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Supporting students in professional socialisation: Guidelines for professional nurses and educators
International Journal of Africa Nursing Sciences 6 (2017) 1–7
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International Journal of Africa Nursing Sciences journal homepage: www.elsevier.com/locate/ijans
Supporting students in professional socialisation: Guidelines for professional nurses and educators Hester Cathrina (Rina) de Swardt a,⇑, Gisela H. van Rensburg b, M.J. Oosthuizen c a
Tshwane University of Technology, Adelaide Tambo School of Nursing Science, Building 5-333, Private Bag x 680, Pretoria 0001, South Africa Unisa, Department of Health Studies, Theo van Wijk Building 6-188, PO Box 392, Unisa, 0003, South Africa c Department of Health Studies, Theo van Wijk Building 6-182, PO Box 392, Unisa, 0003, South Africa b
a r t i c l e
i n f o
Article history: Received 3 September 2016 Accepted 23 November 2016 Available online 1 December 2016 Keywords: Professional socialisation Students Values Nursing education institution
a b s t r a c t Professional socialisation of nursing students involves learning skills, attitudes, behaviour and professional roles, largely in the clinical area. During clinical accompaniment and reflective discussions with a group of undergraduate Baccalaureate nursing students in South Africa, students reported negative professional socialisation experiences, primarily in the clinical area. Such experiences could influence the quality of patient care. The objective of this study was to develop and validate guidelines to support professional nurses and educators in the professional socialisation of student nurses. Evidence was generated from an exploration and description of the perceptions of professional nurses regarding their role in the professional socialisation of students, the perceptions of nurse educators regarding the teaching and facilitation of professional socialisation of students, and the socialisation experiences of students. Following a sequential mixed-methods design, qualitative data guided the collection of quantitative data. All data and literature directed the development of these guidelines, which experts reviewed and validated according to a set of criteria. These guidelines focus on the clinical, nursing educational institution environment and values and beliefs of the nursing profession. Facilitation of sound work ethics, professional behaviour, cultural and gender awareness, role modelling and the application of a range of teaching strategies is proposed. Ó 2016 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
2. Background and rationale
The nursing profession in South Africa should be reconstructed and revitalised to ensure optimal care to all citizens of South Africa (South-Africa, 2013). The strategic plan for nurse education and training in South Africa emphasises the urgency to improve the image of nursing and confidence in the profession. Negative reports on nurses’ professional behaviour contribute to an image of a non-caring profession (Oosthuizen, 2012; South-Africa & Strategic Plan for Nurse Education, 2013). Appropriate socialisation of students into the profession is essential. Nursing schools, the clinical learning environment and the students themselves are integral parts in this process. The process through which students learn the values, attitudes and goals of the profession to form a professional identify is complex, continuous and unpredictable (Dinmohammadi, Peyrovi, & Mehrdad, 2013).
During the professional socialisation process, the student internalises the professional values, technology and language of the profession, which is visible in how the nurse performs the daily nursing activities. Various socialisation agents may influence this process. These agents may include teaching strategies, a curriculum approach, planned clinical learning experiences and the influential role of the educator, mentor, preceptor and peer. Accidental socialisation occurs mostly in the clinical setting where students encounter diverse and unpredictable situations. For example, in a controlled classroom setting the educator can facilitate debates regarding appropriate communication with patients. However, in practice students might encounter insensitive and discourteous engagements with patients (Hovland & Johannessen, 2015). Students learn to apply practical competencies in the clinical setting. They learn by imitating their role models and try to fit into the nursing environment where they gain practical experience. Candidates who select nursing as a profession might have various reasons for their choice. Financial gain, job security, a desire to care and previous encounters with nurses in practice might be
⇑ Corresponding author. E-mail addresses: [email protected] (Hester Cathrina (Rina) de Swardt), [email protected] (G.H. van Rensburg), [email protected] (M.J. Oosthuizen).
http://dx.doi.org/10.1016/j.ijans.2016.11.002 2214-1391/Ó 2016 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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some of the reasons (Hollup, 2012; Price, McGillis Hall, Angus, & Peter, 2013). Students enter the profession with their own set of values and beliefs. Values are learned and influence an individual’s behaviour, which consequently influences how nursing is valued and practised. Kaya, Kaya, S ß enyuva, and Isßık (2012) argue that moral and religious values guide a person’s career choice, such as nursing. Considering all the diverse influences on the professional socialisation of students, it is essential that an appropriate process be facilitated to ensure that patients are nursed by an admirable calibre of nurse. 3. Problem statement The nursing profession in South Africa is challenged by negative media reports on misconduct, shortage of nurses, poor working conditions, perceived negative attitudes and ill-disciplined staff, which affect the quality of nursing care (James & Miza, 2015; Oosthuizen, 2012). This could be a consequence of poor/inadequate socialisation of students in the profession. Nurse educators and professional nurses act as socialisation agents, influencing the novices to assume their professional roles as nurses. These influences could be either positive or negative. A group of undergraduate Baccalaureate nursing students in South Africa reported having negative professional socialisation experiences, primarily in the clinical area. Similar experiences were noticed during clinical accompaniment of students. The problem of exposing students to unprofessional behaviour gave rise to the question: How can the internalisation of skills, knowledge, values and beliefs be guided so that student nurses can be helped to become effectively socialised as professional nurses? 4. Purpose of the article This article reports on guidelines that were developed and validated, which could support professional nurses and educators in the professional socialisation of students. 5. Definition of concepts
6. Research design and guideline development Data were collected applying a sequential, exploratory, mixedmethods design, which informed the development of guidelines. In Phase I, a qualitative, exploratory and descriptive design was followed to obtain data from students’ experiences regarding their professional socialisation as members of the profession and the perceptions of professional nurses, in terms of their role in the professional socialisation of students. Data collection occurred in an academic hospital in Gauteng, South Africa. Five focus group interviews supported by field notes, were conducted. The verbatim transcripts were analysed, utilising Tesch’s (1990) data analysis method. During Phase II, this evidence and literature were used for item generation of an instrument to explore and describe the perceptions of nurse educators’ teaching and facilitation strategies of professional socialisation to students quantitatively. All nursing education institutions’ educators in Gauteng, teaching a specific undergraduate nursing programme, were targeted. The data sets (qualitative and quantitative) were integrated with an extensive literature review using logical reasoning. Based on that, concluding statements (Table 1) were made that led to the development of the guidelines. The guidelines were reviewed and validated by means of a convenient sample of twelve experts who included managers from nursing education institutions, professional nurses, nurse managers, experts in guideline development and educators closely involved with student support. Nine willing and available participants reviewed and validated the guidelines according to the following criteria: clarity, comprehensiveness, applicability, adaptability, credibility and validity. A validation tool with the options not acceptable, acceptable with recommendations or acceptable, could be selected for each criterion. Additional comments could be made. Most of the participants accepted the guidelines as described, since the recommendations were rated as concrete, precise, addressing all aspects of professional socialisation and basing the conclusions and interpretations on true findings. However, cost implications and staffing were indicated a possible barriers.
5.1. Clinical environment
7. Ethical considerations
The clinical environment in this context refers to the place where patients receive nursing care and where student nurses gain practical experience. The clinical environment is described as the place where students’ learning outcomes are influenced by diverse entities (Papastavrou, Lambrinou, Tsangari, Saarikoski, & LeinoKilpi, 2010).
Ethical clearance was obtained from all stakeholders, including the educational and clinical institutions, while informed consent was obtained throughout the study from all participants and respondents. The ethical principles beneficence, respect for human dignity and justice, as well as considerations of scientific integrity and external review, were adhered to. All participants’ anonymity and confidentiality were assured through avoiding association with their identity. Voluntary participation was respected, and participants could withdraw from the study at any stage without incurring any consequences whatsoever.
5.2. Nursing education institutional environment The nursing education institutional environment applies to the academic environment where student nurses receive tuition and support regarding their academic and clinical learning outcomes.
8. Findings 5.3. Guidelines Guidelines are statements that are developed based on evidence to assist the decision-making process about the best health care in a specific clinical situation (Adams & McCarthy, 2007). 5.4. Professional socialisation Professional socialisation is a process through which a person acquires the knowledge, skills, values and ethical standards to form a professional identity (Hao, Niu, Li, Yue, & Liu, 2014).
The integrated qualitative data generated from the professional nurses and students surfaced as themes namely, the characteristics of a professional nurse, values and beliefs related to nursing as a profession, the clinical learning environment, the educator, and cultural and gender orientation (De Swardt, Van Renburg, & Oosthuizen, 2014: 8). Students’ experiences were mainly related to a lack of support and witnessing incivility in the clinical environment. Both the professional nurses and students described which attributes they considered as important in the professional socialisation of students. These attributes relate to the clinical environ-
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Table 1 Summary of the concluding statements derived from the integrated findings. Theme 1: Clinical environment The professional nurse as exemplary role model Students experienced and witnessed some professional nurses not being exemplary role models. Students’ self-confidence and professional identity development were negatively influenced. Exemplary role models would motivate the learning of appropriate skills, knowledge, values and beliefs in students. The professional nurse as clinical supervisor Students experienced many professional nurses in their role as clinical supervisor as being unapproachable, insensitive, failing to orientate students to their new environment and performing procedures differently from the taught procedures. Professional nurses as clinical supervisors should support and facilitate the learning outcomes of students, for example assist with theory-practice integration and discipline and coach students when necessary. Professional nurses were challenged by students’ negative attitudes and their own increased workload. A positive clinical learning environment The clinical environment is characterised by various challenges such as unpredictability, limited resources and overcrowding of students; however, it is rich in learning opportunities. Learning outcomes were challenged by several matters such as underutilisation and fragmentary assigned learning opportunities; completion of hours received priority over learning outcomes. Many professional nurses were unsupportive regarding the students’ situation. The role of the preceptor and mentor was unclear, although it was recognised as important in assisting students’ professional socialisation. Communication between the clinical field and nursing education institutions, as well as within the clinical field, was ineffective. Theme 2: The nursing education institutional environment Educator as role model Educators considered themselves as having noteworthy teaching practices, levels of subject knowledge and skills and good interpersonal skills and were positive about their careers. However, they did not view their colleagues in a similar way. Students experienced educators as knowledgeable and supportive. Educators considered themselves as clinically competent; however, time constraints hindered them from maintaining their clinical skills. Educators’ conflict-resolving abilities were perceived as average. The nursing education institution’s clinical support to students Clinical accompaniment of students is part of educators’ job description, but large numbers of students and student absenteeism hindered this support to students. Simulation and orientation were mostly used to prepare students for their first clinical exposure – debriefing was used less often. Reflection on clinical experiences was provided to some extent. Lack of equipment and procedures performed differently in practice were reported as theory-practice discrepancies, but were addressed through clinical accompaniment and different teaching strategies. Teaching and facilitation strategies An outcomes-based curriculum philosophy was mostly used, though not all educators were sure which philosophy they followed. A more educator-centred approach regarding the teaching of values and beliefs was followed. Values and beliefs are mostly learned through the hidden curriculum. Support and mentoring were mostly used to address individual learning orientations of students. Limited diverse teaching and assessment methods were used to address students’ learning orientations. Mannequins and more class space were among the greatest needs regarding training and equipment facilities. Educators were easily accessible for consultation. A scheduled programme of tests and assignments was provided in advance. Students experienced professional nurses in the clinical field as insensitive to their needs in this regard. Theme 3:Values and beliefs of the nursing profession Work ethic of the professional nurse and educator Students witnessed and experienced gross violation of human rights. Some professional nurses physically abused patients, while students were humiliated and exploited. Students perceived educators to be indifferent regarding reported misconduct issues. Educators perceived themselves as having a sound work ethic, yet perceived their colleagues as acting less respectfully to others (educators’ own perspective). Respect for human dignity is one of the core values promised in the ‘‘Nurses’ Pledge of Service” when a nurse qualifies. Students’ behaviour Some students displayed undisciplined behaviour and negative attitudes to professional nurses, educators and their peers. Disciplinary procedures should be followed in case of undesirable student behaviour. Rebellious behaviour was noted more often in second-year students; students’ behaviour improved towards the third and fourth year. Nursing as a profession Some students did not consider nursing as a first career choice for reasons such as financial gain. Educators and professional nurses perceived some students as uncaring and not interested in nursing. Student attrition was ascribed to poor academic performance and a wrong career choice. Educators have a positive attitude to nursing education as a career. Professional nurses experienced that some members of the public disrespected their career. Unprofessional behaviour and inappropriate dress code concerned professional nurses and students, as it contributed to an undesirable image of the profession. Cultural and gender awareness English as the official language of communication was not consistently used, which excluded some students from learning opportunities. Racial conflict resulted in students physically attacking one another; however, good relationships between different races were also reported. Educators and professional nurses did not experience cultural conflict as problematic. Educators were to some extent aware of cultural differences during their communication with others. Male students were perceived as having negative attitudes, while professional nurses in some cultures believed that males should be treated differently from females. Male students experienced this as preferential treatment. Students had limited opportunities to reflect among themselves on different cultural orientations.
ment, professional values and cultural orientation of professional nurses, educators and students. Six professional socialisation constructs (phase II) that were developed from phase one, revealed that educators regarded themselves as admirable, but lack conflict resolving abilities. They believed that less suitable candidates enter into the nursing while students were perceived as rebellious, especially in level two. Less
emphasis was given to the teaching of values and beliefs of the nursing profession. Overall they perceived their teaching and facilitation strategies of professional socialisation as positive. Three major themes that emerged from the integrated data of all phases and literature were identified (Fig. 1), namely the clinical environment, nursing education institutional environment and the values and beliefs of the nursing profession. From these findings
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Nursing education institutional environment ï Nurse educator as role model Clinical environment ï The professional nurse as exemplary role model ï The professional nurse as clinical supervisor
ï Nursing education institution's clinical support to students ï Teaching and facilitation strategies
Values and beliefs of the nursing profession ï Work ethic of professional nurse and educator ï Student's behaviour
ï A positive clinical learning environment
ï Nursing as a profession ï Cultural and gender awareness
PROFESSIONAL SOCIALISATION OF THE STUDENT NURSE
Fig. 1. Themes emerged from the integrated qualitative and quantitative data.
ten guidelines were developed, aimed at supporting professional nurses and educators with the professional socialisation of students. 9. Discussion of the guidelines based on integrated findings Concluding statements were derived from the integrated findings (phase I and II). A summary of these conclusions are depicted in Table 1. The following ten guidelines are discussed. 10. Guideline 1: the professional nurse as exemplary role model Students consider nurses in the clinical field are as the most influential role models in shaping their clinical practice, consequently their socialisation process (Baldwin, Mills, Birks, & Budden, 2014; James & Miza, 2015). The objective of guideline one is to facilitate and support professional nurses in becoming role models whose behaviour students could imitate. Nursing management and professional nurses should collaboratively: – Empower professional nurses to improve their level of knowledge, for example by providing opportunities for continuous professional development. – Assess and empower professional nurses with qualities such as teamwork, communication abilities and demonstrating respectfulness. – Promote reflection on one’s own values, beliefs and behaviour through portfolios, discussions and workshops. – Reaffirm professional values such as the ‘‘Nurses’ Pledge of Service” – Create and maintain structures to report and address unethical behaviour. – Acknowledge exemplary role models in a culturally sensitive manner, for example by celebrating achievements. – Encourage the creation of a positive work environment (respect for different views and value orientation). 11. Guideline 2: the professional nurse as clinical supervisor The clinical environment is challenging for both the professional nurse and student. While professional nurses are responsi-
ble for quality nursing care, students need to learn how it is practised. Professional nurses are willing to fulfil this dual role of patient care and clinical supervision of students; however, acknowledgement and empowerment are essential (Browning & Pront, 2015). Guideline two’s objective is to support the professional nurse to be a clinical supervisor fostering positive learning experiences for students. Professional nurses should: – Include orientation of students as a standard procedure, especially for first-year students. – Take an honest interest in students, understanding their learning and teaching needs. – Collaborate with nursing education institutions to assist students with their theory-practice integration, for instance by encouraging discussions, comparing current practice with best evidence and applying reflective activities. – Treat students as valued members of the multidisciplinary team. – Coach and monitor students regarding acceptable behaviour through fair judgement and honest feedback. – Improve relationships with students through purposeful student feedback or reflection sessions. – Encourage students to communicate their learning needs in order to provide support through creating opportunities for learning. Nursing management should: – Support professional nurses to fulfil their roles as manager, caregiver and clinical supervisor through providing sufficient staff, equipment, mentors and preceptors. – Motivate the development of mentors and preceptors as part of a career development plan for professional nurses. – Support a structured approach regarding clinical supervision and standards of care. – Involve all levels of staff in the annual review of resources and infrastructure plans, ensuring the provision of adequate resources.
12. Guideline 3: a positive clinical learning environment Students learn to apply their knowledge and skills and to become acquainted with the culture of nursing in the clinical field (Papastavrou et al., 2010). Guideline 3 is aimed at creating a positive clinical learning environment that could facilitate desirable learning outcomes. Educators and professional nurses should: – Prepare students for the unpredictable clinical environment through role-play and guided clinical observation sessions, followed by reflective learning exercises. – Ensure that meaningful learning opportunities are aligned with the learning outcomes of students. Nursing education institutions and clinical facilities should: – Coordinate student placement, considering available clinical facilities, learning objectives and minimum prescribed hours, with the emphasis on competency. – Ensure adequate communication with relevant stakeholders regarding student-related matters. – Ensure sufficient precautionary measures for health and safety risks and measure compliance with health and safety standards. – Encourage formalised peer mentoring. Professional nurses should: – Be considerate and unbiased about the students’ learning outcomes.
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If a positive clinical environment is created through supervision, leadership and healthy interpersonal relationships (D’Souza et al., 2015), students could become competent practitioners who would provide quality nursing care. 13. Guideline 4: educator as role model The nurse educator’s role is far beyond merely teaching theory, but has the potential to model a positive attitude to the nursing profession (Baldwin et al., 2014). The guideline for the educator as role model intends to maintain and support educators being role models whose behaviour students could imitate. Educators and the management of nursing education institutions should: – Commit to maintaining high standards of teaching practices for earning CPD points, reflecting on their teaching practices and attending conferences. – Encourage educators to practise evidence-based education. – Provide educators access to scientific information through partnerships with universities. – Demonstrate sound ethical principles in their teaching approach. – Provide and allocate sufficient time, ensuring that educators remain clinically competent. – Acknowledge those educators who are regarded as exemplary role models. The management of nursing education institutions should: – Facilitate opportunities for educators to improve their conflict management skills. 14. Guideline 5: nursing education institution’s clinical support to students The nursing education institutions’ clinical support to students is essential, as students in this study spend a minimum of 4000 hours in the clinical field. Guideline five addresses support to students through support structures, with the aim of improving students’ clinical learning experiences. Management of nursing education institutions and management of the clinical field should: – Clarify and expand the role and function of the mentor, preceptor and peer mentoring in order to assist educators and professional nurses in supporting students with their clinical learning. – Encourage direct visibility of educators in the clinical field. Educators should: – Explore possibilities to employ innovative teaching strategies to address the large number of students (e.g. virtual learning). – Prepare students for the diverse challenges of the clinical field through developing their cognitive, psychomotor and especially affective domain. Reflection should be encouraged. – Prepare students for theory-practice discrepancies and realign teaching strategies accordingly. – Address student absenteeism in collaboration with professional nurses who are in the clinical field, according to a formal protocol on student behaviour.
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Newman, & Schwartzstein, 2012). Guideline six aims at supporting students by using teaching strategies that will enhance professional socialisation. Educators and management of nursing education institutions should: – Integrate the underlying curriculum philosophy with regard to their teaching and planning (e.g. assessment and teaching strategies). – Ensure that the teaching and facilitation of values and beliefs concerning the nursing profession receive sufficient emphasis (e.g. through curriculum design, teaching being studentcentred). – Incorporate teaching strategies that will positively influence the effect of the hidden curriculum (e.g. role modelling, reflection on practical experiences). – Apply diverse teaching, facilitation and assessment strategies to address the different learning orientations of students. – Budget for and explore innovative strategies to improve facilities and equipment of the skills laboratory. – Have consultation hours according to a structured system. – Communicate important student-related matters effectively to the clinical field (e.g. tests and assignments). 16. Guideline 7: work ethic of the professional nurse and educator Cultivating sound work ethics in all environments will ultimately be manifested in quality patient care (Bartzak, 2010). Guideline seven is intended to facilitate and support good work ethics of professional nurses and educators. Management of nursing education institutions and nursing management of clinical facilities should: – Create structures for students and patients’ significant others to report cases of misconduct anonymously. – Appraise professional conduct of professional nurses and educators (e.g. performance appraisals). – Counsel professional nurses and educators who exhibit professional misconduct. – Facilitate healthy work environments where basic human rights are valued. – Create awareness of the various legislative measures (e.g. self-reflection, case studies, CPD training). Professional nurses and educators should: – Commit themselves to upholding the nursing values as pledged in the ‘‘Nurses’ Pledge of Service”. – Report cases of misconduct and follow specific institutional guidelines dealing with misconduct. A good work ethic is essential, as it will influence students’ learning experiences in respect of how ethical problems are identified and addressed (Salminen et al., 2015).
17. Guideline 8: students’ behaviour Students exhibiting disruptive behaviour in the classroom or clinical environment will have a negative impact on their academic progress and the development of a sound ethical orientation, consequently on patient care (Ibrahim & Qalawa, 2015). This guideline (eight) aims at facilitating appropriate student behaviour.
15. Guideline 6: teaching and facilitation strategies Successful learning outcomes require an appreciation of students’ learning styles, values, beliefs and interests (Roberts,
All stakeholders involved in student education should: – Report undesirable student behaviour and promptly follow institutional policies in this regard.
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– Provide and implement clear guidelines regarding students’ behaviour (e.g. student rules, student contracts). – Acknowledge well-behaved students in a culturally sensitive manner (e.g. sharing positive experiences). – Provide opportunities to create awareness of professional conduct (e.g. debate and reflection). – Be aware that second-year students might need more opportunities to discuss issues of concern. – Refer students, if indicated, for counselling when signs of disruptive behaviour are exhibited. Creating a positive learning environment where the student, professional nurse, clinical teaching staff and educator treat one another with dignity will reinforce appropriate student behaviour.
18. Guideline 9: nursing as a profession Hoeve, Jansen, and Roodbol (2014) state that nurses need to make a deliberate effort to portray a professional image, for example by using social media as mechanism. Guideline nine suggests interventions that may improve the image of the nursing profession. All stakeholders (South African Nursing Council, nursing unions, nursing education institutions, clinical facilities and individual educators, professional and student nurses) should: – Promote nursing as a profession (e.g. media, career exhibitions, appreciation of the positive). – Participate in professional nursing associations to promote the nursing profession. – Take responsibility for the professional conduct of nurses. – Be conscious of how they portray the image of nursing (e.g. in speech, dress and interaction). Nursing education institutions should assess their recruitment and selection strategies. Government should review the method of financial assistance to students (e.g. bursaries and stipends). Nurses need to engage in constructive strategies continuously (Chauke, Van Der Wal, & Botha, 2015), such as sharing positive stories and appreciating the good.
20. Conclusion Guidelines that could support educators and professional nurses with the professional socialisation of student nurses in a South African context were developed and validated. These guidelines were evidenced by qualitative data obtained from professional nurses’ perceptions and student nurses’ experiences regarding professional socialisation. Quantitative data were obtained from educators’ teaching and facilitation strategies. All data and literature were used to develop these guidelines. These guidelines are aimed at providing a supportive clinical and nursing education institutional environment where the professional values and beliefs of nursing are respected. A positive clinical environment is characterised by professional nurses who are exemplary role models and able to supervise students in the clinical environment. Students need to be prepared for the diverse challenges of the clinical setting and supported during their clinical placement. Educators should be admirable role models who apply innovative teaching and facilitation strategies to create a supportive educational environment. Appropriate support from the education institution, such as mentors, preceptors and effective collaboration with all stakeholders, is vital. Students’ behaviour should be shaped while they are still in a developmental stage. Revision of the student recruitment and selection process is advised. Celebrating the core values of nursing is imperative. Students and significant others should strive to be more culture and gender sensitive. Sound work ethics of the professional nurse and educator are recommended to facilitate appropriate professional values. Fostering a professional identity where appropriate skills, knowledge and values are facilitated is complex. The students themselves and various socialisation agents influence this process. This study attempted to contribute to the professional socialisation of students. Conflict of interest The authors declare no conflict of interest. Author contributions All authors (HCdS, GHvR, MJO) contributed to all phases of the study and drafting, revising and approving the article.
19. Guideline 10: cultural and gender awareness Acknowledgment Being aware of others’ cultural and gender differences is an important skill required for being culturally competent. The final guideline was developed to facilitate cultural and gender awareness among educators, professional nurses and students. Management of education institutions, nursing management, professional nurses and students should: – Respect institutional policies regarding the use of the official language (English) during communication in the workplace. All stakeholders should be encouraged to learn another commonly spoken language. – Encourage people to report any cultural or gender conflict anonymously. – Improve cultural and gender competency (e.g. awareness of cultural differences through reflection). Critical self-reflection, self-awareness and discussions about cultural competence are needed to develop not only students’ but also other health care workers’ cultural competencies (Kokko, 2011).
We could like to thank all participants and institutions who participated in this study. References Adams, S., & McCarthy, A. M. (2007). Evidence-based practice guidelines and school nursing. Journal of School Nursing, 23, 128–136 http://www.ncbi.nlm.nih.gov/ pubmed/17536916. Baldwin, A., Mills, J., Birks, M., & Budden, L. (2014). Role modeling in undergraduate nursing education: An integrative literature review. Nurse Education Today, 34, e18–e26. http://dx.doi.org/10.1016/j.nedt.2013.12.007. Bartzak, P. J. (2010). Professional work ethic: Strategies to motivate bedside nurses to deliver high-quality patient care. Medsurg Nursing, 19, 85–89. Browning, M., & Pront, L. (2015). Supporting nursing student supervision: An assessment of an innovative approach to supervisor support. Nurse Education Today, 35, 740–745. http://dx.doi.org/10.1016/j.nedt.2015.02.003. Chauke, M. E., Van Der Wal, D., & Botha, A. (2015). Using appreciative inquiry to transform student nurses’ image of nursing. Curationis, 38(1), 1–8. http://dx.doi. org/10.4102/curationis.v38i1.1460. D’Souza, M. S., Karkada, S. N., Parahoo, K., & Venkatesaperumal, R. (2015). Perception of and satisfaction with the clinical learning environment among nursing students. Nurse Education Today, 35, 833–840. http://dx.doi.org/ 10.1016/j.nedt.2015.02.005.
Hester Cathrina (Rina) de Swardt et al. / International Journal of Africa Nursing Sciences 6 (2017) 1–7 De Swardt, H. C., Van Renburg, G. H., & Oosthuizen, M. J. (2014). An exploration of the professional socialisation of students. Africa Journal of Nursing and Midwifery, 16(2), 1–13 http://reference.sabinet.co.za/webx/access/electronic_ journals/ajnm/ajnm_v16_n2_a2.pdf. Dinmohammadi, M., Peyrovi, H., & Mehrdad, N. (2013). Concept analysis of professional socialization in nursing. Nursing Forum, 48, 26. Hao, Y.-F., Niu, H.-J., Li, L.-P., Yue, S.-J., & Liu, X.-H. (2014). Measurement of professional identity in Chinese nursing students. International Journal of Nursing Sciences, 1, 137–144. http://dx.doi.org/10.1016/j.ijnss.2014.05.002. Hoeve, Y. T., Jansen, G., & Roodbol, P. (2014). The nursing profession: Public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing, 70, 295. Hollup, O. (2012). Nurses in Mauritius motivated by extrinsic rewards: A qualitative study of factors determining recruitment and career choices. International Journal of Nursing Studies, 49, 1291–1298. http://dx.doi.org/10.1016/j. ijnurstu.2012.05.011. Hovland, O. J., & Johannessen, B. (2015). What characterizes Norwegian nursing students’ reflective journals during clinical placement in an African country? International Journal of Africa Nursing Sciences, 2, 47–52. http://dx.doi.org/ 10.1016/j.ijans.2015.03.003. Ibrahim, S. A. E.-A., & Qalawa, S. A. (2015). Factors affecting nursing students’ incivility: As perceived by students and faculty staff. Nurse Education Today, 36, 118–123. James, S., & Miza, T. M. (2015). Perceptions of professional nurses regarding introduction of the Batho Pele principles in state hospitals. Curationis, 38(1), 1–9. http://dx.doi.org/10.4102/curationis.v38i1.1128.
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Kaya, H., Kaya, N., Sß enyuva, E., & Isßık, B. (2012). Personal values of baccalaureate nursing students in Turkey. International Journal of Nursing Practice, 18, 527–536. http://dx.doi.org/10.1016/j.nedt.2015.08.014. Kokko, R. (2011). Future nurses’ cultural competencies: What are their learning experiences during exchange and studies abroad? A systematic literature review. Journal of Nursing Management, 19, 673–682. Oosthuizen, M. J. (2012). The portrayal of nursing in South African newspapers: A qualitative content analysis. Africa Journal of Nursing and Midwifery, 14(1), 49–62 http://uir.unisa.ac.za/handle/10500/8897. Papastavrou, E., Lambrinou, E., Tsangari, H., Saarikoski, M., & Leino-Kilpi, H. (2010). Student nurses’ experience of learning in the clinical environment. Nurse Education in Practice, 10, 176–182. http://dx.doi.org/10.1016/j. nepr.2009.07.003. Price, S. L., McGillis Hall, L., Angus, J. E., & Peter, E. (2013). Choosing nursing as a career: A narrative analysis of millennial nurses’ career choice of virtue. Nursing Inquiry, 20, 305–316. Roberts, D. H., Newman, L. R., & Schwartzstein, R. M. (2012). Twelve tips for facilitating millennials’ learning. Medical Teacher, 34, 274–278. Salminen, L., Stolt, M., Metsämäki, R., Rinne, J., Kasen, A., & Leino-Kilpi, H. (2015). Ethical principles in the work of nurse educator—A cross-sectional study. Nurse Education Today, 36, 18–22. http://dx.doi.org/10.1016/j.nedt.2015.07.001. South-Africa. (2013). Strategic plan for nurse education, training and practice 2012/ 13–2016/17. In: S.A.D.o. Health (Ed.). South, Africa 2013.. Tesch, R. (1990). Qualitative research: Analysis types and software Tools. New York, NY: Falmer Press.
Contents lists available at ScienceDirect
International Journal of Africa Nursing Sciences journal homepage: www.elsevier.com/locate/ijans
Supporting students in professional socialisation: Guidelines for professional nurses and educators Hester Cathrina (Rina) de Swardt a,⇑, Gisela H. van Rensburg b, M.J. Oosthuizen c a
Tshwane University of Technology, Adelaide Tambo School of Nursing Science, Building 5-333, Private Bag x 680, Pretoria 0001, South Africa Unisa, Department of Health Studies, Theo van Wijk Building 6-188, PO Box 392, Unisa, 0003, South Africa c Department of Health Studies, Theo van Wijk Building 6-182, PO Box 392, Unisa, 0003, South Africa b
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Article history: Received 3 September 2016 Accepted 23 November 2016 Available online 1 December 2016 Keywords: Professional socialisation Students Values Nursing education institution
a b s t r a c t Professional socialisation of nursing students involves learning skills, attitudes, behaviour and professional roles, largely in the clinical area. During clinical accompaniment and reflective discussions with a group of undergraduate Baccalaureate nursing students in South Africa, students reported negative professional socialisation experiences, primarily in the clinical area. Such experiences could influence the quality of patient care. The objective of this study was to develop and validate guidelines to support professional nurses and educators in the professional socialisation of student nurses. Evidence was generated from an exploration and description of the perceptions of professional nurses regarding their role in the professional socialisation of students, the perceptions of nurse educators regarding the teaching and facilitation of professional socialisation of students, and the socialisation experiences of students. Following a sequential mixed-methods design, qualitative data guided the collection of quantitative data. All data and literature directed the development of these guidelines, which experts reviewed and validated according to a set of criteria. These guidelines focus on the clinical, nursing educational institution environment and values and beliefs of the nursing profession. Facilitation of sound work ethics, professional behaviour, cultural and gender awareness, role modelling and the application of a range of teaching strategies is proposed. Ó 2016 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
2. Background and rationale
The nursing profession in South Africa should be reconstructed and revitalised to ensure optimal care to all citizens of South Africa (South-Africa, 2013). The strategic plan for nurse education and training in South Africa emphasises the urgency to improve the image of nursing and confidence in the profession. Negative reports on nurses’ professional behaviour contribute to an image of a non-caring profession (Oosthuizen, 2012; South-Africa & Strategic Plan for Nurse Education, 2013). Appropriate socialisation of students into the profession is essential. Nursing schools, the clinical learning environment and the students themselves are integral parts in this process. The process through which students learn the values, attitudes and goals of the profession to form a professional identify is complex, continuous and unpredictable (Dinmohammadi, Peyrovi, & Mehrdad, 2013).
During the professional socialisation process, the student internalises the professional values, technology and language of the profession, which is visible in how the nurse performs the daily nursing activities. Various socialisation agents may influence this process. These agents may include teaching strategies, a curriculum approach, planned clinical learning experiences and the influential role of the educator, mentor, preceptor and peer. Accidental socialisation occurs mostly in the clinical setting where students encounter diverse and unpredictable situations. For example, in a controlled classroom setting the educator can facilitate debates regarding appropriate communication with patients. However, in practice students might encounter insensitive and discourteous engagements with patients (Hovland & Johannessen, 2015). Students learn to apply practical competencies in the clinical setting. They learn by imitating their role models and try to fit into the nursing environment where they gain practical experience. Candidates who select nursing as a profession might have various reasons for their choice. Financial gain, job security, a desire to care and previous encounters with nurses in practice might be
⇑ Corresponding author. E-mail addresses: [email protected] (Hester Cathrina (Rina) de Swardt), [email protected] (G.H. van Rensburg), [email protected] (M.J. Oosthuizen).
http://dx.doi.org/10.1016/j.ijans.2016.11.002 2214-1391/Ó 2016 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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some of the reasons (Hollup, 2012; Price, McGillis Hall, Angus, & Peter, 2013). Students enter the profession with their own set of values and beliefs. Values are learned and influence an individual’s behaviour, which consequently influences how nursing is valued and practised. Kaya, Kaya, S ß enyuva, and Isßık (2012) argue that moral and religious values guide a person’s career choice, such as nursing. Considering all the diverse influences on the professional socialisation of students, it is essential that an appropriate process be facilitated to ensure that patients are nursed by an admirable calibre of nurse. 3. Problem statement The nursing profession in South Africa is challenged by negative media reports on misconduct, shortage of nurses, poor working conditions, perceived negative attitudes and ill-disciplined staff, which affect the quality of nursing care (James & Miza, 2015; Oosthuizen, 2012). This could be a consequence of poor/inadequate socialisation of students in the profession. Nurse educators and professional nurses act as socialisation agents, influencing the novices to assume their professional roles as nurses. These influences could be either positive or negative. A group of undergraduate Baccalaureate nursing students in South Africa reported having negative professional socialisation experiences, primarily in the clinical area. Similar experiences were noticed during clinical accompaniment of students. The problem of exposing students to unprofessional behaviour gave rise to the question: How can the internalisation of skills, knowledge, values and beliefs be guided so that student nurses can be helped to become effectively socialised as professional nurses? 4. Purpose of the article This article reports on guidelines that were developed and validated, which could support professional nurses and educators in the professional socialisation of students. 5. Definition of concepts
6. Research design and guideline development Data were collected applying a sequential, exploratory, mixedmethods design, which informed the development of guidelines. In Phase I, a qualitative, exploratory and descriptive design was followed to obtain data from students’ experiences regarding their professional socialisation as members of the profession and the perceptions of professional nurses, in terms of their role in the professional socialisation of students. Data collection occurred in an academic hospital in Gauteng, South Africa. Five focus group interviews supported by field notes, were conducted. The verbatim transcripts were analysed, utilising Tesch’s (1990) data analysis method. During Phase II, this evidence and literature were used for item generation of an instrument to explore and describe the perceptions of nurse educators’ teaching and facilitation strategies of professional socialisation to students quantitatively. All nursing education institutions’ educators in Gauteng, teaching a specific undergraduate nursing programme, were targeted. The data sets (qualitative and quantitative) were integrated with an extensive literature review using logical reasoning. Based on that, concluding statements (Table 1) were made that led to the development of the guidelines. The guidelines were reviewed and validated by means of a convenient sample of twelve experts who included managers from nursing education institutions, professional nurses, nurse managers, experts in guideline development and educators closely involved with student support. Nine willing and available participants reviewed and validated the guidelines according to the following criteria: clarity, comprehensiveness, applicability, adaptability, credibility and validity. A validation tool with the options not acceptable, acceptable with recommendations or acceptable, could be selected for each criterion. Additional comments could be made. Most of the participants accepted the guidelines as described, since the recommendations were rated as concrete, precise, addressing all aspects of professional socialisation and basing the conclusions and interpretations on true findings. However, cost implications and staffing were indicated a possible barriers.
5.1. Clinical environment
7. Ethical considerations
The clinical environment in this context refers to the place where patients receive nursing care and where student nurses gain practical experience. The clinical environment is described as the place where students’ learning outcomes are influenced by diverse entities (Papastavrou, Lambrinou, Tsangari, Saarikoski, & LeinoKilpi, 2010).
Ethical clearance was obtained from all stakeholders, including the educational and clinical institutions, while informed consent was obtained throughout the study from all participants and respondents. The ethical principles beneficence, respect for human dignity and justice, as well as considerations of scientific integrity and external review, were adhered to. All participants’ anonymity and confidentiality were assured through avoiding association with their identity. Voluntary participation was respected, and participants could withdraw from the study at any stage without incurring any consequences whatsoever.
5.2. Nursing education institutional environment The nursing education institutional environment applies to the academic environment where student nurses receive tuition and support regarding their academic and clinical learning outcomes.
8. Findings 5.3. Guidelines Guidelines are statements that are developed based on evidence to assist the decision-making process about the best health care in a specific clinical situation (Adams & McCarthy, 2007). 5.4. Professional socialisation Professional socialisation is a process through which a person acquires the knowledge, skills, values and ethical standards to form a professional identity (Hao, Niu, Li, Yue, & Liu, 2014).
The integrated qualitative data generated from the professional nurses and students surfaced as themes namely, the characteristics of a professional nurse, values and beliefs related to nursing as a profession, the clinical learning environment, the educator, and cultural and gender orientation (De Swardt, Van Renburg, & Oosthuizen, 2014: 8). Students’ experiences were mainly related to a lack of support and witnessing incivility in the clinical environment. Both the professional nurses and students described which attributes they considered as important in the professional socialisation of students. These attributes relate to the clinical environ-
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Table 1 Summary of the concluding statements derived from the integrated findings. Theme 1: Clinical environment The professional nurse as exemplary role model Students experienced and witnessed some professional nurses not being exemplary role models. Students’ self-confidence and professional identity development were negatively influenced. Exemplary role models would motivate the learning of appropriate skills, knowledge, values and beliefs in students. The professional nurse as clinical supervisor Students experienced many professional nurses in their role as clinical supervisor as being unapproachable, insensitive, failing to orientate students to their new environment and performing procedures differently from the taught procedures. Professional nurses as clinical supervisors should support and facilitate the learning outcomes of students, for example assist with theory-practice integration and discipline and coach students when necessary. Professional nurses were challenged by students’ negative attitudes and their own increased workload. A positive clinical learning environment The clinical environment is characterised by various challenges such as unpredictability, limited resources and overcrowding of students; however, it is rich in learning opportunities. Learning outcomes were challenged by several matters such as underutilisation and fragmentary assigned learning opportunities; completion of hours received priority over learning outcomes. Many professional nurses were unsupportive regarding the students’ situation. The role of the preceptor and mentor was unclear, although it was recognised as important in assisting students’ professional socialisation. Communication between the clinical field and nursing education institutions, as well as within the clinical field, was ineffective. Theme 2: The nursing education institutional environment Educator as role model Educators considered themselves as having noteworthy teaching practices, levels of subject knowledge and skills and good interpersonal skills and were positive about their careers. However, they did not view their colleagues in a similar way. Students experienced educators as knowledgeable and supportive. Educators considered themselves as clinically competent; however, time constraints hindered them from maintaining their clinical skills. Educators’ conflict-resolving abilities were perceived as average. The nursing education institution’s clinical support to students Clinical accompaniment of students is part of educators’ job description, but large numbers of students and student absenteeism hindered this support to students. Simulation and orientation were mostly used to prepare students for their first clinical exposure – debriefing was used less often. Reflection on clinical experiences was provided to some extent. Lack of equipment and procedures performed differently in practice were reported as theory-practice discrepancies, but were addressed through clinical accompaniment and different teaching strategies. Teaching and facilitation strategies An outcomes-based curriculum philosophy was mostly used, though not all educators were sure which philosophy they followed. A more educator-centred approach regarding the teaching of values and beliefs was followed. Values and beliefs are mostly learned through the hidden curriculum. Support and mentoring were mostly used to address individual learning orientations of students. Limited diverse teaching and assessment methods were used to address students’ learning orientations. Mannequins and more class space were among the greatest needs regarding training and equipment facilities. Educators were easily accessible for consultation. A scheduled programme of tests and assignments was provided in advance. Students experienced professional nurses in the clinical field as insensitive to their needs in this regard. Theme 3:Values and beliefs of the nursing profession Work ethic of the professional nurse and educator Students witnessed and experienced gross violation of human rights. Some professional nurses physically abused patients, while students were humiliated and exploited. Students perceived educators to be indifferent regarding reported misconduct issues. Educators perceived themselves as having a sound work ethic, yet perceived their colleagues as acting less respectfully to others (educators’ own perspective). Respect for human dignity is one of the core values promised in the ‘‘Nurses’ Pledge of Service” when a nurse qualifies. Students’ behaviour Some students displayed undisciplined behaviour and negative attitudes to professional nurses, educators and their peers. Disciplinary procedures should be followed in case of undesirable student behaviour. Rebellious behaviour was noted more often in second-year students; students’ behaviour improved towards the third and fourth year. Nursing as a profession Some students did not consider nursing as a first career choice for reasons such as financial gain. Educators and professional nurses perceived some students as uncaring and not interested in nursing. Student attrition was ascribed to poor academic performance and a wrong career choice. Educators have a positive attitude to nursing education as a career. Professional nurses experienced that some members of the public disrespected their career. Unprofessional behaviour and inappropriate dress code concerned professional nurses and students, as it contributed to an undesirable image of the profession. Cultural and gender awareness English as the official language of communication was not consistently used, which excluded some students from learning opportunities. Racial conflict resulted in students physically attacking one another; however, good relationships between different races were also reported. Educators and professional nurses did not experience cultural conflict as problematic. Educators were to some extent aware of cultural differences during their communication with others. Male students were perceived as having negative attitudes, while professional nurses in some cultures believed that males should be treated differently from females. Male students experienced this as preferential treatment. Students had limited opportunities to reflect among themselves on different cultural orientations.
ment, professional values and cultural orientation of professional nurses, educators and students. Six professional socialisation constructs (phase II) that were developed from phase one, revealed that educators regarded themselves as admirable, but lack conflict resolving abilities. They believed that less suitable candidates enter into the nursing while students were perceived as rebellious, especially in level two. Less
emphasis was given to the teaching of values and beliefs of the nursing profession. Overall they perceived their teaching and facilitation strategies of professional socialisation as positive. Three major themes that emerged from the integrated data of all phases and literature were identified (Fig. 1), namely the clinical environment, nursing education institutional environment and the values and beliefs of the nursing profession. From these findings
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Nursing education institutional environment ï Nurse educator as role model Clinical environment ï The professional nurse as exemplary role model ï The professional nurse as clinical supervisor
ï Nursing education institution's clinical support to students ï Teaching and facilitation strategies
Values and beliefs of the nursing profession ï Work ethic of professional nurse and educator ï Student's behaviour
ï A positive clinical learning environment
ï Nursing as a profession ï Cultural and gender awareness
PROFESSIONAL SOCIALISATION OF THE STUDENT NURSE
Fig. 1. Themes emerged from the integrated qualitative and quantitative data.
ten guidelines were developed, aimed at supporting professional nurses and educators with the professional socialisation of students. 9. Discussion of the guidelines based on integrated findings Concluding statements were derived from the integrated findings (phase I and II). A summary of these conclusions are depicted in Table 1. The following ten guidelines are discussed. 10. Guideline 1: the professional nurse as exemplary role model Students consider nurses in the clinical field are as the most influential role models in shaping their clinical practice, consequently their socialisation process (Baldwin, Mills, Birks, & Budden, 2014; James & Miza, 2015). The objective of guideline one is to facilitate and support professional nurses in becoming role models whose behaviour students could imitate. Nursing management and professional nurses should collaboratively: – Empower professional nurses to improve their level of knowledge, for example by providing opportunities for continuous professional development. – Assess and empower professional nurses with qualities such as teamwork, communication abilities and demonstrating respectfulness. – Promote reflection on one’s own values, beliefs and behaviour through portfolios, discussions and workshops. – Reaffirm professional values such as the ‘‘Nurses’ Pledge of Service” – Create and maintain structures to report and address unethical behaviour. – Acknowledge exemplary role models in a culturally sensitive manner, for example by celebrating achievements. – Encourage the creation of a positive work environment (respect for different views and value orientation). 11. Guideline 2: the professional nurse as clinical supervisor The clinical environment is challenging for both the professional nurse and student. While professional nurses are responsi-
ble for quality nursing care, students need to learn how it is practised. Professional nurses are willing to fulfil this dual role of patient care and clinical supervision of students; however, acknowledgement and empowerment are essential (Browning & Pront, 2015). Guideline two’s objective is to support the professional nurse to be a clinical supervisor fostering positive learning experiences for students. Professional nurses should: – Include orientation of students as a standard procedure, especially for first-year students. – Take an honest interest in students, understanding their learning and teaching needs. – Collaborate with nursing education institutions to assist students with their theory-practice integration, for instance by encouraging discussions, comparing current practice with best evidence and applying reflective activities. – Treat students as valued members of the multidisciplinary team. – Coach and monitor students regarding acceptable behaviour through fair judgement and honest feedback. – Improve relationships with students through purposeful student feedback or reflection sessions. – Encourage students to communicate their learning needs in order to provide support through creating opportunities for learning. Nursing management should: – Support professional nurses to fulfil their roles as manager, caregiver and clinical supervisor through providing sufficient staff, equipment, mentors and preceptors. – Motivate the development of mentors and preceptors as part of a career development plan for professional nurses. – Support a structured approach regarding clinical supervision and standards of care. – Involve all levels of staff in the annual review of resources and infrastructure plans, ensuring the provision of adequate resources.
12. Guideline 3: a positive clinical learning environment Students learn to apply their knowledge and skills and to become acquainted with the culture of nursing in the clinical field (Papastavrou et al., 2010). Guideline 3 is aimed at creating a positive clinical learning environment that could facilitate desirable learning outcomes. Educators and professional nurses should: – Prepare students for the unpredictable clinical environment through role-play and guided clinical observation sessions, followed by reflective learning exercises. – Ensure that meaningful learning opportunities are aligned with the learning outcomes of students. Nursing education institutions and clinical facilities should: – Coordinate student placement, considering available clinical facilities, learning objectives and minimum prescribed hours, with the emphasis on competency. – Ensure adequate communication with relevant stakeholders regarding student-related matters. – Ensure sufficient precautionary measures for health and safety risks and measure compliance with health and safety standards. – Encourage formalised peer mentoring. Professional nurses should: – Be considerate and unbiased about the students’ learning outcomes.
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If a positive clinical environment is created through supervision, leadership and healthy interpersonal relationships (D’Souza et al., 2015), students could become competent practitioners who would provide quality nursing care. 13. Guideline 4: educator as role model The nurse educator’s role is far beyond merely teaching theory, but has the potential to model a positive attitude to the nursing profession (Baldwin et al., 2014). The guideline for the educator as role model intends to maintain and support educators being role models whose behaviour students could imitate. Educators and the management of nursing education institutions should: – Commit to maintaining high standards of teaching practices for earning CPD points, reflecting on their teaching practices and attending conferences. – Encourage educators to practise evidence-based education. – Provide educators access to scientific information through partnerships with universities. – Demonstrate sound ethical principles in their teaching approach. – Provide and allocate sufficient time, ensuring that educators remain clinically competent. – Acknowledge those educators who are regarded as exemplary role models. The management of nursing education institutions should: – Facilitate opportunities for educators to improve their conflict management skills. 14. Guideline 5: nursing education institution’s clinical support to students The nursing education institutions’ clinical support to students is essential, as students in this study spend a minimum of 4000 hours in the clinical field. Guideline five addresses support to students through support structures, with the aim of improving students’ clinical learning experiences. Management of nursing education institutions and management of the clinical field should: – Clarify and expand the role and function of the mentor, preceptor and peer mentoring in order to assist educators and professional nurses in supporting students with their clinical learning. – Encourage direct visibility of educators in the clinical field. Educators should: – Explore possibilities to employ innovative teaching strategies to address the large number of students (e.g. virtual learning). – Prepare students for the diverse challenges of the clinical field through developing their cognitive, psychomotor and especially affective domain. Reflection should be encouraged. – Prepare students for theory-practice discrepancies and realign teaching strategies accordingly. – Address student absenteeism in collaboration with professional nurses who are in the clinical field, according to a formal protocol on student behaviour.
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Newman, & Schwartzstein, 2012). Guideline six aims at supporting students by using teaching strategies that will enhance professional socialisation. Educators and management of nursing education institutions should: – Integrate the underlying curriculum philosophy with regard to their teaching and planning (e.g. assessment and teaching strategies). – Ensure that the teaching and facilitation of values and beliefs concerning the nursing profession receive sufficient emphasis (e.g. through curriculum design, teaching being studentcentred). – Incorporate teaching strategies that will positively influence the effect of the hidden curriculum (e.g. role modelling, reflection on practical experiences). – Apply diverse teaching, facilitation and assessment strategies to address the different learning orientations of students. – Budget for and explore innovative strategies to improve facilities and equipment of the skills laboratory. – Have consultation hours according to a structured system. – Communicate important student-related matters effectively to the clinical field (e.g. tests and assignments). 16. Guideline 7: work ethic of the professional nurse and educator Cultivating sound work ethics in all environments will ultimately be manifested in quality patient care (Bartzak, 2010). Guideline seven is intended to facilitate and support good work ethics of professional nurses and educators. Management of nursing education institutions and nursing management of clinical facilities should: – Create structures for students and patients’ significant others to report cases of misconduct anonymously. – Appraise professional conduct of professional nurses and educators (e.g. performance appraisals). – Counsel professional nurses and educators who exhibit professional misconduct. – Facilitate healthy work environments where basic human rights are valued. – Create awareness of the various legislative measures (e.g. self-reflection, case studies, CPD training). Professional nurses and educators should: – Commit themselves to upholding the nursing values as pledged in the ‘‘Nurses’ Pledge of Service”. – Report cases of misconduct and follow specific institutional guidelines dealing with misconduct. A good work ethic is essential, as it will influence students’ learning experiences in respect of how ethical problems are identified and addressed (Salminen et al., 2015).
17. Guideline 8: students’ behaviour Students exhibiting disruptive behaviour in the classroom or clinical environment will have a negative impact on their academic progress and the development of a sound ethical orientation, consequently on patient care (Ibrahim & Qalawa, 2015). This guideline (eight) aims at facilitating appropriate student behaviour.
15. Guideline 6: teaching and facilitation strategies Successful learning outcomes require an appreciation of students’ learning styles, values, beliefs and interests (Roberts,
All stakeholders involved in student education should: – Report undesirable student behaviour and promptly follow institutional policies in this regard.
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– Provide and implement clear guidelines regarding students’ behaviour (e.g. student rules, student contracts). – Acknowledge well-behaved students in a culturally sensitive manner (e.g. sharing positive experiences). – Provide opportunities to create awareness of professional conduct (e.g. debate and reflection). – Be aware that second-year students might need more opportunities to discuss issues of concern. – Refer students, if indicated, for counselling when signs of disruptive behaviour are exhibited. Creating a positive learning environment where the student, professional nurse, clinical teaching staff and educator treat one another with dignity will reinforce appropriate student behaviour.
18. Guideline 9: nursing as a profession Hoeve, Jansen, and Roodbol (2014) state that nurses need to make a deliberate effort to portray a professional image, for example by using social media as mechanism. Guideline nine suggests interventions that may improve the image of the nursing profession. All stakeholders (South African Nursing Council, nursing unions, nursing education institutions, clinical facilities and individual educators, professional and student nurses) should: – Promote nursing as a profession (e.g. media, career exhibitions, appreciation of the positive). – Participate in professional nursing associations to promote the nursing profession. – Take responsibility for the professional conduct of nurses. – Be conscious of how they portray the image of nursing (e.g. in speech, dress and interaction). Nursing education institutions should assess their recruitment and selection strategies. Government should review the method of financial assistance to students (e.g. bursaries and stipends). Nurses need to engage in constructive strategies continuously (Chauke, Van Der Wal, & Botha, 2015), such as sharing positive stories and appreciating the good.
20. Conclusion Guidelines that could support educators and professional nurses with the professional socialisation of student nurses in a South African context were developed and validated. These guidelines were evidenced by qualitative data obtained from professional nurses’ perceptions and student nurses’ experiences regarding professional socialisation. Quantitative data were obtained from educators’ teaching and facilitation strategies. All data and literature were used to develop these guidelines. These guidelines are aimed at providing a supportive clinical and nursing education institutional environment where the professional values and beliefs of nursing are respected. A positive clinical environment is characterised by professional nurses who are exemplary role models and able to supervise students in the clinical environment. Students need to be prepared for the diverse challenges of the clinical setting and supported during their clinical placement. Educators should be admirable role models who apply innovative teaching and facilitation strategies to create a supportive educational environment. Appropriate support from the education institution, such as mentors, preceptors and effective collaboration with all stakeholders, is vital. Students’ behaviour should be shaped while they are still in a developmental stage. Revision of the student recruitment and selection process is advised. Celebrating the core values of nursing is imperative. Students and significant others should strive to be more culture and gender sensitive. Sound work ethics of the professional nurse and educator are recommended to facilitate appropriate professional values. Fostering a professional identity where appropriate skills, knowledge and values are facilitated is complex. The students themselves and various socialisation agents influence this process. This study attempted to contribute to the professional socialisation of students. Conflict of interest The authors declare no conflict of interest. Author contributions All authors (HCdS, GHvR, MJO) contributed to all phases of the study and drafting, revising and approving the article.
19. Guideline 10: cultural and gender awareness Acknowledgment Being aware of others’ cultural and gender differences is an important skill required for being culturally competent. The final guideline was developed to facilitate cultural and gender awareness among educators, professional nurses and students. Management of education institutions, nursing management, professional nurses and students should: – Respect institutional policies regarding the use of the official language (English) during communication in the workplace. All stakeholders should be encouraged to learn another commonly spoken language. – Encourage people to report any cultural or gender conflict anonymously. – Improve cultural and gender competency (e.g. awareness of cultural differences through reflection). Critical self-reflection, self-awareness and discussions about cultural competence are needed to develop not only students’ but also other health care workers’ cultural competencies (Kokko, 2011).
We could like to thank all participants and institutions who participated in this study. References Adams, S., & McCarthy, A. M. (2007). Evidence-based practice guidelines and school nursing. Journal of School Nursing, 23, 128–136 http://www.ncbi.nlm.nih.gov/ pubmed/17536916. Baldwin, A., Mills, J., Birks, M., & Budden, L. (2014). Role modeling in undergraduate nursing education: An integrative literature review. Nurse Education Today, 34, e18–e26. http://dx.doi.org/10.1016/j.nedt.2013.12.007. Bartzak, P. J. (2010). Professional work ethic: Strategies to motivate bedside nurses to deliver high-quality patient care. Medsurg Nursing, 19, 85–89. Browning, M., & Pront, L. (2015). Supporting nursing student supervision: An assessment of an innovative approach to supervisor support. Nurse Education Today, 35, 740–745. http://dx.doi.org/10.1016/j.nedt.2015.02.003. Chauke, M. E., Van Der Wal, D., & Botha, A. (2015). Using appreciative inquiry to transform student nurses’ image of nursing. Curationis, 38(1), 1–8. http://dx.doi. org/10.4102/curationis.v38i1.1460. D’Souza, M. S., Karkada, S. N., Parahoo, K., & Venkatesaperumal, R. (2015). Perception of and satisfaction with the clinical learning environment among nursing students. Nurse Education Today, 35, 833–840. http://dx.doi.org/ 10.1016/j.nedt.2015.02.005.
Hester Cathrina (Rina) de Swardt et al. / International Journal of Africa Nursing Sciences 6 (2017) 1–7 De Swardt, H. C., Van Renburg, G. H., & Oosthuizen, M. J. (2014). An exploration of the professional socialisation of students. Africa Journal of Nursing and Midwifery, 16(2), 1–13 http://reference.sabinet.co.za/webx/access/electronic_ journals/ajnm/ajnm_v16_n2_a2.pdf. Dinmohammadi, M., Peyrovi, H., & Mehrdad, N. (2013). Concept analysis of professional socialization in nursing. Nursing Forum, 48, 26. Hao, Y.-F., Niu, H.-J., Li, L.-P., Yue, S.-J., & Liu, X.-H. (2014). Measurement of professional identity in Chinese nursing students. International Journal of Nursing Sciences, 1, 137–144. http://dx.doi.org/10.1016/j.ijnss.2014.05.002. Hoeve, Y. T., Jansen, G., & Roodbol, P. (2014). The nursing profession: Public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing, 70, 295. Hollup, O. (2012). Nurses in Mauritius motivated by extrinsic rewards: A qualitative study of factors determining recruitment and career choices. International Journal of Nursing Studies, 49, 1291–1298. http://dx.doi.org/10.1016/j. ijnurstu.2012.05.011. Hovland, O. J., & Johannessen, B. (2015). What characterizes Norwegian nursing students’ reflective journals during clinical placement in an African country? International Journal of Africa Nursing Sciences, 2, 47–52. http://dx.doi.org/ 10.1016/j.ijans.2015.03.003. Ibrahim, S. A. E.-A., & Qalawa, S. A. (2015). Factors affecting nursing students’ incivility: As perceived by students and faculty staff. Nurse Education Today, 36, 118–123. James, S., & Miza, T. M. (2015). Perceptions of professional nurses regarding introduction of the Batho Pele principles in state hospitals. Curationis, 38(1), 1–9. http://dx.doi.org/10.4102/curationis.v38i1.1128.
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Kaya, H., Kaya, N., Sß enyuva, E., & Isßık, B. (2012). Personal values of baccalaureate nursing students in Turkey. International Journal of Nursing Practice, 18, 527–536. http://dx.doi.org/10.1016/j.nedt.2015.08.014. Kokko, R. (2011). Future nurses’ cultural competencies: What are their learning experiences during exchange and studies abroad? A systematic literature review. Journal of Nursing Management, 19, 673–682. Oosthuizen, M. J. (2012). The portrayal of nursing in South African newspapers: A qualitative content analysis. Africa Journal of Nursing and Midwifery, 14(1), 49–62 http://uir.unisa.ac.za/handle/10500/8897. Papastavrou, E., Lambrinou, E., Tsangari, H., Saarikoski, M., & Leino-Kilpi, H. (2010). Student nurses’ experience of learning in the clinical environment. Nurse Education in Practice, 10, 176–182. http://dx.doi.org/10.1016/j. nepr.2009.07.003. Price, S. L., McGillis Hall, L., Angus, J. E., & Peter, E. (2013). Choosing nursing as a career: A narrative analysis of millennial nurses’ career choice of virtue. Nursing Inquiry, 20, 305–316. Roberts, D. H., Newman, L. R., & Schwartzstein, R. M. (2012). Twelve tips for facilitating millennials’ learning. Medical Teacher, 34, 274–278. Salminen, L., Stolt, M., Metsämäki, R., Rinne, J., Kasen, A., & Leino-Kilpi, H. (2015). Ethical principles in the work of nurse educator—A cross-sectional study. Nurse Education Today, 36, 18–22. http://dx.doi.org/10.1016/j.nedt.2015.07.001. South-Africa. (2013). Strategic plan for nurse education, training and practice 2012/ 13–2016/17. In: S.A.D.o. Health (Ed.). South, Africa 2013.