Transition shock among nursing students during clinical practice: a scoping review protocol
Transition shock among nursing students during clinical practice: a scoping review protocol
Transition shock is a very common negative clinical practice experience for nursing students, which not only makes the adaptation to clinical practice difficult but also influences the smooth transition from nursing students to registered nurses and eventually could lead them to leave the nursing field. Therefore, transition shock of nursing students deserves attention. Recently, there has been a notable increase in research dedicated to transition shock experienced by nursing students. However, the overview of research done on this topic remains unclear. Therefore, we will conduct a scoping review to summarise assessment tools, influencing factors, the impacts and intervention strategies of transition shock among nursing students and identify knowledge gaps in this field to guide further research.
We will follow the Joanna Briggs Institute scoping review guidelines to conduct this scoping review. A comprehensive literature search will be conducted through 12 databases and grey literature sources. The search period will be restricted from May 2009 to December 2024, and this review will only incorporate publications in Chinese or English. Two researchers will independently screen the literature according to inclusion criteria, and then conduct data extraction. Any differences arising between the two researchers will be addressed by engaging in discussion with a third researcher. We will collate, summarise and analyse the extracted data and subsequently present the results by means of figures, tables and descriptive narratives. This review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews reporting checklist.
As this review does not involve patients or the public, there is no need for ethical approval. The results of this scoping review will be disseminated by means of conference presentations and publication in a peer-reviewed academic journal.
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Clinical practice is a crucial aspect of nursing education.1 During the clinical practice period, nursing students engage in a hospital environment to apply their knowledge and skills to clinical nursing, guided by experienced practitioners.2 This is an essential period for preparing nursing students for the role of registered nurses.3 However, due to insufficient knowledge and skills, as well as the complexity during the clinical practice period, nursing students often experience a series of emotional and interpersonal fluctuations when they first enter clinical practice.4 This phenomenon is commonly referred to as ‘transition shock’. Transition shock refers to a series of psychological and emotional responses when transitioning from a familiar role to a relatively unfamiliar one; this was initially used to describe conflicting experiences that newly graduated nurses encountered during their adaptation to the professional nursing role.5 Nevertheless, recent studies have indicated that nursing students also undergo transition shock when moving from the academic environment of school to the clinical environment, describing their adaptation to clinical demands as similar to ‘being thrown in the deep end’.6 7 This negative clinical practice experience not only makes the adaptation to clinical practice difficult but also influences the smooth transition from nursing students to registered nurses and eventually could lead them to leave the nursing profession.8 9 Thus, identifying the factors that have impacts on transition shock among nursing students and developing strategies to help them cope with it are crucial for ensuring a successful transition into nursing roles. Previous literature has shown that the influencing factors of transition shock include individual factors,10 organisational factors11 and educational factors.12 In addition, transition shock negatively affected professional identity,13 quality of nursing care14 and patient outcomes.15 Intervention strategies to reduce transition shock involve peer or mentor support,16 psychological interventions17 and transition programmes.18 However, these studies mainly focus on newly graduated nurses. Due to the differences in job content and level of responsibility between nurses and nursing students, the assessment, influencing factors and intervention strategies of transition shock among nursing students may differ from those for newly graduated nurses. Recently, there has been a notable increase in research dedicated to transition shock among nursing students. Kim and Shin modified the Transition Shock Scale for newly graduated nurses and verified the validity and reliability of this scale among nursing students.19 The modified scale has been widely used to assess transition shock among nursing students.20 21 Zhao et al’s study indicated that nursing students experienced a moderate extent of transition shock in clinical placement; patient safety attitudes, professional identity and climate of caring were negatively correlated with transition shock.2 Kim et al’s study indicated that higher levels of incivility and lower levels of psychological capital were significantly associated with increased levels of transition shock among nursing students.22 Despite the attention given to transition shock among nursing students during clinical practice, the overview of research done on this topic remains unclear. The scoping review methodology is widely recognised as an effective approach for synthesising existing evidence. Therefore, we will conduct a scoping review to systematically review the literature on transition shock among nursing students during their clinical practice, synthesise existing evidence and identify knowledge gaps to guide further research.
The purpose of this scoping review is to map the literature on assessment tools, influencing factors, the impacts and intervention strategies of transition shock among nursing students and to identify knowledge gaps to guide further research.
In accordance with the objectives of this scoping review, the primary research questions are as follows: (1) what assessment tools have been used to measure transition shock among nursing students? (2) What are the factors that affect transition shock among nursing students? (3) What impact does transition shock have among nursing students during clinical practice? (4) What intervention strategies are available to reduce transition shock among nursing students?
We will follow the Joanna Briggs Institute scoping review guidelines to conduct this scoping review.23 This review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting checklist.24 This protocol is registered in the Open Science Framework (https://osf.io/2r6jn/).
The inclusion criteria are formulated in accordance with the elements of population, concept and context and the types of evidence sources.
Population
Literature focusing on nursing students who are currently undergoing clinical practice or have already completed their clinical practice will be included, while those focusing on newly graduated nursing students will not be included.
Concept
This scoping review will focus on studies regarding assessment tools, influencing factors, the impacts and intervention strategies of transition shock among nursing students.
Context
Various stages of nursing students’ clinical practice.
Types of study design
Given that this scoping review focuses on primary research to identify gaps, we will include primary studies that employ a variety of research designs, including quantitative, qualitative and mixed methods designs. Reviews will not be included. Nevertheless, their reference lists will still be searched to ensure relevant articles are retained. Conference abstracts, research protocols or commentaries will not be considered either, as they do not provide sufficient information to answer the research questions.
We will conduct a three-step search strategy to identify relevant studies on the topic. In the initial step, a preliminary search will be conducted in PubMed to identify text words and the index terms. Subsequently, we will employ the identified keywords and index terms to conduct systematic searches across all included databases, ensuring the comprehensive identification of relevant literature. These databases include: PubMed, Cumulated Index to Nursing and Allied Health Literature (Plus with Full Text), Scopus, ProQuest, Embase, PsycInfo, Web of Science, Cochrane Library, ScienceDirect, China National Knowledge Infrastructure, Wan Fang and SinoMed. In addition, grey literature will be searched through Google Scholar and OpenGrey. Full search strategies for all included databases are detailed in online supplemental table 1. Finally, we will hand search the reference lists of all selected studies to uncover any additional studies that may have been missed. The search period will be restricted from May 2009 to December 2024, as the concept of transition shock was initially described by Duchscher in 2009.25 We will only include papers written in Chinese or English because the research team is proficient in these two languages. Moreover, the majority of papers published in widely used international databases are in English. Therefore, considering English papers can maximise the coverage of papers that meet the inclusion criteria. The researchers will also search databases that mainly cover Chinese publications to scope evidence from the context of China.
The search results will be imported into reference manager software EndNote 20 for deduplication. Following the removal of duplicate records, two researchers (P-LS and YM) will independently conduct a preliminary screening of the titles and abstracts of the included studies and then proceed to full-text screening based on the inclusion criteria. Any discrepancies arising between the two reviewers during the screening process will be resolved through consultation with a third reviewer (G-YZ). Before initiating the formal literature screening process, we will conduct a pilot test on 5% of the randomly selected references to verify the reliability of the screening process.26 Two researchers will independently conduct the literature screening based on predetermined inclusion criteria. Then, we will use the percentage agreement calculation method to evaluate the consistency level of the two researchers in the literature screening process.27 Only when the consistency between the two researchers reaches 75% or higher will we initiate the formal literature screening.28 The results of the literature search and the screening process will be depicted in a PRISMA-ScR flow diagram, as shown in figure 1.24 The selection of studies will be conducted between January 2025 and March 2025.
Our research team will develop a data extraction form based on the research objectives to capture relevant information, which will be recorded in Microsoft Excel. The extracted data will include author(s), title, publication year, country of origin, aim, study design, settings, population and sample size, assessment tools, influencing factors, outcomes, intervention strategies and key findings. To ensure the feasibility of the data extraction form, two researchers (P-LS and YM) will pilot the form independently on a random 10% sample of the included studies. If necessary, the draft of the data extraction form will be adjusted or revised. The final form will be presented in the scoping review report. The draft of the data extraction form is presented in online supplemental table 2. During the data extraction process, two researchers (P-LS and YM) will independently perform data extraction from each included study using the form. Any discrepancies arising between the two reviewers will be resolved through consultation with a third reviewer (G-YZ). Critical appraisal assessment is generally not recommended in scoping reviews because the aim is to map the available evidence rather than provide a synthesised and clinically meaningful answer to a question.29 Considering that the purpose of this scoping review is to provide a broad overview of research on transition shock among nursing students during their clinical practice, critical quality appraisal of the included studies will not be conducted. Data extraction will be conducted between March 2025 and July 2025.
We will use both qualitative and quantitative methods for data synthesis. First, we will use frequency distribution and descriptive statistics to summarise the characteristics of the included studies. Second, regarding research questions, qualitative inductive methods will be used to classify the assessment tools, influencing factors, the impacts and intervention strategies of transition shock among nursing students. The results of this scoping review will be presented using tables, figures and descriptive narratives to demonstrate how the findings are related to the review objectives. Data analysis will be conducted between July 2025 and November 2025.
No patients and/or the public are involved in this review.
As this review does not involve patients or the public, there is no need for ethical approval. The results of this scoping review will be disseminated by means of conference presentations and publication in a peer-reviewed academic journal.
Not applicable.
