Nursing students experienced academic emotions during education - a longitudinal descriptive study from a nursing bachelor's program in Sweden.

AIM: To explore nursing students' academic emotions during ongoing learning activities focusing on perceived challenge and competence. BACKGROUND: Emotions plays an important part in learning. Positive emotions can be beneficial while negative emotions can be detrimental to educational outcomes. Optimal experiences are situations when learners simultaneously experience sufficient challenge and competence. Since various learning activities are performed in different learning environments during the nursing program, it is of interest to investigate students' ongoing emotions in the occurring contexts. DESIGN: A longitudinal descriptive study. METHODS: By using the Contextual Activity Sampling System, data was collected every third week on a three-year nursing program. From August 2015 to January 2020, a total of 2, 947 questionnaires were answered by 158 students. Experiences of positive and negative academic emotions were calculated for the entire program. Optimal experience was calculated for courses where high discrepancy between positive and negative experiences were identified. RESULTS: Students self-reported academic emotions varied over time and in relation to learning activities. High ratings of negative emotions were reported during clinical practice in all semesters except the final. Students' positive academic emotions and optimal experience in clinical practice increased after having deepened their academic knowledge. CONCLUSION: Nursing students had an increased positive experience when they themselves practice a learning activity and it appeared that they benefit from academic preparation prior to entering internship. Nursing students need an academic competence to develop their skills during training in the clinical reality. Increased collaboration between academia and clinic would be beneficial for students' clinical development.

The impact of learning styles on attitudes to interprofessional learning among nursing students: a longitudinal mixed methods study.

BACKGROUND: A functional interprofessional teamwork improves collaborative patient-centred care. Participation in interprofessional education promotes cooperation after graduation. Individuals tend to use different approaches to learning depending on their individual preferences. The purpose of this study was to explore nursing students' experiences of professional development with a focus on the relationship between attitudes to interprofessional learning and learning styles. METHODS: A longitudinal parallel mixed-methods design. The study was carried out at a Swedish three-year nursing program from August 2015 to January 2020. On enrolment, thirty-four students self-assessed their attitudes to interprofessional learning according to the Readiness for Interprofessional Learning Scale, and their learning style according to Kolbs' Learning Style Inventory. In the final semester the students participated in an interview focusing on their experiences and perceptions of teamwork and they self-assessed their attitudes to interprofessional learning again. RESULTS: Our findings indicated that 64.7% had a predominantly concrete learning style and 35.3% had a predominantly reflective learning style. No significant relationship with internal consistency reliability was identified among the participants between attitudes to interprofessional learning and learning styles. The content analysis resulted in four main categories: Amazing when it's functional; Deepened insight of care; Increased quality of care; Understanding own profession which were summarized in the theme: Well-functioning teams improve patients' outcome and working environment. CONCLUSION: The students' attitudes to interprofessional learning were positive and it was considered as an opportunity to participate in interprofessional cooperation during internship. Transformative learning is a useful strategy in fostering interprofessional relationships due to the interdependence of various professions in interprofessional teams. When students are guided to use reflection to develop new perspectives and meaning structures, they acquire emotional and rational skills beneficial for interprofessional cooperation.

Undergraduate nursing students' experiences of becoming a professional nurse: a longitudinal study.

BACKGROUND: During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students' development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students' experiences of professional competence development during education. METHODS: A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions. RESULTS: The results revealed that students' professional role developed gradually. The students' started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students' focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained. CONCLUSIONS: Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university.

Views on education and upcoming profession among newly admitted students at a Swedish baccalaureate nursing program: A descriptive mixed method study.

AIM: The aim of this study was to investigate newly admitted nursing students' views on nursing education and their future profession. BACKGROUND: Students' choice of education can be influenced by societal and familial values and among nursing students' altruistic motives are common. Students', conceptions, expectations and doubts combined with their orientations to learning affect their ability to successfully cope with studies in higher education. DESIGN: A descriptive design using mixed method. METHODS: This mixed-method study is based on 126 qualitative semi-structured interviews and 158 questionnaires with newly admitted nursing students. The data collection was conducted during their first six weeks of education. Collected data were analyzed using content analysis and descriptive statistics. This study was conducted and reported in accordance with the COREQ checklist. RESULTS: The overarching theme: "Making a difference if managing to become a professional nurse", describing students' dichotomous emotions of expectations and doubts in relation to their conceptions, emerged from seven main categories. Students' ratings of emotions revealed high ambition and motivation. Fears and worries about uncertainty expressed in interviews correlated with ratings of negative emotions. CONCLUSION: Newly admitted nursing students think highly of the nursing profession and upcoming education. Students put faith in their own ability which is accompanied by doubts derived from uncertainty about forthcoming demands in academic, clinical and personal settings. Understanding of students' conceptions, expectations, doubts and their orientations to learning could be helpful in guiding them to acquire the nurse competencies necessary to become professional nurses that are able to handle complex situations.

Nursing students' expectations of the process of writing a bachelor's thesis in Sweden: A qualitative study.

While performing various academic work, such as writing a bachelor's thesis, are known to be challenging for university students, less is known about students' expectations in this regard. AIM: The aim was to describe students' expectations of the upcoming process of writing a bachelor's thesis. DESIGN: The study employed an explorative, qualitative approach with a single, written open-ended question design. METHODS: The data were collected consecutively 2013-2016 in class. A total of 93 final-year students volunteered and provided hand-written accounts which were analyzed using qualitative content analysis. RESULTS: The students' accounts revealed three generic categories of expectations: Gaining professional knowledge and competency, Planning and organizing the work, and Taking stock of personal resources. Writing a bachelor's thesis was a new challenge for most of the students and the answers testify to mixed feelings about the upcoming work and its supervision. CONCLUSIONS: The nursing students' expectations included present and future competencies, skills and abilities. In promoting development of transferable skills and knowledge, educators of future health-care professionals would be well advised to invite students to reflect on and discuss, their expectations prior to writing a bachelor's thesis and similar academic student papers. This study adds to the research on students' studying and learning in nursing education by bringing to the fore students' expectations of academic learning tasks as an important aspect to consider in higher education contexts, both nationally and internationally.

Challenging encounters as experienced by registered nurses new to the emergency medical service: explored by using the theory of communities of practice.

The aim of this study was to explore challenging encounters experienced by registered nurses (RN) during their first year in the emergency medical service by using the social learning theory of communities of practice. During the first year in a new professional practice, a new RN experiences a transition during which the new professional identity is being formed. This is a challenging and demanding period of time. According to the learning theory of communities of practice by Lave and Wenger, individuals' learning and development in a new professional practice occurs through participation in social activity and is influenced by context. This study is based on the qualitative data from semi-structured interviews. Thirty-two RNs working in the Swedish emergency medical service were interviewed via telephone during the spring of 2017. A qualitative content analysis with deductive reasoning of the interviews was used. The analysis process generated the main category; New RNs participation is challenged by unpredictability and uncertainty in practice. The main category was based on three generic categories; Loneliness in an unpredictable context, Uncertainty about the team, and Uncertainty in action. The challenges new RNs encounter during the first year relate to all three dimensions of a community of practice; mutual engagement, joint enterprise and shared repertoire. The encountered challenges also relate to the EMS context. Taking into account all these aspects when designing support models for RN's professional development may be advantageous for creating positive development for RNs new to the EMS and/or similar practices.

Treat me nice! -a cross-sectional study examining support during the first year in the emergency medical services.

BACKGROUND: Working in the emergency medical service (EMS) can be extremely varying and sometimes physically and psychologically demanding. Being new in this context can be a great challenge. This study aim to describe what ambulance nurses consider to be important support during the first year in the EMS. METHODS: Three hundred and eighty-nine eligible participants that had graduated from the prehospital emergency care program were identified via university registrations office in Sweden. The eligible participants received a study specific questionnaire via mail consisting of 70 statements about support during the first year. The perceived importance of each statement were graded on a 7-point Likert scale. The gradings were analysed using descriptive statistics and frequencies, mean and SD were calculated. RESULTS: Two hundred and thirty questionnaires were returned fully completed, giving a response rate of 59%. Fourteen statements regarding desirable support were rated with mean values > 6.00 and SD < 1.00 and considered as being the most important during the first year in the EMS. The important supports regarded; colleagues and work environment, management and organisation, experience-based knowledge, introduction period, practical support, and theoretical support. Most statements regarded culture and climate and the way the newcomers wanted to be treated. CONCLUSION: It was concluded that an important way to support newcomers in the EMS is to treat them 'nice'. This can be achieved by creating an open climate and a welcoming culture where the new professionals feel trusted and treated with respect, created ways to work structurally, have applicable medical guidelines, and for newcomers to receive feedback on their actions.

Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden.

New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, "Striving for balance during the transition process in the ambulance context". Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development.

Get it together: Issues that facilitate collaboration in teams of learners in intensive care.

INTRODUCTION: The study describes issues that facilitate collaboration in teams of learners in an interprofessional education unit in intensive care. METHODS: A descriptive qualitative study design was applied using semi-structured interviews based on the critical incident technique and qualitative content analysis. Nineteen participants, eight learners in their specialist training, nine supervisors and two head supervisors in Sweden identified 47 incidents. RESULT: Teams of learners having control was the core issue. Motivation, time, experiences and reflection were central issues for facilitating collaboration. CONCLUSION: Efficiently training teams how to collaborate requires learners having control while acting on their common understanding and supervisors taking a facilitating role supporting teams to take control of their critical analysis.

Supervisors' pedagogical role at a clinical education ward - an ethnographic study.

BACKGROUND: Clinical practice is essential for health care students. The supervisor's role and how supervision should be organized are challenging issues for educators and clinicians. Clinical education wards have been established to meet these challenges and they are units with a pedagogical framework facilitating students' training in real clinical settings. Supervisors support students to link together theoretical and practical knowledge and skills. From students' perspectives, clinical education wards have shown potential to enhance students' learning. Thus there is a need for deeper understanding of supervisors' pedagogical role in this context. We explored supervisors' approaches to students' learning at a clinical education ward where students are encouraged to independently take care of patients. METHOD: An ethnographic approach was used to study encounters between patients, students and supervisors. The setting was a clinical education ward for nursing students at a university hospital. Ten observations with ten patients, 11 students and five supervisors were included in the study. After each observation, individual follow-up interviews with all participants and a group interview with supervisors were conducted. Data were analysed using an ethnographic approach. RESULTS: Supervisors' pedagogical role has to do with balancing patient care and student learning. The students were given independence, which created pedagogical challenges for the supervisors. They handled these challenges by collaborating as a supervisory team and taking different acts of supervision such as allowing students their independence, being there for students and by applying patient-centredness. CONCLUSION: The supervisors' pedagogical role was perceived as to facilitate students' learning as a team. Supervisors were both patient- and student-centred by making a nursing care plan for the patients and a learning plan for the students. The plans were guided by clinical and pedagogical guidelines, individually adjusted and followed up.

Exploring teams of learners becoming "WE" in the Intensive Care Unit--a focused ethnographic study.

BACKGROUND: Research about collaboration within teams of learners in intensive care is sparse, as is research on how the learners in a group develop into a team. The aim of this study was to explore the collaboration in teams of learners during a rotation in an interprofessional education unit in intensive care from a sociocultural learning perspective. METHODS: Focused Ethnographic methods were used to collect data following eight teams of learners in 2009 and 2010. Each team consisted of one resident, one specialist nurse student and their supervisors (n = 28). The material consisted of 100 hours of observations, interviews, and four hours of sound recordings. A qualitative analysis explored changing patterns of interplay through a constant comparative approach. RESULTS: The learners' collaboration progressed along a pattern of participation common to all eight groups with a chronological starting point and an end point. The progress consisted of three main steps where the learners' groups developed into teams during a week's training. The supervisors' guided the progress by gradually stepping back to provide latitude for critical reflection and action. CONCLUSION: Our main conclusion in training teams of learners how to collaborate in the intensive care is the crucial understanding of how to guide them to act like a team, feel like a team and having the authority to act as a team.

Patients' approaches to students' learning at a clinical education ward--an ethnographic study.

BACKGROUND: It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting. METHODS: An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. RESULTS: The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. CONCLUSIONS: Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students' learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

The anatomy of learning anatomy.

The experience of clinical teachers as well as research results about senior medical students' understanding of basic science concepts has much been debated. To gain a better understanding about how this knowledge-transformation is managed by medical students, this work aims at investigating their ways of setting about learning anatomy. Second-year medical students were interviewed with a focus on their approach to learning and their way of organizing their studies in anatomy. Phenomenographic analysis of the interviews was performed in 2007 to explore the complex field of learning anatomy. Subjects were found to hold conceptions of a dual notion of the field of anatomy and the interplay between details and wholes permeated their ways of studying with an obvious endeavor of understanding anatomy in terms of connectedness and meaning. The students' ways of approaching the learning task was characterized by three categories of description; the subjects experienced their anatomy studies as memorizing, contextualizing or experiencing. The study reveals aspects of learning anatomy indicating a deficit in meaningfulness. Variation in approach to learning and contextualization of anatomy are suggested as key-elements in how the students arrive at understanding. This should be acknowledged through careful variation of the integration of anatomy in future design of medical curricula.

Stereotyping at the undergraduate level revealed during interprofessional learning between future doctors and biomedical scientists.

Interprofessional education (IPE) involving undergraduate health professionals is expected to promote collaboration in their later careers. The role of IPE between doctors and biomedical scientists has not been explored at the undergraduate level. Our aim was to introduce IPE sessions for medical and biomedical students in order to identify the benefits and barriers to these groups learning together. Medical and biomedical students together discussed laboratory results, relevant literature, and ideas for developing new diagnostic tools. The programme was evaluated with questionnaires and interviews. While there was general support for the idea of IPE, medical and biomedical students responded differently. Biomedical students were more critical, wanted more explicit learning objectives and felt that their professional role was often misunderstood. The medical students were more enthusiastic but regarded the way the biomedical students communicated concerns about their perceived role as a barrier to effective interprofessional learning. We conclude that stereotyping, which can impede effective collaborations between doctors and biomedical scientists, is already present at the undergraduate level and may be a barrier to IPE. Effective learning opportunities should be supported at the curriculum level and be designed to specifically enable a broad appreciation of each other's future professional roles.

Learning orthopaedics: assessing medical students' experiences of interprofessional training in an orthopaedic clinical education ward.

Interprofessional training is becoming commonplace in undergraduate medical education. Orthopaedics is considered to be a setting that offers good opportunities for interprofessional training. Curriculum overload is a common problem, which has to be addressed with respect to content. The aim of this study was to assess medical students' experiences of interprofessional care during their orthopaedic training. Over a two-week period, medical, nursing, physiotherapy and occupational therapy students trained together in teams in an orthopaedic ward (Clinical Education Ward, CEW). A questionnaire was distributed to assess the impact of this new curriculum on medical students. A patient-satisfaction questionnaire was also administered to assess patients' satisfaction with the treatment provided by students at the CEW. In general, the medical students were satisfied with the interprofessional course in the CEW. Of the 178 medical students who took the course, 134 (75%) responded to the questionnaire. Total time devoted to orthopaedics was reported to be between 7 - 44% (mean). The total time regarding medical tasks was reported to be between 57 - 71% (mean). Results from the patient-satisfaction questionnaire showed that patients perceived CEW as highly satisfactory. The medical students reported generally satisfactory experiences of interprofessional orthopaedic training in general. In an interprofessional training context, professional supervision and role modeling takes on added importance, and may be regarded as essential ingredients in helping students to learn effectively within an authentic clinical setting.