Clinical Placement Experiences Research Articles

The duration of clinical placements: a key influence on nursing students’ experience of belongingness

Objective: This paper reports selected findings from a study that investigated nursing students’ experience of belongingness. The manner in which this experience is influenced by the duration of students’ clinical placements is the focus of the discussion. Design: A mixed method, multi‑site case study approach using an anonymous online survey: the Belongingness Scale ‑ Clinical Placement Experience was completed by 362 students, 18 of whom also participated in semi‑structured interviews. Setting: The setting for the study was two Australian universities and one university in the United Kingdom offering undergraduate nursing programs. Subjects: Third year undergraduate students (n=362) were recruited into the study. Main outcome measure: Nurses experience of belongingness and the influence of the duration of clinical placement on the experience of belongingness. Results: Students’ self‑concept, degree of self‑efficacy, confidence, resilience, willingness to question or conform to poor practice, career decisions, capacity and motivation to learn were all impacted by the extent to which they experienced belongingness. Differences in belongingness scores between the students from the three sites were statistically significant, with participants from the United Kingdom scoring higher than those from either of the Australian sites, F(2, 355) = 21.70, p = <.001, ηp2 = 0.11. Although the reasons for these results are multifactorial, this study found the duration and structure of clinical placements to be one of the most important factors affecting students’ belongingness. Conclusion: A consolidated period of practice for students to ‘settle in’ and establish collegial relationships is an important influence on their experience of belonging and a necessary precursor to their active and participative learning. Findings from this study call for a re‑examination of the assumptions, educational philosophies, policies and practices that underpin the duration of clinical placements in contemporary undergraduate nursing programs.

Mentorship in contemporary practice: the experiences of nursing students and practice mentors

This paper explores the role of the mentor in contemporary nursing practice in the UK. It presents findings from a recent study which investigated the impact of a locality-based nursing education initiative on students, practice mentors and academic staff and draws on another study, conducted in the same setting and two Australian sites, to examine the perceptions of nursing students and mentors. Within nursing, mentorship is integral to students' clinical placement experiences and has attracted increasing interest among researchers. Despite a plethora of studies focussing on mentoring and its nature and application within the practice setting, limited attention has been paid to the extent to which guidelines provided by regulatory bodies for nursing inform and influence the practice of mentoring in contemporary health-care settings. The study used a two-phased design with data on mentorship being focussed on the second phase. Data were collected using an online survey questionnaire of pre-qualifying students and a postal questionnaire for practice mentors. The findings highlight the importance of mentorship for prequalifying students and emphasise the need to provide mentors with adequate preparation and support. They confirm previous research, but also highlight improvements in bridging the gap between rhetoric and reality for mentorship. Results are further strengthened when compared with those of the second study. Findings provide new evidence of a narrowing of the gap between the theory and practice of mentoring and for the continuing implementation of national standards to clarify the roles and responsibilities of the mentor. They also suggest the benefits of developing such standards in countries with similar systems of support for nursing students. Mentorship is pivotal to students' clinical experiences and is instrumental in preparing them for their role as confident and competent practitioners.

Clinical experience in mental health nursing: Determining satisfaction and the influential factors

Clinical exposure to the mental health environment has been identified as a major factor in promoting a more favourable attitude towards mental health nursing. However, little attention has been devoted to measuring specific aspects of the clinical placement experience. This paper presents the findings of a survey of 703 undergraduate nursing students designed to measure satisfaction and identify factors influencing satisfaction (length and type of placement, time spent with a preceptor). A questionnaire was administered to undergraduate nursing students in Victoria, Australia, at the conclusion of their clinical experience in mental health. The findings demonstrate a high level of satisfaction, particularly in feeling welcomed, well oriented and supported, and opportunities for patient care. Students' views were influenced by the duration and type of placement and time spent with a preceptor. These findings provide valuable information about characteristics of a positive clinical experience that should be considered in structuring clinical placements in the mental health field.

Almost There

Lawyers’ professional (ethical) behaviour is under challenge as a result of major public disclosures in recent years. In an effort to deal with such challenges, a focus on ethical fundamentals is called for. It is not unreasonable to assume that lawyers’ moral reasoning might play some role in the decisions that are made in everyday legal practice, especially those that lead to subsequent criticism. However, until now there has been a dearth of research into ethical responses of Australian lawyers or law students. A longitudinal study exploring the relationships between values and ethical behaviour for early-career legal practitioners has been concluded. This study situated participants within hypothetical contexts that provided for ethical dilemmas and comprised a representative Australian cohort of final year law students, tracking them through their first two years of employment or further study. Of particular interest in the conclusions reached in this study was the effect of gender, clinical experience and prior ethics education on changing responses. Findings suggested that there were significant differences over time in responses to ethical dilemmas, particularly for females and participants who experienced clinical and ethics-focused subjects during their law degree. Like females, participants who had completed a clinical placement and ethics course were more likely to exhibit significant changes in responses across the three years of the study. The direction of change could be said to be largely in the direction of better ethical conduct. This could be a consequence of greater exposure to ethical dilemmas and scenarios during clinical placement experiences and ethics courses. The implications of results are discussed in the contexts of ethics education in a tertiary educational environment, and postadmission to legal practice.

Improving the Undergraduate Clinical Placement Experience in Mental Health Nursing

Recruitment in mental health nursing is an international problem. Improving the undergraduate clinical placement experience may help to attract students into mental health nursing. In this paper, the authors describe the development and evaluation of a clinical facilitation program aimed at improving the placement experience. Students were surveyed about their attitudes to mental health nursing before and after placement. Based on the results from 254 pre-placement and 248 post-placement surveys there was a large significant increase in students' interest in mental health nursing following clinical placement. Data collected from focus groups also indicated that facilitators, students, and clinical nurses all viewed the program positively.

Factors influencing the quality of student learning on practice placements

AbstractPractice/clinical placements are central to learning in healthcare programmes, and optimizing learning during placements is important. However, little literature exists on physiotherapy students’ practice placement experiences. That which has been published presents a picture of both positive and negative experiences.The topic was addressed within a larger longitudinal study into the learning experiences of students from non‐traditional backgrounds undertaking a 4‐year part‐time physiotherapy programme. Seventeen students from the 2000 cohort participated in the qualitative phenomenographic study. The study met institutional ethical requirements and participants’ gave written informed consent. Within the individual semi‐structured interviews undertaken in the final year, participants were asked to identify the aspects of their practice placements which had least and most facilitated their learning.Data were analysed using a phenomenographic approach, which identifies variation in the ways in which people experience phenomena. The iterative process began with identification of interview responses from verbatim transcriptions of the interviews, and ended with a set of categories of description which, together, captured the full set of participants’ responses. Representative quotations illustrated the nature and scope of each category of description and provided evidence regarding the rigour of the data analysis process.Some categories were identified as both positive and negative, for example direct involvement with patients, educator–student interaction, with the degree and nature of context deciding on the direction of participants’ perceptions. Factors relating to placement organization were also found to have both positive and negative influences on learning. Effective communication is proposed as a means to addressing the negative aspects identified.This study provides useful information on participant's perceptions of the quality of their clinical placement experiences. However, the research base on this important topic continues to be small, and further research is needed on physiotherapy students from both traditional and non‐traditional backgrounds.

Undergraduate nursing students’ attitudes towards mental health nursing: Determining the influencing factors

Available evidence clearly demonstrates that undergraduate nursing students typically hold unfavourable attitudes towards psychiatric/mental health nursing as a career. It has been suggested that students’ negative attitudes towards mental illness and consumers of mental health services may be responsible for the unpopularity of this specialty area; however, research exploring the relationship between career choices and students’ attitudes is lacking. A sub-set of data from a large Victorian study that examined undergraduate nursing students’ attitudes towards mental illness, mental health nursing, and mental health clinical placement experiences was used to clarify the nature of this relationship. In total, complete data was available from 605 students undertaking their first mental health placement who provided responses to a 24-item pre-placement survey. This survey assessed the following three areas:1. preparedness for the mental health field;2. attitudes towards mental illness; and3. attitudes towards mental health nursing.The findings demonstrate significant relationships between students’ attitudes, beliefs, and characteristics and desire to pursue a career in psychiatric mental health nursing. The identification of these relationships provides a basis from which interventions to influence nursing students’ attitudes towards psychiatric/mental health nursing, can be planned.

Belongingness: A montage of nursing students’ stories of their clinical placement experiences

The psychological and social sciences literature is replete with assertions that human beings are fundamentally and pervasively motivated by the need to belong. This paper reports on some of the findings from the qualitative phase of a mixed-method, multi-site study that explored nursing students’ experience of belongingness while on clinical placements. Students from Australia and the United Kingdom were interviewed to identify factors that impact upon and are consequences of belongingness. A montage of participants’ stories is used to illustrate some of the key features of clinical workplaces that are conducive to the development of belongingness. Contextual factors and interpersonal dynamics were seen to have a significant bearing on students’ experiences. Clinical leaders/managers who were welcoming, accepting and supportive, and nursing staff who were inclusive and encouraging, facilitated students’ perception of being valued and respected as members of the nursing team. Additionally, the provision of consistent, quality mentorship was identified as important to students’ feelings of connectedness and fit. The experience of belongingness, in turn, enhanced students’ potential for learning and influenced their future career decisions. Alternatively, alienation resulted from unreceptive and unwelcoming clinical environments and from the dissonance created when students’ personal and professional values did not articulate with those evident in practice environments. Consequently, distress, detachment and disengagement occurred and students’ capacity and motivation for learning was negatively impacted.

Pharmacy student views on preceptorship during rural placements

Aims: To identify factors that undergraduate pharmacy students valued most highly in a rural clinical placement experience. Methods: Pharmacy students from four universities were invited to participate in a survey and/or focus group. A 42 item questionnaire was used in which students were asked to rate various aspects of their rural placement on a five point Likert scale. During the focus groups students were invited to explore positive and negative aspects of their rural placement and to make suggestions for future placements. Results: About 108 students responded to the questionnaire and 26 participated in the focus groups. Students rated most highly the role of the preceptor in making their rural placement a success. Two themes emerged from the focus groups which highlighted the relationship between preceptorship and learning. Conclusion: Students valued their placements highly when they were in a supportive learning environment, with an organised structure and adequately supported by the universities.

Perceptions of Nursing Student Clinical Placement Experiences

There is an unprecedented shortage of registered nurses (RNs) in the United States of America. Efforts to educate more RNs have been limited by a shortage of both clinical placements and preceptors for nursing students. The purpose of this study was to examine nursing education issues associated with student clinical placement as experienced by hospital personnel who coordinate the placements with various schools of nursing. A qualitative study involving 15 state-wide participants directly associated with clinical placement of nursing students was conducted. Emergent themes from the data included lack of consistent terminology and definition of student and preceptor roles, preference of clinical scholars, process of site placements, rewards for supervision of students, dis-satisfiers to the supervision of students and suggested strategies for change. Recommendations which developed from the research are summarized and discussed.

Enhancing nursing students’ clinical placement experiences: A quality improvement project

Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students’ clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians’ perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues.Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates’ readiness for practice.Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made.

You have no credibility: Nursing students’ experiences of horizontal violence

Horizontal violence is a significant issue confronting the nursing profession both in Australia and internationally. The term horizontal violence is used to describe bullying and aggression involving inter-group conflict. Some evidence suggests that nursing students commonly experience this during clinical placement(s). Despite the current shortage of nurses and the fact that clinical placement experiences may influence whether students remain in the nursing profession, there has been little research undertaken on this topic. This study used a questionnaire to investigate 152 second and third year nursing student's experiences of horizontal violence (either directly experienced or witnessed). Analysis identified five major themes: humiliation and lack of respect; powerlessness and becoming invisible; hierarchical nature of horizontal violence; coping strategies; and future employment choices. More than half of the sample indicated that they had experienced or witnessed horizontal violence; importantly, most of these (51% of the total sample) also indicated that it would impact on their future career and/or their employment choices. Strategies are discussed that could be implemented to reduce the effect of horizontal violence, including giving a higher priority to debriefing within a supportive university environment, and teaching assertiveness and conflict resolution skills within the Bachelor of Nursing Degree.

CLINICAL PLACEMENTS IN RESIDENTIAL AGED CARE FACILITIES: THE IMPACT ON NURSING STUDENTS’ PERCEPTION OF AGED CARE AND THE EFFECT ON CAREER PLANS

Objectives: Undergraduate nursing students have often found clinical placements in aged care unsatisfactory and/or unsettling, dissuading them from considering aged care as an employment option on graduation. This study asked which elements of the clinical placement experience produced that outcome; and what changes could yield more positive outcomes. Design: A descriptive qualitative pilot study was carried out in late 2003. A combination of nominal groups and semi-structured interviews was used with students and experienced nurses to identify commonalities and variations in issues nominated as important and in the views expressed on those issues. Transcripts were independently analysed by two experienced investigators. Themes identified were discussed among the researchers. Subjects: Fourteen volunteer undergraduate nursing students, all of whom had completed clinical placements in residential care and some of whom had prior experience in such facilities, participated in the nominal groups. Twelve registered nurses who had acted as clinical teachers in aged care facilities were interviewed. Results: Perceived issues included: unexamined assumptions about nursing’s core skills; lack of pre-placement orientation to the residential care environment; the appeal of and apprehension aroused by autonomous practice; and status, income and career progression considerations. Conclusions: Analysis of the sometimes ambivalent and conflicting views expressed pointed to possible changes, all within the domain of training and employing institutions, capable of bringing submerged issues to the surface for examination and resolution as part of raising student understanding of gerontology as a demanding specialty and residential care as a rewarding career.

Belongingness: A critique of the concept and implications for nursing education

Clinical experience is recognised as central to nursing education. Quality clinical placements across a range of venues are vital to the development of competent and confident professionals. However there is evidence, both empirical and anecdotal, suggesting that nursing students' clinical placement experiences are often fraught with problems. These problems are long standing and multi-dimensional. For many students clinical placements are typified by feelings of alienation and a lack of belongingness. This paper proposes that the problematic nature of clinical placements may be better understood through the lens of 'belongingness'. A critical review of selected studies drawn from the psychological and social science literature provides insight and useful direction for a more focused review of the nursing literature. The potential relationships between belongingness, nursing students, and their clinical placement experiences are then exemplified by excerpts taken from the nursing literature (including unpublished material). Finally, an ongoing study that seeks to address the paucity of empirical research in this area is highlighted.

An investigation of job satisfaction, organizational commitment and role conflict and ambiguity in a sample of Chinese undergraduate nursing students

This study aimed to explore the relationships between job satisfaction and organizational commitment, role conflict and ambiguity, and demographic variables associated with retention of nurses within the Chinese healthcare workforce. A hypothetical model derived from a review of research studies investigating relationships between these variables was tested in a cross-sectional questionnaire survey of all the final year nursing students in a medical university in China. Seventy-one out of the total sample of 75 final year nursing students completed the questionnaire, producing a response rate of 95%. Descriptive and inferential statistical analysis of the data revealed a positive relationship between job satisfaction and organizational commitment, and a negative relationship between job satisfaction and role conflict and ambiguity. These results largely support the hypothesised associations between variables found in research studies derived mainly from samples of Western qualified nurses. However, contrary to previous studies, the findings suggest that aspirations to work in a clinical post are associated with high job satisfaction, and degree level student nurses have relatively high job satisfaction. The main implications for nursing education and practice are that educators and clinical mentors should work collaboratively to reduce the gap between theory and practice, specifically to improve the quality of student nurses' clinical experience in China and elsewhere. Positive clinical placement experience is related to high job satisfaction, and so, potentially, to improved retention. Future studies are needed which investigate changes in job satisfaction and other related variables over time, which have student nurse samples that are sufficient to enable the predictive value of these variables on retention in the healthcare workforce to be investigated.

Iranian student nurses’ experiences of clinical placement

Nursing as a practice-based profession requires that student nurses learn how to become professional in the clinical environment. Many studies have addressed student nurses' clinical learning and related problems, but few have explored the whole clinical experience of being a student nurse. To understand and gain deeper insight into Iranian student nurses' lived experience of clinical placement. Five student nurses were interviewed about their clinical experience during clinical placement. The researchers analysed the verbatim transcripts using van Manen's phenomenological methodology, keeping in mind the recommended six research activities. Five themes emerged by which the phenomenon of clinical experience could be illustrated. These themes were: caring-orientated relationships, attractive aspects of clinical experience, finding oneself in the clinical milieu, being supportive to classmates, and actualizing potential. Fourteen subthemes expanded and clarified the meaning of these themes. The attention paid and acknowledgement given to 'caring' and 'knowledge' by the student nurses showed that they are progressing toward their ultimate goal of being professional nurses. The student nurses' awareness of 'what is going on there?' and also support from other significant people facilitates the students' adaptation process and guarantees this progress.

Place(ment) matters: students’ clinical experiences and their preferences for first employers

Although a significant volume of nursing research has focused on students' experiences of clinical placements, to date, none has considered these experiences in the context of workforce recruitment and specifically how they may impact upon preferences for working for health care providers. In this context, the research used a place-sensitive geographical perspective and a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) method to collect data on the complex range of clinical experiences which together impact upon the perceived attractiveness of different health care settings. The data identified a range of experiential factors associated with mentorship, ward management, learning opportunities and racism. An important finding was that although students' experiences are obtained at the micro ward level, even if they may not necessarily reflect what happens throughout the hospital, they potentially impact, both positively and negatively, upon their broader perceptions of the hospital and the likelihood of seeking work there. The study highlighted a variety of issues that should be addressed by both higher education institutions and hospitals so that they may be able to provide a more consistent and positive experience for students. In the longer term, this may pay dividends through increased recruitment of new graduates.

Evaluation of a problem-based curriculum in midwifery

Objective: to evaluate the implementation of a ‘problem-based’ learning (PBL) curriculum within midwifery.Design: a ‘realistic evaluation’ model based on cost-effectiveness models of economics, and incorporating both qualitative and quantitative methodology. The design used historical comparison, comparing students following the new curriculum with a baseline of previous student cohorts and exploring staff and student experiences.Setting: a ‘new’ university, providing a degree-level 18 month pre-registration midwifery programme for an intake of about 40 students per cohort.Participants: all students in the cohort qualifying immediately before the implementation and all those in the first cohort following the new curriculum were invited to participate fully. Assessment outcomes for three cohorts of students qualifying before and the first three cohorts qualifying following the change were analysed. All clinical staff directly involved in mentoring the relevant student groups, all academic staff involved in delivering the new curriculum and the course external examiner were invited to participate.Intervention: the evaluation studied a major change in the way the overall midwifery curriculum was delivered, widely described as PBL.Measurements: students' experiences and perspectives were sought through review of routine evaluation documents, nominal group technique exercises and focus group discussions at about six months following qualification. Clinical staff experiences and perspectives were sought through written structured questionnaires. Academic staff views were sought through personal semi-structured interviews. Participant observation of the process, review of course documents and of staff reflective commentaries were also conducted. Data on student completion rates and final grade were analysed.Findings: although students' views of the curriculum were generally positive, they experienced some discomfort and difficulty in adjustment to a new style of learning. Small group learning, independence and skills in using and conveying information and research evidence were valued aspects of the new approach. Quality of clinical placement experience and university-practice links were an important area of positive experience or concern. Clinical staff views of the curriculum showed considerable stability, with major concerns being the balance of theory and practice time and skills which were not influenced by the curriculum change. At both points, ability to critically evaluate and use evidence in practice was regarded highly. Student outcomes showed some evidence of possible divergence of grades in the new curriculum.Conclusions and implications for practice: the manner and context of implementation of educational change may have important implications for student experiences and outcomes and the experiences of educators. Adequate preparation at all levels for a different, more independent style of learning is important and students are likely to need clear guidance and feedback on their progress in the early stages of the curriculum, to monitor progress and to provide reassurance. Longer-term research is needed to assess the impact of PBL on theory-practice links and on the midwives as practitioners.

Factors influencing student nurses in their choice of a rural clinical placement site

Rural health and government bodies have identified the need for greater numbers of health professionals in rural and remote health care settings. Providing students with the opportunity to experience a rural clinical placement has been suggested as one strategy for future health professionals to gain familiarity with the rural workplace and an awareness of the employment opportunities available in these areas. Although substantial numbers of student nurses have participated in a rural undergraduate clinical placement program at Queensland University of Technology, Australia, since 1996, available places remain unfilled. This study aimed to investigate the factors influencing student nurses in their choice of a rural or metropolitan clinical placement. This study utilised a descriptive survey design. In the 24-item questionnaire, questions related to demographics, previous experience of a rural lifestyle, previous work experience and issues of importance regarding the clinical placement experience. All final-year Bachelor of Nursing students in the year 2000 (n = 212) were included in the sample, with a 65% response rate for the pre-test (n = 137). Frequency distributions, chi2 analysis (for nominal data) and ANOVA (for interval data) were used to describe differences between the characteristics of students choosing a rural or remote placement and students choosing a metropolitan placement. Findings demonstrated that possession of a rural background, previous work experience in a rural community and family, financial and/or employment commitments all influenced students' choice of undertaking a rural clinical placement. Students who have previously lived and/or worked in a rural area are more likely to choose a rural setting for clinical placements or postgraduate employment. However, the value of rural clinical placements as a method of increasing awareness of employment opportunities in the rural setting is considerable. Family, financial and employment commitments should be considered in the development of recruitment and retention strategies for health professionals to rural areas.

Uncovering Knowing in Practice amongst a Group of Undergraduate Student Nurses

This paper discusses the ways of knowing utilised by a group of undergraduate student nurses (n = 8) undertaking a three-year pre-registration Bachelor of Nursing degree in a major university, in Melbourne Australia. The student nurses kept reflective diaries during their clinical placement experiences over an academic semester. The paper highlights the influence the students' clinical experience has not only in their development of their ways of knowing but also to some extent on their reflective ability. The author concludes that all educators and practitioners should be aware of the influences that can impinge upon a student's development of knowing in practice.