Relationships between reality shock, professional self-concept, and nursing students' perceived trust from nursing educators: A cross-sectional study

Journal Pre-proof Relationships between reality shock, professional self-concept, and nursing students' perceived trust from nursing educators: A cross-sectional study

Ji-Soo Kim PII:

S0260-6917(19)31409-1

DOI:

https://doi.org/10.1016/j.nedt.2020.104369

Reference:

YNEDT 104369

To appear in:

Nurse Education Today

Received date:

17 September 2019

Revised date:

17 December 2019

Accepted date:

15 February 2020

Please cite this article as: J.-S. Kim, Relationships between reality shock, professional selfconcept, and nursing students' perceived trust from nursing educators: A cross-sectional study, Nurse Education Today(2020), https://doi.org/10.1016/j.nedt.2020.104369

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© 2020 Published by Elsevier.

Journal Pre-proof Relationships between reality shock, professional self-concept, and nursing students’ perceived trust from nursing educators: A cross-sectional study

Author name

Ji-Soo Kim, RN, Ph D (Corresponding)

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Associate Professor,

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College of Nursing, Gachon University

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191 Hambakmoero, Yeonsu-gu, Incheon, 21936, Republic of Korea

Tel: +82-32-820-4206

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E-mail: [email protected]

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Fax: +82-32-820-4201

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(GCU-2019-0344)‖

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Acknowledgments: ―This work was supported by the Gachon University research fund of 2019.

Conflict of interest: The author reports no conflicts of interest relevant to this article.

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Funding: This work was supported by the Gachon University research fund.

Journal Pre-proof Relationships between reality shock, professional self-concept, and nursing students’ perceived trust from nursing educators: A cross-sectional study

Abstract Background: Nursing students establish their professional role through clinical practice. However, during the first clinical practice, they might experience reality shock given the gap

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between theory and practice, which could negatively influence their professional self-concept.

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Furthermore, nursing educators in clinical practice play an important role in improving nursing

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students’ clinical experience.

Objectives: To examine the relationship between nursing students’ reality shock and professional

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self-concept, and to examine the associations of perceived trust from nursing educators with

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nursing students’ reality shock and professional self-concept.

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Design: A cross-sectional, descriptive correlational study Setting: Nursing schools in one metropolitan area and three cities in South Korea

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Participants: Data were collected from 184 nursing students who experienced their first clinical

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practice in preceding four weeks of data collection. Methods: Surveys assessing participants’ characteristics, reality shock, professional selfconcept, and perceived trust from nursing educators were conducted. A hierarchical regression analysis was performed to examine the relationship between reality shock and professional selfconcept, and the relationships between perceived trust from nursing educators and nursing students’ reality shock and professional self-concept. Results: Nursing students’ reality shock was negatively related to their professional self-concept. Perceived interpersonal relationship with nursing educators was positively related to professional

Journal Pre-proof self-concept and negatively related to the experienced reality shock. Furthermore, this negative relationship decreased when reality shock was combined with perceived interpersonal relationship with nursing educators. Conclusions: Nursing students’ reality shock during their first clinical practice may be negatively associated with the establishment of their professional self-concept. However, students’ reality shock could be reduced by enhancing their interpersonal relationship with the

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nursing educator, which might reduce the negative association of reality shock with professional

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self-concept. Therefore, nursing educators should develop skills to establish interpersonal

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relationships with students to positively influence students’ clinical adaptation. Keywords: reality shock, clinical practice, professional self-concept, nursing student,

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interpersonal relationship

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Introduction

Clinical practice is an essential aspect of nursing education that enables students to apply

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theoretical knowledge to developing skills. Furthermore, a clinical environment also enables

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nursing students to prepare for actual nursing practice and the requirements of future nursing professionals (Collier, 2018; Salifu et al., 2018). However, in contrast to the supportive teaching environment of nursing schools, most nursing students who begin their clinical practice are placed in unfamiliar clinical environments. In addition, they lack experience in providing care to patients in collaboration with other healthcare professionals in real-life clinical settings (Alshahrani et al., 2018; Mlinar Reljić et al., 2019). Numerous studies have reported that nursing students experience nervousness, distress, confusion, and anxiety during their first clinical practice (Alshahrani et al., 2018; Levett-Jones et al., 2015; Mlinar Reljić et al., 2019; Sun et al.,

Journal Pre-proof 2016). Moreover, nursing students tend to perceive a considerable gap between their expectations and actual experiences at the clinical environment. Studies have also reported that they experience a conflict between the theoretical content taught in nursing schools and actual clinical practice (Papathanasiou et al., 2014; Salifu et al., 2018).

Background

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The term ―reality shock‖ initially referred to newly graduated nurses’ experiences of

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conflict between their nursing preparation and adaptation to a professional nurse’s role (Kramer,

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1974). However, recent studies suggest that the term could also be used to describe nursing students’ experiences of real-life clinical practice, which differ from their expectations based on

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theoretical knowledge (Kaihlanen et al., 2019; Kim and Shin, 2019; Salifu et al., 2019).

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Successful clinical experiences can help students to enhance their nursing skills, as well as can

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provide opportunities to develop nursing professionalism (Alshahrani et al., 2018; Kwon and Kim, 2018). A previous study reported that nursing students’ professional self-concept is

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positively associated with their satisfaction with clinical practice (Dong and Choi, 2016). On the

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other hand, adverse experiences might negatively influence their professional self-concept (Barry et al., 2019; Dong and Choi, 2016). Professional self-concept refers to nurses’ thoughts and feelings about themselves as a nurse. It is one of the vital components for improving nursing professionalism in nursing education, clinical practice, and nursing management (Arthur and Randle, 2007). It is an ongoing process since professional self-concept may develop during nursing students’ transition from nursing schools to clinical settings (Barry et al., 2019; Dong and Choi, 2016). Furthermore, professional self-concept is distinct from self-efficacy, which is defined as believing in one’s own capabilities to act efficiently in different situations (Bandura,

Journal Pre-proof 1993). Professional self-concept is regarded as an individual’s subjective perception of themselves as a professional in their nursing roles, while self-efficacy does not involve the perception of one’s own self-worth (Arthur and Randle, 2007; Bandura, 1993). Previous studies have reported that higher professional self-concept and self-efficacy are related to nursing students’ professional competence, which is defined as the ability to apply knowledge, skills, and attitude to their clinical practice (Gardulf et al., 2016; Kwon and Kim, 2018; Mohamadirizi et al.,

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2015). However, little is known about the relationship between nursing students’ professional

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self-concept and reality shock during their first clinical practice.

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According to previous studies, nursing educators in clinical practice play an important role in improving nursing students’ clinical experiences (Arkan et al., 2018; Kim and Shin,

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2018). In South Korea, nursing educators refer to professionals who guide nursing students’

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clinical practice and are of two types. School clinical instructors refer to nurses who primarily

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work in nursing schools and meet students regularly at clinical sites to teach nursing practice, while clinical nurse instructors or registered nurses are nurses working in hospitals, who are

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delegated by the nursing school to coordinate students with patients (Jang and Lee, 2017). The

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Korean Accreditation Board of Nursing Education requires school clinical instructors to have a master’s degree and clinical nurse instructors to have a bachelor’s degree in nursing. Furthermore, school clinical instructors must have at least two years of nursing experience, while clinical nurse instructors are required to have at least three years of nursing experience (Korean Accreditation Board of Nursing Education, 2019). Nursing educators help students to incorporate theoretical knowledge into clinical practice and to better adapt to real-life nursing work expected in clinical environments (Kim and Shin, 2017; Valiee et al., 2016). Therefore, nursing educators play a crucial role in the development of nursing students’ professionalism and clinical

Journal Pre-proof experiences (Ismail et al., 2016; Niederriter et al., 2017). Previous studies have reported that the common characteristics of efficient nursing educators perceived by nursing students include interpersonal relationships with students and nursing competence in terms of professional knowledge and skills (Collier, 2018; Ismail et al., 2016; Valiee et al., 2016). More importantly, nursing students reported that a trusting relationship with nurse educators is an effective factor to improve their clinical learning experience (Niederriter et al., 2017). However, no empirical

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studies have examined the association of nursing educators’ trust with nursing students’

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professional self-concept and reality shock during nursing students’ first clinical practice.

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Therefore, the present study aimed to examine the relationships between reality shock, professional self-concept, and nursing students’ perceived trust from nursing educators.

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Moreover, this study introduced grade point average (GPA) as a confounding variable, since

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academic achievements are related to nursing students’ clinical practice and professional self-

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concept (Je and Bang, 2018; Yoo and Choi, 2019). Based on a literature review (Arkan et al., 2018; Barry et al., 2019; Dong and Choi, 2016; Ismail et al., 2016; Niederriter et al., 2017; Kim

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and Shin, 2018), the present study hypothesized that reality shock experienced by nursing

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students during first their clinical practice would negatively influence their professional selfconcept. In addition, the present study hypothesized that nursing educators’ trust perceived by nursing students would reduce their reality shock in clinical practice, and that it would positively influence their professional self-concept. Figure 1 shows the conceptual framework of the present study.

Method Design and Participants

Journal Pre-proof This study employed a cross-sectional descriptive correlational study design. Participants were nursing students who experienced clinical practice for the first time. Four nursing schools providing a four-year nursing study course were selected by convenience sampling method to recruit participants. The nursing schools were located in one metropolitan area and three cities in South Korea. The inclusion criteria were 1) nursing students who finished their first stage of clinical practice as part their nursing study course, 2) and those who undertook clinical practice

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during the last four weeks for the first time. In South Korea, most nursing students undertake

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clinical practice for at least four weeks during their first practicum course. Students who

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undertook clinical practice in a previous nursing school and transferred to the present nursing school were excluded from the study. The sample size was estimated using G*Power 3.1.9.4

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(Faul et al., 2009). The minimum sample size required for a multiple linear regression analysis

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was 181, assuming an effect size of 0.10, significance level of 0.05, a power of 0.90, and six

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predictors. However, considering the possibility of dropout, the questionnaires were distributed to 200 nursing students. Of them, 189 questionnaires were returned (response rate: 94.5%).

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However, four questionnaires with incomplete responses and one participant who did not meet

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the inclusion criteria were excluded. Thus, 184 questionnaires were used in the analyses as valid data.

Measures Self-administered questionnaires were used to collect data on participants’ characteristics (age, sex, and GPA in the previous semester), experience of reality shock, professional selfconcept, and perceived trust from nursing educators. Reality shock was measured using the Transition Shock Scale for Nursing Students,

Journal Pre-proof modified and validated by Kim and Shin (2019). The original scale was developed by Kim et al. (2017) to measure newly graduated nurses’ transition shock, and it consists 18 items across six subscales. However, the modified version of the scale Kim and Shin (2019) consists of 17 items across six subscales: conflict between theory and practice (3 items), overwhelming practicum workload (3 items), loss of social support (2 items), shrinking interpersonal relationship (3 items), ambiguity in professional nursing values (4 items), and incongruity between clinical

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practicum and personal life (2 items). Each item is rated on a 4-point Likert scale (1 = ―strongly

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disagree‖; 4 = ―strongly agree‖). An example item is, ―I feel frustrated with the nursing

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hierarchy.‖ The total score ranges from 17 to 68, with higher scores indicating greater reality shock during clinical practice. In Kim and Shin’s (2019) study, the content validity indexes

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(CVI) of all items were more than .78, and the average variance extracted (AVE) was .51–.68 in

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a confirmatory factor analysis for construct validity test. The reliability coefficient (Cronbach's

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alpha) of the scale in Kim and Shin’s (2019) study was .85; in the present study, it was .82. Professional self-concept was measured using the Korean version of the Professional

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Self-Concept scale (Sohng and Noh, 1996), which was translated and validated from the

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Professional Self-Concept of Nurses Instrument (Arthur, 1995). It consists of 27 items across three subscales: professional practice (16 items), communication (7 items), and satisfaction (4 items). Each item is rated on a 4-point Likert scale (1 = ―strongly disagree‖; 4 = ―strongly agree‖). An example item is, ―Overall, I am satisfied with my creative approach to my clinical practice as a nurse.‖ The total score ranges from 27 to 108, with higher scores indicating higher professional self-concept as a nurse. This scale was validated through an exploratory factor analysis in Sohng and Noh’s (1996) study; the three factors explained 38.1% of variance. The reliability coefficient (Cronbach's alpha) of the scale in Sohng and Noh’s (1996) study was .85; in

Journal Pre-proof the present study, it was .88. Perceived trust from nursing educators was measured using the Professor Trust Scale developed by Jeong and Park (2009). This scale comprises 27 items across four characteristics of a trusted professor: interpersonal relationship (8 items), expertise (8 items), teaching skill (5 items), and leadership (6 items). However, the present study used two characteristics, ―interpersonal relationship‖ and ―expertise,‖ given that nursing students perceive interpersonal

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relationships and professional competence as the characteristics of an efficient nursing educator

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(Collier, 2018; Ismail et al., 2016; Valiee et al., 2016). Using a 5-point Likert scale ranging from

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1 (strongly disagree) to 5 (strongly agree), participants rated the extent to which they perceived each item during the clinical practice in the preceding four weeks. An example item of the

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perceived interpersonal relationship with nursing educators is, ―The nursing educators are

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friendly to students.‖ An example item of the perceived expertise is, ―The nursing educators are

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expert in their field.‖ The total score ranges from 8 to 40, with higher scores indicating greater perceived interpersonal relationship and expertise among nursing educators. This scale was

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validated through an exploratory factor analysis in Jeong and Park’s (2009) study; the four

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factors explained 70.7% of variance. The reliability coefficient of the scale in Jeong and Park’s (2009) study, the Cronbach’s alphas for perceived interpersonal relationship and expertise were .78 and .77, respectively. In the presents study, Cronbach’s alphas were .93 and .94, respectively.

Data Collection Data were collected from May to June 2019. Convenience sampling method was used to select four undergraduate nursing schools providing a four-year nursing course. An email was sent to professors who taught third-year nursing students, as most of the nursing students in South Korea

Journal Pre-proof begin their clinical practicum in the third year. The e-mail included the purpose of study, inclusion criteria, contents of the questionnaire, and the certificate from the institutional review board (IRB). After obtaining permission from the professors to collect data, parcels were mailed to the professors. Depending on the request of each professor, 40–80 questionnaires, informed consent form, return envelopes, and ball pens for participants who completed the questionnaires were provided. The nursing professors explained the purpose of the study to nursing students

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who completed four weeks of clinical practice in the first stage of their practicum and returned to

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the school for the theoretical course. The questionnaire and informed consent form were

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distributed to nursing students who agreed to participate; none of the students disagreed to participate. After providing written informed consent, the participants immediately completed

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the questionnaires. Participants put the completed questionnaires inside the return envelopes. The

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questionnaire took approximately five minutes to complete, and participants were given a ball

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pen for their cooperation. The professors mailed the completed questionnaires and written

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Data Analyses

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consent forms to the researcher.

The data were analyzed using SPSS Statistics 25.0 (IBM Corp., Armonk, NY, USA). The normal distribution of the study variables was confirmed using the Kolmogorov-Smirnov test (p > .05). Means, standard deviations (SD), and frequencies with percentages were computed to describe participants’ characteristics, experiences of reality shock, professional self-concept, and perceived trust from nursing educators. Pearson’s and Spearman’s correlation coefficients were used to examine the correlations among the study variables. To examine the relationship between the study variables, a hierarchical multiple regression was performed in three stages. The

Journal Pre-proof statistical assumptions for the regression analysis are met when there is no multicollinearity. The variance inflation factors were between 1.076 and 1.291, which were below the 10.0 cut-off, indicating the absence of multicollinearity (Kutner et al., 2004).

Ethical Considerations Prior to data collection, the study protocol was approved by the relevant institutional review

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board (IRB Approval No.). Written informed consent was obtained from each individual

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participant prior to survey. Participants were informed that participation is voluntary, that

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participants’ anonymity is guaranteed, and that the collected data would be only coded into numbers. Participants were also informed that no personal information would be provided to

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external parties and that they could withdraw their participation at any time without any negative

Results

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Participants’ characteristics

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consequences.

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The mean age of the participants was 21.5 (SD = ±1.5) years. Most of the participants were female (90.8%). The highest proportion of participants (37.0%) had an average grade of 3.0–3.4, followed by 3.5–3.9 (33.2%; Table 1).

Mean scores and correlations among the study variables Participants’ mean score on reality shock was 41.5 (SD = ±6.9) out of 68.0. The mean score on professional self-concept was 73.4 (SD = ±9.7) out of 108.0. As for the perceived trust from nursing educators, the mean scores on interpersonal relationship and expertise were 29.0

Journal Pre-proof (SD = ±6.8) and 33.4 (SD = ±5.4) out of 40.0, respectively. The participants perceived higher educator expertise than interpersonal relationship (Table 2). Reality shock had a significant negative correlation with professional self-concept (r = .53, p < .001). Perceived interpersonal relationship with the nursing educator had a significant negative correlation with reality shock (r = –.27, p < .001) and a positive correlation with professional self-concept (r = .41, p < .001). However, perceived nursing educators’ expertise

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had a significant positive correlation with only professional self-concept (r = .25, p = .001).

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Relationships between reality shock, professional self-concept, and perceived trust from nursing educators

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Table 3 shows the results of the hierarchical regression analysis after adjusting for

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participants’ characteristics. In the first model, the results showed that perceived nursing

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educators’ interpersonal relationship was negatively related to reality shock (β = –.29, p = .003), explaining 7.0% of the variance in reality shock. Meanwhile, in the second model, GPA (β = .14,

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p = .042) and nursing educators’ interpersonal relationship (β = .41, p < .001) were positively

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related to professional self-concept, explaining 17% of the variance in professional self-concept. In a third model, in which reality shock was entered as an independent variable, reality shock was negatively related to professional self-concept (β = –.54, p < .001) and positively related to GPA (β = .17, p = .009), explaining 30% of the variance in professional self-concept. When both perceived trust from nursing educators and reality shock were entered in the fourth model, GPA (β = .14, p = .022) and nursing educators’ interpersonal relationship (β= .27, p = .001) were positively related to professional self-concept, while reality shock was negatively related to professional self-concept (β= -.46, p < .001), explaining 36% of the variance in professional self-

Journal Pre-proof concept. However, perceived expertise of nursing educators was not related to nursing students’ reality shock and professional self-concept. Figure 2 presents the relationships among reality shock, professional self-concept, and perceived nursing educators’ interpersonal relationship in nursing students’ clinical practice. Higher reality shock experience was related to less professional self-concept (β = –.54, p < .001). Meanwhile, higher perceived nursing educators’ interpersonal relationship was related to less

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reality shock (β = –.29, p = .003), while higher perceived nursing educators’ interpersonal

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relationship was related to higher professional self-concept (β = .41, p < .001). However, reality

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shock combined with nursing educators’ interpersonal relationship reduced nursing students’

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professional self-concept (β = –.54, p < .001 → β = –.46 p < .001).

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Discussion

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Clinical practice for nursing students is more than just education; it is a process of transitioning from a nursing student to a professional (Kim and Shin, 2019; Mlinar Reljić et al.,

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2019). However, as they transition from a familiar school environment to an unfamiliar clinical

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environment, during their first contact with a clinical environment, they might experience a reality shock due to the gap between theory and practice and an environment different from their expectation (Kaihlanen et al., 2019; Salifu et al., 2019). Kramer (1974) emphasized that reality shock stems from the conflict between ―professional‖ and ―bureaucratic‖ orientations in the school and hospital contexts. Therefore, role-related conflicts between idealized role (professional) in the school and actualized role (bureaucratic) in the clinical practice can be anticipated during nursing students’ first clinical practice. The nursing students’ reality shock level in the present study was similar to that of registered nurses in a study by Kim et al. (2017).

Journal Pre-proof Previous studies suggest that negative experiences in clinical practice due to reality shock can influence the establishment of nursing students’ professional role (Barry et al., 2019; Salifu et al., 2018). The present study found that higher reality shock experienced by nursing students during first clinical practice was related to a lower professional self-concept. Similarly, a previous study showed that the reality shock might have the strongest influence on nursing students’ adaptation to clinical practice (Kim and Shin, 2018). Accordingly, the study results suggest that reducing

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reality shock might help nursing students to adapt to the clinical environment in order to

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establish their professional self-concept as a nurse in the future. Furthermore, nursing students’

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clinical practice should also be understood as a transition process that matches the experiences of newly graduated nurses in their first clinical setting. Nurse educators should be aware that the

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reality shock experienced by nursing students might be associated with this process.

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Although it is difficult to reduce reality shock by being exposed to clinical practice alone,

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it can be controlled by nursing students’ preparation for the transition or through social support (Kumaran and Carney, 2014). In this context, nursing educators can play the most effective role

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in students’ clinical learning process by providing adequate educational and professional support

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(Arkan et al., 2018; Valiee et al., 2016). The present study revealed that higher perceived interpersonal relationship with nursing educators was related to lower reality shock and higher professional self-concept during the first clinical practice. Meanwhile, perceived nursing educators’ expertise was correlated with nursing students’ professional self-concept in the univariate analysis; however, it was not related to reality shock and professional self-concept in the multiple linear regression. The results of this study suggest that among the characteristics of trusted nursing educators, interpersonal relationship—rather than expertise—is more practically associated with nursing students’ reality shock and professional self-concept. In particular, the

Journal Pre-proof negative association of reality shock with professional self-concept decreased when nursing students perceived an interpersonal relationship with the nursing educators. This suggests that among the characteristics of trusted nursing educators, interpersonal relationship might be associated with lower reality shock experienced by students during their first clinical practice, which might be associated with higher professional self-concept in nursing students. Similarly, previous studies have also shown that trusting relationships and guidance from nursing educators

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who aim to address the problems of students were the most effective characteristics preferred by

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the students (Niederriter et al., 2017; Valiee et al., 2016). However, in the present study, the

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students perceived more expertise rather than interpersonal relationship. Therefore, in order to reduce the reality shock of students during the first clinical practice and to improve the nursing

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practice experience of the nursing students, it is necessary for nursing educators to develop the

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ability to establish interpersonal relationships.

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Additionally, the present study found that higher GPA of the participants was related to higher professional self-concept. A recent study (Yoo and Choi, 2019) showed that academic

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achievements are correlated with nursing students’ professional self-concept. Furthermore, Wang

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et al. (2019) also showed that the professional self-concept of nursing students negatively is related to their academic burnout. Therefore, it is recommended that future studies of nursing students’ professional self-concept consider the academic achievements of the students as a confounding variable.

Limitations Although this study identified the perceived interpersonal relationship with nursing educators associated with nursing students’ reality shock and professional self-concept during their first

Journal Pre-proof clinical practice, there are several limitations to this study. First, since the participants of this study were nursing students from South Korea, it is difficult to generalize the results to nursing students from other countries or from different cultural backgrounds. Second, the Professional Self-Concept Scale used in this study was originally developed to measure the professional selfconcept of registered nurses. Further studies are needed to develop a standardized tool to measure the professional self-concept of Korean nursing students. Third, the present study only

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considered interpersonal relationship and expertise among the characteristics of nursing

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educators’ trust. Future studies are needed to identify different characteristics related to nursing

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students’ reality shock and professional self-concept. Finally, the cross-sectional design

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precludes causal inferences; therefore, the study findings should be interpreted with caution.

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Conclusions

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Professional self-concept is a critical factor to reduce nurses’ stress in clinical settings and to maintain nursing professionalism (Cao et al., 2015). However, the results from the present

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study suggest that the reality shock experienced by nursing students in their first clinical practice

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is negatively associated with the establishment of professional self-concept. Therefore, nursing educators should be aware that the reality shock of nursing students is similar to that of newly registered nurses in their first clinical setting, and educational strategies should be developed to reduce the reality shock. The present study suggests perceiving higher interpersonal relationship with nursing educators might be associated with lower reality shock in nursing students. Moreover, the negative association of reality shock with professional self-concept could be reduced when perceived interpersonal relationship with nursing educators was combined with reality shock. However, perceived expertise of nursing educators was not associated with reality

Journal Pre-proof shock and professional self-concept. Nursing educators should be aware that establishing interpersonal relationships with students might be positively associated with the clinical adaptation of the students and therefore, should develop an ability to establish trusting interpersonal relationships. The results from the present study provide more insight into the association between nursing educators’ trust and students’ clinical practice. However, since only two types of characteristics of trusted nursing educators were considered in this study, it is

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recommended that future studies explore other characteristics that affect reality shock and

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nursing professionalism. Furthermore, studies need to examine the mediating effects of nursing

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educators’ trust in relationship between reality shock and professional self-concept in nursing

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students.

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Journal Pre-proof Author statement

Ji-Soo Kim: Conceptualization, Methodology, Software, Data curation, Writing-Original draft

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preparation, Investigation, Validation, Writing- Reviewing and Editing

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Figure 1 The conceptual framework of the present study

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Figure 2 Results of the hierarchical multiple regression of the relationships between reality

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shock, professional self-concept, and perceived interpersonal relationship

Journal Pre-proof Table 1 Participants’ Characteristics (N = 184) Characteristics

n (%) Mean ± SD

21.5 ± 1.5

(range 20–27)

Sex

Female

167

(90.8)

Male

17

(9.2)

Year in school

Third

184

(100.0)

GPA on a 4.5 scale in the previous

≤ 2.4

1

(0.5)

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Age (years)

18

(9.8)

3.0–3.4

68

(37.0)

3.5–3.9

61

(33.2)

≥ 4.0

36

(19.6)

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2.5–2.9

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semester

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Note. SD = standard deviation, GPA = grade point average

Journal Pre-proof Table 2 Means and Correlation Coefficients of the Study Variables (N = 184) Variable

Mean ± SD

Perceived interpersonal

Perceived expertise

Reality sho

relationship

r (p)

r (p)

r (p) Perceived interpersonal

29.0 ± 6.8

1

Perceived expertise

33.4 ± 5.4

.64 (< .001)

1

Reality shock

41.5 ± 6.9

-.27 (< .001)

-.13 (.073)

1

Professional self-concept

73.4 ± 9.7

.25 (.001)

-.53 (<.001

GPA on a 4.5 scale in the

3.6 ± 0.9

.08 (.293) b

-.02 (.817)

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.41 (< .001) .08 (.266) b

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previous semester a

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relationship

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Table 3

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Note. SD = standard deviation. a GPA (grade point average) was measured as an ordinal measure (1 = ≤ 2.4, 2 = 2.5–2.9, 3 = 3.0–3.4, 4 = 3.5–3.9, 5 = ≥ 4.0) b Spearman’s Rho correlation coefficients

Hierarchical Regression Analysis Predicting the Relationships Between Reality Shock, Professional Self-concept, and Perceived Trust from Nursing Educators (N = 184) pendent variables Reality shock Professional selfProfessional selfconcept concept Model 1 Model 2 Model 3 β (p) β (p) β (p)

e (years) (female) a

A on a 4.5 scale in the previous mester b

ceived interpersonal relationship

Professional se concept Model 4 β (p)

-.01 (.987)

.08 (.295)

.07 (.269)

.07 (.235)

.14 (.072)

.03 (.734)

.09 (.160)

.09 (.166)

-.01 (.949)

.14 (.042)

.17 (.009)

.14 (.022)

-.29 (.003)

.41 (<.001)

.27 (.001)

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ceived expertise

.03 (.723)

-.02 (.832)

-.01 (.965)

ality shock

.17

.30

.36

3.67 (.004)

8.25 (< .001)

20.74 (< .001)

18.35 (< .001)

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Note. a Dummy coded. b GPA (grade point average) was entered as an ordinal measure (1 = ≤ 2.4, 2 = 2.5–2.9, 3 = 3.0–3.4, 4 = 3.5–3.9, 5 = ≥ 4.0)

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p)

-.46 (< .001)

.07

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usted R2

-.54 (<.001)

Journal Pre-proof Highlights Nursing students experience reality shock during their first clinical practice.



Experience of reality shock is negatively related to professional self-concept.



Interpersonal relationship may influence reality shock and professional self-concept.



Interpersonal relationship may reduce reality shock’s effects on professionalism.



Nursing educators should enhance interpersonal relationships with students.

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

Figure 1

Figure 2