Interventions that support novice nurses' transition into practice: A realist review.

BACKGROUND: Many transition-to-practice programs have been developed to support novice nurses during their first years into practice. These programs report improvements in retention, wellbeing and clinical competence, but the driving mechanisms of these interventions remain largely unclear. OBJECTIVE: To identify how transition-to-practice programs for novice nurses work and in what contexts they work successfully. METHODS: A realist review was conducted. Eligibility criteria included intervention studies aimed at novice nurses in their first two years of practice that reported outcomes on organizational or individual nurse level. The underlying theory of included transition-to-practice programs was extracted, and relevant contextual factors, mechanisms and outcomes were explored and synthesized into context-mechanism-outcome (CMO) configurations. The search was limited to studies between 2000 and 2023. RESULTS: A total of 32 studies were included, evaluating 30 different transition-to-practice programs with a wide range of intervention components including stress management, clinical education, professional and peer support, and ward rotations. Transition-to-practice programs were often designed without a theoretical foundation. Driving mechanisms behind the programs pertained to psychological, professional, and social development. Contextual factors that activated the mechanisms were enabling conditions for mentors and novice nurses, selection and motivation of novice nurses and organizational culture. CONCLUSIONS: Current transition-to-practice programs primarily focus on the individual and professional development of nurses. However, transition to practice can benefit from a systemic approach that includes development initiatives on the organizational level. REGISTRATION: PROSPERO ID CRD42021268080, August 15, 2021. TWEETABLE ABSTRACT: Context and mechanisms determine successful implementation of transition to practice programs for novice nurses. @transitiontopractice @nurseworkforce.

Further Validation of a Dutch Translation of the Sussex Oxford Compassion for the Self Scale in Samples of Crisis Line Volunteers, Military Personnel and Nursing Students.

Self-compassion is considered an important, transdiagnostic factor for mental health. The Sussex Oxford Compassion for the Self Scale (SOCS-S) is a recently developed comprehensive measure of self-compassion, that was found to have promising psychometric properties among health care staff and university students in the initial validation study. The aim of this study is the further psychometric evaluation of a Dutch translation of the SOCS-S in different populations and settings. The SOCS-S was administered in three different Dutch samples [crisis line volunteers (n = 560), military personnel (n = 244) and nursing students (n = 255)]. The results confirm the five-factor structure of the SOCS-S and its reliability and criterion and convergent validity across the samples. Measurement invariance was demonstrated for gender in two samples and for age in all three samples, but not across professions. Finally, the SOCS-S was found to explain additional variance in mental health in comparison to a widely used self-compassion measure (SCS-SF).

Do physical work factors and musculoskeletal complaints contribute to the intention to leave or actual dropout in student nurses? A prospective cohort study.

BACKGROUND: Little is known, whether physical workload and musculoskeletal complaints (MSCs) have an impact on the intended or actual dropout of nursing students in the later years of their degree program. PURPOSE: Studying the determinants of intention to leave and actual dropout from nursing education. We hypothesized that physical workload and MSCs are positively associated with these outcomes. METHODS: A prospective cohort study among 711 third-year students at a Dutch Bachelor of Nursing degree program. Multivariable backward binary logistic regression was used to examine the association between physical work factors and MSCs, and intention to leave or actual dropout. RESULTS: Intention to leave was 39.9% and actual dropout 3.4%. Of the nursing students, 79% had regular MSCs. The multivariable model for intention to leave showed a significant association with male sex, working at a screen, physical activity, decision latitude, co-worker support, distress and need for recovery. The multivariable model for dropout showed a significant association with living situation (not living with parents), male sex, sick leave during academic year and decision latitude. CONCLUSIONS: Our research shows that the prevalence of MSCs among nursing students is surprisingly high, but is not associated with intention to leave nor with actual dropout.

Conflict or connection? A feasibility study on the implementation of a training based on connecting communication in a nursing curriculum.

BACKGROUND: Nursing students frequently experience offensive behaviour and communication problems with patients, clinical supervisors, and nursing and faculty staff. A communication training was developed based on connecting communication to prevent and manage conflict, and build interpersonal trust-based relationships. OBJECTIVES: Feasibility study to evaluate the acceptability, demand, implementation, integration, and limited efficacy of a training based on connecting communication within a nursing curriculum. DESIGN: Mixed method design. PARTICIPANTS: Third-year nursing students (n = 24). SETTING: A Dutch Bachelor of Nursing degree programme in Rotterdam. METHODS: Between November 2019 and March 2020, data were collected from students and trainers, using quantitative and qualitative methods. Feasibility aspects, including limited efficacy testing, were measured with pre- and post-training surveys. Descriptive statistical analyses and (non)parametric tests were used to analyse feasibility aspects and baseline and follow-up scores for empathy, self-compassion, and exposure to violence. In addition, reflection reports of students and two paired interviews with the two trainers were analysed using qualitative content analysis with a deductive approach. RESULTS: The post-training survey and reflection reports showed a positive assessment of the training on acceptability, demand, and integration. Students rated the training as helpful in improving their communication skills and in dealing with conflict situations. Furthermore, they recommended to implement the training in earlier years of the educational programme. According to the trainers, miscommunication, students' lack of preparation for lessons, and the timing of the training prohibited full participation in the training. The pretest-posttest survey results show statistically significant improved self-compassion (3.77 vs. 4.10; p = 0.03) and decreased self-judgement (4.21 vs. 3.50; p = 0.03). Empathy and exposure to violence did not change. CONCLUSIONS: From the perspective of nursing students and trainers involved, this 10-week training based on connecting communication is feasible to implement in the Bachelor of Nursing degree programme, preferably before clinical placements.

What sociodemographic and work characteristics are associated with musculoskeletal complaints in nursing students? A cross-sectional analysis of repeated measurements.

Musculoskeletal complaints (MSCs) arise during nursing education. We examined cross-sectional associations between self-reported MSCs and both sociodemographic and workplace characteristics in different clinical placement settings. We included two observations among three cohorts of third-year Dutch nursing students (total N = 711) of the undergraduate nursing program of Rotterdam University of Applied Sciences. Questionnaire data on sociodemographic, physical and psychosocial work characteristics, and MSCs were used. Generalized estimating equation analysis for repeated measurements with backward elimination was used to examine associations with MSCs. In total, 79% of students experienced MSCs. Female sex (OR 0.37, 95% CI 0.22-0.62), lifting and bending (OR 1.01, 95% CI 1.00-1.03), physical job demands (OR 2.33, 95% CI 1.68-3.22) and need for recovery (OR 1.02, 95% CI 1.01-1.03), were statistically significantly associated with overall MSCs. Models for regional complaints are also presented in this article. Nursing school and clinical placement staff should consider these factors when dealing with nursing students with MSCs.

Psychosocial work characteristics associated with distress and intention to leave nursing education among students; A one-year follow-up study.

BACKGROUND: Dropout in later years of the nursing degree programme involves lost investment and is a particular problem for both students and educators. Reasons for late dropout seem to be related to the work and learning environment of the clinical placement. OBJECTIVES: The aim of this study was to investigate associations between psychosocial work characteristics and distress and intention to leave nursing education among third-year nursing students. DESIGN: A prospective cohort study. SETTING: A Bachelor of Nursing programme of a University of Applied Sciences in the Netherlands. PARTICIPANTS: 363 third-year nursing students. METHODS: Baseline and one-year follow-up measurements were used from a prospective cohort study. Third-year nursing students were invited annually in May between 2016 and 2018. Psychosocial work characteristics were psychological demands, supervisor and co-worker support, and acts of offensive behaviour. Logistic regression analyses were used to build multivariate models. RESULTS: Frequent exposure to violence (OR = 2.52, 95% CI: 1.29-4.92) was univariately associated with distress. In the multivariate model for distress, psychological demands (OR = 1.63, 95% CI: 1.05-2.52) and frequent exposure to violence (OR = 3.02, 95% CI: 1.48-6.19) were associated with distress. Supervisor support (OR = 0.54, 95% CI: 0.36-0.80) and co-worker support (OR = 0.41, 95% CI: 0.24-0.72) were negatively associated with intention to leave (i.e. were protective) in the univariate model. In the adjusted multivariate model, only co-worker support (OR = 0.50, 95% CI: 0.25-0.97) was a protective factor for an intention to leave. CONCLUSION: Psychological demands and frequent exposure to violence are risk factors for distress, and co-worker support is a protective factor reducing the intention to leave nursing education in the last stage of the programme. Improving the psychosocial working climate of nursing students may reduce the intention to leave at a late stage in nursing education, and hence actual late dropout.

Improving mental health of student and novice nurses to prevent dropout: A systematic review.

AIMS: To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout-related outcomes. DESIGN: Systematic review. DATA SOURCES: Research papers published between January 1971-February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar. REVIEW METHODS: We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer-reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout-related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta-analysis of studies was performed. RESULTS: We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout-related outcomes. The overall risk of bias was high. CONCLUSION: A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high-quality studies in this field, preferably with a randomized controlled design.

Effective interventions for preventing work related physical health complaints in nursing students and novice nurses: A systematic review.

From the start of their career, nursing students and novice nurses are at risk of developing physical health problems due to high physical workload, which may lead to early exit from nursing. To provide an overview of interventions preventing physical health problems in early career, a systematic review was performed. A comprehensive search of the literature was conducted up to December 2017. Primary outcome of interest was education/work dropout. Secondary outcomes were musculoskeletal symptoms. Independent authors selected studies, appraised quality and extracted data. After screening 7111 titles and abstracts, eleven studies were included. Seven studies evaluated interventions for moving/handling training. Four evaluated other interventions. None focused on our primary outcome education/work dropout. All studies reported on physical complaints among student nurses only. Overall, risk of bias was high and clinical heterogeneity prohibited pooling of data. Intervention effects were small and inconsistent. In conclusion, evidence for the effectiveness of interventions in the nursing curricula for the prevention/treatment of physical complaints is scarce and where available conflicting. We recommend high quality research on dropout due to physical health problems, as well as on the prevention/treatment of physical complaints.

Late dropout from nursing education: An interview study of nursing students' experiences and reasons.

The global shortages of nurses require a closer look at why nursing students stop in the later years of their degree programme. The purpose of this study is to explore nursing students' experiences and reasons that lead to this late dropout. Semi-structured interviews were held in 2017 with eleven former nursing students who dropped out in the third year of their Bachelor's Nursing degree programme in the Netherlands. Data was collected and analysed iteratively, following the principles of Thematic Analysis. Two core themes were identified: 'ending up in a downward spiral of physical, psychological and social problems' and 'experiencing an increasing mismatch between expectations and reality'. Reasons for late dropout from nursing education are diverse and interlinked. In contrast with studies on early dropout, academic difficulties did not play a major role in late dropout. Negative experiences during clinical placements led to dropout in both groups. One group lacked a safe learning environment in clinical placements, study coaching and psychological support. The other group missed realistic information provision about nursing education and the broad range of career opportunities in nursing.

Physical and mental determinants of dropout and retention among nursing students: protocol of the SPRiNG cohort study.

BACKGROUND: The shortage of nursing professionals is of growing concern. The causes of this include the demanding physical and mental workload, leading to a dropout of nurses that may start during their education. However, it is unclear to what extent nursing students already perceive a physical and mental workload leading to health problems during their nursing education and placement, and to what extent these health problems cause students to dropout from nursing education. Very few prospective cohort studies have investigated protective and risk factors in relation to dropout and retention among nursing students. METHODS: Three cohorts of third-year nursing students will be followed for 2.5 years. Students will be enrolled from the Bachelor of Nursing program of the Rotterdam University of Applied Sciences. At baseline, students will receive a self-administered questionnaire. Primary outcome is dropout from nursing education and dropout from the nursing profession. Data on dropout from nursing education will be retrieved from the student administration on a yearly basis. Dropout from the nursing profession will be measured one year after graduation, using the self-reported questionnaire. Secondary outcomes are presenteeism and sick leave (during internship/work). In addition to student characteristics, the questionnaire asks about physical and mental internship/work characteristics, personal and behavioral factors, and experienced physical and mental burden.Main aims of this study are to determine: 1) the prevalence and incidence rates of dropout, 2) the protective and risk factors, and early indicators of dropout, and 3) the interaction between these factors and the indicators. DISCUSSION: Data analysis of a large, prospective cohort study with regard to determinants of dropout and retention of nursing students and newly graduated nurses is in progress. Findings emerging from this study can be used to develop a predictive model to identify the first indicators of dropout from nursing education and nursing profession, for which targeted interventions can be deployed.

Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies.

BACKGROUND: Receiving adequate support seems to be crucial to the success of self-management. Although different empirical studies separately examined patients' preferences for self-management support (SMS), an overview is lacking. OBJECTIVE: The aim of this qualitative review was to identify patients' needs with respect to SMS and to explore by whom this support is preferably provided. SEARCH STRATEGY: Qualitative studies were identified from Embase, MEDLINE OvidSP, Web of science, PubMed publisher, Cochrane central, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. INCLUSION CRITERIA: Articles needed to meet all of the following criteria: (i) focuses on self-management, (ii) concerns adult patients with rheumatic diseases (rheumatoid arthritis and fibromyalgia), a variant of cancer or chronic kidney disease, (iii) explores support needs from the patients' perspective, (iv) uses qualitative methods and (v) published in English. DATA EXTRACTION AND SYNTHESIS: A thematic synthesis, developed by Thomas and Harden, was conducted of the 37 included studies. MAIN RESULTS: Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support. DISCUSSION AND CONCLUSIONS: Patients do not self-manage on their own. Patients expect health-care professionals to fulfil a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs.

Pediatric bag-in-the-lens intraocular lens implantation: long-term follow-up.

PURPOSE: To evaluate long-term follow-up results of pediatric cataract surgery using the bag-in-the-lens (BIL) intraocular lens (IOL) implantation technique. SETTING: Antwerp University Hospital, Edegem, Antwerp, Belgium. DESIGN: Prospective case series. METHODS: All pediatric cataract surgeries with BIL IOL implantation performed at the Antwerp University Hospital were evaluated. Only cases that completed a follow-up of 5 years at the hospital's Department of Ophthalmology were included in this study. RESULTS: Forty-six eyes of 31 children had a complete follow-up of 5 years or more after BIL IOL implantation. Sixteen cases were unilateral and 15 were bilateral. Patient age at time of surgery ranged from 2 months to 14 years. The mean refraction at the end of follow-up was -1.99 diopters (D) ± 3.70 (SD). In bilateral cases, a corrected distance visual acuity (CDVA) of better than 0.5 was attained in 86.7% and a CDVA of 1.0 was achieved in 56.7%. In unilateral cases, 31.2% achieved a CDVA of better than 0.5 but none obtained a CDVA of 1.0. A clear visual axis was maintained in 91.3% of cases during follow-up. Visual axis reopacification was detected in 4 eyes of 3 cases, all due to inadequate BIL IOL positioning. None of these eyes needed more than 1 intervention to maintain visual axis clarity. Other than 1 case of glaucoma, no severe complications were detected. CONCLUSION: Long-term follow-up results show that BIL IOL implantation is a safe, well-tolerated approach for treating pediatric cataract with a very low rate of visual axis reopacification and a low rate of secondary interventions for other postoperative complications. FINANCIAL DISCLOSURE: Dr. Tassignon has intellectual property rights to the bag-in-the-lens intraocular lens (U.S. patent 6 027 531; EU patent 009406794.PCT/120268), which is licensed to Morcher GmbH, Stuttgart, Germany. No other author has a financial or proprietary interest in any material or method mentioned.

Use of a task-oriented self-instruction method to support children in primary school with poor handwriting quality and speed.

Two studies were conducted to investigate the effect of a task-specific self-instruction intervention to improve handwriting ability of children with poor handwriting quality in schools for regular education (Study 1) and children with poor handwriting quality in schools for special education (Study 2). Study 1 showed that children with poor handwriting quality who received handwriting intervention on an individual basis for three months improved on average more on quality of writing than control children without handwriting problems who did not receive intervention. In contrast, the control group improved more in speed of writing after the intervention period. At an individual level, three out of the seven children with poor handwriting quality before intervention were not classified as such anymore after the intervention period. Study 2 showed that after six months of intervention in a group setting children with poor handwriting quality improved their quality of writing more so than children with poor handwriting quality who had not received intervention. On speed of handwriting no significant group differences emerged. We conclude that the task-oriented self-instruction method applied in this study seems to improve especially the quality of handwriting, not speed, of children initially identified as having poor handwriting quality.