Rural healthcare professionals' participation in Medical Assistance in Dying (MAiD): beyond a binary decision.

BACKGROUND: Medical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals' experiences with assisted dying set against the backdrop of legislative expansion. METHODS: A qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified. RESULTS: Between the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals' decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making. CONCLUSIONS: The interplay of multiple factors and their degree of influence on healthcare professionals' decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals' uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational.

Nurses' perceptions of climate sensitive vector-borne diseases: A scoping review.

OBJECTIVE: Nurses are well positioned to play an integral role in the mitigation of climate change and climate-driven vector-borne diseases, however, they lack awareness and knowledge about their role. The purpose of this scoping review was to map existing literature on nurses' perceptions, knowledge, attitudes, and experiences with vector-borne diseases, specifically Lyme disease and West Nile virus. DESIGN: A scoping review was conducted using Joanna Briggs Institute (JBI) scoping review methodology. CINAHL, ProQuest Nursing & Allied Health Premium, MEDLINE, APA PsycINFO, ProQuest Dissertations & Theses, and Web of Science were searched for English-language publications. The PRISMA-ScR was used. After initial screening as per study protocol, a total of 33 items were reviewed independently by four reviewers. RESULTS: Thirty-three articles, including seven sources from grey literature, met the criteria for this scoping review. Results were mapped according to the five domains of the Guidelines for Undergraduate Nursing Education on Climate-Driven Vector-Borne Diseases. CONCLUSIONS: Findings from the review indicate that nurses play a role in climate-related health effects and should be knowledgeable about vector-borne diseases. However, scant literature exists on nurses' knowledge, perceptions, attitudes toward vector-borne diseases, and practice readiness, signifying a need for further research on this emerging topic.

Social justice in pandemic immunization policy: We're all in this together.

Policy decisions regarding immunization during a pandemic are informed by the ethical understandings of policy makers. With the possibility that a vaccine might soon be available to mitigate the deadly COVID-19 pandemic, policy makers can consider learnings from past pandemic immunization campaigns. This critical analysis of three policy decisions made in Alberta, Canada, during the 2009 H1N1 influenza pandemic demonstrates the predominance of distributive justice principles and the problems that this created for vulnerable groups. Vulnerable groups identified in Alberta include rural and First Nations populations. We propose a social justice approach as a viable alternative to inform pandemic immunization policy and invite debate.

A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning.

AIMS AND OBJECTIVES: To systematically assemble, examine and map the extant literature pertaining to the integration of ethics education in high-fidelity simulation-based learning experiences in nursing undergraduate programmes. BACKGROUND: The value of ethics education for undergraduate nursing students is well established in the literature. Whether high-fidelity human simulation (HFHS) supports the development of ethical reasoning or positively impacts the acquisition of ethical knowledge and reasoning skills in undergraduate nursing students is inconsistently addressed. DESIGN: A scoping review was conducted using the Arksey and O'Malley framework. METHOD: CINAHL, ProQuest Nursing & Allied Health Source, ProQuest Dissertations & Theses A&I, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and the Joanna Briggs Institute EBP databases were searched for English-language manuscripts published between 2012 and 2020. The PRISMA-ScR was used. RESULTS: Eight papers that met the inclusion criteria were extracted for this review. Three broad categories were identified: the 'what' in ethics education, the 'how' of ethics education and the 'when' of ethics education in high-fidelity human simulation. CONCLUSION: The integration of ethics education into simulation-based learning has the potential to positively promote nursing students' ability to develop knowledge of and skills in ethical practice. However, the inclusion of ethics education scenarios in HFHS is a relative new teaching innovation in undergraduate nursing education. As such, there continues to be no consensus on the 'what', 'how' or 'when' of ethics education for best practice in ethics education for undergraduate nursing programmes. RELEVANCE TO CLINICAL PRACTICE: Quality improvement processes and research studies are needed to determine: the types of ethical dilemmas and debriefing sessions and optimal timing of HFHS ethics simulation in undergraduate nursing education, student support needed for running HFHS, and the learning needs of nurse educators seeking to incorporate ethics within HFHS.

Analysis of Undergraduate Nursing Students' Sensitivity to Microethical Dilemmas During Simulation.

BACKGROUND: Simulation can extend ethics education in undergraduate nursing programs beyond the cognitive domain. However, the degree to which nursing students recognize and respond to microethical dilemmas in simulation is unknown. METHOD: Using a mixed-methods convergent parallel design, 68 third- and fourth-year undergraduate nursing students completed a sensitivity questionnaire. Twelve students also participated in an interview. Data were compared to create meaning. RESULTS: Many students reported having a high level of ethical sensitivity toward microethical dilemmas during simulation. However, some students expressed uncertainty in their ability to identify microethical dilemmas during nurse-patient interactions. Students also reported limited confidence in being able to transfer their ethical knowledge to the practice setting. CONCLUSION: Nurse educators must be moral agents during simulated learning experiences by helping students learn what microethical dilemmas are and strategies to manage them. [J Nurs Educ. 2020;59(2):88-92.].

Effects of a Brief Mindfulness Intervention on After-Degree Nursing Student Stress.

BACKGROUND: This exploratory study investigated the effectiveness of a shortened version of an 8-week mindfulness-based stress reduction (MBSR) intervention with a small sample of after-degree nursing students for managing stress during their practicum. METHOD: A qualitative evaluation design with a purposive criterion sample (n = 5) was used to investigate the impact of a Brief Mindfulness-Based Stress Reduction (MBSR-B) intervention on the experience of stress in after-degree nursing students. RESULTS: Thematic analysis of participants' narratives resulted in the identification of four categories: (a) hitting a reset button, (b) self-compassion, (c) avoiding a downward spiral, and (d) using an internal coping mechanism. These findings suggested a metatheme of self-awareness involving more efficient and effective detection and management of stress. CONCLUSION: The positive impact for participants in this study suggests that stress management for after-degree nursing students through the use of an MBSR-B intervention is worthy of nurse educators' consideration. [J Nurs Educ. 2019;58(3):165-168.].

A pilot study exploring the relationship between the use of mobile technologies, walking distance, and clinical decision making among rural hospital nurses.

Providing evidence-based information at the point of care for time-poor nurses may lead to better clinical care and patient outcomes. Smartphone applications (apps) have the advantage of providing immediate access to information potentially increasing time spent with patients. This small-scale pre-post survey study explored the impact a smartphone app had on the distance nurses walked and their perceived clinical decision-making ability. A total of 20 nurses working in a rural hospital medical/surgical unit participated. The findings suggest that the use of the smartphone app did not decrease nurses' walking distance. Nor did using the app enhances nurses' perception of their clinical decision-making ability. However, there was a statistically significant increase in confidence in the app over time (F(1,16) = 5.416, p = 0.033, partial η2 = 0.253), suggesting that providing training opportunities including time to learn how to use smartphone applications has the potential to enhance nurses work.

Comparison of Nursing Student and Instructor Preferences for Block and Nonblock Clinical Models.

Clinical experiences are the hallmark of prelicensure nursing programs and assist students with applying nursing theory into practice. The literature is limited with respect to nursing student and instructor preferences for type of clinical model to facilitate student learning. This article explores these perceptions in the nursing programs of 5 universities located in 4 Western Canadian provinces. Findings support the use of both nonblock and block clinical models throughout nursing education programs.

Nursing Student Preference for Block Versus Nonblock Clinical Models.

BACKGROUND: Clinical experiences are essential in undergraduate nursing student education to develop professionalism and integrate theory into practice. However, little evidence is available to guide curricular planners in determining the appropriate and effective use of different clinical models in nursing education. METHOD: Nursing students and four schools of nursing in two western Canadian provinces participated in this descriptive exploratory study examining student preference for clinical models. Thematic analysis of qualitative data addressed two research questions: What type of clinical model is preferred by nursing students? and How does clinical structure influence nursing students' perceived learning? RESULTS: Nonblock clinical practice is preferred by students with respect to a balanced lifestyle, concurrent integration of theory and practice, and critical reflection, whereas the block model is preferred for assimilation, consolidation, and socialization. CONCLUSION: Integration of both clinical models is recommended within undergraduate nursing curricula, as each model can facilitate student learning. [J Nurs Educ. 2017;56(3):152-157.].

Nursing students' belongingness and workplace satisfaction: Quantitative findings of a mixed methods study.

BACKGROUND: The relationship between nursing students' belongingness and workplace satisfaction has received limited attention in the literature to date. AIM: The aim of this study was to explore the relationship between, and factors that may influence final semester nursing students' need to belong, sense of belonging and workplace satisfaction while on clinical placements. METHODS: A cross-national longitudinal multiphase explanatory sequential mixed methods study underpinned by a pragmatic theoretical framework was used for this study. A convenience sample of third-year nursing students from two Australian and one Canadian university (n=468) were recruited. Participants were asked to complete a 62 item survey which was a composite of three previously validated surveys: the 10 item 'Need to Belong Scale', the 34 item 'Belongingness Scale: Clinical Placement Experience (BES:CPE)' and the 18 item 'Nursing Workplace Satisfaction Questionnaire'. Data were analysed using descriptive and inferential statistics. RESULTS: Key results indicated that participants wanted to have someone to turn to, and to be accepted; they found nursing work interesting and considered it worthwhile to make an effort in this meaningful job. Participants were usually comfortable to ask for and accept help but many felt discriminated against during clinical placements. Only belongingness was strongly correlated with workplace satisfaction. CONCLUSIONS: Irrespective of site, nursing students' satisfied sense of belonging influenced their workplace satisfaction while on clinical placements. Workplace satisfaction is a key determinant of career decisions and the results from this study have the potential to inform clinical placement practices and policies and to influence beginning nurses' decisions to continue in the profession.

New Rural Acute Care Nurses Speak Up: "We're it" But We're Not Ready.

Many novice registered nurses feel ill-prepared for rural nursing practice. Using a mixed method design, an assessment of the learning needs of new graduate nurses (NGNs) working in rural hospitals in Alberta, Canada, was undertaken. NGNs in rural practice indicated that they struggle with becoming "multispecialists." Consequently, administrators and nurse educators need to tailor workplace structures by establishing collaborative programs with urban facilities and using orientation tailored to the learning needs of NGNs.

Exploring masculinity and marginalization of male undergraduate nursing students' experience of belonging during clinical experiences.

Aggressive recruitment strategies used in Canadian undergraduate nursing programs have enjoyed only moderate success, given that male students represent a small percentage of the student population. To determine whether there were gender differences in their sense of belonging, undergraduate nursing students (n = 462) in southern Alberta were surveyed using the Belongingness Scale-Clinical Placement Experience questionnaire. No significant gender differences were found on two of the subscales. However, male students demonstrated significantly lower scores on the efficacy subscale (p = 0.02). This finding suggests that some men experience feelings of marginalization and discrimination. Nurse educators and students are encouraged to explore their worldviews related to gendered performances and teaching practices that create bias. Practice environments are encouraged to deinstitutionalize policies and procedures that accentuate femininities of care. Finally, men entering into the nursing profession are encouraged to reflect on how their gender performance may facilitate or detract from their feelings of belonging.

"It all depends": how minority nursing students experience belonging during clinical experiences.

AIM: The purpose of this study was to identify factors that influence minority nursing students' sense of belonging during clinical experiences. BACKGROUND: Minority nursing students encounter multiple barriers within their clinical education experiences and have a higher attrition rate than Caucasian women. METHOD: A mixed-method approach using a survey and individual qualitative interviews was used to generate data for this study. RESULTS: Minority students' sense of belonging is dependent on their interactions with registered nurses with whom they work, clinical nursing instructors, and student peers. Positive experiences enhance students' sense of belonging, while negative experiences may severely impact their belongingness. CONCLUSION: Every interaction that minority students have with clinical nursing instructors, registered nurses, and their student peers has the potential to impact belongingness. Engaging in reflection, developing mission statements that appreciate and value diversity, and using transformative learning strategies enhance minority students' sense of belonging.

Exploring the acquisition of entry-to-practice competencies by second-degree nursing students during a preceptorship experience.

BACKGROUND: Nursing programs across Canada have begun to implement at an unprecedented rate second-degree nursing programs in response to consumer demands and a nursing shortage. While these types of programs are enjoying considerable popularity among prospective students and employers, it is imperative that nursing programs assess their graduates' ability to meet Registered Nursing entry-to-practice competencies (ETCs). OBJECTIVES: This study sought to determine if second-degree undergraduate nursing students achieved the entry-to-practice competencies established by the provincial regulatory body for registered nurses of Alberta, Canada. SETTING: The study took place in southern Alberta, Canada as the first cohort of second-degree undergraduate nursing students were completing the final practice course for the program. DESIGN: In this exploratory study, quantitative and qualitative data generation approaches were used. Quantitative data were collected using the nursing program's standardized Clinical Evaluation Tool which is mapped to the 119 ETCs established by the regulatory body. Qualitative data were generated by conducting focus group interviews with students, faculty advisors, and preceptors. PARTICIPANTS: A convenience sample consisting of both male and female students (n=14) submitted their mid-term and final clinical evaluations for inclusion in the dataset. Thirteen preceptors submitted mid-term and final clinical evaluations. Three students, three faculty advisors, and two preceptors participated in focus group interviews. RESULTS: At mid-term, statistically significant differences were noted on 31% of the indicators within the clinical evaluation tool between students and preceptors with preceptors consistently ranking students higher than the students' ratings of their performance. Student and preceptor ratings of students' clinical performance were more consistent on the final evaluation. However, where there were differences, preceptors rated students higher than student ratings. Qualitative data analysis suggests that the concept of competence is complex and multifaceted and understood differently by students, preceptors, and advisors. CONCLUSIONS: The findings of this study suggest that there is ambiguity among second-degree students, preceptors and faculty advisors surrounding the concept of competence. In order to develop an understanding of competence, nursing program administrators must encourage faculty advisors, preceptors and students to engage in a discussion at the outset of the preceptored practice experience in regard to what is meant by competence within various practice setting. Further, we suggest nursing programs in collaboration with their clinical partners and re-examine their practice evaluation tools to determine the degree to which they are sensitive to the clinical practice context.

Comparison of second-degree and traditional undergraduate nursing students' sense of belonging during clinical placements.

Second-degree undergraduate nursing programs are proliferating throughout Canada. Although these shorter programs are attracting students from a variety of disciplines and professions, a sense of belonging and the meaning or implications of belongingness have not been examined for this unique nursing student cohort. A survey design, using the Belongingness Scale-Clinical Placement Experience questionnaire, explores second-degree nursing students' sense of belonging, compared with that of 4-year undergraduate nursing students. Overall, second-degree nursing students experienced a sense of belonging during clinical placements to a lesser degree than their counterparts in a traditional nursing program. Providing second-degree students with opportunities to know and create partnerships with nurse educators and staff while on placements, as well as providing them with feedback presented in positive terms, will help these students flourish and engender a greater sense of belonging.

A critique of the undergraduate nursing preceptorship model.

The preceptorship model is a cornerstone of clinical undergraduate nursing education in Canadian nursing programs. Their extensive use means that nursing programs depend heavily on the availability and willingness of Registered Nurses to take on the preceptor role. However, both the health service and education industries are faced with challenges that seem to undermine the effectiveness of the preceptorship clinical model. Indeed, the unstable nature of the clinical setting as a learning environment in conjunction with faculty shortages and inadequate preparation for preceptors and supervising faculty calls us to question if the preceptorship model is able to meet student learning needs and program outcomes. In a critical analysis of preceptorship, we offer a deconstruction of the model to advance clinical nursing education discourse.

Rural hospital interdisciplinary team members' experience of undergraduate nursing preceptorship: a qualitative descriptive study.

Rural hospital preceptorships offer Canadian undergraduate nursing students the opportunity to work with interdisciplinary teams. In a qualitative descriptive study, rural hospital interdisciplinary team members' experience of preceptorship was explored. Five focus groups and eight individual in-depth semi-structured interviews were conducted with professionals from nursing, medicine, social work, respiratory, recreational, occupational therapy, records keeping, dietary, pharmacy, hospital administration, and laboratory services. The data suggests time and patterns of communication within the clinical learning environment influence students' ability to effectively work within an interdisciplinary healthcare team framework. As a result, students' exposure to the interdisciplinary team must be deliberately and carefully planned. As well, students need to learn to work effectively within the team approach through interdisciplinary education.

Points of tension: a qualitative descriptive study of significant events that influence undergraduate nursing students' sense of belonging.

INTRODUCTION: Soon-to-be graduate nurses who choose to begin their career in rural hospital settings face not only the challenge of learning to do rural nursing, but also how to navigate the complex personal and professional relationships that characterize the close knit community of rural hospital teams. Since every encounter with registered nurses and other members of the team is contextually mediated, the challenge for students, preceptors, other professional staff members, and nurse educators is to develop a supportive clinical environment that fosters students' sense of belonging. The objective of this study was to describe events that influence undergraduate nursing students' sense of belonging during a rural hospital preceptorship, and to explore their meaning. METHODS: Using the clinical incident technique, a purposive sample of fourth year nursing students completing a rural hospital-based preceptorship in southern Alberta and British Columbia, Canada was used. Individual in-person and telephone interviews as well as written accounts were analyzed. Inductive and comparative analysis was used to uncover the themes 'points of tension' and 'minimizing the differences'. RESULTS: The clinical environment that includes everyone who interacts with the student has the potential to positively or negatively influence students' sense of belonging. Tension developed when students' expectations of their preceptor, nurses, and other professional team members did not coincide with the reality of the everyday clinical environment. Only when the differences between themselves and the registered nurses they worked with on daily basis were minimized did the participants in this study feel as if they belonged to the community of professional nurses. CONCLUSION: Nurse Educators need to carefully assess not only students' knowledge of rural nursing practice, but also students' expectations of themselves, their preceptor, other professional staff members, and the overall clinical environment. As such, students need to develop social awareness and facility. Preparation also extends to everyone in the clinical setting who is involved in the students' experience so that they learn not only what students know but how to interact with them. In this way the clinical environment is supportive of students' learning and transition to the graduate nurse role.

Students' perception of faculty involvement in the rural hospital preceptorship experience.

Faculty in Canadian undergraduate nursing programs have come to rely on preceptorship as the primary model for teaching and learning during the final clinical course. A focused ethnography was completed in order to examine undergraduate nursing students' experience of rural hospital preceptorship in western Canada. Data analysis revealed that students perceive nursing faculty involvement and support to be peripheral to the clinical experience. Strategies aimed at clarifying the faculty role and nursing programs' involvement are presented as a means to enhance the rural hospital learning experience.