First Encountering With Nursing Practice: Undergraduate Students' Fundamental Nursing Practicum in ICU

Background: Fundamental nursing practicum is nursing students’ first class in clinical setting. It helps students to recognize the value and culture of professionalism and build up self-confidence. Positive practicum experiences and successful adaptation is crucial to enhance students’ willing to engage in nursing profession (Levett-Jones, Lathlean, Mcmillan & Higgins, 2007; Pedersen & Sivonen, 2012). Furthermore, Intensive care unit (ICU) nurses are often nimble, quickly adaptive with proficient nursing skills while facing multiple stressors. Having fundamental nursing practicum in ICU may help students to early encounter and early adapt clinical reality.  

Purpose: The purpose of this study was to explore nursing students’ fundamental nursing practicum experiences in ICU

Methods: A qualitative research was conducted to explore nursing students’ ICU practicum experiences. According to the inclusion criteria, 17 second-year undergraduate nursing students in southern Taiwan who took fundamental nursing practicum class were recruited. Students’ reflection notes about their fundamental nursing practicum experiences in ICU were collected and analyzed using content analysis (Hsieh & Shannon, 2005; Weber, 1990). First, we read the reflection notes for several times until a whole understanding of nursing students’ practicum experience in ICU were obtained. Second, we summarized a keyword or phrase in the reflection notes by reading again, moving back-and-forth, and underlining the significant words, terms, and paragraphs. Third, we identified each experience within its specific context as an analytic unit. These experience of the reflection notes were classified into several major content areas. Forth, we condensed and sorted those content areas into different meaning units and interpreted the underlying meanings within the whole context. Fifth, we labeled the meaning units and compared the difference and similarities among each students. Finally, we sorted them into categories and formulated four themes. 

Results: Four themes were identified, including encountering psychological stressors, adapting and engaging themselves in clinical settings using multiple strategies, shaping professionalism, and gaining self-growth. In the first theme, encountering psychological stressors, nursing students’ psychological stresses were derived from three aspects, including the interaction with patients and medical team, the lack of confidence and overwhelming challenges caused by insufficient clinical knowledge and skills, and the ethical dilemma between medical treatments and patients’ concerns. After encountering those reality shocks, students were trying to adapt themselves to the conditions. In the second theme, adapting and engaging themselves in clinical settings using multiple strategies, students sought for peers’ supports, embraced imperfection by self-acceptance, and strengthened clinical knowledge and skills. The experience in adaptation helped students shape their professionalism and gain self-growth. In the third theme, shaping professionalism, students identified commitments of nursing professionalism and established confidence to practice clinical skills and performed nursing ethics discreetly. Finally, in the fourth theme, gaining self-growth, students encompassed contemplating life meanings as being with dying patients and valuing personal relations.       

Conclusion: The results indicated that most students experienced psychological stressors in their first practicum in ICU; however, after adaptation, their professional identity and self-growth were found. This study provided a comprehensive picture of nursing students’ practicum experiences in ICU which may help clinical mentors and preceptors to understand the causes of nursing students’ reality shock, recognize the gap between classes and clinical settings, and realize nursing students’ progressive process.