Yolanda Babenko-Mould

Resilience in Nursing Education: An Integrative Review.

BACKGROUND Resilience is a phenomenon known to buffer the negative effects of stress. Resilience is important in the lives of nursing students and nurse educators. METHOD An integrative literature review was conducted to explore the current state of knowledge of resilience in the context of nursing education. Implications from the review findings were deduced for nursing education practice and research. RESULTS Three theoretical papers and 16 empirical reports were included in the review. Three themes emerged from the analysis: (a) Resilience Is Important in Nursing Education, (b) Resilience Is Conceptualized as Either a Trait or a Process, and (c) Resilience Is Related to Protective Factors. CONCLUSION The findings provide data to support interventions to enhance the resilience of nursing students and nurse educators and offer a foundation for further research of resilience in nursing education.

Nursing Students' Perceptions of Clinical Teachers' Use of Empowering Teaching Behaviours: Instrument Psychometrics and Application

The authors present findings of 2nd year nursing students’ (N = 352) perceptions of their clinical teachers’ use of empowering teaching behaviours (ETB) and to highlight steps undertaken to establish psychometric properties of the Empowering Teaching Behaviours Questionnaire – Student (ETBQ-S). The authors identify a) the process involved in the adoption of the ETBQ-S, b) ETBQ-S validity procedures completed prior to instrument implementation, c) results of nursing students’ responses to the ETBQ-S, d) criterion validity, and e) ETBQ-S confirmatory factor analysis findings conducted after study completion. The ETBQ-S reliably measures five facets of empowering actions that clinical teachers can employ with nursing students in practice to enhance their confidence, involve them in decision-making and goal setting, make learning meaningful, and help them to become more autonomous nurses.

Effects of Incivility in Clinical Practice Settings on Nursing Student Burnout

Abstract Aims. To examine the relationship between nursing students’ exposure to various forms of incivility in acute care practice settings and their experience of burnout. Background. Given that staff nurses and new nurse graduates are experiencing incivility and burnout in the workplace, it is plausible that nursing students share similar experiences in professional practice settings. Design and sample. A cross-sectional survey design was used to assess Year 4 nursing students’ (n=126) perceptions of their experiences of incivility and burnout in the clinical learning environment. Methods. Students completed instruments to assess frequency of uncivil behaviors experienced during the past six months from nursing staff, clinical instructors, and other health professionals in the acute care practice setting and to measure student burnout. Results. Reported incidences of incivility in the practice setting were related to burnout. Higher rates of incivility, particularly from staff nurses, were associated with higher levels of both components of burnout (emotional exhaustion and cynicism).

Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter's and Spreitzer's Theories

Abstract The purpose of this study was to explore Rwandan nursing clinical instructors’ (CIs) experiences of structural and psychological empowerment. CIs play a vital role in students’ development by facilitating learning in health care practice environments. Quality nursing education hinges on the CI’s ability to enact a professional role. A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter’s Theory of Structural Power in Organizations and Spreitzer’s Psychological Empowerment Theory were used as theoretical frameworks to interpret experiences. Interview data from 21 CIs were used to complete a secondary analysis. Most participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for CIs stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting.

Conscientious objection and nurses: Results of an interpretive phenomenological study:

Background: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. Research question: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? Research design: Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. Participants and research context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. Ethical considerations: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. Findings: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. Discussion: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. Conclusion: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Continuing Professional Development in Maternal Health Care: Barriers to Applying New Knowledge and Skills in the Hospitals of Rwanda

Objectives Training healthcare professionals in emergency maternal healthcare is a critical component of improving overall maternal health in developing countries like Rwanda. This paper explored the challenges that healthcare professionals who participated in a Continuing Professional Development (CPD) program on Advanced Life Support in Obstetrics® (ALSO) face in putting the learned knowledge and skills into practice in hospitals of Rwanda. Methods This study used a mixed methods approach to understand the challenges/barriers to applying new knowledge and skills in the hospitals of Rwanda. We conducted thirteen purposive in-depth interviews with ALSO® trainees (nurses, midwives and physicians) complemented with a cross-sectional survey on staff turnover in eight of the nine hospitals in the Eastern province of Rwanda. Results Our study found that trainees do not get enough opportunity to apply the new knowledge and skills in their hospitals and expand to health centers. In part because they are frequently rotating to different departments of the hospital and are not getting the opportunity to train their colleagues to share the learned knowledge and skills. The lack of refresher trainings/mentorship and the high personnel turnover were also reported as a barrier to applying new knowledge and skills. Reasons for staff turnover included pursuing further studies, a better opportunity (job/remuneration), low morale, and family related motives including joining a spouse or better schools for children. Conclusions for Practice Expanding and formalizing CPD training to all the healthcare professionals involved in providing maternal care services would improve the provision of emergency maternal healthcare in Rwanda.

A moral profession.

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators’ selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators’ choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those ‘deserving’ often understood as the suffering person doing enough to help themselves. Discussion: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). Conclusion: To feel cared about people need to feel ‘visible’ as though they matter. Nurses need to be alert to problems that may arise if their ‘moral vision’ is influenced by ideas of desert and how much the patient is doing to help himself or herself.

A moral profession: Nurse educators’ selected narratives of care and compassion

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators’ selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators’ choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those ‘deserving’ often understood as the suffering person doing enough to help themselves. Discussion: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). Conclusion: To feel cared about people need to feel ‘visible’ as though they matter. Nurses need to be alert to problems that may arise if their ‘moral vision’ is influenced by ideas of desert and how much the patient is doing to help himself or herself.

Conscience, conscientious objection, and nursing: A concept analysis:

Background: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses’ ethical care provision. Conscientious objection is one such strategy for addressing nurses’ personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. Research aim: To analyze the concepts of conscience and conscientious objection in the context of nurses. Design: Concept analysis using the method by Walker and Avant. Research context: Data were retrieved from Philosopher’s Index, PubMed, and CINAHL with no date restrictions. Ethical consideration: This analysis was carried out per established, scientific guidelines. Findings: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. Discussion and conclusion: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

Nursing as a moral profession: insight from nurse educators’ elected narratives of care and compassion

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators’ selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators’ choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those ‘deserving’ often understood as the suffering person doing enough to help themselves. Discussion: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). Conclusion: To feel cared about people need to feel ‘visible’ as though they matter. Nurses need to be alert to problems that may arise if their ‘moral vision’ is influenced by ideas of desert and how much the patient is doing to help himself or herself.