Experiences and challenges of enrolled nurses undertaking a Bachelor of Nursing Science programme in Namibia.

BACKGROUND:  Globally, enrolled nurses (ENs) are embarking on an educational journey to become registered nurses (RNs) in order to enhance their knowledge and career opportunities. However, their aspiration is not without challenges. In Namibia, the experiences of these nurses have not been extensively researched. OBJECTIVES:  This study aims to explore and describe the experiences and challenges of ENs undertaking a Bachelor of Nursing Science at the University of Namibia. METHOD:  A qualitative, exploratory, descriptive and contextual research strategy was followed as the basis of conducting the study. A sample of 15 nursing students was purposively selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes. The collected data were analysed thematically using an inductive approach. RESULTS:  Three main themes subsequently emerged from the study: ENs' positive experiences advancing in the Bachelor of Nursing Science (BNSc) programme; nurses' negative experiences advancing in the BNSc programme; and recommendations to ensure effective advancement in the BNSc programmeConclusion: The findings of this study revealed that ENs positively experience becoming a RN when it comes to self-development; however, they have negative experiences such as not receiving exemptions for prior learning and having to learn a new curriculum.Contribution: These findings may be used by the Faculty of Health Sciences, School of Nursing and Public Health management in order to develop targeted interventions and ongoing strategies during their curriculum review cycles to ensure positive student experiences and success within the programme.

Assess the feasibility of flipped classroom pedagogy in undergraduate nursing education in Sri Lanka: A mixed-methods study.

BACKGROUND: The nursing education system has evolved with an increased emphasis on student-centred education, such as implementing flipped classroom pedagogy. Given the promising positive educational outcomes, the trend of using flipped classroom pedagogy has become increasingly popular in undergraduate nursing education. However, little is known about how these flipped classroom methods impact on nursing educational practices in limited-resource settings situated in South Asia. OBJECTIVE: To assess the feasibility of implementing flipped classroom pedagogy in undergraduate nursing education from the nursing students' perspective. METHODS: This mixed-methods study employed a quantitative survey and six focus group discussions conducted in three state universities in Sri Lanka. The Nursing Students' Readiness for Flipped Classroom (NSR-FC) questionnaire was used to collect quantitative data. The semi-structured focus group discussions were conducted by using 18 reflective and open-ended questions. Descriptive statistics and multivariate analysis of variance methods were employed when analysing quantitative data. An inductive thematic analysis approach was used to summarize the focus group discussions. RESULTS: The questionnaire survey revealed that nursing students reported high levels of personal, technical, and pedagogical readiness across all three universities, while environmental readiness was perceived as low. The inductive thematic analysis identified three themes, namely: enablers, challenges, and benefits. Specifically, nursing students valued the student-centred approach. They were ready to utilize their own devices to overcome limited technological provision; however, a short training session about how to engage in the flipped classroom was desirable. Also, their exposure to basic educational technology was perceived as adequate and they were aware of the positive outcomes of flipped classroom pedagogy. CONCLUSION: Nursing students were ready to enrol in a flipped classroom programme. The provision of technological resources in the education environment was identified as a great challenge for flipped classroom implementation. Overall, the findings indicate there are promising feasibilities for the flipped classroom implementation.

Simulated Wound Care as a Competence Assessment Method for Student and Registered Nurses.

OBJECTIVE: To describe the development and use of a wound care simulation assessing RNs' and graduating student nurses' practical wound care competence and to describe observations of participants' wound care competence. METHODS: A descriptive, qualitative design was used. Data were collected in 2019 from 50 healthcare professionals and students using a simulated wound care situation and an imaginary patient case. The simulation was based on a previously developed and tested wound care competence assessment instrument, which included a 14-item checklist that assesses practical wound care competence of chronic wounds. The data were analyzed and described based on the 14 competence areas or as other competencies. RESULTS: Participants showed competence in identification of wound infection, debridement, dressing selection, tissue type identification, and consultation. Participants' shortcomings were related to pain assessment and management, asepsis, offloading, and documentation. Simulation was shown to be a promising tool to assess healthcare professionals' and students' practical wound care competence in a safe and standardized situation. CONCLUSIONS: This study provided new information about simulation as a method to assess student nurses' and RNs' wound care competence. The results could be used in wound care education planning and development in both undergraduate nursing education and continuing education for nursing professionals.

Student Nurse Knowledge of and Attitudes Toward Pressure Injury Prevention: How Sufficient Is Undergraduate Education?

OBJECTIVES: To assess the knowledge and attitudes of student nurses regarding evidence-based guidelines for preventing pressure injuries. METHODS: This study used a descriptive research design. The participants included second-, third-, and fourth-year nursing students completing their bachelor's degrees at a faculty of nursing in Turkey. Data collection forms consisted of a student nurse information form, the Pressure Ulcer Prevention Knowledge Assessment Instrument, and the Attitude Towards Pressure Ulcer Prevention Instrument. RESULTS: The overall mean score for knowledge was 49.9% (11.7/26). The highest scores for the instrument's subthemes were for nutrition (72%), and the lowest were for etiology and development (40.1%). The overall mean attitude score was 42.20 ± 2.40, although a statistically significant difference among grades was found (P < .001). The highest mean scores showed agreement among students that pressure injury prevention should be a priority (10.50 ± 1.43). A significant difference was found in the competence subscale according to the number of dressing changes observed and sense of competence in pressure injury care (P = .003). A weak but statistically significant positive relationship was found between knowledge and attitude scores (r = 0.158; 95% confidence interval, .040-.269; P < .001). CONCLUSIONS: This study revealed that certain revisions are needed in the nursing curriculum to improve the knowledge and attitudes of nursing students toward the prevention and care of pressure injuries. More details should be covered in the classroom and laboratories through simulation or clinical practice for improved management of pressure injuries.

Feedback in clinical settings: Nursing students' perceptions at the district hospital in the southern part of Namibia.

BACKGROUND: Feedback was the backbone of educational interventions in clinical settings. However, it was generally misunderstood and demanding to convey out effectively. Nursing students were not confident and did not feel free to practise clinical skills during practical placements because of the nature of the feedback they received whilst in these placements. Moreover, they experienced feedback as a barrier to completing practical workbooks. OBJECTIVE: The purpose of this article was to report on a qualitative study, which explored nursing students' perceptions of the feedback they received in clinical settings, at a district hospital. METHOD: This study was conducted at a district hospital located in southern Namibia. An explorative qualitative design with an interpretivist perspective was followed. A total of 11 nursing students from two training institutions were recruited by purposive sampling and were interviewed individually. All interviews were audio recorded with a digital voice recorder followed by verbatim transcriptions, with the participants' permission. Thereafter, data were analysed manually by qualitative content analysis. RESULTS: Themes that emerged as findings of this study are feedback is perceived as a teaching and learning process in clinical settings; participants perceived the different nature of feedback in clinical settings; participants perceived personal and interpersonal implications of feedback and there were strategies to improve feedback in clinical settings. CONCLUSION: Nursing students appreciated the feedback they received in clinical settings, despite the challenges related to group feedback and the emotional reactions it provoked. Nursing students should be prepared to be more receptive to the feedback conveyed in clinical settings.

Changes in proportion of bachelor's nurses associated with improvements in patient outcomes.

This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims data from state agencies in California, Florida, New Jersey, and Pennsylvania. The study sample included general surgical patients aged 18-99 years admitted to one of the 519 study hospitals. Multilevel logistic regression and truncated negative binomial models were used to estimate the cross-sectional and longitudinal effects of the proportion of hospital BSN nurses on patient outcomes (i.e., in-hospital mortality, 7- and 30-day readmissions, length of stay). Between 2006 and 2016, the average proportion of BSN nurses in hospitals increased from 41% to 56%. Patients in hospitals that increased their proportion of BSN nurses over time had significantly reduced odds of risk-adjusted mortality (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), 7-day readmission (OR: 0.96, 95% CI: 0.94-0.99) and 30-day readmission (OR: 0.98, 95% CI: 0.95-1.00), and shorter lengths of stay (incident rate ratio [IRR]: 0.98, 95% CI: 0.97-0.99). Longitudinal findings of an association between increased proportions of BSN nurses and improvements in patient outcomes corroborate previous cross-sectional research, suggesting that a better educated nurse workforce may add value to hospitals and patients.

Assessing Undergraduate Student Nurses' Performance in Various Public Health Roles Using Simulation.

Purpose: To expose students to various public health roles and complement clinical experience using simulated encounters.Design: This exploratory study assessed students' performance of basic nursing tasks for three public health nurse roles.Methods: 15-guided questions were used to evaluate a convenience sample of 137 students' expected performance compared to their actual performance of basic nursing skills.Findings: Students' performed well in all nurse roles with some significant differences in completing a few critical tasks in the case manager and school nurse roles.Conclusion: Simulation can address gaps in nursing programs and expose student nurses to various public health roles using real-life scenarios.Clinical Evidence: Lack of clinical sites in public health limits students' experience to a myriad of nurse functions within communities.

Impostor Phenomenon in Undergraduate Nursing Students: A Pilot Study of Prevalence and Patterns.

BACKGROUND: Impostor phenomenon (IP) is an experience of doubt in personal ability and a sense that achievements are fraudulent, resulting in increased psychological distress. This pilot study explored the prevalence and pattern of IP in baccalaureate nursing students related to gender, level in program, and racial identity. METHOD: A convenience sample of prelicensure baccalaureate nursing students (n = 150) was surveyed using the Clance Impostor Phenomenon Scale (CIPS). RESULTS: The mean CIPS score was 60.13 (range, 26-92). Patterns observed across gender, level in program, or racial identity did not differ significantly. However, frequent to intense feelings of impostorism were reported by 48.7% of students, and 92% reported at least moderate IP characteristics. CONCLUSION: Many students in this study reported IP experiences, indicating risk for negative effects such as anxiety and lack of confidence. Further study in this population and specifically among minority nursing students is needed. [J Nurs Educ. 2021;60(6):329-332.].

Honors and Nursing: Reasons for Enrollment, Persistence, and Withdrawal.

BACKGROUND: The intertwining of honors within collegiate nursing education can be rewarding and challenging for students. This study examined why students enroll in honors, why students persist in honors, why some students withdraw from honors, and what resources are beneficial to honors success. METHOD: An online survey was sent to 130 nursing students enrolled in an honors program at one midwestern university. RESULTS: Forty-six nursing students completed the survey. Students indicated they enrolled in honors programs to attend classes with fewer students, to achieve Honors College Distinction, and to gain skills in professionalism and leadership. Reasons for withdrawal from honors included lack of time, increased workload, and added stress. CONCLUSION: Nursing students face many challenges in successful completion of an honors program. The results from this study led to the development of Honors and Nursing: A Supplemental Honors Nursing Guidebook for Honors Student Success, a resource for nursing honors students at the university. [J Nurs Educ. 2021;60(6):333-336.].

"He just teaches whatever he thinks is important": Analysis of comments in student evaluations of teaching.

Student evaluations of teaching are ubiquitous in higher education; however, most prior research has focused on the numeric ratings, with little systematic attention given to the qualitative comments. In this study, written comments were collected as part of the regular evaluation of a community health nursing course over four semesters. Taken as a whole, student comments were strikingly consistent and mostly negative. Students emphasized the authority of the textbook and framed the course as preparation for the National Council Licensure Examination (NCLEX). Instructor efforts to focus on critical analysis of social issues were met with confusion, suspicion, and resistance. Student comments were further analyzed in relation to 3 levels of discourse: the student/teacher level, the nursing-education level, and the social-historical level. For each level, the comments reveal problems, but not the ones suggested by a conventional reading of student evaluations. If students and teachers have conflicting expectations about goals and methods for learning, formal student evaluations may be less useful as a measure of teaching effectiveness. This study also raises troubling concerns about current practices in nursing pedagogy, particularly the emphasis on standardized testing and highly structured didactics, and the overlap between student evaluation systems and the technologies of neoliberalism.

Examining the racial and ethnic diversity of associate degree in nursing programs by type of institution in the US, 2012-2018.

BACKGROUND: Increasing nursing workforce diversity is essential to quality health care. Associate Degree in Nursing (ADN) programs are a primary path to becoming a registered nurse and an important source of nursing diversity. PURPOSE: To examine how the number of graduates and racial/ethnic student composition of ADN programs have changed since the Institute of Medicine's recommendation to increase the percentage of bachelor's-prepared nurses to 80%. METHODS: Using data from the Integrated Postsecondary Education System, we analyzed the number of graduates and racial/ethnic composition of ADN programs across public, private not-for-profit, and private for-profit institutions, and financial aid awarded by type of institution from 2012-2018. DISCUSSION: Racial/ethnic diversity among ADN programs grew from 2012-2018. Although private for-profits proportionally demonstrated greater ADN student diversity and provided financial aid institutionally to a higher percentage of students, public schools contributed the most to the number and racial/ethnic diversity of ADN graduates. CONCLUSION: Given concerns regarding private for-profits, promoting public institutions may be the most effective strategy to enhance diversity among ADN nurses.

Experiences of undergraduate nursing students during clinical practice at health facilities in Western Cape, South Africa.

BACKGROUND: This study explored the experiences of undergraduate nursing students during clinical practice at healthcare facilities in the Boland Overberg area in Western Cape, South Africa. Few studies have been done on experiences of nursing students during clinical practice. However, there are still inadequacies, which lead to the deterioration of clinical practice quality. OBJECTIVES: To explore and describe the experiences of undergraduate student nurses during clinical practice in healthcare facilities in Boland Overberg, in Western Cape, South Africa. METHOD: A qualitative, exploratory descriptive design was applied. Data collection was done using focus-group interviews to ascertain the undergraduate student nurses' experiences during clinical practice in healthcare facilities in the Boland Overberg area in Western Cape Region. Thirty-eight undergraduate nursing students from Boland Campus were selected, using purposive sampling. The sample size was based on data saturation. Colaizzi's method of coding and thematic content analysis was used to interpret the data. Ethical principles were adhered to. RESULTS: After data analysis, the following themes emerged: clinical learning environment, challenges and inability to reach objectives. CONCLUSION: During clinical practice in healthcare facilities, students were confronted with dilemmas which must be addressed with proper planning to decrease the challenges in clinical education of future nurses. The findings can be used in planning of nursing education, could provide help to develop effective clinical teaching strategies in nursing education and to support these undergraduate nursing students.

A preceptorship model to facilitate clinical nursing education in health training institutions in Botswana.

BACKGROUND: Despite the wide use of preceptorship, there is evidence that preceptorship and the role of preceptor in clinical nursing education are not clearly understood or supported. OBJECTIVES: To develop a preceptorship model to facilitate clinical nursing education in Botswana. METHOD: The model development in this study followed the steps of theory generation as described by Chinn and Kramer. These four steps are concept analysis, relationship statements, description and critical reflection of the model. RESULTS: Four main themes emerged from the empirical study that formed the basis for key concepts and model development. The model has six components, namely, agent, recipient, context, procedure, dynamics and terminus. The description of the model is based on Chinn and Kramer. CONCLUSION: The need for a preceptorship model to facilitate preceptorship cannot be overemphasised in this regard. This model will guide the planning and implementation of preceptorship procedures by different stakeholders to improve its effectiveness in clinical nursing education.

Exploratory Factor Analysis of the Indonesian Version of the Clinical Learning Environment, Supervision, and Nurse Teacher Scale (CLES + T).

BACKGROUND AND PURPOSE: The purpose of this article is to describe an evaluation of psychometric properties of the Indonesian version of the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES + T) scale, a scale that measures nursing students' perceptions of their clinical learning environment. METHODS: The CLES + T was completed by 292 nursing students. Inter-item correlations, exploratory factor analysis, Cronbach's alpha, and evidence of validity were used to examine reliability and validity. RESULTS: Four factors were extracted that explained 58% of the variance. Cronbach alphas ranged from .86-.95. Wording to describe different titles of supervisors was unclear to some of the participants. CONCLUSION: The Indonesian version of the CLES + T is a reliable version. More research is needed to clarify some of the wording.

Seizing opportunity: Diverse early-entry nursing students' perceptions of seeking a PhD.

BACKGROUND: The aging and retirement of the current nursing professoriate and the increasing numbers of nurses pursuing practice doctorates has precipitated decreasing numbers of nurses, specifically diverse nurses pursuing a research doctorate, thus limiting the development of nursing science. PURPOSE: To describe factors influencing decisions about entering a PhD program from the perspectives of early-entry PhD nursing students. METHOD: A qualitative descriptive design using semistructured interviews to explore the perceptions of making the decision to pursue a PhD in nursing of the students who participated in two early-entry mentoring programs. FINDINGS: A model, entitled "Seizing Opportunity" was developed from the findings about the process of students deciding to pursue a PhD. DISCUSSION: Motivators and detractors that can help nursing educators understand how to successfully recruit diverse PhD students were uncovered. Providing knowledge and mentoring for early entry students can increase the numbers of diverse students pursuing a PhD in nursing.

Midwifery students' views and experiences of birth on mainstream factual television.

OBJECTIVES: To investigate midwifery students' experiences of viewing childbirth on mainstream factual television and to explore implications for student career intentions and potential pedagogical uses of television excerpts in midwifery education. DESIGN: Twenty-two undergraduate midwifery students at one of two universities took place in focus groups between February and June 2019. Ethical approval was obtained at both sites. Thematic analysis was employed to generate key themes from the data. SETTING: Two UK universities based in the East Midlands and East Yorkshire regions of England. PARTICIPANTS: Twenty-two midwifery students at any stage of their studies. FINDINGS: Researchers generated four key themes from the data a) Changed Perspectives on Televised Childbirth, b) Representations of Midwives and Social Implications, c) Representation of Childbirth and Social Implications and d) The Role of Televising Childbirth in Midwifery Education. KEY CONCLUSIONS: Midwifery students often experience a change of perspective on birth on television as they acquire new knowledge and skills. They recognise the potential social implications of how childbirth and midwifery are represented on television. Pedagogical use of televised birth has potential benefits but needs further investigation in the context of midwifery education. IMPLICATIONS FOR PRACTICE: Midwifery students are likely to begin their studies with pre-existing views and experiences around how birth is represented on mainstream factual television. They may need support to reflect on these to consider their expectations of the profession, to effectively support childbearing women and to potentially influence future production of media images of childbirth.

Presence of the Reflective and Critical Thinking Capacity in Nursing Curricula in Iberian America.

OBJECTIVES: The objective was to identify the presence of the capacity for reflexive-critical thinking or similar, in Nursing Curricula in Iberian America. METHODS: The article gathers the results of one of the objectives of the macro-project developed by the Iberian American Network on Nursing Education Research, titled Strategies to develop reflective and critical thinking in nursing students: Iberian America situation. To achieve this, a descriptive and exploratory research was conducted with qualitative approach. An instrument created for this project was used, along with some guiding questions to focus the information. RESULTS: Eight countries participated (Bolivia, Brazil, Colombia, Ecuador, Spain, Mexico, Peru, and Venezuela), which contributed information from 189 curricular plans. The R&CT was found in the majority of the curricula, although with diverse denominations. The principal learning strategies used were problem-based learning, group dynamics, reflective reading, clinical practice, and simulation laboratories. The evaluation methods used are the knowledge test, case analysis, and practical exam. CONCLUSIONS: Significant stress exists in the discourse and curricular organization. Incongruences were found and a clear inclination toward the formation of professionals with broad technical skills under a traditional, memory, banking and knowledge accumulation education.

Houser Gear Conceptual Model for New Nurse Educators.

This article presents a conceptual model explaining classroom dynamics, to guide novice nurse educators who are transitioning from clinical practice to academia. A critical review using Fawcett's framework for analysis and evaluation of nursing models was used to develop the Houser gear conceptual model, a visual representation of a gear system depicting the fundamental relationship among nursing leadership, active teaching strategies, and student learning outcomes.

Evaluation of the Psychometric Properties of Relational Insights 360 Among Baccalaureate Nursing Students With the Use of Standardized Patients.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate reliability and validity of the relational competency assessment instrument, Relational Insights 360 (RI-360) (Koloroutis & Trout, 2012), among 104 baccalaureate nursing students and 10 standardized patients (SPs) upon completion of a communication simulation. METHODS: The reliability of the RI-360 was determined by Cronbach's alpha coefficient. Interrater reliability of the RI-360 was measured between the SPs and the primary investigator with percentages. Factor analysis was run to evaluate the construct validity. RESULTS: The RI-360 was internally consistent with an alpha coefficient of 0.93. Interrater reliability for all items on the RI-360 was 42% between students' scores and SPs' scores and 38.9% between the Primary Investigator's scores and SPs' scores. Exploratory factor analysis showed that factor loadings ranged from 0.29 to 0.84. CONCLUSIONS: The RI-360 appears to be a valid and reliable scale for use in measuring relational competency among nursing students and SPs.

Faculty Perceptions of Teaching Nursing Content Online in Prelicensure Baccalaureate Nursing Programs.

BACKGROUND: The purpose of this study was to explore the perceptions of nursing faculty regarding the nature, challenges, and strengths of teaching course content online in prelicensure collaborative baccalaureate nursing programs and the implications for online course delivery. METHOD: This was an exploratory-descriptive, mixed-methods design based on document analysis, an online survey completed by 32 faculty, and interviews with 16 faculty in a representative sample of 13 English speaking colleges in Ontario. RESULTS: Participants perceived content containing complex cognitive concepts, experiential learning as in relational practice, and psychomotor skill mastery as better suited for traditional classroom delivery. Faculty identified challenges with developing higher level online discussions and having students collaborate. CONCLUSION: Online teaching took much more time and should be acknowledged in workload assignments. A hybrid teaching environment was preferred. Online education was useful when the content and the semesters/years were appropriate, and necessary supports were in place. [J Nurs Educ. 2020;59(12):683-691.].