Bakgrund: Sjuksköterskeyrket innebär flera utmaningar som ansvar, arbetsuppgifter och handledning till sjuksköterskestudent. Handledning till sjuksköterskestudent är en del av sjuksköterskeutbildningen och förväntas kunna utföras av legitimerad sjuksköterska parallellt med omvårdnad. Syfte: Syftet med litteraturstudien var att undersöka sjuksköterskors erfarenhet av att handleda sjuksköterskestudenter. Metod: Litteraturstudien baserades på vetenskapliga artiklar med kvalitativ metod. Databassökningen av vetenskapliga artiklar genomfördes i Cinahl och PubMed. Tio vetenskapliga artiklar med kvalitativ design valdes ut. Sju av artiklarna ansågs ha hög kvalitet och tre av medelhög kvalitet. Samtliga tio vetenskapliga artiklar undersökte sjuksköterskors erfarenhet av att handleda sjuksköterskestudenter. De vetenskapliga artiklarna analyserades utifrån Willmans & Stoltz (2017) metasyntes. Resultat: I resultatet presenterades fem huvudrubriker vilka var utmaningar, ansvar, relation, stöd och personlig utveckling. Utmaningar resulterade i tre underrubriker vilka var tidsbrist, kunskapsbrist och kunskapsbehov. Huvudrubriken relation resulterade i en underrubrik vilken var tillit och förtroende. Konklusion: Litteraturstudien visade på att sjuksköterskors erfarenhet av att handleda sjuksköterskestudenter är både positiva och negativa samt påverkas av olika faktorer. Återkommande faktorer var tidsbrist utifrån svårighet att handleda sjuksköterskestudent parallellt med omvårdnad av patient. Kunskapsbrist var kopplad till saknad kunskap inom handledning, samt ett behov av handledarutbildning. Litteraturstudien visade på att sjuksköterskor upplever stort ansvar i handledarskapet och att handledning till sjuksköterskestudent upplevs som ett ömsesidigt lärande. Nyckelord: erfarenhet, handledning, klinisk placering, sjuksköterska, sjuksköterskestudent. / Background: There are many challenges in the nursing profession when it comes to responsibilities, assignments and preceptoring nursing students. Preceptoring nursing students is the foundation of nursing education and is expected of the legitimized nurse alongside with nursing care.       Aim: The aim with the literature review was to explore nurses’ experience of preceptoring nursing students. Method: The data was collected through a literature review based on scientific articles with a qualitative method. Cinahl and PubMed were used as databases during the article search. Ten scientific articles with a qualitative design were selected. Seven articles were considered to have high quality and three was considered to have an average quality. Each article explored nurses’ experience of preceptoring nursing students. The scientific articles were analyzed through Willman & Stoltz (2017) metasynthesis.   Result: The results revealed five main headlines which were challenges, responsibility, relation, support, and personal development. Challenges resulted in three subheadings which were lack of time, lack of knowledge and needs for knowledge. The headline relation resulted in one subheading which were trust and confidence. Conclusion: The literature review showed that the nurses’ experiences of preceptoring nursing students are both positive and negative, which is affected by different factors. Recurrent factors were lack of time based on difficulties in preceptoring nursing students parallel with nursing care. Lack of knowledge were linked to lack of knowledge in preceptoring, as well as a need of preceptor education. The literature review showed that nurses experienced great responsibilities in the role as a preceptor and that preceptoring to nursing students was experienced as a mutual learning opportunity.   Keywords: experience, clinical placement, nurse, nursing student, preceptoring.

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Bakgrund: Sjuksköterskestudenter integrerar teori och praktiska moment med stöd av sjuksköterskor under verksamhetsförlagd utbildning. Vårdandets konst är en process som kräver ständig reflektion för att se och vårda patienters problem och behov. Sjuksköterskestudenter ska vårda ur ett humanistiskt förhållningssätt och vårda patientsäkert för att stödja patienters vårdprocess. Målet för sjuksköterskestudenter är att visa teoretiska och praktiska färdigheter som krävs för en legitimerad sjuksköterska för att få sjuksköterskeexamen. Syfte: Att beskriva sjuksköterskestudenters erfarenheter av att vårda patienter under verksamhetsförlagd utbildning. Metod: En litteraturstudie med beskrivande syntes baserad på 14 vårdvetenskapliga artiklar. Resultat: Sjuksköterskestudenter skapade nya erfarenheter av att vårda patienter under den verksamhetsförlagda utbildningen. När sjuksköterskestudenter vårdade patienter ur ett humanistiskt förhållningssätt skapades det en vårdande relation. Den vårdande relationen missgynnades om sjuksköterskestudenter var osäkra i vårdandet. De handledande sjuksköterskor vägledde sjuksköterskestudenter för att överbrygga det teoretiska och praktiska kunskaperna. Vissa sjuksköterskestudenter missgynnades däremot i inlärningsprocessen av handledande sjuksköterskor när deras kunskaper ifrågasattes. Slutsats: Sjuksköterskestudenters erfarenheter utspelades olika under den verksamhetsförlagda utbildningen beroende på vart den ägde rum. Handledning från sjuksköterskor erhöll en avgörande roll för sjuksköterskestudenter i erfarenhetsinlärningen av att vårda patienter. Integreringen av de teoretiska och praktiska momenten var intensivt och sjuksköterskestudenter utvecklades i rollen som blivande sjuksköterskor. / Background: Nursing students integrate theory and practical training with the support of nurses during clinical practice. The art of caring is a process that needs constant reflection to see and care for patients problems and needs. Nursing students must follow a humanistic and a patient safety approach to support the caring process for patients. The goal for nursing students is to show theoretical and practical skills that are required for registered nurses to obtain a nursing degree. Aim: To describe nursing students' experience of caring during their clinical practice. Method: A literature study with descriptive synthesis based on 14 caring science articles. Result: Nursing students gained new experiences of caring for patients during the clinical practice. When nursing students cared for patients with a humanistic approach, they created a caring relationship. The caring relationship was lacking when the nursing students felt insecure of caring for the patients. The registered nurses’ guidance the nursing students to handle theoretical and practical knowledge. Some of the nursing students were disadvantaged in their learning process of the registered nurses and started to question themselves. Conclusion: Nursing students' experiences played out differently during the clinical practice depending where it took place. The guidance from the registered nurses played a crucial role in the experiential learning for the nursing students of caring for the patients. The integration of the theoretical and practical moments was intense, and the nursing students developed their role as future nurses.

Objective: Rates of pregnancy smoking in the rural South are twice national averages and contribute to poor birth and long term outcomes for affected women and children. Efforts to intervene during prenatal care with pregnant women have been hampered by lack of knowledge, skill, comfort, and commitment from prenatal providers and their nursing staff. Regional community providers and staff have been reluctant to participate in available trainings, and even those who do seldom exhibit attitude and practice change long term. Therefore, efforts to educate health care professionals on the dangers of pregnancy smoking, and to provide necessary skills for intervention efforts, may need to occur before they ever enter practice. Thus, the goal of the current project was to implement and evaluate a pregnancy smoking-related training session for baccalaureate nursing students in rural Southern Appalachia. Design: Nursing students attended training on pregnancy smoking dangers/intervention techniques. Sample: Third year students beginning clinical rotations in obstetrics. Methods: 1.5-hour training including pre- and post-tests. Implementation Strategies: Four months later, follow-up survey assessed gains in knowledge, skill, comfort, and willingness to address smoking. Results: Over seven semesters, 659 nursing students were trained. Substantial gains in knowledge of pregnancy smoking issues were seen from pre- to post-testing, with knowledge retained at four- month follow-up. The percentage of students who felt they lacked skills to intervene with pregnant smokers dropped from 39% at pre-test to 6% at same day post-test. In addition, the percentage who reported they would be uncomfortable talking with pregnant women about smoking dropped from 10% to 1%, while the percentage who indicated they would always make time to address smoking with pregnant women increased from 54% to 87%. While most students did address smoking with multiple pregnant patients encountered during clinicals, and over half felt the patients benefited from their actions, only 58% were confident in their intervention skills at four month follow-up. Finally, 83% felt the training had been beneficial, and over 90% committed to addressing smoking with pregnant patients once they graduated. Conclusion/Implications for nursing practice: Training can increase nursing student knowledge, skill, comfort, and willingness to address smoking with pregnant women. However, it appears ongoing education may be needed to promote skills and confidence long term. In the rural South, where smoking rates are high and provider efforts to address pregnancy smoking are inconsistent, educating future nurses could have substantial impact on pregnancy smoking rates and birth outcomes into the future.

Bakgrund: Människor som befinner sig i livets slut har ofta stort behov av omvårdnad. Ansvarig för omvårdnaden är sjuksköterskan som kan lindra lidande för den som genomgår faserna i livets slut. Det finns inte något krav på att undervisning om omvårdnad i livets slut behöver ges under sjuksköterskeutbildningen, vilket kan innebära att sjuksköterskestudenter har bristande kunskap när de ska ut i arbetslivet. Syfte: Syftet var att belysa sjuksköterskestudenters upplevelse av att ge omvårdnad i livets slut. Metod: Studien genomfördes som en litteraturstudie där 10 vetenskapliga artiklar granskades och inkluderades i resultatet. Resultat: Resultatet visar att omvårdnad i livets slut ger upphov till många olika upplevelser hos studenter vilket resulterade i tre kategorier: upplevelser av känslomässig karaktär, upplevelser av att skapa kontakt och upplevelser som ledde till utveckling. Konklusion: Många olika känslor uppstår hos studenter när de ger omvårdnad i livets slut och känslorna kan vara svåra att hantera. Hur situationen hanteras kan till stor del påverkas av en mentor men också av reflektion och istället för en negativ upplevelse kan upplevelsen bidra till utveckling och kunskap. / Background: People who are at the end of their lives often have a great need for care. Responsible for nursing is the nurse who can alleviate the suffering of those who go through the phases at the end of life. There is no requirement that teaching about nursing in the end of life needs to be given during nursing educaton, which may mean that nursing students have a lack of knowledge hen they enter working life. Aim: The aim was to shed light on nursing students' experience of end-of-life nursing. Method: The study was contucted as a literature study where 10 scientific articles were reviwed and included in the results. Result: The results show that nursing at the end of life gives rise to many different experiences in students, which resulted in three categories: experiences of an emotional nature, experiences of creating contact and experiences that led to development. Conclusion: Many different emotions arise in students when they provide nursing at the end of life and the emotions can be difficult to manage. How the situation is handled can largely be influenced by a mentor but also by reflection and instead of a negative experience, the experience can contribute to development and knowledge.

Bakgrund: Inom sjuksköterskeyrket föreligger risk för eventuell stickskada vid hanteringen av medicinteknisk utrustning. Erhållen stickskada innebär en ökad risk för blodburen smitta, psykologiska besvär och långt gångna rädslor som riskerar att drabba sjuksköterskor och sjuksköterskestudenter på livsövergripande plan.  Syfte: Syftet med denna litteraturstudie var att beskriva erfarenheter bland legitimeraade sjuksköterskor och sjuksköterskestudenter som drabbats av stickskador i den kliniska verksamheten.  Metod: En litteraturstudie med kvalitativ metod genomfördes. 11 vetenskapliga artiklar med kvalitativ ansats identifierades genom sökning i databaserna PubMed och Cinahl för att besvara studiens syfte. Artiklarna granskades och analyserades med hjälp av SBU:s granskningsmall vilket resulterade i två teman: Fysisk och psykosocial påverkan och påverkan på professionen.  Resultat: Studieresultatet visade att stickskador har en stor påverkan på sjuksköterskor och sjuksköterskestudenters liv i sin helhet. Ångest, oro och frustration upplevdes hos deltagarna i samtliga studier. Dels på grund av rädslan att bli smittade med Hepatit B, Hepatit C eller HIV och dels på grund av bristande stöd från omgivningen men även kopplingen till socialt stigmatiserande beteenden.  Konklusion: Sjuksköterskor och sjuksköterskestudenter riskerar att utsättas för en stickskada i sitt vardagliga arbete. Rädslan och oron för blodsmitta och den psykosociala påverkan kan leda till en känsla av sårbarhet och tveksamhet till yrkesvalet. / Background: Within the nursing profession, there is always a risk of a possible needlestick injury when handling a medical technical equipment. Suffering a needlestick injury means an increased risk of blood-borne infections, psychological problems and far-reaching fears that risk affecting nurses and nursing students on a lifelong level.  Purpose: The purpose of this study was to describe experiences among licensed nurses and nursing students who suffer from needlestick in clinical practice. Method: A literature study with qualitative method was implemented. 11 scientific articles with a qualitative approach were identified by searching the PubMed and Cinahl databases to preserve the purpose of the study. The articles were reviewed and analyzed by using SBU's review template, which resulted in two themes: Physical and psychosocial impact and impact on the profession. Results: The study results showed that needlestick injuries have a major impact on the lives of nurses and nursing students in its entirety. Anxiety, worry and frustration were experienced by the participants in all studies. Partly because of the fear of being infected with Hepatitis B, Hepatitis C or HIV and partly because of a lack of support from the enviroment but also the connection to socially stigmatized behaviours. Conclusion: Nurses and nursing students are at risk of being exposed to blood-borne infections by needlestick injuries in their everyday work. The fear and concern about blood-borne infection and the psychosocial impact can lead to feelings of vulnerability and hesitation about the choice of profession.

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Introduktion: Verksamhetsförlagd utbildning (VFU) är en viktig del av sjuksköterskeutbildningen och ger studenterna möjlighet att tillämpa teori till praktik. Relationen mellan student och handledare samt patientens medverkan spelar stor roll för studenters lärande och patienters upplevelser. Relationen mellan student och patient kan kopplas till Hildegard Peplau´s omvårdnadsteori “Interpersonel relations model” som beskriver olika roller som sjuksköterskan agerar efter. Syfte: Syftet var att undersöka patienters upplevelser av att vårdas av sjuksköterskestudenter  Metod: En litteraturöversikt med beskrivande design användes som metod. Resultatet baserades på tio kvalitativa vetenskapliga artiklar Resultat: Patienterna upplevde studenternas vård som både positiv och negativ. Avgörande för en positiv respektive negativ patientupplevelse var ofta patient-student relationen. En dålig patient-student relation innebar att patienterna upplevde studenterna som blyga, stressade, negativa samt att de hade brist på kunskap. Patient-student relation påverkades positivt då patienterna ansåg att studenterna var närvarande och intresserade. Resultatet visade att studenternas attityd spelade roll då studenterna som var osäkra hade negativ effekt på patienterna medan studenterna som var självsäkra istället hade en trygghetsingivande effekt. Vidare visade resultatet att aktivt deltagande och information var högt prioriterat hos patienterna när de vårdades av studenter. Flera patienter upplevde att de var med och bidrog till studenternas lärande och utveckling. Slutsats: Det fanns både positiva och negativa patientupplevelser från vården av sjuksköterskestudenter. Majoriteten av patientupplevelserna var positiva förutsatt att studenterna visade på kompetens, intresse, samt förmåga att etablera goda relationer. / Background: Clinical placement is an integral part of nursing education, providing students with the opportunity to apply theory to practice. The relationship between student and supervisor, as well as patient involvement, plays a significant role in student’s learning and patient’s experiences. The relationship between student and patient can be linked to Hildegard Peplau’s nursing theory, “Interpersonal Relations Model” which describes the various roles the nurse strives for. Aim: The aim was to study how patients experience being cared for by nursing students Method: A literature review with a descriptive design was used as a method. The result was based on ten qualitative scientific articles.  Result: The patients experienced the students' care as both positive and negative. The patient-student relationship was often crucial for a positive or negative patient experience. A poor patient-student relationship meant that the patients perceived the students as shy, stressed, negative, and lacking in knowledge. The patient-student relationship was positively influenced when the patients felt that the students were present and interested. The results showed that the students' attitude played a role, as students who were unsure had a negative effect on the patients, while those who were confident instead had a comforting effect. Furthermore, the results indicated that active participation and information were highly prioritized by the patients when they were cared for by students. Several patients felt that they were involved and contributed to the students' learning and development. Conclusion: There were both positive and negative patient experiences from the care provided by nursing students. The majority of patient experiences were positive provided that the students demonstrated competence, interest, and the ability to establish good relationships.

Background Patient safety is an undisputable part of healthcare. The use of clinical practice guidelines, usually based on evidence-based practice/best practice, promotes patient safety and high quality care, reduces unnecessary patient suffering, and healthcare costs. Analysing results from venous blood specimen collection is one of the most commonly used services within healthcare, and a substantial number of decisions on diagnosis, treatment, and treatment evaluation are based on the results. Hence, the accuracy of these tests are vitally important. Earlier research has demonstrated that healthcare staff report suboptimal adherence to venous blood specimen collection guidelines together with the need for improved practices. Blood sample collection is carried out by several professionals, among them registered nurses and, as a consequence, nursing students too. University nursing students learn and practice venous blood specimen collection in one of their first semesters. After initial skill training at clinical skill laboratories, they continue to perform the task during clinical placements in various clinical settings. Few or no studies have been performed on nursing students, hence it seemed important to assess guideline adherence to venous blood specimen collection among university students as well as to further explore adherence to guidelines among healthcare staff. Therefore, the overall aim for this thesis was to explore adherence to, and factors influencing venous blood specimen collection guidelines practice among university nursing students and healthcare staff. Methods The thesis includes four studies. Study I-III had a quantitative, cross-sectional design, study IV had a qualitative approach. Study I included 164 healthcare staff from 25 primary healthcare centres. Study II included 101 nursing students in their 5th and 6th semesters, and study III included 305 nursing students in their 2nd, 4th, and 6th semesters. To assess adherence to venous blood specimen collection guidelines, data were collected using the Venous Blood Specimen Questionnaire, completed with background variables (I, II, III) and additional scales (III). Descriptive statistics, multilevel and multiple logistic regression analyses were used to analyse the data. In study IV, data were collected through five focus group interviews among 6th semester nursing students (n=26). Data were analysed using qualitative content analysis. Results Workplace affiliation was found to explain variances in reported adherence between different primary healthcare centres. Associations between reported venous blood specimen collection practices and individual as well as workplace factors were revealed. Nursing students were found to increasingly deviate from guideline adherence during their education. Also among students, several associations between guideline adherence and other iv factors were revealed. Reported research use at clinical practice was associated with higher levels of adherence, as were higher capability beliefs regarding both evidence-based practice and academic ability. Analyses from focus group interviews summarised students’ reflections on deviations from VBSC guidelines in the overall theme ‘Striving to blend in and simultaneously follow guidelines’. Conclusion Both healthcare staff at primary healthcare centres and nursing students demonstrate decreasing levels of guideline adherence with time. Factors influencing adherence are both individual as well as contextual. This indicate that both students and staff are subjected to socialisation processes that influences levels of adherence. In order to enhance venous blood specimen collection practices and thereby patient safety, actions must be taken - both in healthcare clinical contexts and by educators. The use of models in practical skill training, and in the ambition to bridge the theory-practice gap may be the path to success. It is reasonable to assume that collaboration between, on the one hand, education representatives and on the other, supervising RNs in clinical settings, will be fruitful. Finally, by empowering students their self-efficacy may be strengthened, and hence their ability to maintain guideline adherence.