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BackgroundThe international literature has largely conceptualised transition to university as a process of adjustment to both the social and the academic demands of university life. Several factors influence this process including: student, parent and university staff expectations; student preparedness; and student belongingness. Moreover, some student groups (groups well-represented in nursing) appear to have particular difficulty in successfully transitioning to university life.Study AimsTo explore first year nursing students' experiences of the transition to university; to compare nursing students' experiences with those of other disciplines and identify ways of easing the transition for nursing students.MethodologyAs part of their coursework, first year nursing students at an English University submitted a 500-word, formative reflection on the transition to university. Anonymised reflections from 161 students were available to the researchers for thematic content analysis; 50 reflections, however, proved sufficient for ‘information power’.ResultsTwo main themes emerged from the data: (i) ‘managing expectations’, an overarching theme that permeated most of the reflections; and (ii) ‘practical tools and support aids’, the practical, concrete actions that either the university took, or the students developed themselves, to ease the transition. Both themes embraced inter-related academic, social and personal domains.ConclusionsNursing students' transition experiences are similar to those of other university students. However, the particular demographics of nursing student cohorts amplifies certain aspects of the transition experience: more students who are likely to struggle with transition but also more students who embrace the developmental aspects of going to university. Transition requires joint enterprise between students and university staff, especially in terms of expectations and the support required to become independent learners. Transitions can be eased by tapping into student resourcefulness and seeing transition as a gradual process that cuts across academic, social and personal dimensions rather than as a short, one-off event.

Objectives This systematic review aimed to offer insight and understanding, through synthesis of findings from studies that report on perspectives of student nurses/midwives, clinical instructors, clinical nurses/midwives on the challenges faced by student nurses/midwives in the clinical learning environment (CLE). Design All primary qualitative research studies published in the English language that reported on the views of student nurses/midwives, clinical instructors and clinical nurses/midwives on the challenges faced by student nurses/midwives in the CLE were included. Data sources The electronic databases of Medline EBSCO (1946-), CINAHL (1970), Embase Ovid (1974-), ScielO, WHOLIS (2002-), ASSIA (1985-), Web of Science (1956-), PsycINFO (1800s-) and Maternal and Infant Care (1970-) were searched in November 2019. Review methods Retrieved papers were reviewed independently by two authors for selection by title, abstract and full text, and two authors agreed for inclusion of the papers. The COREQ criteria checklist was used for assessment of methodological quality of the included studies. Results The review included 32 studies published over 22 years between 1997 and 2019 involving 853 nursing/midwifery students, clinical instructors, and clinical nurses/midwives from 14 countries. Three key themes emerged: ‘The support structure’, ‘Personal factors’, and ‘Planning and organisation – influence of extrinsic factors’. Conclusion Attitude of clinical staff, instructors, and significant others had a major influence on students' clinical learning. Lack of a sense of belongingness and self-motivation to learn, and perceived fear of doing errors were some of the demotivating factors. Lack of resources to facilitate need-based training, staff shortages, workload and inconsistencies between theory and practice were other key challenges in the CLE. Understanding the challenges faced by students in clinical practice can help overcome the barriers leading to development of competent and confident nurses and midwives.

Background Although learning in clinical settings is a key element of nursing education, for many learners these are challenging developmental contexts often marked by isolation and a lack of belongingness. Despite the massive appropriation of mobile instant messaging (MIM) platforms and the connective properties attendant to them, very little is known about their role in and impact on nursing students' clinical learning experiences. Approach and Methods To address this gap, the study, which was part of a multinational research project on the use of mobile social media in health professions education in developing countries, examined the use of the instant messaging platform WhatsApp by nursing students during placements and potential associations with socio-professional indicators. The survey involved a total number of 196 nursing students from 5 schools in Oyo State, Nigeria. Results The findings suggest that students used WhatsApp relatively frequently and they perceived that this platform strongly enhanced their communication with other students and nurses. WhatsApp use during placements was positively associated with students' maintained social capital with peer students, the development of a professional identity, placement satisfaction and with reduced feelings of isolation from professional communities. The determinants that influenced WhatsApp use during placements were perceived usefulness and perceived ease of use. No associations were found between WhatsApp use during placement and age, attitude, subjective norms and placement duration. Conclusion This study is one of the first of its kind that points to the relevance of mobile instant messaging as part of nursing students' (inter)personal learning environments in clinical settings and, particularly, in the development setting under investigation. Further research is needed to corroborate these findings, to enhance the understanding of the impact mechanisms, and to evaluate a more systematic use of MIM in clinical learning contexts.

Objective To identify nurses' behaviours that promote student accountability for learning in clinical practice. Background Health care services are experiencing significant strain in meeting clinical education requirements of increasing numbers of nursing students enrolled in undergraduate nursing programs. Internationally, the transition to university based education for nurses has seen the emergence of issues for busy clinicians trying to manage increasing workloads with responsibility for student learning. An understanding of what types of supervisor behaviours promote student accountability for learning, may support clinicians to more effectively manage their dual roles of clinical care and student support. Design An integrative approach was adopted for this review. Data sources A search of the Cumulative Index of Nursing and Allied Health Literature, Pubmed, Scopus and Embase was undertaken, limited to articles published between 2000 and March 2017. Review methods Whittemore and Knafls' (2005) framework for conducting integrative reviews was used to ensure a methodological and rigorous approach. Results Nine studies were considered. Behaviours emerged in relation to four themes including: belongingness associated with a genuine partnership; empowerment and increasing student self-efficacy; trust linked to increasing and staged independence; and balancing clinical and educational requirements. Conclusion Behaviours of nurses significantly influence students' accountability for learning and accordingly, their ability to be adequately prepared for professional nursing practice. Understanding behaviours that impact on students' approach to clinical placement can guide nurses in their approach to facilitating student learning, in particular, behaviours that increase student responsibility and independence over the continuum of clinical education.

Summary Aim This paper reports the development and psychometric testing of the Ascent to Competence Scale, an instrument designed to measure nursing students' perceptions of the quality of their clinical placement experience. Background The key purpose of clinical placements is to facilitate students' learning and progress toward the attainment of competence. The attainment of competence requires personal commitment and active involvement of students; support and guidance of clinical and academic staff; and clinical environments that are welcoming and inclusive of students. Method The items for the Ascent to Competence Scale were identified following a critical review of the literature. Content and face validity were established by an expert panel. During 2010 the instrument was tested with third year nursing students (n = 88) from one Australian university. Exploratory factor analysis with promax oblique rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Results The final scale demonstrated satisfactory internal consistency (alpha 0.98). Exploratory factor analysis yielded a three-component structure termed “Being welcomed”; “Belongingness” and “Learning and competence”. Each subscale demonstrated high internal consistency: 0.89; 0.96; and 0.95 respectively. Conclusion The Ascent to Competence Scale provides a fresh perspective on clinical placements as it allows for the relationship between belongingness, learning and competence to be explored. The scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work. Relevance to clinical practice The Ascent to Competence Scale profiled in this paper will be of benefit to both educational and healthcare institutions. The use of a quantified yardstick, such as the Ascent to Competence Scale, is important in evaluating the efficacy of programs, placements and partnerships between higher education and health services.

Clinical experience is recognised as central to nursing education. Quality clinical placements across a range of venues are vital to the development of competent and confident professionals. However there is evidence, both empirical and anecdotal, suggesting that nursing students' clinical placement experiences are often fraught with problems. These problems are long standing and multi-dimensional. For many students clinical placements are typified by feelings of alienation and a lack of belongingness. This paper proposes that the problematic nature of clinical placements may be better understood through the lens of 'belongingness'. A critical review of selected studies drawn from the psychological and social science literature provides insight and useful direction for a more focused review of the nursing literature. The potential relationships between belongingness, nursing students, and their clinical placement experiences are then exemplified by excerpts taken from the nursing literature (including unpublished material). Finally, an ongoing study that seeks to address the paucity of empirical research in this area is highlighted.

Summary Introduction The rigorous efforts students put into baccalaureate nursing programs to become a professional nurse is compounded by their need to have a sense of belonging in their clinical placements. In addition, the students' perceived stress may contribute to their physiological and psychological wellbeing undermining academic achievements and confidence. Background A sense of belonging and perceived stress have research history in psychological and sociological realms; but not used together in the nursing profession as applied in clinical placements. The Perceived Stress Scale is a psychological instrument used globally; however, the Belongingness Scale-Clinical Placement Experience (BES-CPE) measurement tool has not been used in published research in the United States. Methods A descriptive correlational research design examining the relationship between a sense of belonging and perceived stress among baccalaureate nursing students in clinical placements. Three measurement tools were used for data collection: BES-CPE, Perceived Stress Scale (PSS-10) and demographic questionnaire. Students were able to access the online survey through SurveyMonkey®. Participants A national study was conducted using 1296 volunteer nursing students from the National Student Nurses Association (NSNA) database. These nursing students were currently enrolled in a baccalaureate nursing program, 18 years of age and completed at least one clinical experience. Results The findings from this study revealed a statistically significant low inverse relationship (r = − .277) between a sense of belonging and perceived stress among baccalaureate nursing students in their clinical placements. The findings also supported the use of BES-CPE as a reliable and valid measurement tool for nursing students in clinical placements. Conclusion The results of this study supported the concept of a sense of belonging as a fundamental human need, having a positive influence and impact on students' learning, motivation and confidence. In contrast, perceived stress has negative consequences on the students' self-concept, learning skills and competence.

© 2014 Elsevier Ltd. Background: Belongingness has been identified both as a fundamental human need and as a prerequisite for nursing students' clinical learning. Belongingness has also been associated with students' academic achievement, retention, self-esteem, self-directed learning, and self-efficacy. The Belongingness Scale - Clinical Placement Experience is a valid and reliable measure of nursing students' belongingness scores; however, a Persian version of this scale is not currently available. Aim: This study aimed to translate the Belongingness Scale. -. Clinical Placement Experience into Persian, to evaluate its psychometric properties, and to measure the belongingness experiences of Iranian nursing students. Methods: Following translation and initial validity and reliability testing of the scale, 300 nursing students from three universities in Iran completed the survey. Further psychometric testing was undertaken followed by analysis of descriptive statistics. Results: Based on the results of confirmatory factor analysis two items were removed from the scale. The mean score of Persian version of the Belongingness Scale. -. Clinical Placement Experience was 3.21 (0.57). The whole scale had a high internal consistency (Cronbach's alpha. = 0.92). The alpha coefficients of the subscales of "self-esteem", "connectedness", and "efficacy" were 0.85, 0.86, and 0.80 respectively. Conclusion: Similar to previous versions of the Belongingness Scale. -. Clinical Placement Experience, the Persian version demonstrated strong psychometric properties with strong validity and reliability, indicating its utility and appropriateness when measuring Iranian nursing students' belongingness experiences. Further testing with other cohorts would strengthen these results.

Summary Background Phase 1 of this study examined student, mentor and clinical manager's perceptions of a ‘Hub and Spoke’ practice learning model in year 1 of an undergraduate nursing programme. Findings from Phase 1 suggested that the model had significant educational merit in orientating students to clinical learning and emphasising the primacy of the mentor relationship in developing and supporting students. Following the students through year 2 of their programme, wherein they experienced a ‘rotational’ practice learning model, which provided an opportunity to explore student perceptions of both models. Aims To explore undergraduate nurses' perceptions of two experienced practice learning models: hub and spoke model, and the classical rotational model. In a previous study the hub and spoke model appeared to develop 1st year students' sense of belongingness, continuity and quality of practice learning, there for it was important to understand what students reported about these issues when recounting their 2nd year experience in the clinical setting that was organised according to a classical rotational model. Design Qualitative approach utilising focus groups. Participants 10 under-graduate student nurses at the end of 2nd year. Methods Focus group interviews. Results Students responded in ways that indicate they believed the experiences of year 1 had raised their faith in their ability to cope with the practice learning and educational demands of nursing. They saw themselves as being better prepared for year 2 as a result of their exposure to hubs and spokes. The study has identified traits of resilience, continued belongingness and self-confidence in orientation to learning in clinical practice in hub and spoke experienced students. Conclusions The student nurses found the hub and spoke model valid in 1st year, whilst stating that for 2nd year the rotational model can be valid. This supports earlier findings that student nurses require a structured and supportive 1st year learning environment to enable development of resilience for subsequent years.

Summary Background Clinical placements form a large and integral part of midwifery education. While much has been written about nursing students' clinical placements, less is known about clinical experiences of undergraduate midwifery students. In nursing, belongingness has been demonstrated to be a key factor in clinical learning but little is known about this in midwifery education. Objectives This study sought to examine undergraduate midwifery students' sense of belongingness in their clinical practice. Design A quantitative design using an online questionnaire was employed. A tool adapted by Levett-Jones (2009a), and previously used with nursing students, was utilised to examine sense of belonging in undergraduate midwifery students. Participants Sixty undergraduate midwifery students from two campuses at one Australian university participated in the study. Students were drawn from a single Bachelor of Midwifery degree and a double Bachelor of Nursing/Bachelor of Midwifery degree. Methods On completion of a scheduled lecture, students were invited by one of the researchers to participate in the study by completing the online questionnaire and the link provided. Data were analysed using descriptive statistics. Results Midwifery students generally reported similar perceptions of belongingness with previous studies on nursing students. However, a few differences were noted that require further exploration to fully understand. Conclusions Midwifery students experienced a sense of belonging in their clinical placements. The findings contribute to understandings of the experiences for midwifery students and provide a foundation on which to develop future clinical placement experiences.

Summary Background Most of UK students' practice learning experience is based on a rotational placement model which often leads to students lacking confidence and feeling anxious about the complexities of the care environment. Objectives To evaluate the impact of Hub and Spoke model(s) of clinical practice placement across geographically diverse locations, with a particular focus on enhancing the student practice learning experience. Design Multiple case study design. Setting & Participants Comprised undergraduate student nurses from Adult, Learning Disability and Mental Health programmes from 3 Scottish Schools of Nursing. Methods A mixed methods approach which included quantitative and qualitative date tools. Results All three Hub and Spoke models shared two broad findings: 1) In the three Hub and Spoke models detailed in this paper, there is a continuum of student led learning which supports the process with opportunities for individual students to be positively innovative and creative in their learning approaches. Depth of learning was achieved in two ways; a) the method in which Hub placements are organised, managed and structured and, b) the depth of empathy and sensitivity to the individual at the centre of the care. 2) Placement capacity is increased: The classification of placements is reviewed to produce broader categories, Engagement of mentors/enhanced student/mentor relationship. Conclusions Practice Learning must be seen as an academic endeavour that promotes deep, meaningful, person-centred learning rather than superficial, compartmentalised placement-centred learning.