Exploring undergraduate nursing students' perceptions of working in aged care settings: a review of the literature

OBJECTIVES: To explore undergraduate nursing students' perceptions of working in the aged care setting through a review of the literature. DESIGN: A review of available literature relating to undergraduate nursing students' attitudes, perceptions and experiences in the aged care setting, or in the care of older adults. DATA SOURCES: CINAHL Plus with Full Text was the primary database used. Other databases include PsycINFO and Health Source: Nursing/Academic Edition. REVIEW METHODS: Studies focused on undergraduate nursing students and their experiences in the aged care setting and on the perceptions and attitudes of nursing students toward older adults, were included. Studies that did not present an original study or those that did not meet the aim of the study were excluded from the review. RESULTS: Following removal of duplicates and exclusion of articles not meeting the aim of this paper, 24 articles remained. Three main themes emerged from the review of the literature: perceptions of aged care placement, attitudes to working in aged care, and experiences in aged care. CONCLUSION: The experiences of nursing students employed as undergraduate AINs in the aged care setting can provide an immersive clinical learning experience in preparation for their new graduate (NG) year. Furthermore, it is an opportunity to challenge ageist attitudes and instil core nursing values in novice nurses such as promoting compassionate care.

Corrigendum to "Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: An Australian multi-centre study" [Nurse Educ. Today 34(5) (May 2014

The authors regret that the original text: The SAGAT instrument has been previously validated (Bell et al., 2006) is incorrect and should read: The SAGAT technique has been demonstrated as valid, sensitive and reliable measure of situation awareness in diverse applications (Endsley, 2000).

Endsley, M. R. (2000) Direct measurement of situation awareness: Validity and use of SAGAT. In Endsley, M.R. & Garland, D.J. (Eds.), Situation awareness analysis and measurement (pp 147–173). New Jersey: Lawrence Erlbaum Associates.

The authors would like to apologise for any inconvenience caused.

An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration

AIM: The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions.

BACKGROUND: Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted.

DESIGN: A descriptive exploratory design.

METHODS: Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed.

RESULTS: Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions.

CONCLUSIONS: Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication.

Undergraduate pre-registration nursing education in Australia: a longitudinal examination of enrolment and completion numbers with a focus on students from rural and remote campus locations

Introduction: There is much evidence to indicate a shortage of Registered Nurses (RNs) in Australia and to suggest that the shortage may be more pronounced in rural and remote locations. Attracting RNs to work in rural and remote areas may not be as simple as increasing the intake of students into university undergraduate pre-registration nursing courses. There is some evidence indicating that student nurses may be more likely to enter the nursing workforce in rural and remote locations if they have existing associations with rural and remote areas and/or their undergraduate education provides opportunities to undertake supported placements in rural and remote settings. Two important difficulties have been associated with measuring outcomes in relation to rural and remote pre-registration nursing students. One is defining what constitutes a rural or remote location and the other is suspect data on the number of nursing students enrolled in, and completing, nursing courses. The aims of this study were to provide a longitudinal profile of the number of domestic students studying and completing undergraduate pre-registration nursing courses in Australia, with a particular emphasis on identifying those at rural and remote university campuses, and to compare results across States and Territories.
Method: This study presents the combined findings from two investigative reports. Data on undergraduate pre-registration nursing student numbers were collected via electronic survey instruments completed by staff at all Australian educational institutions offering undergraduate pre-registration nursing education programs in 2001 and 2002. Australian domestic students were the focus of this study. Data included the total number of domestic students enrolled in undergraduate pre-registration nursing courses in 2001 and 2002, the number of domestic students who successfully completed courses in 1999, 2000 and 2001, and estimates for the number expected to complete in 2002. Surveys were sent to course coordinators or other staff nominated by heads of divisions of nursing at each institution.
Results: There was a 100% response rate. Twenty-four rural and remote campus locations were identified using an adjusted form of the Rural, Remote and Metropolitan Areas (RRMA) classification system. The Australian Capital Territory and the Northern Territory did not have any rural or remote campus locations. In contrast, undergraduate pre-registration nursing in Tasmania was offered at a rural campus only (for the first 2 years). From 2001 to 2002, there was an increase of just over 5% in the total number of domestic students enrolled in undergraduate pre-registration nursing courses in Australia (2002 total = 22 811 students). Rural and remote location students accounted for slightly more than 25% of these students in 2001, and almost 27% in 2002. The States Victoria, New South Wales and Queensland had the highest percentage of students enrolled at rural and remote campus locations, greater than the Australian average for both years. In contrast, South Australia and Western Australia had less than 11% of students enrolled at rural and remote campus locations for each year. Total undergraduate pre-registration course completions increased by approximately 16% across Australia between 1999 (n = 4868) and 2002 (n = 5667), although for 2002, the figure was projected. Of these total course completions, the percentage of students completing at rural and remote campus locations increased from almost 23% to nearly 28% during the same period. Of the States/Territories with both metropolitan and rural/remote campus locations, only Victoria and Queensland had more than 25% of their total student completions consisting of students enrolled at rural and remote campus locations for each year. In contrast, South Australia and Western Australia had approximately 6% of student completions consisting of students enrolled at rural and remote campus locations in 1999, increasing to approximately 12% projected for 2002.
Conclusion: In this study, the authors attempted to improve the accuracy of data collection in relation to the number of domestic undergraduate pre-registration nursing students in Australia, which is representative of the potentially new Australian domestic RN workforce. There was a trend towards an increasing number of students being enrolled in undergraduate pre-registration nursing courses, and also toward an increasing number of course completions. From the perspective of the rural and remote RN workforce, the percentage of students enrolled and completing courses at rural and remote campus locations was found to be increasing. However, there may be some areas of concern for education and workforce planners in States and Territories that are providing a smaller percentage of their undergraduate pre-registration nursing courses in rural and remote areas. Several study limitations are discussed and suggestions made for future research.

Predictors of academic performance of nursing and paramedic students in first year bioscience

The expanding scope of practice of paramedics and nurses demands they possess a sophisticated knowledge of bioscience to enable them to think critically and make rational clinical decisions. It is well documented that nursing students struggle with bioscience but there are no studies examining the performance of paramedic students in this crucial subject. In this study, we compared the academic performance of first year nursing, paramedic and nursing/paramedic double degree students in a bioscience subject. Regression analyses were used to identify predictors of academic success. Data revealed a low success rate in bioscience for all three degree programs (63.2, 58.8, and 67.6% respectively) and a strong correlation between academic success in bioscience and non-bioscience subjects (r(2)=0.49). The best predictors of overall academic success were the University Admission Index score and mature entry into the course. Previous study of biology was associated with an increased bioscience and overall GPA but not with non-bioscience grades. Discriminant analysis was used to develop a model that could predict overall academic success with an accuracy of 78.5%. These criteria may be useful during the admission process and for the early identification of students at risk of failure.

Students perceptions of learning outcomes from group-based, problem-based teaching and learning activities

Objective: A study aimed at exploring the variation in perceptions of learning outcomes reported by undergraduate nursing students enrolled in a problem-based learning subject in a pre-registration Bachelor of Nursing course (BN).
Method: Students were asked to respond to four open-ended questions which focussed on their learning outcomes in the different teaching/learning modalities of the subject. Data were analysed in two phases using a modified phenomenographic analysis. In the first phase a set of categories of description were developed from the student responses to questions related to the learning modalities. In the second phase the individual responses were classified in terms of the categories. Finally, correlations between the learning modalities were identified. In this paper the approach to analysis, the process of category identification and the correlations between the learning modalities will be described and the implications for further research and teaching will be discussed.
Results: The findings indicated that there were two distinct groups of student responses. Inward focussed students who described outcomes in terms of their own learning and students whose focus was outward i.e. describing learning in terms of patient care and how learning relates to that care. Another important result shows the relationship between the learning modalities and outcomes. From the students' perspective, the most sophisticated outcomes of the lectures and laboratories were ideas and skills to be used and applied in clinical settings. Whereas, the group-based activities in which clinical problems were presented to the students in the form of Situation Improvement Packages (SIPS) focussed their attention on the clinical setting which constituted a preparation for the realities of clinical practice.
Conclusion: The findings from this study indicate that students perceive their learning in the group based teaching/learning modality (SIPS) as effective in focussing them on the reality of their role in the clinical practice environment while lectures and laboratories provided the skills and knowledge required for this setting.

Nursing education and graduates in Victoria : profiles for 2000, 2001, and 2002 with projections for 2003

This project is the second of two projects commissioned by the Nurse Policy Branch, Victorian Department of Human Services (VDHS). The project investigated nursing education at the undergraduate and postgraduate levels in the university sector and in the VET sector. The data gathered from the project provided VDHS with a better understanding of nurse labour force issues.

Mapping drug calculation skills in an undergraduate nursing curriculum

The ability to calculate drug dosages correctly is an essential skill for registered nurses to possess. Performing drug calculations accurately is not a skill that new graduates have the luxury of developing over time. Drug errors are in many instances directly related to either the administration of an incorrect dose or incorrect infusion rate (Gladstone, 1995) caused by calculation errors. A strategy for implementing drug calculation skills into our new under graduate nursing curriculum was initiated to assist students in developing proficiency in drug calculations. The aim of this program is to promote the development of calculation skills in undergraduate nursing students, rather than simply assessing their skills.

Dealing with ethical issues in nursing practice

Transitions in Nursing is an important book for undergraduate nurses and recent graduates as they move from student nurse to graduate nurse. As with the 1st edition, this book has been written by a breadth of Australian academics and clinical nurse practitioners. Unique in its Australian foundation and application, this book deals with all the professional issues nursing students need to consider as they prepare to move from university to the workplace of the graduate nurse.

Bioethics : a nursing perspective

The 5th edition of 'Bioethics' provides nursing students with the necessary knowledge and understanding of the ethical issues effecting nursing practice. Groundbreaking in its first edition, Bioethics continues its role as a vital component of nursing education and provides a framework for students to understand the obligations, responsibilities and ethical challenges they will be presented with throughout their careers. This latest edition responds to new and emerging developments in the field and marks a significant turning point in nursing ethics in that it serves not only to inform but also to revitalise and progress debate on the issues presented.

Clinical teachers' conceptions of nursing

Lack of knowledge exists about clinical teachers’ understanding of nursing. A likely relationship between teachers’ conceptions of nursing and what they focus on when teaching nursing students in the clinical setting means that the identification of different conceptions of nursing is important. This study investigated clinical teachers’ experiences of nursing and clinical teaching of undergraduate nursing students. This article reports on clinical teachers’ conceptions of nursing. Semistructured interviews of 20 nurses employed as clinical teachers in Australian universities were conducted. Data were analyzed using a phenomenographic approach. The findings suggest that nursing is conceived as performing tasks; providing appropriate care; providing individualized patient care aimed at achieving patient outcomes; or collaborating with health care team members to provide appropriate, individualized patient care aimed at achieving patient outcomes. Insights will assist with future preparation and support of clinical teachers, the education of nursing students, and improved curriculum design.

Evaluating objective structured clinical assessment (OSCA) in undergraduate nursing

The aims of this mixed methods study were to gain insight into how individual assessors determine an Objective Structured Clinical Assessment (OSCA) result for undergraduate nursing students and identify whether individual assessor perceptions and professional characteristics have an impact on students' results. Results from 25 participants showed that although less than half (44%) of the participants were teaching in the course that they were assessing, the participants were highly experienced clinicians and nearly three-quarters (72%) had completed formal teaching qualifications. There were wide variations in pass rates (16.7–90%) between assessors. The widest disparity was observed between assessors with and those without critical care experience (66% versus 39%), as well as assessors who were teaching the course and those who were not (68% versus 49%). Qualitative analysis revealed three dominant themes within participants' transcripts. The themes focused on determining student safety, and the use of personal perceptions and clinical experience to determine competency. Findings indicate that assessors' individual perceptions and clinical experience have the potential to influence and determine undergraduate nursing students OSCA results. Development of criteria standards and objective assessment may be enhanced by greater involvement of assessors and thorough education and training within the context of student assessments.

Opportunity lost? The major in mental health nursing in Australia

The ongoing difficulty in educating and sustaining an adequate nursing workforce in mental health settings has been identified throughout the world. Different strategies have been implemented internationally to deal with this situation. In Australia major streams in mental health nursing were introduced in some Australian universities to promote mental health nursing as a viable career choice for nursing students. Fourteen universities had implemented or planned to implement a major stream in mental health nursing. From a survey of these programs a lack of consistency in the structure and content of programs was evident. For most programs the intakes had been relatively small, although retention rates appeared promising.

Learning transitions-a descriptive study of nurses' experiences during advanced level nursing education

BACKGROUND: Building capacity in a changing health care system is a challenge for advanced nursing education programs. Master-level nursing education is increasingly becoming the required education level for specialist nurses, and additional studies are needed to learn more about students' experiences and learning transitions while undertaking such education. This study aimed to explore nursing students' experience of their learning transitions while undertaking advanced nursing education and to describe how they translated the new knowledge and competence they gained into clinical practice. METHODS: We used a qualitative research design with narrative self-reported reflections. 34 nurses (95 % women) from both urban and rural areas working with children, with adults in outpatient and inpatient endocrinology clinics in hospitals or with adults, including older people, attending primary health care services participated in the study. We collected data at two time points 15 months apart. Time one was the first week of the advanced nursing education, and time two was the completion of the education program. We used Malterud's modification of Giorgi's phenomenological analysis, otherwise known as systematic text condensation, to analyze the data. RESULTS: Two core themes captured the participants' experiences. The first theme was "assessing the situation of people with diabetes from a different perspective", with the subthemes "an expanded perspective of practice and higher level of reflection", "applying critical thinking in practice" and "changing patient-nurse relationships in diabetes care". The second core theme was "a change in participants' perception of their professional position", with the subthemes "a greater knowledge base enhancing professional confidence" and "a more equal position within the professional team". CONCLUSIONS: The study provides in-depth information about transition into advanced nursing education and can inform curriculum developers, nurse educators, policy-makers and nursing managers about how nursing education broadened participants' perspectives of nursing and enhanced their confidence and professional position.

Exploring the impact of clinical placement models on undergraduate midwifery students

BACKGROUND: Learning undertaken through clinical placements provides up to 50% of the educational experience for students in pre-registration midwifery courses. However little is known about of the impact various models of clinical placement have on the learning experiences of undergraduate midwifery students. Two clinical placement models have been employed for undergraduate midwifery students at Monash University, including the block placement model and the continuous two days per week model. OBJECTIVE: This project sought to explore the learning experiences of students in these two models of placement. METHOD: Focus groups were held on two campuses with a total of 17 students from different cohorts and programs. DISCUSSION: No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model. CONCLUSION: No one type of placement was favoured over another both had benefits and disadvantages. Further, this study found that regardless of program and clinical placement model the major learning impact for students was related to the midwife they worked with each day on placement rather than to the model.