Nursing Students’ Perceptions of the Transition to Shift Work

 identify nursing students’ perceptions of problems and potential solutions related to shift work and long work
hours.

The extent to which nursing students’ transition to shift work poses immediate or long-term risks to nurses’ health or
patient safety is unknown. It is known that nursing students have a deep fear of causing adverse events (Noland &
Carmack, 2015). When engaged in facilitated dialogues regarding mistakes, students’ narratives focused on negligence,
administering incorrect medications, or mislabeling something such as laboratory results (Noland & Carmack, 2015).

Understanding nursing student perceptions as they transition to shift work can inform the development of interventions
from a Total Worker Health™ (TWH) perspective. A TWH framework integrates “ . . . protection from work-related safety
and health hazards with promotion of injury and illness prevention efforts to advance worker wellbeing” (Centers for
Disease Control and Prevention, 2015). Sleep and sleep hygiene have been cited as opportunities in TWH research
(Hammer & Sauter, 2013) and are the focus of this study.

This qualitative, descriptive study engaged nursing students in a process designed to guide the development of future
interventions addressing sleep and safe practice. The study methods were adapted from a structured participatory
process developed by the Center for Promotion of Health in the New England Workplace (Robertson et al., 2013). The
goal of this process, referred to as the Intervention Design and Analysis Scorecard (IDEAS) Process, was to use iterative
rounds of worker input to inform a more comprehensive understanding of occupational health issues, problems, and
solutions (Robertson et al., 2013).

First group round

 December 2015
 identify problems and contributing factors” associated with shift work, including shifts over 8 hours, multiple
shifts in a row, and working nights and evening

Second group round

 May 2016
 “brainstorm solutions” to previously identified problems

Directed content analysis was used to identify how students cope with shift work and summarize their suggestions to
promote healthy behaviors and safe clinical practice (Hsieh & Shannon, 2005). The goal of directed content analysis is to
validate, or conceptually extend, a theoretical framework, in this case the TWH model.

Evidence of Importance of Simulation

: The study provided evidences on the effectiveness of the SIMPLE program in enhancing the students' preparedness for
their transition to graduate nurse practice. A key success of the SIMPLE program was the used of simulation strategy and
the involvement of practicing nurses that closely linked the students with the realities of current nursing practice to
prepare them for the role of staff nurses. (“Sci-Hub | Easing Student Transition to Graduate Nurse: A SIMulated
Professional Learning Environment (SIMPLE) for Final Year Student Nurses. Nurse Education Today, 34(3), 349–355 |
10.1016/J.nedt.2013.04.026,” 2013)
RESEARCH QUESTIONS:

What are the most common challenges and experienced by nursing students during their transition from
classroom to clinical practice

How do nursing students perceive the transition process from a didactic learning environment to a clinical
setting

What are the specific clinical skills and competencies that nursing students find most challenging to acquire
during their transition, and how can curriculum and teaching methods be modified to address these challenges
more effectively?

Are there differences in the transition experiences and challenges faced by nursing students in different clinical
specialties (e.g., medical-surgical, pediatrics, mental health), and if so, how can tailored strategies be developed
to address these differences?

What role does simulation-based training play in preparing nursing students for clinical practice, and how can
simulation experiences be optimized to bridge the gap between theory and practice?

What role does clinical faculty support play in helping nursing students navigate the transition from classroom
to clinical practice, and what strategies can be implemented to enhance this support?

What innovative technology and digital tools can be utilized to enhance the transition experience for nursing
students and promote more efficient learning in clinical settings?

Model:

 Key stages
 Likert Scale for Quantitative
 Interview for Qualitative

KEY STAGES:

Conceptual Model: Transition Process of Nursing Students from Classroom to Clinical Practice
1. Preparation Phase:
  Academic Foundation: Nursing students acquire theoretical knowledge and fundamental skills
in the classroom.
 Prerequisite Training: Students complete courses in anatomy, physiology, pharmacology, and
basic nursing skills.
 Expectations: Students form expectations about their clinical experiences based on classroom
learning.
1. Orientation Phase:
 Clinical Orientation: Students receive orientation sessions that introduce them to the clinical
environment, hospital policies, and patient care protocols.
 Mentorship: Assigned clinical preceptors or mentors provide guidance and support.
 Initial Anxiety: Students may experience anxiety as they transition into the clinical setting.
1. Immersion Phase:
 Direct Patient Care: Students begin hands-on patient care under supervision.
 Integration of Knowledge: Application of classroom knowledge to real patients and clinical
situations.
 Challenges: Encounter challenges related to time management, communication, and clinical
decision-making.
 Skill Development: Gradual improvement of clinical skills.
1. Adaptation Phase:
 Increased Autonomy: Students gain more independence in patient care.
 Reflective Practice: Encouraged to reflect on experiences, mistakes, and learning opportunities.
 Stress Management: Develop strategies to manage stress and cope with the demands of clinical
practice.
 Clinical Competence: Achieve a higher level of clinical competence.
1. Transition Outcomes:
 Confidence and Competence: Successful transition results in increased confidence and
competence in providing patient care.
 Professional Identity: Nursing students develop a stronger professional identity as they
assimilate clinical experiences.
 Resilience: Ability to adapt to challenging situations and continue learning.
 Patient-Centered Care: Emphasis on providing safe and compassionate care to patients.
1. Support Factors:
 Educational Support: Support from nursing faculty, educational programs, and curricular
alignment with clinical experiences.
 Peer Support: Interaction and collaboration with fellow nursing students.
 Clinical Preceptorship: Effective mentoring and guidance from experienced nurses.
 Mental Health Support: Access to counseling and resources for managing stress and emotional
challenges.
1. Challenges and Concerns:
 Time Constraints: Balancing academic coursework with clinical hours.
 Emotional Impact: Coping with patient suffering and emotionally challenging situations.
 Communication Challenges: Developing effective communication skills with patients, families,
and healthcare team members.
 Critical Thinking: Enhancing critical thinking abilities in complex clinical scenarios.

SCORING SYSTEM/ INDEX

Transition Experience Scoring System for Nursing Students (TESS-NS):

Note: The scoring system can use a Likert scale, ranging from 1 to 5 (1 = Strongly Disagree, 5 = Strongly
Agree), for each indicator.

A. Academic Preparation (Maximum Score: 20)

 Relevance of classroom learning to clinical practice (1-5)
 Confidence in theoretical knowledge (1-5)
 Preparedness for clinical responsibilities (1-5)
 Alignment of curriculum with clinical experiences (1-5)
B. Clinical Orientation (Maximum Score: 15)
 Quality of clinical orientation (1-5)
 Clarity of hospital policies and procedures (1-5)
 Adequacy of mentorship and support (1-5)
 Preparedness for the clinical environment (1-5)
C. Immersion and Skill Development (Maximum Score: 30)
 Progress in clinical skills development (1-5)
 Comfort with direct patient care (1-5)
 Handling challenging clinical scenarios (1-5)
 Integration of classroom knowledge into practice (1-5)
 Time management in clinical settings (1-5)
D. Adaptation and Coping (Maximum Score: 20)
 Ability to work independently (1-5)
 Effective coping with stress and emotional challenges (1-5)
 Reflective practice and learning from experiences (1-5)
 Decision-making in clinical situations (1-5)
E. Transition Outcomes (Maximum Score: 15)
 Confidence in providing patient care (1-5)
 Development of a professional identity (1-5)
 Resilience in the face of challenges (1-5)
 Commitment to patient-centered care (1-5)
F. Support Factors (Maximum Score: 10)
 Effectiveness of educational support (1-5)
 Peer support and collaboration (1-5)
 Quality of clinical preceptorship (1-5)
 Access to mental health support resources (1-5)
G. Challenges and Concerns (Maximum Score: -10)
 Time constraints (1-5, reversed)
 Emotional impact and stress (1-5, reversed)
 Communication challenges (1-5, reversed)
 Critical thinking challenges (1-5, reversed)

Total Transition Experience Score (Maximum Score: 100)

 Sum of scores from sections A to F, minus the total score from section G.
In this scoring system, each section represents a different aspect of the transition experience, with subsections
that delve into specific indicators or factors. The total score provides a quantitative measure of the nursing
student's transition experience, with higher scores indicating a smoother transition, and lower scores indicating
greater challenges and concerns.

STUDY DESIGN
This study used a sequential mixed-method approach with two distinct but linear phases: quantitative and
qualitative [31]. This design was appropriate for this study because it neither pledge conformity to any
paradigmatic viewpoint nor is confined to any methodological root [32], and it does not omit its interpretative
obligation [33]. Data collection for this study involves two phases. The first phase involves descriptive
quantitative design through the administration of a questionnaire to examine SNs’ transition experience. In the
second phase, the use of descriptive qualitative design was supported through a focus group interview. This
approach not only permits flexibility and unrestricted studying of SNs’ transition experiences, it also obviates
any preconceived influence pertaining to the description of findings by researchers to eliminate biases, a term
known as bracketing.

MEASURES:

1. The first section of the questionnaire involved collecting participant’s demographic data with
anonymity.
2. The second and third sections of the questionnaire contained a 100 item of the five-point Likert
scale survey.
3. Another measure is a focus group interview to stimulate initial discussion with subsequent questions elicited
based on participants’ responses, or any new issues that arose during the discussion

TO QUANTIFY THE INTERVIEW:

The focus group interview was transcribed verbatim. The survey data were analyzed together with qualitative data from
field notes and audio recordings using both manifest and latent content analysis framework [40]. Manifest content
analysis implies describing elements of data that are visible and tangible, while latent content analysis involves
uncovering the underlying meaning of the existing phenomenon. In this study, manifest content analysis was undertaken
on the questionnaire data using descriptive statistics, and latent content analysis was performed on the focus group
interview data.

Following verbatim transcription, focus group interview data were identified, coded and categorized into ‘meaning units’.
This implies classifying and clustering recurrent patterns of findings and words that convey similarity or a relationship by
their content or context [40]. The next step involved condensing the meaning units to reduce its comprehensiveness
while to retain its underlying meaning [40]. All condensed meaning units were then interpreted, matched and further
grouped to form sub-categories. They were further reviewed to unify them under a main heading or theme.

DATA ANALYSIS:

Statistical Package of Social Science (SPSS) version 19.0 was utilized to analyze the quantitative survey data using mode,
mean, and standard deviation and tabulated to display the frequency of responses and the level of agreement on each
item of the questionnaire