Nursing and midwifery students' encounters with poor clinical practice: A systematic review

Abstract

The aim of this paper was to systematically review evidence about nursing and midwifery students' encounters with poor clinical care. We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students' encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis. N = 14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students. Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so.

“My mentor didn't speak to me for the first four weeks”: Perceived Unfairness experienced by nursing students in clinical practice settings

“…Indeed, the NMC (2008: 26) state that mentors must , “ be an advocate for students to support them accessing learning opportunities that meet their individual needs.” Advocacy for students can become even more important especially in the face of difficult experiences such as the witnessing of poor clinical practice. Students worry about raising concerns about practice not least because they are relying on staff to sign them off as competent on completion of the placement (Ion et al., ). However, if the mentor can legitimise students concerns, this contributes to effective learning and ultimately patient safety.…”

“…This clinical preparation is similar to that found in Europe, the USA and Australia (Saarikoski, Marrow, Abreu, Riklikiene, & Ozbicakci, ). Learning in the clinical practice setting, not only offers opportunities for skill development but is an important part of the socialisation process and can support decision‐making about future career choices (Ion, Smith, & Dickens, ). Clinical practice experiences have the greatest influence on students’ desire to remain on their programme, and negative experiences are linked to attrition and stress (Crombie, Brindley, Harris, Marks‐Maran, & Morris Thompson, ; Hamshire, Wilgoss, & Wibberley, ).…”

Failure to report poor care as a breach of moral and professional expectation

“…Numerous researchers and commentators have examined this topic. Jackson et al () reviewed the empirical work which explores the responses of registered nurses to poor practice, with Milligan et al (), Ion et al (), Bickhoff, Levett‐Jones, and Sinclair () and Fagan, Parker, and Jackson () undertaking similar work in relation to nursing students. They reach the same general conclusions.…”

“…In their review of the whistleblowing literature, Jackson et al () identified situations where be very significant. An awareness of these potentially adverse consequences is also clear in some of the empirical work on student encounters with poor care which was reviewed by Ion et al (). Sadly such fears are well‐founded as the literature on the negative effects of whistleblowing on the whistleblower shows (Wilkes, Peters, Weaver, & Jackson, ).…”

“…Stenhouse, Ion, Roxburgh, Devett, and Smith () provide an overview of these discussions, with Paley (), Randall and McKeown (), Roberts and Ion () and Bagnasco et al () among the many who have contributed more detailed accounts. An additional strand of work has examined the responses of those who witness poor care, with evidence suggesting that many choose not to take action—reviews by Jackson et al () and Ion, Smith, and Dickens () summarise much of this literature. In this paper, we consider a related, but comparatively neglected issue—specifically the legal, moral and ethical position of those who witness poor care.…”