Perceptions of care homes as practice learning environments for pre-registration nursing students: A systematic-narrative hybrid literature review

Background: The ageing population is increasing demand for skilled nurses in long-term care settings, such as care homes. However, attracting qualified nurses remains challenging. Pre-qualification experience could enhance skills, recruitment and retention, but requires greater understanding and support of care homes as learning environments.

Aim: To identify and synthesise research evidence related to care homes as learning environments, and to investigate factors influencing learning within such settings.

Design: Systematic-narrative hybrid review.

Data sources: CINAHL, PubMed, Medline, Scopus, Web of Science, Nursing and Allied Health and Google Scholar were searched for research articles published between January 2014 and October 2023 which sought to explore the learning opportunities of nursing students in care homes. Studies published in English were considered.

Review methods: Retrieved articles were assessed for suitability, quality and inclusion through title and abstract examination facilitated by the use of an appropriate critical appraisal tool (PICO). Articles were read, and re-read, evidence extracted, tabulated, and then synthesised using a thematic approach. Reporting is consistent with PRISMA guidelines for reporting systematic reviews.

Results: 4203 articles were screened, 31 studies matched the inclusion criteria. Three key themes were developed through thematic synthesis: (i) Positive but challenging experiences (ii) Barriers to learning include lack of registered nurses, time pressure and high workload, and lack of financial investment (iii) Facilitators of learning in care homes include positive supervisory relationship, effective orientation and reception, and partnership and collaboration between educational institutions and care home settings.

Conclusion: This review reveals the potential of care homes as settings that offer valuable learning opportunities for nursing students, as well as a sector that support the future needs of an ageing population. Advocating for policies that specifically address the support of nurse education and nurses in this environment is warranted.