Critique an Article 2-3 pages

R E V I E W

A systematic review of mentoring nursing students in clinical placements

Merja Jokelainen, Hannele Turunen, Kerttu Tossavainen, David Jamookeeah and Kirsi Coco

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, peda-

gogical 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.

Key words: clinical, mentoring, nursing student/undergraduate, placement, systematic review

Accepted for publication: 17 August 2010

Introduction

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 educa-

tion 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

Authors: Merja Jokelainen, MNSc, PHN, RN, PhD Candidate,

Department of Nursing Science, University of Eastern Finland;

Hannele Turunen, PhD, Professor, Department of Nursing Science,

University of Eastern Finland; Kerttu Tossavainen, PhD, Professor,

Department of Nursing Science, University of Eastern Finland,

Kuopio, Finland; David Jamookeeah, MEd, FHEA, Cert Ed, RNT,

BA Hons, RCNT, RGN, Director of Clinical Education & Quality

Assurance, University of Bradford, Bradford, UK and Adjunct

Associate Professor, University of Mauritius, Reduit, Mauritius;

Kirsi Coco, MHSc, RN, PhD Candidate, Department of Nursing

Science, University of Eastern Finland, Kuopio, Finland

Correspondence: Merja Jokelainen, PhD Candidate, Department of

Nursing Science, University of Eastern Finland, P.O. Box 1627,

70211 Kuopio, Finland. Telephone: +358 50 526 8610.

E-mail: [email protected]

2854 � 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 2854–2867 doi: 10.1111/j.1365-2702.2010.03571.x

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 opportuni-

ties, 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 coun-

tries, 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 appear-

ance 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 espe-

cially 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 1999 Andrews & Chilton

2000, Neary 2000, McKinley 2004) for further investigations

of mentoring of nursing students.

Aim of the study

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 profes-

sionals. 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

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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

Systematic review

A systematic review was used in this study to integrate and

provide scientific knowledge from previous studies (Grim-

shaw 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 data-

bases, 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 limita-

tion 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.

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 inclu-

sion criteria in the search strategy (n = 2649). Second, pub-

lications were tentatively selected by title according to the

review question (n = 2018). In the following phase, equiva-

lence 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 rea-

sonable 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).

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

Table 1 Inclusion criteria in the systematic review

Criterion 1: Time duration Literature during 20 years (1986–2006)

Criterion 2: Language Literature in all languages

Criterion 3: Terms/concepts/Keywords Terms/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: Content Undergraduate/pre-registration student mentoring in clinical practice or training

(in placement), which is included in their professional education (bachelor level)

Criterion 5: Fields of science Different 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: Publication Published research articles in valid peer-reviewed scientific journals (referee evaluation used,

at least two reviewers)

Criterion 7: Availability Possibility to obtain and handle with reasonable resources and time

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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 eval-

uation 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 mini-

mum 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%.

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

Table 2 Search strategy and results of the first and last phases in the systematic review process

Database

Search 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

n

Accepted 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: research

633 20

CSA/Eric KW (mentor* OR preceptor* OR supervis*)

AND KW clinic* OR train*) AND KW

student*

- further limitations: published work and journal

article/peer-reviewed article, duplicates

removed

724 2

Medic KT (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,

Medline

484 0

Cochrane library AT (mentor*) OR AT (preceptor*) AND AT

(practic*) AND AT (student*)

- no further limitations

149 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

removed

449 1

ISI Web of Science TI (mentor* OR supervis* OR preceptor*) AND

TI (practic* OR clinic* OR train*) AND TS

student*

- further limitations: document type: article,

review

167 0

Total n = 2649 n = 23

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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 pub-

lished 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

Rejected publications based on title, which did not conform to inclusion criteria 3 or 4 (n = 631)

Literature based on search strategy and inclusion criteria 1, 2 and 3 (n = 2649)

Rejected publications based on abstract, which did not conform to inclusion criteria 3 or 4 and 5 (n = 1529)

Publications based on title (n = 2018)

Publications/research articles based on abstract (n = 489)

Available and single publications/ research articles (n = 311)

Rejected whole original research based on the text of invalid content, which did not conform to inclusion criteria 4 and 5 (n = 224)

Rejected non-scientific publications, which did not conform to inclusion criterion 6 (n = 5)

Research articles in valid scientific journals with a referee system (n = 306)

Research articles based on the valid content (n = 82)

Rejected research based on the evaluation of quality, which did not conform to the specific evaluation criteria (n = 25)

Rejected ‘not available’ publications (inclusion criterion 7) (n = 69) and ‘duplicate’ publications (n = 109)

Research articles based on the evaluation criteria (n = 57)

Accepted nursing research articles on mentoring of nursing students for this review (n = 23)

Rejected research articles which are not from the field of nursing (n = 11)

Research articles in nursing science (n = 46)

Rejected nursing research articles which do not use the concept of mentoring (n = 23)

Figure 1 Systematic review process.

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Table 3 Evaluation form with evaluation sections and criteria for research articles

Evaluation sections Evaluation criteria with levels of value and points

I Background of the research 3 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 questions

3 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

research

3 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/sample 3 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

collection

3 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 analysis 3 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 Results 3 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

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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.

Results

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).

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 place-

ment, planning and organising learning opportunities and

being aware of details of students and their training docu-

ments, like the nursing curriculum. The other arrangements

were ensuring fluent implementation of training and place-

ment 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 stu-

dents’ 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 environ-

ment’ 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 commit-

ted 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.

Table 3 (Continued)

Evaluation sections Evaluation criteria with levels of value and points

VIII Ethical issues 3 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 Reliability 3 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 results 3 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

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2860 � 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 2854–2867

- Providing the relevance of placement for training - Informing the student on placement and its prerequisites - Assuring learning possibilities despite a narrow specialty

- Clearing the contextual learning possibilities in the ward - Planning applicable patients for training in placement - Planning learning situations and visits to different units

- Arranging suitable practices to gain nursing experiences - Organising hands-on possibilities in placement - Observing limitations of activities in placement for training

- Knowing details of the student and the nursing curriculum - Reading up on instructions on training beforehand - Orientation to learning tasks and evaluation of training

- Naming a personal mentor and a substitute mentor - Organising a 1:1 relationship between student and mentor - Having a continuous relationship with the mentor

- Giving information on the first day of training - Arranging the student’s arrival to placement - Working in the same shift with the student on the first day

- Ensuring a substitute mentor during absence - Committing all the staff to support the student with the mentor

- Making it possible to work in all shifts - Organising varying shifts - Working in the same shifts with the mentor

- Working near the student as a present hostess - Being available to the student

- Spending particular time only with the student - Organising time for the student every day - Giving quality time to the student

- Having appointments with the mentor frequently - Sharing events with the mentor regularly

- Helping the student adjust to the new environment - Integrating the student with the work organisation - Familiarising the student with the training hospital and ward

- Helping the student adapt to the atmosphere in the ward - Helping the student understand practices, routines and

protocol in the ward - Connecting the student to the new culture, staff and community

- Participation of the student as a part of a nursing team - Taking care of the student’s entry into the working team - Having a feeling as being an equal partner in the working group

- Adapting the student to the nursing profession - Involving the student with the nursing staff and other personnel - Integrating the student as a part of the workers in the ward - Creating feelings of belonging to the personnel

- Awakening feelings of being welcome to placement - Helping in settling down and accepting the standards of placement - Giving the student equal staff rights - Accepting the student as a legal worker in the working society

- Participating in holistic patient care with other professionals - Working in close and open relationships with co-workers - Working as an advocate of the student

- Organising trusted collaboration between the student and patients - Discussing training and problems with other colleagues - Sharing support of the student with other staff

- Having support from the school/educational unit - Having regular meetings with the teacher/other educators - Linking school and clinical placement work together - Working with teachers by sharing knowledge and feedback

Planning training and placement learning in advance

Ensuring fluent implementation of training and placement learning

Assuring individual support opportunities for placement learning

Familiarising with placement as a working environment

Co-operating with other stakeholders participating in training

Enabling equal participation in teamwork in placement

Preparing

clinical

placement

fitness for

learning

Organising training in an inter- personal learning environment

Creating a supportive learning

environment

Reduced impressions Class Subcategory Upper category

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

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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 profes-

sionals. 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 honour-

ing 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

Facilitating

students’

Learning

Strengthening

students’

Professionalism

Creating a supportive Learning

environment

Enabling an individual Learning process

Empowering development of

Professional attributes and

identity

Enhancing attainment of Professional competence

Preparing clinical placement fitness for learning

Organising training in an interpersonal learning environment

Making possible a personal goal-oriented learning path

Assessing personal development and achievement of learning outcomes

Treating as an equal individual and a nursing colleague

Interacting as professional partners in a co-operative relationship

Promoting growth and commitment to the nursing profession

Facilitating attainment of stipulated clinical skills

Enabling improvement of theoretical skills

Deepening the development of critical and reflective thinking

Mentoring nursing students in clinical placements

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

M Jokelainen et al.

2862 � 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 2854–2867

issues. These included showing interest in, caring for and

understanding students and also trusting them, which con-

firms students’ capability in nursing. ‘Interacting as profes-

sional 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 pro-

fessionals 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 occupa-

tion, 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 compe-

tence’ 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 com-

munication 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 counsel-

ling. 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 pro-

cedures 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 prob-

lem-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

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 develop-

ment, 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 atmo-

sphere in the learning environment is very significant for

nursing students. Therefore, advance preparation and orga-

nisation 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

Review Mentoring nursing students in clinical placements

� 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 2854–2867 2863

UK, this aspect is becoming increasingly demanding, partic-

ularly 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 devel-

opment of a professional identity were other important

aspects of mentoring. Students want to be treated as

individuals and colleagues during placement learning. There-

fore, 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 educa-

tion 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 discour-

aged 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 develop-

ing 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 evalu-

ation 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 mini-

mised 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 publica-

tions and other prescriptive literature, authors’ guidelines,

non-research-based reports or discussions, unpublished

manuscripts, books and articles published outside the desig-

nated time, were included in this review.

M Jokelainen et al.

2864 � 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 2854–2867

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

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 organisa-

tions 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

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

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

Study design: MJ, HT, KT; data collection and analysis: MJ,

HT, KT, DJ, KC and manuscript preparation: MJ, HT, KT, DJ.

Conflict of interest statement

None declared.

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