Nyutexaminerade sjuksköterskor yrkessocialisation - Erfarenheter av ett introduktionsprogram

ABSTRACT Through the ”VÅRD 77” amendment and the higher education reform from 1993, nursing education has been changed from vocational to academic. Theoretical aspects of nursing have been emphasised above clinical ones, and since 1993 clinical training has been reduced in such a way that the traditional professional and clinical skills of newly graduated nurses have changed. An increased theoretical focus and decreased clinical training have resulted in sharp criticism from health care institutions against the content of the nursing education programme, specifically regarding the fact that newly graduated nurses fail to meet demands and expectations on the professional skills and competence of a nurse. As a consequence of this criticism, employers offer newly graduated nurses introduction programmes after they have completed their nursing education. This study focuses on the newly graduated nurses´ experience of an introduction programme as they are about to enter the labour market. The aim is to analyse and describe the learning process of newly graduated nurses in professional situations and how they are socialised into the profession and seek meaning in their encounter with that environment. The theoretical framework is symbolic interactionism, used to understand how the newly graduated nurse interacts with other members of the staff as well as the environment in which interaction takes place. The research method is ethnographic, and the empirical material is based upon data from participant observations, interviews and field notes. The result shows that all eight workplaces use the master-apprentice system as a model for supervising newly graduated nurses during the introduction programme. In this model, the novices learn how to imitate and seek knowledge through the experienced nurses. The fact that workplaces are free to choose among supervision models may explain why the traditional model is used in the introduction programme. This model primarily offers the novices an opportunity to practice practical and technical tasks and learn how to act like the master. The result also shows that the novices have theoretical knowledge and know what action to take, but that they may have trouble assessing which part of their knowledge to use, which shows that they do not have the readiness to act or the competence required in the profession. The introduction programme must therefore give newly graduated nurses the opportunity to practice professional skills in different patient situations and allow them to perform tasks independently to a higher degree. Results also show that the staff questions and strongly doubts the professional skills of the novices, which means that they must constantly prove their professional ability in order to attain member status. Through various sanctions and master suppression techniques employed by the staff, the novice is formed into a nurse oriented towards medicine/science. The novices end up as outsiders if they deviate from the norms and expectations associated with the professional role. This explains why several of the novices in this study become outsiders. Novices must therefore adapt in order to avoid becoming outsiders. The result further shows that there is tension between the academic environment of the nursing college and the professional environment. Within nurse education the ideology of nursing and the development of critical thinking have been prominent, but within the profession the emphasis is on good vocational skills. This means that novices end up posited between two cultures, something which can be described as being in a marginal situation. One conclusion that can be drawn from the result of this study is that the introduction programme, as it is structured today, posits an obstacle in the professional development of the novices

A feasibility study of a cognitive behavioral based stress management intervention for nursing students : results, challenges, and implications for research and practice

Background Stress related psychological problems are growing in nursing education and constitute an essential challenge for educators. This makes research about strategies and interventions to meet these problems important. Stress management interventions need to be tested for feasibility and acceptability, before conducting large scale RCTs. The objective of our study was to assess the feasibility and acceptability of a newly developed cognitive behavioral stress management intervention for nursing students. Methods Data were collected using a combination of standardized measurements and newly created questionnaires in combination with qualitative data. Our data included recruitment capability, sample characteristics, intervention acceptability and preliminary evaluation of participant psychological changes. Results Findings suggested that the feasibility of conducting a full-scale evaluation was confirmed for intervention acceptability, data collection procedures, and adherence. However, difficulties relating to recruitment capability and homework were identified. All aspects taken together, the intervention was found feasible and acceptable to nursing students, and thus a potential stress management intervention for the nurse education context. Conclusions Overall, this study provides an insight into the challenges and complexities of developing and evaluating a new brief cognitive behavioral based stress management training intervention in a nurse education setting.Publicerades som manuscript i avhandlingen med titel: Cognitive Behavioral Stress Management Training for Nursing Students </p

Operating theatre nurses' with managerial responsibility : Self-reported clinical competence and need of competence development in perioperative nursing

AIM: The aim of this study was to investigate operating theatre nurses (OTNs) with managerial responsibility, and their self-rated clinical competence and need for competence development in perioperative nursing. DESIGN: A cross-sectional study was applied using a modified version of Professional Nurse Self-Assessment Scale of Clinical Core Competence I. METHOD: Data were collected from 303 OTNs in Sweden, 80 of whom indicated that they had managerial responsibility. Statistics analysis was used to identify the relationships between background variables to compare OTNs with and without managerial responsibility and their need for competence development. RESULTS: OTNs with an academic degree and managerial responsibility self-rated their clinical competence higher compared with OTNs without an academic degree. It also turned out that OTNs with RN education and 1-year advanced nursing in theatre care, and master's 60 credits had a lower need for competence development in cooperation and consultation, professional development and critical thinking

The clinical learning environment during clinical practice in postgraduate district nursing students' education : a cross‐sectional study

Aim To describe and compare the clinical learning environment in community-based home care and primary health care in postgraduate district nursing students' education. Design Cross-sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.CC BY 4.0First published: 05 September 2022Correspondence: Margaretha Larsson, Institution of Health Sciences, University of Skövde, Skövde SE-541 28, Sweden. Email: [email protected] external funding. The respective universities funded their scientists.</p

Self-assessed competence and need for further training among registered nurses in somatic hospital wards in Sweden : a cross-sectional survey

Background Professional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses' self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (&lt;= 0,5 year, &gt; 0,5-5 years, and &gt;= 6 years). Methods A cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out. Results Registered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients' health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant. Conclusions Although the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed

Self-assessed competence and need for further training among registered nurses in somatic hospital wards in Sweden: a cross-sectional survey

Background Professional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses’ self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (≤ 0,5 year, > 0,5–5 years, and ≥ 6 years). Methods A cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out. Results Registered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients’ health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant. Conclusions Although the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed

Self-assessed competence and need for further training among registered nurses in somatic hospital wards in Sweden: a cross-sectional survey

Background Professional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses’ self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (≤ 0,5 year, > 0,5–5 years, and ≥ 6 years). Methods A cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out. Results Registered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients’ health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant. Conclusions Although the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed

Overcoming barriers to reach for a helping hand : Adolescent boys' experience of visiting the public health nurse for mental health problems

Mental health problems among adolescents have become a public health issue in Norway. However, few adolescent boys seek help for their mental health problems. This study focus on adolescent boys' experiences related to visiting the public health nurse for mental health problems. Twelve adolescent boys were interviewed and qualitative content analysis was used to analyse the data. The theme identified from the data was: overcoming barriers to reach for a helping hand. The theme consisted of four categories: the public health nurse must be accessible; breaking the norm is a prerequisite for the adolescent boys to talk about mental health problems; ensuring that confidentiality is respected; and the public health nurse is a trustworthy person who can open up for new perspectives. The adolescent boys experienced barriers to visiting the public health nurse. When they had crossed these barriers, the visit was experienced as positive.Artikeln ingick som manuskript i Granruds doktorsavhandling.</p

Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education

AIMS AND OBJECTIVES: To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education. BACKGROUND: Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference. DESIGN: A cross-sectional study with evaluative design. METHODS: Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included. RESULTS: Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis. CONCLUSIONS: The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation. RELEVANCE TO CLINICAL PRACTICE: It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support

Methods and strategies to promote academic literacies in health professions : a scoping review

BACKGROUND: Universities enroll students from diverse backgrounds every year, with 300 million students expected in higher education by 2025. However, with widening participation, increasing numbers of students enrolling in higher health education and future health professions will be underprepared to meet demands of academic literacies, i.e. ability to read, interpret and critically evaluate academic texts and communicating the understanding verbally or in writing. The aim of this scoping review was to describe and explore methods and strategies to promote development of academic literacies. RESULTS: Thirty-one relevant studies were included and analyzed according to scoping review guidelines. The results showed four strategies: (1) integrating learning activities to develop academic literacies in the regular curriculum, (2) changing the course design with new methods for teaching and learning, (3) establish collaborations amongst academics and librarian faculty, and (4) adding courses or foundation year focusing on development of academic literacies. The results are discussed in light of the United Nations Agenda 2030 Sustainable Development, Goal 4, Quality Education, and widening participation. CONCLUSIONS: Aspects of widening participation and inclusion in higher education have been debated, and increasing numbers of students from diverse backgrounds are expected to enter health studies in higher education. We encourage integration of teaching and learning activities targeting parallel learning of course materials and development of academic literacies, beyond study skills. Embracing epistemic complexity and diversity as well as choosing strategic work with academic literacies may provide a starting point toward realizing sustainable development goals and widening participation