title: Nursing students' changing orientation and attitudes towards nursing during education: A two year longitudinal study.
abstract: BACKGROUND
  Previous studies have shown that nursing students' perceptions of nursing change over time. Little research has been undertaken in the Netherlands of students entering nursing programmes and of how they progress.
  
  
  OBJECTIVE
  The aims of this study were to explore whether nursing students' orientation and attitudes towards nursing changed over time, when these changes occurred, and what factors influenced the changes. We also aimed to identify the factors which prompted them to consider leaving their programmes, and what factors affected their motivation to stay.
  
  
  METHODS
  The study used a longitudinal quantitative design.
  
  
  METHODS
  Questionnaires were administered to all students enrolled in a Bachelor's of Nursing programme at four nursing universities of applied sciences in the Netherlands (n=1414). The data for this study were collected during the first two years of the programme, from September 2011 to June 2013. A total of 123 respondents completed the survey each year and this group was used to examine changes over time.
  
  
  METHODS
  At four time intervals respondents completed a survey consisting of 1) the Nursing Orientation Tool, 2) the Nursing Attitude Questionnaire and 3) background characteristics. Non-parametric tests were used to explore changes in factor scores over time.
  
  
  RESULTS
  The results showed an improvement in the students' orientation and attitudes towards knowledge, skills and the professional roles of nurses, while empathic behaviour decreased over time. Although the changes showed non-linear patterns over time, the results showed clear effects between the different time points. The reasons for attrition (24%) proved to be related both to problems with the educational programme and to personal problems. An important motivator for students to stay in the course was their passionate desire to become nurses, suggesting that the positive aspects of a nursing career dominated the problems they encountered.
  
  
  CONCLUSIONS
  Tutors and mentors should pay more attention to the individual perceptions and problems of first and second-year students, both in the classroom and during clinical placements. Knowledge of the students' perceptions from the very beginning could be vital to study success.
authors.affiliation: University of Groningen, University Medical Center Groningen, School of Nursing & Health, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: y.ten.hoeve@umcg.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Ten Hoeve
authors.affiliation: Lentis Research, Lentis Psychiatric Institute, P.O. Box 86, 9700 AB Groningen, The Netherlands. Electronic address: s.castelein@lentis.nl.
authors.forename: Stynke
authors.initials: S
authors.lastname: Castelein
authors.affiliation: Utrecht University, Department of Social and Organizational Psychology, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands. Electronic address: w.s.jansen@uu.nl.
authors.forename: Wiebren S
authors.initials: WS
authors.lastname: Jansen
authors.affiliation: Hanze University of Applied Sciences, School of Nursing, Master of Advanced Nursing Practice, Eyssoniusplein 18, 9714 CE Groningen, The Netherlands. Electronic address: gr.j.jansen@pl.hanze.nl.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Jansen
authors.affiliation: University of Groningen, University Medical Center Groningen, School of Nursing & Health, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; Hanze University of Applied Sciences, School of Nursing, Master of Advanced Nursing Practice, Eyssoniusplein 18, 9714 CE Groningen, The Netherlands. Electronic address: p.f.roodbol@umcg.nl.
authors.forename: Petrie F
authors.initials: PF
authors.lastname: Roodbol
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002321:Career Choice; D004508:Education, Nursing, Baccalaureate; D006801:Humans; D008137:Longitudinal Studies; D009042:Motivation; D009426:Netherlands; D013332:Student Dropouts; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Attitude; Attrition; Changes; Nursing students; Orientation