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Chao YC, Hu SH, Chiu HY, Huang PH, Tsai HT, Chuang YH. The effects of an immersive 3d interactive video program on improving student nurses' nursing skill competence: A randomized controlled trial study. NURSE EDUCATION TODAY 2021; 103:104979. [PMID: 34049120 DOI: 10.1016/j.nedt.2021.104979] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 04/29/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Acquired accurate clinical nursing skills are among the most important core nursing competencies for nursing students, as nursing students' inadequate skill capacities might endanger patients safety. Therefore, it is essential to develop teaching strategies to strengthen students' nursing skills. This study examined the effects of an immersive three-dimensional (3D) interactive video program on improving nursing students' nasogastric tube feeding skill competence. DESIGN A randomized controlled trial research design. SETTINGS AND PARTICIPANTS Forty-five nursing students from a university in northern Taiwan. METHODS The students were randomly assigned to an intervention group (n = 22) and a comparison group (n = 23). The intervention group received the immersive 3D interactive video program on nasogastric tube feeding, whereas the comparison group watched a regular demonstration video. The questionnaire was used to collect data before the intervention, immediately after the intervention, and one month after the intervention. RESULTS Nursing students' knowledge and confidence in nasogastric tube feeding were significantly improved after the intervention in both groups. Although there were no significant differences in students' knowledge, skill, and confidence between the two groups, participants' average satisfaction score with the immersive 3D interactive video program in the intervention group was significantly higher than in the comparison group that watched a regular video (t = 2.302, p = 0.026). CONCLUSIONS The findings of this study showed that both immersive 3D interactive video program and regular demonstration video could improve nursing students' learning outcomes. The higher satisfaction score in the intervention group indicates that learning through immersive 3D interactive video is acceptable and satisfactory. This study provides useful information for nursing faculty members for designing and developing teaching methods for the acquisition of nursing skills. It can also serve as a reference for further studies relating to AR, VR, or immersive learning materials.
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George TP, Munn AC, Phillips TA, Marty Hucks J. The impact of telehealth objective structured clinical evaluations in intraprofessional nursing education: A mixed methods study. NURSE EDUCATION TODAY 2021; 103:104978. [PMID: 34049127 DOI: 10.1016/j.nedt.2021.104978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Telehealth is an expanding modality of providing care. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) released a white paper encouraging the inclusion of telehealth into nurse practitioner education. It is important for nursing students to gain experience with telehealth so that they are prepared to provide care via telehealth. OBJECTIVES The purpose of this project was to evaluate the impact of incorporating telehealth simulation into objective structured clinical examinations (OSCEs) in the family nurse practitioner (FNP) and bachelor of science in nursing (BSN) programs. SETTING This study was conducted at a public, liberal arts university in a rural area of the Southeast United States. PARTICIPANTS The FNP and BSN students participated in this study. The FNP program is a hybrid master's degree program, which has a two-year plan of study. The BSN program is a traditional campus-based program, which includes two years of upper-division nursing courses. METHODS This mixed-methods study included a pre- and post-survey design utilizing both quantitative and qualitative measures to evaluate undergraduate and graduate nursing students understanding of and comfort with telehealth and their perceptions of a simulated intradisciplinary telehealth OCSE experience. RESULTS Students' telehealth knowledge, skills, and confidence were improved after the telehealth OSCE experience. Directed content analysis of the responses revealed three themes: increased knowledge of telehealth, technical difficulties, and teamwork/communication. CONCLUSIONS It is beneficial for both undergraduate and family nurse practitioner students to have exposure to telehealth in their respective curriculums.
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Pourteimour S, Nobahar M, Raiesdana N. Moral intelligence, clinical placement experience and professional behaviors among Iranian undergraduate nursing students in a baccalaureate nursing program: A descriptive correlational study. Nurse Educ Pract 2021; 55:103146. [PMID: 34304128 DOI: 10.1016/j.nepr.2021.103146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
AIMS This study was intended to examine the relationship of both moral intelligence (MI) and Clinical Placement Experience (CPE) with the level of nursing students' professional behaviors (PB). BACKGROUND The foundation of belief, belonging and ethical values develop PB as a meaningful attribute during the period students and caring for patients. DESIGN A descriptive correlational study was conducted. METHODS Descriptive data were derived from the Belongingness Scale-Clinical Placement Experience (BES-CPE), the Moral Intelligence Questionnaire (MIQ) and the Nursing Students Professional Behaviors Scale (NSPBS) including 200 students (response rate 94.5%). RESULTS We found a statistically strong positive correlation between NSPB, MI and CPE. The regression model accounted for 57.8% of the variance in NSPB; CPE and MI were significant explanatory variables of NSPB. Moreover, the non-employed dormitory students had a significant statistical difference in the scores of all three variables. Female students had significantly higher CPE and MI (p˂0.05). CONCLUSIONS According to our findings, preventive and mediation endeavors for nursing students can explicitly target their behavioral skills to reduce perceived rejection and improve morality. As a result, an optimal plan to improve the quality of professional training courses for students should be designed based on the comprehension of clinical belonging and moral intelligence.
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Ma D, Shi Y, Zhang G, Zhang J. Does theme game-based teaching promote better learning about disaster nursing than scenario simulation: A randomized controlled trial. NURSE EDUCATION TODAY 2021; 103:104923. [PMID: 33962185 DOI: 10.1016/j.nedt.2021.104923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND With the development of information technology, game-based teaching has continuously attracted the attention of nursing educators. It has been proven that games, as an auxiliary tool of traditional teaching, can improve students' learning motivation and learning effects. However, compared with the traditional scenario simulation teaching, whether game-based teaching has obvious advantages is still unknown. OBJECTIVES This study aimed to explore whether theme game-based teaching is more effective than scenario simulation in improving students' disaster nursing competency. DESIGN A randomized controlled trial. SETTING The study was conducted at a provincial vocational college in Xiaogan, Hubei, China. PARTICIPANTS A total of 104 sophomore nursing students (intervention group = 51, control group = 53) participated. METHODS After the participants were randomly assigned to the intervention group or control group, disaster-themed games were used in the intervention group, while multi-station disaster simulation was applied in the control group. Pre- and post-tests were conducted to assess the participants' disaster nursing competence using the Questionnaire of Disaster Rescue Ability. RESULTS After the intervention, disaster nursing competence levels were significantly higher in the intervention group than in the control group (4.04 ± 0.43 vs. 3.77 ± 0.45, P = 0.002). Three domains of disaster nursing competence, cognition (4.05 ± 0.56 vs. 3.75 ± 0.48, P = 0.004), skill (3.88 ± 0.50 vs. 3.62 ± 0.53, p = 0.008) and affective response (4.25 ± 0.42 vs. 4.02 ± 0.48, P = 0.010), were also significantly higher in the intervention group. CONCLUSIONS Compared with scenario simulation, theme game-based teaching is more effective in improving the disaster nursing competence of nursing students.
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Cervera-Gasch A, Andreu-Pejó L, González-Chordá VM, Lopez-Peña N, Valero-Chilleron MJ, Roman P, León-Larios F, Mena-Tudela D. Breastfeeding knowledge in university nursing students. A multicentre study in Spain. NURSE EDUCATION TODAY 2021; 103:104945. [PMID: 33965716 DOI: 10.1016/j.nedt.2021.104945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Exclusive breastfeeding is one of the main health and infant survival elements. To start and maintain breastfeeding, health professionals must receive culturally sensitive evidence-based breastfeeding training to offer future mothers the required information and support. While studying the nursing degree, acquiring the necessary knowledge and skills to successfully perform this work is essential. OBJECTIVE Study the level of nursing students' breastfeeding knowledge at three Spanish public universities; explore which variables are related to acquire this knowledge. DESIGN An observational, descriptive, cross-sectional multicentre study. METHODS Participants were the students registered for the 4 nursing degree years at the three participating universities (N = 1540). They were asked about their breastfeeding knowledge with the self-administered AprendeLact Questionnaire; breastfeeding-related socio-demographic variables were included. RESULTS The overall mean score of the 684 returned questionnaires was 4.659 (±2.377) out of 10. The year-4 students from the Castellón university obtained significantly higher mean scores and had been on practicals in maternity or neonatology units, belonged to breastfeeding associations and were artificially fed as infants. University belonged to, current academic year and placements in maternity or neonatology units were relevant factors for acquiring breastfeeding knowledge. CONCLUSIONS Syllabi based on progressive transversal learning, and participating in real maternity-related health settings, could be facilitating strategies to acquire a suitable level of breastfeeding knowledge.
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Velarde-García JF, Cachón-Pérez JM, Rodríguez-García M, Oliva-Fernández O, González-Sanz P, Espejo MM, González-Hervías R, Álvarez-Embarba B, Moro-López-Menchero P, Fernández-de-Las-Peñas C, Palacios-Ceña D. The challenges of "learning on the go": A qualitative study of final-year Spanish nursing students incorporated to work during the first Covid-19 pandemic. NURSE EDUCATION TODAY 2021; 103:104942. [PMID: 33965720 PMCID: PMC9756394 DOI: 10.1016/j.nedt.2021.104942] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. OBJECTIVES To explore the perspectives of a group of final-year nursing students who were hired on the basis of a relief contract for health professionals during the first COVID-19 outbreak, regarding their learning process and their mixed role as students and novice nurses. DESIGN A qualitative exploratory study was conducted. SETTINGS The Nursing Department of the European University of Madrid, and the Red Cross College of Nursing. PARTICIPANTS Eighteen nursing students were recruited, aged between 18 and 65 years old, enrolled in the fourth year of Nursing Studies and who were hired under a relief contract for health professionals during the pandemic. METHODS Purposive sampling was used. Semi-structured, in-depth interviews were carried out using a question guide. Interviews were conducted in a private video chat room platform. Also, a thematic, inductive analysis was performed. This study was conducted according to the Consolidated Criteria for Reporting Qualitative Research and the Standards for Reporting Qualitative Research. RESULTS Four specific themes emerged: a) The students' role during the relief contract; b) The learning process during the pandemic; c) Barriers to learning; and d) A unique learning opportunity. The students had an undefined mixed role, which hindered their skills and activities. Learning was self-directed, sometimes through trial and error, and through experiencing critical events. Time constraints and having to learn under pressure were experienced as difficulties for learning. Nevertheless, this was a unique professional learning opportunity. The students learned to be organized and effective, acknowledge their limitations, gain confidence, face their fears, and mature. CONCLUSIONS These results can help inform nurse training programs and improve the organization and incorporation of nurses in health care facilities during the COVID-19 pandemic.
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Dack D, Ban S. To what extent does the use of a coaching-based style of student supervision in clinical practice impact experiences of placements for staff and students: A state-of-the-art literature review. NURSE EDUCATION TODAY 2021; 103:104941. [PMID: 33965717 DOI: 10.1016/j.nedt.2021.104941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/15/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The one-to-one style of mentorship of pre-registration nursing students has been identified across the globe as not always fulfilling the requirements of the profession or the individual. In recent years, there has been a move toward a coaching-based style of student supervision. This shift in supervision is welcomed by regulatory bodies and is supported in the UK by the NMC (2018). METHODOLOGY A structured state-of-the-art review was used to assess the impact of a coaching-based style of student supervision on staff and students' experiences of clinical placements. 14 papers, published between 2007 and 2020 were reviewed, and data was extracted using thematic analysis. FINDINGS Three themes were established; a, the relationship between students and registered staff in clinical practice, b, student autonomy and c, change management. CONCLUSION The use of a coaching style of student supervision is widely beneficial to nursing culture. The enhanced quality of the working relationship between staff and students serves to create more autonomous, critical, and skilled staff nurses in the future.
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Oanh TTH, Hoai NTY, Thuy PT. The relationships of nursing students’ satisfaction and self-confidence after a simulation-based course with their self-confidence while practicing on real patients in Vietnam. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2021; 18:16. [PMID: 34325495 PMCID: PMC8382883 DOI: 10.3352/jeehp.2021.18.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Simulation teaching refers to the replication of real-life scenarios, enabling students to practice nursing skills and learn actively in a safe environment. It also helps students control their anxiety and fears when caring for real patients. This study investigated the relationships of Vietnamese nursing students’ self-confidence in clinical practice with their satisfaction and self-confidence in simulation-based practice. METHODS This cross-sectional descriptive study included 182 nursing students. The data collection included 2 separate stages with 2 main questionnaires. The Student Satisfaction and Self-Confidence in Learning Scale was used to measure students’ satisfaction and self-confidence after learning in the simulation room. The Confidence Scale was used to measure students’ self-confidence when first performing techniques on actual patients. Data were analyzed by descriptive and Pearson correlation statistics. RESULTS Students’ satisfaction and self-confidence during the simulation course were quite high (mean±standard deviation [SD], 4.06±0.48 and 4.11±0.46 out of 5.0, respectively). In contrast, their confidence when first practicing on a patient was moderate (mean±SD, 3.19±0.62 out of 5.0). Students’ satisfaction showed moderate and weak positive correlations with self-confidence in pre-clinical practice and in clinical practice (r=0.33, P<0.001 and r=0.26, P<0.001, respectively). CONCLUSION Simulation has become an effective teaching strategy that can help nursing students be well-prepared for clinical placements in Vietnam. An effective nursing education strategy is needed to enhance the satisfaction and self-confidence of nursing students in simulation and then in clinical practice to help achieve professional engagement and development.
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Nursing students' experiences of psychological safety in simulation education: A qualitative study. Nurse Educ Pract 2021; 55:103163. [PMID: 34333233 DOI: 10.1016/j.nepr.2021.103163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 06/16/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The study aims to explore nursing students' experiences of psychological safety during simulation education using a high-fidelity simulator. BACKGROUNDS Simulation education allows trainees to practice repeatedly in a safe environment; however, increased anxiety and stress could result from simulation experiences. To better understand psychological safety in simulation education, the evidence for what causes impediments to psychological safety must be investigated. DESIGN An exploratory qualitative study was used. METHODS Four focus group interviews were conducted with students from the nursing departments of two universities in Korea. In total, 20 students who had experienced simulation education participated in this study. The collected data were analyzed using thematic analysis. RESULTS The analysis identified four themes and eight subthemes. The themes included dealing with uncertainty, feeling disrespected, dangers of team dynamics and being exposed during simulation education. CONCLUSIONS Results indicated that robust and consistent faculty development, from being aware of cues for psychological risk and designing the scenario, to debriefing and evaluation, is required to be able to create a learning environment that elicits psychological safety.
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Smadi O, Chamberlain D, Shifaza F, Hamiduzzaman M. Factors affecting the adoption of the Community of Inquiry Framework in Australian online nursing education: A transition theory perspective. Nurse Educ Pract 2021; 55:103166. [PMID: 34358856 DOI: 10.1016/j.nepr.2021.103166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/27/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This paper aims to understand the factors influencing the adoption of teaching, social and cognitive presence in online nursing education and explain the novice nurse academics journey in adopting these aspects. BACKGROUND The quality of the online/blended courses is about the content and a need for suitable pedagogical design, clear instructions and a collaborative environment based on a valid and reliable theoretical framework. DESIGN AND SETTINGS A qualitative study involves semi-structured interviews with 11 nurse academics from three Australian Universities and thematic analysis was conducted. RESULTS AND CONCLUSIONS The Community of Inquiry framework informed three themes including several factors in each from the interviews: (1) Teaching Presence (TP): the lack of understanding of educational theory use, the inadequate course evaluation and the resources scarcity found to be the factors affecting the adoption of TP in online nursing education; (2) Social Presence: the engagement difficulty and creating a learning community affected the adoption of SP; and (3) Cognitive Presence: the variety in learning styles and formative assessment and discussion forums found to be affecting the adoption of CP. This study paper is unique because it uses the Community of Inquiry framework and Meleis's Transition Theory and provides insight on how to facilitate the transition [from role insufficiencies to role supplementation to role mastery] of nurse academics' journey in adopting teaching, social and cognitive presence for online higher education.
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661
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Liu YM, Hou YC. Effect of multi-disciplinary teaching on learning satisfaction, self-confidence level and learning performance in the nursing students. Nurse Educ Pract 2021; 55:103128. [PMID: 34315062 DOI: 10.1016/j.nepr.2021.103128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to design a multidisciplinary teaching method that combines game-based learning with a clinical situation-based teaching program and to test learning motivation, learning satisfaction and self-confidence. BACKGROUND Research has suggested that game-based learning and clinical situation-based teaching can effectively capture student attention and stimulate student learning motivation as well as increase learning satisfaction and self-confidence. DESIGN The randomized and experimental design used in this study was a pretest-posttest control group design. METHODS This study recruited participants from a technical college in the north of Taiwan. The experimental group (receiving multidisciplinary teaching) comprised 48 participants and the control group (receiving traditional teaching) comprised 50 participants. Participants took a pretest before the multidisciplinary teaching intervention, received a total of 12 weeks of intervention and then took a posttest within 1 week of the end of the course. These participants completed a questionnaire regarding learning satisfaction, confidence and learning performance. RESULTS The multidisciplinary teaching intervention improved learning satisfaction (t = 7.36, p < 0.001), self-confidence (t = 7.34, p < 0.001) and learning performance (t = 6.66, p < 0.001). Multidisciplinary teaching interventions can improve learning satisfaction, self-confidence and learning performance among nursing students. CONCLUSIONS Multidisciplinary teaching should be promoted in the context of nursing teaching and students have the multidisciplinary learning.
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Jiang N, Wei B, Lin H, Wang Y, Chai S, Liu W. Nursing students' attitudes, knowledge and willingness of to receive the coronavirus disease vaccine: A cross-sectional study. Nurse Educ Pract 2021; 55:103148. [PMID: 34311170 PMCID: PMC8275930 DOI: 10.1016/j.nepr.2021.103148] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023]
Abstract
Aim This study aimed to investigate the knowledge, attitudes and willingness of nursing students to receive the coronavirus disease (COVID-19) vaccine and the influencing factors. Background Vaccination is one of the most effective measures to prevent COVID-19, but the vaccination acceptance rate varies across countries and populations. As trustworthy healthcare providers, nursing students’ attitudes, knowledge and willingness to receive the COVID-19 vaccine may greatly affect the present and future vaccine acceptance rates of the population; however, studies related to the vaccine acceptance rates among nursing students are limited. Methods A convenience sampling method was adopted to select two medical universities in China. Following the cluster sampling method, nursing college students who were eligible for the study were selected. A cross-sectional survey was conducted by asking nursing students to complete an online questionnaire from February to April 2021. Descriptive statistics, t-tests/one-way analysis of variance (normal distribution), U tests/H tests (skewness distribution) and multivariate linear regression were performed. Results A total of 1488 valid questionnaires were collected. The score rates of the attitude, knowledge and vaccination willingness dimensions were 70.07%, 80.70% and 84.38%, respectively. Attitude was significantly influenced by vaccination status of family members. The main factors influencing knowledge were gender, grade and academic background. In terms of willingness, gender, academic background, visits to high-risk areas, vaccination status of family members and the side effects experienced after receiving other vaccines were significant influencing factors. Conclusions Nursing students showed satisfactory vaccine acceptance rates. However, more attention should be paid to male students, younger students, those with a medical background, those with low grades and those whose family members had not received the COVID-19 vaccine or had side effects from the vaccine.
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Readiness for clinical practice amidst coronavirus among nursing students in southwest Nigeria. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021; 15:100328. [PMID: 34277348 PMCID: PMC8276559 DOI: 10.1016/j.ijans.2021.100328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022] Open
Abstract
Background COVID-19 is a public health problem that has claimed the lives of many men, women, and children globally, apart from its overwhelming economic impact. Nurses are inexorably faced with this situation as part of the frontline hospital workers, likewise student nurses on clinical practice while on training. Objective To assess readiness on resumption for clinical practice amidst coronavirus pandemic among Nursing students in South-West Nigeria. Methods This is a cross-sectional descriptive study that utilized a multistage sampling technique to select the respondents. Three-hundred respondents were recruited for the study. Data were analyzed using SPSS 22.0, descriptive statistics were presented in tables and charts while the hypotheses were tested with Chi-square at a significant level of p = 0.05. Results The findings revealed that the mean and standard deviation of the respondents was 22.16 ± 3.11 years; 61.7% were ready for clinical practice, 92(30.7%) were ready to nurse coronavirus patients. There is a significant difference between nursing institutions and readiness for clinical practice p = 0.000. There is no significant difference between years of clinical exposure and readiness for clinical practice p = 0.594. Conclusion This study revealed that though the students had a high level of readiness, only few are ready to practice in coronavirus wards, this could pose a challenge to future nurses. It is important to build clinical competence and students’ confidence to work in areas of infectious diseases like coronavirus.
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Howard V. Undergraduate mental health nursing students' reflections in gaining understanding and skills in the critical appraisal of research papers - An exploration of barriers and enablers. Nurse Educ Pract 2021; 55:103143. [PMID: 34280659 DOI: 10.1016/j.nepr.2021.103143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore a cohort of mental health nurses' views and experiences in developing and applying critical appraisal of research skills to identify helping and hindering factors. BACKGROUND In accordance with evidence-based practice principles, there is an expectation that student (mental health) nurses will become competent in understanding research to make judgements about its trustworthiness and applicability in the clinical setting. This process is termed the 'critical appraisal of research' and it is deemed important to healthcare professionals because it facilitates the use of evidence from research to underpin practice. DESIGN The study incorporated qualitative secondary research using thematic analysis and a poststructural lens. METHODS Following undertaking a module including tuition on the critical appraisal of research, a cohort of student mental health nurses' submitted essay reflections focusing on critical appraisal experiences were thematically analysed. The thematic analysis included both deductive and inductive components in adjunct to a poststructuralist analysis to explore influencing factors of language, meaning and subjectivity. RESULTS The study identified there are both pedagogical factors and wider societal considerations influencing the critical appraisal of research experiences. Psychological and emotional factors, incorporating anxiety components were identified as a key barrier to engagement and understanding which has not previously been identified in comparable research. Enablers to the understanding and application of critical appraisal skills were identified as peer learning, accessing academic supervision, gaining a satisfaction of personal learning and self-directed learning with library skills support. CONCLUSIONS The findings indicate that there are specific pedagogic considerations which can be applied when supporting mental health student nurses in developing and gaining skills in the critical appraisal of research. It is recommended that these are applied universally for nursing students and considered for other populations of healthcare students.
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Bodys-Cupak I. Psychometric properities of the Polish version of clinical learning environment inventory. BMC Nurs 2021; 20:126. [PMID: 34238304 PMCID: PMC8265108 DOI: 10.1186/s12912-021-00649-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Clinical experience is a crucial activity for nursing students. The way students` perceive clinical placement exerts an immense influence on the learning process. This study aims to test the psychometric properties of a 19-item version of the Clinical Learning Environment Inventory under Polish clinical conditions. Method For this study, Discriminant validity and Cronbach’s alpha reliabilities were computed. In order to measure content validity, the criterion validity Generalized Self Efficacy Scale and the Life Orientation Test - Revised were used. Results Cronbach’s Alpha for the Clinical Facilitator Support of Learning Scale and the Satisfaction with Clinical Placement scale is 0.949 and 0.901, respectively. The Spearman’s rank correlation coefficient indicates the existence of a positive correlation between the students’ satisfaction with clinical placement and their [overall] life optimism. Age correlates negatively with perceived teacher support and positively with satisfaction with clinical placement. The sense of self-efficacy correlates negatively with their satisfaction with clinical placement. Clinical Learning Environment Inventory − 19 could be a useful tool to evaluate the quality of the clinical learning process in Polish conditions.
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Jallad ST, Işık B. The effectiveness of virtual reality simulation as learning strategy in the acquisition of medical skills in nursing education: a systematic review. Ir J Med Sci 2021; 191:1407-1426. [PMID: 34227032 DOI: 10.1007/s11845-021-02695-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This review was aimed to evaluate the effectiveness of virtual reality simulation as a teaching / learning strategy on the acquisition of clinical skills and performance, self-confidence, satisfaction and anxiety level in nursing education. METHODOLOGY The Preferred Reporting Items for Systematic Reviews guidelines, using the PICO model that is based on an evidence-based practice process was matched. A total of twenty-three studies included six themes: performance skills (n = 13), self-confidence (n = 8), satisfaction (n = 10), anxiety level (n = 3), self-efficacy (n = 4), and knowledge (n = 15). Experimental randomised control trials and quasi-experimental studies from 2009 to 2019, conducted in English, were included. Nursing students (n = 1797; BSN, ADN, MSc, LPN) participated. RESULTS AND CONCLUSION This review was indicated that virtual reality simulation provides learning strategy to acquire clinical skills, improve knowledge acquisition, increase self-confidence, self-efficacy, and satisfaction level, and decrease anxiety levels among nursing students.
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Egerod I, Kaldan G, Nordentoft S, Larsen A, Herling SF, Thomsen T, Endacott R. Skills, competencies, and policies for advanced practice critical care nursing in Europe: A scoping review. Nurse Educ Pract 2021; 54:103142. [PMID: 34265667 DOI: 10.1016/j.nepr.2021.103142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Management of critically ill patients is changing due a rise in population age, comorbidity and complexity. To accommodate these changes, the demand is increasing for advanced practice nurses. More knowledge is needed regarding the role of advanced practice critical care nurses in European countries. The aim of the study was to review the literature describing skills and competencies required for advanced practice critical care nursing in Europe and to investigate related policy. REVIEW METHOD We performed a scoping review including papers published in 1992-2019 targeting policy and the intersection of advanced practice nursing (level of practice), critical care nursing (specialty area) and Europe (geographical origin). DESIGN AND DATA SOURCES Main sources of evidence were PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, SweMed+, Scopus, ERIC and Social Sciences Citation Index. We also searched grey literature, webpages, reference lists and performed hand-search. RESULTS The search identified 11,478 papers/references of which 42 were included. Four levels of practice were identified with unclear boundaries: professional nurse, specialized nurse, advanced practice nurse and advanced critical care practitioner (nurse or other). Most skills and competencies described in the literature were generic to advanced practice and only few were area specific to critical care. Advanced practice critical care nurses were often unable to fulfil their role because education, supportive policy and legislation were lacking. CONCLUSIONS This scoping review informs the policy makers and the INACTIC study of existing advanced practice in critical care nursing in Europe. The advanced role in critical care nursing is characterized by inconsistency regarding policy, education, titles, roles, scope of practice, skills and competencies. Levels of practice and areas of specialization need to be clarified. Most skills and competencies identified were generic for advanced practice nursing and many were generic for any profession. Task-shifting from physician to nurse needs to be more clearly defined and patient outcomes described. Given the scarcity of papers in our target area, we believe it might be too early to conduct a systematic review at this time.
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Does volunteering change attitudes towards people with disabilities? A qualitative study of the experience of orthodox Jewish nursing students. Nurse Educ Pract 2021; 55:103141. [PMID: 34256260 DOI: 10.1016/j.nepr.2021.103141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND People with disabilities identify negative staff attitudes and behaviors as barriers to accessing health services. Studies show that nursing education activities specific to people with disabilities improves nursing care. This study explores the experience of orthodox Jewish nursing students volunteering with people with disabilities, how their attitudes towards this population changed. DESIGN A qualitative design was used. This research is part of an extensive ongoing study of orthodox and ultra-orthodox (Haredi) students volunteering with people with disabilities. METHODS Data from 13 semi-structured interviews, conducted between July and September 2017, with 14 male students (two students chose to be interviewed together) and four people with disabilities were analyzed using thematic analysis. RESULTS Volunteering enhanced students' awareness of the needs of people with disabilities, changed their attitude towards this population and enhanced their confidence as nurses. The individuals with disabilities valued the help they received as well as the opportunity to change the students' prior notions and stigmas regarding disability. CONCLUSIONS Projects such as ours could improve the attitude of nursing staff towards individuals with disabilities and improve nursing care. We recommend involving people with disabilities in designing such projects.
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Palese A, Chiappinotto S, Canino E, Martinenghi G, Sist R, Milani L, Marcomini I, Grassetti L, Destrebecq A. Unfinished Nursing Care Survey for Students (UNCS4S): A multicentric validation study. NURSE EDUCATION TODAY 2021; 102:104908. [PMID: 33894594 DOI: 10.1016/j.nedt.2021.104908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them. OBJECTIVES To validate a tool measuring UNC as perceived by nursing students. DESIGN A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. SETTING Three nursing programmes in Northern Italy. PARTICIPANTS All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved. METHODS Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed. RESULTS 737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into 'Communication', 'Priority setting', 'Nurses' aides' supervision', 'Material resources', 'Human resources', and 'Workload unpredictability'. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors. CONCLUSION The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity.
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Çiftçi B, Aras GN, Yıldız Ö. Examining the correlation between intercultural sensitivity and individualized care perception of nursing students. NURSE EDUCATION TODAY 2021; 102:104937. [PMID: 33971535 DOI: 10.1016/j.nedt.2021.104937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Intercultural sensitivity is accepting the existence of cultural differences and similarities between individuals without attributing a value to them. In order to provide individualized nursing care, it is required to train nurses who can respond to cultural needs of society, have cultural knowledge and skills regarding society and show a high intercultural sensitivity. PURPOSE The purpose of this study is to examine the correlation between intercultural sensitivity and individualized care perception of nursing students, who will become a member of professional health discipline. METHOD The population of this study consisted of nursing students receiving education in a state university in Ağrı. The sample of the study consisted of 2nd, 3rd, and 4th year students who agreed to participate in the study and were not absent during the data collection process. In the study, the "Student Information Form", "Intercultural Sensitivity Scale" and "Individualized Care Scale" were used. The study was completed with 90 individuals. Statistical analyses were performed in the SPSS program using arithmetic mean, standard deviation, and correlation analysis. RESULTS Nursing students' Intercultural Sensitivity Scale total mean score was 89.10 ± 10.42 and their Individualized Care Scale mean score was 3.97 ± 0.59. It was determined that there was a weak, positive and statistically significant correlation between total mean score of Intercultural Sensitivity Scale and total mean score of Individualized Care Perception Scale among the nursing students (r = 0.274, p = 0.009). CONCLUSION It was determined that the correlation between nursing students' intercultural sensitivity and individualized care perception was weak, positive and statistically significant. It was found that as nursing students' intercultural sensitivity level increased, their individualized care perception also increased.
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Stokman AI, Brown SL, Seacrist MJ. Baccalaureate nursing students' engagement with end-of-life curriculum: A grounded theory study. NURSE EDUCATION TODAY 2021; 102:104914. [PMID: 33894595 DOI: 10.1016/j.nedt.2021.104914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The art of being prepared to support patients and their families during end of life experiences is not always emphasized in nurse education. Despite the efforts from the American Association of Colleges of Nursing and End of Life Nursing Education Consortium (ELNEC), only 25% of nursing schools across the United States are using their modules. OBJECTIVE The purpose of this study was to explore how student nurses engage with end of life education. DESIGN Qualitative study using a grounded theory approach. SETTING Baccalaureate nursing program located in the rural agricultural western United States. PARTICIPANTS Using purposive sampling, a single cohort of baccalaureate student nurses in two focus groups (n = 17; n = 23). METHODS Using a grounded theory approach, student experiences and engagement with the curriculum were explored. Using the constant comparative method, three researchers coded the data independently and then came together to reach consensus on themes and for the development of the conceptual model. RESULTS Three categories emerged from the data to describe the student engagement with the curriculum: Novice, Evolving, and Prepared. The central theme for the Novice students was Being Afraid. Students expressed fear over the unknown and not knowing what to say or do. Becoming Aware was the central theme for the Evolving students which included a blend of being aware of their deficiencies as well as the important aspects of end of life care. The final category was Prepared. The theme for this category was Becoming Accomplished, which included recognition of respectful care, disrespectful care, team work, and advocacy. CONCLUSION End of life education is essential for nursing students to provide appropriate care at end of life, as well as providing improved knowledge, attitudes, and confidence of students. The End of Life Nursing Education Consortium modules, placed strategically within the curriculum, allow nursing students to move through the process of Being Afraid, to Becoming Aware, and finally Becoming Accomplished upon graduation.
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Cuartero N, Tur AM. Emotional intelligence, resilience and personality traits neuroticism and extraversion: predictive capacity in perceived academic efficacy. NURSE EDUCATION TODAY 2021; 102:104933. [PMID: 33957394 DOI: 10.1016/j.nedt.2021.104933] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/04/2021] [Accepted: 04/19/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Recent studies have shown the importance of promoting emotional intelligence and resilience, as well as knowing the personality (extraversion versus emotional instability or neuroticism) in both nursing students and nursing professionals, for better academic adherence, due to stressful situations derived from high academic and attendance requirements for healthcare practices in clinical settings. However, there is little research that analyzes the importance of the perceived academic effectiveness of university students and its relationship with the psychological variables of resilience, emotional intelligence and personality. OBJECTIVE To analyse the relationships between perceived academic efficacy, emotional intelligence (EI), resilience and the personality factors of emotional instability and extraversion, as well as to observe the variables that predict perceived academic efficacy. MATERIALS AND METHODS Cross-sectional study on a sample of 434 nursing students in Valencia (Spain) aged 17-54 (M = 21; SD = 0.320). They filled in standard tests on perceived academic efficacy, EI, resilience, emotional instability and extraversion. RESULTS Perceived academic efficacy is closely and positively related to EI and resilience; and to a lesser extent to emotional instability, but negatively. The academic efficacy predictor variables were EI (global trait, well-being and sociability), resilience (social support and emotional regulation) and emotional instability (R2 of 0.201). CONCLUSIONS Perceived academic efficacy is fundamentally related to EI and resilience positively, and to a lesser extent to emotional instability negatively, fundamentally via these factors: global trait, social support, well-being, problem-solving capacity. Nursing students' perception of academic efficacy is relevant for building professional skills and carrying out the nurse's role in organisations. So, it is necessary to promote training programs to increase the emotional intelligence and resilience of nursing students, aimed at promoting competence in professional practice.
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Li R, Zhou W, Wu J. Identifying the subtypes of psychological profiles in senior undergraduate nursing students and its relationship with academic performance: A latent class analysis. J Prof Nurs 2021; 37:757-764. [PMID: 34187675 DOI: 10.1016/j.profnurs.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Students' academic performance is closely related to their personal psychological factors. The subtypes and heterogeneity of psychological profiles among nursing students has not been systematically examined. PURPOSE To identify subtypes of psychological profiles among nursing students using latent class analysis (LCA). METHODS A cross-sectional study design included 379 senior nursing undergraduate students aged 18-22 from three medical colleges in Shanghai. The subjects were investigated by Ruminative Responses Scale, Academic Burnout Scale and Psychological Capital Scale and were categorized into subtypes by LCA. RESULTS Four latent classes were identified: Class 1 - General group; Class 2 - Negative psychological dominated group; Class 3 - Positive psychological dominated group; and Class 4 - Ambivalence psychological group. Students with higher exam failure rate were more likely to belong to Class 2. After adjusted for demographic variables, the subtypes of psychological profiles significantly correlated with academic performance. CONCLUSIONS The significant heterogeneities were noted between psychological profile subtypes and academic performance among senior undergraduate nursing students.
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Ramjan LM, Salamonson Y, Batt S, Kong A, McGrath B, Richards G, Roach D, Wall P, Crawford R. The negative impact of smartphone usage on nursing students: An integrative literature review. NURSE EDUCATION TODAY 2021; 102:104909. [PMID: 33894590 DOI: 10.1016/j.nedt.2021.104909] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Smartphones are ubiquitous, and for some, an indispensable companion. In nursing education curricula and clinical healthcare settings, smartphones have the potential to augment student learning. Nursing students report significant benefits to smartphone use, which extend beyond learning, to include enhanced communication, clinical decision making and evidence-based practice. Despite these benefits, little is known about the negative impact of smartphones on student learning. OBJECTIVES This integrative review aimed to synthesise findings from published research that referred to the detrimental direct or indirect effect of smartphone usage on nursing students. DESIGN The integrative review was guided by the five-stage approach as conceptualised by Whittemore and Knafl (2005). METHODS Seven electronic databases were systematically searched in consultation with a university librarian (CINAHL Plus, Ovid Medline ALL, Nursing and Allied Health Database, PsycINFO, PubMed, Scopus and ERIC) using a combination of key search terms and medical subject headings. A total of 646 articles were retrieved, and following removal of duplicates, screening of titles and abstracts, a final 27 articles met the inclusion criteria for this review. RESULTS Studies in the review originated from Korea (n = 7), Turkey (n = 6), India (n = 4), Spain (n = 3), USA (n = 2), Spain/Portugal (n = 1), Iran (n = 1), France (n = 1), Canada (n = 1) and Egypt (n = 1). Personal smartphone use was reported to be a distraction within clinical and classroom learning, and considered as uncivil, and compromised professionalism. Frequently, smartphones were used for entertainment (e.g. social networking) rather than professional purposes. The studies identified a concerning level of nomophobia and smartphone addiction among nursing students that caused stress and anxiety, and adversely affected sleep, learning and academic performance. Recommendations were proposed for smartphone policies. CONCLUSIONS Excessive smartphones use among nursing students may adversely affect physical and mental health and potentially impact on student learning within the classroom and clinical environment. Educators should consider the implementation of policies or guidance for the responsible use of smartphones by nursing students whilst in the classroom setting and during clinical placement, to mitigate the potential negative impact on health and academic performance.
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Hari R, Geraghty S, Kumar K. Clinical supervisors' perspectives of factors influencing clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement: A qualitative study. NURSE EDUCATION TODAY 2021; 102:104934. [PMID: 33934040 DOI: 10.1016/j.nedt.2021.104934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Undergraduate nursing students from culturally and linguistically diverse backgrounds experience unique challenges with their learning needs during clinical placements. There is limited research on clinical supervisors' perspectives of the factors impacting clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement. OBJECTIVES This study sought to identify clinical supervisors' perspectives of the factors impacting on the clinical learning experience of nursing students from culturally and linguistically diverse backgrounds and strategies to overcome challenges. DESIGN A qualitative research design using semi-structured interviews. METHODS Nine nurses who had experience supervising culturally and linguistically diverse nursing students were interviewed as part of data collection. Thematic analysis was used for data interpretation. RESULTS Identified factors include: Poor proficiency in English language, unfamiliarity with Australian slang and medical terminologies, cultural expectations interfering with professional responsibilities, incongruity with teaching delivery and learning style, short duration of placement, inconsistency with preceptor allocation and inadequate preceptor training. CONCLUSION Recommendations to facilitate the learning of nursing students from culturally and linguistically diverse (CALD) backgrounds on clinical placement include flexibility with assessments, modifying teaching styles according to learning needs, providing appropriate orientation, creating a welcoming environment, providing consistency with allocation of preceptors, and providing appropriate training for preceptors. Inconsistency in preceptor allocation was reported to have a negative influence on CALD student learning. A collaborative approach between Universities and the health care settings is essential in assisting clinical supervisors to address the unique learning needs of nursing students from culturally and linguistically diverse backgrounds while on clinical placement.
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