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Keywords:

  • clinical;
  • mentoring;
  • nursing student/undergraduate;
  • placement;
  • systematic review

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

Aim and objective.  This systematic review describes mentoring of nursing students in clinical placements.

Background.  Mentoring in nursing has been widely investigated, but mentoring among students has remained vague. There is no universal agreement on student mentoring in nursing placements; therefore, mentoring approaches vary. A unified description of student mentoring is needed to ensure the quality of placement learning in nursing organisations.

Design.  Systematic review.

Method.  The data were collected from nursing research articles over 20 years (1986–2006). The articles (n = 23) were analysed using inductive content analysis.

Results.  Mentoring of nursing students in clinical placements was described according to two themes: (1) facilitating nursing students’ learning by creating supportive learning environments and enabling students’ individual learning processes, (2) strengthening students’ professionalism by empowering the development of their professional attributes and identities and enhancing attainment of students’ professional competence in nursing.

Discussion.  This description of student mentoring in nursing clinical placements integrates environmental, collegial, pedagogical and clinical attributes. To ensure effective student mentoring, an individual mutual relationship is important, but also essential is organisation and management to provide adequate resources and systematic preparation for mentors.

Conclusions.  The description of student mentoring needs to be systematically reviewed to reflect changes in nursing and education and compared within related concepts to achieve and maintain a workable description. A clear and systematic strategy for student mentoring in nursing organisations could be one opportunity to enhance recruitment of nursing students to the workforce.

Relevance to clinical practice.  A unified description of student mentoring will help improve the quality of placement learning opportunities and support for students, also for exchange students. A clear description of student mentoring enables the development of systematic provisions for mentoring of nursing students in placements and adequate mentor preparation programmes for nurses.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

Nursing education in Europe has been undergoing changes based on the European Union’s (EU) education policy that emphasises the need to modify unified procedures in education and training in the EU countries to ensure equal qualifications of education (CEU 2009). Therefore, nursing education with a clinical practice component should also meet this challenge. At the EU level, the clinical practice component should comprise at least 50% of the total degree programme in nursing (77/453/EEC), and during these clinical practice periods, nursing students must be mentored by a professional nurse in placement, as stated in the guidelines for nursing education, for example in the UK (e.g. RCN 2005, NMC 2008) and in Finland (ME 2006). This kind of 1:1 relationship between a professional nurse and the student is used nowadays in the UK and Finland, but because of the shortage of nurses in the UK and Finland as well as in many other countries (OECD 2008), it will be a challenge in the future.

The trend towards unifying the approaches used in the clinical practice component of nursing education enhances the quality in placement learning. The quality of opportunities, provision and support for nursing students in placement learning is well debated, for instance in the UK. However, a report in the Nursing Standard (Waters 2008) reveals that 26% of all nursing students in the UK interrupt their studies before graduating and this causes about £99 million (€107 million) in costs a year. Therefore, it is important to reduce attrition rates of students. Adequate support of students in placements and positive clinical experiences can increase students’ enthusiasm and retention in profession (Pearcey & Elliott 2004, Pellatt 2006).

Furthermore, describing and comparing education and clinical practice between EU countries requires the use of unified terminology. Despite this, the term ‘mentoring’ is not universally used in the clinical practice component of nursing education; other related terms like supervising, preceptoring or facilitating are used, instead. Because of the lack of unified use and understanding of the term ‘mentoring’ in the context of students in clinical practice, mentoring approaches in placements vary across EU countries. Consequently, also mentoring preparation programmes for nursing professionals acting as student mentors vary considerably in the EU countries and they are said to be insufficient (Andrews & Chilton 2000). In the UK, for example, there are national standards for student mentors, which include requirements for training, annual updating, local registering, review and maintenance of qualifications (NMC 2008). In many countries, Finland among them, there are no nationally agreed standards for mentor preparation; existing education varies by country and is voluntary. Thus, there is a need for a uniform preparation programme for mentoring of students, which is based on an agreed description of mentoring of students, at least in the EU countries.

Overall, mentoring has been under discussion in nursing literature over 25 years (Bray & Nettleton 2007). The earliest articles have been published in the beginning of the 1980s (e.g. May et al. 1982, Darling 1984), and after the appearance of the term ‘mentorship’ in nursing in 1987, the amount of literature on mentoring has increased. In the early 1990s, there have been debates about mentoring in the context of nursing education (e.g. Morle 1990, Armitage & Burnard 1991, Fields 1991), but mentoring has mainly been focused on career development in a long-term relationship among nursing professionals (e.g. Donovan 1990, Yoder 1990, Steward & Krueger 1996). In the late 1990s, mentoring literature started to also focus more on the student’s perspective and mentoring of students was presented as a long-term mentorship relationship between a student and an older, more experienced nurse expert (e.g. Andrews & Wallis 1999). Studies of student mentoring have been done especially in the UK since 2000 as a result of changes in nursing education and clinical placements as learning environments. In these studies, mentoring was seen as the work of a mentor - a clinical nurse, who supervises, teaches and assesses student nurses in placements during their clinical practice period (Neary 2000, Jinks 2007). In addition, in a student–mentor relationship, positive emotional aspects were considered very significant (Wilkes 2006).

Despite the many studies of mentoring in nursing, there is still confusion about the description of mentoring in the context of students (Bray & Nettleton 2007). It seems that, in most cases, the focus of previous research has been on nursing professionals, academics and managers. For example, this has been seen in North American studies, where mentoring is mostly used in the context of professionals rather than students. Overall, mentoring activity related to nursing professionals and students is presented to be different (Andrews & Wallis 1999). Therefore, many proposals have been made (e.g. Andrews & Wallis 1999Andrews & Chilton 2000, Neary 2000, McKinley 2004) for further investigations of mentoring of nursing students.

Aim of the study

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

This study is part of a Finnish–British research project. The purpose of this systematic review is to develop and provide a unified understanding of student mentoring in the context of clinical nursing placements implemented by nursing professionals. This kind of information is needed in the EU countries and for example in Finland, where one of the main goals of a national action plan for nursing for 2009–2011 is to build up national-level structures and common principles for mentoring of nursing students in clinical placements (MSHA 2009). The aim of this study is to describe mentoring of nursing students in clinical placements by reviewing prior empirical research articles published in scientific journals dealing with student mentoring and investigating the topic from the perspectives of mentors, leaders, students and educators. The specific review question is: What is mentoring of nursing students in clinical placements as it is expressed from diverse perspectives in nursing research literature?

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

Systematic review

A systematic review was used in this study to integrate and provide scientific knowledge from previous studies (Grimshaw et al. 2003, Duffy 2005). This review was performed systematically in phases in line with a scientific research process where each phase is built on the basis of the previous one (Hawker et al. 2002, Grimshaw et al. 2003). One broad review question from the specific topic was identified, and the relevant literature from empirical research published in scientific journals was collected, systematised and evaluated with specific criteria including levels of values with points (Magarey 2001, Hawker et al. 2002, Whittemore 2005), which is described in detail in the data evaluation section. This type of review is empirical and the approach is partly integrative, because literature from different types of research designs and multiple research methodologies, both qualitative and quantitative, was included (e.g. Whittemore & Knafl 2005, Evans 2007, Whittemore 2007).

Data collection

Databases

The literature search was performed systematically, first widely from different fields of science and electronic databases, where data concerning student mentoring in clinical practice or training are available. Seven databases were chosen: CINAHL (Cumulative Index to Nursing, Allied Health Literature), Medic, PubMed (Medline), ERIC (CSA Illumine), EBSCOhost and ISI Web in Science. Furthermore, data were also searched from the Cochrane Library, but no results focusing on mentoring of nursing students were obtained.

Inclusion criteria and search strategy

Data collection was carried out using seven inclusion criteria (Table 1). The data were collected from literature published over 20 years (January 1986–December 2006). The limitation of years was based on the ‘mentorship’ term, which became a subject heading in the CINAHL database since 1987. The first three inclusion criteria were used as search limitations in every database. The search strategy, terms and search results are presented in Table 2.

Table 1.   Inclusion criteria in the systematic review
Criterion 1: Time durationLiterature during 20 years (1986–2006)
Criterion 2: LanguageLiterature in all languages
Criterion 3: Terms/concepts/KeywordsTerms/concepts/keywords used (based on the database): ‘mentoring’ (mentor*) OR ‘preceptoring’ (precept*) OR ‘supervision’ (supervis*) AND ‘clinical’ (clinic*) AND ‘practice’/‘training’ (pract*, train*) AND ‘student’ (stud*)
Criterion 4: ContentUndergraduate/pre-registration student mentoring in clinical practice or training (in placement), which is included in their professional education (bachelor level)
Criterion 5: Fields of scienceDifferent fields of science concerning the human content: Health sciences (Nursing Science, Medical Science, Pharmacy, Nutrition, Physical Education), Social Sciences, Pedagogy, Science of Economic and Business and Law
Criterion 6: PublicationPublished research articles in valid peer-reviewed scientific journals (referee evaluation used, at least two reviewers)
Criterion 7: AvailabilityPossibility to obtain and handle with reasonable resources and time
Table 2.   Search strategy and results of the first and last phases in the systematic review process
DatabaseSearch strategy Limitations in all databases: - years 1986–2006 (inclusion criterion 1) - all languages (inclusion criterion 2) Terms used based on the database (inclusion criterion 3)Search results based on the inclusion criteria nAccepted nursing research articles on mentoring of nursing students n
CINAHL Ovid[(mentor$.mp OR Mentorship) OR preceptor$ OR (supervisor.mp or ‘Supervisors and Supervision’) OR (Clinical Supervision or ‘Supervisors and Supervision’ OR supervising.mp)] AND (clinic$. mp OR train$.mp OR practic$.mp) AND (student$. mp or Students) - further limitations: research63320
CSA/EricKW (mentor* OR preceptor* OR supervis*) AND KW clinic* OR train*) AND KW student* - further limitations: published work and journal article/peer-reviewed article, duplicates removed724 2
MedicKT (mentor* OR ohja* OR supervis* OR precept*) AND KT (harjoittel* OR pract* OR clinic* OR train*) AND KT (opisk* OR stud*) - no further limitations 43 0
PubMed/MEDLINE[(mentor* OR preceptor* OR supervis*) AND (practic* OR clinical* OR train*)] AND student* - further limitations: adults 19+, humans, different kinds of research/studies/articles, Medline484 0
Cochrane libraryAT (mentor*) OR AT (preceptor*) AND AT (practic*) AND AT (student*) - no further limitations149 0
EBSCO host/Academic & Business Source Elite, SocINDEX(KW mentor* OR KW preceptor* OR KW supervis*) AND (KW practic* OR KW clinic* OR KW train*) AND KW stud* - further limitations: document and publication type: journal article, case study, literature review, peer-reviewed journal, duplicates removed449 1
ISI Web of ScienceTI (mentor* OR supervis* OR preceptor*) AND TI (practic* OR clinic* OR train*) AND TS student* - further limitations: document type: article, review167 0
Total n = 2649n = 23
Progression of the systematic review

The progression of the systematic review process is shown in Fig. 1. Each phase of this process was performed by two scholars. First, a literature search was made based on inclusion criteria in the search strategy (n = 2649). Second, publications were tentatively selected by title according to the review question (n = 2018). In the following phase, equivalence was checked from the abstract (n = 489). After that, hard copies of research articles were searched from Finnish libraries. Some of the articles were not available with reasonable resources; therefore, they were omitted, as were duplications (n = 311). Moreover, non-scientific publications were removed, and only articles published in valid scientific journals with a referee system (n = 306) were accepted. In the next phase, data collection and article approval was carried out on the basis of the valid content of the whole text of the research articles (n = 82).

image

Figure 1.  Systematic review process.

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Data evaluation

The evaluation of the selected research articles with valid content (n = 82) was carried out using the evaluation form described in Table 3. This form was created and formulated on the basis of the assessment form presented by Hawker et al. (2002). The evaluation form included ten specific evaluation sections. Each of these sections consisted of evaluation criteria on four levels of value with points: good (3), fair (2), poor (1) and very poor (0). Therefore, each research article could have a maximum value of 30 points and minimum of 0 points. Research articles that accumulated 30–15 points were accepted for the next phase. Furthermore, two independent scholars performed the data evaluation by evaluating the quality of the selected research articles. The evaluation achieved inter-rater agreement of 84%.

Table 3.   Evaluation form with evaluation sections and criteria for research articles
Evaluation sectionsEvaluation criteria with levels of value and points
I Background of the research3 The background is inclusive, relevant and presented systematically 2 There is a moderate background with some main points presented 1 There is hardly any background and it is superficial and/or its context is insufficient 0 The background/context does not meet the aim of the research or it is entirely lacking
II Aim of the research and research questions3 The aim of the research is described precisely and clearly, the research questions are accurate and realistic 2 The aim of the research is described briefly; the research questions are discussed with minor inaccuracies 1 The aim of the research is described inadequately. Research questions are presented inaccurately or implicitly 0 The aim of the research is unclear or is lacking completely. The research questions are lacking or it is hard to recognise them
III Design and method of research3 The design and method of the research are well suited with respect to the aim of the research, and they are described clearly 2 The design and method are applicable but their description could be more accurate 1 The design of the method is only briefly covered or it is unclear. The method is described inaccurately and/or its applicability is questionable 0 There is no design and method of research, or they are inappropriate
IV Study group/sample3 The study group is described accurately as is the reason why the group concerned was chosen. Those who did or did not answer have been accounted for and explained. The size of the sample is appropriate, clearly described and justified as suited for the research 2 The data/selection of the study group is mainly described with some inaccuracies. The size of the sample is sufficient, it is described and justified 1 There is hardly enough information about the study group. The size of the sample is mentioned but there are no other details 0 There is no mention about either the study group or the size of the sample
V Material and data collection3 The material applies well to the research, and it is described in detail. The data collection method is appropriate and fits the research questions. Data collection is described accurately 2 The material is appropriate, and it is described sufficiently. The data collection methods are appropriate with respect to the research questions. Data collection is described briefly with the main points included 1 Reasonable material with scarce description. The data collection method is questionable with respect to the research questions. Data collection is described inaccurately 0 The material is scarce, and there is no description of the data collection. The method of data collection is inappropriate
VI Data analysis3 The choice of the data analysis method and the data analysis are justified and clearly described Qualitative: The data analysis process is described accurately and carried out correctly Quantitative: Analysis and justifications for the statistical analysis methods are accurately described and carried out correctly 2 The choice of qualitative and quantitative analysis is briefly told, the main points of the data analysis process can be found but examples are lacking 1 There is a brief mention about the material analyses with minor/inaccurate data analysis 0 There is no mention about data analyses, or they are performed incorrectly
VII Results3 The results with respect to the research questions are clearly told, consistent and proceed logically. The results are interpreted appropriately, and they are compared with previous research. The tables/charts (if they exist) are explained in the text 2 The results are mentioned briefly, and there could be more information. The interpretation of the results is fair, and they are partly compared with previous research. The charts/tables (if they exist) partly support the text 1 The results are described inaccurately, there are no explanations and they do not follow logically. The results repeat data (analysis unfinished) and their interpretation is inaccurate, and comparison with previous researches is scarce 0 The results are not mentioned, or they do not relate to the research question. The interpretation of the results is incorrect, and no comparison with previous research is made
VIII Ethical issues3 The ethical issues of the research are widely told (incl. acquisition of anonymity, research approval and contraction of informed consent). (The use of an existing questionnaire). The weaknesses of the research are considered 2 The ethical issues of the research are considered but they have minor deficiencies or inaccuracies 1 There is scarce or unessential mention about ethical issues or weaknesses 0 There is no mention about ethical issues or weaknesses
IX Reliability3 The reliability of the implementation of the research (concepts, study group, questionnaire, material, data collection and analysis) is widely considered (e.g. internal and external validity). The results are realistic and credible 2 The implementation of the research and the reliability of the results are described moderately with minor deficiencies 1 There is a scarce description about the reliability of the research and the results 0 There is no description about the reliability of the research or the results
X Usefulness of the results3 Conclusions are presented; they are clear, based on results and bring in something new/different. The effects of the results have been considered from practical and developmental point of view. Issues of further research are considered and proposed 2 Two issues from the aforementioned section are mentioned (the lacking issues are mentioned) 1 Only one issue from the first section is mentioned 0 There are no issues mentioned from the first section
Final data

After data evaluation, the number of research articles was 57. In the following phase, only research articles in the field of nursing science (n = 46) were selected. In these articles, the terms used were mentoring (n = 23), preceptoring (n = 12), supervising (n = 6) and others (n = 5), like facilitating, guiding and clinical teaching. The term mentoring was used in 23 nursing research articles, which were finally accepted for this review. These research articles (n = 23) were published during 1993 – 2006, mostly in year 2000 (n = 5). Most of these articles were from the UK (n = 14) and others were from Australia (n = 3), Scotland (n = 2), Hong Kong (n = 2), Finland (n = 1) and Ireland (n = 1). The methodological approach in these articles was mostly qualitative (n = 13), having sample sizes ranging from 3–48. Six of these articles had triangulation as the research design and four of them employed quantitative research with sample sizes between 11–300. The list of research articles is available from the research group.

Data analysis

Data from 23 nursing research articles were analysed using inductive content analysis (Cavanagh 1997, Holloway & Wheeler 2002). After becoming familiar with the content of the data, the analysis started by choosing a unit of analysis, which was one combination of words or the meaning of a sentence or phrases. After this, the data were reduced. Similarities and dissimilarities were sought from the reduced impressions. Impressions with the same meaning were gathered first into one class by doing a classification. Next, after undergoing categorisation, classes with similar content were combined into subcategories and these were labelled. In the next phase, subcategories with similar contents were combined into upper categories. Finally, by further abstraction, two themes were formulated based on the four upper categories. An example of the content analysis process of one upper category, which is a part of one theme, is presented in Fig. 2.

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Figure 2.  Example of the content analysis process in one upper category.

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Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

Mentoring of nursing students in clinical placements is presented in two themes labelled ‘Facilitating students’ learning in clinical placements’ and ‘Strengthening students’ professionalism’. These include issues of mentoring expressed as actions that promote students’ learning and professional development. These two themes are presented in detail in the following, based on the content of the four upper categories and ten subcategories (Fig. 3).

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Figure 3.  Mentoring of nursing students in clinical placements based on the systematic review.

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Facilitating students’ learning in clinical placements

This theme was based on two upper categories. The one of them was creating a supportive clinical learning environment, which included all the arrangements in placements that prepare students’ practice and organise their support system. ‘Preparing clinical placement fitness for learning’ consisted of advance planning of training and placement learning, which included, for example, ensuring the applicability of placement, planning and organising learning opportunities and being aware of details of students and their training documents, like the nursing curriculum. The other arrangements were ensuring fluent implementation of training and placement learning, for example, naming personal and substitute mentors and organising the student’s first day in placement, relevant or same shifts with the mentor and enabling an interpersonal relationship with the mentor. Assuring students’ individual support opportunities in placement learning was another preparation issue. This included practices of organising student guidance needed during training, for example, availability of a mentor, enough time and regular meetings with the mentor. All these issues concerning the learning environment helped students learn nursing. The ‘Organising training in an interpersonal learning environment’ subcategory presented actions that supported students in learning nursing issues in placements. One of these actions was familiarising the student with placement as a working environment, including adjusting to the hospital, different units and the student’s own ward and the culture of care and the climate in the ward. In addition, one action was enabling students’ equal participation in teamwork in placement. This included familiarising the student with all the staff in the ward, making it possible for the student to become committed to placement and the working society and for the staff to accept the student as a member of the care team. Moreover, co-operating with other stakeholders in placement who are participants in students’ clinical training was another issue. This included, for example, the mentor’s regular meetings with the lecturer or other educators from the university and the mentor’s working in a collaborative relationship with colleagues and patients.

‘Enabling an individual learning process’ was the other upper category, and it described mentoring as ensuring the possibility for nursing students to study based on personal learning plans and to develop by evaluating learning. The ‘Making possible a personal, goal-oriented learning path’ subcategory was formulated from actions that help nursing students advance, based on current personal skills and learning goals. Additionally, clarifying the basic level of students’ skills, observing students’ personal learning needs and goals, taking into account students’ individual zones of development and advancements according to the phases and demands of studies were actions in mentoring of nursing students. Mentoring was focused on increasing students' responsibility to work independently by steps and helping students to grow from observers to independent workers, which increased students’ skills in coping with nursing actions independently. Providing learning possibilities, taking care of students’ learning situations and helping students with career planning were essential in mentoring. The ‘Assessing personal development and achievement of learning outcomes’ subcategory concerned evaluation of students’ learning and performance during the clinical learning period. These mentoring actions included sharing feedback on learning between mentor and student, which involved giving real-time, regular and constructive feedback on performance, mistakes and nursing skills. The other actions were making objective judgements of students’ development in learning and performance, which included knowing the evaluation criteria and assessing students’ learning outcomes.

Strengthening students’ professionalism

This other theme included two upper categories of mentoring nursing students’ professional responses and behaviour. First mentoring was shown as ‘Empowering development of professional attributes and identity’ of students, which presented treating students as persons and nursing professionals. This was achieved by working with students in a professional relationship and implementing actions that promote students’ growth in the nursing profession. The first subcategory, ‘Treating as an equal individual and a nursing colleague’, included aspects of positive attitudes towards the student as a human being, including respecting and honouring the student as person and a learner of nursing. In addition, taking care of students and showing empathy towards them during the clinical practice period were other issues. These included showing interest in, caring for and understanding students and also trusting them, which confirms students’ capability in nursing. ‘Interacting as professional partners in a co-operative relationship’ was the second subcategory, which presented mentoring as co-work between mentors and students in patient care situations and close interactive relationships. Working together as nursing professionals meant students were taken into different kinds of nursing activities in every shift to work with the mentor like nurses side-by-side. In addition, working in a close interactive relationship included acting as equal pairs in co-operation, having mutual, trusted communication and interaction and working together as collegial friends. The ‘Promoting growth and commitment to the nursing profession’ subcategory, based on the nursing profession and mentoring, was expressed as motivating students to study nursing with psychological support and encouragement. Furthermore, familiarising students with nursing as work and an occupation, acting as a role model for students, showing different aspects and functions in the work of nurses and also imaging demands of the nursing profession were included in this subcategory. Moreover, mentoring is an action that facilitates students’ emotional development and helps students to understand their own feelings and emotions and those of the patients they care for and supports students in dealing with emotions in difficult nursing situations.

Second, the ‘Enhancing attainment of professional competence’ upper category contained three subcategories focusing on nursing students’ clinical, theoretical and critical thinking skills. In the first subcategory, ‘Facilitating attainment of stipulated clinical skills’, mentoring was presented as training the student to improve hands-on clinical nursing and communication skills in interaction with patients. This included teaching and advising on how to use different nursing methods in real care situations and also guiding students in meeting patients, communicating and co-operating with them. Second, mentoring was also described as ‘Enabling improvement of theoretical skills’ by enhancing students’ understanding and knowledge of relevant care processes, linking theory into nursing practice, supporting the search for and application of knowledge. Other mentoring elements consisted of direct teaching, guidance, advising and counselling. The third subcategory, ‘Deepening the development of critical and reflective thinking’, included mentoring actions that create opportunities for students to develop their critical thinking skills. One action was to facilitate students to learn from experiences using active listening, discussions and sharing of nursing experiences. Mentoring also involved encouraging students to consciously reflect on nursing procedures and their own learning. The development of critical reflections encouraged students to ask questions and present arguments about nursing practice and to debate the key issues. Mentoring also facilitated the development of problem-solving and decision-making skills by helping to clear up difficult nursing situations. Furthermore, supporting students in expressing their personal opinions, alternatives and ideas and helping students understand reasons and evaluating nursing systematically were also included in this subcategory.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

This systematic review described mentoring of nursing students in clinical placements. The results showed that student mentoring integrates individual and organisational aspects and environmental, collegial, pedagogical and clinical attributes in nursing placements. This kind of integration of learning and practice, professional and personal development, bridges the gap between theory and practice in working life. All these aspects have unified importance in student mentoring, by supporting students’ learning and professional growth, as is also highlighted in nursing authors’ guidelines (e.g. MSHA 2004, NMC 2008). Furthermore, this review showed aspects similar to those presented by Yoder (1990) and Andrews and Wallis (1999) in their description of mentoring as personal and career development in teaching and learning. The long duration of a mentoring relationship, as Andrews and Wallis (1999) expressed, was not visible in the results of this review.

The mutual relationship between an individual nurse and the student is an important aspect, but it is increasingly essential for the managerial level to provide opportunities for student mentoring with enough resources and education. First, a very notable aspect is the creation of a supportive learning environment, because it does not exist self-evidently. Likewise, early studies (e.g. Saarikoski & Leino-Kilpi 2002, Pearcey & Elliott 2004) argued that a positive ward atmosphere in the learning environment is very significant for nursing students. Therefore, advance preparation and organisation of placements for students’ clinical learning are very important, because students feel safe and are assured of the quality of the placement learning opportunity, provision and support. This is crucial if we wish to retain nursing students and reduce attrition. Second, facilitating students’ individual learning processes is also essential; this requires pedagogical competence from the nursing professionals in placements. First of all, this influences their ability to provide a goal-oriented assessment of students’ performance, which requires, among other things, a deep understanding of the goals of education. Assessment is said to be challenging in student mentoring (Bray & Nettleton 2007) and, for example, in the UK, this aspect is becoming increasingly demanding, particularly with the implementation of the NMC (2008) sign-off of mentors’ policy and guidelines. Therefore, there is a need to organise formal education in student assessment for nurses, as Pellatt (2006) suggests, which should be fair, constructive, objective and not influenced by other factors, such as friendship, emphasise Bray and Nettleton (2007) as well as Webb and Shakespeare (2008).

Strengthening the student’s professionalism and the development of a professional identity were other important aspects of mentoring. Students want to be treated as individuals and colleagues during placement learning. Therefore, enthusiasm and positive attitudes in placements are important, as Webb and Shakespeare (2008) highlight and they influence students’ learning significantly. Furthermore, in a mentoring relationship, it is possible to achieve a level of collegiality with students. Friendship was also included in mentoring, but it seldom happened in practice (Bray & Nettleton 2007). On the other hand, current nursing education values the student’s independence and self-direction in learning, which puts the responsibility on students to be active in the mentoring relationship (Andrews & Chilton 2000). However, it is significant that mentors motivate students to learn nursing in placements and act as role models of nurses. Surprisingly, a clear expression of being proud of the nursing profession was not brought out in the review. Nevertheless, Pearcey and Elliott (2004) presented that a positive image of the profession strengthened students’ view of their own career as nurses and a negative image discouraged students’ career planning in the future. In addition, the wellness and job satisfaction of nurses are enhanced by taking on mentoring (Dyer 2008).

Student mentoring included facilitation of achievement of professional competence and professional growth of the students. Reflective learning and critical thinking are crucial for students to learn to be able to develop new thinking and practices in clinical nursing when working as professional nurses in the future. However, it was surprising to note that the influence and use of technology in nursing practice was not considered in mentoring of students. However, the growth of technology is increasing in health care, for example, in the use of electronic documentation.

Student mentoring was seen in this review mostly from the perspectives of a mutual 1:1 relationship between the student and a mentor, who is considered a very significant person for students in clinical placement (Elcigil & Sari 2008, Hyatt et al. 2008) and this working relationship has been said to be a requirement for effective mentoring. However, the role of ward managers or head nurses in student mentoring did not emerge explicitly in this review, as expressed in the study by Saarikoski and Leino-Kilpi (2002). Nevertheless, leadership and management are essential baselines in organising, coordinating and developing student mentoring in placements (e.g. MSHA 2009). Surprisingly, in this review, student mentoring did not include group or peer mentoring, whereas co-operation with lecturers and other stakeholders in placement was a part of student mentoring. The relationship between education and practice has also been presented as inadequate (Myall et al. 2008), which needs enhancing. Moreover, the roles of stakeholders in supporting nursing students in clinical practice vary internationally and need to be reviewed closely (Carnwell et al. 2007).

Validity of the review

The validity of this systematic review process has been taken into account through careful planning, working and evaluation in every phase of the process. The use of a peer reviewer increases the validity of the content (Whittemore 2005), as two scholars from the research group independently reviewed the articles based on specific pre-formulated inclusion and evaluation criteria (Magarey 2001). Moreover, the inclusion criteria were pretested before the search with a couple of random literature publications, as was the evaluation form, to select only relevant research articles of good quality (Whittemore 2005).

The review question was quite broad but clear, and there were enough data to answer the question sufficiently. Therefore, it was not necessary to widen or renew the search strategy, which was exactly defined. Saturation of data was achieved; so, there was no manual search made in addition to the electronic search. Furthermore, the validity of the data analysis was ensured by formulating the categories using the process of content analysis (see Cavanagh 1997).

Limitations of the review

The limitation of unrepresentative search results was minimised by planning the keywords of the databases carefully together with library professionals. For this review, only the term mentoring in the field of nursing was accepted from the search. Other related terms were excluded because of the large amount of material and the intent to obtain a clear description within one concept. Furthermore, only published research articles, excluding academic theses, review publications and other prescriptive literature, authors’ guidelines, non-research-based reports or discussions, unpublished manuscripts, books and articles published outside the designated time, were included in this review.

In addition, some research articles had to be rejected because of availability or translation problems from the native language to English (Slovenian, Norwegian, Korean, Chinese, Portuguese, French and Danish); the search strategy did not limit the language of the articles. Moreover, it was surprising that no nursing research articles from the USA emerged in this review. Nevertheless, according to the ISI Web of Science database, over half of the nursing mentoring publications in 2000–2004 were from the USA. It might be possible that American publications emphasise mentoring mostly in the context of nursing professionals or peers. These aforementioned issues might limit the search results and cause selection bias.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

This systematic review provides a unified description of mentoring of nursing students in clinical placements. It needs to be systematically and regularly reviewed to reflect changes in nursing practice, education and the health care context. Especially, we have to carry out comparative research of student mentoring approaches in clinical practice contexts at the national and European level. Moreover, further research needs to be carried out because of limitations owing to the variability of terminology used in clinical practice and education. However, related concepts of mentoring, as used and applied in different health care contexts and disciplines, must also be considered and compared to achieve and maintain a workable description.

Inevitably, a clear and systematic strategy for mentoring nursing students, achieved through adequate resources, formal preparation and education of mentors, will prove challenging for management in nursing organisations. The provision of effective student mentoring in nursing organisations could be one of the issues with which the nursing organisation can promote recruitment and retention of nursing students as a workforce in the future. This is crucial to take into account in nursing organisations at the present, when a shortage of nurses is an increasing problem in most EU countries.

Relevance to clinical practice

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

A clear description of student mentoring is essential in clinical nursing placements to ensure parity in the approach to mentoring. The clarity of the description will facilitate effective mentoring of students, also international and exchange students, by acquiring positive clinical experiences and increasing confidence in clinical placement learning. The development of systematic provisions and structure for student mentoring in the health care context will help improve the quality of placement learning opportunities, provision and support for students. A unified understanding of student mentoring also makes it possible to develop and evaluate an appropriate mentor preparation programme for nurses and create a basis for a multi-professional mentor preparation programme in health care organisations.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

We thank the Finnish Foundation of Nursing Education for giving a grant to the research project and the University of Eastern Finland (formerly University of Kuopio) for giving a PhD grant to the corresponding researcher, which made this systematic review possible.

Contributions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References

Study design: MJ, HT, KT; data collection and analysis: MJ, HT, KT, DJ, KC and manuscript preparation: MJ, HT, KT, DJ.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim of the study
  5. Methods
  6. Results
  7. Discussion
  8. Conclusion
  9. Relevance to clinical practice
  10. Acknowledgements
  11. Contributions
  12. Conflict of interest statement
  13. References
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