INTRODUCTION: Research indicates that newly graduated registered nurses struggle to develop practical skills and clinical understanding and to adapt to their professional role. To ensure quality of care and support new nurses, it is vital that this learning is elucidated and evaluated. Aim The aim was to develop and evaluate the psychometric properties of an instrument assessing work-integrated learning for newly graduated registered nurses, the Experienced Work-Integrated Learning (E-WIL) instrument.

METHOD: The study utilized the methodology of a survey and a cross-sectional research design. The sample consisted of newly graduated registered nurses (n = 221) working at hospitals in western Sweden. The E-WIL instrument was validated using confirmatory factor analysis (CFA).

RESULTS: The majority of the study participants were female, the average age was 28 years, and participants had an average of five months' experience in the profession. The results confirmed the construct validity of the global latent variable E-WIL, "Transforming previous notions and new contextual knowledge into practical meaning," including six dimensions representing work-integrated learning. The factor loadings between the final 29 indicators and the six factors ranged from 0.30 to 0.89, and between the latent factor and the six factors from 0.64 to 0.79. The indices of fit indicated satisfactory goodness-of-fit and good reliability in five dimensions with values ranging from α = 0.70 to 0.81, except for one dimension showing a slightly lower reliability, α = 0.63, due to the low item number. Confirmatory factor analysis also confirmed two second-order latent variables, "Personal mastering of professional roles" with 18 indicators, and "Adapting to organisational requirements" with 11 indicators. Both showed satisfactory goodness-of-fit, and factor loading between indicators and the latent variables ranged from 0.44 to 0.90 and from 0.37 to 0.81, respectively.

CONCLUSION: The validity of the E-WIL instrument was confirmed. All three latent variables could be measured in their entirety, and all dimensions could be used separately for the assessment of work-integrated learning. The E-WIL instrument could be useful for healthcare organisations when the goal is to assess aspects of newly graduated registered nurses' learning and professional development.

Aim: The aim of this study was to describe newly graduated nurses´(NGNs´) experience of work-integrated learning (WIL), from an educational and occupational perspective.

Background: NGNs often find themselves unprepared to meet occupational demands on their competence on entering working life, and express difficulties integrating educational theory into a practical context. Qualitative and effective WIL becomes particularly important for NGNs to develop the competence required to handle the transition from education to working life.

Design: This is a qualitative, descriptive study with an inductive approach.

Methods: Seven focus-group discussions were performed and subjected to qualitative content analysis.

Results: The results revealed that WIL for NGNs includes personal mastering of several professional roles: a self-directed and collaborative learning role, a relational nursing role, and a transition from a student role to a collegial role. Furthermore, WIL entails adapting to organisational requirements, including development of contextual workplace knowledge and understanding; striving for confidence in medical-technical performance; and developing an experience-based understanding of clinical situations.

Conclusion: The results reveal that WIL is complex, encompassing adaptation to roles and personal capabilities that increase new graduates´competence and preparation for work. In addition, WIL requires personal commitment to one’s own learning as well as organisational and social support. 

The program in Social Psychiatric Care is a three-year program at the university level leading to a vocational qualification in social psychiatric care and a bachelor's degree in the field of Health Sciences. Until the spring of 2018, six litters have graduated. Students in the social psychiatric care program often have personal interest, previous professional experience from the business areas or inspiration from related friends working in the field of activity. Personal experiences of problems in the fields of activity are also prominent among the students. Students believe that personal experience, willingness and ability is important in order to work within the profession. Characteristics of the students are also an interest and a clear empathetic willingness to work with people and they consider that the profession primarily requires characteristics such as altruism, empathy, social skills and deeper knowledge and understanding in the field. Upon completion of education, students want a career role where they can help other people, feel motivated, or they aim for specific positions or areas of activity. Both managers and alumni from the Social Psychiatric Care program value the broad professional competence that the program leads to. Psychiatric competence is emphasized as particularly valuable by both alumni and managers. This competence means that they also complement the other professions in the activities. Students consider themselves possessed a professional identity that involves introducing psychiatric and custody skills to organizations that previously lacked these perspectives. Something that also brings new approaches to patients, users and clients. Being able to use knowledge from several disciplines are considered to be a strength and competence that are well-needed in environments where people with mental ill health are cared for. The alumni perceive their knowledge as both interdisciplinary and interprofessional.

The project "Health care interaction" among different care providers was introduced as a trial activity in the municipalities of Strömstad and Tanum in the spring of 2010. The aim of health care interaction is to provide citizens health care adapted to their specific need within shortest possible time frame; Is emergency care not needed, the aim is to avoid that the care seeker ends up in an emergency room at the hospital. In this study experiences from health care interaction is described with quantitative as well as qualitative data. Empirical data is based on available medical statistics, focus group interviews with nurses with long experience from pre-hospital emergency care and home health care, questionnaires data gathered from other health professionals involved in the activity, individual interviews with nurses and physicians at call centers for medical information, primary health care centers, home health care, pre-hospital health care and elderly care. The analysis of the data reveal opportunities and expectations among the personnel as well as their willingness to develop and improve the health care. It's also evident that the general impression among health care personnel is that increased interaction among health care providers improves the quality of the health care given. Health care interaction also contributes to improved opportunities for person-centered care with an increased degree of continuity and participation for the patient. The study also reveals that collaboration between colleagues promotes development of individual and collective knowledge. Conclusions drawn from the study is that the documentation and information system used in health care interaction needs to strengthen the participation of the care seekers as well as to improve in accessibility for the personnel involved. In order for health care interaction to evolve and develop through close follow-up and evaluation, a more transparent and uniform system for documentation is recommended. It's also concluded from the study that the call center for medical information (1177) as one of the major actors in the health care interaction program has the best potential to instigate an expansion and development of the health care interaction among care providers.

The aim of this study was to describe nurses’ experiences of person-centered care within an integrated care chain.

Method: The study included four data sets: Two focus group interviews with a total of 22 nurses; an open questionnaire answered by 17 nurses; and individual follow-up interviews with 4 volunteers from among the 17 nurses. In total, 39 informants were included in this study. Qualitative content analysis was carried out to identify the latent content of the focus group and interview data, and the manifest content of the questionnaire data.

Results: The results showed that learning about, from and with each other were prerequisites for achieving person-centered care. The ability to provide person-centered care was influenced by factors that could be related to both the organization and to the individual nurse. Important factors were organizational transparency and structure, leadership and collaboration between healthcare centers, partnership, sole caregiver attitudes and skills.

Conclusion: In order to develop person-centered care, it is crucial that an integrated care chain feature a joint documentation system; efficient use of the resources allocated to the needs of the various healthcare centers; and a change of focus from the professional to the person seeking care.

Aim: To explore how nurses during their early working life learn to provide high-quality care in relation to organisational prerequisites in a hospital setting.BackgroundWhen nurses enter employment in contemporary hospital settings, they face multiple learning challenges. Organisational prerequisites that have been identified to affect their ability to learn to provide high-quality care are related to staffing turnovers, large patient groups and a lack of experienced staff to support their learning.

Design: Qualitative.

Methods: The study was conducted between 2018 and 2019 at a medium-sized hospital in Sweden. Data from interviews with 10 nurses with fewer than two years’ work experience were subjected to qualitative content analysis.

Results: The results describe the nurses’ learning during their early working life in two categories: Performing tasks in relation to organisational prerequisites and Making use of clinical experiences to grasp the complexity of nursing care. The first theme reflected a learning process that was initially characterised by seeking confirmation and instructions from colleagues of how to act safely and by balancing the demands of time efficiency and sustaining patient safety. The second theme reflected that, after addressing organisational prerequisites, the nurses tried to understand and make use of clinical experiences to grasp the complexity of nursing care by encountering and processing clinical patient situations.

Conclusions: The results of this study revealed that nurses’ learning during early working life seemed to be primarily directed towards handling tasks, with sometimes limited opportunities to grasp the complexity of nursing care. Their learning depended largely on their own initiative and motivation and was strongly influenced by organisational prerequisites. The limited availability of experienced nurse colleagues and lack of time devoted for reflection needs to be dealt with to support nurses’ learning.

Successful preparation of newly graduated nurses (NGN) is a critical concern for the healthcare sector. This study explores the learning processes enacted in a transition program with NGNs implemented in hospitals in western Sweden. Group interviews with NGNs and ward managers were conducted, with the data analyzed using qualitative thematic analysis. The following themes were identified as the learning processes secured through the program: Recognizing the NGNs' role as novice practitioners, Emphasizing newly graduated nurses as learners, and Progressing towards a comprehensive nursing role. To support these learning processes, the program should provide opportunies to consolidate and reconcile NGNs' experiences as novices in healthcare environments where effective performance is crucial. If NGNs are supported in these ways, the program can make salient contributions to develop the knowledge bases of their occupational expertise. 

Newly graduate nurses (NGN) transition between basic education and work in a complex health care practice, as well as their intention of leaving the profession during the first year of work and how this can be prevented, is a global concern. NGN experience difficulties integrating workplace environment, expectations, and educational experiences. This is an evaluation study of a one-year transition program, which was implemented as a project during 2016-17, at six hospitals in Sweden.

An explorative research design was used and data consist of focus group and individual interviews with NGNs, interviews with first-line managers, observations of simulation training, and survey material from the hospitals. Data was analyzed using thematic analysis. Results show an overarching structure for all hospitals in the region, the NGNs are engaged in the following learning activities; introduction at the ward and a senior RN as preceptor, lectures and/or simulations, change of ward, process-oriented reflection seminars and mentorship.

The different learning activities contribute to the overall learning in different ways. Continuous supervision and structured reflection are central to NGNs professional learning. Organizational conditions create prerequisites for learning during the transition program and a change of ward is a particular challenge to get organized. The results, also provides a deeper understanding of the foundational components in NGNs early development of expertise, security as professionals, and essential knowledge for bridging the practices of the first cycle program and healthcare practice at hospitals.

Purpose

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses.

Design/methodology/approach 

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

Findings

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

Originality/value 

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

BACKGROUND:

Transition programs for newly graduated nurses in hospital settings are reported to provide learning opportunities, strengthening confidence, workplace integration and skills, retention and job satisfaction. Still, our knowledge of long-term effects is scarce and few studies have used control groups.

OBJECTIVE:

To explore the long-term impact of having attended a transition program on the nurses’ experiences of the first years of practice. More specifically, ideology-infused psychological contract, ethical stress, perceived organizational support, job satisfaction, opportunities for learning, and intention to stay in the nursing profession, were explored as outcome variables.

METHODS:

A questionnaire survey was carried out among registered nurses from November 2019 to January 2020, with a 54% response rate. The analysis was based on 149 nurses who had attended a transition program, and 72 who had not attended. The nurses had seniority between one and three years. Independent samples t-test were used to investigate differences between the groups.

RESULTS:

The two groups showed small and non-significant differences in the outcome variables. However, regarding the frequency of ethical value conflicts induced by insufficient resources, as well as experiences of ethical value conflict distress, the group of nurses who had attended a transition program showed statistically significantly higher mean values, although the effect sizes were small.

CONCLUSION:

Newly graduated nurses need more than transition programs and skills training to progress in their nursing role and develop competence, increase job satisfaction, and reduce stress. Achieving these goals requires a long-term supportive learning environment that is integrated into everyday work.

Background: The purpose of this survey was to relate completion rate and results on national clinical final examinations to student’s admission background and examination results for nursing and medical courses.

Methods: The research data were based on a quantitative case study, with 286 nursing students, using statistical analysis.

Results: The programme's overall completion rate was 76%, i.e. almost one out of four students did not complete the programme. The higher students' upper secondary/high school grades, the fewer attempts they needed to pass the nursing and medical courses exams (p<0.001). The average examination attempts needed to pass courses in medical science was significantly greater than the number needed to pass courses in nursing science (p<0.001). In a multivariate analysis both upper secondary/high school grades and average examination attempts needed to pass were significant predictors for national clinical final examination score.

Conclusion: In sum, upper secondary/high school grades and examination attempts needed, especially for courses in medical science, may be regarded as important indicators of achieved knowledge and skills which are tested in the national final examination.

Healthcare unit managers are pivotal to promote nurses' Perceived Organizational Support and hence to ensure nurses' health and well-being, as well as high-quality care. Despite this fact, there is a dearth of studies addressing how healthcare unit managers act and organize their work to promote nurses' Perceived Organizational Support and which working conditions enable them to do so. Through a mixed methods approach, comprising qualitative interviews and quantitative surveys among healthcare unit managers and nurses, this paper underscores that healthcare unit managers' availability to their nursing staff was essential for their ability to promote nurses' Perceived Organizational Support, and that responsive support from the care unit managers' superior management, administration, and managerial colleagues constituted enabling working conditions. Superior manager support strongly promoted the care unit manager's own Perceived Organizational Support, which, in turn, was positively correlated with nurses' organizational climate of Perceived Organizational Support.

AIM: Investigate care unit managers' perceptions of how the COVID-19 pandemic influenced their ability to support the nurses.

BACKGROUND: The COVID-19 pandemic placed extreme pressure on healthcare organizations. More knowledge regarding how the pandemic influenced care unit managers' ability to support nurses is central to ensuring high-quality healthcare in future crises.

METHOD: A mixed-methods study in Swedish hospitals with a survey (n=128) and interviews (n=20) with care unit managers.

RESULTS: Approximately half of the managers reported having spent more time available to and supporting the nurses. Availability was positively predicted by their perceived organizational support while negatively by their job demands. These job demands concerned meeting staff anxiety and managing organizational restructuring. Full focus on direct patient care, and strong professional and social support were important job resources.

CONCLUSION: For care unit managers to effectively support the nurses during a crisis, they need proficient job resources and moderate job demands. Managers' perceived organizational support positively affects the quality of their crisis leadership. Creating arenas in which staff collegiality can form and develop is beneficial for the ability to meet future crises. Implications for Nursing Management This study specifies important job resources that should be acknowledged and reinforced to strengthen the ability of care unit managers to actively support the nurses during a crisis.

PURPOSE: The purpose of this paper is to inductively explore the context-specific preconditions for nurses' perceived organizational support (POS) in healthcare organizations.

DESIGN/METHODOLOGY/APPROACH: A qualitative interview study was performed, based on the critical incident technique (CIT), with 24 registered nurses in different specialities of hospital care.

FINDINGS: The nurses perceived three actors as essential for their POS: the first-line manager, the overarching organization and their college. The preconditions affecting the nurses' perceptions of organizational support were supportive structuring and structures at work, as well as individual recognition and professional acknowledgement.

ORIGINALITY/VALUE: Previous studies of POS have mostly had a quantitative outset. In this paper, context-specific preconditions for nurses' POS are described in depth, enabled by the qualitative approach of the study. The findings may be used to guide healthcare organizations and managers aiming to foster nurses' POS, and thereby, benefit nurses' well-being and retention, as well as healthcare quality and efficiency.

Background: Most continuing professional development (CPD) programmes do not include an educational training module. In our country, educational practice in the areas of CPD and continuing medical education relies traditionally on conventional lectures. This is in sharp contrast to the educational research that clearly demonstrates that educational programmes emphasising adult learning methods have greater potential to change physicians'clinical practice. To investigate whether lecture-oriented educators were prepared to change their educational practice towards principles of adult learning, we decided to combine learning for educators and participants in a paediatric CPD programme.The aim of the study was to investigate educators' reflections on their learning and educational practice after they have undergone an educational skills component integrated in the implementation of a CPD learning module for paediatricians and evaluate the results from the participants' perspective.

Methods: The objectives of the educational skills component of the learning module were developed according to adult learning theories. The learning objectives for the CPD learning module were based on a pre-course needs assessment. Evaluations were made using questionnaires.

Results: Seven of 10 participants in the educational skills component of the learning module and all the participants, 13 paediatricians and 14 nurses, who participated in the learning module, answered the questionnaires.The results of this pilot study show that educators whose main experience of teaching was based on lectures were strengthened in their practice; they defined their competence and were prepared to move towards adult learning principles. The participants in the learning module expressed a high degree of satisfaction.

Conclusions: We conclude that it is feasible to combine learning for educators and participants in a paediatric CPD programme and that lecture-oriented educators are prepared to change their educational practice towards principles of adult learning.

Background: Evaluations, using questionnaires, of a two-year long CPD program for on-call consultant paediatricians, showed that the overall objective of the program was largely met. We stipulate that the coherency of the CPD program contributed to the learning. To gains a deeper understanding of the participants learning within and beyond the overall objectives of the program, we decided to conduct an interview study enrolling participants from the frst two CPD courses.

Methods: Nine experienced paediatric consultants were interviewed 1-4 years after completing a coherent two-year long CPD program, focusing on what and how they learned. The interviews were audio-recorded and transcribed as text, analysed, and categorised using qualitative content analysis.

Results: What the participants learned: improved medical competences, greater confdence in the role of an on-call consultant, better understanding of the role of an on-call consultant and importance of professional networks. Several categories were outside the overall objective, at personal level: an understanding of one’s own and other’s competences, taking responsibility for one’s own CPD and managing things one does not know. At professional level: more secure as an individual and with colleagues.How it was learned: relevant objectives, preparatory material and case discussions were important. Participants learned by preparing, repeating, refecting, and participating actively, and by applying what they learned in clinical practice. The participants learned from one other over a period of two years, when they also got to know one another and created networks. A safe learning environment imposed demands and enabled participants to defne their competence and learn accordingly.

Conclusions: This study describes what and how on-call consultant paediatricians learned during a coherent two year long CPD program. The learning took place within and beyond the framework of the overall objectives. The study suggests that evaluation methods based on objectives may be blind to important areas of learning and need to be combined with qualitative methods that examine a broad impact of learning. Taken together, the analysis of what and how the participants learned shows that they were better equipped to work as consultant on call and deal with the things they did not know.

There is a global nurse shortage, and researchers have made great efforts in trying to unveil the reasons for turnover and how to increase retention. However, such research has had a tendency to study variables related to intention to leave (ITL) or turnover as isolated phenomena. Objective. To simultaneously explore what factors motivate experienced nurses in the workplace and the underlying reasons for strong ITL and high staff turnover within the profession. Design. An inductive qualitative content analysis was used based on data from open-ended survey questions. The data originated from the longitudinal analyses of nursing education/employment/entry (LANE) in work-life study. The qualitative data analyzed in this study were distributed in October 2017-January 2018, to all nurses in three cohorts corresponding to 11-, 13- and 15-year postgraduation. Of the 2,474 nurses answering the survey, 1,146 (46%) responded to one or more of the open-ended questions. Results. The result showed that what motivates experienced nurses, their intention to leave (ITL), and reasons for turnover could be described in the form of five broad categories, namely, organizational characteristics, work characteristics, relationships at work, work recognition, and health issues. There was rarely a one single reason described, rather several reasons needed to be experienced over time for nurses to stay motivated or leave the profession. Conclusions. There is no single reason that makes nurses leave the profession, nor is there one single reason that makes them motivated to stay. Retention and turnover are complex processes and need to be addressed as this, not as a single isolated phenomenon. © 2023 Anna Hörberg et al.

The move from student to nurse has been described as difficult and tough for new nurses. New nurses' feeling of lacking competence can reduce the opportunity to develop professional competence.They also reported fears of being "exposed" as clinically incompetent, and failing to provide safe care.Entering the nursing profession requires a high degree of adaptation where graduates are shown what skills are needed.There is a qualitative difference between the professional competence conveyed during education and the competence demanded in working life.The aim of this paper is to discuss and propose hown urses ́praxis can be developed by means of Work Integrated Learning as a pedagogical approach.The study departs from a model which shows processes newly registered nurses must manage to achieve a sense of competence. These processes will behighlighted by discussing the model's processes related to praxis in the Aristotelian tradition, situated learning, social construction and WIL.One idea behind this paper is to,by using the concept of praxis, hold up the potential of WIL It is concluded that WIL may provide an analytical perspective using reflection where the student is given the opportunity to develop metacognitive skills to reflectt heir experiences in orde rto create understanding and manifest praxis by learning in and by clinical practice, the move from being a student to becoming a nurse. The intent of praxis and WIL is to integrate scientific knowledge with practical knowledge as a pedagogical approach that provide an analytical perspective where the student is given the opportunity to develop metacognitive skills and to test their experiences in order to create understanding and manifest their praxis by learning in and by clinical practice, the move from being a student to becoming a nurse.One way to do it is by using praxis as a component in WIL and to identify knowledge that is generated in practical knowledge, professional nursing activities and endeavors by nurses on the one hand and scientific knowledge that is generated in the academy on the other hand, in order to elaborate ways to mixt hem and create a certain kind of knowledge that is neither theoretical nor purely practical.The result of this study will be proposed as a complement to nursing program curriculum in clinical practice, to identify special challenges facing students when managing and developing their professional competence

Genom cooperative education (co-op) ges studenter möjlighet att inomutbildningen, praktiskt tillämpa sina kunskaper på en arbetsplats. Under co-op tilldelasstudenten en av arbetsgivaren utsedd handledare. Co-op är ett trepartssamarbete mellanhögskola, student och arbetsplats. Merparten av tidigare studier fokuserar studenternasupplevelse av co-op eller vad co-op kan innebära för studentens studiemotivation, framtidakarriär och möjlighet till arbete. Syftet med denna fenomenografiska studie är att beskrivahandledares uppfattning om handlednings syfte. Studien kan därmed bidra till kunskap om denutbildningssituationen studenter ställs inför i co-op. Studiens resultat, som är baserad påintervjuer, visar fyra olika uppfattningar om handlednings syfte: Stödja in i gemenskapen, Delgespecifikt kunskapsinnehåll, Att få möjlighet att lära och Bidra till produktionen. Handledarnasuppfattningar indikerar att studenten förväntas praktiskt tillämpa teoretisk kunskap och fåarbets- och yrkesrelaterade erfarenheter genom ett socialt lärande. Variationerna i handledarnasuppfattningar antyder även att det samlade kunskapsinnehållet som studenten får ta del av underco-op kan variera stort. Utifrån resultatet diskuteras möjligheter och hinder för studentenslärande under co-op.

The move from student to nurse has been described as difficult for newly registered nurses. Newly registered nurses’ feelings of lacking competence can reduce the opportunity to develop professional competence. Entering the nursing profession requires a high degree of adaptation. The difference between the professional competence conveyed during education and the competence demanded in working life is substantial and needs to be taken seriously. The aim of this paper is to propose a model for developing professional competence. The theoretical discussion starts with a model showing processes newly registered nurses must manage to achieve a sense of competence. These processes are highlighted by discussing how they relate to praxis in the Aristotelian tradition, situated learning and Work Integrated Learning (WIL). Learning Integrated Work (LIW) is a pedagogical approach aiming to integrate scientific knowledge with practical knowledge, and to provide an analytical perspective where students have the opportunity to develop metacognitive skills and praxis  by learning in and by clinical practice experiences. One way to achieve this is to learn from the knowledge and skills used when performing practical work. The aims of WIL and LIW are to identify both practical knowledge generated by nurses in the course of their professional activities and theoretical knowledge generated in the academy, and to elaborate an understanding constituting the essence of both theoretical and practical knowledge. By integrating theoretical and practical vocational knowledge, one promotes professionalization, including the ability to perform the expected tasks and to have a critical and development-oriented attitude in daily work.

Background: Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. Research aim: This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. Research design: This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically. Participants and research context: Healthcare teachers (n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. Ethical considerations: This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. Findings: Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time? Conclusions: This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible  © The Author(s) 2023.

Objective: Moral distress emanating from value conflicts comprising ethical dimensions pose a threat to nurses’ health and retention, as well as to the quality of care. The aim of the present study was to investigate the relationships between the frequency of ethical value conflicts (EVC), and the perceived distress when they occur, respectively, and nurses’ work-related stress, burnout symptoms, turnover intent, team effectiveness, and patient safety.

Method: A two-wave longitudinal cohort questionnaire study was performed among registered nurses at six hospitals in two Swedish regions. Cross-sectional analyses (T1) were based on 1817 nurses in 228 care units (CU), and longitudinal analyses (T1 – T2) on 965 nurses in 190 CU. Hypothesis testing was performed using multilevel controlled regression modeling.

Result: The results indicated that nurses who were often exposed to EVC also to a higher extent tended to report these conflicts as stressful. Frequent exposure to EVC induced by insufficient resources, inapt organizational structures or interpersonal staff relations were cross-sectionally associated with work-related stress, burnout symptoms, turnover intent, and team effectiveness. The longitudinal analyses indicated that EVC induced by a lack of resources primarily had negative effects on nurses’ health and well-being. At the CU level, such conflicts also impaired team effectiveness. At the individual level, EVC induced by organizational constraints or interpersonal relations negatively affected care effectiveness.

Conclusions: EVC are related to negative consequences in healthcare, and such processes take place both on the individual and organizational levels.</p>

Professional development is a process that starts in education and continues through working life. To be a new graduated registered nurse has been described as difficult and tough. The healthcare organization, patients and nurses would all benefit if the professional development was smooth and supportive. The aim was to develop a model describing newly graduated registered nurses professional development during the first years of healthcare practice. To develop a model a constant comparative analysis was performed. Data consisted of written answers to an open question concerning what newly graduates perceived of particular significance to facilitate the transition between education and professional life. In this study the core concept constructed from data was mastering the professional role and was seen as a result of an ongoing process regarding the individual's experiences as well as relations with the surrounding environments. The analysis shows that the professional developmental process involves three interrelated sub-processes; Evaluating and re-evaluating educational experience, developing professional self-efficacy and developing clinical competence. These sub-processes are all influenced by six factors, social values and norms, the healthcare organization, nurse-management, coworkers, patients/relatives and private life situation. These factors affect nurse' professional development directly, indirectly or as mediating influences and can lead to various possible orientations. The result underlines the importance of knowing of how to develop the personal professional role within in a working life context inorder to experience to mastering the professional role. In this process the new registered nurses need support from both their nursing school and employer. This model will be the subject of further measurement and testing

Professional development is a process starting during undergraduate education and continuing throughout working life. A new nurse's transition from school to work has been described as difficult. This study aims to develop a model describing the professional development of new nurses during their first years of work. To develop this model, constant comparative analyses were performed. The method was a qualitative study of survey data on 330 registered nurses. The results showed that mastering the professional role was the result of an ongoing process building on the nurse's experiences and interactions with the surrounding environment. The professional developmental process involves the following interrelated sub-processes: evaluating and re-evaluating educational experiences, developing professional self-efficacy and developing clinical competence. These sub-processes are influenced by the following factors: social values and norms, healthcare organization, management of new nurses, co-workers, patients and significant others and the nurse's own family and friends. These factors affect professional development directly, indirectly or as mediating influences and can lead to possible outcomes, as new nurses choose to remain in or leave the profession. The results underscore the importance of developing a professional nursing role within the new working context. To facilitate this professional development, new nurses need support from their nursing-school educators and their healthcare employers. The model described here will be the subject of further measurement and testing. © 2012 Elsevier Ltd.

Aim:

To investigate how NGNs perceived and applied an intervention for preventing stress-related ill health embedded in a transition-to-practice programme when enter-ing their professional life.

Design:

A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention.

Methods:

In this qualitative methodology process evaluation, semi-structured and audio-recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis.

Results:

The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional devel-opment and health and (c) Practical steps for skills development, healthy habits and better-organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward.

Conclusion:

This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work.

Impact:

When entering a new profession, it is crucial to receive a well-thought-out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies.

Aim: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts.

Design: A mixed methods design with a longitudinal questionnaire survey and focus group interviews.

Methods: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November–January 2019/2020 and November–January 2020/2021). A cross-lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April–October 2021). Qualitative data collection and analysis were inspired by Grounded Theory.

Results: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur.

Conclusion: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve.

Implications for the Profession: By ensuring a shared care ideology, good interprofessional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful.

Impact: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress.

Patient or Public Contribution: No patient or public contribution.

Background During clinical supervision, medical students are expected to gain experience through clinical work, with the support of their clinical supervisor. What each supervisor chooses to emphasize and considers important will have a decisive impact on students’ understanding of what is content necessary to master in order to gain clinical skills. Therefore, in this study, the focus of attention is on what supervisors choose to emphasise during clinical supervision of fourth year medical students during a surgical course.

Method An ethnographic approach was used, including a selective intermittent time mode, where observation and informal interviews were conducted. Twelve supervisors and nine medical students at a teaching hospital in Sweden participated. Field notes were made during observation; these were transcribed and analysed qualitatively.

Results The analysis resulted in six topic areas describing what was emphasized during supervision. The topic areas were: 1) Identifying, collecting and combining information, 2) Problem-solving and decision-making, 3) Handling treatment of disease, 4) Practical skills and illustration of technical equipment, 5) Communicating with patients, and 6) Handling organisational demands.

Conclusions The findings of this study show the existence of several areas that are focused on in supervision. In authentic clinical situations, these topic areas were intertwined and overlapped and often appeared simultaneously. The clinical situations were adjusted neither to the students’ clinical experience nor to the needs of the students. Consequently, the students may find it difficult to determine what to learn and what to achieve during supervision. They may also find it difficult to understand the situations in the same way as their supervisors, because students focus on handling situations with a more theoretical and declarative approach to a larger extent than do their supervisors. The students therefore need supervisor support to develop and integrate theoretical knowledge. One conclusion that can be made is that supervisor awareness of students’ understanding is of crucial significance for the effective supervision. Regarding the nature of the content chosen in supervised situations, research in other settings and specialities would be required to map and to determine a more general theory of what is focused during medical supervision

Introduction: Medical student's professional attitudes are expected to be developed in medical school, and particularly during clinical education. In this study we focus on supervision in order to describe the attitudes emphasized in the clinical education of fourth-year medical students taking a surgical course.Methods: An ethnographic approach was applied where observation and interviews were conducted. Nine medical students and twelve supervisors at a teaching hospital in Sweden participated. Field notes were made during observation as well as interviews; these were transcribed and analysed qualitatively.Result: The analysis resulted in six topic areas describing the attitudes emphasized. The medical students were expected to be: 1) Informed and effective decision makers, 2) Sensitive to patients' needs and expectations, 3) Communicative, 4) Authoritative and patriarchal, 5) Adaptable to organizational demands, and 6) Mindful of nurse's knowledge and requests.Conclusions: This study reveals that the attitudes emphasised during supervision are: dualistic and complex to learn, developed by a former generation and influence student learning. Students need support in order to handle the state of tension that exists in the attitudes emphasized. Medical students might experience difficulties in adopting some attitudes belonging to a former generation. There is a need for competence development among supervisors concerning how students may experience the attitudes emphasized in supervision.

Background:  Clinical teaching is a complex learning situation influenced by the learning content, the setting and the participants' actions and interactions. Few empirical studies have been conducted in order to explore how clinical supervision is carried out in authentic situations. In this study we explore how clinical teaching is carried out in a clinical environment with medical students.

Methods:  Following an ethnographic approach looking for meaning patterns, similarities and differences in how clinical teachers manage clinical teaching; non-participant observations and informal interviews were conducted during a four month period 2004-2005. The setting was at a teaching hospital in Sweden. The participants were clinical teachers and their 4th year medical students taking a course in surgery. The observations were guided by the aim of the study. Observational notes and notes from informal interviews were transcribed after each observation and all data material was analysed qualitatively.

Results:  Seven pedagogical strategies were found to be applied, namely: 1) Questions and answers, 2) Lecturing, 3) Piloting, 4) Prompting, 5) Supplementing, 6) Demonstrating, and 7) Intervening.

Conclusions:  This study contributes to previous research in describing a repertoire of pedagogical strategies used in clinical education. The findings showed that three superordinate qualitatively different ways of teaching could be identified that fit Ramsden's model. Each of these pedagogical strategies encompass different focus in teaching; either a focus on the teacher's knowledge and behaviour or the student's behaviour and understanding. We suggest that an increased awareness of the strategies in use will increase clinical teachers' teaching skills and the consequences they will have on the students' ability to learn. The pedagogical strategies need to be considered and scrutinized in further research in order to verify their impact on students' learning.

Digital healthcare information systems impose new demands on healthcare professionals, and information security rules may induce stressful value conflicts, which the professional culture may help professionals to handle.

The aim of the study was to elucidate physicians' and registered nurses' shared professional assumptions and values, grounded in their professional cultures, and how these assumptions and values explain and guide healthcare professionals' handling of value conflicts involving rules regulating the use of electronic medical records.

Methods Healthcare professionals in five organisations in two Swedish healthcare regions were interviewed.

Results The study identified ensuring the patients' physical health and well-being as the overarching value and a shared basic assumption among physicians and registered nurses. A range of essential professional and organisational values were identified to help attain this goal. In value conflicts, different values were weighted in relation to each other and to the electronic information security rules.

Conclusions The results can be used to guide effective design and implementation of electronic medical records and information security regulations in healthcare.

The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work.

Background: Previous research has raised questions about new graduate nurses’ (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs’ expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce.

Design: A cross-sectional survey design was used. Method: NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses.

Results: Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit.

The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses’ readiness for clinical work, the challenges they perceive, and their needs for learning and supp

Aim

This study aimed to explore how new graduated nurses experience a one-day simulation based education, contributing to providing care in acute situations two months after completion.

Background

Simulation-based education is often offered to new graduated nurses as part of important workplace learning. Simulation-based education is a valid learning and teaching strategy and is suggested as a measure to improve nurses’ ability in acute situations. However, studies are often conducted as pre-post evaluations immediately after completion of a simulation. Thus, knowledge of the clinical impact of simulation-based education on actual acute care situations could benefit both research and practice.

Design/method

During the winter of 2021–2022, 14 semi-structured interviews were conducted with newly graduated nurses two months after they completed the simulation-based education and the interviews were analyzed using thematic analysis.

Results

The results are presented in three themes: a structured and shared strategy to handle acute situations, a developed role in acute situations and a more comprehensive understanding of acute situations. The results revealed that simulation-based education can contribute to the ability to care in acute situations in terms of action readiness and broad contextual understanding.

Conclusion

Simulation-based education can help develop the ability to care for patients in acute situations. However, differences in participant experiences must be acknowledged and processed in order for the implementation and outcome to be successful.

Introduction:

Simulation-based education is frequently used in transition programs for new graduate nurses. Simulation-based education is implemented as a measure to practice nursing skills, gain experience, and prepare nurses for caring in challenging situations, such as acute situations. However, concerns about the data supporting the use of simulation are obtained from small studies that do not use validated measurement scales.

Objective:

This study aimed to explore the influence of simulation-based education on new graduate nurses’ perceivedability to provide care in acute situations.

Methods:

A total of 102 new graduate nurses participated in simulation-based education as a mandatory part of an introductory program. They completed a premeasurement and a postmeasurement using the Perception to Care in Acute Situations scale. The Wilcoxon signed-rank test and the paired samples ttest were used to test the statistical significance of outcomes for the simulation-based education, with the alpha set at 0.05.Cohen’s d formula was used to calculate the effect size.

Results:

The Wilcoxon signed-rank test on the total scale score showed that simulation-based education resulted in a statistically significant change in the nurses’ perceptions of their abilityt o care in acute situations (N ¼ 99; Z ¼ 7877; P < .001). The paired samples

t test showed that the mean posteducation scorewas significantly higher (P < .001) in the total score. Cohen’sd formula (-1.24) indicated a large effect size on the total score.

Discussion:

Simulation-based education can provide an effective means of improving new graduate nurses’ perceivedability to provide care in acute situations. 

Purpose

This study aims to investigate how aspects of the sex/gender were scrutinized in a team’s production of clinical guidelines for psychiatric compulsory care and what the implications were for the final guidelines and for interprofessional learning.

Design/methodology/approach

The study is a case study, where interviews were conducted and a narrative analysis was used.

Findings

The results reflected how sex/gender arose in a discussion about gender differences when using restraining belts. Furthermore, discussions are presented where profession-specific experiences and knowledge about sex/gender appeared to stimulate interprofessional learning. However, the team’s learning about the complexity of sex/gender resulted in guidelines that emphasized aspects of power and focused on the individual patient. Thus, discussions leading to analysis and learning related to gender paradoxically produced guidelines that were gender-neutral.

Originality/value

The study highlights the potential interprofessional learning in discussions of sex/gender and its complex relation in medicine.