The registered nurse is teaching a nursing student about the pathologic influence on mobility

PLoS One. 2021; 16(5): e0252483.

Ann-Chatrin L. Leonardsen, Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Writing – original draft, Writing – review & editing,1,2,* Siri E. Brynhildsen, Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing,1 Mette T. Hansen, Conceptualization, Data curation, Formal analysis, Writing – review & editing,1 and Vigdis A. Grøndahl, Conceptualization, Data curation, Formal analysis, Methodology, Writing – review & editing1

Mojtaba Vaismoradi, Editor

Abstract

Clinical placements and supervision is an integral part of nursing education internationally. There are significant differences between students’ expectations of clinical learning and their fulfillment. Few studies have focused on supervisors’ perspectives on clinical placements. The objective of this study was to explore nursing supervisors’ perspectives on students’ preparedness for clinical placements.

Methods

The study was conducted in a county in Southeastern-Norway, with 317.000 inhabitants, and within one hospital and one university college catchment area. Focus group interviews were conducted in the periode August to December 2018. Data were analyzed using Hsieh and Shannon’s conventional content analysis.

Results

34 nursing supervisors participated, three intellectual disability nurses and 31 registered nurses, working in four different primary healthcare wards and four different hospital wards. Participants’ age ranged from 23 to 58 years, one male only. Through the analysis we derived the category ‘Shared responsibility for preparation’ with subcategories a) Individual initiative, and b) University college facilitation.

Conclusions

Findings indicate that there is a gap between nursing supervisors’ expectations and reality regarding students’ preparedness for clinical placements. Moreover, nursing supervisors did not seem to focus on their own role in student preparedness.

Introduction

Nurse education in Europe is characterized by different structures, standards and approaches to the relationship between theoretical and practice based learning [1, 2]. The European Commission has, through the Bologna Treaty Process, promoted greater harmonisation of educational systems in the European area [3]. Such harmonisation seeks to increase the employment and educational mobility of nursing staff and students.

Clinical environments offer registered nursing- (RN) and intellectual disability nursing (IDN) students a possibility to gain clinical training, that requires them to employ their knowledge and skills to develop qualifications to be able to take care of patients [4, 5]. To provide high quality care, clinical supervision is widely used as a professional process to support undergraduate nursing students [6], in the development of professional competence and confidence [7]. The support provided through clinical supervision helps the students to link theoretical knowledge provided through lectures, with patient care in the clinical environment [6, 8, 9]. Clinical placements enables supervisors to directly observe students in the clinical environment, and also gives an opportunity to build a supportive relationship between the supervisor and the student [10]. Such supportive relationship will hereby optimize students’ learning [11]. Lack of this supportive supervisor–supervisee relationship has been found to result in negative clinical learning experiences [12]. Scholars internationally emphasize the need to strengthen clinical supervision, in order to contribute to nursing student’s personal development and increased competence [8, 11].

Expectations may be understood as reasonable likelihood that something will occur [13]. Expectations are linked with motivational (interests) and cognitive (assessment) aspects of behavior, and have great impact in the processes of decision-making, as well as in academic and workplace performance [14–16]. Statistically significant differences have for example been found between the nursing students’ initial expectations and their fulfillment at the end of the academic year for all the factors and in all years of the nursing bachelor degree program [17]. Clinical placements are a central part of the nursing education cirrucula. In Norway, nursing services are provided by either registered nurses (RNs) or intellectual disability nurses (IDNs). Both cirrucula includes three years full-time studies, and results in a total of 180 ECTs (European Credit Transfer and Accumulation System). Clinical placements and supervisors are essential in the RN and IDN students’ path to being a competent professional. Educators expect students to be actively engaged in contributing to their clinical placement experience and determining appropriate learning outcomes. In the clinical context, this requires that educators collaborate with students’ to identify their learning needs and ensure they are provided with opportunities together with the clinical supervisor [12, 14]. For the student, this requires that they are well prepared in terms of basicknowledge and attitudes during their clinical placement periods. This include that they accept a share of the responsibility for planning and preparing for the learning experience [18]. Research on supervisors’ perspectives on clinical placements, as the ones who direct the students to gain professionally related skills in the clinical environment, is limited [18, 19]. Moreover research on supervisors’ expectations, and their perspectives on students’ preparedness are lacking. Consequently, the aim of this study was to explore RN- and IDN supervisors’ perspectives on students’ preparedness to clinical placements.

Materials and methods

Design

The study is in-line with the Consolidated criteria for reporting qualitative research–COREQ [20]. The study had a qualitative design, utilizing focus group interviews to explore RN and IDN supervisors’ perspectives on students’ preparedness for clinical placements. A qualitative approach is appropriate when aiming to explore how individuals experience a phenomenon, dependent on their background, interests and interpretation [21]. Focus groups are appropriate when exploring experiences and perceptions, enabling further development of these through group discussions among participants. During focus group interviews interaction, dialogue, and shared reflections between the participants, can increase and deepen the understanding of the phenomenon that is explored [22, 23].

Setting

The study was conducted in a county in south-eastern Norway concisting of 18 municipalities, and within the cathcment area of one hospital trust that covers 317 000 inhabitants. Within the municipalities there are five decentralized acute care wards and five casualties. Moreover, there are 34 nursing homes, and more than 4o home based nursing wards, in addition to institutional services for persons with intellectual and physical disabilities. The county adhere to one university college, which provides bachelor degree education for RN and IDN students. A total of approximately 1700 clincial placements are carried out every year, and approximately 160 registered nurses (RN) and between 45 and 95 intellectual disability nurses (IDN) finish their bachelor’s degree from the university college each year.

Sample

A purposive sampling strategy was utilized, where supervisors from all the different types of clinical placement wards were invited to participate. The researchers aimed at including supervisors from both primary healthcare services and different hospital wards. Pragmatically, the aim was to include participants to eight focus group interviews. Two medical and two surgical hospital wards respectively were randomly selected, as well as four wards in primary healthcare services. The RNs/IDNs nearest leader (RNs/IDNs themselves) in each ward selected participants assumed to be information rich, experienced with supervision of RN/IDN students. Inclusion criteria were; RN/IDNs who had supervised bachelor students within the last two years. No exclusion criteria were added.

The supervisors were given verbal and written information about the study and asked to participate by their manager. The supervisors who wanted to participate, signed an informed consent.

Interview guide

A semi structured interview guide was developed by the authors, based on the respective bachelor program’s curriculum, informal feedback from teachers at the university college and from supervisors, also including the researchers’ own experiences and competencies from education and the clinical field (see S1 File). The interview guide was assessed and discussed in a research group, consisting of six RNs and one IDN with both clinical and educational experience (in addition to the authors), and no revisions were needed. The questions were used to guide the focus group interviews. Table 1 gives an overview of the interview guide.

Table 1

Examples of questions from the interview guide.

Procedure

The focus group interviews were conducted nearby the participants’ workplace in an office or meeting-room away from the actual ward. The interviews started with an open dialogue where the participants were encouraged to freely discuss their experiences related to supervision of RN/IDN students during clinical placement. The interview guide was then used as a «checklist» to the ensure that the themes were covered. The focus group interviews were conducted by two and two participants of the research group, consisting of RN and IDN educators and clinicians, some with a PhD and some without (two males). Their roles were as active interviewer and observer respectively. All researchers were experienced RN/IDNs, with several years of professional practice, and/or several years of experience as educators. Moreover, a researcher with qualitative research experience participated in all interviews. The interviewers were not familiar to the participants.

The focus group interviews were conducted in the periode August to December 2018. The interviews lasted from 30 to 70 minutes (mean 50 minutes). The interviews were digitally recorded, and transcribed verbatim by an external transcriber, who had signed a non disclosure agreement. The recordings were deleted after transcription.

Analysis

Data were analysed according to Hsieh and Shannon’s conventional content analysis, which is appropriate when the aim of the study is to describe an under- or unexplored phenomenon [24]. The analysis started with reading the transcripts repeatedly to obtain a sense of the whole (all authors). Then the transcripts were read word by word, and exact words that appeared to capture key thoughts or concepts were highlighted (two of the authors). Notes were made to catch the first impressions, thoughts and initial analysis, and subsequently codes were derived based on more than one key thought (three of the authors). During the analysis, the transcripts were included in a table. Key words were marked yellow. Labels for codes were then transferred to the next column (initial coding scheme), and categories placed in the next column. All authors (of which two were experienced qualitative researchers) read the transcripts, and the preliminary derived codes were discussed untill consensus was reached. The codes were then sorted into different categories depending on how they were related and linked (three of the authors). The development of categories were also discussed among all authors untill consensus was reached. This was an iterative process, moving back and forth from transcripts to codes to categories.

Ethical consideration

The study was approved by the Norwegian Center for Research Data (NSD) (Ref. no.951914), and was conducted in-line with recommendations in the Declaration of Helsinki [25]. The supervisors received oral and written information about the study purpose, and delivered signed written consents to participate. Due to the nature of a focus group, it was not possible to withdraw from the study. Participation was voluntary.

Results

A total of 34 RN/IDN student supervisors participated. Table 2 gives an overview of the participants’ general characteristics.

Table 2

Participants’ general characteristics.

The supervisors worked in psyciatric and substance abuse care, in home healthcare, in housing for disabled people, in a nursing home in primary healthcare, and in medical and surgical wards, including the children’s ward in hospital.

Through the analysis we derived the category ‘Shared responsibility for preparation’ with subcategories a) Individual initiative, and b) University college facilitation. Illustrative quotes are marked with focus group (FG) number.

Shared responsibility for preparation

All of the focus group participants found preparedness as essential for students to get the most out of their clinical placement, both personally and related to learning outcomes. For students to be prepared for clinical placement supervisors assumed a shared responsibility between the student and the university college. They expected the student to be acquainted with the patient groups as well as with possible learning outcomes for the specific clinical placement. Moreover, they expected that the university college provided the students with theoretical introduction and practical exercises in different practical procedures. These aspects were discussed and emphasized as important in all focus groups, across RN/IDN specialization and across primary- and hospital healthcare wards. In addition, there were no disagreements between participants within the focus groups regarding these aspects.

Individual initiative

Throughout, there was an agreement in all focus groups that the student had an individual responsibility to be prepared, and hereby needed to show individual initiative. The supervisors in all focus groups emphasized that the students should reflect on their role as a student. Moreover, supervisors expected students to have insight into the learning outcomes related to the specific educational semester, as well as the potential learning opportunities at the specific ward. Most focus groups (FG) also expressed increasing expectations of the students’ preparedness from first to the last semester of the education program. One of the supervisors in FG 4 stated;

«That he thinks through what is expected as a student. That he knows what he is good at, and that he is prepared for those things is important for the third year.» (FG 4)

This was supported by the other supervisors in the group. Supervisors in all groups also found it important that students had knowledge about different relevant diseases in the actual placement, both regarding pathology, medical treatment and nursing care needed in the specific group of patients. As stated in FG 6:

«That they are prepared and have knowledge about the patient group they will meet.» (FG 6)

Some of the wards had developed an information letter about the placement that students got access to before the placement periode. Here, supervisors expected the students to have read the information, even though this was not always the case. The supervisors in many of the focus groups also would like the students to visit the ward in advance.

In some of the focus groups, supervisors expressed that it was an advantage when the students had work experience from health or social services before starting their education and also that they worked during their studies. This was particularly emphasized as an advantage by IDN supervisors prior to clinical placements in substance abuse care and mental health work;

«To have som psychiatric experience or know a little of relationships, man, wholeness.» (FG 9)

University college facilitation

In all focus groups, supervisors expressed that they assumed that the university college is responsible for facilitating for students to access both theoretical and practical knowledge. They all expected that the students had been introduced to, and given the opportunity to perform different practical skills and procedures at least once at the university college. Hygienic principles and aseptic procedures were examplified as knowledge that could be transferred to many procedures, and the supervisors assumed that the university college enabled students to do so. Moreover, they pointed out that by letting the students practice on each other, one might perhaps lessen the discomfort one can feel when the procedures are to be performed on a patient for the first time. In FG 3 this was prompted:

«That they experience what it is like to have your teeth brushed by someone else, or be fed or having a bed bath.» (FG 3)

and further

«Then the training can be done during the clinical placement, you get to try it several times, like injections, or, yes, wound care» (FG 3)

The supervisors also expected that the university prepared the students for various clinical placements. For example, before clinical placement in surgical wards the participants expected the students to have knowledge of preoperative and postoperative nursing. A supervisor in FG 10 said:

«… then I expect that they have had lectures in pre and postoperative nursing. They should know what to look for when someone has just had surgery. What is the postoperative nursing, elimination, pain…..» (FG 10)

Prior to clinical placement in mental health care, the IDN supervisors expected the students to have knowledge of e.g. guardianship, law of coercion and force, and also of the most common drugs used in mental health treatment. FG 7 agreed on this statement:

«What is psychiatry? It is no longer just the medication. If they do not want to take their medicines, we can not force them, and then we have to do something else, and what do we do then?» (FG 7)

In several of the focus groups, the supervisors claimed that the university college had to prepare the students to be creative and adapt the nursing care to the current situation in the different care settings. This was espescially emphasized when the students were in clinical placements in the patient`s home in home health care services. In FG 4 this was concretized:

«Because we can enter a home and there is a man with a cardiac arrest in bed, what do you do?» (FG 4)

Discussion

Our findings show that supervisors had expectations regarding students’ individual initiative to be prepared for clinical placement, as well as to the university college facilitation of such preparedness. The focus groups consisted of participants from various primary healthcare wards, as well as hospital wards, and both RNs and IDNs, still there were no disagreements on these issues.

Supervisors perceived that students should take their part of the responsibility for being prepared for clinical placements. Moreover, they emhasized that this would require individual initiative, since the students would have to reflect, search for relevant literature regarding specific conditions or even visit the actual ward prior to the placement periode. This is in-line with findings from e.g. Chipchase et al [18], who emhasized that students should accept a share of the responsibility for planning and preparing for the learning experience. Webb et al. [26] also found that supervisors wants students who are well prepared theoretically in front of clinical placements. In a recent study, supervisors rated professionalism and willingness as the most important characteristics in nursing students, followed by personal attributes. The authors concluded that further strengthening learning opportunities related to these characteristics in the nursing curriculum may improve the students’ preparedness for clinical learning [27].

The supervisors also discussed the need to combine theoretical knowledge and practical skills, to be able to meet patients as whole human beings. According to Bloom [28] there are three domains of learning: 1. Knowledge (cognitive, mental skills), 2. Skills (psychomotor, manual or physical skills), and 3. Attitude (affective, growth in feelings). The clinical environment is a place for students to practice and gain both confidence and competence in all three of these domains [29]. Clinical training is regarded as an integral part of learning and education in nursing [5, 30]. Furthermore, the clinical learning environment plays an important role in turning nursing students into professionals and preparing them to function as nurses [31]. Nevertheless, supervisors expected that students had both knowledge and skills before their clinical placement.

The supervisors expected the university college to provide students with both theoretical knowledge and practical training relevant for the specific clinical placement. In a recent study across primary and tertiary healthcare in the same county, we found that RNs/IDNs perceived that students should learn technical skills in the university college first, and then get more training in clinical placement [32]. This was supported by findings from the focus group discussions in the current study.

Earlier studies have emphasized that supervising nursing students affects RNs’ daily work to different degrees, depending on students’ knowledge, progress and willingness to learn, but also on the supervisors themselves [33, 34]. Moreover, studies indicate that the nursing students are not psychologically prepared for clinical placements [35, 36]. In the current study, issues related to the supervisors themselves were not discussed. The gap between supervisors’ expectations, and students’ preparedness could lead to challenges both regarding the establishment of a constructive supervisor-supervisee relationship, the supervisors’ experience of their role as a burden, and to the students’ clinical learning. According to Kalyani et al. [37], educational policymakers should focus on increasing supervisors’ influence on management, education and clinical education, as well as teaching positive and constructive strategies to cope with inadequate educational contexts. Donough et al. [38] also suggest a need for continuous professional development for clinical supervisors by means of in-service training.

Our findings indicate that RN/IDN supervisors expect for students to show individual initative to get prepared for clinical placements. In addition, they assume that the university college has ensured students’ preparedness related to theoretical knowledge and procedural competence. Even though the importance of supervisors’ in students’ clinical placements has been emphasized in many studies [5–16], participants in our study did not discuss their own role in student preparation.

Limitations

Within the qualitative research study lies the lack of generalizability of study findings. Moreover, the study presented here has some further limitations. First, the data was collected by seven different interviewers., which may have introduced a researcher-bias. Still, they all had experience in conducting interviews, and had long experience from both clinical practice as RNs/IDNs and educators. In addition, to minimize the possible differences, the interview guide was discussed in advance among the researchers to reach a joint understanding of the questions and how to perform the focus group interviews.

Second, in this study, both RNs and IDNs were included, but few IDNs participated. IDNs are authorized healthcare personnel and work in different clinical settings. Inclusion of more IDNs might have proved additional data. Even if they were few in numbers, they contributed with important experiences from being supervisors. In addition, several of the supervisors who were RNs also supervised IDN students, adding to the IDN student perspective.

Credibility was ensured through several and iterative analysis and discussions both between the authors and with the research group members. The research group consisted of 12 IDNs and RNs from both clinical wards and the university college. The supervisors represented both RNs and IDNs, from a variety of clinical wards both in primary- and hospital healthcare, indicating transferability of findings. To ensure dependability, the first author verified the authenticity of the recordings of the interviews against the transcripts. Unfortunately, non-verbal expressions during the interviews were not charted and included in the analysis. This may have had an impact on the results of our study.

Conclusion

Findings indicate that the supervisors across primary and tertiary healthcare have expectations to students’ individual initiative to get prepared for clinical placement, as well as the educational institutions’ fascilitation thereof. In contrast, they did not discuss their own role in getting students prepared for clinical placements, or how they could support students at the beginning of the clinical placement periode. Our findings indicate that there is a gap between supervisors expectations and reality, which could impact both their relationship to the student, as well as the students’ learning process. Clinical placement quality improvement initatives should focus on closing this gap.

Relevance to clinical practice

Further studies should focus on how supervisors could contribute to students’ preparedness, together with the educational institutions. Moreover, students’ and supervisors’ perspectives should be compared and efforts made to align these, aiming for expectations to be in-line with reality. Educational policymakers should focus on increasing supervisors’ influence on clinical placements, as well as the importance of collaboration between the supervisors and employees in the educational institutions. In addition, supervisors should be given the opportunity to access formal competence in supervision.

Supporting information

Acknowledgments

Inger Hjelmeland, Ina Kristin Blågestad, Anne Grethe Gregersen, Lars Gunheim-Hatland, Anne Herwander Kvarsnes, Mona Martinsen, Richard Olsen, and Wenche Charlotte Hansen are acknowledged for participating in the planning of the study, as well as in development of the interview guide. In addition, Anne Grethe Gregersen and Lars Gunheim-Hatland are acknowledged for participating in the focus group interviews.

Funding Statement

ACL received fundings from Østfold University College (https://www.hiof.no/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

Data cannot be shared publicly due to confidentiality issues, and the possibility that individuals may be recognized in the data. Data may be shared upon reasonable request to a data contact person: Ann Karin Helgesen, Professor and Head of Research at Østfold University College. Email: .

References

1. Salminen L, Stolt M, Saarikoski M, Suikkala A, Vaartio H, Leino-Kilpi H. Future challenges for nursing eductaion- A European perspective. Nurse Educ Today. 2009;30(233–238). 10.1016/j.nedt.2009.11.004 [PubMed] [CrossRef] [Google Scholar]

2. Suhonen R, Saarikoski M, Leino-Kilp H. Cross-cultural research: a discussion paper. Int J Nurs Stud. 2009;45:593–602. [PubMed] [Google Scholar]

4. Henderson A, Twentyman M, Heel A. Students’ perception of the psycho-social clinical learning environment: an evaluation of placement models. Nurse Educ Today. 2006;26:564–71. 10.1016/j.nedt.2006.01.012 [PubMed] [CrossRef] [Google Scholar]

5. Dadgaran I, Parvizy S, Peyrovi H. Nursing students’ views of sociocultural factors in clinical learning: a qualitative content analysis. Jpn J Nurs Sci. 2013;10:1–9. 10.1111/j.1742-7924.2012.00205.x [PubMed] [CrossRef] [Google Scholar]

6. Franklin N. Clinical supervision in undergraduate nursing students: a review of the literature. J Business Educ Scholarship Teach. 2013;7(1):34–42. [Google Scholar]

7. Muthathi A, Thurling C, Armstrong S. Through the eyes of the student: Best practices in clinical facilitation. Curationis. 2017;40(1):8. 10.4102/curationis.v40i1.1787 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Amsrud K, Lyberg L, Severinsson E. The influence of clinical supervision and its potential for enhancing patient safety- undergraduate nursing students views. J Nurs Educ Pract. 2015;5(6):87–95. [Google Scholar]

9. Brunero S, Stein-Parbury J. The effectiveness of clinical supervision in nursing: an evidence based literature review. Austr J Adv Nurs. 2011;25(3):86–94. [Google Scholar]

10. Bifarin O, Stonehouse D. Clinical supervision: an important part of every nurses’ practice. Br J Nurs. 2017;26(6):331–5. 10.12968/bjon.2017.26.6.331 [PubMed] [CrossRef] [Google Scholar]

11. Nabolsia M, Zumotb A, Wardamc L, Abu-Moghli F. The experience of Jordanian nursing students in their clinical practice. Procedia- Soc Behav Sci. 2012;46(2012):5849–57. [Google Scholar]

13. Edberg A, Andersson P. The shift from a medical to a nursing orientation: a comparison of Swedish nursing students’ expectations when entering the nursing degree programme in 2003 and 2013. Nurse Educ Today. 2015;35:78–83. 10.1016/j.nedt.2015.06.015 [PubMed] [CrossRef] [Google Scholar]

14. Cowen K, Hubbard L, Hancock D. Expectations and experiences of nursing students in clinical courses: a descriptive study. Nurse Educ Today. 2018;67:15–20. 10.1016/j.nedt.2018.04.024 [PubMed] [CrossRef] [Google Scholar]

15. Hamshire C, Willgoss T, Wibberley C. What are reasonable expectations? Healthcare students perceptions of their programmes in the North West of England. Nurse Educ Today. 2013;33(2):173–9. 10.1016/j.nedt.2012.02.014 [PubMed] [CrossRef] [Google Scholar]

16. Lovric R, Prlic N, Milutinovic D, Marjanac I, Zvanut B. Changes in nursing students’ expectations of nursing clinical faculties competences: a longitudinal, mixed methods study. Nurse Educ Today. 2017;59:38–44. 10.1016/j.nedt.2017.08.013 [PubMed] [CrossRef] [Google Scholar]

17. Hidalgo-Blanco M, Puig-Llobet M, Lluch-Canu M. Expectations of nursing degree students: A longitudinal analysis. Nurs Educ Today. 2020. 10.1016/j.nedt.2020.104474 [PubMed] [CrossRef] [Google Scholar]

18. Chipchase L, Buttrum P, Dunwoodie R, Hill AJ, Mandrusiak A, Moran M. Characteristics of student preparedness for clinical learning: clinical educator perspectives using the Delphi approach. VBMC Med Euc. 2012;12(1):112. 10.1186/1472-6920-12-112 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

19. Lewallen L, De Brew J. Succesful and unsuccesful clinical nursing students. J Nurs Educ. 2012;51(7):389–95. 10.3928/01484834-20120427-01 [PubMed] [CrossRef] [Google Scholar]

20. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19|(6):349–57. 10.1093/intqhc/mzm042 [PubMed] [CrossRef] [Google Scholar]

21. Langdridge D. Phenomenological psychology: theory, research and method. Harlow, UK: Pearson Education; 2007. [Google Scholar]

22. Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. J Adv Nurs. 2004;18:145–53. 10.1111/j.1471-6712.2004.00258.x [PubMed] [CrossRef] [Google Scholar]

23. Beck D, Polit C. Nursing Research. 11th ed. Wolters Kluwer Health; 2018. [Google Scholar]

24. Hsieh H, Shannon S. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. 10.1177/1049732305276687 [PubMed] [CrossRef] [Google Scholar]

26. Webb C, Shakespeare P. Judgements about mentoring relationships in nurse education. Nurse Education Today. 2008;28(5):563–671. 10.1016/j.nedt.2007.09.006 [PubMed] [CrossRef] [Google Scholar]

27. Banneheke H, Dnadarajah V, Ramamurthy S. Student preparedness characteristics important for clinical learning: perpsectives of supervisors from medicine, pharmacy and nursing. BMC Med Educ. 2017;17:130. 10.1186/s12909-017-0966-4 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

28. Anderson L, Karthwohl D, Bloom B. A taxonomy for learning, teaching and assessing: a revision of Bloom’s taxonomy of educational objectives. Boston: Allyn& Bacon; 2001. [Google Scholar]

29. Delany C, Molloy E. Learning and teaching in clinical context: a practical guide. Chatswood: Elsevier; 2018. [Google Scholar]

30. Egan T, Jayae C. Communities of clinical practice: the social organization of clinical learning. Health & social care in the community. 2009;13:107–25. 10.1177/1363459308097363 [PubMed] [CrossRef] [Google Scholar]

31. Woodley L. Clinical teaching in nursing. Teaching in nursing and role of the educator. The complete guide to best practice teaching, evaluation and cirruculum development. New Yrok: Springer Publishing Company; 2013. [Google Scholar]

32. Leonardsen A, Blågestad I, Brynhildsen S, Olsen R, Gunheim-Hatland L, Gregersen A, et al. Nurses’ perspectives on technical skill requirements in primary and tertiary health care. Nursin Open. 2020;00:1–7. [PMC free article] [PubMed] [Google Scholar]

33. Hallin K, Danielson E. Preceptoring nursing students: registered nurses’ perceptions of nursing students’ preparation and study approaches in clinical education. Nurse Educ Today. 2010;30(4):296–302. 10.1016/j.nedt.2009.08.004 [PubMed] [CrossRef] [Google Scholar]

34. Brammer J. Issues in undergraduate education. RN as gatekeeper: gatekeeping as monitoring and supervision. J Clin Nurs. 2008;17:1868–76. 10.1111/j.1365-2702.2008.02376.x [PubMed] [CrossRef] [Google Scholar]

35. Joolaee S, Amiri S, Farahani M, Varaei S. Iranian nursing students’ preparedness for clinical training: A qualitative study. Nurse Educ Today. 2015;35(10):13–7. 10.1016/j.nedt.2015.07.026 [PubMed] [CrossRef] [Google Scholar]

36. Mirzaie T, Oskouie F, Rafii F, Ravari A. Nursing students’ time management: unwanted enty, marginalization of educational tasks. Iran J Nurs. 2014;26:39–50. [Google Scholar]

37. Kalyani M, Jamshidi N, Molazem Z, Torabizadeh C, Sharif F. How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study. BMJ Open. 2019;9(7):028052. [PMC free article] [PubMed] [Google Scholar]

38. Donough G, Van der Heever M. Undergraduate nursing students’ experience of clinical supervision. Curationis. 2018;41(1):a1833. 10.4102/curationis.v41i1.1833 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Decision Letter 0

22 Mar 2021

PONE-D-21-03784

Nursing supervisors’ perspectives on student preparedness before clinical placements- a focus group study

PLOS ONE

Dear Dr. Leonardsen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by May 03 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at gro.solp@enosolp. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Prof, Mojtaba Vaismoradi, PhD, MScN, BScN

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please include a copy of the interview guide used in the study, in both the original language and English, as Supporting Information, or include a citation if it has been published previously.

3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

In your revised cover letter, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

We will update your Data Availability statement on your behalf to reflect the information you provide.

4. Thank you for submitting the above manuscript to PLOS ONE. During our internal evaluation of the manuscript, we found significant text overlap between your submission and the following previously published works, some of which you are an author.

https://bmcmededuc.biomedcentral.com/track/pdf/10.1186/1472-6920-12-112.pdf

https://link.springer.com/article/10.1186/s12909-017-0966-4?code=3b519ef9-c50c-49a5-94ee-5ab75637dc44&error=cookies_not_supported

We would like to make you aware that copying extracts from previous publications, especially outside the methods section, word-for-word is unacceptable. In addition, the reproduction of text from published reports has implications for the copyright that may apply to the publications.

Please revise the manuscript to rephrase the duplicated text, cite your sources, and provide details as to how the current manuscript advances on previous work. Please note that further consideration is dependent on the submission of a manuscript that addresses these concerns about the overlap in text with published work.

We will carefully review your manuscript upon resubmission, so please ensure that your revision is thorough.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer #1: Thank you so much for the opportunity to review your paper. First of all, this topic is very practical and the information is meaningful to the nurse supervisors, educators, and nurse students as well. Following recommendations may help improve the paper quality:

1. This paper did not indicate that the observations were charted during the interview and therefore, they were not included in the analysis. For interviews, verbal expressions are important, but the non-verbal information is equally important to the study. Thus, the results might be affected when the non-verbal information is missed.

2. Some spelling errors: such as Ln 102, "purposeful", it is better to use the word " purposive". Ln 301, Fidnings-findings.

Reviewer #2: This is a qualitative study aims at exploring supervisors’ perspectives on student preparedness for clinical placements.

The manuscript is well-written and explains the research clearly. The findings provide useful information for the readers.

I enjoyed reading this and I have one minor comment:

1. sample (lines 102 -109): i would suggest not to use first person such as "we"

Reviewer #3: I was very interested in the topic of focus group interviews on supervisors' perspectives of students in practice. From my experience managing practitioners, I don't think the results of this study's interviews are new to the nurses currently working in hospitals. However, when it is read by nursing students or professors leading students, it seems to be helpful to some extent.

The overall regret about the result is that the concept derived from the interview that lasted for 5 months is small. Interviews must have been conducted with 34 people for 5 months, but there is no information on how many interviews the data was saturated. I wonder if the concept has been sufficiently drawn from the interview data. Although it has been suggested as a limitation of the study, it is regrettable that there is no mention of IDN. Thank you.

Reviewer #4: 1. The paper has grammatical and needs grammar editing to improve its quality

2. The introduction needs to be improved to bring out the problem

3. The paper should also highlight the policy implications of the findings.

4. What do the authors mean by ‘piloting within the research group’? Sounds confusing to the reader.

5. How did the interviewers relate to the participants? What was their positioning within the study?

Reviewer #5: The authors have explored an area which required research. Findings are genuine. It would have been really nice if results were more clearly depicted. Conclusions are sound and upto the mark. Kindly publish, if possible.

Reviewer #6: Thanks for giving me the opportunity to review the manuscript

It is a good study and authors have selected an important topic. However there is a scope to improve this manuscript and some of my suggestions are given below:

The introduction needs to provide a better background on the existing opportunities for nursing students preparedness before clinical placement and the role of nursing supervisors in the selected setting in order for larger global readers to understand the context and need of the study.

Method section:

Total population of nursing supervisors in the selected setting needs to be mentioned.

Mention the sample size in the sample section and the basis on which sample size is calculated for the study also needs to be justified .

Line no 110-111 not very clear what do you mean by saying that they were asked to participate by their manager? Since the cadre and nomenclature related to different nursing posts differ worldwide so clearly mention who is a manager in these health care setting

Although you have mentioned some of the questions of the semi structured interview guide but it would be good if you attach interview guide as a supplementary file.

Mention and justify how many focus group discussions were done.

Write few lines to summarize the result and the discussion section at the end

Add the recommendations and also comment on the generalizability of the study results.

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at gro.solp@serugif. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: PONE-D-21-03784_reviewer.pdf

Author response to Decision Letter 0

6 Apr 2021

PLOS ONEE

Prof, Mojtaba Vaismoradi, PhD, MScN, BScN

Academic Editor

Re-submission of manuscript: PONE-D-21-03784

Nursing supervisors’ perspectives on student preparedness before clinical placements- a focus group study

Dear Editor

We would like to thank the editors and reviewers for their comments on our manuscript. Below You will find the issues raised, followed by our response to these remarks.

Comments from the editor

Comment 1: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

We will update your Data Availability statement on your behalf to reflect the information you provide.

Response: When including transcript from the focus group interviews, there is a risk that the discussions themselves, or references to actions, patients, places or challenges, may identify specific wards/locations and hereby patients. Therefore, we did not include this as supporting information. Moreover, the transcripts of the interviews are in Norwegian, and therefore not accessible to an international audience. Hence, we wish to keep our statement- if possible.

Comment: 4. Thank you for submitting the above manuscript to PLOS ONE. During our internal evaluation of the manuscript, we found significant text overlap between your submission and the following previously published works, some of which you are an author.

https://bmcmededuc.biomedcentral.com/track/pdf/10.1186/1472-6920-12-112.pdf

https://link.springer.com/article/10.1186/s12909-017-0966-4?code=3b519ef9-c50c-49a5-94ee-5ab75637dc44&error=cookies_not_supported

We would like to make you aware that copying extracts from previous publications, especially outside the methods section, word-for-word is unacceptable. In addition, the reproduction of text from published reports has implications for the copyright that may apply to the publications.

Please revise the manuscript to rephrase the duplicated text, cite your sources, and provide details as to how the current manuscript advances on previous work. Please note that further consideration is dependent on the submission of a manuscript that addresses these concerns about the overlap in text with published work.

We will carefully review your manuscript upon resubmission, so please ensure that your revision is thorough.

Response: We have revised the manuscript thoroughly, and hope that our revisions now are deemed not-overlapping with present publications.

Reviewers' comments

Reviewer #1

Comment 1: Thank you so much for the opportunity to review your paper. First of all, this topic is very practical and the information is meaningful to the nurse supervisors, educators, and nurse students as well. Following recommendations may help improve the paper quality:

1. This paper did not indicate that the observations were charted during the interview and therefore, they were not included in the analysis. For interviews, verbal expressions are important, but the non-verbal information is equally important to the study. Thus, the results might be affected when the non-verbal information is missed.

Response: We appreciate this input. Due to several researchers conducing the interview, as well as the large number of interviews, non-verbal information was not included in the analysis. We have added this as a further limitation to the study. Please see manuscript with track changes.

Comment 2: 2. Some spelling errors: such as Ln 102, "purposeful", it is better to use the word " purposive". Ln 301, Fidnings-findings.

Response: We thank the reviwer for this comment, and have consequently revised the manuscript accordingly. Please see manuscript with track changes.

Reviewer #2

Comment 1: This is a qualitative study aims at exploring supervisors’ perspectives on student preparedness for clinical placements.

The manuscript is well-written and explains the research clearly. The findings provide useful information for the readers. I enjoyed reading this and I have one minor comment:

1. sample (lines 102 -109): i would suggest not to use first person such as "we"

Response: We thank the reviewer for positive inputs. The first person has been deleted in the revised manuscript.

Reviewer #3

Comment 1: I was very interested in the topic of focus group interviews on supervisors' perspectives of students in practice. From my experience managing practitioners, I don't think the results of this study's interviews are new to the nurses currently working in hospitals. However, when it is read by nursing students or professors leading students, it seems to be helpful to some extent.

The overall regret about the result is that the concept derived from the interview that lasted for 5 months is small. Interviews must have been conducted with 34 people for 5 months, but there is no information on how many interviews the data was saturated. I wonder if the concept has been sufficiently drawn from the interview data.

Response: We thank the reviewer for this input. Saturation is a discussed term in qualitative research, and there is no consensus of whether it is appropriate to refer to. Our experience was that some themes were repeated across interviews, but repeated interviews also added new information/themes. Hence, we can not claim that saturation has been reached.

Comment 2: Although it has been suggested as a limitation of the study, it is regrettable that there is no mention of IDN. Thank you.

Response: We are also sorry that we were not able to recruit more IDNs to this study. Some places in the results section, we specify that IDNs also related to statements or discussions. In the revised manuscript, we have included some more information about IDNs’ statements. Unfortunately, research on IDNs’ supervision or practice is lacking, so we have not been able to identify studies to include in the discussion section.

Reviewer #4:

Comment 1: The paper has grammatical and needs grammar editing to improve its quality

Response: We have revised the manuscript for grammatical errors. Please see manuscript with track changes.

Comment 2: The introduction needs to be improved to bring out the problem

Response: We have tried to highlight «the problem» further- please see manuscript with track changes.

Comment 3: The paper should also highlight the policy implications of the findings.

Response: In the revised manuscript we have added policy implications, under the «Relevance to clinical practice» section. Please see manuscript with track changes.

Comment 4: What do the authors mean by ‘piloting within the research group’? Sounds confusing to the reader.

Response: The study was initiated in a research group consisting of a total of 12 participants. The interview guide was piloted in this group. In the revised manuscript, we have tried to clarify this.

Comment 5: How did the interviewers relate to the participants? What was their positioning within the study?

Response: The interviewers were not familiar to the participants. The interviewers were participants in the research group initiating the study. We have tried to clarify this in the revised manuscript. Please see manuscript with track changes.

Reviewer #5

Comment:The authors have explored an area which required research. Findings are genuine. It would have been really nice if results were more clearly depicted. Conclusions are sound and upto the mark. Kindly publish, if possible.

Response: We thank the reviewer for appreciating our study.

Reviewer #6

Comment 1: Thanks for giving me the opportunity to review the manuscript

It is a good study and authors have selected an important topic. However there is a scope to improve this manuscript and some of my suggestions are given below:

The introduction needs to provide a better background on the existing opportunities for nursing students preparedness before clinical placement and the role of nursing supervisors in the selected setting in order for larger global readers to understand the context and need of the study.

Response: We thank the reviewer for this input, and have revised the background. Please see manuscript with track changes.

Comment 2: Method section:

Total population of nursing supervisors in the selected setting needs to be mentioned.

Response: Unfortunately, we do not have any overview of the number of supervisors in the selected setting. The RNs/IDNs circulate the supervisory role, and there are no statistics presenting the number of employed healthcare personnel. In fact, this is a national problem, stated by the gouvernment.

Comment 3: Mention the sample size in the sample section and the basis on which sample size is calculated for the study also needs to be justified .

Response: We are not familiar with sample size calculations in qualitative studies. Hence, we did not perform any sample size calculations.

Comment 4: Line no 110-111 not very clear what do you mean by saying that they were asked to participate by their manager? Since the cadre and nomenclature related to different nursing posts differ worldwide so clearly mention who is a manager in these health care setting

Response: We thank the reviewer for pointing this out. We have revised the methods section, and we hope that this now is more clear. Please see manuscript with track changes.

Comment 5: Although you have mentioned some of the questions of the semi structured interview guide but it would be good if you attach interview guide as a supplementary file.

Response: The interview guide has been attached as a supplementary file.

Comment 6: Mention and justify how many focus group discussions were done.

Response: We chose the number of groups pragmatically, as stated in the manuscript. In qualitative research environments, there are no consensus on the number of participants in interviews, or the number of focus groups in such discussions. Hence, we aimed at including participants from two surgical and two medical hospital wards, and a variety of primary healthcare wards (n=4).

Comment 7: Write few lines to summarize the result and the discussion section at the end

Response: The results section has been summarized in the beginning of the discussion section, We have added a summary of the discussion section as recommended.

Comment 8: Add the recommendations and also comment on the generalizability of the study results.

Response: We have added recommendations, and have commented on the generalizability of the study results. Please see manuscript with track changes.

Concluding remarks

The comments provided here are submitted in adition to a manuscript with track changes, as well as a clean copy. We hope our revisions are deemed sufficient, and that the paper will be accepted for publication in PLOS One. Thank You for considering our revised manuscript for publication.

Yours sincerely

Ann-Chatrin Linqvist Leonardsen

________________________________________

Decision Letter 1

17 May 2021

Nursing supervisors’ perspectives on student preparedness before clinical placements- a focus group study

PONE-D-21-03784R1

Dear Dr. Leonardsen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at gro.solp@gnillibrohtua.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact gro.solp@sserpeno.

Kind regards,

Prof Mojtaba Vaismoradi, PhD, MScN, BScN

Academic Editor

PLOS ONE, 

& Nord Universitet, Norge

Acceptance letter

19 May 2021

PONE-D-21-03784R1

Nursing supervisors’ perspectives on student preparedness before clinical placements- a focus group study

Dear Dr. Leonardsen:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact gro.solp@sserpeno.

If we can help with anything else, please email us at gro.solp@enosolp.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Professor Mojtaba Vaismoradi

Academic Editor

PLOS ONE

Articles from PLOS ONE are provided here courtesy of PLOS