Background: Extramuralisation in healthcare has influenced medical and nursing curricula internationally with the incorporation of themes related to primary/ community care. Despite this, students do not easily change their career preferences. The hospital is still favourite, leading to labour market shortages in extramural care. This study investigates how baccalaureate nursing students' perceptions of community care and placement preferences develop over time in a more 'community-care-oriented' curriculum, to gain insights on which curriculum elements potentially influence career choices.Methods: A nursing student cohort of a University of Applied Sciences in the Netherlands (n = 273) underwent a new four-year curriculum containing extended elements of community care. The primary outcome was assessed with the Scale on Community Care Perceptions (SCOPE). Data were collected each year of study. Descriptive statistics were used to investigate students' placement preferences and perceptions, and linear mixed model techniques (LMMs) for measuring how students' perceptions develop over time. Patterns of placement preferences at individual level were visualised.Results: Students' perceptions of community care, as measured with SCOPE, show a slight decrease between year 1 and 4, while items mutually differ substantially. In contrast, the preference of community care for a placement increases from 2.6% in year 1 tot 8.2% in year 4. The hospital is favourite in year 1 (79.8%), and remains most popular. At individual level, students often change placement preferences, although a preference for the hospital is more consistent. The LMMs indicates that, at the four time-points, the estimated marginal means of students' perceptions fluctuate between 6 and 7 (range 1-10). A placement in community care did not positively influence students' perceptions, and an intensive 1 week theoretical programme was only temporarily influential.Conclusions: Although interest for placement in community care increased substantially, it was not clear which curriculum elements stimulated this, nor did the curriculum positively influence students' perceptions. As most students do not look forward to the high responsibility of the field, other curricula with educational tracks for more mature students/ nurses with a vocational training may be an alternative contribution to solving the labour market problems in community care.
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Perceptions of community care and placement preferences in first-year nursing students: A multicentre, cross-sectional studyMargriet VAN IERSEL MSc1, Corine H.M. LATOUR PhD1, Rien DE VOS PhD2, Paul A. KIRSCHNER PhD3,5, Wilma J.M. SCHOLTE OP REIMER PhD1,4.1 ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands2 Centre of Evidence Based Education, Academic Medical Centre, Amsterdam, The Netherlands3 Open University of the Netherlands, Heerlen, The Netherlands4 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands 5 University of Oulu, Oulu, FinlandBackground: Despite increasing shortages of well-educated community nurses, far too few nursing students choose community care for their future profession; a strong societal problem that urgently needs resolution. This study provides a solid understanding of causes for the fields’ low popularity by exploring first-year baccalaureate nursing students' perceptions of community care, and their placement preferences along with their underlying assumptions. Insights from this study can be used by educators to positively influence students’ perceptions with targeted curriculum redesign strategies.Summary of work: A cross-sectional multicentre survey study was performed. First-year nursing students from six universities of applied sciences in the Netherlands (n = 1058) participated in the study from September-December 2014. The students completed the ‘Scale on Community Care Perceptions’ (SCOPE), consisting of demographic data, current placement preferences, and three subscales measuring the affective component of community care perception, perceptions of a placement, and a profession in community care. Descriptive statistics were used. Summary of results: For placement, 71.2% of the students prefer the general hospital, 23.4% another area, and only 5.4% choose community care. Students consider opportunities for advancement and enjoyable relationships with patients as most important for their placement. Community care is perceived as a ‘low-status-field’ with many elderly patients, where students expect to find little care variety and few opportunities for advancement. Discussion and conclusions: This study shows why few students show an interest for a career in community care. Students’ perceptions of the field are at odds with aspects they regard as important for their placement. They also underestimate the complexity of community care, where specific traits are required to ensure appropriate nursing care in patients’ homes. Take-home messages: The results of this study allow for three recommendations. First, students and educators should be aware of misconceptions about career opportunities in the field of community care. Second, educators should provide students with experiences that foster an optimistic and realistic career outlook on community care. Third, growing shortages in the community care sector urgently require representatives from the field and educators to collaborate to make community nursing an attractive career alternative.Keywords: Career choice; Students
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Background: Despite increasing shortages of highly educated community nurses, far too few nursing students choose community care. This means that a strong societal problem is emerging that desperately needs resolution.Objectives: To acquire a solid understanding of the causes for the low popularity of community care by exploring first-year baccalaureate nursing students' perceptions of community care, their placement preferences, and theassumptions underlying these preferences.Design: A quantitative cross-sectional design.Settings: Six universities of applied sciences in the Netherlands.Participants: Nursing students in the first semester of their 4-year programme (n =1058).Methods: Data were collected in September–December 2014. The students completed the ‘Scale on Community Care Perceptions’ (SCOPE), consisting of demographic data and three subscales measuring the affective componentof community care perception, perceptions of a placement and a profession in community care, and students' current placement preferences. Descriptive statistics were used.Results: For a practice placement, 71.2% of first-year students prefer the general hospital and 5.4% community care, whereas 23.4% opt for another healthcare area. Students consider opportunities for advancement and enjoyable relationships with patients as most important for choosing a placement. Community care is perceived as a ‘low-status-field’ with many elderly patients, where students expect to find little variety in caregiving and few opportunities for advancement. Students' perceptions of the field are at odds with things they believe to be important for their placement.Conclusion: Due to misconceptions, students perceive community care as offering them few challenges. Strategies to positively influence students' perceptions of community nursing are urgently required to halt thedissonance between students' preference for the hospital and society's need for highly educated community nurses.
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