Holistic admission review in student nurse selection: A concept analysis

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Abstract
Background: Workforce diversity reduces health care disparities and enhances patient-centred care. Holistic admission review (HAR) in student nurse selection has been proposed to increase diversity in nursing. Nursing has been slow in the uptake of HAR. Additionally, South Africa nursing programme admissions primarily emphasise academic metrics. The focus on academic measures leads to the exclusion of academically successful, diverse and competent candidates. Objectives: This study sought to analyse the concept of HAR in the context of nursing education, addressing the question of the conceptual meaning of HAR in this context. Method: Walker and Avant’s eight-step concept analysis framework was implemented to establish a clear understanding of HAR. A scoping review, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, was conducted across 10 databases and institutional repositories. Sources were screened using Covidence, and data extraction followed the conceptual analysis framework. Results: Out of 8558 screened sources, 84 were included in the analysis. Holistic admission review requires policies to address the use of a diverse selection committee using a standardised rubric to assess both cognitive and non-cognitive attributes. Conclusion: Holistic admission review is triggered by a lack of diversity and bias in selection processes. The HAR framework consists of four phases and ultimately fosters an inclusive student body equipped to deliver high-quality patient care. Holistic admission review enhances student retention, empowers future leaders and strengthens the nursing workforce. Contribution: This concept analysis will refine the research questions for subsequent phases, including exploring HAR’s meaning and developing a nursing education model for equitable student selection in South Africa.

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