This systematic review aimed to offer insight and understanding, through synthesis of findings from studies that report on perspectives of student nurses/midwives, clinical instructors, clinical ...nurses/midwives on the challenges faced by student nurses/midwives in the clinical learning environment (CLE).
All primary qualitative research studies published in the English language that reported on the views of student nurses/midwives, clinical instructors and clinical nurses/midwives on the challenges faced by student nurses/midwives in the CLE were included.
The electronic databases of Medline EBSCO (1946-), CINAHL (1970), Embase Ovid (1974-), ScielO, WHOLIS (2002-), ASSIA (1985-), Web of Science (1956-), PsycINFO (1800s-) and Maternal and Infant Care (1970-) were searched in November 2019.
Retrieved papers were reviewed independently by two authors for selection by title, abstract and full text, and two authors agreed for inclusion of the papers. The COREQ criteria checklist was used for assessment of methodological quality of the included studies.
The review included 32 studies published over 22 years between 1997 and 2019 involving 853 nursing/midwifery students, clinical instructors, and clinical nurses/midwives from 14 countries. Three key themes emerged: ‘The support structure’, ‘Personal factors’, and ‘Planning and organisation – influence of extrinsic factors’.
Attitude of clinical staff, instructors, and significant others had a major influence on students' clinical learning. Lack of a sense of belongingness and self-motivation to learn, and perceived fear of doing errors were some of the demotivating factors. Lack of resources to facilitate need-based training, staff shortages, workload and inconsistencies between theory and practice were other key challenges in the CLE. Understanding the challenges faced by students in clinical practice can help overcome the barriers leading to development of competent and confident nurses and midwives.
•A supportive clinical learning environment is the key in facilitating a positive learning experience.•Supportive clinical staff and instructors are strong factors in the learning process.•A sense of belongingness facilitates learning.•Addressing the theory-practice gap is crucial in the learning pathway.
Background
During the pandemic and with the growing shortage of nurses, the problem of how to retain existing nurses was of paramount importance. However, there is limited evidence on the ...relationship between nurses' self-acceptance and intention to stay.
Objectives
This study aimed to investigate the factors influencing nurses' intention to stay at work, and explore the relationship between self-acceptance and their intention to stay.
Methods
Convenience sampling was conducted to select nurses who worked in a clinical environment during June 2020, in hospitals in Shandong Province, China. Self-designed basic information and two questionnaires, namely, the “self-acceptance questionnaire” and “intention to stay” were adopted. Mean, median, related analysis, and regression analysis were adopted to describe the relationship of self-acceptance and intention to stay on part of Chinese nurses.
Results
A total of 1,015 clinical nurses participated in the survey. The mean score of intention to stay among participants was 22.00. The multiple regression analysis revealed various factors, such as age, family support the work, interest in work, job suitability, type of employment, professional level, weekly working hours, working department and self-acceptance influenced the nurse's intention to stay (β range from −1.506 to 2.249).
Conclusion
Our findings identified several factors that are significantly related to and impact the level of intention to stay among clinical nurses.
Little is known about the clinical impact of simulation-based education (SBE) for hospital nurses.
Scoping review methodology was used to examine the impact of nurse SBE programs within six patient ...safety domains.
Twenty-six articles described over 20 education topics. Based on Kirkpatrick's four levels of evaluation, programs prioritized superficial levels of evaluation: Level 1—Reaction, Level 2—Learning. Only seven studies measured Level 3—Behavior change (nurses' performance) or Level 4—Results (impact on patient care).
Nurses' CPD programs should include both short-term evaluations and longitudinal measures to detect practice improvements that may advance patient safety.
•Clinical nurses are required to maintain competency and safe practice.•Continuing professional education and training contribute to nurses' competency.•Simulation-based education has become an education method of choice.•Simulation-based education improves nurses' knowledge/skills (learning).•Nurses' education contributes to clinical care quality and improved patient safety.
Aims
The aim of this study was to develop the advance care planning (ACP) practice preference scale and validate its psychometric properties among clinical nurses.
Design
An instrument development ...and validation study was completed in the following three phases: (a) the generation and revision of the item, (b) the preliminary exploration and evaluation of the item and (c) the psychometric evaluation of the scale.
Methods
A literature review was conducted to develop the indicator system. A total of 360 clinical nurses (for item analysis) and 688 clinical nurses (for psychometric evaluation) were recruited. The exploratory factor analysis and confirmatory factor analysis were conducted to evaluate the construct validity. The reliability was explored by internal consistency and test–retest reliability. The study was conducted from October 2021 to January 2022.
Results
A total of 24 items were finally retained by the item analysis from the initial 78‐item pool. In the exploratory factor analysis, the six‐factor model explained 79.933% of the total variation. After limiting to three factors, 59.305% of the total variation was explained. Above factor models supported by the confirmatory factor analysis were consistent with the theoretically structure, and the fitting indexes were all satisfactory. Also, the findings showed appropriate internal consistency and test–retest reliability.
Conclusions
ACP practice preference scale presents satisfactory psychometric properties among clinical nurses and can be adopted to evaluate the propensity of clinical nurses to practice ACP.
Impact
ACP practice preference scale can be adopted to understand the training needs of clinical nurses on ACP clinical practice.
Patient or Public Contribution
Clinical nurses participated in the pilot testing and validation of ACP practice preference scale.
Speaking up about patient safety concerns is critical when bedside nurses encounter unsafe situations. Training programs that encourage nurses' speaking up behavior have been introduced, but there is ...limited evidence regarding whether such training leads to behavior change or improves patient safety.
The aim of this review was to identify the effectiveness of speak-up training programs for clinical nurses, focusing on program content and outcomes.
A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to the Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines.
This study used bibliographic databases of PubMed, Embase, PsycINFO, Scopus, ProQuest Dissertations and Theses Global for the English language, and NDSL, KCI, RISS, KISS, and DBpia for the Korean language. The literature search used a combination of keywords and subject headings related to speak-up training programs for nurses or any type of nurse training program with an assertiveness component. Training outcomes were evaluated according to the 4-level Kirkpatrick model.
A total of 4808 references were retrieved, of which 21 articles were selected. These 21 studies were conducted in different parts of the world and published from 1981 to 2020. Speak-up training primarily increased some degree of nurses' levels of assertiveness and speak-up behavior, and also led to secondary outcomes such as job stress, work motivation, and communication conflicts. Most studies (n = 19) applied traditional training formats which consisted of multi-session lectures and practice, whereas three studies applied new methodologies such as high-fidelity simulations and online learning. According to the Kirkpatrick model, five studies assessed reactions to speak-up training (level 1), all studies evaluated learning as a result of training (level 2), two studies measured the effect of speak-up training on nurses' behavior (level 3), and one study evaluated nurses' results (level 4) while no studies evaluated patient-level outcomes.
Speak-up training for nurses can improve their levels of assertiveness or speak-up behaviors. Despite inconsistent or mixed findings, speak-up training has the potential to improve nurses' psychological well-being, leading to positive organizational performance. New training methods are directed at specialized education for clinical situations. Future speak-up training should consist of training programs based on real clinical situations in which team members participate together to comprehensively evaluate the effect of training on behavioral changes of health professionals as well as patient safety.
Numerous articles have sought to identify the impact of educational interventions for improving evidence-based practice (EBP) amongst nurses, most of these focus on skills and knowledge acquired. No ...systematic review has explored whether this educational input translates into improved patient outcomes.
To review the evidence on (1) The change in patient outcomes following educational interventions to support practising nurses in implementing EBP. (2) The instruments or methods used to determine whether EBP education improves patient outcomes.
A systematic review following PRISMA guidance was conducted. Literature was comprehensive searched including 6 databases, journal handsearching, citation tracking, and grey literature websites. Studies were included if they reported an EBP educational intervention aimed at practising nurses and contained objective or self-reported measures of patient related outcomes. The quality of the included studies was assessed using a modified Health Care Practice R&D Unit (HCPRDU) tool. Because of the poor homogeneity of the included studies, the data were analysed by narrative synthesis.
Of the 4284 articles identified, 18 were included: 12 pre–post studies, three qualitative studies, and three mixed-methods study designs. The level of quality was modest in the studies. The results of the EBP educational interventions on patient outcomes were assessed using three methods: individual projects to implement an evidence-based approach, qualitative approaches, and a questionnaire survey. The majority of the articles concluded there was a positive change in patient outcomes following an educational intervention to improve EBP; a wide range of context specific outcomes were described.
Educational interventions for clinical nurses to support the implementation of EBP show promise in improving patient outcomes. However, the direct impact of EBP interventions on clinical outcomes is difficult to measure. Further testing and development is needed to improve the quality of studies and evaluation instruments in order to confirm the current findings.
Aims
This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors ...analysis and classification system (HFACS).
Design
A nationwide cross‐sectional survey was conducted.
Methods
Multi‐stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors.
Results
A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs.
Conclusion
The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs.
Relevance to Clinical Practice
Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere.
No Patient or Public Contribution
Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.
The current lack of the number of nurses and high nurse turnover rate leads to major problems for the health-care system in terms of cost, patient care ability, and quality of care. Theoretically, ...burnout may help link emotional labor with turnover intention. The purpose of this study was to investigate the mediating effect of burnout in the association between emotional labor and turnover intention in Korean clinical nurses.
Using data collected from a sample of 606 nurses from six Korean hospitals, we conducted a multiple regression analysis to determine the relationships among clinical nurses' emotional labor, burnout, and turnover intention, looking at burnout as a mediator.
The results fully and partially support the mediating role of burnout in the relationship between the subfactors of emotional labor and turnover intention. In particular, burnout partially mediated the relationship between emotional disharmony and hurt, organizational surveillance and monitoring, and lack of a supportive and protective system in the organization. In addition, we found that burnout has a significant full mediation effect on the relationship between overload and conflicts in customer service and turnover intention. Although the mediating effect of burnout was significantly associated with the demands and regulation of emotions, no significant effects on turnover intention were found.
To reduce nurses' turnover, we recommend developing strategies that target both burnout and emotional labor, given that burnout fully and partially mediated the effects of emotional labor on turnover intention, and emotional labor was directly associated with turnover intention.
Principles of Clinical Pharmacology is a successful survey covering the pharmacologic principles underlying the individualization of patient therapy and contemporary drug development. This essential ...reference continues to focus on the basics of clinical pharmacology for the development, evaluation, and clinical use of pharmaceutical products while also addressing the most recent advances in the field. Written by leading experts in academia, industry, clinical and regulatory settings, the third edition has been thoroughly updated to provide readers with an ideal reference covering the wide range of important topics impacting clinical pharmacology as the discipline plays an increasingly significant role in drug development and regulatory science. The Third Edition has been endorsed by the American Society for Clinical Pharmacology and Therapeutics Includes new chapters on imaging and the pharmacogenetic basis of adverse drug reactions Offers an expanded regulatory section that addresses US and international issues and guidelines Provides extended coverage of earlier chapters on transporters, pharmacogenetics and biomarkers and also illustrates the impact of gender on drug response Presents a broadened discussion of clinical trials from Phase 1 to incorporate Phases II and III.
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