Fostering Clinical Judgment During Preceptorship

The role transition from student nurse to new graduate nurse commonly includes a preceptor relationship. Preceptorships are often the culminating nursing education experience for senior baccalaureate nurses and are used as well for orienting new graduates as they begin their staff nurse role in the hospital setting. The preceptee is paired with an experienced nurse who is charged with supporting, teaching, and exemplifying safe and competent patient care. In many cases preceptors are ascribed the task of independently validating the preceptee\u27s ability to exercise clinical judgment. Today\u27s health care environment requires nurses to be proficient critical thinkers. Patients need more complex care delivered in a shortened time frame in a technology-laden environment and with a frequently changing knowledge base. In addition, nursing practice continues to become increasingly autonomous. How do nursing students safely transition from task orientation to safe, competent, and independent practice

Cultural Norms of Clinical Simulation in Undergraduate Nursing Education

Simulated practice of clinical skills has occurred in skills laboratories for generations, and there is strong evidence to support high-fidelity clinical simulation as an effective tool for learning performance-based skills. What are less known are the processes within clinical simulation environments that facilitate the learning of socially bound and integrated components of nursing practice. Our purpose in this study was to ethnographically describe the situated learning within a simulation laboratory for baccalaureate nursing students within the western United States. We gathered and analyzed data from observations of simulation sessions as well as interviews with students and faculty to produce a rich contextualization of the relationships, beliefs, practices, environmental factors, and theoretical underpinnings encoded in cultural norms of the students’ situated practice within simulation. Our findings add to the evidence linking learning in simulation to the development of broad practice-based skills and clinical reasoning for undergraduate nursing students

The lived experience of students in an accelerated nursing program: Intersecting factors that influence experiential learning

The goal of this interpretive research study was to articulate the lived experience of students in an accelerated master’s of nursing entry program learning the practice of nursing within a clinical setting. Specific questions included: How did previous life experiences, education, and career choices influence the experience of second-degree students? What were the potential effects on learning of condensing and accelerating the curriculum as is requisite in second-degree programs? Data from small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Akin to the experience of tourists or new immigrants, students were confronted with new physical demands, new equipment, new time patterns, and most importantly, new ways of relating to people, all within a condensed time frame. What stood out most in these students’ accounts was the ubiquitous context of inpatient nursing care in which lives were at stake

Exploring barriers to organ donation in the African American communities of California

There are a disproportionate number of African-Americans on transplant waiting lists across the country. The outcomes of a transplant are greatly improved when the donor and the recipient are from the same ethnic group. Sadly, the demand for cadaver organs in the African-American community exceeds the supply. Researchers in the past have sought to identify barriers to organ and tissue donation. To date, the studies have been conducted in the eastern and southern regions of the United States. This study examines whether the previously identified barriers are applicable in the African-American communities of California. A revised version of the Bone Marrow Donation Intention Tool was administered both in person and online. A t-test was used for analysis. The findings revealed statistically significant agreement/disagreement statements. These statements indicated that the barriers to organ donation from other areas of the United States were not representative of the respondents on the west coast

Integrating a professional apprenticeship model with clinical simulation for psychiatric nursing students

In this article, we present a theory-based application of clinical simulation in psychiatric-mental health nursing education. As described by Benner, Sutphen, Leonard, and Day, a three-pronged apprenticeship that integrates intellectual, practical, and ethical aspects of the professional role is critical in the development of practical reasoning in nursing education and training. Clinical encounters are often fraught with ambiguity and uncertainty. Therefore, educating for a practice discipline requires experiential and situated learning. Using the three-pronged experiential model in simulated psychiatric-mental health nursing practice supports the development of critical nursing skills, ethics, and theoretical concepts. A clinical scenario is presented that demonstrates the application of this model of professional apprenticeship in psychiatric-mental health education. Applications of the concept presented may be used in training nurses new to the practice of psychiatric-mental health nursing

Learning formative skills of nursing practice in an accelerated program

The purpose of this qualitative research study was to describe how students in an accelerated master’s degree entry program experientially learned the practice of nursing. One research question examined in this study was: What formative experiences did students identify as helping them develop and differentiate their clinical practice? Data from clinical observations and a combination of small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Students identified formative skills learned through the independent care of a patient as pivotal in their identity and agency development. By experiencing the responsibility and action from within the body and from within concrete situations, students developed a new understanding that changed their embodied ways of perceiving and orienting to the situation, as well as their skills and sense of agency

The composite first person narrative: Texture, structure, and meaning in writing phenomenological descriptions

This paper illustrates the use of composite first person narrative interpretive methods, as described by Todres, across a range of phenomena. This methodology introduces texture into the presently understood structures of phenomena and thereby creates new understandings of the phenomenon, bringing about a form of understanding that is relationally alive that contributes to improved caring practices. The method is influenced by the work of Gendlin, Heidegger, van Manen, Gadamer, and Merleau-Ponty. The method's applicability to different research topics is demonstrated through the composite narratives of nursing students learning nursing practice in an accelerated and condensed program, obese female adolescents attempting weight control, chronically ill male parolees, and midlife women experiencing distress during menopause. Within current research, these four phenomena have been predominantly described and understood through quantified articulations that give the reader a structural understanding of the phenomena, but the more embodied or “contextual” human qualities of the phenomena are often not visible. The “what is it like” or the “unsaid” aspects of such human phenomena are not clear to the reader when proxies are used to “account for” a variety of situated conditions. This novel method is employed to re-present narrative data and findings from research through first person accounts that blend the voices of the participants with those of the researcher, emphasizing the connectedness, the “we” among all participants, researchers, and listeners. These re-presentations allow readers to develop more embodied understandings of both the texture and structure of each of the phenomena and illustrate the use of the composite account as a way for researchers to better understand and convey the wholeness of the experience of any phenomenon under inquiry

Formation in an accelerated nursing program: Learning existential skills of nursing practice

AbstractFORMATION IN AN ACCELERATED PROGRAM: TAKING UP EXISTENTIAL SKILLS OF THE PRACTICESusan McNieshIn response to increasing concerns over the national shortage of nurses, schools of nursing, public and private health funding agencies, and health care service organizations have joined forces to offer solutions to the increasing demand for nurses. One solution is to tap into a new population of potential students, those with undergraduate degrees in disciplines other than nursing. There has been little research on accelerated nursing programs and many schools have not yet tailored their curricula to meet the needs of this richly experienced group. The goal of this qualitative research study was to articulate the background understanding of how students in an accelerated master's entry program experientially take up the practice of nursing. Specific aims included: What pivotal formative experiences do students identify as helping them develop and differentiate their clinical practice? How does "the press of the situation" affect the student's performance? How do previous life experiences, education, and career choices influence the experience of second degree students? What potential effects does condensing and accelerating the curriculum have on learning in second degree programs?Data from clinical observations and a combination of small group and individual interviews (N=19) were analyzed using interpretive phenomenological methods. Two lines of inquiry were revealed. The first includes an articulation of the layering of factors that co-constitute to form the background of intensity in an accelerated program. A second line of inquiry articulates the pivotal and formative skills learned through the independent care of a patient. By experiencing the responsibility and action from within the body and from within concrete situations the student is transformed and develops a new understanding that literally changes the individual's embodied ways of perceiving and orienting to the situation, as well as his or her skills and set to act.This research extends the horizon of what can be seen of the background that grounds the taking up of nursing practice in accelerated learning environments. Further research could uncover additional aspects of this rich learning community including relationships among students, with clinical instructors, and with the nurses that facilitate the students' journey