An effective educator-student relationship is a key factor to ensure a positive learning climate where learning can take place. Educators must work together to build caring relationships with students, provide support to eliminate barriers and create a positive learning climate. This will establish an atmosphere characterised by mutual support, caring and understanding, all of which are fundamental to a sound educator-student relationship. Resilience research consistently points to the importance of positive and supportive relationships between the educator and student as a key protective factor in students’ progress. Strengthening students’ resilience from the beginning of their nursing career through a positive and supportive educator-student relationship can improve their well-being, as well as improve the quality of education and eventually the patient care delivered. The overall aim of this study was to explore and describe the basic elements required for an effective educator-student relationship in a private nursing education institution in the North-West Province. The study enabled the researcher to recommend guidelines to strengthen the resilience of nursing students within the educator-student relationship. An explorative, descriptive and contextual qualitative design was followed. This study made use of a non-probability sample and specifically a purposive sampling method. The sample consisted of forty enrolled nursing auxiliary students. The “World Café” method was used to collect data. Data were analysed by using Creswell’s steps in data analysis. Five main categories were identified: (1) teaching/learning environment, (2) educator-student interaction, (3) educator qualities, (4) staying resilient and (5) strategies to strengthen resilience. Conclusions were drawn by looking at the interrelation between the literature review, the theoretical framework chosen for this study, namely Kumpfers’ resilience framework, and the findings of the research. It is eminent that students need a caring and supportive learning environment including enough space, lighting and ventilation. Students reported that they need interaction that is constructive, interaction that acknowledges human rights and interaction that makes use of appropriate non-verbal communication. The educator must display qualities of love and care, respect, responsibility, morality, patience, openness to new ideas, motivation, willingness to “go the extra mile” and punctuality. Students reported various ways through which they manage to stay resilient namely: being positive, having a support system, improving study methods, self-motivation, setting personal goals, taking pride, perseverance and determination. Recommendations were formulated for nursing education, nursing practice and further research. / MCur, North-West University, Potchefstroom Campus, 2014

Doctor of Philosophy (PhD) / Abstract Clinical teachers’ experiences of nursing and teaching Clinical nurse teachers’ experiences of nursing and teaching undergraduate nursing students on clinical placement are explored in this thesis because of concerns about the quality of nursing students’ learning outcomes. The aim was to identify variation in clinical teachers’ conceptions of nursing and their conceptions of, and approaches to teaching undergraduate nursing students. The study was significant because clinical teachers’ conceptions of nursing and approaches to clinical teaching have not been researched previously. Underpinning the study was a phenomenographic perspective on learning and teaching. This perspective views learning and teaching in terms of how they were experienced. Experience of nursing and clinical teaching, for example, can be understood in terms of related ‘what’ and ‘how’ aspects. The ‘what’ aspect concerns how nursing and clinical teaching were understood. The ‘how’ aspect is concerned the ways nursing and clinical teaching were approached. Experience of nursing and clinical teaching were described and analysed in terms of the separate ‘what’ and ‘how’ aspects and are understood in terms of the relationship between each of the aspects. Data from semi-structured interviews with twenty clinical teachers were analysed using phenomenographic research techniques (Marton & Booth, 1997) in order to identify variation in how nursing and clinical teaching were experienced. To extend the description, the research also sought to identify the empirical relationships between each of the aspects investigated. Key aspects of variation in clinical teacher experiences of nursing and clinical teaching and associated relationships have been identified. The results suggest that clinical teachers who adopted a student-centred approach to teaching conceived of nursing and clinical teaching in complex ways. The phenomenographic approach provides for an experiential and holistic account of clinical teaching: a perspective absent in nursing education research literature. The research findings extend knowledge that will assist with preparation and support of clinical teachers.

Background Trauma is the leading cause of death in the young (ages 1-44) and the current life situation is responsible for producing emergency injuries from motor vehicle accidents, violence and from acute life threatening illnesses. The training of emergency nurses is therefore of priority based on the increasing demands on the entire emergency health care system. The study evaluates the education and training of emergency nursing programme that has been offered for the past seven (7) years at a Nursing Education Institution (NEI) in the Limpopo province. The programme has not has not been formally evaluated. Aim The overall aim of the study is to explore and describe the views of students pertaining to the emergency nursing programme offered at the NEI in the Limpopo province and to make recommendations for the refinement of the emergency nursing programme, based on the views of the nursing students. Methods A qualitative design working from an Appreciative Inquiry approach was employed. Purposive sampling was used and focus group interviews were conducted with 20 Professional nurses who are trained as emergency nurses at the NEI from 2007 to 2013. Two main themes emerged: theoretical aspects and clinical aspects, which included both positive and negative views. The findings were used to make recommendations to refine the programme / Health Studies / M.A. (Health Studies)

Problématique : L’avènement de la documentation infirmière des soins dans les dossiers cliniques informatisés (DCI) engendre des changements dans la pratique infirmière actuelle. Le personnel infirmier devra acquérir les habiletés et savoirs nécessaires pour documenter électroniquement la démarche de soins infirmiers. À cet effet, des chercheurs de l’Université de Sherbrooke, en collaboration avec une compagnie informatique, ont développé un logiciel de simulation nommé Environnement Virtuel d’Apprentissage (EVA). Ce dernier vise à permettre aux personnes étudiantes infirmières, au moyen d’un simulateur sur écran, de pratiquer, à partir d’histoires de cas, l’évaluation clinique, l’examen physique, de même que la documentation électronique de la démarche de soins infirmiers, tout en se familiarisant avec une terminologie infirmière standardisée. But : Cette étude visait à évaluer l’impact du système EVA sur le sentiment d’auto-efficacité d'étudiants et étudiantes en sciences infirmières concernant leur performance clinique associée à la documentation électronique de la démarche de soins infirmiers. Méthodologie : Un devis quasi-expérimental avant-après a permis de décrire le sentiment d’auto-efficacité du groupe témoin et expérimental. Une appréciation concernant les fonctionnalités d’EVA a aussi été documentée par le groupe expérimental. Analyses et résultats : L’échantillon était composé majoritairement de femmes entre 21 et 30 ans ayant moins d’un an d’expérience en soins infirmiers. Un total de 63 personnes étudiantes ont rempli le questionnaire d’enquête au pré-test. Les résultats sur le sentiment d’auto-efficacité initial étaient similaires chez les groupes témoin et expérimental. En raison d’une importante perte de sujets, les calculs en post-test et pour la comparaison des groupes dans le temps ne sont pas significatifs. Une présentation graphique et une comparaison descriptive des données de quatre sujets ont été possibles pour décrire l’évolution du sentiment d’auto-efficacité dans le temps. Conclusion : Malgré quelques embûches concernant la participation du groupe expérimental, nous avons décrit le sentiment d’auto-efficacité avant et après l’utilisation du logiciel, effectué des comparaisons inter et intra groupe et fourni une rétroaction au développeur du logiciel. / Abstract : Issue: The advent of nursing care documentation in computerized clinical records generates changes in the current nursing practice. Nurses will need to acquire the skills and knowledge required to electronically document the nursing process. To this end, researchers at the University of Sherbrooke, in collaboration with an IT company, have developed a simulation software called Environnement Virtuel d’Apprentissage (EVA). The purpose of this program is to enable nursing students, using a simulation software, to practice, from case histories, clinical assessment, physical examination, as well as electronic documentation of the nursing process while becoming familiar with the nursing terminology. Purpose: This study aimed to assess the impact of the software EVA on the self-efficacy of nursing students about their clinical performance associated with electronic documentation of the nursing process. Methods: A quasi-experimental design before and after allowed to describe the feeling of self- efficacy in the control and experimental sample. An appreciation regarding EVA’s features was described by the experimental sample. Findings: The sample was predominantly composed of females between 21 and 30 years of age with less than one year of experience in nursing. A total of 63 students completed the survey questionnaire in the pretest. The results for the initial self-efficacy measure were similar in for the control and experimental group. Due to a significant loss of participants, our calculations regarding the post-test and comparison of groups over time were not significant. A graphic presentation and a descriptive comparison of four subjects was possible to describe the evolution of self- efficacy over time. Conclusion: Despite some difficulties concerning the participation of the experimental sample, we described the feeling of self-efficacy before and after using the software, made inter and intra-group comparisons and provided feedback to the software developer.

The purpose of this study was to examine efficacious instructional strategies that the New England Community College (NECC) nursing program could implement in the curricula to improve National Council Licensure Examination Registered Nurse (NCLEX-RN) first-time pass rates. Effective strategies from students and nursing program faculty had used were investigated. Such strategies support student nurses in their efforts to succeed on the first administration of the exit examination. The rationale for this study and resulting project was that they could improve NCLEX-RN first-time pass rates and positively impact the local hiring of qualified nurses. Guided by Knowles's adult learning theory, key results of the study and resulting project were developed from effective instructional strategies discovered from former NECC students. The central research question focused on identifying which teaching-learning strategies in the NECC nursing curricula improved students' critical thinking skills and problem solving skills. A qualitative case study design was employed with a purposeful sample of 15 former NECC nursing program graduates. Participant focus groups and annual program/accreditation documents were used to collect data to address how student nurses learn best in order to be successful on the exit examination. The project was the creation of a 3-day seminar in the first semester curriculum that focuses on effective licensure preparation instructional strategies to establish and maintain high NCLEX-RN pass rates. Implications for positive social change include, but are not limited to, improving students' problem solving skills and application of critical thinking strategies in order to positively impact the lives of the patients whom they will serve.

Negativa attityder gentemot personer med psykisk sjukdom förekommer bland sjukvårdspersonal. Sjuksköterskeutbildningens psykiatriska delkurs är uppbyggd på olika sätt på olika högskolor i landet. Syftet var att studera sjuksköterskors och sjuksköterskestudenters attityder gentemot patienter med en psykisk sjukdom utifrån två frågeställningar: Vilken betydelse har olika bakomliggande faktorer för sjuksköterskors attityder? Går det att påverka dessa attityder och i så fall på vilka sätt? Metoden var en litteraturstudie, där kvalitativa och kvantitativa artiklar studerades och jämfördes. De teoretiska referensramar, som användes, var Parses omvårdnadsteori och den socialpsykologiska Tripartite Model of Attitude Change. Resultatet visade att rädsla, okunskap och brist på erfarenhet var de främsta faktorerna, som låg bakom de negativa attityderna. Framgångsrika strategier för att förbättra attityderna är enligt resultatet praktisk erfarenhet och utbildning, ökad kontakt med personer med psykisk sjukdom, viss teoretisk utbildning samt ett organisatoriskt stöd på arbetsplatsen. Det organisatoriska stödet kan ges i form av handledning och professionellt stöd i det vardagliga arbetet. Vår rekommendation är att sjuksköterskeutbildningarna borde ha en gemensam linje, där praktik med handledning och reflekterande seminarier överväger. / Negative attitudes towards people with mental illness are found among medical personnel. The nursing psychiatric training module is structured in different ways at different universities in the country. The aim of this study was to investigate nurses´ and nursing students´ attitudes towards patients with a mental illness with two questions: What is the importance of different underlying factors of nurses' attitudes? Is it possible to influence these attitudes and if so in what ways? The method was a literature study, where qualitative and quantitative articles were studied and compared. The theoretical frame of reference, which was used, was Parse´s nursing theory and the social psychological theory The Tripartite Model of Attitude Change. The results showed that fear, ignorance and inexperience were the main factors behind the negative attitudes. Successful strategies for improving attitudes, according to the results, are practical experience and training, increased contact with persons with mental illness, theoretical training and organizational support in the workplace. The organizational support may take the form of mentoring and professional support in their everyday work. Our recommendation is that all universities with nursing education should have a common line, where practice with supervision and reflective seminars are predominant.

This study intends to determine how stress levels change over time in nursing students in the Baccalaureate program at East Tennessee State University. The instrument utilized for this survey was the Perceived Stress Scale by Mind Garden, Inc. This survey was passed at the beginning of the semester and at the end of the semester. There was no-significant difference found between the two time spots, leading us to conclude that the level of stress perceived by nursing students is a steady factor during their school semester.

Avhandlingens övergripande syfte var att klarlägga sjuksköterskors erfarenheter av sjuksköterskeprofessionen avseende omvårdnad, handledning och utveckling. Avhand‐lingen innefattar två kvalitativa (I, II) och två kvantitativa (III, IV) studier. Femton sjuksköterskor intervjuades sex år efter examen (I, II). Sjuksköterskorna var bland de första i Sverige med treårig sjuksköterskeutbildning. Handledare till sjuksköterske‐studenter i verksamhetsförlagd utbildning besvarade ett frågeformulär om handledning före/efter införd handledningsmodell (III, IV). I handledningsstudierna deltog 113 sjuksköterskor år 2000 (III) och 109 (III) respektive 142 (IV) sjuksköterskor år 2006. Svarsfrekvensen motsvarade ca 71% (III, IV). Innehållsanalys (I, II) och statistiska beräk‐ningar (III, IV) utfördes. Analysen visade att sjuksköterskor med treårig sjuksköterskeutbildning och sex års erfarenhet hade hittat sin nisch (II). Ingen ångrade sitt yrkesval. Många var under‐stimulerade samtidigt som de balanserade mellan påfrestning och stimulans (I) hinder och möjligheter (II). Flertalet var tveksamma till om de skulle orka arbeta fram till pensionsåldern (I, II). Inrättandet av en handledningsmodell som gav stöd till både sjuksköterskestudenter och handledare visade sig vara ett bra sätt i att organisera samverkan mellan handledare och lärare (III). Flertalet handledare var nöjda med det stöd de fått och upplevde säkerhet i handledarrollen (III). Emellertid, sjuksköterskor med och utan specialistutbildning värderade sjuksköterskestudenter olika (IV). Behovet av ett fokuserat lärande visades som ett mönster genom resultaten (I, II, III, IV). Avhandlingen visar genom resultaten att sjuksköterskor verkar i en komplex pro‐fession där det krävs skickliga sjuksköterskor för att klara det arbete sjuksköterskan är satt att sköta. För framgång i omvårdnad, handledning och utveckling är den lärande miljön central. En miljö där teori, praktik, forskning och reflektion vävs samman och där stöd, samverkan och professionell utveckling är ledstjärnor. Avhandlingen visar att en ökad samverkan mellan vårdverksamhet och universitet/högskola är nödvändig för att sjuksköterskeutbildningen och omvårdnadsarbetet skall kunna anpassas till hälso‐ och sjukvårdens ökade krav. Avhandlingens resultat kan användas som grund för fortsatta diskussioner med hänsyn till omvårdnadsvetenskap och beslut kring sjuksköterskans arbete såväl i utbildningssammanhang som i vårdverksamhet. / The overall aim of this thesis was to elucidate Registered Nurses’ (RNs) experiences of the nursing profession regarding nursing, preceptoring and professional development. The thesis includes two qualitative studies (I, II) and two quantitative studies (III, IV). Fifteen RNs were interviewed six years after graduation (I, II). These nurses were among the first in Sweden to graduate from the 3‐year Bachelor programme in nursing. Preceptors for nursing students in clinical education answered a questionnaire regarding experiences of the preceptor role before/after the introduction of a preceptor model (III, IV). In the studies related to preceptoring 113 RNs participated in 2000 (III), and 109 (III) respectively 142 (IV) RNs participated in 2006, with similar response rates of roughly 71% (III, IV). A content analysis (I, II), and statistic analysis (III, IV) were performed. The analysis showed that RNs graduates from the Bachelor programme in nursing, with six years nursing experience, had found their niche (II). None regretted the choice of profession. Several were under stimulated at the same time as they oscillated between strain and stimulation (I) and between obstacles and opportunities (II). The majority thought that growing old in nursing could prove to be difficult (I, II). The introduction of the preceptor model, with its support to both nursing students and preceptors, showed how to organize co‐operation between preceptors and teachers (III) successfully. The majority of the preceptors were satisfied with the support they had received and experienced a feeling of confidence in their role as preceptor (III). However, specialist nurses and non‐specialist‐nurses valued nursing students differently (IV). The necessity of adopting focused learning emerged as a pattern (I, II, III, IV). The results of the thesis show that RNs work in a complex profession that demands skilled nurses to accomplish the tasks they are required to perform. To successful nursing, preceptoring and development the teaching environment is pre‐dominant. It is an environment where theory, practice, research, feedback and reflection are interwoven and where support, co‐operation and professional development are the guiding‐stars. The thesis shows an increased co‐operation between the healthcare organization and university is necessary in order to adapt the nursing education and profession to the ever increasing demands in health care. The results of the thesis are a contribution to continued discussions regarding nursing science and RN’s work from both educational and health care context.

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