Clinical education is a cornerstone of undergraduate nursing education programs. Although protecting patient safety in clinical learning experiences is a standard of practice, no standard definition of the "unsafe" student exists. The purpose of this study was to describe the viewpoints of undergraduate student nurses and their clinical educators about unsafe clinical student practices. Using Q methodology, 57 students and 14 clinical educators sorted 39 unsafe student practice statements. These statements were generated from an integrated review of nursing and related literature and two undergraduate student focus groups. The use of centroid factor analysis with varimax rotation produced three dimensions of unsafe student practices. An unsafe student was characterized by his/her Compromised Professional Accountability, Incomplete Praxis, and Clinical Disengagement. A shared attribute among these three features was violated professional integrity. While students' affective, cognitive, and praxis competencies were priority elements in the conceptualization of unsafe student practice, this study also identified the salient role of educators as active participants in preparation of safe practitioners.

Based on work conducted by Laurentian University's School of Nursing and Centre for Continuing Education in Sudbury, Ontario, Canada, working in conjunction with community partners, this article looks at the findings of an analysis of nurses' writing activity in a university-level web-based module for evidence of critical thinking using Johns' Model of Structured Reflection (1995). Also considered are student-teacher interactions and discipline-specific writing. The findings suggest that high levels of critical thinking by nurse learners and growth in thinking and writing competence over time can occur in an online setting. Further highlighted are the role of the instructor, assignment design, and support in fostering such development.

This article describes three learning activities used in the undergraduate nursing degree program at a mid-sized university in northeastern Ontario, Canada. Each activity, a reflective writing assignment, scenario testing, and an OSCE experience, is considered in terms of integrative thinking. Formal and informal evaluation of the activities is also discussed.Based on the authors' experiences, integrative thinking including habits of mind and cognitive skills can be directed and enhanced. To maximize students' growth as integrative thinkers, they should be exposed to many kinds of activities that target this growth. Generally, such activities tend to be case-based and interactive in nature. They also require a level of scaffolding or directedness. To develop and implement such activities, teachers are encouraged to work with educational researchers and instructional designers.

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