Modifiable factors contributing to belongingness of undergraduate nursing students in the clinical learning environment: An exploratory study.

BACKGROUND: Belongingness has been tied to positive personal and educational outcomes in undergraduate nursing students in the clinical learning environment, but there is limited literature on specific factors that promote these important feelings of acceptance and value alignment. OBJECTIVES: This study aimed to assess demographic characteristics, program/clinical structure factors, and modifiable clinical setting factors that may impact feelings of belongingness in U.S. undergraduate nursing students in the clinical learning environment. DESIGN: A cross-sectional survey design was used to assess the relationship between demographics, program/clinical structure factors, and modifiable clinical setting factors and levels of belongingness using the U.S. version of the Belongingness Scale - Clinical Placement Experience. SETTING: A national study was conducted via the National Student Nurses Association database from December 2022 to January 2023. PARTICIPANTS: 759 volunteer undergraduate nursing students in the U.S. who had completed at least one clinical course. METHODS: An online survey was disseminated to assess demographic factors, program/clinical structure factors, students' perceptions on the frequency of occurrence and perceived value of modifiable clinical setting factors (including clinical format, clinical site, relationship and interpersonal, and miscellaneous factors), and to measure levels of belongingness experienced. RESULTS: Bivariate analyses revealed one statistically significant program/clinical structure factor (p <.001) and 10 statistically significant modifiable clinical setting factors (p <.001) that contribute to belongingness. The findings also support the use of the U.S. version of the BES-CPE as a reliable and valid instrument. CONCLUSIONS: Results demonstrate the importance of fostering belongingness in undergraduate nursing students in the clinical learning environment and, for the first time, extrapolate qualitative findings from the literature into the identification of factors that contribute to these critical feelings of inclusion. There are immediate implications for nursing educators and a rich foundation for future intervention research is proposed.

Belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment: A scoping review.

AIM: The aim of this scoping review was to map the literature investigating belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment. BACKGROUND: The concept of belongingness, which encompasses feelings of acceptance, connection and value alignment, has been tied to positive outcomes in undergraduate/pre-licensure nursing students including increased learning, participation, confidence and professional socialization. It is critical for educators and clinical staff to foster a sense of belongingness for nursing students to promote positive and effective clinical learning experiences. DESIGN: The scoping review strategy established by the Joanna Briggs Institute was followed. The databases searched were CINAHL Complete (EBSCO), Education Source, Medline Complete (EBSCO), APA PsycINFO (EBSCO) and Epistemonikos. METHODS: Following a search of the five databases, studies were screened by title and abstract by two independent reviewers for inclusion. Data including population, concept, context, methods and key findings relevant to the review question were extracted and synthesized using an instrument developed by the reviewers. RESULTS: A total of 47 articles with varying methodologies were critically appraised. Three overarching focus areas emerged: outcomes resulting from feelings of belongingness versus alienation, factors that contribute to a sense of belongingness in the clinical learning environment and interventions to promote a sense of belongingness while students are immersed in the clinical learning environment. CONCLUSIONS: Belongingness in the clinical learning environment is an important concept that lends itself to positive learning experiences and increased satisfaction of undergraduate/pre-licensure nursing students. Environmental, relational and experiential factors can be maximized and specific interventions employed to promote belongingness. This review identifies a lack of evidence on measured interventional effectiveness at the student, school and clinical unit level. Future research to address these gaps is recommended. TWEETABLE ABSTRACT: Scoping review suggests environmental, relational and experiential factors promote positive outcomes in belongingness of nursing students.

A Psychometric Analysis of the Health Literate Health Care Organization-10 Item Questionnaire.

The concept of a Health Literate Healthcare Organization (HLHO) is a relatively new approach to health literacy that moves the focus from the individual patient to the overarching health care system. The HLHO-10 questionnaire was developed internationally to assess the 10 Attributes of HLHOs as described by participants of the Institute of Medicine Roundtable on Health Literacy. The purpose of this study was to establish reliability and validity of the HLHO-10 among a sample of United States hospitals. Reliability and validity were established through assessing the factor structure for the HLHO-10 and psychometric evaluation. The HLHO-10 was found to be reliable with a Cronbach's alpha of .855 and a two-factor structure was revealed through exploratory factor analysis. Additional research is needed to further validate use of the HLHO-10 in the U.S., but initial findings of this emerging tool are promising and timely as the issue of health literacy comes to the forefront of U.S. health care systems and associated regulatory agencies. [HLRP: Health Literacy Research and Practice. 2022;6(2):e137-e141.].

Early Career Outcomes of Family Medicine Residency Graduates Exposed to Innovative Flexible Longitudinal Tracks.

BACKGROUND AND OBJECTIVES: The Preparing the Personal Physician for Practice (P4) project used a case series design to study innovations in the content, length, structure, and location of residency training in 14 geographically diverse family medicine programs between 2007 and 2012. We aimed to explore how offering flexible longitudinal tracks (FLT) affected graduates' scope of practice, particularly in maternal child health (MCH), which included at least 17 months of focused training that increased each year over 4 years. METHODS: We administered a cross-sectional survey to graduates of P4 residencies approximately 18 months after they completed training (2011-2014) and compared graduates of the John Peter Smith (JPS) Family Medicine Residency MCH FLT to all other P4 graduates. RESULTS: The overall response rate was 81.8% (365/446). JPS graduates who completed the flexible MCH track (n=15) compared to all other P4 graduates (n=332) were more likely to deliver babies (13/15, 86.7% versus 48/324, 14.6%) and perform C-sections as the primary surgeon (12/15, 80.0% versus 15/322, 4.7%). Additional areas of expanded scope associated with the MCH track included endoscopy (4/15, 26.7% versus 10/323, 3.1%), the care of hospitalized adults and associated procedures (central lines, eg: 8/15, 53.3% versus 47/322, 14.6%), and the care of hospitalized children (13/15, 86.7% versus 111/323, 34.4%). CONCLUSIONS: Graduating from the JPS MCH FLT was associated with a higher provision of maternal, child, and ill adult patient care services, including associated procedures.

O corpo na velhice: usos, abusos, desusos do soma à fantasia / The body in old age: use, abuse,misuse from soma to fantasy / El cuerpo en la vejez, usos abusos desusos del soma a la fantasía

O corpo biológico está velado. No discurso manifesta-se sempre através do corpo erógeno ligado às experiências de prazer e desprazer, este último freqüentemente expressa-se através da dor. Sua presença cria um tal grau de perturbação na vida psíquica que põe em marcha conteúdos sepultados no mais profundo do inconsciente. Assim, se estabelece sobre um registro corporal, a unificação de todas as experiências prazerosas, constituindo o ego ideal, que marca uma mudança qualitativa na constituição do sujeito. Embora esta imagem do corpo seja subjetiva e pessoal, é tributária de representações sócio-culturais que vão constituindo o ideal do ego. As vicissitudes dessa passagem de um estágio a outro e os fatores determinantes dessa transformação são o objeto desta apresentação. O corpo acompanha as vicissitudes do projeto vital. (AU)

The biological body is veiled. In the discourse its only manifestation happens through the erogenous body tied to experiences of pleasure and displeasure, the latter expressed often through pain. Its presence creates such a degree of disturbances in the psychic life as to bring forward contents deeply embedded in the unconscious. Thus, the unification of all pleasant experiences forming the ideal Ego occurs on a body register and this marks a qualitative change in the constitution of the subject. Though this body image is subjective and personal, it´s also part of socio-cultural representations that form the ideal of the Ego. The vicissitudes of this passage from one stage to the other, and the determinant factors of this transformation are the topics of this presentation. The body accompanies the vicissitudes of the vital project. (AU)

Psicoanálisis y Gerontologia / Psychoanalysis and Gerontology

Partiremos da idéia básica que considera a subjetividade como produto da vincularidade, para logo depois entrar nas análises específicas que se relacionam com o nosso tema. Analisaremos conceitos como identificação, eu ideal, ideal do eu e castração, para compreender o processo de envelhecimento a partir de um referencial psicanalítico. Analisaremos o trabalho psíquico ao que nos vemos obrigados quando a vida avança no tempo e as representações psíquicas que devemos transitar afetivamente com nosso 'eu'. Veremos as conseqüências da quebra do sentido da vida e o articularemos com a deprivação afetiva e o 'contrato narcísico'. Depois analisaremos o que chamo: 'síndrome de Dorian Gray' ou o risco de desinvestir, a problemática do corpo, da morte e da constituição do 'eu horror'

El ideal, el edipo y la temporalidad: dos posiciones de la subjetividad / The ideal, Oedipus and temporality: two positions of subjectivity

A autora distingue duas posições que percorrem a subjetividade ao longo da vida e que dependem de um tempo lógico e não cronológico. O sujeito, ao ser marginalizado socialmente, atualiza um fantasma que tinha sido prematuramente negado. Assim, as tensões entre o "eu-horror" e o Eu Ideal, devido às confrontações com o Ideal do Eu, marcam estas posições, as quais ainda concorrem movimentos da estrutura edipiana que também obedecem o decurso temporal. Conceitua sobre a representação e a afetividade que aguarda o eu e a organização defensiva que se pôe em marcha ante a emergência da depressão. O registro intersubjetivo é um fator determinante nestas alterações. Finalmente, privilegia o mecanismo grupal como instrumento para a elaboração destes períodos críticos.

El ideal, el edipo y la temporalidad. Dos posiciones de la subjetividad / The ideal, Oedipus and temporality. Two positions of subjectivity

A autora distingue duas posições que percorrem a subjetividade ao longo da vida e que dependem de um tempo lógico e não cronológico. O sujeito, ao ser marginalizado socialmente, atualiza um fantasma que tinha sido prematuramente negado. Assim, as tensões entre o 'eu-horror' e o Eu Ideal, devido às confrontações com o Ideal do Eu, marcam estas posições, as quais ainda concorrem movimentos da estrutura edipiana que também obedecem o decurso temporal. Conceitua sobre a representação e a afetividade que aguarda o eu e a organização defensiva que se pôe em marcha ante a emergência da depressão. O registro intersubjetivo é um fator determinante nestas alterações. Finalmente, privilegia o mecanismo grupal como instrumento para a elaboração destes períodos críticos (AU)

Narcisismo e configuracoes vinculares buscando uma ilusao

Escolher uma estrutura centrada na paridade fala da necessidade de manter um ideal igualitario.