theoretical sampling. Semi-structured, audio-recorded interviews were undertaken in Chinese and transcribed. Initial coding, focused coding, and theoretical coding approaches were used to identify subcategories and categories, and to construct the emergent theory. The basic social process these women used to deal with the breast cancer diagnosis was identified as: Emerging from the 'ku': Fluctuating in adjusting with breast cancer. Four categories were revealed following analysis: confronting challenges, orienting to reality, accommodating the illness, and transforming their lives, which encapsulated the main cognitive and emotional processes in which Chinese women engaged in their adjustment to living with their illness. The core process was influenced by a variety of contextual influences, which were identified as personal factors, social-environmental factors, and some specific cultural factors which emphasized positive changes. Chinese cultural values such as "Wuwei" coping strategies, familial primacy, and Chinese self-disclosure contribute to Chinese women's adjustment processes and post-traumatic growth experiences. Hence, there is a need to consider Chinese cultural features, in designing culturally tailored supportive programs in multi-cultural clinical settings.

Telephone triage in midwifery practice: A cross-sectional survey.

BACKGROUND: Childbearing women commonly access maternity services via the telephone. A midwife receiving these calls listens to the woman's concerns and then triages women according to their assessment. This may result in the provision of advice and instruction over the telephone or inviting the woman into the health service for further assessment. Midwives are responsible for all care and advice given to women, including via the telephone. OBJECTIVES: The purpose of this study was to explore the experiences and practices of midwives regarding their management of telephone triage. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: Purposive non-probabilistic sampling of currently practising midwife members of professional organisations was used to recruit participants. From this, 242 midwives responded and 230 returned valid surveys were used in data analysis. METHODS: Participant demographics, telephone triage processes, skills, educational preparation, confidence and anxiety levels, and external factors that influence midwives' management of telephone triage were collected via an on-line survey. Descriptive statistics and further analyses were conducted to explore relationships between variables. RESULTS: Eighty-three percent of midwives respond to 2-5 telephone calls per shift, with only 11.7% (n = 24) of midwives reporting that this is included in their workloads. Telephone triage is frequently managed in environments with distractions. Most midwives (84%; n = 177) report receiving no training in this skill. Confidence in performing telephone triage was reported, with higher confidence levels related to midwives' increased years of experience (p < 0.05) and age (p < 0.01). Anxiety related to managing telephone triage has been experienced by 73% (n = 151) of midwives, with this being greater in midwives with less years of experience. Anxiety is reported less by midwives in rural or remote settings compared to metropolitan or regional (p < 0.05) settings in this study. A variety of standards and aids to guide practice, and document calls are utilised in a range of ways. CONCLUSION: To the authors' knowledge, this is the first study conducted to explore midwives' practises in telephone triage. The findings suggest the need for appropriate environments to conduct telephone calls and the inclusion of telephone triage in midwifery workloads. In addition, consistent education and processes are required to reduce anxiety and support midwives provision of this service to women.

How graduate nurses adapt to individual ward culture: A grounded theory study.

AIM: To increase understanding of strategies graduate nurses use on a day-to-day basis to integrate themselves into pre-existing social frameworks. BACKGROUND: Being a graduate nurse and transitioning from a novice to beginner in the first year of clinical practice is stressful, challenging and overwhelming due to steep learning curves and adjusting to working in professional environments. How graduate nurses socially adapt and fit into ward cultures is a hurdle to successful transition and can be difficult. DESIGN: A qualitative constructivist grounded theory methodology was used. METHODS: Seven adult, Registered Nurses were recruited using a purposive sampling technique. Participants were undertaking a graduate nurse transition programme, in one of two acute care, adult public hospitals in South Australia. Data collection conducted in 2016 used individual interviews consisting of open-ended questions in an unstructured format. Transcripts were transcribed verbatim. Data analysis processes included initial and focused coding, theory building, memo-writing and theoretical sampling. RESULTS: Three main categories: self-embodiment and self-consciousness, navigating the social constructs and raising consciousness, supported by subcategories describe the main strategies graduate nurses use to facilitate adaptation into complex clinical environments and ward cultures. Subsequent concept and theory development explains how graduate nurses find the social and professional balance to fit in. CONCLUSIONS: Understanding the graduates' adaptation strategies can inform improvements in graduate nurse transition programmes. Facilitating and enhancing graduate nurse adaptation is the precursor in creating more resilient nurses ready to face the challenges that exist in today's work environments.

Telephone triage and midwifery: A scoping review.

BACKGROUND: Midwives use telephone triage to provide advice and support to childbearing women, and to manage access to maternity services. Telephone triage practises are important in the provision of accurate, timely and appropriate health care. Despite this, there has been very little research investigating this area of midwifery practice. AIM: To explore midwives and telephone triage practises; and to discuss the relevant findings for midwives managing telephone calls from women. METHODS: A five-stage process for conducting scoping reviews was employed. Searches of relevant databases as well as grey literature, and reference lists from included studies were carried out. FINDINGS: A total of 11 publications were included. Thematic analysis was used to identify key concepts. We grouped these key concepts into four emergent themes: purpose of telephone triage, expectations of the midwife, challenges of telephone triage, and achieving quality in telephone triage. DISCUSSION: Telephone triage from a midwifery perspective is a complex multi-faceted process influenced by many internal and external factors. Midwives face many challenges when balancing the needs of the woman, the health service, and their own workloads. Primary research in this area of practice is limited. CONCLUSION: Further research to explore midwives' perceptions of their role, investigate processes and tools midwives use, evaluate training programs, and examine outcomes of women triaged is needed.

A qualitative study of the barriers and enablers to fertility-awareness education in general practice.

AIMS: To understand the barriers and enablers to fertility-awareness education in general practice. BACKGROUND: Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. DESIGN: A descriptive exploratory qualitative study using deductive content analysis. METHODS: General practitioners (N = 11) and practice nurses (N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. FINDINGS: The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. CONCLUSION: This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge.

How do interprofessional student teams interact in a primary care clinic? A qualitative analysis using activity theory.

Practice based interprofessional education opportunities are proposed as a mechanism for health professionals to learn teamwork skills and gain an understanding of the roles of others. Primary care is an area of practice that offers a promising option for interprofessional student learning. In this study, we investigated what and how students from differing professions learn together. Our findings inform the design of future interprofessional education initiatives. Using activity theory, we conducted an ethnographic investigation of interprofessional education in primary care. During a 5 months period, we observed 14 clinic sessions involving mixed discipline student teams who interviewed people with chronic disease. Teams were comprised of senior medicine, nursing, occupational therapy, pharmacy and physiotherapy entry level students. Semi-structured interviews were also conducted with seven clinical educators. Data were analysed to ascertain the objectives, tools, rules and division of labour. Two integrated activity systems were identified: (1) student teams gathering information to determine patients' health care needs and (2) patients either as health consumers or student educators. Unwritten rules regarding 'shared contribution', 'patient as key information source' and 'time constraints' were identified. Both the significance of software literacy on team leadership, and a pre-determined structure of enquiry, highlighted the importance of careful consideration of the tools used in interprofessional education, and the way they can influence practice. The systems of practice identified provide evidence of differing priorities and values, and multiple perspectives of how to manage health. The work reinforced the value of the patients' voice in clinical and education processes.

A contemporary examination of workplace learning culture: an ethnomethodology study.

BACKGROUND: Creating and maintaining a sustainable workforce is currently an international concern. Extensive literature suggest that students and staff need to be 'engaged', that is they need to interact with the health team if they are to maximise learning opportunities. Despite many studies since the 1970s into what creates a 'good' learning environment, ongoing issues continue to challenge healthcare organisations and educators. A 'good' learning environment has been an intangible element for many professions as learning is hindered by the complexity of practice and by limitations on practitioners' time available to assist and guide novices. OBJECTIVES: This study sought to explore the nature of the learning interactions and experiences in clinical nursing practice that enhance a 'good' workplace learning culture for both nursing students and qualified nurses. DESIGN: An ethnomethodology study. SETTING: A range of clinical settings in Victoria and Queensland, Australia. PARTICIPANTS: Students and registered nurses (n=95). METHODS: Fieldwork observations were carried out on student nurses and registered nurses, followed by an individual interview with each participant. An iterative approach to analysis was undertaken; field notes of observations were reviewed, interviews transcribed verbatim and entered into NVivo10. Major themes were then extracted. RESULTS: Three central themes: learning by doing, navigating through communication, and 'entrustability', emerged providing insights into common practices potentially enhancing or detracting from learning in the workplace. CONCLUSIONS: Students' and registered nurses' learning is constrained by a myriad of interactions and embedded workplace practices, which can either enhance the individual's opportunities for learning or detract from the richness of affordances that healthcare workplace settings have to offer. Until the culture/or routine practices of the healthcare workplace are challenged, the trust and meaningful communication essential to learning in practice, will be achievable only serendipitously.

Exploring ward nurses' perceptions of continuing education in clinical settings.

BACKGROUND: Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care. OBJECTIVES: To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward. DESIGN: A case study approach was utilized. SETTING: A major teaching hospital in Melbourne, Australia. PARTICIPANTS: A range of clinical nursing staff (n=23). METHODS: Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data. RESULTS: Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace. CONCLUSIONS: Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong learning and a culture conducive to learning.

Fertility-awareness knowledge, attitudes, and practices of women seeking fertility assistance.

AIMS: To report a descriptive study of fertility-awareness knowledge, attitudes, and practice of infertile women seeking fertility assistance. BACKGROUND: Previous research has suggested that poor fertility-awareness may be a contributing cause of infertility among women seeking fertility assistance at assisted reproductive technology clinics. The actual practices and attitudes towards fertility-awareness in this particular group of women are unknown. DESIGN: A cross-sectional questionnaire-based survey. METHODS: The study was conducted over 6 months, from 2007-2008, of women on admission to two assisted reproductive technology clinics in a major city in Australia. RESULTS: Two hundred and four of 282 distributed questionnaires were completed (response rate = 72·3%). Eighty-three per cent had attempted conception for 1 year or more, 86·8% actively tried to improve their fertility-awareness from one or more sources of the information, 68·2% believed they had timed intercourse mainly within the fertile window of the menstrual cycle in their attempts at conception, but only 12·7% could accurately identify this window. Ninety-four per cent believe that a woman should receive fertility-awareness education when she first reports trouble conceiving to her doctor. CONCLUSIONS: Most women seeking assistance at assisted reproductive technology clinics attempt timed intercourse within the fertile window of the menstrual cycle. However, few accurately identify this window, suggesting that poor fertility-awareness may be a contributing cause of infertility.

Student centredness in clinical learning: the influence of the clinical teacher.

AIM: This article reports a longitudinal study examining how nursing students learn on clinical placements in three cohorts of undergraduates at a large Australian university. BACKGROUND: Preceptorship models of clinical learning are increasing in popularity as a strategy to maximize collaboration between university and healthcare organizations. A clinical education model, underpinned by preceptorship, was offered by an Australian university in partnership with a tertiary healthcare organization to some students. DESIGN: The study utilized a mixed method approach of surveys and interviews. METHOD: It was hypothesized that students participating in the preceptorship partnership model would have more positive perceptions of the clinical learning environment than students participating in other models of clinical education. Data were collected over 3 years, from 2006-2008, using a modified Clinical Learning Environment Inventory from second (n = 396) and third (n = 263) year nursing students. Students were classified into three groups based on which educational model they received. RESULTS: On the inventory factor, 'Student centredness', a Welch test indicated an important difference between the responses of students in the three groups. Games-Howell post hoc test indicated that students in the clinical preceptorship partnership model responded more positively than students who had both a clinical teacher and a preceptor in a non-preceptorship partnership model. CONCLUSION: Developing sustainable approaches to enhance the clinical learning environment experience for student nurses is an international concern. The significance of continuity of clinical teachers to the contribution of student centredness is an important aspect to be considered.

Outcomes of a clinical partnership model for undergraduate nursing students.

BACKGROUND: Over the last decade several innovative approaches to enhance students' transition to graduate nurse year have been implemented or piloted. This paper describes a study that investigated how the social practices of clinical partnership placement model underpin workplace learning for undergraduate students as they transitioned to graduate. METHODS: A mixed method approach was utilized comprising individual interviews with students, observation of clinical workplaces across six different areas of nursing practice, student surveys of the clinical learning environment and participant workshops. RESULTS: Three themes were identified that influenced participants' preparedness for work and enhanced the transition into the workplace: 'organizational familiarity', 'continuity' and 'social participation'. CONCLUSION: A clinical partnership model offers a degree of work readiness for novices when commencing their professional practice role. It enables individuals to participate and engage in workplace activities which are a central component of their learning.

Better knowledge, better health: piloting an education intervention in chronic condition self-management support.

Chronic condition self-management and lifestyle risk modification education is paramount for General Practice registrars. A multi-dimensional learning package 'Better Knowledge, Better Health' was developed and piloted to improve General Practice registrars' understanding of their role in supporting chronic condition self-management in patients with osteoarthritis. This pilot study was supported by the Australian Better Health Initiative. Pre-training learning needs analysis with a new intake of General Practice registrars (n=40) indicated high levels of confidence in supporting patients in chronic condition management and lifestyle risk modification, and locating and interacting with local resources and allied health professionals. Conversely, interviews with General Practice Supervisors (n=13) found most would not identify chronic condition self-management skills as priorities for registrar learning. Supervisors were also not familiar with core principles of chronic condition self-management, in particular application of motivational interviewing to behaviour change. Disparities between General Practice Supervisors' perceptions of the importance of chronic condition self-management and lifestyle risk modification education and levels of access to learning opportunities in chronic condition self-management for registrars are discussed. Difficulties in implementing a pilot study within tight timeframes are also explored.