This systematic review is based on the students’ need to experience holism and empowerment in the classroom for positive learning experience, but to integrate the learned holism and empowerment in their professional practice. The aim of this review is to review the evidence based articles on innovations designed to determine the process of how the nursing students’ learning experiences in clinical practice. The process used in this study were systematic review and evidence synthesis analysis which includes RCTs, literature review, PDSA, grounded study, quasi-experimental designs, descriptive and exploratory study, systematic review using PRISMA, qualitative and quantitative components, Review Instrument (JBI-QARI), systematic review using Joanna Briggs Institute systematic approach and framework analysis. The sources of data were gotten from PUBMED databases. The process followed the PRISMA checklists that contributed to the evidence synthesis, results and discussions. 20 studies were included in my analysis. The reviews found that the process of students’ learning was based on the series of steps of preparations, adjustments and learning. First, it focused on the preparation of nursing students, secondly, it focused on adjustments of nursing, and thirdly, it focused on the learning of the students from adjustments.

In the reviews of the articles, the basis of students learning were preparations as where knowledge is where learning begins, the adjustments of the preparations to learn should make teaching-learning process interactive and learning should have interconnectedness between teachers and students and nurture one another of environmental factors that influence the readiness to learn.

Holism, Empowerment, Learning.

This systematic review is based on the students’ need to experience holism and empowerment in the classroom for positive learning experience, but to integrate the learned holism and empowerment in their professional practice. The aim of this review is to review the evidence based articles on innovations designed to determine the process of how the nursing students’ learning experiences in clinical practice. The process used in this study were systematic review and evidence synthesis analysis which includes RCTs, literature review, PDSA, grounded study, quasi-experimental designs, descriptive and exploratory study, systematic review using PRISMA, qualitative and quantitative components, Review Instrument (JBI-QARI), systematic review using Joanna Briggs Institute systematic approach and framework analysis. The sources of data were gotten from PUBMED databases. The process followed the PRISMA checklists that contributed to the evidence synthesis, results and discussions. 20 studies were included in my analysis. The reviews found that the process of students’ learning was based on the series of steps of preparations, adjustments and learning. First, it focused on the preparation of nursing students, secondly, it focused on adjustments of nursing, and thirdly, it focused on the learning of the students from adjustments.

In the reviews of the articles, the basis of students learning were preparations as where knowledge is where learning begins, the adjustments of the preparations to learn should make teaching-learning process interactive and learning should have interconnectedness between teachers and students and nurture one another of environmental factors that influence the readiness to learn.

Holism, Empowerment, Learning.

The Empowered Holistic Nursing Education (EHNE) nursing theory is a middle range nursing theory that was developed between 2008 and 2014. It is particularly used in undergraduate level of nursing education, where students are first being exposed into nursing professional practice. Moreover, the central philosophy of this nursing theory is based on, that students need to experience holism and empowerment in the classroom for positive learning experience, but to integrate the learned holism and empowerment in their professional practice. The aim of this review is to review the evidence based articles on innovations designed to determine the process of how the nursing students’ learning experiences in clinical practice. It also determines what comes first or the sequence of the learning process among nursing students.

Further, systematic reviews of the articles related to holism and empowerment enhances our role as clinical instructor whether in classroom or in practice. The results of the reviews enable both clinical instructors and students in terms of sharing and spreading of evidence-based interventions and learning. The researcher believe that the learning from the lectures and return demonstrations has its own steps and process before it is being used to be demonstrated in actual practice as it is experienced in the realities of the hospital work. The process of students learning follows the steps of preparations, adjustments from the preparations and learning from the adjustments. These results were supported by ten articles and many authors as a forefront to link student’s learning between education and practice.

The process used in this study were systematic reviews and evidence synthesis analysis which includes RCTs, literature review, PDSA, grounded study, quasi-experimental designs, descriptive and exploratory study, systematic review using PRISMA, qualitative and quantitative components, Review Instrument (JBI-QARI)systematic review using Joanna Briggs Institute systematic approach and framework analysis. The sources of data were gotten from PUBMED databases. The process followed the PRISMA checklists that contributed to the evidence synthesis, results and discussion.

Based on the reviews, the articles included nursing students as a population group as well as their clinical tutors. Countries that were included in the reviews were Scotland, Australia, Turkey and USA. Population groups were adolescent nursing students. The researcher included studies that were software based such as NVivo 10, the used of AEMR, t-test, analysis of variance and univariate linear model. Aside from nursing students, factors such as school level (p<0.001), where age, religion and parents’ educational background were assigned as covariates. Methodologies were evaluated to fit the criteria. However, the researcher excluded studies that were not relevant to the topic such as nursing students with other professionals, medical and surgical treatments, health professionals and repeating thematic inquiry.

The reviews that the researcher used were based primarily on PUBMED databases. Keywords were used to capture and refined the search. Online supplements that PUBMED released were appropriate to find a solution to the problem identified. PUBMED data sources lined the different collections on qualitative and quantitative researches, systematic reviews, literature review, mixed method study and quasi-experimental study. The search yielded 70 articles but screened into more specific areas of nursing student’s preparations of learning, adjustments during preparations and learning from the adjustments. Personal analysis was used to include and what not to include in the search. The search surfaced on the preparation, adjustments and learning’s of nursing students in clinical settings.

The basis of selecting appropriate sources was predetermined based on inclusion and exclusion criteria. Each article was independently screened its titles and abstracts. Full-text manuscripts were obtained for all articles entering the reviews. Any uncertainties about article entering the review were resolved using the PRISMA criteria. The PUBMED database searches yielded 70 hits, of which were screened based on inclusion and exclusion criteria which trimmed down to 20 articles.

The 20 identified articles met the inclusion criteria were retrieved and critically appraised by the researcher using PRISMA checklist.

20 articles were reviewed. The researcher had included studies that were software based such as NVivo 10, the used of AEMR, t-test, analysis of variance and univariate linear model, qualitative and quantitative researches, systematic reviews, literature review, mixed method study and quasiexperimental study. Of the 20 articles, only 2 randomized trial surfaced which can provide the most definitive evidence of effectiveness. 18 non-randomized designs were also considered since most of the answers to the problem identified surfaced on this area, these were qualitative and quantitative researches, systematic reviews, literature review, mixed method study and quasi-experimental study. The effective components of the articles were identified such as the thematic analysis. As part of this review, the researcher classified how interventions were similarly relevant with EHNE of Katie Love nursing theory.

In total, 20 articles met the inclusion criteria and were included in the systematic review. These included 2 randomized trial, 8 qualitative and quantitative researches, 3 systematic reviews, 2 literature reviews, 1 mixed method study and 2 quasi-experimental studies, 1 case study and 1PDSA. The summary findings are given below.

RCT: The 2 articles focused on the RCTs which examined interventions to solve the identified problem. The variables were experiment that introduced a mobile AEMR application to the students and evaluation of the training programs in schools. The RCT results of this experiment were enhanced nursing informatics competencies, improved critical thinking disposition, improved nursing intervention and documentation and satisfaction with clinical practicum and the efficacy for enhancing school curriculum are achieved.

Non-randomized designs: 18 non-randomized designs studies were included in researchers’ analysis. The reviews found that the process of students’ learning was based on the series of steps of preparations before learning, adjustments during preparations and learning during adjustments. 6 articles focused on the preparation of nursing students. The first article results say that preparations before learning will improve students’ attitudes towards preparation and facilitating mutual respect between teachers and students [1]. The second article, results showed that these preparations may provide problem solving skills and higher levels of attendance and punctuality to class discussion and better nursing intervention and documentation [2]. The third article, results showed that prepared students for practice enhance their self-confidence [3]. The fourth article, results showed that it would heightened students’ sense of responsibility [4]. The fifth article, results showed that nursing students may enhance their depth and breadth of cultural competence [5]. The sixth article, results showed that prepared students may induct their learning into professional practice [6].

Further, four articles focused on adjustments of nursing students. The first article resulted into students’ struggle from medical, psychosocial and behavioral challenges as part of the transition of learning [7]. The second article results into anxiety; anxiety was identified in relation to environmental adjustments and student behavior modifications during learning [8]. The third article, results showed that school readiness affects emotions and social competence of the students [9]. The fourth article results showed that students may have an inability to transfer classroom learning as learning problem [10].

Furthermore, 8 articles mentioned that there is learning after preparations and adjustments of learning. The first article results showed that there was effective in improving competence and confidence in a three month frame of learning and adjustments [11]. The second article results showed that there are improved clinical learning, educational atmosphere, students’ personal charactering and student’s perceptions in clinical learning [12]. The third article results showed that there was effectiveness in clinical education in terms of shaping and polishing students to ensure academic needs were met [13]. The fourth article results showed that there was a reality of situations and interactions, perceived learning achieve [14]. The fifth article result into shaping and polishing their learning that ensured academic needs were met [15]. The sixth article showed that learning can engage classroom experience and boosted their self-confidence [16]. The seventh article showed that perceived confidence levels are increased [17] and the eight article showed that students may integrate approaches to life experiences and may transfer knowledge through clinical reasoning [18].

Thematic analysis of interventions: 4 out of 20 articles used thematic analysis of interventions to solve the problem identified. One article mentioned have used framework analysis and came up with thematic results, it says, when nursing students once learned from their academic tasks will results into perceived professional roles, priorities, respect, communication, teamwork and improved quality of care. Other article mentioned that transcribed nursing students verbatim and thematically analyzed, themes surfaced on “diamonds are rough” which means shaping and polishing to ensure academic needs were met [19].

In total, 20 articles met the inclusion criteria and were included in the systematic review. These included 2 randomized trial, 8 qualitative and quantitative researches, 3 systematic reviews, 2 literature reviews, 1 mixed method study and 2 quasi-experimental studies, 1 case study and 1PDSA. The summary findings are given below.

RCT: The RCTs examined interventions that fell into the variable below.

Outcomes: The RCT results of this experiment were enhanced nursing informatics competencies, improved critical thinking disposition, improved nursing intervention and documentation and satisfaction with clinical practicum and the efficacy for enhancing school curriculum are achieved.

Non-randomized designs: There were 18 nonrandomized designs used in this review. These included 2 randomized trial, 1 grounded theory, 7 qualitative and quantitative researches, 3 systematic reviews, 2 literature reviews, 1 mixed method study and 2 quasi-experimental study, 1 case study and 1 PDSA. The summary findings are given below.

18 studies were included in my analysis. The review found that the process of students’ learning was based on the series of steps of preparations, adjustments and learning. 8 articles focused on the preparation of nursing students. The first article used a grounded theory protocol with qualitative analysis support of NVivo 10 software states that if students were prepared to participate in interprofessional education and collaboration, results says that preparations will improve students’ attitudes towards preparation and facilitating mutual respect between teachers and students. The 7 articles used both qualitative and quantitative methods, results mentioned that if nursing students were participating in classroom using feminist model pedagogy, results showed that these preparations may provide problem solving skills and higher levels of attendance and punctuality to class discussion and better nursing intervention and documentation, prepared nursing students help them build their self-confidence, heightened sense of responsibility and communication challenges, and nursing students will enhance their depth and breadth of cultural competence and preparing students for inducting into professional practice. Articles used t-test, analysis of variance and a univariate general linear to analyzed data.

4 articles focused on the adjustments of students learning in process. The article is a product of systematic review using PRISMA guidelines states that adjustments of learning may results into anxiety; anxiety was identified in relation to environmental adjustments and student behavior modifications during learning, that school readiness affects emotions and social competence of the students and students may have an inability to transfer classroom learning as learning problem. It also showed that schoolrelated adjustments in adolescents may result into students’ struggle from medical, psychosocial and behavioral challenges as part of the transition of learning.

Furthermore, 8 articles mentioned that there is learning after preparations and adjustments of learning. These articles used systematic reviews and literature review, quasi-experimental study, case study and PDSA. The results in the articles focused on the competence, confidence and knowledge retention of nursing students, results showed that there was effective in improving competence and confidence in a three month frame of learning and adjustments. It also states clinical learning environment affects student’s clinical learning process; results showed that there are improved clinical learning, educational atmosphere, students’ personal charactering and student’s perceptions in clinical learning. The article focused on the systematic review utilized Joannna Briggs Institute systematic review approach. It states that effectiveness of clinical education of nursing students will result into the effectiveness in clinical education in terms of shaping and polishing students to ensure academic needs were met. Results also showed that there was a reality of situations and interactions, perceived learning achieved. These article used PDSA which states that nursing student’s experiences in academic once supported will result into shaping and polishing their learning that ensured academic needs were met, school readiness affects emotions and social competence of the students learning can engage classroom experience and boosted their self-confidence, perceived confidence levels are increased, students may integrate approaches to life experiences and may transfer knowledge through clinical reasoning.

This write-up was derived from Katie Love nursing theory which is based on the philosophy that students need to experience holism and empowerment in the classroom not only have a positive learning experience, but to integrate holism and empowerment in their own professional practice. In the reviews of the articles, the basis of students learning were preparations as where knowledge is where learning begins, the adjustments of the preparations to learn should make teaching-learning process interactive and learning should have interconnectedness between teachers and students and nurture one another of environmental factors that influence the readiness to learn.

The researcher believed that the strength of these articles reviewed was that it seeks to promote the development and holistic approach to nursing education, this is to support the foundation of nurse education practice, that can be both learning in the classroom and its related learning experiences as well as promoting and adhering evidence based education papers from health care professions which have the same foundation of her philosophy.

The researcher believed that the weakness of these articles was that students can learn differently from one another to another. The articles may reflect personal bias, points of view, experiences from the authors itself. These articles also fail to mention specific nursing student’s involvement of diverse backgrounds of race, religion, and the socio economic status. It must be the diversification of nursing students on how they view a diverse holistic approach of nursing education from classroom lectures to related learning experiences.

But generally, the articles can be used as an innovative development because it demonstrates how nursing students and clinical instructors teach and facilitate student learning, together with scholarly reflection and action that seeks to transform their nursing students in preparing them to the professional practice.