Nursing student-patient relationship and associated factors

The purpose of this study was to analyse the nursing student-patient relationship and factors associated with this relationship from the point of view of both students and patients, and to identify factors that predict the type of relationship. The ultimate goal is to improve supervised clinical practicum with a view to supporting students in their reciprocal collaborative relationships with patients, increase their preparedness to meet patients’ health needs, and thus to enhance the quality of patient care. The study was divided into two phases. In the first phase (1999-2005), a literature review concerning the student-patient relationship was conducted (n=104 articles) and semi-structured interviews carried out with nursing students (n=30) and internal medicine patients (n=30). Data analysis was by means of qualitative content analysis and Student-Patient Relationship Scales, which were specially developed for this research. In the second phase (2005-2007), the data were collected by SPR scales among nursing students (n=290) and internal medicine patients (n=242). The data were analysed statistically by SPSS 12.0 software. The results revealed three types of student-patient relationship: a mechanistic relationship focusing on the student’s learning needs; an authoritative relationship focusing on what the student assumes is in the patient’s best interest; and a facilitative relationship focusing on the common good of both student and patient. Students viewed their relationship with patients more often as facilitative and authoritative than mechanistic, while in patients’ assessments the authoritative relationship occurred most frequently and the facilitative relationship least frequently. Furthermore, students’ and patients’ views on their relationships differed significantly. A number of background factors, contextual factors and consequences of the relationship were found to be associated with the type of relationship. In the student data, factors that predicted the type of relationship were age, current year of study and support received in the relationship with patient. The higher the student’s age, the more likely the relationship with the patient was facilitative. Fourth year studies and the support of a person other than a supervisor were significantly associated with an authoritative relationship. Among patients, several factors were found to predict the type of nursing student-patient relationships. Significant factors associated with a facilitative relationship were university-level education, several previous hospitalizations, admission to hospital for a medical problem, experience of caring for an ill family member and patient’s positive perception of atmosphere during collaboration and of student’s personal and professional growth. In patients, positive perceptions of student’s personal and professional attributes and patient’s improved health and a greater commitment to self-care, on the other hand, were significantly associated with an authoritative relationship, whereas positive perceptions of one’s own attributes as a patient were significantly associated with a mechanistic relationship. It is recommended that further research on the student-patient relationship and related factors should focus on questions of content, methodology and education.Sairaanhoitajaopiskelija-potilassuhde ja suhteeseen yhteydessä olevat tekijät Tutkimuksen tarkoituksena oli analysoida sairaanhoitajaopiskelijan ja potilaan välistä suhdetta ja suhteeseen yhteydessä olevia tekijöitä opiskelijoiden ja potilaiden näkökulmista. Lisäksi tarkoituksena oli tunnistaa tekijöitä, jotka ennustavat suhdetyyppejä. Tavoitteena on kehittää ohjattua harjoittelua, joka kannustaa opiskelijoita vastavuoroiseen yhteistyösuhteeseen potilaiden kanssa, lisää heidän valmiuksiaan vastata potilaiden terveystarpeisiin ja siten edistää potilaiden hoidon laatua. Tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisessä vaiheessa (1999–2005) opiskelijan ja potilaan suhdetta käsittelevä tieteellinen kirjallisuus (n=104) ja sairaanhoitajaopiskelijoiden (n=30) ja sisätautipotilaiden (n=30) teemahaastattelut analysoitiin laadullisella sisällön analyysillä. Kirjallisuuden ja haastatteluaineiston perusteella kehitettiin kyselylomakkeet (SPR scales) opiskelijoille ja potilaille. Tutkimuksen toisessa vaiheessa (2005–2007) aineisto kerättiin kyselylomakkeilla (SPR scales) sairaanhoitajaopiskelijoilta (n=290) ja sisätautipotilailta (n=242) ja analysoitiin tilastollisesti SPSS 12.0 -tilasto-ohjelmalla. Tulosten mukaan opiskelija-potilassuhde oli joko mekanistinen, auktoritatiivinen tai helpottava. Mekanistisessa suhteessa korostuivat opiskelijan oppimistarpeet, auktoritatiivisessa suhteessa opiskelijan näkemys potilaan hyvästä ja helpottavassa suhteessa opiskelijan ja potilaan yhteinen hyvä. Opiskelijat arvioivat suhteen useammin helpottavana ja auktoritatiivisena kuin mekanistisena. Potilaat puolestaan arvioivat suhteen olevan useimmiten auktoritatiivinen ja vähiten usein helpottava. Lisäksi opiskelijoiden ja potilaiden näkemykset suhteesta erosivat merkitsevästi toisistaan. Useat taustatekijät, kontekstuaaliset tekijät ja suhteen merkitykset olivat yhteydessä suhdetyyppiin. Opiskelija-aineistossa ikä, opiskeluvuosi ja opiskelijan saama tuki potilassuhteeseen liittyvissä asioissa ennustivat suhdetyyppiä. Helpottava suhde oli sitä todennäköisempi, mitä vanhemmasta opiskelijasta oli kyse. Neljännen vuoden opinnot ja muilta kuin opiskelijaohjaajalta saatu tuki olivat puolestaan merkitsevästi yhteydessä auktoritatiiviseen suhteeseen. Potilasaineiston perusteella useat tekijät ennustivat opiskelija-potilassuhdetyyppiä. Helpottavaan suhteeseen olivat merkitsevästi yhteydessä yliopistotutkinto, useat aikaisemmat hoitojaksot sairaalassa, sairauden takia kutsuttuna hoidossa olo, kokemus sairaan perheenjäsenen hoitamisesta sekä potilaan myönteinen käsitys toimintailmapiiristä ja opiskelijan persoonallisesta ja ammatillisesta kasvusta. Auktoritatiiviseen suhteeseen olivat merkitsevästi yhteydessä potilaiden myönteiset käsitykset opiskelijan persoonallisista ja ammatillisista ominaisuuksista ja potilaan terveydentilan kohentumisesta ja itsehoitoon sitoutumisesta. Toisaalta potilaiden myönteinen käsitys itsestä potilaana oli merkitsevästi yhteydessä mekanistiseen suhteeseen. Jatkotutkimuksia opiskelija-potilassuhteesta ja siihen yhteydessä olevista tekijöistä ehdotetaan kohdennettavaksi sisällöllisiin, menetelmällisiin ja koulutuksellisiin kysymyksiin.Siirretty Doriast

Nursing student-patient relationship-a 10-year comparison study in Finland

ObjectiveThis study aimed to describe and compare the group-level findings from 2005–2006 and 2015–2016 regarding students’ and patients’ views of the nursing student-patient relationship and associated factors.MethodsThe data were in both cases collected using Student-Patient Relationship Scales. The data were analysed statistically.ResultsIn both student cohorts, authoritative and facilitative student-patient relationships were reported by the students more frequently than mechanistic relationships. Authoritative relationships were most common in both patient cohorts, whereas facilitative relationships had become more frequent than mechanistic relationships. A positive change of views in the student and patient cohorts was found in factors associated with the relationship.ConclusionIn order to strengthen a clinical learning culture that reflects a facilitative student-patient relationship, further research is needed on the processes and outcomes of that relationship.</p

Nursing student‐patient relationship and related factors – A self‐assessment by nursing students

Aims and objectivesTo describe the nursing student–patient relationship in terms of three types of relationships—mechanistic, authoritative and facilitative—and analyse the factors related to the type of relationship.BackgroundAs future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student–patient relationship throughout the nursing education may result in positive outcomes for both students and patients.DesignA cross-sectional study.MethodsThe data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi-square test, two-sample t test, one-way analysis of variance and multinomial logistic regression. The STROBE Statement — Checklist for cross-sectional studies was used (Appendix S1).ResultsStudents most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students’ older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self-assessed competence levels than students in a mechanistic relationship.ConclusionsIt seems that the facilitative student–patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students’ clinical learning should be enhanced.Relevance to clinical practiceEfforts aimed at contributing to facilitative student–patient relationships have a crucial role in shaping students’ competency and in promoting high-quality patient care. Thus, supervision of students organised around establishing mutual student–patient relationships with the preceptors acting as facilitators will benefit both students and patients.</p

Students' Self-assessed Competence Levels During Nursing Education Continuum - A Cross-sectional Survey

During nursing education, nursing students are required to develop their competence to be able to fulfill their duties safely as Registered Nurses. The aims of this study were to explore 1) nursing students' self-assessed competence levels during education 2) the relationship with competence and frequency at which competencies are utilized in clinical practice, and 3) factors related to competence levels. 841 (response rate 67.6 %) nursing students responded to the Nurse Competence Scale in a cross-sectional study. The self-assessed overall competence levels were improving during the education continuum (VAS-means 1st 56.6; 2nd 58.3; 3rd 59.8 and 3.5th -year students 68.4). Every group revealed a significant positive correlation with competence and frequency at which competencies are utilized in clinical practice in clinical placement. Risk factors for low competence were also identified. Systematic multimethod competence evaluations with longitudinal designs are needed to monitor outcomes of nursing education.</p

Palliatiivisen hoidon osaamista tutkimus-, kehittämis- ja innovaatiotoiminnalla

TiivistelmäEduPal-hanke on perustunut parhaaseen mahdolliseen näyttöön. Hankkeessa on tuotettu uutta näyttöön perustuva tietoa sähköisten kyselyjen, työpajojen, haastattelujen, opetussuunnitelmaanalyysien ja järjestelmällisten katsausten avulla. Hankkeen tutkimus- ja kehittämistoiminnassa on hyödynnetty laajasti palliatiivisen hoidon ammattilaisten, asiantuntijoiden, opettajien, opiskelijoiden ja kansalaisten näkemyksiä. Ammattikorkeakoulujen ja yliopistojen tutkimus- ja koulutusyhteistyö on mahdollistanut vastavuoroisen asiantuntijuuden jakamisen, joustavat opintopolut ja opetustarjonnan laajentamisen sekä ammattikorkeakoulu- että yliopisto-opiskelijoille. EduPalhanke on ollut kansainvälisesti suunnan näyttäjänä näyttöön perustuvan palliatiivisen hoidon perusopetuksen sekä erikoistumiskoulutusten kehittämisessä. Hoitotyön ja lääketieteen opetussuunnitelmasuositusten juurruttamisen ohella tutkimus-, kehittämis- ja innovaatiotoimintaa tulee jatkossa suunnata simuloituihin ja autenttisiin potilaskontakteihin perustuvaan moniammatilliseen opetukseen sekä opettajien palliatiivisen hoidon opetuksen osaamiseen.AbstractCompetence in palliative care through research, development and innovation activitiesThe EduPal-project was based on the best available evidence. The project has produced new evidence-based knowledge through surveys, workshops, interviews, curriculum analyses and systematic reviews. For that purpose, the views of palliative care professionals, experts, teachers, students and citizens have been widely used in the research and development process. Research partnership and educational collaboration between universities of applies sciences and universities have fostered shared expertise between professionals from different faculties and disciplines, offered flexible study paths for students as well as expanded high-quality educational options over educational organizations. The EduPal-project has received international attention through international collaboration and now the development of palliative care education continues also at the European level. In addition to implementing the curriculum recommendations in nursing and medical education, research, development and innovation activities should be focused on in palliative care education for the multidisciplinary personnel and students, especially on use of simulated and authentic patient contacts in education, and teachers’ competence of teaching palliative care.Tiivistelmä EduPal-hanke on perustunut parhaaseen mahdolliseen näyttöön. Hankkeessa on tuotettu uutta näyttöön perustuva tietoa sähköisten kyselyjen, työpajojen, haastattelujen, opetussuunnitelmaanalyysien ja järjestelmällisten katsausten avulla. Hankkeen tutkimus- ja kehittämistoiminnassa on hyödynnetty laajasti palliatiivisen hoidon ammattilaisten, asiantuntijoiden, opettajien, opiskelijoiden ja kansalaisten näkemyksiä. Ammattikorkeakoulujen ja yliopistojen tutkimus- ja koulutusyhteistyö on mahdollistanut vastavuoroisen asiantuntijuuden jakamisen, joustavat opintopolut ja opetustarjonnan laajentamisen sekä ammattikorkeakoulu- että yliopisto-opiskelijoille. EduPalhanke on ollut kansainvälisesti suunnan näyttäjänä näyttöön perustuvan palliatiivisen hoidon perusopetuksen sekä erikoistumiskoulutusten kehittämisessä. Hoitotyön ja lääketieteen opetussuunnitelmasuositusten juurruttamisen ohella tutkimus-, kehittämis- ja innovaatiotoimintaa tulee jatkossa suunnata simuloituihin ja autenttisiin potilaskontakteihin perustuvaan moniammatilliseen opetukseen sekä opettajien palliatiivisen hoidon opetuksen osaamiseen.Abstract Competence in palliative care through research, development and innovation activities The EduPal-project was based on the best available evidence. The project has produced new evidence-based knowledge through surveys, workshops, interviews, curriculum analyses and systematic reviews. For that purpose, the views of palliative care professionals, experts, teachers, students and citizens have been widely used in the research and development process. Research partnership and educational collaboration between universities of applies sciences and universities have fostered shared expertise between professionals from different faculties and disciplines, offered flexible study paths for students as well as expanded high-quality educational options over educational organizations. The EduPal-project has received international attention through international collaboration and now the development of palliative care education continues also at the European level. In addition to implementing the curriculum recommendations in nursing and medical education, research, development and innovation activities should be focused on in palliative care education for the multidisciplinary personnel and students, especially on use of simulated and authentic patient contacts in education, and teachers’ competence of teaching palliative care

Healthcare student-patient relationship and the quality of the clinical learning environment - a cross-sectional study

Background Relationships with patients are seen as the core component of establishing the quality of patient-centred care and promoting patients' autonomy and relevant use of services. A clinical learning environment that emphasizes relationship-based healthcare is essential for encouraging future healthcare professionals to work in partnership with patients. There is also broad agreement that the insight of patients should be used actively in healthcare students' clinical learning. The aim of this study was to describe healthcare students' perceptions of their relationship with patients and the quality of the clinical learning environment and to identify factors associated with both of these. Methods A cross-sectional survey using an electronic questionnaire was applied to collect data from 1644 Finnish healthcare students, mostly nursing students, between January 2018 and May 2018. The data were analysed statistically using descriptive statistics, Spearman's correlation coefficients, and multifactor analysis of variance. Results Students perceived the level of the student-patient relationship and the role of the teacher as good while pedagogical atmosphere, premises of care, premises of learning, and supervisory relationship were perceived to be at very good level. The correlations between the student-patient relationship and all clinical learning environment dimensions were perceived as moderate. Furthermore, a number of student-related factors associated with the student-patient relationship and the quality of the clinical learning environment were detected. Conclusions In this study, the rarely explored perspective of the student-patient relationship within the context of the clinical learning environment was included. The student-patient relationship and the quality of the clinical learning environment were perceived as good by the students, with a number of determining factors affecting these perceptions. Giving the student-patient relationship a role in clinical education may be conducive to students' learning with the patient in focus, and may thus promote the competence needed in the rapidly evolving healthcare environment and the changing scope of clinical practice.</div

Psychometric testing of the facilitative student–patient relationship scale within six EUROPEAN countries

Aim: The aim of the study was to test the psychometric properties of the Facilitative Student–Patient Relationship (FSPR) Scale in clinical practicum in hospital settings within six European countries. Design: A multi-country, cross-sectional survey design was applied. Methods: A convenience sample of graduating nursing students (N = 1,796) com- pleted the FSPR Scale. Psychometric testing was carried out through explorative fac- tor analysis and confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha. Results: Both validity and reliability of the scale were confirmed. The explorative factor analysis yielded a two-factor construct explaining 47.7% of the total variance, identifying two sub-scales: caring relationship and learning relationship. Confirmatory factor analysis confirmed the two-factor structure. The Cronbach alpha coefficients (0.8–0.9) indicated acceptable reliability of the scale

Psychometric testing of the facilitative student–patient relationship scale within six EUROPEAN countries

Aim: The aim of the study was to test the psychometric properties of the Facilitative Student-Patient Relationship (FSPR) Scale in clinical practicum in hospital settings within six European countries.Design: A multi-country, cross-sectional survey design was applied.Methods: A convenience sample of graduating nursing students (N = 1,796) completed the FSPR Scale. Psychometric testing was carried out through explorative factor analysis and confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha.Results: Both validity and reliability of the scale were confirmed. The explorative factor analysis yielded a two-factor construct explaining 47.7% of the total variance, identifying two sub-scales: caring relationship and learning relationship. Confirmatory factor analysis confirmed the two-factor structure. The Cronbach alpha coefficients (0.8-0.9) indicated acceptable reliability of the scale.Keywords: clinical; education; nursing; psychometric; student-patient relationship; students; surveys.</p

The nurse teacher’s pedagogical cooperation with students, the clinical learning environment and supervision in clinical practicum: a European cross-sectional study of graduating nursing students

Background: A supportive clinical practicum experience may enhance the successful transition and socialization to working life of graduating nursing students. Nurse teachers have the main responsibility of supporting and guiding nursing students with their pedagogical expertise during the students' clinical practicum. Thus, the clinical role of nurse teachers is seen as an essential part of a high-quality clinical practicum. Nursing students appreciate the nurse teacher's cooperation with students, but it is often reported to be unattainable. The aim of this study was to explore and compare graduating nursing students' experiences of the nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision in their final clinical practicum, and to analyze factors associated with these experiences in six European countries.Methods: A cross-sectional comparative international survey design was used. The modified Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) Scale, with a new subscale measuring the nurse teacher's pedagogical cooperation with students, was used. A convenience sample of graduating nursing students in Finland, Germany, Iceland, Ireland, Lithuania and Spain completed the online survey in 2018-2019. The data were analyzed using a Chi-Square test, Pearson's correlation coefficients, and linear models.Results: A total of 1796 (response rate 49%) nursing students completed the survey. Overall, students had positive experiences of the nurse teacher's pedagogical cooperation, the clinical learning environment and supervision in their final clinical practicum. Students in Spain had the most positive experiences. Educational background factors appeared to be associated with the students' experiences of the nurse teacher's pedagogical cooperation with students, the clinical learning environment and supervision. The relationships between the subscale Nurse teacher's pedagogical cooperation with students and the Clinical Learning Environment and Supervision Scale were perceived as weak to strong depending on the country.Conclusions: This study reveals that nurse teachers play an essential role in supporting and guiding nursing students' final clinical practicum. In this light, researchers, educators, and leaders should collaborate seamlessly between educational institutions and healthcare organizations to establish the nurse teachers' pedagogical cooperation role within the clinical learning environment.</p