Actor-Network Theory as a sociotechnical lens to explore the relationship of nurses and technology in practice: methodological considerations for nursing research.

Actor-Network Theory is a research lens that has gained popularity in the nursing and health sciences domains. The perspective allows a researcher to describe the interaction of actors (both human and non-human) within networked sociomaterial contexts, including complex practice environments where nurses and health technology operate. This study will describe Actor-Network Theory and provide methodological considerations for researchers who are interested in using this sociotechnical lens within nursing and informatics-related research. Considerations related to technology conceptualization, levels of analysis, and sampling procedures in Actor-Network Theory based research are addressed. Finally, implications for future nursing research within complex environments are highlighted.

Resilience in Nursing Education: An Integrative Review.

BACKGROUND: Resilience is a phenomenon known to buffer the negative effects of stress. Resilience is important in the lives of nursing students and nurse educators. METHOD: An integrative literature review was conducted to explore the current state of knowledge of resilience in the context of nursing education. Implications from the review findings were deduced for nursing education practice and research. RESULTS: Three theoretical papers and 16 empirical reports were included in the review. Three themes emerged from the analysis: (a) Resilience Is Important in Nursing Education, (b) Resilience Is Conceptualized as Either a Trait or a Process, and (c) Resilience Is Related to Protective Factors. CONCLUSION: The findings provide data to support interventions to enhance the resilience of nursing students and nurse educators and offer a foundation for further research of resilience in nursing education.

Nursing students' understanding and enactment of resilience: a grounded theory study.

AIM: The aim of this study was to explore nursing students' understanding and enactment of resilience. BACKGROUND: Stress is considered to be a major factor affecting the health, well-being and academic performance of nursing students. Resilience has been extensively researched as a process that allows individuals to successfully adapt to adversity and develop positive outcomes as a result. However, relatively little is known about the resilience of nursing students. DESIGN: A constructivist, grounded theory qualitative design was used for this study. METHOD: In-depth individual interviews were conducted with 38 nursing students enrolled in a four-year, integrated baccalaureate nursing degree programme at a university in Ontario, Canada. Face-to-face interviews were conducted from January to April 2012 using a semi-structured interview guide. FINDINGS: The basic social process of 'pushing through' emerged as nursing students' understanding and enactment of resilience. Participants employed this process to withstand challenges in their academic lives. This process was comprised of three main phases: 'stepping into', 'staying the course' and 'acknowledging'. 'Pushing through' also included a transient 'disengaging' process where students were temporarily unable to push through their adversities. The process of 'pushing through' was based on a progressive trajectory, which implied that nursing students enacted the process to make progress in their academic lives and to attain goals. CONCLUSION: Study findings provide important evidence for understanding the phenomenon of resilience as a dynamic, contextual process that can be learnt and developed, rather than a static trait or personality characteristic.

Clinical instructors' perceptions of structural and psychological empowerment in academic nursing environments.

The study purpose was to explore clinical instructors' (CIs') perceptions of empowerment in academic nursing environments. Clinical instructors, often part-time faculty, facilitate learning in professional practice environments. However, they also need to function within the academic environment to learn about the curriculum and how students are to be evaluated. The qualitative description method was used to obtain an understanding of CIs' empowerment experiences and to interpret their perceptions within the frameworks of Kanter's structural empowerment and Spreitzer's psychological empowerment theories. Eight CIs from two nursing programs were interviewed for this study. The empowerment components of support and confidence were important, yet insufficient, in CIs' perceptions of their role effectiveness. An implication for CIs was slow development of confidence in their ability to facilitate student learning that was consistent with curriculum goals. Recommendations for CIs and academic faculty are offered to support and retain clinical faculty.

The mandala: first-year undergraduate nursing students' learning experiences.

The mandala is a circular art form used by psychologists to access subconscious thought through symbolism and it has recently been adopted by nurse educators as a learning strategy for self-awareness. The lived experiences of six first-year undergraduate nursing students who completed a mandala assignment for emotional learning were explored using hermeneutic phenomenology. Participants experiences diverged from their original expectations that the mandala assignment would allow for a fun and free expression of 'self'. Participants did describe experiences of self-discovery; however, their experiences also resembled those associated with socialization in nursing education. Participants described both self-reflection and critical-reflection while completing the mandala assignment. Nurse educators and researchers can gain insight regarding the use of this assignment as an integrated transformative learning approach for emotional learning.

Nursing students' perceptions of clinical teachers' use of empowering teaching behaviours: instrument psychometrics and application.

The authors present findings of 2nd year nursing students' (N = 352) perceptions of their clinical teachers' use of empowering teaching behaviours (ETB) and to highlight steps undertaken to establish psychometric properties of the Empowering Teaching Behaviours Questionnaire-Student (ETBQ-S). The authors identify a) the process involved in the adoption of the ETBQ-S, b) ETBQ-S validity procedures completed prior to instrument implementation, c) results of nursing students' responses to the ETBQ-S, d) criterion validity, and e) ETBQ-S confirmatory factor analysis findings conducted after study completion. The ETBQ-S reliably measures five facets of empowering actions that clinical teachers can employ with nursing students in practice to enhance their confidence, involve them in decision-making and goal setting, make learning meaningful, and help them to become more autonomous nurses.

Effects of clinical practice environments on clinical teacher and nursing student outcomes.

The purpose of this study was to use a cross-sectional survey design, with an integrated theoretical perspective, to examine clinical teachers' (n = 64) and nursing students' (n = 352) empowerment, teachers' and students' perceptions of teachers' use of empowering teaching behaviors, students' perceptions of nurses' practice behaviors, and students' confidence for practice in acute care settings. In this study, teachers and students were moderately empowered. Teachers reported using a high level of empowering teaching behaviors, which corresponded with students' perceptions of teachers' use of such behaviors. Teachers' empowerment predicted 21% of their use of empowering teaching behaviors. Students reported nurses as using a high level of professional practice behaviors. Students felt confident for professional nursing practice. The findings have implications for practice contexts related to empowering teaching-learning environments and self-efficacy.

Structural and psychological empowerment and reflective thinking: is there a link?

Baccalaureate nursing education prepares students to become registered nurses in evolving health care systems. During their program, students' perceptions of empowerment in the nursing profession begin to form, and they are introduced to the process of reflective thinking. The purpose of this integrative literature review is unique in that three concepts are examined and linked-structural empowerment (as conceptualized by Kanter), psychological empowerment (as described by Spreitzer), and reflective thinking (as characterized by Mezirow)-and a theoretical model for testing is proposed. In examining the conceptual links, it is apparent that all three are required for learning and nursing practice. By preparing students to be empowered, reflective professionals, it is proposed that they will be more effective in their academic and future practice work. The conceptual links and proposed model described in this article provide the foundation for building a body of evidence to support or refute this contention.

Student perceptions of online participation in baccalaureate nursing computer-conferencing courses.

The purpose of this study was to examine baccalaureate nursing students' perceptions of their own and peers' online participation. The population included baccalaureate nursing students who have been or were recently involved in a computer-conferencing nursing course. Volunteer nursing students (n = 55) from three Canadian universities completed a Web-based questionnaire. The researcher-designed instrument was derived from a modified taxonomy of participation in online courses. The instrument measured three constructs of participation: interpersonal, content, and interface interactions. Overall, students perceived their participation to be at a high level with a reported mean of 3.94/5.00 (SD, 0.476). Students' perceptions of their group members' participation level were also reported as high (mean, 3.60; SD, 0.481). Significant correlations were found among each of the questionnaire's three subcomponents (ie, interpersonal, content, and interface). Results of the study lend support for the use of interface interactions to identify students who may not have the satisfactory computer skills to participate effectively in computer-conferencing courses.

Authentic leadership of preceptors: predictor of new graduate nurses' work engagement and job satisfaction.

AIM: To examine the relationships between new graduate nurses' perceptions of preceptor authentic leadership, work engagement and job satisfaction. BACKGROUND: During a time when the retention of new graduate nurses is of the upmost importance, the reliance on preceptors to facilitate the transition of new graduate nurses is paramount. METHODS: A predictive non-experimental survey design was used to examine the relationships between study variables. The final sample consisted of 170 randomly selected Registered Nurses (RNs) with <3 years experience and who worked in an acute care setting. RESULTS: Hierarchical multiple regression demonstrated that 20% of the variance in job satisfaction was explained by authentic leadership and work engagement. Furthermore, work engagement was found to partially mediate the relationship between authentic leadership of preceptors and engagement of new graduate nurses. CONCLUSIONS: New graduate nurses paired with preceptors who demonstrate high levels of authentic leadership feel more engaged and are more satisfied. Engagement is an important mechanism by which authentic leadership affects job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Managers must be aware of the role preceptors' authentic leadership plays in promoting work engagement and job satisfaction of new nurses.

The intention to pursue graduate studies in nursing: a look at BScN students' self-efficacy and value influences.

The shortage of graduate-level prepared nurses is reaching critical levels. Combined with an anticipated wave of faculty retirements, a relatively older graduate student body, and an insufficient number of graduates at the Masters' and doctoral levels, the recruitment of more and younger students into graduate programs in nursing has become a priority for the profession. Current understanding of why undergraduate nursing students choose to pursue graduate studies in nursing remains vague. A non-experimental descriptive correlational study was designed and 87 useable surveys were collected from fourth-year baccalaureate nursing students at a large South-Western Ontario University (response rate = 67%). The influence of student valuation of graduate studies and self-efficacy (SE) for graduate studies on student intention to pursue graduate studies in nursing was clearly demonstrated with this study (R(2) = .52). Implications for nursing education include working towards undergraduate curricula that enhance students' valuation of and SE for graduate studies in nursing.

The effect of classroom simulation on nursing students' self-efficacy related to health teaching.

The purpose of this descriptive study was to investigate the effect of classroom simulation on third-year baccalaureate nursing students' self-efficacy in health teaching. Bandura's self-efficacy model provided the conceptual framework. A nonprobability, convenience sample of 22 students completed the self-efficacy questionnaire before and after the simulation workshop sessions. Students' overall self-efficacy scores increased significantly (p = 0.001) following the two sessions of role-playing case studies, suggesting more perceived confidence in performing health teaching. Recommendations include continuing the use of simulation as a teaching-learning method, applying simulation as a strategy to enhance other learner behaviors, and cultivating faculty's use of simulation in their teaching.

Codman Award Paper: self-efficacy of staff nurses for health promotion counselling of patients at risk for stroke.

The effect of nurses' confidence to counsel patients at risk of stroke in selected health promotion areas: smoking cessation, exercise and nutrition was examined. Bandura's (1986) self-efficacy and Knowles' adult learning theories provided the theoretical underpinnings for the study. This was a quasi-experimental design in which neuroscience nurses (N = 23) from a quaternary hospital completed questionnaires prior to, immediately after, and 2 months post completion of a self-directed learning manual (SDL). The researcher-designed manual was designed to enhance learning about the risk factors for stroke and the importance of stroke prevention. Along with reflective activities and pre-post test, strategies for counseling high-risk, stroke-prone individuals in the areas of smoking cessation, exercise, and nutrition were also integrated. The Health Promotion Counseling Self-Efficacy Scale (Tresolini, Saluja, and Stritter, 1995), consisting of 10 self-efficacy subscales relating to self-confidence in knowledge and ability to counsel in health promotion areas, was used to capture the nurses' self-report of self-efficacy. Using a 5-point Likert Scale, nurses also rated their amount of agreement or disagreement about health promotion counseling in practice. Overall, self-efficacy levels for both knowledge and counseling increased significantly (p < .01) from pre-to immediately post completion of the manual, and decreased slightly at two-month follow-up. This pattern was evident in all health promotion areas measured except for knowledge in exercise (p = .015). Nurses' attitudes about aspects of health promotion practices correlated significantly (p < 05) at two-month follow-up with all health promotion areas. Results of this study support the usefulness of a self-directed learning manual as a teaching strategy for health promotion counseling of individuals at risk of stroke.

Nurse educators' workplace empowerment, burnout, and job satisfaction: testing Kanter's theory.

BACKGROUND: Empowerment has become an increasingly important factor in determining college nurse educator burnout, work satisfaction and performance in current restructured college nursing programmes in Canada. AIM: This paper reports a study to test a theoretical model specifying relationships among structural empowerment, burnout and work satisfaction. METHOD: A descriptive correlational survey design was used to test the model in a sample of 89 Canadian full-time college nurse educators employed in Canadian community colleges. The instruments used were the Conditions of Work Effectiveness Questionnaire, Job Activities Scale, Organizational Relationship Scale, Maslach Burnout Inventory Educator Survey and Global Job Satisfaction Questionnaire. RESULTS: College nurse educators reported moderate levels of empowerment in their workplaces as well as moderate levels of burnout and job satisfaction. Empowerment was significantly related to all burnout dimensions, most strongly to emotional exhaustion (r = -0.50) and depersonalization (r = -0.41). Emotional exhaustion was strongly negatively related to access to resources (r = -0.481, P = 0.0001) and support (r = -0.439, P = 0.0001). Multiple regression analysis revealed that 60% of the variance in perceptions of job satisfaction was explained by high levels of empowerment and low levels of emotional exhaustion [R(2) = 0.596, F (1, 86) = 25.01, P = 0.0001]. While both were significant predictors of perceived job satisfaction, empowerment was the stronger of the two (beta = 0.49). CONCLUSIONS: The results provide support for Kanter's organizational empowerment theory in the Canadian college nurse educator population. Higher levels of empowerment were associated with lower levels of burnout and greater work satisfaction. These findings have important implications for nurse education administrators.

A facilitative approach to learning about curriculum development.

Graduate students have high ambitions and desire excellence in their work. Creating learning opportunities that capture this drive and help them achieve and exceed their goals is a challenge for educators. This article describes two teaching approaches, group process and an adaptation of Bensusan's escalator model, which were used in a graduate nursing course to help students learn about curriculum development. Students participated as a faculty group, submitting successive iterations of their work as they developed hypothetical curricula. Benefits students identified from course faculty's critiques of their submissions included experiencing enhanced self-direction, self-esteem, and mutual respect among students and between students and course faculty, as well as authentic curriculum development in a safe, caring, and supportive context. This article discusses the strengths and limitations of this pragmatic and productive learning approach to preparing future nurse educators for their role as curriculum developers.

Resident and family perspectives. The first year in a long-term care facility.

The purpose of this longitudinal study was to explore perspectives, needs, and expectations of residents (N = 6) and family members (N = 3) of the resident's first year in a long-term care facility. The narrative method and a semi-structured interview guide were used to obtain participants' views at 2 and 6 weeks, and 3, 6, 9, and 12 months after admission. During data analysis, six themes emerged, which suggest implications for gerontological nursing education and practice. The authors conclude that by listening to residents and family members, nurses can use this information to improve life for residents and dignify them as individuals.