What Helps, What Hinders? Undergraduate Nursing Students' Perceptions of Clinical Placements Based on a Thematic Synthesis of Literature.

INTRODUCTION: Clinical placements are a mandatory component of nursing students' education internationally. Despite clinical education being a key to nursing students' achievement of nursing competencies, few studies have reviewed students' narratives to describe their experiences of learning during clinical placement. Such studies may be important in offering a deeper insight into clinical learning experiences than quantitative surveys. METHODS: A systematic thematic synthesis of qualitative studies between 2010 and June 2020 was conducted. English language studies that offered a thematic analysis of undergraduate nursing students' experiences of learning during placement were sought. A search was made of five databases PubMed, Ovid Medline, CinahlPlus, SCOPUS, and Google Scholar. The study was guided by the ENTREQ statement for enhancing transparency in reporting the synthesis of qualitative research. RESULTS: Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as "Preparation," "Welcomed and wanted" and "Supervision experiences". A conceptual model of clinical placement elements conducive to nursing students' learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed. CONCLUSION: The conceptual model presents positive elements that influence students' clinical placement experiences of learning. This model may provide a framework to guide professional development programs and strategies to support students and supervisors alike, an important step forward in moving beyond the current clinical placement rhetoric.

Nursing degree students' clinical placement experiences in Australia: A survey design.

AIM: This study aimed to evaluate Australian nursing students' views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET). BACKGROUND: Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences. DESIGN: A survey design was used with a contemporary survey tool- the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed. METHODS: A total of 1263 nursing students completed the Placement Evaluation Tool (PET) - 19 items (rated 1-5), one global rating (rated 1-10) - following placement in three Australian States (July 2019-February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall. RESULTS: The total PET mean score was 78.3% with 29.8% being 'extremely satisfied' (10 out of 10 - Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle. CONCLUSIONS: Whilst students' clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.

Measuring the quality of nursing clinical placements and the development of the Placement Evaluation Tool (PET) in a mixed methods co-design project.

BACKGROUND: The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia. METHODS: An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019-20, to confirm validity, reliability and feasibility. RESULTS: The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach's alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students' comments, the tool was deemed applicable and feasible. CONCLUSIONS: The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.

The Nominal Group Technique: Generating Consensus in Nursing Research.

The purpose of this article is to describe the Nominal Group Technique and its application as a consensus-generating approach in nursing research. The approach incorporates face-to-face meetings to explore opinions, generate ideas, and determine priorities. The nominal group technique process, which is based on a study designed to develop a nursing student clinical placement (clinical practicum) evaluation tool, is described. Advantages of the approach include creative face-to-face discussions with minimal resource demands. The nominal group technique is beneficial and can be used to achieve consensus in nursing research, but a lack of anonymity may preclude the process in some investigations. [J Nurs Educ. 2020;59(2):65-67.].