Nursing Research—Principles and Methods

Background: There has been increased attention in the literature about stress among nursing students. It has been evident that clinical education is the most stressful experience for nursing students. Aim: The aim of this paper was to critically review studies related to degrees of stress and the type of stressors that can be found among undergraduate nursing students during their clinical education. Methods: The search strategy involved the utilization of the following databases: MEDLINE (Medical Literature on-Line), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO (Psychology Information) and PubMed. Keywords were stress, undergraduate nursing students, clinical practice. The review included those studies published between 2002 and 2013, conducted in any country as long as reported in English, and including a focus on the clinical practice experience of nursing students. Thirteen studies met the eligibility criteria. Results: Four themes were identified: initial clinical experience, comparison between different academic years, cross-cultural comparison, and eustress aspects of clinical experience. Implications for nursing and health policy: This review expands current knowledge in the area of stress in clinical settings and calls for further research. Nursing teachers should utilize the findings of this review to direct their students during clinical practice. Moreover, hospital administrators need to promote policies to promote a training environment where students are supported and inspired.

A review of the literature regarding stress among nursing students during their clinical education

Clinical practice in the psychiatric/mental health nursing (PMHN) field is considered a highly-stressful experience for nursing students. The purpose of the present study was to identify the degrees of stress, the types of stressors, and coping strategies perceived by undergraduate nursing students during their clinical practice in PMHN courses. A descriptive, longitudinal design was used. Sixty-five students registered in PMHN clinical courses were recruited from five Jordanian universities using a systematic random-sampling method. Data collection was conducted in the second semester of the 2012-2013 academic year at two points of time: pre-PMHN clinical training and post-PMHN training. The Basic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were administered. Students' ages ranged from 20 to 25 years. The findings illustrate that the highest reported types of stressors at both data-collection times were taking care of patients, stress related to teachers and nursing staff, and from assignments and workloads. The most utilized coping strategy at both data-collection times was problem solving. The findings of the present study are useful for clinical educators in identifying nursing students' stressors, easing their learning in the clinical setting, and establishing an efficient PMHN course programme.

Perceived stress and coping strategies among Jordanian nursing students during clinical practice in psychiatric/mental health courses

A systematic review of qualitative studies exploring peer learning experiences of undergraduate nursing students.

Aims and objectives
To aggregate, interpret and synthesise findings from qualitative studies to further our knowledge regarding patients’ pre- and postoperative experiences when participating in an enhanced recovery after surgery.

Background
Numerous quantitative studies have documented benefits of participation in enhanced recovery after surgery programmes. Randomised control trials show that enhanced recovery after surgery reduce patient morbidity and shorten hospital length of stay. However, we presently have only sparse knowledge regarding patients’ experiences of participating in these programmes.

Design
A qualitative systematic review and meta-synthesis.

Methods
A systematic literature search of databases (Cinahl, Medline, PsycINFO, Ovid Nursing, and EMBASE) for qualitative studies published between 2000–2014 were undertaken. The identified studies were critically evaluated using the Critical Appraisal Skills Program, and patient experiences were synthesised into new themes by a team of researchers, using qualitative content analysis.

Results
Eleven studies were included. Upon analysis, four main themes emerged: information transfer, individualised treatment vs. standardised care, balancing burdensome symptoms and expectations for rapid recovery, and sense of security at discharge. Information helped patients feel secure and prepared for surgery. Patients reported being motivated to participate in their recovery process. However, this became challenging when they faced symptoms such as pain, nausea, and weakness. Professional support fostered a feeling of security that was important in helping patients continue their regimen, recover, and be discharged as early as planned.

Conclusions
Patients in enhanced recovery after surgery programmes desired more consistency between pre- and postoperative information. Important opportunities exist to improve symptom management and help patients feel more secure about recovery postoperatively.

Relevance to clinical practice
Nurses are in a unique position to improve communication of standardised regimens and enhance symptom management across the perioperative period. Clinical outreach, such as follow-up visits or phone calls, could target older adults who need additional assistance to meet enhanced recovery after surgery programme goals and derive benefit.

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Patients' experiences of enhanced recovery after surgery: a systematic review of qualitative studies

Background : Clinical education is an essential part of the nursing education program. It aims to achieve a set of competencies, integrate the theory with practice and enhance critical thinking and decision making abilities in the clinical setting. However, clinical education has been recognised to be perceived as a stressful event, especially for novice nursing students or nursing students who have no previous clinical experiences. Purpose : The purpose of this study was to explore and understand the meaning of lived experiences of stress for Indonesian  novice nursing students in clinical education. Methods : It was an interpretive qualitative study informed by phenomenology and, in particular, van Manen’s method. Six Indonesian novice nursing students undertaking clinical education at a nursing school on the Indonesian island of Sumatera participated via an international telephone interview. Thematic analysis, proposed by van Manen, was used to analyse  the data and capture the themes. Results and conclusion: Three main themes emerging from the study were “feelings of pressure”, “challenging relationships”, and “using coping strategies”. There were ten sub-themes, grouped as Clinical, Relationships and Responses and Coping. Nurses as educators play significant roles in assisting nursing students in clinical education to reduce feelings of stress, so that nursing students can undergo clinical education successfully.

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Nelwati

Papers

A systematic review of qualitative studies exploring peer learning experiences of undergraduate nursing students.

Indonesian student nurses' perceptions of stress in clinical learning: A phenomenological study

Factors influencing professional values among Indonesian undergraduate nursing students

The effect of peer learning on professional competence development among Indonesian undergraduate nursing students: A quasi-experimental study.