Moral experiences are experiences where there are values at stake. All people live moral experiences, from the mundane to the extraordinary. Undergraduate nursing students (UNS) have moral experiences during their clinical placements yet little is known about these experiences. Research that acknowledges and accounts for the range of moral experiences that UNSs have when providing patient care better reflects the diversity of these experiences, from the good to the bad, the right to the wrong, and the just to the unjust. Understanding their moral experiences can foster a greater awareness of UNSs as moral beings who live meaningful experiences that affect them as learners and future professionals. The purpose of this research study was to examine clinical placement-related moral experiences of UNSs and the ways in which these moral experiences shape them as learners. The research questions were 1) What are the moral experiences of undergraduate nursing students in the context of clinical placements?; 2) What are the relational dimensions of undergraduate nursing students' moral experiences in the context of clinical placements?; and 3) How do undergraduate nursing students incorporate their moral experiences into their learning process? This study is a constructivist grounded theory as articulated by Charmaz. Twenty-three semi-structured interviews with UNS participants were conducted and retained for analysis. All participants were recruited from the Bachelor of Science in Nursing program at a bilingual university in Ontario, Canada. In keeping with constructivist grounded theory, the data analysis process was iterative and evolving to construct a theory that was grounded in the data. As a result of data analysis, three categories were developed: 1) having a moral experience; 2) learning in motion; and 3) navigating relational contexts. In brief, the first category, having a moral experience, represents the moral experiences described by the participants; these are the stories participants shared that unfolded during or in relation to clinical placements. The second category, learning in motion, describes the participants' learning process. The third category, navigating relational contexts, represents the interconnected relationships that framed the participants' moral experiences. Overall, the findings of this study provide insights into the range of moral experiences that UNSs have during their clinical placements, the relational dimensions at play, and the learning process that UNSs experience as they navigate clinical placements as learners.

A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. Difficulties in the development of valid and reliable assessment measures in nursing competency continue to pose a challenge in nursing education. A holistic approach in the assessment of competency comprises knowledge, skills and professional attitudes, wherein the notion of competency incorporates professional judgement and management skills in the clinical situation. Therefore, the thesis aims to develop a holistic clinical assessment tool with a reasonable level of validity and reliability to meet the needs of clinical education. The conceptual framework underlying this research is formed by establishing a theoretical connection between the practice of learning, and of pedagogy and assessment. This research consists of five studies. In Study I, a systematic review was conducted to explore the current assessment practices and tools for nursing undergraduates. In Studies II, III and IV, a qualitative approach with focus group discussions was adopted to explore the views of final-year undergraduate nursing students, preceptors, clinical nurse leaders and academics on the clinical assessment. Based on the multiple perspectives, it therefore addresses concerns in clinical assessment. In Study V, a holistic clinical assessment tool was developed, for which a psychometric testing was conducted. The systematic review indicated that limited studies adequately evaluate the psychometric properties of the assessment instrument. The qualitative studies have raised an awareness of professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors, and availability of valid and reliable clinical assessment tools were deemed to influence the quality of students’ clinical learning and assessment. In addition, the presence of support systems and formal educational programs for preceptors influenced their preparation and self-confidence. Nursing leaderships in hospitals and educational institutions have a joint responsibility in shaping the holistic clinical learning environment and making holistic clinical assessment for students. The involvement of all stakeholders in the development of a valid and reliable assessment tool for clinical competency is also essential to the process. The Holistic Clinical Assessment Tool (HCAT) was developed by the author based on the systematic review, qualitative findings and the core competencies of registered nurse from the professional nursing boards. The HCAT consists of 4 domains and 36 assessment items. Furthermore, testing of the psychometric properties indicated that the HCAT has satisfactory content validity, construct validity, internal consistency and test-retest reliability. In conclusion, the HCAT is meritorious in that it carries the potential to be used as a valid measure to evaluate clinical competency in nursing students, and provide specific and ongoing feedback to enhance the students’ holistic clinical learning experience. The HCAT not only functions as a tool for self-reflection for the students, but also guides the preceptors in clinical teaching and assessment. In addition, the HCAT can be used for peer-assessment and feedback. It is imperative that the clinical and academic institutions establish various levels of ongoing support for both students and preceptors in the process of clinical assessment.

Considerando que a disciplina de Fundamentos de Enfermagem, na atual estrutura curricular, desempenha função introdutória importante, consubstanciando a transição do ensino das disciplinas básicas, para uma primeira instância prática; identificando problemas de várias naturezas no desenvolvimento do processo ensino-aprendizagem da disciplina e diante da necessidade de reestruturação da estrutura curricular do curso disposta na Lei das Diretrizes e Bases da Educação (Lei nº 9.394, de 20 de dezembro de 1996), busca-se com este trabalho, a partir da compreensão do ensino desta disciplina em quatro escolas públicas do estado do Paraná, contribuir com o diagnóstico atual da mesma e subsidiar reflexões para as alterações instituídas pelas diretrizes curriculares atuais. Trata-se de um estudo exploratório junto as escolas públicas de Enfermagem do estado do Paraná com os objetivos de: identificar o perfil dos docentes da disciplina de FE; caracterizar os programas das disciplinas de FE das escolas de enfermagem públicas do estado do Paraná; identificar a opinião quanto ao desenvolvimento do processo ensino-aprendizagem, pelo coordenador da disciplina de FE; compreender o desenvolvimento do processo ensino-aprendizagem da disciplina de Fundamentos de Enfermagem, do ponto de vista sistêmico.A metodologia constitui-se na aplicação da técnica de entrevista semi-estruturada junto aos professores coordenadores da disciplina de FE, subsidiada em instrumento contendo trinta itens; instrumento contendo doze itens para identificar o perfil dos professores; instrumento contendo onze itens para caracterização do programa das disciplinas e da análise dos programas da disciplina. Para a análise dos dados, agrupamos os em três unidades de análise: caracterização dos professores responsáveis pelo ensino da disciplina de Fundamentos de Enfermagem; caracterização dos programas das disciplinas de Fundamentos de Enfermagem; desenvolvimento do processo ensino-aprendizagem da disciplina de Fundamento de Enfermagem do ponto de vista dos coordenadores da disciplina nas respectivas escolas. Os resultados mostram que a disciplina de FE compreendida como subsistema, nas escolas estudadas, apresenta semelhanças e disparidades no desenvolvimento do processo ensino-aprendizagem. Aspectos como carga horária, proporção aluno-docente, estratégias de ensino, modalidades de avaliação, campo de estágio, capacitação profissional, entre outros, são fontes de questionamentos e permeiam o universo dos docentes na disciplina de FE, evidenciando a necessidade de organização quanto ao desenvolvimento do processo ensino-aprendizagem. / In view of the fact that, in the current curricular structure, the subject Nursing Fundamentals plays an important introductory role, consolidating the transition from the teaching of basic subjects to a first practical moment, identifying various kinds of problems in the development of the teaching-learning process of the subject and considering the need to restructure the curricular structure of the course as established in the Law of Educational Guidelines and Bases (Law nº 9.394, December 20 1996), based on an understanding about how this subject is taught in four public schools in the state of Paraná, Brazil, this study aims to contribute to a current diagnosis and be of aid in reflecting about the changes instituted by the current curricular guidelines. This exploratory study was held in public Nursing schools in the state of Paraná and aimed to: identify the profile of teachers in NF; characterize the NF programs in the public nursing schools in Paraná; identify the NF coordinators’ opinions about the development of the teaching-learning process; understand the development of the teaching-learning process in the subject Nursing Fundamentals, from a systemic point of view. The methodology consisted in the application of the semi-structured interview technique among the teachers who coordinated the subject NF, based on an instrument with thirty items; an instrument with twelve items to identify the teachers’ profile; an instrument with eleven items to characterize and analyze the subject programs. Data were grouped in three units for the sake of analysis: characterization of the teachers responsible for teaching the subject NF; characterization of the NF subject programs; development of the teaching-learning process of the subject NF from the perspective of the coordinators in the different schools. Results show that the subject NF, seen as a subsystem in the analyzed schools, presents similarities and differences with respect to the development of the teaching-learning process. Aspects such as hour load, student-teacher index, teaching strategies, evaluation modes, training area, professional training, among others, are sources of inquiries and cross the universe of NF teachers, demonstrating the need to organize the development of the teaching-learning process.

Considerando que a disciplina de Fundamentos de Enfermagem, na atual estrutura curricular, desempenha função introdutória importante, consubstanciando a transição do ensino das disciplinas básicas, para uma primeira instância prática; identificando problemas de várias naturezas no desenvolvimento do processo ensino-aprendizagem da disciplina e diante da necessidade de reestruturação da estrutura curricular do curso disposta na Lei das Diretrizes e Bases da Educação (Lei nº 9.394, de 20 de dezembro de 1996), busca-se com este trabalho, a partir da compreensão do ensino desta disciplina em quatro escolas públicas do estado do Paraná, contribuir com o diagnóstico atual da mesma e subsidiar reflexões para as alterações instituídas pelas diretrizes curriculares atuais. Trata-se de um estudo exploratório junto as escolas públicas de Enfermagem do estado do Paraná com os objetivos de: identificar o perfil dos docentes da disciplina de FE; caracterizar os programas das disciplinas de FE das escolas de enfermagem públicas do estado do Paraná; identificar a opinião quanto ao desenvolvimento do processo ensino-aprendizagem, pelo coordenador da disciplina de FE; compreender o desenvolvimento do processo ensino-aprendizagem da disciplina de Fundamentos de Enfermagem, do ponto de vista sistêmico.A metodologia constitui-se na aplicação da técnica de entrevista semi-estruturada junto aos professores coordenadores da disciplina de FE, subsidiada em instrumento contendo trinta itens; instrumento contendo doze itens para identificar o perfil dos professores; instrumento contendo onze itens para caracterização do programa das disciplinas e da análise dos programas da disciplina. Para a análise dos dados, agrupamos os em três unidades de análise: caracterização dos professores responsáveis pelo ensino da disciplina de Fundamentos de Enfermagem; caracterização dos programas das disciplinas de Fundamentos de Enfermagem; desenvolvimento do processo ensino-aprendizagem da disciplina de Fundamento de Enfermagem do ponto de vista dos coordenadores da disciplina nas respectivas escolas. Os resultados mostram que a disciplina de FE compreendida como subsistema, nas escolas estudadas, apresenta semelhanças e disparidades no desenvolvimento do processo ensino-aprendizagem. Aspectos como carga horária, proporção aluno-docente, estratégias de ensino, modalidades de avaliação, campo de estágio, capacitação profissional, entre outros, são fontes de questionamentos e permeiam o universo dos docentes na disciplina de FE, evidenciando a necessidade de organização quanto ao desenvolvimento do processo ensino-aprendizagem. / In view of the fact that, in the current curricular structure, the subject Nursing Fundamentals plays an important introductory role, consolidating the transition from the teaching of basic subjects to a first practical moment, identifying various kinds of problems in the development of the teaching-learning process of the subject and considering the need to restructure the curricular structure of the course as established in the Law of Educational Guidelines and Bases (Law nº 9.394, December 20 1996), based on an understanding about how this subject is taught in four public schools in the state of Paraná, Brazil, this study aims to contribute to a current diagnosis and be of aid in reflecting about the changes instituted by the current curricular guidelines. This exploratory study was held in public Nursing schools in the state of Paraná and aimed to: identify the profile of teachers in NF; characterize the NF programs in the public nursing schools in Paraná; identify the NF coordinators’ opinions about the development of the teaching-learning process; understand the development of the teaching-learning process in the subject Nursing Fundamentals, from a systemic point of view. The methodology consisted in the application of the semi-structured interview technique among the teachers who coordinated the subject NF, based on an instrument with thirty items; an instrument with twelve items to identify the teachers’ profile; an instrument with eleven items to characterize and analyze the subject programs. Data were grouped in three units for the sake of analysis: characterization of the teachers responsible for teaching the subject NF; characterization of the NF subject programs; development of the teaching-learning process of the subject NF from the perspective of the coordinators in the different schools. Results show that the subject NF, seen as a subsystem in the analyzed schools, presents similarities and differences with respect to the development of the teaching-learning process. Aspects such as hour load, student-teacher index, teaching strategies, evaluation modes, training area, professional training, among others, are sources of inquiries and cross the universe of NF teachers, demonstrating the need to organize the development of the teaching-learning process.

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.

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.

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.

Technological standards appear to be needed in undergraduate nursing education, as existing research has yet to establish technological standards for undergraduate nursing students. The purpose of this qualitative study was to examine the lived experiences of senior nursing students with respect to their perceptions regarding exposure to and abilities gained in the areas of information management, information literacy, and computer literacy. The framework of the study was based on Bandura's theory of self-efficacy and the Dreyfus model of skills acquisition. Using a phenomenological approach, in-depth face-to-face interviews were used with a purposive sample to collect data about the technological competencies taught to 12 participants during their nursing education. The key research questions pertained to senior-level nursing students' perceptions regarding their educational exposure to technological skills, the level of competencies achieved, and technology's impact on patient care. A thematic analysis was done. The findings from this research study are that students' technological exposure appears to vary and that there is a need for uniform exposure during their nursing education. The results of this research revealed that most students were confident about computer literacy but needed to strengthen their knowledge related to information management and information literacy. Implications for social change is a better understanding of technological competencies offered, or still needing to be included, in undergraduate nursing syllabi. Further positive social change implications of the study for health services include the promotion of clear technological graduation standards for nursing graduates entering the health care workforce.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Background The current health care system in South Africa and its diverse settings of health care delivery system require a nurse who can make decisions, think critically, solve problems and work effectively in a team. Traditional nursing education teaching strategies have over the years relied on didactic and often passive approaches to learning. In pursuit of quality, academics and students must be continually engaged in a process of finding opportunities for improving the teaching and learning process. Purpose of the study The purpose of this study was to evaluate the structure and the process in case based learning at the University of Technology. Methodology This study is qualitative in nature, governed by an interpretive paradigm. This is a case study, which enabled the researcher to merge student interview data with records in order to gain insight into the activities and details of case based learning as practised at the University of Technology under study. Most importantly, the case study method was deemed appropriate for the current study, since case-based learning as a pedagogical approach (and a case) cannot be abstracted from its context for the purposes of study. Case based learning is evaluated in its context namely, the undergraduate nursing programme, using the Donabedian framework of structure, process and product. Results The study recorded that students were positive towards case based learning though some identified dynamics of working in groups as demerits of case based learning. The structures that are in place in the programme and the CBL processes are adequate and support CBL. There are however areas that need attention such as the qualification of the programme coordinator, the size of the class-rooms and the service of the computer laboratory. Conclusion The study found that apart from a few minor discrepancies, case based learning is sufficiently implemented, and experienced as invaluable by students, at the University of Technology under study.

Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search: ‘student*’, ‘nurs* student*’, ‘cardiopulmonary resuscitation (CPR)’, ‘Basic Life Support (BLS)’, ‘Advanced Life Support (ALS)’, ‘Advanced Cardiac Life Support (ACLS)’, and ‘Retention’. Results: The initial database search yielded a total of sixty-seven articles; of which, nine articles met the inclusion criteria and were utilized in the final analysis. The articles analyzed explored the effectiveness of different training modalities including: self-directed, CD-based, low-fidelity simulation, high-fidelity simulation, collaborative high-fidelity simulation, and deliberate practice. Conclusion: Current training is ineffective both in promoting long-term retention and in delaying the decay of previously learned information. The most effective training modality identified was high-fidelity simulation in conjunction with deliberate practice. The use of collaborative simulation through ‘mock codes’ maximizes the acquisition and retention of CPR knowledge and skill by providing the highest degree of fidelity. Deliberate practice was the only modality, which resulted in improvement of knowledge and skill over time. The absence of individualized feedback diminishes the effects of repeated practice. Practical experience is also susceptible to the detrimental effects exerted by the lack of feedback.