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Rethinking Quality in Nursing Education / Repenser la qualité en formation infirmière

Jacinthe Pepin and Susan M. Duncan

Prévenir l’abandon des études en sciences infirmières : un modèle fondé sur le choc de la réalité et l’engagement affectif

Stephanie Maillet, Myriam Breau, Ann Rhéaume, Hara Saadia and Tarik Zaaitar
Problem Statement: In the context of the global nursing shortage, retaining students in nursing education programs is a strategic priority for health care systems. Clinical placements, a central component of nursing education, expose students to complex situations that can trigger reality shock, caused by the gap between expectations shaped during education and the actual conditions of practice. This experience can undermine students’ affective commitment to their education and increase their intention to withdraw from the program.Objective: This study aims to examine the mediating role of affective commitment in the relationship between reality shock and the intention to withdraw from a nursing education program.Method: A cross-sectional quantitative correlational study was conducted with 139 students enrolled in the third or fourth year of a 4-year entry-to-practice Bachelor of Science in Nursing program at a participating francophone Canadian university (outside of Quebec). Data were collected using an electronic questionnaire and then analyzed using a simple mediation model (Model 4) estimated with the PROCESS macro for SPSS.Results: Reality shock is negatively associated with affective commitment to the educational program and positively correlated with the intention to withdraw. Affective commitment is negatively associated with the intention to withdraw. Mediation analysis reveals a significant indirect effect, suggesting partial mediation by affective commitment in the relationship between reality shock and the intention to withdraw.Conclusion: These findings highlight the central role of affective commitment in the relationship between reality shock experienced during clinical placements and the intention to withdraw from the educational program. They suggest that clinical experiences likely to undermine students’ emotional attachment, as well as their sense of identification with and belonging to their program, may contribute to withdrawal intentions. Paying particular attention to the shock experienced in clinical placements, along with the pedagogical and relational conditions that support students’ affective commitment, represents a meaningful avenue for reflection to promote retention in nursing education programs.

Peer Mentorship in Nursing Education: A Scoping Review on the Impact on Mentors

Sarah Dauk, Tania Bergen, Karen Juckes and Kathleen Rodger
A scoping review was undertaken to explore the literature on the role of the peer mentor during undergraduate nursing education in order to determine the personal and professional impacts of participating in this role. Much is known about the benefits of being mentored as a nursing student (Botma et al., 2013; Jacobs, 2017). However, less is written about how peer mentorship affects those who provide mentoring, particularly when the mentors are students themselves. We performed a search and analysis of literature in the method outlined originally by Arksey and O’Malley (2005) and updated by Peters et al. (2024) for the Joanna Briggs Institute for Evidence Synthesis. Key findings from this review indicate that nursing students who participate as mentors gain communication and leadership skills, increase their understanding and ability to perform various nursing roles, improve their self-confidence and self-esteem, and feel a greater sense of belonging in their academic program and in the nursing profession. Challenges of peer mentoring included feelings of insecurity, navigating difficult mentee behaviours, and managing the time requirement amid a busy academic load. Recommendations identified from the literature include providing education and faculty support for mentors, embedding mentorship into undergraduate nursing curriculum, and embarking on longitudinal research to follow mentors into practice and identify long-term impacts of peer mentorship. The benefits of being a peer mentor align well with curriculum outcomes of undergraduate nursing programs and entry-level competencies for registered nurses in Canada, making peer mentorship a relevant and efficacious strategy for nursing programs to meet the educational demands of preparing nursing graduates who are ready for practice.

Implementation and Evaluation of a Peer Mentorship Program in a Linguistic-Minority Setting

Cassidy Riffel, Julie Savard, Teaghan Mitchell, Rhéanne Girard, Ariane Gauthier, Danielle de Moissac and Jacqueline Avanthay Strus
Nursing students face a unique combination of academic, clinical, and personal stressors that place them at heightened risk for psychological distress compared to peers in other disciplines. These stressors include heavy workloads, fear of failure, emotional strain in clinical settings, and challenges transitioning from secondary school. A recent study (de Moissac et al., 2022) conducted among students at a school of nursing in Western Canada in both Canadian official languages confirmed these trends, revealing higher rates of anxiety, sleep disturbances, and self-medication among francophone nursing students. In response, a mentorship program was developed to support first-year nursing students.The purpose of this paper is to describe the process of designing the program using a community-based participatory action framework and a logic model that guided planning, implementation, and evaluation. A comprehensive evaluation toolkit supported iterative assessment and informed decision-making throughout the program’s delivery.Results from the first 2 years indicate that all short-, medium-, and long-term outcomes were achieved. The pilot phase included five mentors and 15 mentees; following improved recruitment strategies and collaboration with the school of nursing’s student club, participation increased to 42 mentees the following year. Early recruitment during orientation was key to maximizing engagement. Although the COVID-19 pandemic limited in-person interaction, virtual meetings provided academic support and connection.Mentors reported increased confidence after completing standardized education, which equipped them with leadership and problem-solving skills. The introduction of a lead mentor role further enhanced coordination and communication between students, faculty, and program coordinators. Lastly, mentees were able to gain support from their peers as they entered their first year of nursing practice and had the opportunity to be integrated into the university community early on.Challenges included limited initial awareness of the program among faculty and temporary disruption in external partner support due to staffing changes. These issues were addressed through staff meetings and re-engagement with the external agency, which now provides on-call support.Overall, the mentorship program demonstrated strong potential to enhance student well-being, leadership development, and academic success in a minority-language nursing education context.

“How Are People Going to Teach This if They Don’t Know About It?”: An Interpretive Descriptive Study of Undergraduate Nurse Educators’ Experiences With Gender Inclusive and Affirming Practices

Jess Crawford, Marnie L. Kramer, Janice L. Ristock, Annette S. H. Schultz, Rosetta Antonacci, Amanda Cervantes, Laura A. Killam and Joyce Tsui
Gender inclusive and affirming practices expand on gender affirming care, normalizing gender diversity and recognizing that transgender and gender diverse (TGD) people exist within institutions—beyond being recipients of care—as nurses and nursing students. Gender inclusive and affirming practices draw on Hafferty’s (1998) three levels of curriculum framework, where formal curriculum is what is taught (e.g., gender affirming care), informal curriculum is how relationships provide unscripted learning (e.g., introductions with pronouns), and hidden curriculum is how environments are experienced (e.g., gender inclusive washrooms). Using initial and follow-up interviews, this interpretive descriptive study explored undergraduate nurse educators’ (n = 7) experiences with gender inclusive and affirming practices. Analysis drew on queer theory and the three levels of curriculum framework. Findings are presented across each level of curriculum. In the formal curriculum, nurse educators are implementing gender affirming care instruction despite significant barriers. At the informal level, gender inclusive and affirming practices are being championed by a few individuals across nursing institutions, which risks perpetuating cisnormativity. At the hidden level, schools of nursing are often not gender inclusive environments, lacking inclusive washrooms and TGD faculty and staff representation. The final theme outlines recommendations from nurse educators to integrate gender inclusive and affirming practices: opportunities for ongoing learning, gender affirming care as a curriculum requirement, evaluation, and shifting nursing values. Implications from this work include the necessity to support educators learning in gender affirming care, improve gender inclusive language, improve TGD representation, and evolve structural nursing changes, such as curriculum-shaping bodies (e.g., accreditors, regulators) explicitly naming gender affirming care in crucial practice documents.

Développement d’une grille par activités professionnelles confiables (APC) pour l’évaluation de compétences en stage des personnes finissantes du baccalauréat en sciences infirmières : une démarche participative

Maria Pilar Ramirez Garcia, Isabelle Guay and Isabelle Chartier
Purpose: Clinical placements are an essential learning method for developing competencies in Bachelor of Science in Nursing (BScN) programs. However, assessing competencies in clinical settings remains challenging, particularly due to difficulties in interpreting them in real-world contexts. The entrustable professional activities (EPAs) approach was originally developed in medical residency programs to operationalize competency frameworks, which were considered too theoretical for education and assessment in clinical settings. Although this approach has been little explored in nursing, it appears promising. While some scholars have proposed EPA frameworks, none have used this approach to develop a tool for assessing competencies in clinical placements. This article presents the process of developing an EPA-based grid to assess the competencies of final-year BScN students during clinical practica.Method: The approach undertaken involved the participation of individuals from both clinical and academic settings involved in clinical placement evaluation, as well as students. In line with the recommendations of Hennus et al. (2023), the process involves four general phases: 1) preparation; 2) development; 3) revision; and 4) implementation. It also incorporates the recommendations proposed by Taylor et al. (2021) to ensure that EPAs accurately reflect professional practice. The first three phases of the process are presented, as the implementation phase is currently ongoing.Results: The grid developed includes three EPAs, further detailed into eight sub-EPAs, which are presented along a vertical axis in the first column on the left. Levels of supervision are displayed along the horizontal axis, progressing from left (“requires someone to perform this activity on their behalf”) to right (“no longer requires supervision to perform this activity”). Descriptors specify the criteria for each sub-EPA according to the level of supervision. The competencies mobilized for each EPA are also specified. The individuals consulted considered the EPA approach to be highly relevant and advantageous, particularly because it clarifies expectations. The EPAs were deemed to align with nursing practice in Quebec. The descriptors were viewed as clear and consistent with the various levels of supervision and expectations for final-year students. In commenting on the feasibility and usefulness of the grid, supervisors indicated that it was more intuitive and easier to complete, thereby facilitating guidance and feedback. Students reported that the grid provided clear direction for developing their competencies and autonomy.Conclusion: The descriptive, criteria-based EPA grid proved to be relevant and useful for developing and assessing the clinical competencies of final-year BScN students. Given that the EPA approach is still rarely used in this context, this adaptation represents a potential avenue for advancement in nursing education and the discipline as a whole.

Do Assessments Drive Learning? Exploring Nursing Students’ Perceptions and Study Approaches: A Cross-Sectional Study

Mohammad Alnaeem and Khaled H. Suleiman
Background: Students’ perceptions of assessment quality can significantly shape their learning behaviors. Understanding this relationship is especially critical in nursing education, where assessment plays a pivotal role in achieving program learning outcomes.Purpose: This study aimed to examine the relationship between undergraduate nursing students’ perceptions of assessment quality and their approaches to learning in a Jordanian private university undergoing ACEN accreditation.Methods: A cross-sectional study was conducted using validated questionnaires: the Students’ Perceptions of Assessment Quality Questionnaire (SPAQQ) and the Approaches to Learning and Studying Inventory (ALSI). A total of 645 students participated. Pearson correlation and multiple regression analyses were used to explore associations between six assessment quality dimensions and five learning approaches.Results: All six SPAQQ dimensions showed strong positive correlations with deep, surface, and strategic learning approaches (r = 0.48–0.78; p < .001). Multiple regression analyses revealed that the perceived credibility, authenticity, and effects of assessment significantly predicted deep learning (R² = 0.61), monitoring studying (R² = 0.50), organized studying (R² = 0.40), and effort management (R² = 0.42). The interpretation of test scores and credibility were significant predictors of surface learning (R² = 0.37).Conclusion: Students’ positive perceptions of assessment quality—particularly its credibility and relevance—are strongly linked to deeper and more strategic learning. These findings highlight the importance of enhancing assessment practices to foster meaningful learning, particularly in institutions seeking international accreditation.

Effects of Educational Intervention on Nurse Leaders’ Knowledge and Perceived Self-Efficacy to Participate in the Health Policy-Making Process: A Study in Nigeria

Goodman John Ani, Ijeoma L. Okoronkwo, Chijioke O. Nwodoh and Habu Haruna
Background: Participation in shaping health policy is a key nursing role as health policy influences the entire health system. Nurses, being the largest and most reachable health care professionals, are critical in health care outcomes. As patient advocates, nurses are in an advantageous position to advance patient-centred policies, and their involvement in the health policy-making process is crucial. Because health policies have a direct bearing on nursing practice, nurses need to participate in health policy formulation.Aim: This study aimed to determine the effects of educational intervention on nurse leaders’ knowledge and perceived self-efficacy to participate in the health policy-making process.Design: The research design used for the study was quasi-experimental. We adopted a treatment-control approach with before-treatment and after-treatment data collection. A total of 32 nurse leaders were purposively selected from Nigeria’s six geopolitical zones; 81% of the participants had a master’s degree or doctorate in nursing.Method: Participants were recruited and split into control and treatment groups. We used a self-structured questionnaire to collect data from both groups. Educational intervention was administered to the treatment group only. We collected post-treatment data from the control and treatment groups for analysis. Data were analyzed using descriptive and inferential statistics using the Statistical Package for Social Sciences.Results: Educational intervention has a positive effect on nurse leaders’ knowledge of the health policy-making process. We observed an increase from 62.5% of participants having very good knowledge to 100% having very good knowledge. We found a statistically significant difference between the participants’ pre-test and post-test knowledge of the policy-making process (p = 0.001). We also found a significant difference in the control group’s and intervention group’s self-efficacy to participate in the health policy-making process (p = 0.006) after educational intervention.Conclusion: Nurse leaders need focused education on the health policy-making process to increase their involvement and efficacy in the health policy-making process.

An Interview With Dr. Nancy Edwards on the Art and Science of Global Public Health Promotion Through Nursing Education and Research / Entretien avec la professeure émérite Nancy Edwards, Ph. D. sur l’art et la science de promouvoir la santé publique mondiale par la formation et la recherche en sciences infirmières

Susan M. Duncan and Jacinthe Pepin