Values, situational judgement, and the clinical practice environment: A study of adult nursing students.

Background: In England, a Values Based Recruitment (VBR) policy intends to ensure that healthcare students’ individual values align with the values of the National Health Service (NHS) Constitution. However, students’ values may become compromised with increased clinical experience, due to, for instance, distress, negative role models and hidden curricula. Aim: To explore potential differences in values between first, second, and third year students of adult nursing, in order to theorise whether and how such students’ values may change over the duration of their programme, upon exposure to clinical practice environments. Objectives: 1. To develop an instrument (Situational Judgement Test, SJT) that assesses students’ congruence with the NHS Constitution values, and whether these are prioritised. 2. To establish whether the values (assessed using the SJT) of students with differing levels of experience (years one, two, and three – particularly clinical practice experience) vary. 3. To generate insights into the considerations and reflections that students have regarding SJT items, and determine whether these vary between the different year groups. 4. To verify and gain a deeper understanding of these findings in the context of students’ (practice) learning, as well as input for recommendations, through adult nursing Practice Liaison Tutors within the university. Methods: This research was granted a Favourable Ethical Opinion by the University of Surrey Ethics Committee. An SJT was developed (objective 1), and reliability and validity were determined with a pilot sample of 47 volunteers. Subsequently, first (n=13), second (n=15) and third (n=9) year students (total N=37) completed the SJT and participated in discussion sessions (objectives 2 and 3). Analysis took place using inferential statistics and thematic methods. Afterwards, six tutors were presented with the findings and interviewed (objective 4). Findings: SJT scores were highest in year one and lowest in year three (significant difference between first and third year group, F=7.28, p=.002). First year students expressed idealism. Second and third year students, however, experienced organisational hierarchy and difficulty speaking up against poor practice on their placements, at times de-prioritising the NHS Constitution values in response. Tutors could relate to these findings and suggested strategies to support students. Discussion: Despite the VBR policy, students’ congruence with the NHS Constitution values may become compromised with increased clinical experience. Recommendations are made for education and placement organisations to prepare students for clinical practice, address hierarchy, and provide a safe and ethical learning environment.