Professional socialization, a process to acquire specialized knowledge, skills, attitudes, values, norms, and interests within nursing [1], has received attention in recent years. Such socialization is vital for the realization of nurses’ professional roles and for the process of professional self-growth, and the student assumes a more professional role as knowledge and socialization are acquired in nursing school.
It is important to understand the development of a professional identity and its impact factors. Research indicates that professional identity is developed through interaction with peers and internalization of knowledge, skills, norms, values, and culture when students are in a nursing program [2]. Effective professional socialization provides sustainable development of student learning and professionalism, and it is important to pay attention to the integration of professional socialization into nursing education early in the learning process [3].
Research shows that the impact that nursing education has on professional socialization depends on the students’ engaging in a reflective learning process and on the beliefs and values promoted in the course [4]. A systematic literature review indicates that many studies on the antecedents of nursing professional socialization focus on setting, profession, and role model [5]. There is, however, a lack of research on students’ individual learner factors that influence professional socialization in nursing education. Therefore, this study aims to explore the factors that influence students’ professional socialization as a means for the design of nursing programs to be strengthened. The objectives of this study are as follows: (1) To verify the reliability and validity of the professional socialization model as a means to study the key aspects of self-learning effectiveness, caring behavior, self-reflection, and nursing competence. (2) To determine whether there are differences in the effects of the professional socialization model in terms of gender. In order to achieve the above research purposes, we perform the following literature review.
The Relationships Between Simulation Self-Learning Effectiveness, Self-Reflection and Insight, and Caring Behavior
Early in their training, nursing students complete basic nursing courses at school and then serve in a clinical hospital internship. The clinical environment is best suited to learning skills and for professional socialization [6-7]. In recent years, however, in consideration of patient safety, schools have added simulation clinical skills centers, and novice nursing students continue to learn and practice in the school clinical skills center. Although the technical aspects of the profession are important, caring and self-reflection also need to be cultivated, and the student’s learning effectiveness in the overall clinical context is important.
Bandura defined perceived self-efficacy as individuals’ judgment of their capabilities [8]. It is concerned not with skills, per se, but with judgments of whatever skills one possesses. Self-efficacy plays a role in promoting individuals’ efforts to engage in behaviors. A study of nursing students found that there is a positive relationship between simulation learning effectiveness and self-reflection; that is, the higher the learning effectiveness, the higher the students’ self-reflection and insight [9]. Caring behavior is considered to be the core of nursing [10]. One study found that self‐efficacy is a predictor of caring behavior [11]. In addition, Chen et al. found that students present greater caring behavior when they also present with higher self-reflection and insight [12].
The Relationships Between Self-Reflection, Caring Behavior, and Nursing Competence
Watson defined competency as the skills that a nurse possesses upon completion of an educational program [1]. According to McCloskey, “Competency is an ability, talent, or skill that allows someone to do something” (p. 356) [13]. Nursing competency has always been an important task for nursing schools to cultivate in their students. In the process of ability cultivation, especially in clinical situational learning, students face cases in which patients have different care needs and changes in their condition. This means that, in addition to being able to provide appropriate care, the students must be self-reflective and have insight.
Previous research has found that self-reflection is significantly positively associated with students’ nursing competence [9, 14]. Pai’s study also indicated that a clinical practice program with self-reflection learning exercises enhance students’ clinical competence [15]. In addition, Naidu found that caring behavior affects patient satisfaction and healthcare quality [16]. These findings show that students’ self-reflection and caring behavior are correlated with their nursing competence.
Professional Socialized and Nursing Competence
Socialization is the process of learning a group’s new role, knowledge, and skills in the context of society. It is the acquisition of behavior and attitudes that allow individuals to become members of groups and society. Professional socialization refers to one process of professional learning, including the learning of professional norms, attitudes, behaviors, skills, roles, and interests [1]. The individual must internalize the values and norms of the profession in terms of his or her behavior and self-concept, and professional socialization is needed for learning [7].
Arnold et al. found that teamwork can promote individual professional socialization [17]. In keeping with this, Watson believes that individual professional image and professional commitment are part of professional socialization [1]. Research shows that professional socialization can promote better professional role behavior for novice caregivers [18]. Dinmohammadi et al. conducted a concept analysis of nursing professional socialization and found that professional socialization is a complex process with four key attributes: learning, interaction, development, and adaptation [5]. Salisu et al. stated that the attributes and antecedents of professional identity of the nurse are related to the personal dimensions of competence, confidence, insight, capability, and self-reflection ability [2]. Nursing competency also has an influence on professional socialization [1, 5, 6, 18].
Framework and Hypotheses
We extend the extant literature by focusing on professional socialization. In this study, simulation self-learning effectiveness, self-reflection with insight, caring behavior, and nursing competence are considered antecedents (exogenous constructs), and professional socialization is an outcome variable (endogenous construct). In this study, simulation self-learning effectiveness is defined as students’ perceived efficacy, such as self-regulation, self-efficacy, and self-motivation, when they perform simulation practice in a school clinical skill center [19]. Caring behavior is defined as intentional actions that convey physical care and emotional concern and promote a sense of security in another [20]. Self-reflection and insight is defined as an inspection, evaluation, and understanding of one’s thoughts, feelings and behaviors [21]. Nursing competence is defined as “the ability of a nurse to effectively demonstrate a set of attributes, such as personal characteristics, professional attitude, value, knowledge, and skill, and to full his/her professional responsibility through their practice [22]. In addition, professional socialization is diverse and has a wide scope. Based on a review of the literature, we drew upon the concept of teamwork in which students practice in groups. Thus, in this study, we define professional socialization as encompassing an attitude that includes nursing image, professional commitment, and teamwork skills. The research model is shown in Figure 1, and the hypotheses are as follows:
H1a: Students’ self-learning effectiveness has a significant positive association with caring behavior.
H1b: Students’ self-learning effectiveness has a significant positive association with self-reflection and insight.
H1c: Students’ scaring behavior has a significant positive association with self-reflection and insight.
H2a: Students’ caring behavior has a significant positive association with nursing competence.
H2b: Students’ self-reflection with insight has a significant positive association with nursing competence.
H3: Students’ nursing competence has a significant positive association with nursing professional socialization.