Exploring the meaning of night shift placement in nursing education: A European multicentre qualitative study.

BACKGROUND: An appropriate clinical learning environment has been identified as pivotal in nursing undergraduate education and should be planned responsibly. Specifically, night shifts placements have been documented as an important opportunity for developing a full understanding of the nursing profession and the whole process of nursing care. However, night shifts during placement have been reported to be stressful and anxiety-provoking, so their usefulness for nursing students is still debated. OBJECTIVES: To elicit nursing students' perceptions of night shift placement through metaphors, with the aim of discussing the pedagogical and ethical implications. DESIGN: A descriptive qualitative study was performed based on metaphors collected in an international cross-sectional study in 2016. SETTINGS: A network comprising five Bachelor of Nursing Science degrees located in the Czech Republic, Italy, Poland, Portugal, and Slovakia was established. METHODS: A total of 907 out of 1347 eligible nursing students from the five European countries described their learning experience on night shifts using a metaphor. RESULTS: Overall, 288/907 (31.7%) metaphors emerged as being negative-oriented and 137/907 (15.1%) as positive, while the remaining students (482; 53.2%) did not report any metaphors. In all five countries, negative metaphors prevailed: 'Wasting time' (37/288), 'Useless' (32/288) and 'Handyman' (22/288) were the most negative reported metaphors on working a night shift. However, doing a night shift is also perceived as a 'Learning opportunity' (22/137), a 'New experience' (20/137) and an 'Opportunity to socialize with the profession' (14/137) as underlined by the positive metaphors. CONCLUSIONS: Students perceive night shift placements mainly as a negative experience, which has little to do with education. While planning night shift placements, nursing educators should responsibly consider the whole process of education, analysing not only the learning outcomes that should be achieved but also the position of students and their experience as a person. Clinical mentoring can be a key resource in supporting students in transforming their night shift placements' experiences into a more meaningful or worthwhile experience. Moreover, night shifts should be offered to more experienced students, independent in their self-learning processes and capable of managing the limited possibility of interacting with other team members and patients.

Night shifts as a learning experience among nursing students across Europe: Findings from a cross-sectional survey.

BACKGROUND: Organising clinical placements during nights has been reported as an additional opportunity to introduce students to the whole picture of their future responsibilities. However, studies in this field are still lacking. OBJECTIVES: To describe and compare (a) the night shift experience of nursing students across Europe, (b) the patient-related problems that they face during night shifts, (c) the night care activities nursing students are called to perform, and (d) the perceived effects of night shift work on learning outcomes. DESIGN: A cross-sectional study, 2016. SETTINGS: Five European countries: Czech Republic, Italy, Poland, Portugal, and Slovakia. PARTICIPANTS: Nursing students from nine Bachelor of Nursing Science degree programmes attending night shifts during their study period and who were willing to participate were included. A total of 907 out of 1347 (67.3%) eligible students participated. METHODS: Questionnaire based on the available literature, translated into five languages. RESULTS: The duration of the night shift was from an average of 9.8 (CI 95% 9.6-10.0) in Italy to 11.9 (CI 95% 11.7-12.0) in the Czech Republic. Students faced mainly patients' pain without statistical differences across countries (at the overall level, 717 out of 907; 79%; p = .318). However, significant differences in the tasks performed during nights emerged: Polish students reported being more involved in performing basic nursing care (72; 93.5%) as compared to other countries (e.g., Portuguese students 337; 84.9%), (p = .02). Overall, an average of 28.9% of the night shift time was reported to be free of commitments, with higher values among Polish (38%, CI 95% 33.6-42.3) and Slovakian students (33.4%, CI 95% 30.6-36.3) and lower values among Czech Republic students (20.4%, CI 95% 17.6-23.2) (p .001). Boredom and satisfaction were reported as the main feelings during night shifts, with significant differences (p .001) across countries. Students reported significant different effects (p .001) of night shifts on their understanding of a nurse's role (from 5.2 out of 10 in Poland to 6.5 in the Czech Republic), on the understanding of the continuity of nursing care (from 5.2 in Poland to 6.7 in Italy), and on having a relationship with the clinical mentors (from 2.7 and 4.2 in Poland and the Czech Republic, respectively, to 6.9 in Italy). CONCLUSIONS: Night shifts can be both a valuable and a non-valuable learning experience, suggesting the need to carefully plan and assess their effectiveness at the unit level.

Competence-Based Curriculum Development in Nursing Education: A Story From the Western Balkans.

This article describes the process of competence-based curriculum development in nursing education at Western Balkan (WB) universities. Nursing education in the WB has been noncompliant with the standard educational approaches of the European Union's directive on regulated professions. The overall aim of the TEMPUS project "Competency-Based Curriculum Reform in Nursing and Caring in Western Balkan Universities" was to bring curricular reform for bachelor's nursing education in the WB region in line with competence-based education and professional standards to demonstrate compliance with all member countries of the European Union.

Nursing student profiles and occurrence of early academic failure: Findings from an explorative European study.

BACKGROUND: In the European context regulated by the Bologna Process principles, there is little evidence to date on the different profiles, if any, of nursing students enrolled in the 1st academic year and their academic outcomes. AIMS: To describe and compare the nursing student profiles and their academic outcomes at the end of the 1st year across European Bachelor of Nursing Science (BNS) courses. DESIGN: An exploratory multicentre cohort study involving five countries: Nursing students who were enrolled in nursing programmes for the academic year 2011/2012 in the participating BNS courses, willing to participate and regularly admitted to the 2nd academic year, were included in this study undertaken in 2013. Individual and faculty level variables were collected after having ensured the validity of the tools developed in English and then appropriately translated into the language of each participating country. FINDINGS: A total of 378/710 (53.2%) students participated in the study. They attended from 390 to 810h of lessons, while clinical experience ranged from 162 to 536h. The students reported a mean average age of 21.4 (Confidence of Interval [CI] 95%, 21.0-22.3) and foreign students were limited in number (on average 3.7%). The students reported adopting mainly individual learning strategies (92.9%), duplicating notes or lecture notes prepared by professors (74.4%), and concentrating their study before exams (74.6%). The majority reported experiencing learning difficulties (49.7%) and a lack of academic support (84.9%). Around 33.2% reported economic difficulties and the need to work while studying nursing on average for 24h/week. Personal expectations regarding the nursing role were different (45.6%) than the role encountered during the 1st year, as learning workloads were higher (57.2%) with regard to expectations. Around one-third of students reported the intention to leave nursing education while the proportion of those reporting early academic failure was on average 5.6%. CONCLUSIONS: More strategies aimed at harmonising nursing education across Europe, at supporting nursing students' learning processes during 1st year, and identifying factors influencing their intention to leave and their academic failure, are recommended.

Students' and families' expenditures to attend a nursing programme in 2011-2012: a comparison of five southern European countries.

AIM: To compare students' and families' nursing education expenditures across Europe. BACKGROUND: Nursing education costs are affected by investments in public education. The remaining costs fall on the shoulders of students and their families. While remaining somewhat understudied, public and student expenditure for nursing education is becoming critical in the current crisis context. Comparative studies on education costs are inevitably affected by a currency bias. Therefore, a standard measure named the Purchasing Power Standard, which has received no attention in nursing research, has been introduced. DESIGN: A mixed-method study incorporating qualitative and quantitative study designs was undertaken in 2011-2012. METHODS: Five nursing faculties located in the Czech Republic, Greece, Italy, Slovakia and Slovenia were included in the study. A questionnaire evaluating students' expenditures was developed in five languages and validated. Six hundred and twenty-five full-time students were recruited. RESULTS: A Slovakian student wishing to pursue a nursing career is required to commit an amount of money per year that corresponds to 15% of the average annual income of a Slovakian citizen. Lower percentages were required by students in Greece (10%), Italy (11%) and Slovenia (12%), while Czech students bore the lowest costs (5%). CONCLUSION: None of the countries involved was supporting nursing students through either direct or indirect financial incentives. Students in some countries were also required to buy and maintain uniforms. There is a need to develop supportive policies, especially in those countries where nursing programmes are expensive and may not be accessible to all talented and motivated students due to limited public support in education and the current economic context.