title: When are night shifts effective for nursing student clinical learning? Findings from a mixed-method study design.
abstract: BACKGROUND
  Some nursing programmes offer night shifts for students while others do not, mainly due to the lack of evidence regarding their effectiveness on clinical learning.
  
  
  OBJECTIVE
  The principal aims of the study were to describe nursing students' perceptions and to explore conditions influencing effectiveness on learning processes during night shifts.
  
  
  METHODS
  An explanatory mixed-method study design composed of a cross-sectional study (primary method, first phase) followed by a descriptive phenomenological study design (secondary method, second phase) in 2015.
  
  
  METHODS
  Two bachelor of nursing degree programmes located in Northern Italy, three years in length and requiring night shifts for students starting in the second semester of the 1st year, were involved.
  
  
  METHODS
  First phase: all nursing students ending their last clinical placement of the academic year attended were eligible; 352 out the 370 participated. Second phase: a purposeful sample of nine students among those included in the first phase and who attended the highest amount of night shifts were interviewed.
  
  
  METHODS
  First phase: a questionnaire composed of closed and open-ended questions was adopted; data was analyzed through descriptive statistical methods. Second phase: an open-ended face-to-face audio-recorded interview was adopted and data was analyzed through content analysis.
  
  
  RESULTS
  Findings from the quantitative phase, showed that students who attended night shifts reported satisfaction (44.7%) less frequently than those who attended only day shifts (55.9%). They also reported boredom (23.5%) significantly more often compared to day shift students (p=0001). Understanding of the nursing role and learning competence was significantly inferior among night shift students as compared to day shift students, while the perception of wasting time was significantly higher among night shift students compared to their counterparts. Night shift students performed nursing rounds (288; 98.2%), non-nursing tasks (247; 84.3%) and/or less often managed clinical problems (insomnia 37; 12.6% and disorientation/confusion 32; 10.9%). Findings from the qualitative phase showed night shifts are experienced by students as a "time potentially capable of generating clinical learning": learning is maximized when students play an active role, encounter patients' clinical problems and develop relationships with patients, caregivers and staff.
  
  
  CONCLUSIONS
  Night shifts remains ambiguous from the students' perspective and their introduction in nursing education should be approached with care, considering the learning aims expected by students in their clinical placements and the education of clinical mentors education who should be capable of effectively involving students in the process of night care by avoiding non-nursing tasks.
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Italy. Electronic address: alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Italy. Electronic address: basso.felix@spes.uniud.it.
authors.forename: Felix
authors.initials: F
authors.lastname: Basso
authors.affiliation: Department of Surgery, San Daniele del Friuli Hospital, Italy. Electronic address: elena.delnegro@aas3.sanita.fvg.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Del Negro
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Italy. Electronic address: illarj.achil@uniud.it.
authors.forename: Illarj
authors.initials: I
authors.lastname: Achil
authors.affiliation: U.O. Formazione e Aggiornamento, Azienda Ospedaliero-Universitaria (AOU), Ferrara, Italy. Electronic address: a.ferraresi@ospfe.it.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Ferraresi
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Italy. Electronic address: marzia.morandini@uniud.it.
authors.forename: Marzia
authors.initials: M
authors.lastname: Morandini
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Italy. Electronic address: renzo.moreale@uniud.it.
authors.forename: Renzo
authors.initials: R
authors.lastname: Moreale
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Italy. Electronic address: irene.mansutti@virgilio.it.
authors.forename: Irene
authors.initials: I
authors.lastname: Mansutti
mesh_terms: D003430:Cross-Sectional Studies; D004508:Education, Nursing, Baccalaureate; D005260:Female; D006801:Humans; D007558:Italy; D007858:Learning; D008297:Male; D008611:Mentors; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance / Q000523:psychology*; D055815:Young Adult
keywords: Clinical learning; Mixed-methods; Night shifts; Nursing education; Nursing students