Review question/objective
The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students' experiences of professional patient care encounters in a hospital unit.
More specifically the research questions are:
How do nursing students describe their experiences of professional patient care in a hospital unit?
What kinds of experiences do nursing students have in professional patient care encounters?
Background
A hospital unit is a significant learning environment for nursing students and is essential to the education of a nurse.1 In a hospital unit nursing students engage with patients, who are in need of professional nursing care. Nursing students' descriptions of their experiences of their encounters may assist clinical instructors and the teachers at nursing schools in preparing, supervising and providing feedback to students before and during hospital stays.
The clinical learning component is a part of the formal nursing education process. The learning that occurs in the clinical environment presents challenges that may cause students to experience increased stress and anxiety.2 For example, stress can affect students' clinical performance, presenting a clear risk to their success in clinical periods.3 With advances in health care, clinical settings become progressively more stressful as new procedures and technologies are introduced. From a global perspective, nursing education has changed significantly in the last decade with more emphasis being placed on student learning in the clinical environment.4 The purpose of nursing education is to provide the necessary theoretical knowledge and clinical experience to facilitate and prepare nursing students to progress into the professional role of a nurse.5 Such knowledge is valuable in facilitating students to overcome their fears and fulfil their expectations concerning their future expertise.6
Nursing students' experiences
The attrition rate among nursing students is high. In 2006 an investigation in the UK revealed that 26% of all nursing students dropped out of their education. The cost of attrition is estimated to be [pounds]99 million a year.7 Nursing school can cause varying degrees of stress, which may lead to some students dropping out, especially after encountering patients in a hospital unit where they may experience feelings of powerlessness because of their lack of professional experience and their loss of sense of individuality.8,9 Students have reported feeling inadequately prepared to cope with the strain of professional nursing.9 Williams explored how nursing students' perception of the quality of patient care improved after completing a stress reducing workshop and listening to an instructional deep breathing CD five times a week for six weeks.4 Furthermore, Granskar and colleagues identified in a qualitative study that the nursing students' personal qualities and the patients' behavior affected the students' experiences.10 A previously conducted systematic review indicated that as for all student attrition, there was no single reason related to the clinical setting to explain why students chose to leave. However, being particularly young without work experience, or being male, along with being exposed to unpleasant placement experiences, e.g. the attitudes of clinical staff and lack of support were contributing factors.1 Another systematic review offered insight into the clinical competency assessment for nursing students.11 The review showed that students required support and guidance from academics during the assessment process. According to Higgins,12 mentoring the nursing students in their clinical period reduced dropout rates and provided more satisfied students. Having knowledge of the factors relating to encounters with a patient from the student's perspective may improve the clinical instructor's competences in preparation, targeted guiding and feedback in regards to the professional care encounter.12,13 The findings of a descriptive qualitative study demonstrated the importance of understanding nursing students' experiences and that an awareness of these were beneficial to clinical instructors in understanding the pressure placed on students and the difficulties experienced in the encounter upon patient death for the first time.14
Professional patient care encounters
During their clinical period, nursing students come into contact with patients who are in need of professional nursing care. This can also be described as the professional care encounter, which according to Munoz-Pino, can generate positive and negative emotions.15 Professional care encounters are more than the nursing students' mere presence in a hospital unit and meeting the patients. It also involves situations where the students are confronted with basic principles of nursing care related to the patients' physiological and psychological needs.16 Sharif and Masoumi studied the nursing students' experiences of clinical periods.2 Their findings describe professional encounters as an integral part of generating clinical experience. It prepares nursing students to be "doing" as well as "knowing" the clinical principles in practice. The clinical practice stimulates students to use their critical thinking skills for problem solving. The nurse-patient encounter is of moral significance because the way nursing students meet patients is an indication of the extent of their understanding of patient vulnerability.17 When nursing students demonstrate this understanding, patients may willingly share their thoughts and feelings with the nursing students. Clinical experience seems to be one of the components of nursing education which causes the most anxiety, as identified by nursing students themselves. In an earlier descriptive correlational study by Beck and Srivastava, 94 nursing students reported in a questionnaire that clinical experience was the most stressful part of nursing education.18 Lack of clinical experience, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated were expressed by the nursing students as anxiety-producing aspects of their clinical period.19
To the best of the knowledge of the reviewers, there have been no systematic reviews conducted that have focused on exploring the phenomenon of nursing students' experiences of professional care encounters in a hospital unit as an approach to preparing and guiding nursing students through their clinical period. The rationale for conducting this review is to contribute to the body of knowledge on the characteristics of the nursing students' experiences of professional patient care encounters in a hospital unit. The results of this review may also provide useful insights to assist with the development of educational strategies to prevent attrition. A preliminary search of the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, CINAHL, PubMed, The Cochrane Database of Systematic Reviews and PROSPERO databases revealed that there are no available systematic reviews or protocols on this specific topic.
Inclusion criteria
Types of participants
This review will consider studies that include undergraduate and postgraduate nursing students. The range of participants includes all nursing students independently of the level of their clinical period. There will be no limitations regarding the age, gender or ethnicity of participants.
Types of phenomena of interest
This review will consider studies that investigate nursing students' learning experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients' physiological and psychological needs. Studies that reflect nursing students' comprehension of or attitudes towards nursing interventions in nurse-patient relations, e.g. bed bath, an admission interview, administration of medicine or a meeting with a terminally ill patient, will also be included.
Types of contexts
This review will consider studies that investigate the clinical education in any area within a hospital. Studies that consider acute intensive, chronic long-term, rehabilitation or palliative care hospital settings will be included.
Types of studies
This review will consider studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Qualitative data from qualitative descriptive or mixed methods studies will also be included.
Search strategy
The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of PubMed and CINAHL will be conducted, followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second systematic search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Studies published in English, Swedish, Norwegian and Danish will be considered for inclusion in this review. Databases will be searched from their inception up until June 2015. The literature search will be carried out under the guidance of a research librarian.
The databases to be searched include:
PubMed, CINAHL, ERIC, Turning Research into Practice (TRIP), Academic SearchTM Premier.
The search for unpublished studies will include the following databases and websites:
Mednar, Google Scholar, ProQuest Dissertations and Theses, OpenGrey and clinical education relevant websites such as Nursingtimes.net and Uddannelsesnyt.
Initial keywords to be used will be:
Students, Nursing OR Nursing students OR Student nurse OR Undergraduate nursing students OR postgraduate nursing students
AND
Experience OR Comprehension OR Attitude OR Emotion OR View OR Opinion OR Perception OR Feeling OR Understanding
AND
Patient care OR Basic Nursing Care OR Nurse-Patient Relations OR Patient Care Encounters
AND
Hospital Unit OR Hospital Setting OR Learning Environment OR Clinical setting OR Education, Nursing OR Hospital Ward
Assessment of methodological quality
Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data extraction
Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review question and specific objectives.
Data synthesis
Qualitative research findings will, where possible be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form.
Conflicts of interest
The authors declare that there are no conflicts of interest.
References