Exploring the psychological experience of novice nurses in stomatological hospitals in China: a phenomenological study

doi:10.21203/rs.3.rs-3319143/v1

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Exploring the psychological experience of novice nurses in stomatological hospitals in China: a phenomenological study

https://doi.org/10.21203/rs.3.rs-3319143/v1

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published 01 Apr, 2024

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Background

At the onset of their professional journey, novice nurses often undergo a multifaceted psychological experience as they transition from theoretical knowledge to clinical practice, potentially impacting their development of professional identity. However, limited research has been conducted on the psychological aspects pertaining to newly graduated nurses in our country.

Methods

Objective sampling method was used to recruit 21 novice nurses, conduct semi-structured virtual interviews with them, and analyze the data using Colaizzi's seven-step analysis method.

Results

Seven themes emerged from the analysis: i) Interest and relaxation; ii) Nurse-patient conflict is reduced; iii) Decreased enthusiasm for work; iv) Insecurity and self-doubt; v) Decreased career accomplishment; vi) Make up for weaknesses; vii) Focus on knowledge transfer.

Conclusion

The novice nurses experience a range of complex negative and positive emotions during the initial stages of their employment. Further research and appropriate psychological counseling can enhance their professional engagement in oral outpatient nursing.

Novice nurse

Stomatological hospital

Psychology

Qualitative study

Phenomenological research

According to statistics, there has been a recent increase in the number of patients with oral diseases in China, resulting in a total of 703 million cases of dental caries[1], malocclusion, pulpitis, and other oral conditions[2]. Dental nurses play a crucial role as integral members of the medical service team in the field of oral health care. However, studies[3]have indicated that most dental clinic nurses receive training primarily focused on general nursing rather than specialized oral care. In clinical practice, these nursing students typically undergo rotations lasting over eight months at top three general hospitals.[4] Consequently, they have limited exposure to professional knowledge regarding oral care and lack systematic foundational knowledge and practical courses related to this area. At the same time, their initial interest upon entering an oral clinic tends to wane due to increasing work intensity and demands [5, 6]. Therefore, adopting a phenomenological perspective for this study involved conducting in-depth interviews with newly employed nurses who did not specialize in oral nursing but had recently joined stomatological hospitals. The aim was to extract their psychological experiences during the transitional stage [7], identify strategies for stress relief and coping mechanisms while providing valuable insights for enhancing professional development and management practices among nurses within stomatological hospitals.

Object of study

An objective sampling method was employed to select a total of 21 newly graduated nurses, with less than one year of work experience, from two stomatological hospitals in Jiangsu Province between March 2023 and June 2023 as the research participants. The inclusion criteria were as follows: i) Graduation with a nursing major and possession of a valid nurse practicing certificate; ii) Engagement in dental specialist outpatient nursing duties; iii) Less than one year of working experience; iv) Provision of informed consent and voluntary participation in this study. Exclusion criteria included: i) Taking sick leave or being on sick leave for more than three months; ii) Transferring to non-oral outpatient nursing positions. The sample size was determined based on information saturation, ensuring no new topics emerged.

Determine the interview outline

Based on a thorough literature review and extensive discussions within the research group, the researcher initially developed an interview outline aligned with the study's objectives. The outline was then refined through consultations with two dental specialists, two dental outpatient nursing managers, and one dental nurse. Five novice nurses were selected for pre-interviews to further modify the language used in the interviews, resulting in a final formal interview outline that covers topics such as: i) Why do you choose to engage in oral outpatient care? ii)What are the difficulties encountered when entering the dental specialist outpatient nursing work? iii)What do you think are the differences between clinical nursing and oral outpatient nursing? iv)What kind of help do you expect from nursing managers in the future?

Data collection

The non-structured interview method was employed for data collection. Nurses who met the inclusion and exclusion criteria and expressed willingness to participate were provided with information regarding the study's purpose and significance, after which they signed informed consent forms. One-to-one in-depth interviews were conducted, lasting between 30 to 45 minutes each. The interview location was chosen based on the preferences of the participants, either in the hospital lounge, department study room, or their own homes. An open atmosphere was maintained during the interviews without any structured questions, allowing participants to freely express their genuine sentiments while feeling trusted and at ease. Throughout the interviews, the researcher remained impartial without guiding or hinting responses; interruptions were avoided unless necessary clarifications or counter-questions were required until no new information emerged. All interviews were recorded meticulously as researchers attentively listened and documented participants' expressions, movements, and emotional reactions. To ensure confidentiality of participants' identities, their names have been replaced by numerical identifiers (N1 ~ N21). General information about each participant is presented in Table 1.

Data analysis

Within 24 hours after the end of each interview, the researcher transcribed the recording into written data, and marked the respondents' movements, expressions and emotional changes at the corresponding positions. Colaizzi 7-step analysis method was used for data analysis: i)Read all data carefully; ii)Extract significant statements; iii) Encode recurring ideas; iv) Assemble the encoded ideas; v)Write a detailed, unomitted description; vi)Identify similar views, sublimate the theme concept; vii)The results were returned to the respondents for verification. Two researchers will independently analyze and code the original data, and the research group will discuss and reach a consensus if there is any disagreement.

Ethical considerations

The Ethics Committee of the Stomatology Hospital Affiliated to the School of Medicine of Nanjing University provided an ethical review. All participants signed an informed consent document before the interview. Additionally, participants were informed that their participation in the study was voluntary and the information gathered from the interviews would be recorded and used only for scientific purposes. Participants’ names were replaced by codes to ensure information confidentiality.

A total of 21 nurses participated in the interview and their demographic information is shown in Table 1. There were 18 female nurses and 3 male nurses, ranging in age from 20 to 23 years.

Table 1

Socio-demographic characteristics of participants (N = 21).
Code	Age	Gender	Reasons for working in stomatological hospitals
N1	23	Female	②
N2	21	Female	①、②、⑤
N3	22	Female	②、③、⑤
N4	20	Female	①、③、④
N5	22	Female	②、⑤、⑥
N6	23	Female	①、②
N7	21	Female	①、②、⑤、⑥
N8	21	Female	①、②、③、⑥
N9	22	Female	③
N10	22	Male	②、⑥
N11	23	Female	②
N12	23	Female	②、③、⑤、⑥
N13	20	Female	①、④
N14	23	Male	③、④
N15	22	Female	④
N16	22	Female	③
N17	23	Female	③、④、⑤
N18	22	Female	①、④
N19	22	Female	①、②、⑤、⑥
N20	21	Male	③、④
N21	22	Female	①、②
Reasons for working in stomatological hospitals:①=Clean working environment; ②=Simple interpersonal relationship; ③=Personal interest; ④=Good prospects for development; ⑤=High income; ⑥=Low working pressure

Seven themes emerged from the data analysis and the detailed results are summarised in Table 2.

Table 2

Summary of themes and sub-themes.
Themes	Sub-themes
Interest and relaxation	Willing to accept nursing work without night shift Interesting in every nursing operation
Nurse-patient conflict is reduced	Never conflict with the patient Smile is essential
Decreased enthusiasm for work	Be careful not to pick it up wrong
Insecurity and self-doubt	Became less and less confident
Decreased career accomplishment	not involved in any real work Be out of place,
Make up for weaknesses	record consult
Focus on knowledge transfer	Competent transform and accurately

Interest and relaxation

All interviewees reported that oral outpatient nursing was less physically demanding than clinical nursing for the same amount of time. At the same time, because the night shift in the oral clinic decreased or even some of them did not have night shift, they all indicated that the daily self-management time increased, and they were more willing to accept nursing work without night shift. The participants provided the following accounts of their experiences:

“Before that, I worked as an intern in the intensive care unit of a Grade III general hospital, where I had to turn over for patients every two hours. I was very nervous and tired every day, because I did not want to continue working night shifts, so I entered the dental clinic after graduation”. (N5)

“I am very interested in every nursing operation, hope to master as soon as possible, and want to learn new knowledge every day.”(N6)

Nurse-patient conflicts are reduced

The working environment of the oral clinic is relatively clean and quiet, and doctors are responsible for the main treatment and communication work. Nurses need to cooperate with doctors in the process of diagnosis and treatment to prepare materials before diagnosis and treatment, four-hand operation, delivery of goods, mixing materials, disposal of materials, and health education for patients, etc., which avoids long-term direct contact between nurses and patients and reduces nurse-patient conflicts. Participants shared their experiences in this regard:

“There is no need to directly face the patient, there is no need to explain to the patient before doing the operation, only cooperate with the doctor to pass the instrument, do their own work, and never conflict with the patient”.(N18)

I am very friendly to every patient, working in the dental clinic smile is essential.(N4)

Decreased enthusiasm for work

After the short enthusiasm for the new environment, with the increase of work intensity and the requirements of job duties, nursing students who have just entered the company will often feel uneasy and even fall into self-doubt due to their lack of oral care expertise and weak practical operation. Participants shared their experiences as follows:

“I have never been involved in the specialty of oral medicine before. I majored in nursing (clinical nursing) before, and there are many instruments in the orthodontic department that I am not familiar with. I work at a slow pace, and every time I pick up the equipment, I'm very careful not to pick it up wrong.”(N3)

“Sometimes I will be nervous, afraid of taking the wrong equipment, a few times to take the wrong equipment saw the doctor very helpless to me shaking his head, the enthusiasm for work came down.”(N14)

Insecurity and self-doubt

With the passage of time, their own high demands on the essential work and often frustrated in the outpatient nursing work, the new nurses have become less and less confident. Participants shared their experiences as follows:

“When mixing materials, I did not have a good grasp of the nature of the materials, and each doctor had different preferences. Sometimes I would confuse their preferences, which made them dissatisfied, and I became less and less confident.”(N7)

Decreased career accomplishment

Strong sense of belonging, reduced professional achievement, desire for understanding and support. Participants shared their experiences as follows:

“Nurses and doctors cooperate in the clinical division of labor, and nurses can do a lot of operations. For example, intravenous infusion, enema, sputum aspiration and other operations, but to the oral clinic I feel that I can do too little, just at the beginning is to take instruments for the doctor, in clinical care can better reflect my advantages.”(N8)

“Sometimes I feel like I'm just a runner and not involved in any real work.”(N17)

“I felt that it was too different from the clinical, I felt that I was out of place, and the operational skills I knew before were less useful here.”(N15)

Make up for weaknesses

At this stage, nursing students realize their negative emotions in the work, begin to adjust their mentality, accept their shortcomings in ability and strive to enrich themselves, and gradually adapt to the nursing work in the oral clinic. Participants shared their experiences as follows:

“Like the previous internship, I will prepare a small book, and record in time what I don't understand in my usual work. After work, I will consult the information or consult my colleagues and head nurses.”(N19)

Focus on knowledge transfer

Nursing students with improved abilities in all aspects can independently carry out nursing operations, and when they encounter problems, they are no longer afraid and uneasy, and begin to think about how to use existing resources to change the status quo. They are eager for long-term development, and strive to become a dental specialist nurse in order to better show their value in work. Participants shared their experiences as follows:

“At work, I have a cooperative relationship with doctors, but we have different division of labor. Whether it is clinical work or oral clinic work, it is a process of continuous learning and accumulation of knowledge. I believe that I can become a qualified and competent nurse in any field.” (N21)

“After all, I was in clinical practice, and the doctor praised me for my strong aseptic concept when I operated in four hands. I found that clinical and oral outpatient work have many similarities, but we need to transform and accurately apply it to the usual outpatient work.”(N11)

“During my postgraduate study, I have done a lot of research in clinical nursing, and after entering the work of oral outpatient nursing, I have a lot of new inspirations. I hope that the leaders of the hospital can pay attention to the investment in nursing scientific research, and I also hope to make a good breakthrough in oral nursing.”(N20)

The objective of this study is to investigate the psychological aspects experienced by novice nurses during their initial period of employment. From the perspective of these individuals, they are likely to exhibit curiosity and unfamiliarity at the onset, which may subsequently evolve into feelings of anxiety and uncertainty as they progress in their work.

Improving the working environment

Studies have shown that [8] poor working environment, uncooperative service objects and overloaded workload tend to cause nurses to be in a state of long-term high pressure. Long-term high pressure can lead to anxiety, empathy fatigue, headache and other sub-health [9], which also enhances nurses' turnover intention. In addition, greater work pressure will not only affect the physical and mental health of nurses [10], but also pose a threat to the life safety of patients. This study shows that the working environment in the dental clinic is more conducive to nurses' physical and mental relaxation than the clinical working environment. The most direct and obvious impact is to protect nurses' sleep and reduce nurse-patient conflicts. Among them, all interviewees mentioned that within the same working hours, oral outpatient nursing work consumes less physical energy, and self-perception of oral outpatient working environment is better. This is consistent with the survey results of Wang Qian [5] et al. Therefore, working environment, work load and good nurse-patient relationship are more conducive to nurses' involvement in work, and are also one of the factors for nurses to choose jobs. Hospitals should pay attention to the working environment and workload of nurses, conduct on-the-job skills and theoretical knowledge training for nurses, and take corresponding measures to improve the working environment and timely adjust the allocation of human resources, so as to alleviate the physical and mental fatigue of nurses and reduce the turnover rate of nurses.

Regulating your emotions

According to the emotional regulation process model of Campos et al. [11] (1994), the purpose of individual emotional regulation is to choose socially acceptable responses to coordinate inconsistent conflicts in daily interactions. If not solved in time, the negative psychology in interpersonal communication is likely to cause individuals to have distress and avoidance behaviors in social activities [12, 13]. In this study, with the increase of work intensity over time, nurses in the transition period felt more conflict between ideal and reality. On the one hand, due to the lack of theoretical knowledge and practical skills in stomatology, I am often frustrated in nursing work, which leads to the reduction of professional achievement; On the other hand, there are studies [14] showing that nurses will take doctors as the reference objects for social comparison in terms of career promotion, social status and treatment. The more unfairness they feel, the more negative emotions they will have. Therefore, it is suggested that nurses in the withdrawal period should learn cognitive reappraisal [15], that is, change their understanding of emotional events, change the meaning given by emotions to adjust emotions, and should not be troubled by emotions. They should re-examine their roles and correctly understand their responsibilities and importance in work. It is understood that although the working environment and nursing operation of the dental clinic are different from the clinical clinic, the essence of nursing work is patient-centered, rather than focusing on a certain specialty. Different professional and technical personnel need to collaborate with each other to provide better service to patients.

Positive learning attitude

In traditional Chinese ethics, people attach great importance to the cultivation of learning attitude. Some studies [16, 17] show that positive learning attitude helps cross-professional nursing students master professional knowledge, integrate into team work more quickly and improve critical thinking of nursing students. In this study, some of the nurses in the dental clinic during the transition period had clinical work experience, or even had rich work experience and status. However, due to the change of the working environment, the weak theoretical knowledge and practical operation ability of stomatology will make them feel uncomfortable. However, after self-emotional management and psychological construction, they have given up the praise of the past honor, maintain a positive learning attitude in daily work, be sensitive and studious, and strive to enrich themselves to fill the vacancy in oral expertise. Therefore, it is suggested that nurses should maintain a positive learning attitude at any stage of their work to enrich their professional knowledge. At the same time, nursing managers should also pay attention to the cultivation of nurses' learning attitude.

Improving the ability of knowledge transfer

The ability to acquire and transform knowledge [18] is more important than knowledge itself, and to achieve the integration of knowledge and action requires improving one's own knowledge transformation ability. SECI[19], a knowledge transformation model proposed by Ikujiro Nonaka, holds that tacit knowledge and explicit knowledge can transform each other. In this study, clinical nurses based on clinical nursing knowledge applied strong aseptic concept to oral outpatient nursing work, and also learned oral medicine knowledge in the work. As a branch of nursing, oral nursing adds the basic course of oral medicine on the basis of nursing, which is the cross specialty of nursing and oral medicine. Therefore, it is suggested that nurses should quickly transform the relevant theoretical knowledge and practical experience in nursing, oral care and oral medicine into their work field, and treat their work and patients with a proactive attitude [20]. Learn to use their own knowledge, experience, communication and other advantages combined with the existing environment, strengthen the ability of knowledge transformation, so that no matter how the working environment changes, as a nurse can quickly qualified for new posts. Just as scholar Han Bin [21] said, "Only by targeting the needs of patients and providing professional guidance can the nursing specialty outpatient clinics have vitality."

Study limitations

The study was limited by its use of a single data source, as participants were recruited from only two dental specialty hospitals and were not generalized nationwide. So it may not be generalizable to other nurses.

Implications for practice

The study provides evidence for improving the adaptability of new graduates to work more quickly.Nursing managers should strengthen the training of the newly graduated nurses on the theoretical knowledge of the specialty, and at the same time, they should also provide psychological counseling to such nurses to help them face the work more actively and grow into an excellent nurse quickly.

Through in-depth interviews with 21 cross-specialty dental nurses, this study found that after the cross-specialty dental nurses worked in a dental hospital, the outpatient work mode reduced the damage to their body caused by high-intensity night shift, and the change of working environment reduced the nurse-patient conflict, both of which alleviated the physical and mental pressure of such nurses. However, in terms of work content, they are prone to frustration due to their proficiency in oral nursing when they first enter the job due to their weak knowledge base in oral nursing. Secondly, the nurses in the dental clinic are mainly engaged in nursing cooperation beside the chair, and the relationship between nurses and doctors has changed from cooperation to subordination, and the sense of professional achievement has decreased. With the self-emotional adjustment and the change of mentality, nurses gradually adapt to and be competent for the work of oral outpatient nursing. Therefore, it is suggested that such nurses should continue to learn oral specialized knowledge and skills after entering clinical work. At the same time, as managers, they should strengthen psychological counseling for such nurses, provide support in nursing work and nursing scientific research, so that they can better participate in nursing work, improve the status and importance of nurses in dental clinics, and finally achieve high-quality development of oral nursing.

Funding

No founding was obtained for this study.

Authors’ contributions

Jian Liu: Conceptualization, methodology, data curation, formal analysis, project administration, writing-original draft, writing-review & editing. Tiantian Lu: Data curation, formal analysis.Yan Li : Methodology &editing. Hongyuan Dai: Methodology, writing-review & editing. Li Li: Conceptualization, methodology, supervision, project administration, writing-review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

We would like to thank the 21 participants who shared their feelings about entering a new field of work.

Ethics approval and consent to participate

Before filling in the questionnaire, all participants obtained informed consent

to the content and significance of this study, and then filled in anonymously.

All procedures were carried out in accordance with the 1964 Helsinki declaration, and the research proposal was approved by the Ethics Committee of the Stomatology Hospital Affiliated to the School of Medicine of Nanjing University.(KY-2023NL-081)

Consent for publication

Not applicable.

Data Availability

The datasets generated and/or analysed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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No competing interests reported.

Download PDF

Journal Publication

published 01 Apr, 2024

Read the published version in BMC Nursing →

Editorial decision: Major revision
07 Sep, 2023
Editor assigned by journal
07 Sep, 2023
Submission checks completed at journal
06 Sep, 2023
First submitted to journal
02 Sep, 2023

You are reading this latest preprint version

Exploring the psychological experience of novice nurses in stomatological hospitals in China: a phenomenological study

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Abstract

Background

Methods

Data analysis

Results

Discussion

Conclusion

Declarations

References

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