Phillips Charlotte, Smith Hazel Ann, Crisp Elizabeth, Carter Vanda, Donnelly Helene, Ross Al, Bowie Paul, Latham Callum, Jones Sarahjane
School of Health, Policing and Sciences, University of Staffordshire, Staffordshire, UK.
University Hospitals of North Midlands NHS Trust, Staffordshire, UK.
J Adv Nurs. 2025 Nov;81(11):7447-7463. doi: 10.1111/jan.16751. Epub 2025 Jan 28.
To explore the perceptions and experiences of students raising concerns during pre-registration health and/or social care training in England.
Systematic review.
MEDLINE, CINAHL, ERIC, PsycINFO and Education Research Complete were systematically searched for studies published between September 2015 and August 2024. Grey literature searches were conducted using Google Scholar and ETHOS British Library. Reference lists from included studies were hand searched.
Joanna Briggs Institute methodological guidance for the conduct of systematic review informed conduct and the convergent integrated approach. Mixed methods appraisal tool was used for quality appraisal.
Eleven studies were included. Synthesis of findings generated three themes: (1) conflicting needs of self and others, (2) navigating the professional workspace and, (3) 'choice to voice'.
Speaking up and raising concerns as a pre-registration student is a complex, multi-faceted and non-linear social phenomenon. Experiences and perceptions are impacted by the novice student position alongside individual, interpersonal and organisational factors. Open cultures within teams and organisations, leadership, support and feedback may enable students overcome barriers to raising concerns.
Raising concerns may reduce avoidable harm. Pre-registration students offer a 'fresh pair of eyes'; however, they face barriers related to their student position. Synthesis of speaking-up experiences and perceptions of students in English settings can inform the design of learning environments which equip pre-registration students with the knowledge and skills required to cultivate safety behaviours. These skills contribute positively to safety culture and support learning and improvement in complex systems such as health and social care.
The review followed PRISMA reporting guidelines.
The conceptualisation of this project was informed by engagement events with higher education staff, students and Freedom to Speak Up Guardians.
探讨英格兰预注册健康和/或社会护理培训期间提出担忧的学生的看法和经历。
系统评价。
对MEDLINE、CINAHL、ERIC、PsycINFO和教育研究完整版数据库进行系统检索，查找2015年9月至2024年8月期间发表的研究。使用谷歌学术和大英图书馆的ETHOS进行灰色文献检索。对纳入研究的参考文献列表进行手工检索。
采用乔安娜·布里格斯研究所系统评价的方法学指南指导研究实施，并采用收敛性综合方法。使用混合方法评估工具进行质量评估。
纳入11项研究。研究结果综合产生了三个主题：（1）自我与他人的需求冲突，（2）在专业工作环境中应对，以及（3）“发声的选择”。
作为预注册学生表达意见并提出担忧是一个复杂、多面且非线性的社会现象。新手学生的身份以及个人、人际和组织因素会影响其经历和看法。团队和组织内部的开放文化、领导力、支持和反馈可能有助于学生克服提出担忧的障碍。
提出担忧可能减少可避免的伤害。预注册学生能提供“全新视角”；然而，他们面临与学生身份相关的障碍。综合英语环境下学生发声的经历和看法可为学习环境的设计提供参考，使预注册学生具备培养安全行为所需的知识和技能。这些技能对安全文化有积极贡献，并支持健康和社会护理等复杂系统中的学习与改进。
本评价遵循PRISMA报告指南。
该项目的概念化是通过与高等教育工作人员、学生和“自由发声守护者”的参与活动形成的。
