Journal of Nursing Education

Major Article 

Preparing Students for the Emotional Challenges of Nursing: An Integrative Review

Patricia A. Dwyer, MSN, RN; Susan M. Hunter Revell, PhD, RN

Abstract

A gap exists between how nurse educators teach nursing students to identify and manage the emotional challenges of nursing and nurses’ experiences after they enter practice. An integrative review was conducted to synthesize the literature on how nurse educators prepare students for the emotional challenges of practice. The literature (n = 14) revealed that the concept “emotional challenges of nursing” lacks a clear definition and conceptual clarity. Reflection was a common element found in the educational approaches identified. Research was directed at qualitatively exploring students’ subjective experiences, and most researchers did not address educational outcomes beyond subjective perceptions. Although the authors recognized the importance of teaching in the affective domain, research that used a quantitative experimental design (n = 1) was scarce. A research agenda, including intervention studies, is needed to support the development of evidence-based teaching pedagogies to prepare students for the emotional challenges of practice. [J Nurs Educ. 2015;54(1):7–12.]

Ms. Dwyer is a doctoral student, and Dr. Hunter Revell is Associate Professor, University of Massachusetts Dartmouth, College of Nursing, North Dartmouth, Massachusetts.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Patricia A. Dwyer, MSN, RN, University of Massachusetts Dartmouth, College of Nursing, 285 Old Westport Road, North Dartmouth, MA 02747-2300; e-mail: pdwyer@umassd.edu.

Received: August 21, 2014
Accepted: October 14, 2014
Posted Online: December 24, 2014

Abstract

A gap exists between how nurse educators teach nursing students to identify and manage the emotional challenges of nursing and nurses’ experiences after they enter practice. An integrative review was conducted to synthesize the literature on how nurse educators prepare students for the emotional challenges of practice. The literature (n = 14) revealed that the concept “emotional challenges of nursing” lacks a clear definition and conceptual clarity. Reflection was a common element found in the educational approaches identified. Research was directed at qualitatively exploring students’ subjective experiences, and most researchers did not address educational outcomes beyond subjective perceptions. Although the authors recognized the importance of teaching in the affective domain, research that used a quantitative experimental design (n = 1) was scarce. A research agenda, including intervention studies, is needed to support the development of evidence-based teaching pedagogies to prepare students for the emotional challenges of practice. [J Nurs Educ. 2015;54(1):7–12.]

Ms. Dwyer is a doctoral student, and Dr. Hunter Revell is Associate Professor, University of Massachusetts Dartmouth, College of Nursing, North Dartmouth, Massachusetts.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Patricia A. Dwyer, MSN, RN, University of Massachusetts Dartmouth, College of Nursing, 285 Old Westport Road, North Dartmouth, MA 02747-2300; e-mail: pdwyer@umassd.edu.

Received: August 21, 2014
Accepted: October 14, 2014
Posted Online: December 24, 2014

An essential responsibility of professional nurses is to provide care for patients experiencing an illness or injury. However, providing care for these patients can trigger feelings of emotional stress. The emotional toll of caring has the potential to cause physical and psychological harm to nurses, a phenomenon that has been coined the cost of caring ( Figley, 1999). Researchers across a variety of practice areas have begun to call attention to this practice concern, and considerable attention has been paid to the emotional cost of caring in nursing practice (Beck & Gable, 2012; Sira, White, Swanson, Lamson, & Meadors, 2009; Yoder, 2010).

Despite the importance of maintaining a close link between nursing education and nursing practice, a gap exists between how nurse educators teach nursing students to identify and manage the emotional challenges of practice and nurses’ experiences after they enter practice. Although researchers have highlighted the emotional toll of nursing work as an emerging practice concern (Rudman & Gustavsson, 2011; Sung, Seo, & Kim, 2012), how nursing students learn about the emotional toll of practice is not clearly understood. Nursing students must understand the emotional nature of practice to meet the challenges of providing care in a demanding practice environment (Bulmer Smith, Profetto-McGrath, & Cummings, 2009). Recognition of the potential cost of caring and an understanding of self-care strategies can help students manage these challenges.

In response to the need to strengthen education–practice linkages, a comprehensive literature review of how nurse educators prepare nursing students for the emotional challenges of practice is needed. A deeper understanding of the state of the science of how nurse educators teach students about the emotional challenges of nursing will provide a foundational understanding for setting an educational agenda to help to build these important education–practice linkages.

Background

Emotional responses to providing care to patients are inherent in nursing work, and several researchers have attempted to define these emotional challenges (Coetzee & Klopper, 2010; Sabo, 2006). Several terms describe the emotional toll of nursing; however, a clear conceptual definition of the emotional challenges of nursing has remained elusive. Terms that are often used include secondary traumatic stress, burnout, compassion fatigue, and compassion satisfaction. Figley (1999) defined secondary traumatic stress as “the natural consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by a significant other” (p. 7). Although secondary traumatic stress is often used interchangeably with compassion fatigue, researchers suggest that these concepts have distinct elements (Sira et al., 2009; Yoder, 2010). Burnout describes a negative change in behavior as a result of prolonged exposure to demanding situations (Figley, 1999; Yoder, 2010). Similarly, compassion fatigue is the negative emotional response one feels in relation to the work as a helper and includes elements of both secondary traumatic stress and burnout (Stamm, 2010). Although in contrast to the terms describing the negative responses, compassion satisfaction refers to the positive emotional responses nurses develop from providing care to patients (Stamm, 2010).

Internationally, the term emotional labor (or labour) is often used when discussing the emotional aspects of nursing practice (Smith & Gray, 2001). Emotional labor involves purposeful induction or suppression of feelings to promote a sense of caring in others (Smith & Gray, 2001). Characteristics of emotional labor include face-to-face contact with patients, the ability to produce an emotional state in another, and training to regulate a degree of control over emotional challenges (Smith & Gray, 2001 ). In discussing emotional work in health care, Williams (2012) calls attention to the complexity, difficulty, and skill necessary to manage one’s own emotions when providing care to patients. However, what role emotional labor plays in helping nurses’ handle the emotional challenges of practice has not been explored.

Researchers have begun to explore the relationship between the emotional toll of nurses’ work environments and their job satisfaction and turnover intent (Lu, Barriball, Zhang, & While, 2012; Rudman & Gustavsson, 2011; Sung et al., 2012). Job stress, including psychological responses to work and emotional exhaustion has been identified as factors in job satisfaction (Lu et al., 2012). The emotional toll of nursing practice can play a significant role in nurses’ turnover intent. In a sample of Korean hospital nurses (N = 142), compassion fatigue accounted for 29.6% of the variance for turnover intent (Sung et al., 2012). In addition, compassion fatigue has been strongly correlated with nurse burnout ( r = 0.62, p < 0.001; Burtson & Stichler, 2010). Research findings support that the emotional challenge of nursing is a significant practice concern.

Novice nurses may be particularly vulnerable to the emotional challenges of practice (Beck & Gable, 2012). In a study of early career burnout among nurses, Rudman and Gustavsson (2011) found that every fifth nurse suffers from burnout at some point during the first 3 years of practice and is at the highest risk during their second year of practice. Emotional exhaustion was also found to be significantly related to greater turnover intent among new graduate nurses (Spence Laschinger, Grau, Finegan, & Wilk, 2012). These research findings highlight the gap between how well nursing students are prepared for the emotional challenges of practice and their actual postlicensure experiences.

Although the concept of emotional challenges in nursing lacks conceptual clarity, researchers in the United States and internationally continue to illuminate the emotional toll of nursing as a significant practice concern (Beck & Gable, 2012; Lu et al., 2012; Sung et al., 2012). Preparing nursing’s future work-force requires nurse educators to respond to emerging practice concerns. Nurse educators are instrumental in preparing nursing students to meet the challenges of providing care in a demanding practice environment. Therefore, it is imperative that we have a clear understanding of what educational strategies are being used to prepare students for the emotional realities of practice and what evidence supports these educational approaches.

Purpose

The current integrative review was conducted to identify, analyze, and synthesize the literature on how nurse educators prepare students for the emotional challenges of practice. The following questions guided the literature review: (a) What are nursing students’ experiences with the emotional challenges of nursing? (b) What pedagogies are used to prepare nursing students for the emotional challenges of nursing? and (c) What evidence is currently available to support the pedagogies identified?

Method

The methodology outlined by Whittemore and Knafl (2005) was used to conduct the review. This integrative review method (Whittemore & Knafl, 2005) allows for the analysis of diverse methodologies to capture the context, processes, and subjective elements of the identified problem (Whittemore & Knafl, 2005). To combat the potential for bias and increase the rigor of the review a five-stage framework, including (a) problem identification, (b) literature search, (c) data evaluation, (d) data analysis, and (e) presentation, was used ( Whittemore & Knafl, 2005).

Literature Search

The databases CINAHL®, PsycINFO®, PubMed®, and ERIC were searched for articles published from January 1, 1999, to May 1, 2014, using the subject terms nursing educat*, student nurs*, and nursing student*. Subsequently, the subject terms were searched using the key terms suffering, emotional challenges, emotional work, emotional labour, compassion fatigue, secondary traumatic stress, and burnout. The limitations included English language, peer-reviewed literature, and published between January 1, 1999, and May 1, 2014. A beginning review date of January 1, 1999, was selected because it reflects the period when seminal authors began publishing literature related to the cost of caring among health care professionals (Figley, 1999). Inclusion criteria were qualitative and quantitative research and educational briefs that presented teaching pedagogies used in preparing students for the emotional challenges of nursing. In this review, educational brief was defined as literature that described approaches to teaching–learning, curriculum, or evaluation that had not been empirically evaluated. Exclusion criteria included doctoral dissertations, grey literature (i.e., poster presentations, conference presentations, Web sites), and literature exploring the emotional toll of practice on postlicensure nurses. Literature exploring end-of-life education was excluded because of its specific curricula focus (Cavaye & Watts, 2014; Gillan, van der Riet, & Jeong, 2014).

The initial database search, using a combination of the key terms, revealed 167 articles. Through examination of the titles and abstracts, with reference to duplicate citations and the inclusion and exclusion criteria, the sample was reduced to 42 articles. Ancestry searches of the reference lists of the remaining articles contributed four additional sources. Full-text articles (n = 46) were reviewed for relevance in answering the identified guiding questions. The final sample included 14 articles that contributed to answering the identified review questions. The Figure outlines the search strategy.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the literature search.

Figure.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the literature search.

Data Evaluation

The final sample included nine research articles and five educational briefs. Empirical articles included five qualitative, three quantitative, and one mixed-method study. Due to the inclusion of both empirical and nonempirical literature, the data were evaluated using a 2-point scale (2 = high or 1 = low) for two categories: data rigor and data relevance (Whittemore & Knafl, 2005). Data rigor was evaluated using a modified data appraisal protocol designed to assess methodological rigor of empirical studies (Hawker, Payne, Kerr, Hardey, & Powell, 2002). Non-empirical articles were scored as not applicable. Data relevance was reviewed in reference to the ability of the data to contribute to the identified guiding questions. No article was excluded following the data evaluation process.

Data Analysis

Data analysis included four stages: data reduction, data display, data comparison, and conclusion drawing and verification ( Whittemore & Knafl, 2005). Data analysis used the matrix method (Garrard, 2010). Author and publication date, aim, design and sample, data quality score, and findings relevant to the guiding questions were extracted from each article. The sample was further reduced by subgrouping the articles to reflect applicability in answering the identified guiding questions. The subgroups were displayed in a data matrix (Table A; available in the online version of this article). Articles with higher data quality scores were compared and contrasted to recognize patterns and relationships across and within the articles (Whittemore & Knafl, 2005). Articles with low rigor or relevance scores were subsequently compared with the themes and patterns identified. During the final phase of the analysis, the themes and patterns identified for each guiding question were synthesized and conclusions were offered. Primary sources were re-read in light of the conclusions to provide further detail and verification.

Results

Student Experiences

Five research articles in the current integrative review related to understanding nursing student experiences with the emotional challenges of nursing. The methodology included two qualitative, two quantitative, and one mixed-method design. The review revealed that nursing students do experience emotional challenges when caring for patients (Eifried, 2003; Jack & Wibberley, 2014; Michalec, Diefenbeck, & Mahoney, 2013; Watson, Deary, Thompson, & Li, 2008; Zupiria Gorostidi et al., 2007). These experiences tend to occur within the clinical environment through experiential learning (Eifried, 2003; Jack & Wibberley, 2014). Student descriptions of feeling ill equipped when confronted with patient suffering, uncertainty about feeling the need to cry, and wanting to talk about their experiences were common patterns when describing the students’ emotional challenges ( Eifried, 2003; Jack & Wibberley, 2014). Unfortunately, students experienced human suffering in a learning environment that was “lonely and shrouded in silence” (Eifried, 2003, p. 66). Students felt vulnerable and worried about how they would handle the emotional toll of practice (Michalec et al., 2013). Despite the challenges of experiencing human suffering, students recognized the opportunities for learning that were embedded within the experience (Eifried, 2003).

Three research studies quantitatively explored psychological responses to clinical practice in nursing students (Michalec et al., 2013; Watson et al., 2008; Zupiria Gorostidi et al., 2007). Although contact with suffering and emotional involvement were identified as powerful stressors (Zupiria Gorostidi et al., 2007), students, regardless of year, reported moderate or average levels of emotional exhaustion, personal accomplishment, and burnout (Michalec et al., 2013). In contrast, Watson et al. (2008 ) used a prospective, repeated-measures survey to investigate the interrelationship among personality, stress, coping, and burnout among nursing students in Hong Kong. Those researchers found that nursing students experienced increasing levels of stress, burnout, and psychological morbidity that was largely explained by individual personality traits and coping strategies. Despite the students’ anticipation of developing burnout, they appeared to have no understanding of the signs and symptoms of burnout or self-care strategies that might protect them from adverse emotional responses (Watson et al., 2008).

Student suggestions aimed at supporting their learning about the emotional challenges of nursing were also embedded within this subgroup of articles. Caring instructors or role models who acknowledged their struggles and said it was “OK” to cry and having more time to talk about their experiences were identified as supportive factors (Eifried, 2003; Jack & Wibberley, 2014). Students wished that they were more prepared to help suffering patients and felt that the classroom content was inadequate in preparing them for the reality of the experience (Eifried, 2003).

Pedagogies Used to Prepare Students for the Emotional Challenges of Nursing

A majority of the sample (n = 8) provided data related to educational approaches used to prepare students for the emotional challenges of nursing. Authors recognized the importance of supporting student understanding of suffering and presented a variety of teaching pedagogies, including using the arts and humanities, mentorship, clinical observation, and reflection. The literature also included an innovative course to help students understand suffering (Kazanowski, Perrin, Potter, & Sheehan, 2007) and ideas to support curriculum development (Bunkers, 2008).

Authors presented art, literature, and mentorship as educational strategies related to the emotional challenges of nursing (Hanson, 2013; Harrison, 2013; Jack, 2012; Smith & Gray, 2001). Art was used as an approach for exploring human suffering and student feelings (Harrison, 2013; Jack, 2012). Similarly, Hanson (2013) demonstrated how narrative literature helped students to gain insight into the emotional labor of nursing. Kazanowski et al. ( 2007) described a course titled Understanding Suffering to help students to better comprehend the suffering experience. The educational approaches allowed for student exploration and discussion of feelings related to the emotional aspects of practice (Hanson, 2013; Harrison, 2013; Jack, 2012; Smith & Gray, 2001). Despite the variety of pedagogies used, a common thread among the educational approaches was the use of a reflective component within the learning activity or course.

In addition, one educational brief and one qualitative study explicitly explored the use of reflection as an educational pedagogy to prepare nursing students for the emotional challenges in nursing (Bradbury-Jones, Coleman, Davies, Ellison, & Leigh, 2010; Rees, 2013). The benefit of reflective practice was a common view in both articles. Reflective practice increased student awareness of the emotional toll of nursing, highlighted the importance of protecting their sense of self within the context of care, and allowed nursing students to bring emotions associated with nursing to the forefront.

Evidence to Support the Pedagogies Identified

Although the integrative review identified several research articles that explored teaching pedagogies related to preparing nursing students for the emotional challenges of nursing, only one study investigated the outcome using an experimental design (Skodova & Lajciakova, 2013). A quasi-experimental pretest–posttest design (n = 111) was used to evaluate the effect of a 6-month psychological training intervention on burn-out among undergraduate nursing/midwifery and psychology students. The psychological training focused on communication, self- perception, coping, group decision processes, stress management, burnout and burnout prevention, and relaxation techniques. The intervention group ( n = 58) had significantly lower levels of burnout after attending the educational training. No significant change was found in the control group ( n = 53).

The current review revealed that there is a paucity of literature that provides empirical evidence to support the educational pedagogies used to teach students about the emotional challenges of nursing.

Discussion

Nurse educators have a responsibility to prepare nursing students to meet the demands inherent in today’s multifaceted practice environment. Nursing students must understand the emotional nature of nursing to be prepared to care for others. The current integrative review revealed several concerns related to the education of students in the emotional challenges of nursing. The first issue is that the concept “emotional challenges of nursing” lacks a clear definition and conceptual clarity. Searching the literature was difficult because several terms are used to address similar elements of nurses’ emotional responses to difficult patient circumstances, including compassion fatigue, secondary traumatic stress, burnout, and professional quality of life. Exposure to suffering appears to be a central concept explored in the literature describing student experiences with the emotional work of nursing (Eifried, 2003). Because of the lack of conceptual clarity, it is unclear what role exposure to suffering plays in understanding the emotional challenges of nursing and what other concepts may be involved. Adding to the confusion is the inclusion of the term emotional labor (or emotional labour). Although at first glance this term appears to be similar to emotional work, the concepts are distinct. Nurses’ emotional responses were found to be a central element in the literature that addressed the emotional challenges of nursing. In contrast, emotional labor requires elements of trained responses that assist in the management of patient emotions, as well as the regulation of emotional responses in health care providers (Smith & Gray, 2001).

An additional finding is that educational research to support the pedagogies being used to teach and prepare students for these challenges is lacking. Although the nursing literature reflects an understanding of the importance of presenting content directed at teaching in the affective domain, educational research supporting the various pedagogies is limited. Furthermore, the research was mainly directed at qualitatively exploring the students’ subjective experiences and did not address the outcomes of the proposed pedagogy beyond subjective perceptions (Jack, 2012: Rees, 2013; Smith & Gray, 2001). Only one article in the review used a quasi- experimental design to evaluate outcomes of a scholarly teaching strategy (Skodova & Lajciakova, 2013 ).

Finally, a majority of the literature was generated outside of the United States (n = 9). Although several educational briefs from the United States presented pedagogies to prepare students for emotional challenges, only two research articles explored the topic (Eifried, 2003; Michalec et al., 2013). Despite a considerable amount of research being conducted to the cost of caring within the United States, there is a dearth of educational research exploring how students are prepared for the emotional toll of practice. Education and practice environments vary by country; however, the emotional challenges found in nursing are a global concern. Therefore, there is much work to be done, both globally and within the United States, to develop evidence-based teaching practices to prepare students for the emotional reality of practice.

A radical transformation in nursing education is needed to combat the growing practice–education gap (Benner, Sutphen, Leonard, & Day, 2010). This comprehensive agenda will need to the address the identified gap between how nursing students are taught to identify and manage the emotional challenges of nursing practice and their experiences after they enter professional practice. The body of research that suggests that nurses are struggling with the emotional toll of providing care is growing (Beck & Gable, 2012; Yoder, 2010). Novice nurses are at particular risk for emotional exhaustion and burnout (Rudman & Gustavsson, 2011 ). Building a science of nursing education will require a focus on developing evidence-based teaching practices to address gaps between nursing education and nursing practice concerns.

An important first step will be to gain a better understanding of the concept of emotional challenges in nursing. A thorough concept analysis will provide conceptual clarity for the design and development of evidence-based teaching pedagogies to prepare students for the emotional challenges of nursing. A clear conceptualization of emotional challenges in nursing is critically important in providing an understanding of how the concept is defined and ultimately operationalized.

The concept of reflection was a common element identified when exploring how nursing students are prepared for the emotional challenges of practice. The value of reflection in undergraduate nursing is well documented (Epp, 2008). Reflective practice enables students to explore thoughts, feelings, and emotions related to experience (Schön, 1983). Rees (2013) reported that reflective practice enabled students to make sense of the emotional challenges they encountered in practice. In building an agenda for change, reflective practice is an essential pedagogy to support a framework emphasizing integration of classroom content and student clinical experiences with these emotional challenges. Research using an experimental design is needed to evaluate the use of reflective practice as an educational strategy to prepare students for the emotional challenges of nursing. Educational research that provides evidence to support the pedagogies presented in the current integrative review is essential to building the science of nursing education.

Limitations

This integrative review was limited because the concept of emotional challenges in nursing lacks a clear definition and conceptual clarity. Content related to preparing students for the emotional challenges of nursing may be embedded within other concepts in nursing. These limitations may have affected the literature search results and biased the sample. The exclusion of literature exploring end-of-life education may have led to the exclusion of relevant data, and the inclusion of English-language international literature may have limited the applicability of the findings in the United States. However, the review highlighted the lack of educational research supporting how nurse educators prepare students for the emotional challenges they face in practice within the United States.

Conclusion

The emotional challenges of nursing have emerged as nursing practice concerns (Beck & Gable, 2012; Lu et al., 2012; Rudman & Gustavsson, 2011; Sung et al., 2012). Nurse educators are responsible for preparing students to meet the challenges encountered in today’s complex practice environment. The current literature review revealed significant challenges related to educating students about the emotional nature of nursing that has implications for future educational research. A comprehensive research agenda to support the development of evidence-based pedagogies directed at preparing students for the emotional challenges of nursing will help to close the identified gap between how educators teach nursing students to identify and manage the emotional challenges of nursing and the students’ postlicensure practice experiences.

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Literature Data Matrix

Table A.

Literature Data Matrix

Literature Data Matrix

Literature Data Matrix

Literature Data Matrix

Literature Data Matrix

Literature Data Matrix

Table A: Literature Data MatrixAuthor/Year/CountryAimDesign and SampleData Quality (Rigor/Relevance)Relevant FindingsWhat are nursing students’ experiences with the emotional challenges of nursing?Eifried (2003), USAExplore the meanings of the lived experience of nursing students as they care for patients who are sufferingQualitative Interpretive Phenomenology 13 senior baccalaureate nursing students2/2Students were exposed to suffering through experiential learning. Students experienced human suffering in an environment that was “lonely and shrouded in silence.”
Caring instructors who acknowledged their sadness and time to talk were helpful.
Classroom content was inadequate in preparing them.Jack & Wibberley (2014), United KingdomExplore the meaning of emotion work for nursing students involved in the care of anotherQualitative Interpretive Phenomenology Nine students— three from the first year, three from the second year, and three from the third year of the nursing program2/2General structure of “emotional nurse being” is one of anxiety, grief, and emotional loss of self.
Three constituents: (a) need for emotional “balance”; (b) feeling the need to cry; and (c) feeling the need to talkMichalec et al. (2013), USAProvide insight into experiences of undergraduate nursing students and their potential encounters with emotional exhaustion and burnoutMixed method 436 baccalaureate nursing students completed the questionnaire; 20 third- and fourth-year student participants were interviewed2/2Students, regardless of year, reported moderate/average levels of emotional exhaustion, personal accomplishment, and burnout, low levels of depersonalization and secondary traumatic stress, and high levels of compassion satisfaction. Grade cohorts differed significantly on the emotional exhaustion, burnout, and personal accomplishment subscales.
Three themes identified the enhancement of “otherness,” evidence of role actualization/fulfillment, and predictions of burnout on the horizon.Watson et al. (2008), United KingdomFollow a cohort of nursing students from program entry to the end of the first year and to study the interrelationship of personality, stress, coping and burnoutQuantitative Prospective, repeated-measures survey 147 students at a university school of nursing in Hong Kong2/1Student predictors of stress, burnout, and psychological morbidity appear to be the personality trait neuroticism and the strategy of emotion-oriented coping with stress.Zupiria Gorostidi et al. ( 2007), SpainEvaluate evolution of stressors associated with clinical practiceQuantitative Prospective Cohort 69 students at four stages of education1/1Contact with suffering and emotional involvement were identified as powerful stressors both at the beginning and at the end of studies.What pedagogies are used to prepare nursing students for the emotional challenges of nursing?Bradbury-Jones et al. ( 2010), United KingdomCritique the use of the Peshkin approach to refection and reveal its merits for use in nurse educationEducational Brief One lecturer and eight students maintained journals using the Peshkin approach to reflectionNot applicable/1Much can be gained from raising emotions in a manner that helps nursing students gain self-understanding.Bunkers (2008), USAIntroduces ideas for a nursing curriculum living with adversityEducational brief Answers question: How do we educate professional nurses to be with others in compassionate and helpful ways at times of calamitous or disastrous experiences?Not applicable/1Four possibilities for curriculum: Undergrid nursing knowledge with value- laden nursing theory, provide “away experiences,” include theoretical literature on adversity, and develop programs of research, addressing phenomena of health experienced by those living with adversity.Hansen (2013), AustraliaIllustrate how affective learning can be achieved using narrative and transformational leaning pedagogiesEducational brief 74 students read extracts from Tilda Shalofs’s book A Nurse’s Story: Life, Death and In-Between in an Intensive Care UnitNot applicable/1Students’ insights included recognition of the emotional labor of caring.Harrison (2013), USADescribe a creative teaching strategy using nine self-portraits that chronicle the deterioration from Alzheimer’s diseaseEducational brief Students analyzed physical and mental suffering through art Included a quantitative and qualitative component for evaluation1/1Analyzing the self-portraits proved to be an appropriate tool for examining the nature of suffering in Alzheimer’s disease.Jack (2012), United KingdomExplore Heidegger’s philosophy on meditative thinking to support the development of student emotional self-awarenessQualitative Interpretive Phenomenology Students drew pictures of a time in practice that had emotional significance Data collected during one-on-one interviews One male and two female students1/1Art enabled students to think meditatively about their practice and feelings. Students do want to talk about their feelings when allowed to.Kazanowski et al. ( 2007), USADescribe a course Understanding Suffering developed to help students better understand the suffering experienceEducational brief 14- week course Qualitative Quantitative evaluation componentNot applicable/2Students scored significantly higher on a postcourse evaluation of empathy and stated they felt better prepared to intervene in difficult clinical situations involving suffering.Rees ( 2013), United KingdomUnderstand how engagement with reflective practices enables nursing students to manage the distressing emotional challenges and labor of nursing workQualitative Interpretive Phenomenology Ten female students in the final year of their nursing program2/2Reflection helped the students to develop background resources and strategies to manage the emotional challenges inherent in caring work. Nursing students may suspend their own distress and grieving in practice settings and the emotional labor of nursing work appears to be underrecognized. Reflective activity was used by the participants as an effective instrument to disperse the emotional load created by caring work.Smith & Gray ( 2001), United KingdomDescribes the role of the link lecturer, and mentor in shaping the nursing student’s learning experience in emotional laborQualitative Ethnomethodology Pilot study Sixteen participants were interviewed, including students from the first, second, and third years of training1/1Link lecturers and mentors play central role in student learning, main providers of support related to emotional labor Reflection, storytelling, and the use of oral accounts are ways to demonstrate the content and process of emotional labor in teaching, learning, and caring.What evidence is currently available to support the pedagogies identified?Skodova & Lajciakova (2013), SlovakiaExplore the influence of personality factors on student burnout and the effect of psychosocial training on burnout and personality predictors among students in health care professionsQuantitative Quasi-experimental pretest–posttest design was used to evaluate the effect of psychosocial training 111 university students were divided into experimental and control groups2/2Sociopsychological training had a positive impact on the level of burnout and on personality factors that are related to burnout. Burnout in the experimental group significantly decreased (95% confidence interval: 0.93, 9.25), no significant change was observed in the control group.

10.3928/01484834-20141224-06

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