Assessing the benefits and usefulness of Schwartz Centre Rounds in Second-Year Medical Students using Clinical Educator-Facilitated Group Work Session: not just “A Facilitated Moan”!

Background An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. Schwartz rounds (SR) are an effective means to combat emotional stress and increasingly used in UK and USA hospitals. Recent studies show that the SR format may also provide benefits for medical students. This study aimed to investigate whether the guidance of SR in second year medical students provides the same benefits as to healthcare professionals. Methods SR assessment involved 83 second year MBChB students in facilitated groupwork sessions. Topics discussed were “change and resilience” and “duty of candour”. Students completed a Likert Scale questionnaire evaluating outcomes proffered by the Point of Care Foundation in collaboration with the Schwartz Foundation, with freeform feedback. Results There was an 86% completion rate with 25% providing written feedback. Participants were more likely to agree than disagree that SR were beneficial. SR effectiveness in enhancing students’ working relationship awareness and skills was strongly correlated with understanding the purpose of, and engagement with, the SR (P<0.001). Similarly, engagement with the SR was strongly correlated with self-reporting of enhanced patient-centredness (P < 0.001). Freeform feedback could be grouped into five themes that revolved around understanding of the SR and engagement with the process. Many positive comments regarded the SR as a forum not only to “learn experientially” but to so in a “safe environment”. Many negative comments stemmed from students not seeing any benefits of engagement with the SR, in that sharing experiences was “unbeneficial”, “empathy is inherent and not learnt”, or that sharing emotional problems is simply “moaning”. Conclusion SRs are an effective way of fostering empathy and understanding towards patients and colleagues. However, for the students to benefit fully from the SR it is necessary for them to engage and understand the process. Therefore, for the successful implementation of SR into pre-clinical medical education, it is important to help students realise that SR are not merely a “facilitated whinge”

An exploration of how new registered nurses construct their professional identity in hospital settings

This study was based on twenty-one interviews with sixteen nurses who were within one to three years post graduation from nursing school. All nurse participants were working at three hospitals in Upstate New York. This study began with two main questions: How do nurses in the study think about their occupation and their place in it? And what factors do nurses feel influenced the construction of their professional identity? The interviews were conducted using an open-ended, semi-structured format. Many nurses delayed their entry to nursing school related to family and societal pressures in conjunction with lack of appropriate academic preparation and gender expectations. The majority of nurses with a delayed entry had also experienced a lifelong calling to be a nurse. I argue that relationships with significant others and dissatisfaction with unfulfilling life circumstances tipped the balance in favor of entry. All the participants reported on the rigors of nursing school independent of the type of program they attended. The rigors of nursing school were tolerable with the aid of supportive, encouraging faculty. Unfortunately, many nurses reported that faculty was rigid, inflexible, judgmental, and dehumanizing. I argue that faculty subject students to a hazing process similar to one they themselves were subjected in an effort to produce a successful nurse. The data brought forth the need for a challenging but supportive environment in order to be successful in constructing a positive professional nursing identity. The norms of the hierarchical structure of the hospital environment which reinforce passive dependent professional behavior need to be challenged by all who interact within this environment. This challenge encompasses the societal view of the nurse as the handmaiden of the physician one lacking in autonomy and independent decision making ability. The change process surpasses the hospital environment to national policy making level

The impact of the expanded nursing practice on professional identify in Denmark

Purpose: This article explores the concept of professional identity of Danish nurses working in an expanded practice. The case study explores the experiences of a small group of Danish nurses with a new professional category that reaches into a domain that customarily belonged to physicians. The aim of this case study was to explore the impact of &ldquo;nurse consultations,&rdquo; representing an expanded nursing role, of 5 nurses focusing on their perception of autonomy, self-esteem, and confidence. Methods: The case study used semistructured interviews with 5 participants triangulated and validated with participant observations, a focus group interview, and theoretically derived insights. Findings: This study indicates that nurses working within a new expanded professional practice see themselves as still engaged in nursing and not as substitute physicians. The study also suggests that the involved nurses gained a higher sense of autonomy, self-esteem, and confidence in their practice. These elements have a positive impact on their professional identity. Conclusion: The research demonstrates that for the nurses involved in expanded professional practice, the boundaries of professional practice have shifted significantly. The research indicates that an expanded practice generates a new domain within the professional identity of nurses