Student Nurses Who Witness Critical Events in the Clinical Setting: A Grounded Theory Qualitative Study

Hood, Tiffany Lee. Student Nurses Who Witness Critical Events in the Clinical Setting: A Grounded Theory Qualitative Study. Published Doctor of Philosophy dissertation, University of Northern Colorado, 2020. Background: Nursing students often experience critical events in the clinical setting, and too often, the clinical instructor does not have the training to help students through these situations. The literature shows that students often feel alone and abandoned, requiring them to endure these experiences without proper psychological recovery. Clinical nurse educators and staff nurses may not fully understand their role in emotional support, pre-briefing, and debriefing, not knowing what to do to help students through such difficult situations. Procedure: A grounded theory qualitative study was conducted to better understand the experiences of student nurses who have witnessed critical events in the clinical setting, and to better understand the types of support provided and the effectiveness of the support. Fourteen undergraduate student nurses from three four-year universities in Utah, United States, participated in this study. Results: Using a four-stage coding procedure, 50 initial categories were categorized into one core category, nine primary categories, and nine secondary categories. Relationships between categories were identified, and a theory of student nurse support and recovery through critical events in the clinical setting emerged. Conclusion: Student nurses need active faculty and/or staff support during critical events, and pre-briefing whenever possible. Students should be taught coping skills and have risk and support systems assessed prior to entering the clinical setting. Nursing knowledge, life experiences, values, beliefs, coping skills, current mental health state, and prior history of trauma affect student responses to critical events. Immediate debrief positively affects post-event stress response and coping by providing the opportunity for students to gain closure, decrease anxiety, increase understanding, time to mentally process the event, and emotional support. Lack of debrief increases post-event psychological distress and decrease coping and resilience. Support after critical events should continue in the days, weeks, and months following the event. Students should be monitored for signs of increased psychological distress and psychological trauma and be provided resources for help in coping. Students who do not receive adequate support prior to, during, or after a critical event are at risk for psychological trauma