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Nursing, research, and the evidence

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• Anne Mulhall , MSc, PhD
• Independent Training and Research Consultant West Cottage, Hook Hill Lane Woking, Surrey GU22 0PT, UK

https://doi.org/10.1136/ebn.1.1.4

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Why has research-based practice become so important and why is everyone talking about evidence-based health care? But most importantly, how is nursing best placed to maximise the benefits which evidence-based care can bring?

Part of the difficulty is that although nurses perceive research positively, 2 they either cannot access the information, or cannot judge the value of the studies which they find. 3 This journal has evolved as a direct response to the dilemma of practitioners who want to use research, but are thwarted by overwhelming clinical demands, an ever burgeoning research literature, and for many, a lack of skills in critical appraisal. Evidence-Based Nursing should therefore be exceptionally useful, and its target audience of practitioners is a refreshing move in the right direction. The worlds of researchers and practitioners have been separated by seemingly impenetrable barriers for too long. 4

Tiptoeing in the wake of the movement for evidence-based medicine, however, we must ensure that evidence-based nursing attends to what is important for nursing. Part of the difficulty that practitioners face relates to the ambiguity which research, and particularly “scientific” research, has within nursing. Ambiguous, because we need to be clear as to what nursing is, and what nurses do before we can identify the types of evidence needed to improve the effectiveness of patient care. Then we can explore the type of questions which practitioners need answers to and what sort of research might best provide those answers.

What is nursing about?

Increasingly, medicine and nursing are beginning to overlap. There is much talk of interprofessional training and multidisciplinary working, and nurses have been encouraged to adopt as their own some tasks traditionally undertaken by doctors. However, in their operation, practice, and culture, nursing and medicine remain quite different. The oft quoted suggestion is that doctors “cure” or “treat” and that nurses “care”, but this is not upheld by research. In a study of professional boundaries, the management of complex wounds was perceived by nurses as firmly within their domain. 5 Nurses justified their claim to “control” wound treatment by reference to scientific knowledge and practical experience, just as medicine justifies its claim in other areas of treatment. One of the most obvious distinctions between the professions in this study was the contrast between the continual presence of the nurse as opposed to the periodic appearance of the doctor. Lawler raises the same point, and suggests that nurses and patients are “captives” together. 6 Questioning the relevance of scientific knowledge, she argues that nurses and patients are “focused on more immediate concerns and on ways in which experiences can be endured and transcended”. This highlights the particular contribution of nursing, for it is not merely concerned with the body, but is also in an “intimate” and ongoing relationship with the person within the body. Thus nursing becomes concerned with “untidy” things such as emotions and feelings, which traditional natural and social sciences have difficulty accommodating. “It is about the interface between the biological and the social, as people reconcile the lived body with the object body in the experience of illness.” 7

What sort of evidence does nursing need?

These arguments suggest that nursing, through its particular relationship with patients and their sick or well bodies, will rely on many different ways of knowing and many different kinds of knowledge. Lawler's work on how the body is managed by nurses illustrates this. 6 She explains how an understanding of the physiological body is essential, but that this must be complemented by evidence from the social sciences because “we also practice with living, breathing, speaking humans.” Moreover, this must be grounded in experiential knowledge gained from being a nurse, and doing nursing. Knowledge, or evidence, for practice thus comes to us from a variety of disciplines, from particular paradigms or ways of “looking at” the world, and from our own professional and non-professional life experiences.

Picking the research design to fit the question

Scientists believe that the social world, just like the physical world, is orderly and rational, and thus it is possible to determine universal laws which can predict outcome. They propose the idea of an objective reality independent of the researcher, which can be measured quantitatively, and they are concerned with minimising bias. The other major paradigm is interpretism/naturalism which takes another approach, suggesting that a measurable and objective reality separate from the researcher does not exist; the researcher cannot therefore be separated from the “researched”. Thus who we are, what we are, and where we are will affect the sorts of questions we pose, and the way we collect and interpret data. Furthermore, in this paradigm, social life is not thought to be orderly and rational, knowledge of the world is relative and will change with time and place. Interpretism/naturalism is concerned with understanding situations and with studying things as they are. Research approaches in this paradigm try to capture the whole picture, rather than a small part of it.

This way of approaching research is very useful, especially to a discipline concerned with trying to understand the predicaments of patients and their relatives, who find themselves ill, recovering, or facing a lifetime of chronic illness or death. Questions which arise in these areas are less concerned with causation, treatment effectiveness, and economics and more with the meaning which situations have—why has this happened to me? What is my life going to be like from now on? The focus of these questions is on the process, not the outcome. Data about such issues are best obtained by interviews or participant observation. These are aspects of nursing which are less easily measured and quantified. Moreover, some aspects of nursing cannot even be formalised within the written word because they are perceived, or experienced, in an embodied way. For example, how do you record aspects of care such as trust, empathy, or “being there”? Can such aspects be captured within the confines of research as we know it?

Questions of causation, prognosis, and effectiveness are best answered using scientific methods. For example, rates of infection and thrombophlebitis are issues which concern nurses looking after intravenous cannulas. Therefore, nurses might want access to a randomised controlled trial of various ways in which cannula sites are cleansed and dressed to determine if this affects infection rates. Similarly, some very clear economic and organisational questions might be posed by nurses working in day surgery units. Is day surgery cost effective? What are the rates of early readmission to hospital? Other questions could include: what was it like for patients who had day surgery? Did nurses find this was a satisfying way to work? These would be better answered using interpretist approaches which focus on the meaning that different situations have for people. Nurses working with patients with senile dementia might also use this approach for questions such as how to keep these patients safe and yet ensure their right to freedom, or what it is like to live with a relative with senile dementia. Thus different questions require different research designs. No single design has precedence over another, rather the design chosen must fit the particular research question.

Research designs useful to nursing

Nursing presents a vast range of questions which straddle both the major paradigms, and it has therefore embraced an eclectic range of research designs and begun to explore the value of critical approaches and feminist methods in its research. 8 The current nursing literature contains a wide spectrum of research designs exemplified in this issue, ranging from randomised controlled trials, 9 and cohort studies, 10 at the scientific end of the spectrum, through to grounded theory, 11 ethnography, 12 and phenomenology at the interpretist/naturalistic end. 13 Future issues of this journal will explore these designs in depth.

Maximising the potential of evidence-based nursing

Evidence-based care concerns the incorporation of evidence from research, clinical expertise, and patient preferences into decisions about the health care of individual patients. 14 Most professionals seek to ensure that their care is effective, compassionate, and meets the needs of their patients. Therefore sound research evidence which tells us what does and does not work, and with whom and where it works best, is good news. Maximum use must be made of scientific and economic evidence, and the products of initiatives such as the Cochrane Collaboration. However, nurses and consumers of health care clearly need other evidence, arising from questions which cannot be framed in scientific or economic terms. Nursing could spark some insightful debate concerning the nature and contribution of other types of knowledge, such as clinical intuition, which are so important to practitioners. 15

In summary, in embracing evidence-based nursing we must heed these considerations:

Nursing must discard its suspicion of scientific, quantitative evidence, gather the skills to critique it, and design imaginative trials which will assist in improving many aspects of nursing

We must promulgate naturalistic/interpretist studies by indicating their usefulness and confirming/explaining their rigour in investigating the social world of health care

More research is needed into the reality and consequences of adopting evidence-based practice. Can practitioners act on the evidence, or are they being made responsible for activities beyond their control?

It must be emphasised that those concerns which are easily measured or articulated are not the only ones of importance in health care. Space is needed to recognise and explore the knowledge which comes from doing nursing and reflecting on it, to find new channels for speaking of concepts which are not easily accommodated within the discourse of social or natural science—hope, despair, misery, love.

• ↵ Bostrum J, Suter WN. Research utilisation: making the link with practice. J Nurs Staff Dev 1993 ; 9 : 28 –34. OpenUrl PubMed
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• ↵ Walby S, Greenwell J, Mackay L, et al. Medicine and nursing: professions in a changing health service . London: Sage, 1994.
• ↵ Lawler J. The body in nursing . Edinburgh: Churchill Livingstone, 1997.
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• ↵ Street AF. Inside nursing: a critical ethnography of clinical nursing practice . New York: State University Press of New York, 1992.
• ↵ Madge P, McColl J, Paton J. Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled study. Thorax 1997 ; 52 : 223 –8. OpenUrl Abstract
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• ↵ Barroso J. Reconstructing my life: becoming a long-term survivor of AIDS. Qual Health Res 1997 ; 7 : 57 –74. OpenUrl CrossRef Web of Science
• ↵ Thibodeau J, MacRae J. Breast cancer survival: a phenomenological inquiry. Adv Nurs Sci 1997 ; 19 : 65 –74. OpenUrl PubMed
• ↵ Sackett D, Haynes RB. On the need for evidence-based medicine . Evidence-Based Medicine 1995 ; 1 : 5 –6. OpenUrl Abstract / FREE Full Text
• ↵ Gordon DR Tenacious assumptions in Western biomedicine. In: Lock M, Gordon DR , eds . Biomedicine Examined. London: Kluwer Academic Press, 1988;19–56.

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Nursing Research

Nursing research worldwide is committed to rigorous scientific inquiry that provides a significant body of knowledge to advance nursing practice, shape health policy, and impact the health of people in all countries. The vision for nursing research is driven by the profession's mandate to society to optimize the health and well-being of populations (American Nurses Association, 2003; International Council of Nurses, 1999). Nurse researchers bring a holistic perspective to studying individuals, families, and communities involving a biobehavioral, interdisciplinary, and translational approach to science. The priorities for nursing research reflect nursing's commitment to the promotion of health and healthy lifestyles, the advancement of quality and excellence in health care, and the critical importance of basing professional nursing practice on research.

As one of the world leaders in nursing research, it is important to delineate the position of the academic leaders in the U.S. on research advancement and facilitation, as signified by the membership of the American Association of Colleges of Nursing (AACN). In order to enhance the science of the discipline and facilitate nursing research, several factors need to be understood separately and in interaction: the vision and importance of nursing research as a scientific basis for the health of the public; the scope of nursing research; the cultural environment and workforce required for cutting edge and high-impact nursing research; the importance of a research intensive environment for faculty and students; and the challenges and opportunities impacting the research mission of the discipline and profession.

Approved by AACN Membership: October 26, 1998 Revisions Approved by the Membership: March 15, 1999 and March 13, 2006

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Research benefits from nursing insight.

The Johns Hopkins Clinical Research Network’s nursing collaboration brings clinical nurses into the research realm.

How can novice nurses best learn about the difficulties that older LGBTQ adults face in dealing with the health care system?

Suzanne Dutton, a geriatric advanced practice nurse at Sibley Memorial Hospital, decided to screen Gen Silent , a 2010 documentary that follows six LGBTQ seniors who are trying to decide whether to be open about their sexuality while navigating options in long-term care.

Afterward, according to a 2021 study she published in Nurse Education Today , Dutton found a statistically significant increase in knowledge and inclusive attitudes among the 379 nurses who watched the film.

“If we’re not showing these things — that LGBTQ people had to be closeted and that homosexuality was classified as a pathological disease until 1974 — nurses won’t fully understand their health care challenges and emotional hardships,” Dutton says.

Her study was one of several conducted within the Johns Hopkins Clinical Research Network (JHCRN) nursing research collaboration. The network, founded in 2009, connects physician-scientists and staff members from Johns Hopkins Medicine with community health care systems for multisite clinical research. The nursing portion, started in 2014, engages nurses in research that addresses ways to improve working conditions for nurses as well as outcomes for patients.

“Nursing research is looking at ways to overcome barriers in health care, refine education, promote cultural sensitivity and achieve resilience in nursing,” says Melissa Gerstenhaber, the JHCRN research nurse navigator who started the nursing collaboration. “There are plenty of reasons to study nurses themselves because they’re the ones who are really out there in the grind.”

Along with Johns Hopkins hospitals, partners in the network include Luminis Health, TidalHealth, Reading Hospital, George Mason University and WellSpan. The network offers a triple win: The research benefits from a diverse pool of subjects, the partner hospitals benefit by gaining access to cutting-edge treatments and ideas, and patients benefit by receiving those new treatments at their local hospitals.

In addition to engaging in multisite studies, the research collaboration helps nurses stay abreast of emerging nursing and interdisciplinary research; provides peer review on grant proposals, abstracts and publications; serves as a think tank for future research ideas through sharing possible resources, funding options, journals and conferences; and helps mentor clinical nurses and share best practices to engage them in research. So far, about two dozen nurses have taken part in research throughout the network.

Topics of other published studies from the nursing collaboration include how to engage nurses in research, and burnout and resilience in health care workers (see sidebar).

Dutton’s LGBTQ study won the systemwide award for outstanding research project at the 2021 SHINE Conference (the Johns Hopkins Health System Showcase for Hopkins Inquiry and Nursing Excellence).

Gerstenhaber mentions an upcoming study by Rebecca Wright, an assistant professor and director for diversity, equity and inclusion in the school of nursing, who has received a $10,000 grant from the Dorothy Evans Lyne Fund to study how health care professionals can partner with Puerto Rican and Korean American communities to facilitate culturally sensitive decision-making at the end of life. Additionally, a follow-up looking at the role of mid-level managers in research — led by principal investigator Mary Jo Lombardo, clinical education program manager at Howard County General Hospital — should be published soon.

Adrian Dobs , director of the JHCRN and a professor of medicine at the Johns Hopkins University School of Medicine, says the nursing collaboration is an important part of the network. She notes that because nurses are highly involved in caring for patients, they often have more interactions with them than doctors do.

“Nurses see things and hear things that doctors don’t, which affects conditions and diseases,” Dobs says. “Nursing care needs to be studied. We’re excited that we have this opportunity of working with groups of nurses at many medical institutions.”

Nurses interested in learning more can contact Melissa Gerstenhaber at [email protected] .

Related Reading

Alliance expands research potential.

The Johns Hopkins Clinical Research Network connects investigators to patients in other hospitals.

Making Their Voices Heard

Revised nursing governance structure helps bedside nurses at The Johns Hopkins Hospital brainstorm about problems and possible solutions.

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Research Priorities in Nursing Education

The NLN Research Priorities in Nursing Education 2024-2027 continue to support nurse researchers who undertake research that contributes to the science of nursing education. The 2024-2027 priorities create a roadmap that connects the science of nursing education with the science of learning to develop an evidentiary base to guide educators in the preparation of nurses whose practice promotes and maintains wellness and care throughout the lifespan.

The 2024-2027 research priorities include:

• Build the science of nursing education through the generation and translation of innovative teaching and learning strategies
• Build a diverse nurse faculty capacity and enhance teaching practice
• Create teaching and learning environments that enhance the diversity, equity, and inclusivity for student learning and progression across all academic programs

The ultimate goal of these research endeavors is to develop the science of nursing education that will be used to prepare practitioners who deliver excellent health care. To accomplish this goal, robust research methodologies are needed that focus on the generation and translation of evidence in the areas of innovative teaching and learning strategies, faculty workforce capacity and teaching practice, and student academic progression and success.

NLN Research Priorities in Nursing Education 2024 - 2027

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Preparedness for a first clinical placement in nursing: a descriptive qualitative study

• Philippa H. M. Marriott 1 ,
• Jennifer M. Weller-Newton 2   nAff3 &
• Katharine J. Reid 4  

BMC Nursing volume  23 , Article number:  345 ( 2024 ) Cite this article

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A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students’ perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students’ emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience.

The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews ( n  = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically.

Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants’ feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students’ expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers.

Conclusions

This unique study of first-year postgraduate entry-to-practice nursing students’ perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students’ narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

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First clinical placements enable nursing students to develop their professional identity through initial socialisation, and where successful, first clinical placement experiences can motivate nursing students to persist with their studies [ 1 , 2 , 3 , 4 ]. Where the transition from the tertiary environment to learning in the healthcare workplace is turbulent, it may impact nursing students’ learning, their confidence and potentially increase attrition rates from educational programs [ 2 , 5 , 6 ]. Attrition from preregistration nursing courses is a global concern, with the COVID-19 pandemic further straining the nursing workforce; thus, the supply of nursing professionals is unlikely to meet demand [ 7 ]. The COVID-19 pandemic has also impacted nursing education, with student nurses augmenting the diminishing nursing workforce [ 7 , 8 ].

The first clinical placement often triggers immense anxiety and fear for nursing students [ 9 , 10 ]. Research suggests that among nursing students, anxiety arises from perceived knowledge deficiencies, role ambiguity, the working environment, caring for ‘real’ people, potentially causing harm, exposure to nudity and death, and ‘not fitting in’ [ 2 , 3 , 11 ]. These stressors are reported internationally and often relate to inadequate preparation for entering the clinical environment [ 2 , 10 , 12 ]. Previous research suggests that high anxiety before the first clinical placement can be related to factors likely to affect patient outcomes, such as self-confidence and efficacy [ 13 ]. High anxiety during clinical placement may impair students’ capacity to learn, thus compromising the value of the clinical environment for learning [ 10 ].

The first clinical placement often occurs soon after commencing nursing training and can challenge students’ beliefs, philosophies, and preconceived ideas about nursing. An experience of cultural or ‘reality’ shock often arises when entering the healthcare setting, creating dissonance between reality and expectations [ 6 , 14 ]. These experiences may be exacerbated by tertiary education providers teaching of ‘ideal’ clinical practice [ 2 , 6 ]. The perceived distance between theoretical knowledge and what is expected in a healthcare placement, as opposed to what occurs on clinical placement, has been well documented as the theory-practice gap or an experience of cognitive dissonance [ 2 , 3 ].

Given the pivotal role of the first clinical placement in nursing students’ trajectories to nursing practice, it is important to understand students’ experiences and to explore how the placement experience shapes initial perceptions. Existing research focusses almost entirely either on describing nursing students’ projected emotions and perceptions prior to undertaking a first clinical placement [ 3 ] or examines student perceptions of reflecting on a completed first placement [ 15 ]. We wished to examine consistency and change in student perception of their first clinical placement by tracking their experiences longitudinally. We focused on a first clinical placement undertaken in a Master of Nursing Science. This two-year postgraduate qualification provides entry-to-practice nursing training for students who have completed any undergraduate qualification. The first clinical placement component of the course aimed to orient students to the clinical environment, support students to acquire skills and develop their clinical reasoning through experiential learning with experienced nursing mentors.

This paper makes a significant contribution to understanding how nursing students’ perceptions might develop over time because of their clinical placement experiences. Our research addresses a further gap in the existing literature, by focusing on students completing an accelerated postgraduate two-year entry-to-practice degree open to students with any prior undergraduate degree. Thus, the current research aimed to understand nursing students’ emotional responses and expectations and their perceptions of preparedness before attending their first clinical placement and to contrast these initial perceptions with their end-of-placement perspectives.

Study design

A descriptive qualitative study was undertaken, utilising a pre- and post-design for data collection. Focus groups with first-year postgraduate entry-to-practice nursing students were conducted before the first clinical placement, with individual semi-structured interviews undertaken during the first clinical placement.

Setting and participants

All first-year students enrolled in the two-year Master of Nursing Science program ( n  = 190) at a tertiary institution in Melbourne, Australia, were eligible to participate. There were no exclusion criteria. At the time of this study, students were enrolled in a semester-long subject focused on nursing assessment and care. They studied the theoretical underpinnings of nursing and science, theoretical and practical nursing clinical skills and Indigenous health over the first six weeks of the course. Students completed a preclinical assessment as a hurdle before commencing a three-week clinical placement in a hospital setting, a subacute or acute environment. Overall, the clinical placement aimed to provide opportunities for experiential learning, skill acquisition, development of clinical reasoning skills and professional socialisation [ 16 , 17 ].

In total, sixteen students participated voluntarily in a focus group of between 60 and 90 min duration; ten of these students also participated in individual interviews of between 30 and 60 min duration, a number sufficient to reach data saturation. Table  1 shows the questions used in the focus groups conducted before clinical placement commenced and the questions for the semi-structured interview questions conducted during clinical placement. Study participants’ undergraduate qualifications included bachelor’s degrees in science, arts and business. A small number of participants had previous healthcare experience (e.g. as healthcare assistants). The participants attended clinical placement in the Melbourne metropolitan, Victorian regional and rural hospital locations.

Data collection

The study comprised two phases. The first phase comprised six focus groups prior to the first clinical placement, and the second phase comprised ten individual semi-structured interviews towards the end of the first clinical placement. Focus groups (with a maximum of four participants) and individual interviews were conducted by the lead author online via Zoom and were audio-recorded. Capping group size to a relatively small number considered diversity of perceptions and opportunities for participants to share their insights and to confirm or contradict their peers, particularly in the online environment [ 18 , 19 ].

Focus groups and interview questions were developed with reference to relevant literature, piloted with volunteer final-year nursing students, and then verified with the coauthors. All focus groups and interviewees received the same structured questions (Table  1 ) to ensure consistency and to facilitate comparison across the placement experience in the development of themes. Selective probing of interviewees’ responses for clarification to gain in-depth responses was undertaken. Nonverbal cues, impressions, or observations were noted.

The lead author was a registered nurse who had a clinical teaching role within the nursing department and was responsible for coordinating clinical placement experiences. To ensure rigour during the data collection process, the lead author maintained a reflective account, exploring her experiences of the discussions, reflecting on her interactions with participants as a researcher and as a clinical educator, and identifying areas for improvement (for instance allowing participants to tell their stories with fewer prompts). These reflections in conjunction with regular discussion with the other authors throughout the data collection period, aided in identifying any researcher biases, feelings and thoughts that possibly influenced the research [ 20 ].

To maintain rigour during the data analysis phase, we adhered to a systematic process involving input from all authors to code the data and to identify, refine and describe the themes and subthemes reported in this work. This comprehensive analytic process, reported in detail in the following section, was designed to ensure that the findings arising from this research were derived from a rigorous approach to analysing the data.

Data analysis

Focus groups and interviews were transcribed using the online transcription service Otter ( https://otter.ai/ ) and then checked and anonymised by the first author. Preliminary data analysis was carried out simultaneously by the first author using thematic content analysis proposed by Braun and Clarke [ 21 ] using NVivo 12 software [ 22 ]. All three authors undertook a detailed reading of the first three transcripts from both the focus groups and interviews and independently identified major themes. This preliminary coding was used as the basis of a discussion session to identify common themes between authors, to clarify sources of disagreement and to establish guidelines for further coding. Subsequent coding of the complete data set by the lead author identified a total of 533 descriptive codes; no descriptive code was duplicated across the themes. Initially, the descriptive codes were grouped into major themes identified from the literature, but with further analysis, themes emerged that were unique to the current study.

The research team met frequently during data analysis to discuss the initial descriptive codes, to confirm the major themes and subthemes, to revise themes on which there was disagreement and to identify any additional themes. Samples of quotes were reviewed by the second and third authors to decide whether these quotes were representative of the identified themes. The process occurred iteratively to refine the thematic categories, to discuss the definitions of each theme and to identify exemplar quotes.

Ethical considerations

The lead author was a clinical teacher and the clinical placement coordinator in the nursing department at the time of the study. Potential risks of perceived coercion and power imbalances were identified because of the lead author’s dual roles as an academic and as a researcher. To manage these potential risks, an academic staff member who was not part of the research study informed students about the study during a face-to-face lecture and ensured that all participants received a plain language statement identifying the lead author’s role and how perceived conflicts of interest would be managed. These included the lead author not undertaking any teaching or assessment role for the duration of the study and ensuring that placement allocations were completed prior to undertaking recruitment for the study. All students who participated in the study provided informed written consent. No financial or other incentives were offered. Approval to conduct the study was granted by the University of Melbourne Human Research Ethics Committee (Ethics ID 1955997.1).

Three main themes emerged describing students’ feelings and perceptions of their first clinical placement. In presenting the findings, before or during has been assigned to participants’ quotes to clarify the timing of students’ perspectives related to the clinical placement.

Major theme 1: Adjusting and managing a raft of feelings

The first theme encompassed the many positive and negative feelings about work-integrated learning expressed by participants before and during their clinical placement. Positive feelings before clinical placement were expressed by participants who were comfortable with the unknown and cautiously optimistic.

I am ready to just go with the flow, roll with the punches (Participant [P]1 before).

Overwhelmingly, however, the majority of feelings and thoughts anticipating the first clinical placement were negatively oriented. Students who expressed feelings of fear, anxiety, lack of knowledge, lack of preparedness, uncertainty about nursing as a career, or strong concerns about being a burden were all classified as conveying negative feelings. These negative feelings were categorised into four subthemes.

Subtheme 1.1 I don’t have enough knowledge

All participants expressed some concerns and anxiety before their first clinical placement. These encompassed concerns about knowledge inadequacy and were linked to a perception of under preparedness. Participants’ fears related to harming patients, responsibility for managing ‘real’ people, medication administration, and incomplete understanding of the language and communication skills within a healthcare setting. Anxiety for many participants merged with the logistics and management of their life during the clinical placement.

I’m scared that they will assume that I have more knowledge than I do (P3 before). I feel quite similar with P10, especially when she said fear of unknown and fear that she might do something wrong (P9 before).

Subtheme 1.2 Worry about judgment, being seen through that lens

Participants voiced concerns that they would be judged negatively by patients or healthcare staff because they perceived that the student nurse belonged to specific social groups related to their cultural background, ethnicity or gender. Affiliation with these groups contributed to students’ sense of self or identity, with students often describing such groups as a community. Before the clinical placement, participants worried that such judgements would impact the support they received on placement and their ability to deliver patient care.

Some older patients might prefer to have nurses from their own background, their own ethnicity, how they would react to me, or if racism is involved (P10 before). I just don’t want to reinforce like, whatever negative perceptions people might have of that community (P16 before).

Participants’ concerns prior to the first clinical placement about judgement or poor treatment because of patients’ preconceived ideas about specific ethnic groups did not eventuate.

I mean, it didn’t really feel like very much of a thing once I was actually there. It is one of those things you stress about, and it does not really amount to anything (P16 during).

Some students’ placement experiences revealed the positive benefits of their cultural background to enhancing patient care. One student affirmed that the placement experience reinforced their commitment to nursing and that this was related to their ability to communicate with patients whose first language was not English.

Yeah, definitely. Like, I can speak a few dialects. You know, I can actually see a difference with a lot of the non-English speaking background people. As soon as you, as soon as they’re aware that you’re trying and you’re trying to speak your language, they, they just open up. Yeah, yes. And it improves the care (P10 during).

However, a perceived lack of judgement was sometimes attributed to wearing the full personal protective equipment required during the COVID-19 pandemic, which meant that their personal features were largely obscured. For this reason, it was more difficult for patients to make assumptions or attributions about students’ ethnic or gender identity based on their appearance.

People tend to assume and call us all girls, which was irritating. It was mostly just because all of us were so covered up, no one could see anyone’s faces (P16 during).

Subtheme 1.3 Is nursing really for me?

Prior to their first clinical placement experience, many participants expressed ambivalence about a nursing career and anticipated that undertaking clinical placement could determine their suitability for the profession. Once exposed to clinical placement, the majority of students were completely committed to their chosen profession, with a minority remaining ambivalent or, in rare cases, choosing to leave the course. Not yet achieving full commitment to a nursing career was related to not wishing to work in the ward they had for their clinical placement, while remaining open to trying different specialities.

I didn’t have an actual idea of what I wanted to do after arts, this wasn’t something that I was aiming towards specifically (P14 before). I think I’m still not 100%, but enough to go on, that I’m happy to continue the course as best as I can (P11 during).

Subtheme 1.4 Being a burden

Before clinical placement, participants had concerns about being burdensome and how this would affect their clinical placement experiences.

If we end up being a burden to them, an extra responsibility for them on top of their day, then we might not be treated as well (P10 before).

A sense of burden remained a theme during the clinical placement for participants for the first five to seven days, after which most participants acknowledged that their role became more active. As students contributed more productively to their placement, their feelings of being a burden reduced.

Major theme 2: Sinking or swimming

The second major theme, sinking or swimming, described participants’ expectations about a successful placement experience and identified themes related to students’ successes (‘swimming’) or difficulties (‘sinking’) during their placement experience. Prior to clinical placement, without a realistic preview of what the experience might entail, participants were uncertain of their role, hoped for ‘nice’ supervising nurses and anticipated an observational role that would keep them afloat.

I will focus on what I want to learn and see if that coincides with what is expected, I guess (P15 before).

During the clinical placement, the reality was very different, with a sense of sinking. Participants discovered, some with shock, that they were expected to participate actively in the healthcare team.

I got the sense that they were not going to muck around, and, you know, they’re ‘gonna’ use the free labour that came with me (P1 during).

Adding to the confusion about the expected placement experience, participants believed that healthcare staff were unclear about students’ scope of practice for a postgraduate entry-to-practice degree, creating misalignment between students’ and supervising nurses’ expectations.

It seems to me like the educators don’t really seem to have a clear picture of what the scope is, and what is actually required or expected of us (P10 during).

In exploring perceived expectations of the clinical placement and the modifying effect of placement on initial expectations, three subthemes were identified: translation to practice is overwhelming, trying to find the rhythm or jigsaw pieces, and individual agency.

Subtheme 2.1 Translation to practice is overwhelming

Before clinical placement, participants described concerns about insufficient knowledge to enable them to engage effectively with the placement experience.

If I am doing an assessment understanding what are those indications and why I would be doing it or not doing it at a certain time (P1 before).

Integrating and applying theoretical content while navigating an unfamiliar clinical environment created a significant gap between theory and practice during clinical placement. As the clinical placement experience proceeded and initial fears dissipated, students became more aware of applying their theoretical knowledge in the clinical context.

We’re learning all this theory and clinical stuff, but then we don’t really have a realistic idea of what it’s like until we’re kind of thrown into it for three weeks (P10 during).

Subtheme 2.2 Trying to find the rhythm or the jigsaw pieces

Before clinical placement, participants described learning theory and clinical skills with contextual unfamiliarity. They had the jigsaw pieces but did not know how to assemble it; they had the music but did not know the final song. When discussing their expectations about clinical placement, the small number of participants with a healthcare background (e.g. as healthcare assistants) proposed realistic answers, whereas others struggled to answer or cited stories from friends or television. With a lack of context, feelings of unpreparedness were exacerbated. Once in the clinical environment, participants further emphasised that they could not identify what they needed to know to successfully prepare for clinical placement.

It was never really pieced together. We’ve learned bits and pieces, and then we’re putting it together ourselves (P8 during). On this course I feel it was this is how you do it, but I did not know how it was supposed to be played, I did not know the rhythm (P4 during).

Subtheme 2.3 Individual agency

Participants’ individual agency, their attitude, self-efficacy, and self-motivation affected their clinical placement experiences. Participant perceptions in advance of the clinical placement experience remained consistent with their perspectives following clinical placement. Before clinical placement, participants who were highly motivated to learn exhibited a growth mindset [ 23 ] and planned to be proactive in delivering patient care. During their clinical placement, initially positive students remained positive and optimistic about their future. Participants who believed that their first clinical placement role would be largely observational and were less proactive about applying their knowledge and skills identified boredom and a lack of learning opportunities on clinical placement.

A shadowing position, we don’t have enough skills and authority to do any work, not do any worthwhile skills (P3 before). I thought it would be a lot busier, because we’re limited with our scope, so there’s not much we can do, it’s just a bit slower than I thought (P12 during).

Individual agency appears to influence a successful first clinical placement; other factors may also be implicated but were not the focus of this study. Further research exploring the relationships between students’ age, life experience, resilience, individual agency, and the use of coping strategies during a first clinical placement would be useful.

Major theme 3: The reality of navigating placement relationships

The third main theme emphasised the reality of navigating clinical placement relationships and explored students’ relationships with healthcare staff, patients, and peers. Before clinical placement, many participants, especially those with healthcare backgrounds, expressed fears about relationships with supervising nurses. They perceived that the dynamics of the team and the healthcare workplace might influence the support they received. Several participants were nervous about attending placement on their own without peers for support, especially if the experience was challenging. Participants identified expectations of being mistreated, believing that it was unavoidable, and prepared themselves to not take it personally.

For me it’s where we’re going to land, are we going to be in a supportive, kind of nurturing environment, or is it just kind of sink or swim? (P5 before). If you don’t really trust them, you’re nervous the entire time and you’ll be like what if I get it wrong (P16 before).

Despite these concerns, students strongly emphasised the value of relationships during their first clinical placement, with these perceptions unchanged by their clinical placement experience. Where relationships were positive, participants felt empowered to be autonomous, and their self-confidence increased.

You get that that instant reaction from the patients. And that makes you feel more confident. So that really got me through the first week (P14 during). I felt like I was intruding, then as I started to build a bit of rapport with the people, and they saw that I was around, I don’t feel that as much now (P1 during).

Such development hinged on the receptiveness and support of supervising nurses, the team on the ward, and patients and could be hindered by poor relationships.

He was the old-style buddy nurse in his fifties, every time I questioned him, he would go ssshh, just listen, no questions, it was very stressful (P10 during). It depends whether the buddy sees us as an extra pair of hands, or we’re learners (P11 during).

Where students experienced poor behaviour from supervising nurses, they described a range of emotional responses to these interactions and also coping strategies including avoiding unfriendly staff and actively seeking out those who were more inclusive.

If they weren’t very nice, it wouldn’t be very enjoyable and if they didn’t trust you, then it would be a bit frustrating, that like I can do this, but you won’t let me (P12 during). If another nurse was not nice to me, and I was their buddy, I would literally just not buddy with them and go and follow whoever was nice to me (P4 during).

Relationships with peers were equally important; students on clinical placement with peers valued the shared experience. In contrast, students who attended clinical placement alone at a regional or rural hospital felt disconnected from the opportunities that learning with peers afforded.

Our research explored the emotional responses and perceptions of preparedness of postgraduate entry-to-practice nursing students prior to and during their first clinical placement. In this study, we described how the perceptions of nursing students remained consistent or were modified by their clinical placement experiences. Our analysis of students’ experiences identified three major themes: adjusting and managing a raft of feelings; sinking or swimming; and the reality of navigating placement relationships. We captured similar themes identified in the literature; however, our study also identified novel aspects of nursing students’ experiences of their first clinical placement.

The key theme, adjusting and managing a raft of feelings, which encapsulates anxiety before clinical placement, is consistent with previous research. This theme included concerns in communicating with healthcare staff and managing registered nurses’ negative attitudes and expectations, in addition to an academic workload [ 11 , 24 ]. Concerns not previously identified in the literature included a fear of judgement or discrimination by healthcare staff or patients that might impact the reputation of marginalised communities. Fortunately, these initial fears largely dissipated during clinical placement. Some students discovered that a diverse cultural background was an asset during their clinical placement. Although these initial fears were ameliorated by clinical placement experiences, evidence of such fears before clinical placement is concerning. Further research to identify appropriate support for nursing students from culturally diverse or marginalised communities is warranted. For example, a Finnish study highlighted the importance of mentoring culturally diverse students, creating a pedagogical atmosphere during clinical placement and integrating cultural diversity into nursing education [ 25 ].

Preclinical expectations of being mistreated can be viewed as an unavoidable phenomenon for nursing students [ 26 ]. The existing literature highlights power imbalances and hierarchical differences within the healthcare system, where student nurses may be marginalised, disrespected, and ignored [ 9 , 27 , 28 ]. During their clinical placement, students in our study reported unintentional incivility by supervising nurses: feeling not wanted, ignored, or asked to remain quiet by supervising nurses who were unfriendly or highly critical. These findings were similar to those of Thomas et al.’s [ 29 ] UK study and were particularly heightened at the beginning of clinical placement. Several students acknowledged that nursing staff fatigue from a high turnover of students on their ward and the COVID-19 pandemic could be contributing factors. In response to such incivility, students reported decreased self-confidence and described becoming quiet and withdrawing from active participation with their patients. Students oriented their behaviour towards repetitive low-level tasks, aiming to please and help their supervising nurse, to the detriment of learning opportunities. Fortunately, these incidents did not appear to impact nursing students’ overall experience of clinical placement. Indeed, students found positive experiences with different supervising nurses and their own self-reflection assisted with coping. Other active strategies to combat incivility identified in the current study that were also identified by Thomas et al. [ 29 ] included avoiding nurses who were uncivil, asking to work with nurses who were ‘nice’ to them, and seeking out support from other staff as a coping strategy. The nursing students in our study were undertaking a postgraduate entry-to-practice qualification and already had an undergraduate degree. The likely greater levels of experience and maturity of this cohort may influence their resilience when working with unsupportive supervising nurses and identifying strategies to manage challenging situations.

The theory-practice gap emerged in the theme of sinking or swimming. A theory-practice gap describes the perceived dissonance between theoretical knowledge and expectations for the first clinical placement, as opposed to the reality of the experience, and has been reported in previous studies (see, for instance, 24 , 30 , 31 , 32 ). Existing research has shown that when the first clinical placement does not meet inexperienced student nurses’ expectations, a disconnect between theory and practice occurs, creating feelings of being lost and insecure within the new environment, potentially impacting students’ motivation and risk of attrition [ 19 , 33 ]. The current study identified further areas exacerbating the theory-practice gap. Before the clinical placement, students without a healthcare background lacked context for their learning. They lacked understanding of nurses’ shift work and were apprehensive about applying clinical skills learned in the classroom. Hence, some students were uncertain if they were prepared for their first clinical placement or even how to prepare, which increased their anxiety. Prior research has demonstrated that applying theoretical knowledge more seamlessly during clinical placement was supported when students knew what to expect [ 6 ]. For instance, a Canadian study exposed students as observers to the healthcare setting before starting clinical placement, enabling early theory to practice connections that minimised misconceptions and false assumptions during clinical placement [ 34 ].

In the current study, the theory-practice gap was further exacerbated during clinical placement, where healthcare staff were confused about students’ scope of practice and the course learning objectives and expectations in a postgraduate entry-to-practice nursing qualification. The central booking system for clinical placements classifies first-year nursing students who participated in this study as equivalent to second-year undergraduate nursing students. Such a classification could create a misalignment between clinical educators’ expectations and their delivery of education versus students’ actual learning needs and capacity [ 3 , 31 ]. Additional communication to healthcare partners is warranted to enhance understanding of the scope of practice and expectations of a first-year postgraduate entry-to-practice nursing student. Educating and empowering students to communicate their learning needs within their scope of practice is also required.

Our research identified a link between students’ personality traits or individual agency and their first clinical placement experience. The importance of a positive orientation towards learning and the nursing profession in preparedness for clinical placement has been highlighted in previous studies [ 31 ]. Students’ experience of their first clinical placement in our study appeared to be strongly influenced by their mindset [ 23 ]. Some students demonstrated motivation to learn, were happy to ‘roll with the punches’, yet remain active in their learning requirements, whereas others perceived their role as observational and expected supervising nurses to provide learning opportunities. Students who anticipated a passive learning approach prior to their first clinical placement reported boredom, limited activity, and lack of opportunities during their first clinical placement. These students could have a lowered sense of self-efficacy, which may lead to a greater risk of doubt, stress, and reduced commitment to the profession [ 35 ]. Self-efficacy theory explores self-perceived confidence and competence around people’s beliefs in their ability to influence events, which is associated with motivation and is key to nursing students progressing in their career path confidently [ 35 , 36 ]. In the current study, students who actively engaged in their learning process used strategies such as self-reflection and sought support from clinical educators, peers and family. Such active approaches to learning appeared to increase their resilience and motivation to learn as they progressed in their first clinical placement.

Important relationships with supervising nurses, peers, or patients were highlighted in the theme of the reality of navigating placement relationships. This theme links with previous research findings about belongingness. Belongingness is a fundamental human need and impacts students’ behaviour, emotions, cognitive processes, overall well-being, and socialisation into the profession [ 37 , 38 ]. Nursing students who experience belongingness feel part of a team and are more likely to report positive experiences. Several students in the current study described how feeling part of a team improved self-confidence and empowered work-integrated learning. Nonetheless, compared with previous literature (see for instance, 2), working as a team and belongingness were infrequent themes. Such infrequency could be related to the short duration of the clinical placement. In shorter clinical placements, nursing students learn a range of technical skills but have less time to develop teamwork skills and experience socialisation to the profession [ 29 , 39 ].

Positive relationships with supervising nurses appeared fundamental to students’ experiences. Previous research has shown that in wards with safe psycho-social climates, where the culture tolerates mistakes, regarding them as learning opportunities, a pedagogical atmosphere prevails [ 25 , 39 ]. Whereas, if nursing students experience insolent behaviours or incivility, this not only impacts learning it can also affect career progression [ 26 ]. Participants who felt safe asking questions were given responsibility, had autonomy to conduct skills within their scope of practice and thrived in their learning. This finding aligns with previous research affirming that a welcoming and supportive clinical placement environment, where staff are caring, approachable and helpful, enables student nurses to flourish [ 36 , 40 , 41 , 42 ]. Related research highlights that students’ perception of a good clinical placement is linked to participation within the community and instructor behaviour over the quality of the clinical environment and opportunities [ 27 , 28 ]. Over a decade ago, a large European study found that the single most important element for students’ clinical learning was the supervisory relationship [ 39 ]. In our study, students identified how supervising nurses impacted their emotions and this was critical to their experience of clinical placement, rather than how effective they were in their teaching, delivery of feedback, or their knowledge base.

Students’ relationships with patients were similarly important for a successful clinical placement. Before the clinical placement, students expressed anxiety and fears in communicating and interacting with patients, particularly if they were dying or acutely unwell, which is reflective of the literature [ 2 , 10 , 11 ]. However, during clinical placement, relationships with patients positively impacted nursing students’ experiences, especially at the beginning when they felt particularly vulnerable in a new environment. Towards the end of clinical placement, feelings of incompetence, nervousness and uncertainty had subsided. Students were more active in patient care, which increased self-confidence, empowerment, and independence, in turn further improving relationships with patients and creating a positive feedback loop [ 36 , 42 , 43 ].

Limitations

This study involved participants from one university and a single course, thus limiting the generalisability of the results. Thus, verification of the major themes identified in this research in future studies is needed. Nonetheless, the purpose of this study was to explore in detail the way in which the experiences of clinical placement for student nurses modified initial emotional responses towards undertaking placement and their perceptions of preparedness. Participants in this study undertook their clinical placement in a variety of different hospital wards in different specialties, which contributed to the rigour of the study in identifying similar themes in nursing students’ experiences across diverse placement contexts.

This study explored the narratives of first-year nursing students undertaking a postgraduate entry-to-practice qualification on their preparedness for clinical placement. Exploring students’ changing perspectives before and during the clinical placement adds to extant knowledge about nursing students’ emotional responses and perceptions of preparedness. Our research highlighted the role that preplacement emotions and expectations may have in shaping nursing students’ clinical placement experiences. Emerging themes from this study highlighted the importance students placed on relationships with peers, patients, and supervising nurses. Significant anxiety and other negative emotions experienced by nursing students prior to the first clinical placement suggests that further research is needed to explore the impact of contextual learning to scaffold students’ transition to the clinical environment. The findings of this research also have significant implications for educational practice. Additional educational support for nursing students prior to entering the clinical environment for the first time might include developing students’ understanding of the clinical environment, such as through increasing students’ understanding of the different roles of nurses in the clinical context through pre-recorded interviews with nurses. Modified approaches to simulated teaching prior to the first clinical placement would also be useful to increase the emphasis on students applying their learning in a team-based, student-led context, rather than emphasising discrete clinical skill competencies. Finally, increasing contact between students and university-based educators throughout the placement would provide further opportunities for students to debrief, to receive support and to manage some of the negative emotions identified in this study. Further supporting the transition to the first clinical placement could be fundamental to reducing the theory-practice gap and allaying anxiety. Such support is crucial during their first clinical placement to reduce attrition and boost the nursing workforce.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to the conditions of our ethics approval but may be available from the corresponding author on reasonable request and subject to permission from the Human Research Ethics Committee.

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Acknowledgements

The authors wish to thank the first-year nursing students who participated in this study and generously shared their experiences of undertaking their first clinical placement.

No funding was received for this study.

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Jennifer M. Weller-Newton

Present address: School of Nursing and Midwifery, University of Canberra, Kirinari Drive, Bruce, Canberra, ACT, 2617, Australia

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Department of Nursing, The University of Melbourne, Grattan St, Parkville, VIC, 3010, Australia

Philippa H. M. Marriott

Department of Rural Health, The University of Melbourne, Grattan St, Shepparton, VIC, 3630, Australia

Present address: Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan St, Parkville, VIC, 3010, Australia

Katharine J. Reid

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All authors made a substantial contribution to conducting the research and preparing the manuscript for publication. P.M., J.W-N. and K.R. conceptualised the research and designed the study. P.M. undertook the data collection, and all authors were involved in thematic analysis and interpretation. P.M. wrote the first draft of the manuscript, K.R. undertook a further revision and all authors contributed to subsequent versions. All authors approved the final version for submission. Each author is prepared to take public responsibility for the research.

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Marriott, P.H.M., Weller-Newton, J.M. & Reid, K.J. Preparedness for a first clinical placement in nursing: a descriptive qualitative study. BMC Nurs 23 , 345 (2024). https://doi.org/10.1186/s12912-024-01916-x

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Incorporating evidence-based practice education in nursing research curriculum of undergraduate nursing students: A quasi-experimental study

Affiliations.

• 1 School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China. Electronic address: [email protected].
• 2 School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China. Electronic address: [email protected].
• 3 School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China. Electronic address: [email protected].
• 4 School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China. Electronic address: [email protected].
• 5 School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, Jiangsu Province 210023, China. Electronic address: [email protected].
• PMID: 37245347
• DOI: 10.1016/j.nepr.2023.103671

Aim: To examine the effect of incorporating evidence-based practice (EBP) in Nursing Research curriculum on undergraduate nursing students.

Background: The competence of EBP is essential for nurses and it is an essential task for educators to implement EBP education in nursing students.

Design: A quasi-experimental study.

Methods: Based on Astin's Input-Environment-Outcome model, the study was conducted among 258 third-grade students of a four-year nursing bachelor's program between September through December 2022. The students were divided into two groups. Students in the intervention group received innovative teaching where EBP elements were incorporated in Nursing Research course in a natural, gradual and spiral way, while students in the control group attended conventional teaching. Effect of EBP teaching was examined in terms of students' EBP competence, learning experience and satisfaction and score of team-based research protocol assignment.

Results: Compared with conventional teaching, the innovative teaching characterized by EBP improved students' EBP competence in terms of attitudes and skills and enhanced student's comprehensive ability in nursing research. Students' learning experience and satisfaction were similarly favorable between the two groups.

Conclusions: For undergraduate nursing students, the teaching strategy characterized by EBP is an appropriate and effective way to improve their EBP competence of attitudes and skills, as well as their nursing research ability.

Keywords: Evidence-based practice; Integrated curriculum; Nursing research curriculum; Teaching strategies; Undergraduate nursing students.

Copyright © 2023 Elsevier Ltd. All rights reserved.

• Education, Nursing, Baccalaureate* / methods
• Evidence-Based Nursing / education
• Evidence-Based Practice
• Nursing Research*
• Students, Nursing*

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Importance of continuing education in nursing, rachel r.n..

• May 21, 2024

Nursing is a demanding yet rewarding profession that involves providing compassionate care, promoting health, and treating patients with various medical conditions. Nurses play a crucial role in the healthcare system, working closely with doctors, other healthcare professionals, and patients.

Their duties encompass a wide range of responsibilities, including administering medications, monitoring vital signs, dressing wounds, educating patients and their families about health-related issues, and providing emotional support during challenging times.

Continuing education in nursing refers to the ongoing process of acquiring new knowledge, skills, and expertise to enhance nursing practice and stay current with the latest developments, research findings, and best practices in the healthcare industry.

As the field of medicine continues to evolve rapidly, it is essential for nurses to engage in lifelong learning to provide the highest quality care and meet the changing needs of their patients.

What You'll Learn

Nursing Specialties

The nursing profession offers a diverse array of specialties, allowing professionals to focus on specific areas of interest or patient populations. Here are some popular nursing specialties:

Pediatric Nursing:

Dedicated to caring for infants, children, and adolescents, pediatric nurses specialize in the unique developmental, emotional, and physical needs of young patients. They work in various settings, including hospitals, clinics, and schools, providing care for children with acute or chronic illnesses, developmental disorders, or injuries.

Geriatric Nursing:

As the population ages, the demand for geriatric nurses continues to grow. These nurses specialize in caring for the elderly population, addressing their unique healthcare needs, managing chronic conditions, and promoting quality of life. They work in various settings, such as nursing homes, assisted living facilities, and hospitals.

Critical Care Nursing:

Critical care nurses are highly skilled professionals who work in intensive care units (ICUs), emergency rooms, and other critical care settings. They provide specialized care for patients with life-threatening conditions, monitoring vital signs, administering medications, and assisting with complex medical procedures.

Oncology Nursing:

Oncology nurses specialize in caring for patients with cancer, from diagnosis through treatment and follow-up care. They play a crucial role in administering chemotherapy, managing side effects, providing emotional support, and educating patients and their families about cancer treatment and prevention.

Psychiatric Nursing:

Also known as mental health nursing, psychiatric nurses specialize in caring for individuals with mental health conditions, such as depression, anxiety disorders, and schizophrenia. They work in various settings, including hospitals, psychiatric facilities, and community mental health centers, providing therapeutic interventions, counseling, and support to promote mental well-being.

The Importance of Continuing Education in Nursing

Continuing education is vital for nurses for several reasons:

• Staying Current : The healthcare industry is constantly evolving, with new treatments, technologies, and best practices emerging regularly. Continuing education ensures that nurses remain up-to-date with the latest advancements and can provide the highest quality care to their patients. By staying informed about new research findings, treatment protocols, and evidence-based practices, nurses can make informed decisions and deliver safe and effective care.
• Professional Development: Engaging in continuing education opportunities allows nurses to enhance their knowledge, skills, and expertise, leading to professional growth and career advancement opportunities. Continuing education can help nurses develop specialized skills, gain knowledge in new areas of nursing, or prepare for leadership roles or advanced practice nursing positions.
• Maintaining Licensure and Certification: Many states and professional organizations require nurses to complete a certain number of continuing education credits or units to maintain their licensure and certification. Failure to meet these requirements can result in the loss of the ability to practice nursing legally.
• Improving Patient Outcomes: By continuously updating their knowledge and skills, nurses can better understand and address the unique needs of their patients, leading to improved patient outcomes and enhanced patient satisfaction. Continuing education helps nurses stay informed about the latest treatment approaches, management strategies, and patient education techniques, enabling them to provide more effective and personalized care.
• Enhancing Patient Safety : The healthcare industry places a strong emphasis on patient safety, and continuing education plays a crucial role in promoting safe practices. By learning about new safety protocols, medication administration guidelines, and risk management strategies, nurses can minimize the risk of errors and ensure the well-being of their patients.

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Continuing education in nursing: why is it important?

Requirements for Continuing Education

The specific requirements for continuing education in nursing vary depending on the state, employer, and professional organizations. Generally, nurses are required to complete a certain number of continuing education credits or units within a specified period, typically every one to three years. These credits can be earned through various activities, such as:

• Attending conferences, seminars, or workshops: These educational events provide opportunities to learn from experts in the field, network with peers, and gain hands-on experience through interactive sessions.
• Completing online courses or webinars: Online learning platforms offer a convenient and flexible way for nurses to access continuing education resources and earn credits at their own pace.
• Participating in academic coursework: Enrolling in college or university courses related to nursing or healthcare can provide in-depth knowledge and credits toward continuing education requirements.
• Engaging in professional development activities: Activities such as reading nursing journals, participating in case studies, or attending in-service training sessions can also count toward continuing education credits.

It’s important to note that the specific requirements, accepted activities, and credit values may vary among states and professional organizations. Nurses should consult with their state’s nursing board or relevant professional associations to understand the specific continuing education requirements for their licensure or certification.

Tips for Continuing Your Nursing Education

Here are some tips to help you continue your nursing education effectively:

• Identify Your Goals: Take the time to assess your personal and professional goals, areas of interest, and potential career paths. This will help you identify the specific knowledge and skills you need to acquire through continuing education.
• Explore Different Learning Formats : Consider various learning formats, such as in-person workshops, online courses, conferences, webinars, or self-study materials, to find the methods that align with your learning style, schedule, and preferences.
• Seek Employer Support: Many healthcare organizations recognize the importance of continuing education and offer tuition reimbursement, paid time off for educational activities, or on-site training opportunities for their nursing staff. Inquire about available resources and support from your employer.
• Join Professional Organizations: Membership in professional nursing organizations, such as the American Nurses Association (ANA) or specialty nursing associations, often provides access to continuing education resources, discounts on educational events, and networking opportunities with peers in your field.
• Create a Plan: Develop a comprehensive plan that outlines your continuing education goals, deadlines, and the specific activities or courses you plan to undertake. Break down your goals into manageable steps and allocate time for studying and completing assignments.
• Stay Organized: Maintain detailed records of your continuing education activities, credits earned, certificates, and any other documentation required for licensure or certification renewal. This will help ensure you meet the necessary requirements and can easily provide proof of your continuing education efforts when needed.
• Collaborate and Network: Engage with your colleagues, mentors, or peers in study groups or online forums to share knowledge, discuss best practices, and support each other’s professional development. Networking can also lead to valuable insights and opportunities for continuing education.
• Embrace Lifelong Learning: Cultivate a mindset of lifelong learning and embrace the ever-changing nature of the healthcare industry . Continuously seek out new learning opportunities, stay curious, and strive to improve your skills and knowledge throughout your nursing career.

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What Are The 7 Importance of Statistics in Nursing?

• Post author By admin
• May 27, 2024
• No Comments on What Are The 7 Importance of Statistics in Nursing?

Statistics might sound like a big, complicated word, but in the world of nursing, it’s like a superhero tool that helps nurses save lives and make healthcare better. Imagine statistics as your sidekick, helping you understand all the important data in healthcare. In this blog, we’ll explore 7 importance of statistics in nursing.

Table of Contents

What Are The 4 Main Categories of the Nursing Process?

The nursing process is a systematic framework that guides nursing practice. It consists of four main categories, often referred to as the “ADPIE” framework:

• Assessment: This is the first step in the nursing process, where nurses collect comprehensive data about the patient’s health status, including physical, emotional, social, cultural, and spiritual aspects. Assessment involves gathering subjective information (patient’s symptoms, feelings, and perceptions) and objective data (vital signs, laboratory results, physical examination findings).
• Diagnosis: After gathering information about the patient’s health, nurses look at it closely to figure out what might be wrong or what the patient needs. They make diagnoses, which are not the same as what doctors do. Nurses focus on spotting health issues they can help with on their own.
• Planning: Once nursing diagnoses are established, nurses collaborate with the patient, family, and healthcare team to develop a plan of care. This plan outlines specific goals, outcomes, interventions, and strategies to address the patient’s health needs and achieve optimal health outcomes.
• Implementation: In this phase, nurses execute the planned interventions and actions outlined in the care plan. This means nurses do things like taking care of patients directly, giving them treatments, teaching patients and their families about their health, speaking up for what patients need, and working together with other healthcare workers to make sure patients get all the care they need.

What Are The Different Types of Nursing Statistics?

In nursing, various types of statistics are utilized to analyze and interpret healthcare data effectively. Here are some common types:

Descriptive Statistics

These statistics summarize and describe the main features of a dataset, such as mean, median, mode, and standard deviation.

Inferential Statistics

This type of statistics is used to make predictions or inferences about a population based on a sample of data.

Epidemiological Statistics

Epidemiological statistics focus on the occurrence and distribution of health-related events, such as diseases and injuries, within populations. This includes measures like incidence rates, prevalence rates, and mortality rates.

Clinical Outcome Statistics

These statistics assess the effectiveness of healthcare interventions by measuring clinical outcomes such as mortality, morbidity, and patient satisfaction.

Quality Improvement Statistics

Quality improvement statistics help us keep an eye on how well things are going in healthcare. They help us find areas where we can do better and make sure patients get the best care possible.

Biostatistics

Biostatistics is when we use math to understand health-related information, like in experiments or studies about medicine and biology. It helps us learn more about how different treatments work and how we can stay healthy.

Predictive Analytics

Predictive analytics involves using statistical models and algorithms to analyze current and historical data to make predictions about future healthcare trends, patient outcomes, and resource needs.

• Facilitating Evidence-Based Practice:

Imagine you’re a detective trying to solve a mystery. Statistics are like your clues. In nursing, statistics help nurses make decisions based on evidence. 

For example, if statistics show that a certain treatment works better for patients with a specific condition, nurses can use that information to give the best care possible.

• Research and Data Analysis:

Nurses aren’t just caring for patients; they’re also researchers! Statistics help nurses collect and analyze data to understand healthcare trends and outcomes.

This research helps improve patient care by finding new ways to treat illnesses and prevent diseases.

• Quality Improvement:

Nobody’s perfect, right? But with statistics, nurses can find ways to make healthcare better.

By looking at data, nurses can see what’s working well and what needs improvement. This helps ensure that patients receive the best care possible.

• Risk Assessment and Patient Safety:

Just like a superhero needs to keep people safe, nurses need to keep patients safe. Statistics help nurses identify risks and prevent accidents.

By analyzing data, nurses can spot patterns and take action to keep patients safe from harm.

• Health Policy Development:

Ever wonder how healthcare rules and policies are made? Statistics play a big role!

By using data, nurses can show policymakers what’s happening in healthcare and why certain changes are needed. This helps create better rules and policies to improve healthcare for everyone.

• Resource Allocation and Budgeting:

Imagine you have a limited number of supplies to save the day. You need to use them wisely!

Statistics help nurses figure out where to allocate resources, like medical supplies and staff, so they can help the most people possible without wasting anything.

• Education and Training:

Learning about statistics might not sound exciting, but it’s super important for nurses!

By understanding statistics, nurses can read research papers, interpret data, and make informed decisions. This helps them provide better care for their patients.

What Are The Statistical Methods Used in Nursing Research?

Statistical methods play a crucial role in nursing research by helping to analyze data and draw meaningful conclusions. Here are some common statistical methods used in nursing research:

• Descriptive Statistics: These help us understand the basic details of a group of data. For example, they can tell us the average (mean), the middle number (median), and how spread out the numbers are (range and standard deviation).
• Inferential Statistics: These help us guess things about a larger group based on a smaller group. For instance, if we have data from a few patients, inferential statistics can help us make educated guesses about a whole population.
• Survival Analysis: This is used when we want to understand how long something takes to happen, like how long it takes for someone to recover from an illness or how long until an event occurs, such as death or disease recurrence.
• Meta-Analysis: This method combines and analyzes data from many different studies to get a better understanding of a particular topic. It helps us find more accurate results by looking at a larger pool of data.
• Qualitative Data Analysis: This involves looking at non-number information, like interviews or observations, to find themes or patterns. It helps us understand people’s experiences and feelings, not just numbers.
• Multilevel Modeling: Multilevel modeling, also known as hierarchical linear modeling, is used to analyze nested data structures, such as patients within hospitals or students within schools. It allows researchers to examine the effects of both individual-level and group-level factors on outcomes.
• Structural Equation Modeling (SEM): SEM is a statistical method used to test complex theoretical models by examining the relationships between multiple variables simultaneously. SEM can be used to assess causal pathways, mediation, moderation, and latent variable relationships.

Statistics might seem like a bunch of numbers, but in nursing, they’re like a secret weapon that helps nurses save lives and improve healthcare. From making evidence-based decisions to keeping patients safe, statistics are the unsung heroes of the nursing world. So, the next time you hear about statistics (or think about what are the 7 importance of statistics in nursing), remember that they’re not just numbers—they’re the key to better healthcare for everyone.

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Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature

Mandlenkosi mlambo.

1 Jersey General Hospital, St Helier, Jersey

2 Department of LIME, Karolinska Institutet, Stockholm, Sweden

Charlotte Silén

Cormac mcgrath.

3 Department of Education, Stockholm University, Stockholm, Sweden

Associated Data

The data in the study is comprised of previous research articles. A full list of articles is included in the Table ​ Table3 3 .

Continuing professional development (CPD) is central to nurses’ lifelong learning and constitutes a vital aspect for keeping nurses’ knowledge and skills up-to-date. While we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. A metasynthesis of how nurses experience and view continuing professional development may provide a basis for planning future continuing professional development interventions more effectively and take advantage of examples from different contexts. The aim of this paper is to conduct such a metasynthesis, investigating the qualitative research on nurses’ experiences of continuing professional development.

A metasynthesis of the qualitative literature was conducted. A total of 25 articles fulfilled the inclusion criteria and were reviewed.

We determined five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. This metasynthesis highlights that nurses value continuing professional development and believe that it is fundamental to professionalism and lifelong learning. Moreover CPD is identified as important in improving patient care standards.

Conclusions

Based on the metasynthesis, we argue that access to continuing professional development could be made more attainable, realistic and relevant. Expediently, organizations should adequately fund and make continuing professional development accessible. In turn, nurses should continue to actively engage in continuing professional development to maintain high standards of nursing care through competent practice. This paper highlights the perceived benefits and challenges of continuing professional development that nurses face and offers advice and understanding in relation to continuing professional development. We believe that this metasynthesis contributes with insights and suggestions that would be valuable for nurses and policy makers and others who are involved in nurse education and continuing professional development.

Introduction

Health care professionals need to update their skills regularly and continuing education, or continued professional development (CPD) enables the renewal and updating of skills in health care settings. While we know about the need for CPD, less is known about how nurses experience and perceive CPD, and currently, there is no comprehensive global picture of how nurses view and experience CPD. A metasynthesis of the qualitative literature on nurses’ experiences of CPD may provide a basis for planning future CPD interventions more effectively and take advantage of examples from different contexts. This paper is organised in the following way; first we present the notion of CPD, we then use the United Kingdom, (UK) as a setting to offer an overview of the different mechanisms that exist in one specific health care setting, which may impact engagement with CPD. We acknowledge that similar mechanisms may exist in other health care settings and countries too, and identify the UK context, merely as a way to frame the paper. Subsequently, we conduct a metasynthesis of the qualitative literature addressing the topic of how CPD is experienced by nurses.

Continued professional development

This section aims to unpack the notion of CPD, which exists in different forms and is driven, in part, by top-down requirements, but also, bottom-up, from the needs of practitioners. Continuing professional development (CPD) programmes are central to nurses’ lifelong learning and are a vital aspect for keeping nurses’ knowledge and skills up-to-date. The requirement for nurses to participate in CPD differs between European countries and elsewhere in the world and can be mandatory or voluntary [ 1 , 2 ]. For example, CPD is mandatory in the U. K, Belgium, Spain, Australia and in some states in the United States of America, [ 2 – 4 ]. In these countries, nurses engage in CPD because it is a mandatory condition by nurse regulators for remaining registered to practice. However, in Sweden, Netherlands and Ireland nurses participate in CPD of their own volition [ 1 , 3 – 5 ]. Table  1 provides an overview of some of the European countries which provide mandatory and non-mandatory CPD.

Examples of mandatory and non-mandatory CPD in nursing in Europe (EFN, 2012)

In jurisdictions where CPD is mandatory, nurses engage in continuing education by participating in professional development that is relevant to their areas of practice. Mandatory CPD, refers to “… the process of ongoing education and development of healthcare professionals, from initial qualifying education and for the duration of professional life, in order to maintain competence to practice and increase professional proficiency and expertise” ([ 6 ], p.1). CPD can sometimes refer to a learning framework and activities of professional development which contribute to the continual professional effectiveness and competence [ 7 ]. Broadly, CPD is related to continuing education, and continual learning, both formal and informal, which results in the acquisition of knowledge and skills transfer by the practising nurse with the aim of maintaining licensure and competent practice [ 8 ]. Learners can utilise a mixed style approach to learning depending on the circumstances and context of the learning environment [ 9 – 11 ]. To succeed in providing comprehensive care for their patients, nurses need to utilise the best evidence available to them [ 12 – 14 ]. This requires different modes of learning and ways of knowledge acquisition and construction. To achieve this, nurses can engage in different approaches of acquiring knowledge through CPD, through formal learning, courses or workshops as well as workplace informal learning, through self-reflection, appraising literature for best evidence through journal clubs and giving feedback to each other [ 5 , 7 , 15 ]. Informal learning is often volitional and is largely initiated and controlled by individual nurses with the intention to develop their knowledge and skills [ 16 – 18 ]. Due to its unstructured and, at times, unintentional manner, such learning is often acquired during interactions with colleagues and patients [ 19 ]. One of the advantages of on-site learning, both formal and informal is that learners can utilise expertise which are already available on the ward [ 5 , 15 ]. On-site learning occurs often at the discretion and the willingness of managers to facilitate by providing time and space for learning to occur within the clinical areas. Even so, the fact remains that informal on-site learning is not an event but a continuous process, which draws from daily professional experiences. Lack of CPD trained nurses and ward needs, coupled with poor staffing levels, are cited as main barriers to informal workplace learning [ 5 , 15 ]. Evidence from CPD literature indicates that many nurses prefer informal work-based methods of learning, noting that most meaningful learning occurs through interactions with their colleagues [ 20 ]. From a study by Clarke [ 21 ], it was noted that nurses found informal learning methods such as supervision, attending team meetings/briefings, mentoring and observations to be important. Ultimately, whichever delivery method is used for CPD, continuous professional development extends the practitioner’s professional ability beyond pre-registration training, qualification and induction, thereby potentially enhancing the practitioner’s practice.

Continued professional development: the UK example

This next section aims to illustrate the different mechanisms that arise in one specific health care setting when implementing CPD on a national scale. We recognise that other mechanisms will exist in other contexts, and in places where CPD is not a formal requirement.

Today, nurses in the U.K. are required to engage in continuous learning in order to maintain competence as a means of keeping their licensure with their professional body, the Nursing & Midwifery Council (NMC) [ 22 ]. Since the 1980s, UK nurses and other allied health care professionals such as physiotherapists and occupational therapists have been required to engage in continuous professional development [ 23 ]. A justification for CPD has been the need to maintain professional registration to practice. For registered nurses in the UK, the requirement to engage in CPD came to the fore of continuing education in 1995. It was introduced by the then licensing body, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) as post registration education and practice (PREP) [ 24 ]. Further to that, the Agenda for Change Reforms in 2003 introduced a system for linking pay and career progression to competency called the National Health Service Knowledge and Skills Framework [ 25 ]. The framework is linked to the individual nurse’s ability to demonstrate that they possess the necessary knowledge and skills to get promoted and be remunerated accordingly [ 25 ]. In the UK, further reforms to CPD were introduced in 2012 through the introduction of the Health Education England (HEE) in England [ 27 ]. Its mandate was to equip the NHS (National Health Service) workforce, including nurses with appropriate knowledge and skills to deliver high standard care to patients. The HEE’s role was to support workforce development by providing funding largely for nurses’ CPD. In 2016, PREP was replaced with revalidation, which still requires nurses to attend 35 h of CPD every 3 years [ 24 , 26 ]. Revalidation is the process through with nurses and midwives continue as registrants with the Nursing and Midwifery Council (NMC) [ 25 ]. However, comprehensive HEE budget cuts have had a negative effect on nurse CPD initiatives [ 27 ]. CPD funding in UK was cut from 205 million pounds in 2015–16 to 83 million in 2017–18 [ 28 , 29 ]. Consequently, nurses have struggled to fulfil revalidation requirements due to some authorities freezing access and refusing to give nurses time to attend CPD activities [ 27 ].

This previous section offers an insight into different push-pull mechanisms, in the UK alone. Statutory requirements are underpinned by the need for nurses to maintain and develop the knowledge and skills to meet the expected competence standards of practice in response to expanding nursing roles and global trends. Our experience suggests that local governing bodies may enforce similar measures in contexts where CPD measure are not formalised. Nurses may find themselves caught between a patchwork of statutory requirements and a need to develop their skills and knowledge. Consequently, while we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. Therefore we propose that a metasynthesis of the qualitative literature could be a part of forming such a comprehensive view and use the following three questions to examine the literature What is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge?, What are the conditions necessary for CPD?, and, What are the challenges faced by nurses when engaging in CPD?

In this study, a metasynthesis was used to investigate the qualitative literature [ 30 , 31 ]. Metasynthesis is a form of systematic review method used to review qualitative studies in order to develop theory, to explore and understand phenomena or generate new knowledge, thereby creating meaning from that knowledge [ 32 – 36 ]. In this review, we present a metasynthesis based on the interpretation of qualitative results from topically related qualitative reports. In doing so we strive towards theoretical development, which according to Zimmer refers to the synthesis of findings into a product that is ‘thickly descriptive, and comprehensive’ and thus more complete than any of the constituent studies alone ( [ 30 ] p.313).

The results from metasynthesis studies may be used to underpin and inform healthcare policy, nursing practice and patient care. Furthermore, such information can be utilised by health care professionals involved in nursing education to inform planning and designing of training and educational programs. A number of steps are taken when conducting a metasynthesis [ 36 ] and involve;

a) bringing together a multidisciplinary team, in our case the team of three people includes two skilled medical education professional researchers with extensive experience in qualitative studies, including systematic reviews, moreover these two authors have more than 40 years of comprehensive experience of CPD in health care settings, two of the team are registered nurses and afford the team key insights into the context of nursing CPD, the team is spread across three institutions in two countries, finally, the team consisted of a search engine expert,

b) defining inclusive but manageable research questions, see the questions above;

c) conducting the systematic search, in our case this was conducted by the search engine expert, see Table  2 for the search criteria,

Inclusion and exclusion criteria for the review

d) quality assessment of the studies, this was done using the CASP (Critical Appraisal Skills Programme) criteria, weighting three levels (not met, partially met, totally met) where assessment was done by all three authors see Table  4 , e) extracting data from the studies, see Table  3 ,

Summary of articles with location cohort data collection method

Quality assessment according to modified CASP criteria

e) data analysis, which is explained in more detail below, and.

f) expressing the details of the synthesis which is done in the findings sections below.

Search strategy

A comprehensive systematic search of literature was subsequently conducted on Medline (OVID), PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science (Clarivate) and ERIC (ProQuest). The literature search was conducted by a librarian. The literature search was conducted in December 2019 and was limited to articles published in English from 2010 to 2019. Inclusion and exclusion criteria for the literature search were established and are presented below in Table ​ Table2. 2 . The inclusion criteria comprise of articles from empirical studies (using qualitative methods), discussing nurse continuing learning and education, professional development, lifelong learning, CPD, motivation and barriers.

Data analysis

A total of 1675 records were identified, and following de-duplication, 1395 articles remained. All 1395 articles were screened. Articles had to address nurses’ CPD and continuing education, using qualitative oriented methods. After the first screening 72 articles remained. These articles were divided into three batches and were divided among the researchers. Each author read one batch to further identify if the articles were to be included. For each batch, a second author read the articles, meaning all articles were read by at least two authors. Any remaining ambiguities were discussed and resolved among the team. Figure  1 is a summary of the literature search and screening and Table ​ Table3 3 presents an overview of each study with its citation, location, cohort size and data collection method. 25 articles were identified for the final metasynthesis. All authors read the final 25 articles. Quality assessment using CASP criteria as outlined by Lachal et al., [ 36 ] is reported in Table ​ Table4. 4 . In the quality assessment we assess the following components; Was there a clear statement of the aims of the research?, Is a qualitative methodology appropriate?, Was the research design appropriate to address the aims of the research?, Was the recruitment strategy appropriate to the aims of the research?, Were the data collected in a way that addressed the research issue?, Has the relationship between researcher and participants been adequately considered and reported?, Have ethical issues been taken into consideration?, Is there a clear statement of findings? We also introduce the question of whether the texts are available in Open Access form or not. We introduce this question, as we believe the outcomes on research on nurses’ perceptions and experiences of CPD is potentially important for their practice, and access via Open Access channels could act as a quality dimension. However, without access to the data and the process of interpretation we choose not to assess; How valuable is the research?, Was the data analysis sufficiently rigorous?

Overview of the steps in the literature screening

For the final analysis enabling the synthesis of the studies in this metasynthesis the articles were read carefully, findings related to the research questions; What is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge?, what are the conditions necessary for CPD? And what are the challenges faced by nurses when engaging in CPD?, were identified. In the next step of the analysis, study findings were examined using constant comparative analysis. The findings and conceptual categories were coded, compared, and sorted, focusing on conditions, strategies, and consequences. Finally, the synthesis, the interpretation of the findings, were described as themes, and these were revised several times until a coherent whole was formed [ 30 , 36 – 38 ] Before the final description of the synthesized themes, all the three authors discussed the content of the themes until consensus concerning credibility was reached.

From the metasynthesis we present five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. Each theme is further explained below with references to the relevant literature.

Organisational culture shapes the conditions

Organisational culture played an important role towards the professional development of staff. Organisational commitment and support to personal and professional development of its staff was seen as an indication that staff were valued [ 5 , 15 ] Moreover, CPD initiatives contributed to attracting and retaining staff [ 39 ]. Additionally, a culture that was flexible and adaptable to change was perceived by some participants to be favourable towards CPD [ 40 – 42 ]. Flexibility extends to matters such as CPD availability, and also location, but related also to creating opportunities in the work schedule for the nurses to participate [ 43 ]. Other organisational factors such as funding for CPD programs, staff access of CPD learning, role of management in staff CPD, manageable nursing workloads, the design & delivery of CPD activities, communication and collaboration between CPD providers and management are specifically organisational factors seen as crucial to effective staff development [ 44 , 45 ]. Developing a strategy for CPD was also acknowledged as a key element of organisational culture as a way of enabling participation [ 46 ]. In a similar fashion, it was argued that the organisation needs to be focussed on incremental, but constant development of practices, and here CPD was seen to play a key role [ 47 ]. This sentiment was expressed elsewhere too, but from a re-skilling, or keeping up-to-date perspective, where the organisation is seen to have great importance [ 48 , 49 ]. The value of partnerships and shared understanding between managers and nurses as key enabling factors was identified in several studies [ 46 , 50 ]. In a related fashion, Jantzen argues that organisations should actively avoid fragmentation of CPD initiatives [ 51 ]. As more CPD training is digitised IT/ICT (information communication technology) skills were seen as key to successful CPD implementation [ 46 , 52 ]. It was acknowledged that the transformation to online learning does not only affect nurses, it involves change for the whole department [ 52 ].

Supportive environment as a prerequisite

An environment that supports learning was seen as a necessary prerequisite for CPD. Conditions had to include, flexible off-duty patterns to allow time for staff to study, availability of workplace learning, workloads were not excessive and CPD was fully funded or a shared responsibility between employer and staff [ 46 , 52 ]. Other indicators of a supportive environment included staff access to different CPD activities relevant to their career goals, while at the same time meeting organisational goals and where staff felt free to study openly and not secretively [ 15 , 41 ]. Moreover, the development of local and contextual CPD was seen as something that supported and made participation possible [ 43 , 53 , 54 ]. Participants indicated that nurses required financial support and practical support in the form of adequate time to participate in CPD activities and suitable staff cover when colleagues were away attending CPD activities [ 47 ]. Jantzen et al. [ 51 ] suggest there are three catalysts in a supportive environment; mentors, workplace camaraderie and a highly functional workplace team. Moral support or encouragement was identified in more than one study, where it was articulated that learners want to know there is an appreciation for the time and dedication needed to engage in CPD [ 44 , 46 , 50 ]. The value of learning from other health professionals other than nurses, in the day-to-day work was highlighted for professional development [ 54 ]. Similarly, the sense of a supportive environment with a strong team spirit is communicated elsewhere [ 39 ]. Explicit support is noted in several studies; support for novice nurses [ 39 ] but also the importance of explicit managerial support [ 55 ]. Conversely, in one study, respondents noted that there was less support for experienced or late career nurses [ 56 ].

Attitudes and motivation reflect nurse’s professional values

The value and importance of CPD was discussed in many of the studies. In some, CPD was perceived to be key in defining nurse professionalism [ 6 , 15 , 40 , 47 , 49 ]. Engaging in CPD was also viewed by new nurse graduates as an important element of their individual professionalisation in nursing [ 6 , 15 , 40 ]. In addition, CPD was perceived to be important for enhancing and up or re-skilling, keeping knowledge and skills up-to-date, considering that nursing practice has become more evidence based [ 6 , 43 , 46 , 51 , 54 , 56 ]. Furthermore, nurses stated that CPD was important for maintaining licensure, and felt that the responsibility for enrolling and participating in CPD activities was with the individual nurse, not with the employing organisations [ 53 ]. On the other hand, participants felt more motivated to learn if they could easily access CPD programs, if they felt supported and if there were a variety of CPD activities on offer. Here, bedside and informal learning was emphasized as important [ 57 ]. Similarly, contextualising learning and placing it in close proximity to practice was seen to enhance motivation and engagement [ 42 ]. CPD was also viewed as a way to start networking with other peers [ 44 ]. In one study, a competency framework was introduced, here participants felt that such a framework could help them reflect on their own practice and, as it provides a systematic approach to assessing a patient, look at their own strengths and weaknesses [ 58 ]. Such competency frameworks help to harness scarce training more effectively and encourage individuals to take more responsibility for their own development [ 58 ].

Participants’ attitudes towards CPD funding were mixed, with some stating that funding for CPD was the employer’s responsibility, while others felt that the individual practitioner was responsible or that the burden ought to be shared between the organisation and the nurse [ 5 , 15 , 40 ].

Nurses’ perceptions of barriers

Poor staffing levels, heavy workloads, lack of funding, lack of study time and anti-intellectualism were some of the perceived barriers to CPD brought out by this review. Participants in the studies reviewed felt that a lack of organisational support, especially from their managers, was an indication that the organisation did not take professional development of its staff seriously [ 46 ]. Some respondents reasoned that an anti-academic culture and lack of relevant CPD programs was further indication of this [ 5 , 15 , 40 ]. Seeing a connection to patient care was identified as a strong driver and nurses identified that CPD initiatives would be filtered out unless there was such a clear connection to patient care [ 43 , 51 ].

Additionally, some studies indicated that as role models, managers had to show interest in their own CPD, in order to motivate other nurses. In other words, the manager’s knowledge of CPD activities was reflected by their attitude towards work-based study, acceptance of staff who studied openly, the way the manager prioritised funding support and managed staff shift schedules to allow study release time [ 5 , 39 , 54 , 56 ]. Fatigue was identified as a major barrier. For example in Jho et al. [ 53 ], in a context of mandated CPD, respondents felt tired due to the heavy nursing workload in conjunction with CPD. Lack of strategy, and financial initiatives in terms of money, or time off to study was also acknowledged as a barrier [ 5 , 39 , 54 , 56 ]. Lack of transparent career trajectories were also acknowledged as an area of concern [ 44 ].

Other barriers, or de-motivating factors were identified; difficulties in attending CPD and keeping a life-work balance [ 48 ]. Barriers included: formal CPD courses away from the clinical areas were perceived to lack in authenticity [ 47 , 49 ] and a mis-match in expectations and outputs, where nurses viewed themselves as agents of change, but where the organisation was unable to offer means to capitalise on this perception and desire to bring about change [ 50 , 59 ]. As much as competency frameworks were viewed positively in offering a sense of direction, a divergent view was that they were limiting or created set boundaries that participants experienced as limited, for example, if used as prescriptive, hindering nurses to define their own learning needs [ 58 ]. Lack of IT competence was also perceived as a barrier [ 52 ] with more CPD being conducted online.

Perceived impact on practice as a core value

The impact of CPD on nursing practice was perceived as important and valuable in different ways. The impact could be both direct and indirect depending on the organisational culture [ 41 , 45 ]. This mixed perception could be due to the complex nature of health care organisations which can make knowledge sharing difficult [ 45 ] and that some CPD learning was done secretly, results of which were difficult to evaluate [ 41 ]. In the case where a competency framework was studied, participants felt that using the competency framework helped them organise their work and their thought processes [ 58 ]. A common sentiment was that CPD would benefit health care organisation through the provision and enhancement of practitioners’ knowledge and skills [ 46 ]. Sentiments articulating expectations of an impact of CPD could also be seen elsewhere too [ 52 , 55 , 56 , 60 ]. Moreover, CPD is expected to rely on better communication between managers and nurses as a way of informing each other about needs and means of fulfilling those needs [ 48 ]. Direct impact was realised through improved interprofessional collaboration and the idea that new methods could be directly translated into practice [ 47 ]. Others however, raised concerns that CPD programmes or courses may not translate into new practices [ 50 ]. This sentiment was echoed elsewhere too, where a need to situate CPD in close proximity of patients was seen as important for CPD to impact practice [ 49 ] While indirect impact happened through dissemination of knowledge and skills from CPD learning to other nurses at ward level, arguments were put forward that there will be no difference to practice unless organisational processes support and evaluate its effect on practice [ 46 ]. Participants reported that their professional confidence was enhanced, they felt they could challenge medical decisions and the status quo [ 41 ]. Furthermore, participants felt that CPD enhanced their professional knowledge and skills for better patient care through improved care standards, how they communicated and collaborated with other professionals. Participants also believed that learning increased their chances for career progression and reduced work-related anxiety because of enhanced knowledge [ 40 , 41 ].

The aim of this paper is to conduct a metasynthesis investigating the qualitative research on nurses’ experiences of continued professional development. As a result, this metasynthesis revealed a number of overarching themes, which synthesize the findings of previous qualitative oriented research during the period 2010–2019. 2010 was chosen to include the last 10 years of CPD research. The themes are; Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. The themes put focus on important issues that were recurrently put forward by the nurses in the studies reviewed. However, the themes are not isolated from each other, rather, the content of the themes is interrelated. Some of the themes mainly mirror an overarching perspective at the organisational level of health care, while other themes describe the nurses’ experiences and needs on a personal level. The following discussion explores the above themes in relation to the three questions posed earlier; what is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge? What are the conditions necessary for CPD? What are the challenges faced by nurses when engaging in CPD? While we acknowledge that the questions and themes overlap, we have endeavoured to frame the discussion around the three research questions individually.

What is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge?

Nurses reported that CPD raises professional standards through competencies gained, thereby increasing professional performance with positive benefits for patients, organisations and individual nurses [ 40 ]. These outcomes were seen most prominently in the themes Attitudes and motivation reflect nurse’s professional values, and Perceived impact on practice as a core value. Closely aligned to CPD are the nurses’ clinical effectiveness and competence. Maintaining both requires nurses to keep their practice up-to-date highlighting the importance of CPD for nurses. The knowledge and skills gained by nurses through CPD advances the professional status of nursing, which was an idea that was prevalent in some of the studies in this review [ 15 , 40 , 47 , 50 ], but is also illustrated elsewhere in the literature [ 8 , 21 ]. Nurses acknowledged that expectations of professional accountability meant that standards of practice ought to be kept high in order to pass public scrutiny [ 15 , 40 ]. Furthermore, skills acquired through CPD, such as the ability to conduct systematic peer-reviews [ 45 ] and appraise literature for best evidence, provide nurses with essential professional competencies, embeds values such as caring behaviours, influences beliefs and attitudes which in turn shape nurses’ professional conduct [ 61 ]. As such CPD is seen as a tool for nurses to update their skills, and in doing so deliver safe and high-quality health care. As revealed in this review, nurses were willing to fully fund or part-fund their CPD as long as CPD programs were captivating, easily accessible, there was fair allocation of study time and their efforts towards CPD were recognised. The latter implies that nurses want time and space to transfer their CPD learning into practice and for their CPD to be recorded [ 5 , 45 ]. The belief is that, consequently, patient care will improve with positive impact from organisational change [ 15 , 45 ]. However, it is clear that the organisation is key in making CPD work for nurses. The issues brought up in the theme organisational culture shapes the conditions is thus very important in stimulating nurses to engage in CPD. The nurses’ attitudes and motivation to engage in CPD also depends on a supportive environment and engagement may in turn influence the organisational culture.

What are the conditions necessary for CPD?

A disconnect could be seen in relation to the conditions for CPD, where access to CPD training came to the fore as problematic in some of the studies. Nurses had to travel long distances to attend courses [ 15 , 62 , 63 ]. To avoid these challenges, nurses settle for CPD as long as it fulfils mandatory requirements for registration [ 53 ]. If intentions of CPD are to provide a basis for the continual updating of skills, then authentic learning as an expected outcome is seen as a prerequisite for nurses to engage in CPD, whether it occurs at the bedside, at a training facility or through an IT mediated interaction. This calls for accessible CPD, improved design and delivery methods for all nurses [ 52 ]. Nurses’ experiences described in the themes Organisational culture shapes the conditions, Supportive environment as a prerequisite, show that structural and moral support are both important. Structural support in the form of availability, time to engage in CPD, as well as clear expected outcomes [ 46 , 49 ], but also moral support in the form of an understanding management and environment, and also peers and leaders who themselves also prioritise CPD [ 58 ]. Organisational support and commitment towards CPD should mean allocation of study time, support of nurses who study privately, by creating space for knowledge and skills integration and managing poor cultural practices that hinder open study. Funding is seen as a key factor across many of the studies, both in terms of enabling nurses to participate, but also as a way of acknowledging nurses who engage in CPD. Further studies may need to look more closely at how nurses perceive different aspects of funding. For nurses’ lifelong learning to endure, CPD programs need to be more accessible and kept interesting by making them more relevant to nurses’ practice contexts. Here the importance of the organisation for creating a CPD conducive environment is emphasized [ 46 , 51 , 52 ]. As role models, managers need to lead by example and engage in CPD themselves, but also demonstrate explicit support. They also need to influence policy to create environments conducive to CPD. If funding situations do not improve, work-based CPD learning could be one of the alternative ways of CPD delivery for nurses. To promote CPD engagement and cost reduction, eLearning approaches could be utilised for education and training. However, poor IT skills among nurses, but also within organisations continues to be a potential weakness [ 52 ]. A challenge remains here in enabling nurses to get recognition from informal on-site learning [ 16 – 18 ], where elements of meta-cognitive reflection can be used to acknowledge nurses’ continued professional development.

What are the challenges faced by nurses when engaging in CPD?

In some of the literature reviewed, participants lamented their current conditions for CPD, and identified clear barriers and challenges in the form of concerns related to lack of funding for CPD, staffing levels, time allocation for study, lack of organisational support because of negative cultural practices, CPD design & delivery and limited choice of CPD activities. This is articulated within the themes: Organisational culture shapes the conditions, Supportive environment as a prerequisite, Nurses’ perceptions of barriers [ 2 , 11 , 34 , 41 ] . However, studies did not explore the views of nurses on recruitment and retention and its impact on accessing a variety of CPD activities. Evidence from this review indicates that modernising healthcare and simultaneously cutting CPD funding for nurses could lead to a limited number of nurses attaining the skills and competences needed for the modernisation process. In view of the understaffing that is reported elsewhere [ 5 , 15 ], we identify a cause for concern. These perceived barriers may undermine nurses’ professional development [ 23 , 59 ]. Moreover, the findings presented here revealed that nurses face a number of challenges in relation to their CPD participation. The challenges include limited CPD activities to choose from, poor CPD delivery methods, negative organisational culture practices such as anti-intellectualism and lack of support. As a result, nurses were less motivated to participate in CPD training [ 57 ].

It is clear from the review, that IT concerns are becoming more and more prominent, given that more CPD programmes are being offered through digital platforms [ 47 ]. This is a concern for both the individual nurses, but also their organisations. On concerns regarding CPD delivery methods, nurses indicated that they preferred different styles. With these concerns comes the view that learners learn in different ways depending on the context and subject of study [ 61 , 62 ]. This supports the notion that individuals have different learning preferences [ 61 ], where some adult learners learn better in a structured and teacher guided context, while others prefer self-direction.

Limitations

The search was conducted by an experienced search engine expert. Even so, we may still have been unsuccessful in finding all the relevant articles. The study was focussed on qualitative studies, which means that studies using predominantly quantitative or mixed methods were not included, but could hold important insights. In the introduction to the study we used the UK as an example for how CPD might be regulated. However, we have conducted a comprehensive search of the literature and our analysis was not conducted with a UK-centric perspective. While each study needs to be understood in terms of local rules and regulations, the similarities in the findings are striking.

The metasynthesis indicates that differences exist between the nurses’ CPD needs and expectations and organisations’ approaches to nurses’ professional development. The review lays bare a disconnect between the rhetoric of identifying CPD as a way to enhance nurses’ skills, and the reality of CPD interventions, where nurses do not feel support within their organisations or from their immediate supervisors. The review also revealed that CPD is an important element of nursing practice and nurses’ lifelong learning. Furthermore, it suggests that nurses are motivated to take part in CPD to enhance their knowledge, improve skills and keep up- to -date with recent evidence. While evidence from this review indicates that nurses believe that CPD has a positive impact on patient care, there is lack of contemporary research to qualify this claim and there is limited evidence from this review to support this assumption. However, evidence from the review suggests and confirms, that the greatest barriers for CPD in nursing are a lack of funding and time to participate in CPD activities, which are clearly related to organisation structure. It is difficult to envisage how such conditions could be conducive for nurse CPD to flourish. Such perceived barriers undermine nurses’ efforts to keep knowledge and skills up-to-date and provide better patient care while meeting the ever-changing needs and expectations of their patients. This is further exacerbated by negative organisational cultural practices and lack of knowledge on how to facilitate, design and deliver CPD for their staff. We conclude that policy makers and relevant stakeholders need to put in place strategies to support nurse CPD in long term and in doing so tear down the barriers of CPD.

Acknowledgements

We would like to thank Gun Brit Knutssön, at Karolinska Institutet’s University Library, Stockholm, Sweden for the systematic search.

Abbreviations

Authors’ contributions.

MM, CS and CMG designed the study. MM, CS and CMG defined the inclusion and exclusion criteria for the search. MM, CS and CMG conducted an equal share of the analysis work. Versions of the manuscripts were shared, revised and written by all three authors. All authors have read and approved the submitted manuscript.

Open Access funding provided by Stockholm University.

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Ethical vetting in Sweden is conducted by a central and national committee, the Swedish Ethical Review Authority. Review articles where research is not conducted on humans, or animals does not require ethical vetting as per Swedish Ethical Review Act (SFS 2003:460).

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Bibliometric Analysis of Patient Safety in Nursing

How to cite: BAYER, N.; GÜRSEL, G.; TURUNÇ, Ö.; MERT, İ. S.; AKBAŞ, M. Ç.; ALTAY, M.; ŞEN, C.; KILIÇ, T. Bibliometric Analysis of Patient Safety in Nursing. Preprints 2024 , 2024051689. https://doi.org/10.20944/preprints202405.1689.v1 BAYER, N.; GÜRSEL, G.; TURUNÇ, Ö.; MERT, İ. S.; AKBAŞ, M. Ç.; ALTAY, M.; ŞEN, C.; KILIÇ, T. Bibliometric Analysis of Patient Safety in Nursing. Preprints 2024, 2024051689. https://doi.org/10.20944/preprints202405.1689.v1 Copy

BAYER, N.; GÜRSEL, G.; TURUNÇ, Ö.; MERT, İ. S.; AKBAŞ, M. Ç.; ALTAY, M.; ŞEN, C.; KILIÇ, T. Bibliometric Analysis of Patient Safety in Nursing. Preprints 2024 , 2024051689. https://doi.org/10.20944/preprints202405.1689.v1

BAYER, N., GÜRSEL, G., TURUNÇ, Ö., MERT, İ. S., AKBAŞ, M. Ç., ALTAY, M., ŞEN, C., & KILIÇ, T. (2024). Bibliometric Analysis of Patient Safety in Nursing. Preprints. https://doi.org/10.20944/preprints202405.1689.v1

BAYER, N., Cem ŞEN and Tamer KILIÇ. 2024 "Bibliometric Analysis of Patient Safety in Nursing" Preprints. https://doi.org/10.20944/preprints202405.1689.v1

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