Overwhelming, demanding – yet a rewarding experience? A new study points to several measures that can make the first practice placement for student nurses safer and more educational.
What surprised me the most was the marked difference in how students experienced the follow-up during their practice."
Associate Professor Ingrid Espegren Dalsmo
Over several years, she has studied nursing students at 11 different nursing homes during their first practice period, using observations, individual and group interviews, as part of her doctoral research.
In Norway, nursing students spend half of their study time in practice, with a total of 2,300 hours. This is the part of their training where students participate in practical work in hospitals, nursing homes and similar settings.
"The practice component is a very important learning arena. Research shows that the first experiences impact future career choices. That is why we must create good learning environments from the start, as it contributes to a better education and encourages more people to stay in the profession," she says.
The researcher's five tips for student nurses in practice
- Focus on preparation for everyone involved.
- Utilize the start-up interview to establish a safe space for learning.
- Reflection supports students both academically and emotionally.
- Provide continuous feedback.
- Use relevant educational tools that are available in the programme.
Changes in older people's care - a shock for many
Nursing homes are traditionally the first practice site, and for many students, this is also their very first encounter with both patients and the nursing profession.
"There is a growing need for nurses caring for older people. Nursing homes have also changed a lot in recent decades: Patients are sicker, live longer and require advanced nursing care," says Espegren Dalsmo, who has a background as a nurse, practice supervisor and lecturer in the nursing programme.
For many students, it can be a shock.
"They encounter seriously ill patients, they are given responsibility and are expected to learn and develop at the same time. It's not just about providing care, it's also about making complex clinical assessments."
Varying levels of feedback and room for reflection
During their practice, student nurses study as they do at university. Various learning activities, written and oral assignments and assessments help ensure that they achieve learning outcomes.
But unlike at university, where they are the primary focus as students, patients come first in the nursing home.
"Naturally, they feel uncertain in this setting. 'Am I doing it right?', 'What should I do now?'," says Dalsmo.
There was great variation in the feedback students received during their practice.
"How the students were met and supported made a big difference. There is so much going on, and it's easy to forget that they are not employees. They are there to learn, just like at university."
Make the most of the collaboration with supervisor and lecturer
Students are paired with a nurse who is also their practice supervisor, while the lecturer from their programme visits occasionally.
The so-called "tripartite meeting", where the student, practice supervisor and lecturer all come together, is usually the only setting where all three parties meet.
"It is crucial to make the most of these meetings. Here students reflect on what they have learned. Nevertheless, there is great variation in how these meetings are conducted," says Espegren Dalsmo.
Some meetings focused primarily on formalities and less on the students' nursing experiences at the nursing home.
"The first meeting is particularly important, because it sets the foundation for the journey ahead. If you take time to get to know the student, such as what they bring with them and who they are, you create a safe space for dialogue and the learning process going forward," she says.
Emotional support is also needed
By observing students, the researcher discovered how important it is that they also receive emotional support.
"Many encounter death and serious illness for the first time, and dealing with their own emotions is part of the learning process entering the nursing profession," says Espegren Dalsmo.
Practice supervisors and lecturers play a key role in helping students reflect on their experiences, preventing them from becoming overwhelmed.
"Learning emotion regulation techniques can also help prevent dropouts - and not scare students away. It's not about 'wrapping them in cotton wool' and handing everything on a silver platter, but about guiding them through in a positive way. Here, practice supervisors also serve as important role models," she believes.
Everyone involved must actively participate in student learning
As a learning support and professional resource during the practice period, some students and practice supervisors tested a digital learning tool. This tool is used to prepare for practice and to support learning and reflection during and afterward.
Espegren Dalsmo interviewed 23 students about their use of this tool. There was great variation in how and to what extent it was used.
"One reason for the variation is that both the lecturer and practice supervisor did not use it as much. Students want them to explore it together and use it actively," she says.
The learning tool is designed to support the students' learning, making it very helpful when everyone involved participates actively.
"But it also depends on the practice supervisor's aivailable time, as well as the lecturer, who has to follow up on multiple students at the same time," she points out.
New opportunities with a university nursing home
Espegren Dalsmo is currently involved in developing Norway's first university nursing home, a collaborative effort between UiA, Agder Vocational College and Grimstad municipality.
The building is scheduled for completion in 2030 near UiA's Campus Grimstad. But work is already underway to create robust research environments and connect them more closely to solve challenges in older people's care.
This knowledge could be of great importance in the coming years, and she envisions strong opportunities to rethink practical studies through the university nursing home.
"Here we can organize learning in innovative ways and conduct skills development for students and employees alike."
Espegren Dalsmo believes action is also needed at the political level:
"There should be national standards for practical studies to ensure student learning and high-quality education," she says.
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