Isolation and Marginalization: Exploring Attrition of Men in Preregistration Nursing Programs.

BACKGROUND: In Scotland, similar to other countries, male nursing students have a high attrition rate. This study examined the reasons for and ways to decrease the attrition rate. METHOD: This four-phase collaborative study included four Scottish universities. Phase 1 involved three telephone interviews with men who had left a nursing program. Phases 2 through 4 used focus groups and interviews with 18 nursing students (13 men and 5 women) and 12 nurse lecturers. Thematic analysis followed a four-stage process. RESULTS: Male nursing students in this study felt isolated and marginalized, were stereotyped regarding their masculinity and physical attributes, had difficulty communicating, and were reluctant to seek help. Financial pressures and access to learning opportunities also disproportionately affected male students. Resilience and maturity are required to cope with these challenges. CONCLUSION: Proactive measures and visible role models in academic and clinical environments are needed to support male students in completing their nursing education. [J Nurs Educ. 2022;61(4):179-186.].

Barriers and facilitators to recruiting and retaining men on pre-registration nursing programmes in Western countries: A systemised rapid review.

BACKGROUND: The recruitment of men to pre-registration nursing programmes in many Western countries has remained static at approximately 10% per year. AIM: To identify the experiences and attitudes of men on pre-registration nursing programmes in Western countries and the barriers and enablers to their recruitment and retention. DESIGN: Systematized rapid review. METHODS: Searches were undertaken in Medline (Ovid), CINAHL (EBSCO) and PsychINFO (EBSCO) databases. Studies in English were included if they were from Western countries, were published since 2000 and related to men's experiences of, or attitudes to, applying for or studying pre-registration nursing. Included papers were quality appraised and findings were thematically analysed and presented in a narrative synthesis. RESULTS: Records were de-duplicated and 2063 records were screened and 44 articles assessed for eligibility of which 23 articles relating to 22 empirical studies were included in the review. Findings were categorised into the following themes: recruitment experiences/reasons for studying nursing; gender experiences; barriers, difficulties and challenges with programme; and factors affecting retention. CONCLUSION: Evidence suggests that many men who come into nursing have a family member or acquaintance who is a nurse or that they have had contact with a male nurse as a patient or carer. Motivating factors such as financial security, career mobility and the opportunity to have a job in a caring profession were reported. Improved career advice at school is needed and shortened graduate programmes could be attractive. On programme, some clinical areas were easier for male students, while in others, treatment refusal could cause difficulties. Being in a minority and gender stereotyping can affect experiences. Ensuring equitable treatment, providing additional support and placements in clinical areas with more men could minimise these challenges.

An exploration of the influences on under-representation of male pre-registration nursing students.

BACKGROUND: Worldwide, men are under-represented in the nursing profession. In Scotland less than 10% of pre-registration nursing students are male. Reasons for this imbalance need to be understood. OBJECTIVES: To explore the views of male pre-registration nursing students, nursing lecturers and school teachers about this imbalance. DESIGN: Mixed methods study using focus groups and online survey. SETTINGS: Focus groups in four locations across Scotland. Online survey sent to teachers across Scotland. PARTICIPANTS AND METHODS: Eight focus groups with 33 male nursing students; four focus groups with 21 university and college nursing lecturers; 46 school teachers returned the online survey. RESULTS: Although nursing was considered a worthwhile career with job stability and many opportunities, it was also viewed as not being a career for men. Assumptions about the profession and femininity were challenging for men and use of the term 'male nurse' was felt to be anomalous. In some circumstances the provision of intimate care to particular patient groups caused difficulty. Positive encouragement from others, a positive role model or knowledge of nursing from significant others could be helpful. However concerns about low earning potential and negative media publicity about the NHS could be a disincentive. Being mature and having resilience were important to cope with being a male nursing student in a mainly female workplace. Some more 'technical' specialties were felt to be more attractive to men. CONCLUSIONS: Nursing is viewed as a worthwhile career choice for men, but the gendered assumptions about the feminine nature of nursing can be a deterrent.

Nursing students' learning dynamics with clinical information and communication technology: A constructive grounded theory approach.

BACKGROUND: The learning of nursing students can be facilitated through direct and/or indirect experiences of using clinical information and communication technology during clinical placements. However, nursing students experience difficulties in using technology for learning. Despite the difficulties, nursing students' learning dynamics with technology in real clinical contexts is poorly understood. OBJECTIVES: To develop a theoretical model by identifying nursing students' learning dynamics with clinical information and communication technology and the factors influencing the dynamics. DESIGN: A constructivist grounded theory approach was employed in order to develop the theoretical model. SETTINGS: This research was conducted by recruiting nursing students from four universities in Seoul, South Korea. PARTICIPANTS: Sixteen fourth year nursing students were recruited by purposive sampling. METHODS: This research collected qualitative interview data in up to four rounds of interviews using open-ended and semi-structured interview questions. A total of 23 interviews were conducted. The data were transcribed verbatim. All interview data were analysed using three coding methods; initial, focused, and theoretical coding. NVivo 11 was used for data management. RESULTS: This research developed a theoretical model of nursing students' learning dynamics with clinical information and communication technology. The model explains three dynamics that influence nursing students' use of clinical information and communication technology (interpersonal, organisational and emotional dynamics) and the students' responses regarding the dynamics for learning in clinical contexts. CONCLUSIONS: Nursing educators can use the theoretical model to understand how best to support nursing students in navigating their clinical environments to build competency in using clinical information and communication technology.

How do Korean nursing students build knowledge? A constructivist grounded theory study.

INTRODUCTION: Nursing is a knowledge-intensive profession. Therefore, to cope with the demands of the nursing role, nursing students need to become competent in managing information to build nursing knowledge. However, nursing students' knowledge building process is poorly understood. This research aimed to explore (1) nursing students' dynamics of how they process nursing information for knowledge building and (2) nursing students' learning context in South Korea for their knowledge building. METHODS: A constructivist grounded theory approach was used for this research. Data collection was achieved through four rounds of intensive individual and group interviews with 16 fourth year nursing students in South Korea. The collected data were coded by initial, focused and theoretical coding methods. Constant comparison analysis between data, codes, memos and categories was applied. RESULTS: This research identified knowledge building dynamics consisting of three cognitive processes: connecting with information, deciding to accept information and building knowledge. Five motivational factors, including learners' interest, necessity of information, volition to learn, utility of information and the frequency of information that influence the processes were discovered. Moreover, four knowledge stages of memorising, understanding, synthesising and applying and creating emerged. CONCLUSIONS: This is the first empirical study on knowledge building dynamics in educational environments for healthcare professionals. The findings of this research provide nursing educators with a practical model that can be used to improve nursing curricula in facilitating students' knowledge building processes. Moreover, a deeper understanding of sociocultural influences on nursing education can assist educators to adapt and generalise the findings to their pedagogical contexts, providing a culturally sensitive and relevant approach to nursing education.

Nursing students' learning dynamics and influencing factors in clinical contexts.

Clinical placements are essential for students to develop clinical skills to qualify as nurses. However, various difficulties encountered by nursing students during their clinical education detract from developing clinical competencies. This constructivist grounded theory study aims to explore nursing students' experiences in clinical nursing education, and to identify the factors that influence the clinical education students receive. Twenty-one individual and six group semi-structured interviews were conducted with sixteen fourth year nursing students and four registered nurses. This research identified six factors that influence nursing students' clinical education: interpersonal, socio-cultural, instructional, environmental, emotional and physical factors. The research has developed a dynamic model of learning in clinical contexts, which offers opportunities to understand how students' learning is influenced multifactorially during clinical placements. The understanding and application of the model can improve nursing instructional design, and subsequently, nursing students' learning in clinical contexts.

Health value & perceived control over health: behavioural constructs to support Type 2 diabetes self-management in clinical practice.

AIMS AND OBJECTIVES: To explore health value and perceived control over health in relation to self-management behaviours in adults with Type 2 diabetes mellitus. BACKGROUND: Helping people to modify health related behaviour in diabetes is complex due to a multitude of factors. Exploring the meaning of the constructs of Modified Social Learning Theory could be beneficial to identifying people at risk of poor diabetes self-management. DESIGN: An exploratory qualitative study. METHODS: Thirteen adults with insulin-treated Type 2 diabetes mellitus were purposively sampled. Data were collected through semi-structured interviews. An in-depth thematic analysis was carried out. RESULTS: Health became a value priority on diagnosis of Type 2 diabetes mellitus. Participants described holding both terminal (relating to desired end states) and instrumental (a means to an end) health values pre-diagnosis but these became instrumental post-diagnosis to meet new lifestyle needs and maintain their quality of life. Descriptions of 'conflicts' in locus of control beliefs when managing Type 2 diabetes mellitus demonstrated influences on levels of self-efficacy and health value. Common themes that impacted on diabetes self-management included co-morbidities, medication management, blood glucose monitoring and reasoning for Type 2 diabetes mellitus. CONCLUSIONS: Locus of control beliefs, levels of self-efficacy and health value were influenced by complications associated with Type 2 diabetes mellitus. The findings on Modified Social Learning Theory and instrumental health value as a moderator to health behaviour resulted in the development of a proposed framework with potential practical utility. RELEVANCE TO CLINICAL PRACTICE: This research demonstrates the relevance of exploring the constructs of Modified Social Learning Theory (MSLT) in relation to diabetes self-management behaviours in Type 2 diabetes mellitus. The proposed Type 2 diabetes mellitus Self-management Behaviour Support framework incorporates Modified Social Learning Theory and instrumental health value as the theoretical basis for development and could provide clinical nurses and doctors with a tool that will allow for in-depth assessment and planning of Type 2 diabetes mellitus patients' self-management behaviours.

An audit of growth hormone replacement for GH-deficient adults in Scotland.

OBJECTIVE: Guidelines on the clinical use of growth hormone therapy in adults were issued by the UK National Institute for Clinical Excellence (NICE) in August 2003. We conducted a retrospective clinical audit on the use of growth hormone (GH) in Scotland to evaluate the use of these guidelines and their impact on clinical practice. The audit had two phases. In phase I, the impact of NICE criteria on specialist endocrine practice in starting and continuing GH replacement was assessed. In phase II, the reasons why some adults in Scotland with growth hormone deficiency were not on replacement therapy were evaluated. METHODS: A retrospective cross-sectional case note review was carried out of all adult patients being followed up for growth hormone deficiency during the study period (1 March 2005 to 31 March 2008). Phase I of the audit included 208 patients and phase II 108 patients. RESULTS: Sellar tumours were the main cause of GH deficiency in both phases of the audit. In phase I, 53 patients (77%) had an AGHDA-QoL score >11 documented before commencing GH post-NICE guidance, compared with 35 (25%) pre-NICE guidance. Overall, only 39 patients (18%) met the full NICE criteria for starting and continuing GH (pre-NICE, 11%; post-NICE, 35%). Phase II indicated that the main reasons for not starting GH included perceived satisfactory quality of life (n = 47, 43%), patient reluctance (16, 15%) or a medical contraindication (16, 15%). CONCLUSIONS: Although the use of quality of life assessments has increased following publication of the NICE guidelines, most adults on GH in Scotland did not fulfil the complete set of NICE criteria. The main reason for not starting GH therapy in adult GH-deficient patients was perceived satisfactory quality of life.

Followers and the co-construction of leadership.

AIMS: This study aimed to (1) identify how leadership is perceived and experienced by community nurses, and (2) examine the interaction between recent policy and leadership development in community nursing in the United Kingdom (UK). BACKGROUND: Leadership is a 'hot topic' yet little is known about leadership in community nursing. Traditionally, the study of leadership is viewed from a leader-centric perspective in which the discussion of followership and its impact on leadership in theory and research is noticeable absent. METHODS: A qualitative study using individual interviews (n = 31) and three focus groups (n = 13) was conducted. RESULTS: 'Following' is a complex process with a socially co-constructed view of leaders undertaken in a variety of ways through 'doing following''standing by' or 'resisting following'. Followers do not necessarily fit into one category but may move between categories depending on the situation. Future research into leadership requires consideration of leadership and followership as interdependent concepts. CONCLUSIONS: Successful leadership is dependent on the actions of many within organizations. Followers play an active role in leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Failure to consider differences amongst followers denies the impact followers have on the success (or failure) of the leadership process and ultimately on an organization's ability to achieve goals.

Understanding leadership in community nursing in Scotland.

There is limited evidence concerning leadership in community nursing. NHS policy also fails to clarify and define what leadership is, though regarding it as key to developing safe and high quality care. This paper reports the findings of a research study that aimed to identify how leadership is perceived and experienced by community nurses, and to examine the interaction between recent policy and leadership development in community nursing. Mixed qualitative methods were used involving 31 individual interviews and three focus groups with community nurses and nurse leaders (n-39) in three health boards in Scotland. Findings indicate the leadership qualities valued by participants, including the importance of leaders' visibility. Team leaders in particular were recognised for their visibility and clinical leadership. Strategic and professional leadership was less evident, so acting as a barrier to the development of the profession. The strategic vision was often not clear to community nurses, and they engaged in differing ways with the strategies and action plans of senior nurse leaders. New leadership roles, like change, need time to evolve and new leaders need space and the education to develop leadership. Future leaders in community nursing need to focus beyond clinical leadership, ensuring that good leadership is a process requiring interdependence between leaders and followers.

Assessment and management of patients with hypothyroidism.

This article explains how to assess, diagnose and treat patients with an underactive thyroid gland (hypothyroidism), including an outline of replacement therapy options. The need for regular monitoring and ongoing support is also highlighted.

Peripheral vascular structure and function in men with contrasting GH levels.

Both GH deficiency and excess are associated with cardiovascular disease. The mechanisms are unclear, but direct effects of GH in the vessel wall may be important. Previous reports suggest that GH enhances endothelium-dependent vasodilatation and alters large artery structure. Here we report a detailed assessment of large artery and microvascular structure and function in patients with contrasting GH levels. We studied six age-matched healthy control men, five men with acromegaly, and seven men with adult-onset GH deficiency before and at the end of 16 wk of GH replacement therapy. We measured arterial wall thickness by ultrasound of the common carotid artery; arterial stiffness by pulse wave analysis at the radial artery; microvascular structure by measurement of flow during maximal dilatation in the forearm and dermal circulation and counting dermal capillaries using video microscopy; and endothelial function in the forearm during brachial artery infusion of vasodilators (acetylcholine and sodium nitroprusside). Cardiac output was measured by Doppler ultrasound in GH-deficient patients and controls. GH-deficient patients tended to have increased arterial wall thickness and arterial stiffness, compared with controls. GH replacement reduced arterial stiffness (radial augmentation index 0.28 +/- 0.07 to 0.20 +/- 0.12, P = 0.02) and increased the number of dermal capillaries perfused (28.6 +/- 5.0 to 30.9 +/- 6.5 cm(-2), P = 0.03), but a reduction in arterial wall thickness was not statistically significant. With respect to maximum flow in forearm and dermis and endothelial function, GH-deficient patients were not different from controls, and GH therapy had no effect. Moreover, acromegalic patients were not different from controls in any vascular parameters studied. We conclude that the direct vascular effects of GH excess and deficiency in man are of modest magnitude and should not therefore be given the highest priority in considering the risks of cardiovascular events in patients with pituitary disease.