Effectiveness of flipped classroom teaching models in nursing education: A systematic review

OBJECTIVES

The purpose of this systematic review was to reveal the evidence of how the method of flipped classroom was applied in nursing education and examine the results associated with this teaching method.

DATA SOURCES

Peer-reviewed studies published from 2013 to 2020 were selected from the PubMed, Web of Science, and Science Direct databases.

REVIEW METHODS

A systematic review was conducted according to the PRISMA Statement Guidelines. Electronic databases were searched using a range of keywords, and the findings were integrated into a narrative synthesis. Quality appraisal was undertaken.

RESULTS

In total, 7470 articles were retrieved including the 24 paper those were finally selected for the systematic reviews. The themes identified were: academic performance outcomes, student perceptions, activities, and structures.

CONCLUSIONS

It was determined that the flipped classroom method supported learning effectively and increased the quality of teaching. Nursing courses are suggested to be structured as flipped classrooms.

Is undergraduate nursing education sufficient for patient's nutrition care in today's pandemics? Assessing the nutrition knowledge of nursing students: An integrative review

AIM

To establish whether nurses are well prepared to provide nutrition care by identifying studies that evaluated undergraduate (baccalaureate) student nurses' nutrition knowledge, practices and selfcare and to identify areas for improvement.

BACKGROUND

The importance of nutrition care in health is well recognised, with poor nutrition behaviour contributing to many million deaths annually and to less resilience to COVID 19. Nurses as the largest health professional group are ideally positioned to provide basic nutrition care.

DESIGN

Integrative Review METHODS: Whittemore & Knafl's integrative review methodology guided this review. Appropriate search terms were used in seven databases (PubMed, Medline, Embase, ProQuest Nursing and Allied Health, the Royal College of Nursing Journals, Scopus) for Undergraduate nurses' nutrition knowledge during the period 2010-2020. The quality of the studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Of the 250 studies identified, ten studies met the inclusion criteria: seven studies also investigated nurses' eating patterns and health habits. Two themes emerged from data synthesis and analysis. Nursing students lack sufficient nutrition knowledge to develop the professional capacity to provide effective nutrition care to patients; nursing students' eating patterns and health habits suggest insufficient nutrition knowledge for appropriate selfcare.

CONCLUSION

Improvements in undergraduate nutrition care are required. Consideration should be given to the inclusion of nutrition experts to guide nurse educators to develop and implement innovative nutrition care programmes.

Hand hygiene education of Greek medical and nursing students: A cross-sectional study

AIM

To investigate medical and nursing students' education on hand hygiene, their attitude on hand hygiene education and how this education influences their hand hygiene knowledge and practices.

BACKGROUND

Hospital-acquired infections are associated with prolonged hospitalisation and mortality. The most effective measure for their control is healthcare workers' hand hygiene compliance. Since medical and nursing students constitute the future healthcare workers, our study focuses on them.

DESIGN

Cross-sectional study METHODS: This study was conducted during the academic year 2016-2017, using a modified World Health Organisation questionnaire. Our sample consisted of 132 medical and 111 nursing students from National and Kapodistrian University of Athens, Greece. In data analysis, the Mann-Whitney and Fisher's exact tests were applied to compare differences in continuous variables and proportions in categorical variables, respectively. Knowledge and practices overall scores were calculated per student group. Multiple linear regression analyses were performed to assess the influence of potential confounders on these scores.

RESULTS

We found that 73.1% of medical and 98.2% of nursing students had received relevant education, which was reported as "only theoretical" by 77.4% of the former and as "hands-on and theoretical" by 88.1% of the latter group. Besides the risk of infection, knowledge acquired in lectures and trainer's behaviour were also considered very influential factors shaping hand hygiene attitude in both groups. Overall, medical students reported better hand hygiene practices than nursing ones (69.9% and 59.7%, respectively; p < 0.001). The opposite finding was observed regarding their overall knowledge on hand hygiene (57.2% of medical versus 60.4% of nursing students, p = 0.04). The majority of students (86.6% of all participants; p < 0.001) supported the inclusion of compulsory hand hygiene education in their curriculum. Compulsory education and seminars were assessed as the most effective measures to increase hand hygiene compliance (71.4% of all students).

CONCLUSION

In our study, medical students scored better in practices questions than nursing students; this did not apply for the knowledge score. The majority of students supported the inclusion of compulsory education on hand hygiene principles in their Departments' curricula, highlighting compulsory education and seminars as the most effective measures to increase compliance with hand hygiene.

The knowledge about patient safety among undergraduate nurse students in Cyprus and Greece: a comparative study

BACKGROUND

The Patient safety movement contributed to the reduction of preventable adverse events associated with health care. Although patient safety issues have received the attention of educators in the health care studies, there is evidence that in nursing education and the associated curricula it is not well-incorporated. This may not allow students to acquire scientific knowledge and develop strong competencies to assure patient safety throughout their professional life. The aım of the study was the exploration of the undergraduate nursing student perspectives regarding knowledge received during their training about patient safety-related issues.

METHODS

A descriptive comparative study was conducted with three and four-year undergraduate nursing students from the Cyprus Republic (n = 243) and Greece (n = 367). All students were surveyed using the Health Professional Education Patient Safety Survey (H-PEPSS) to describe students' knowledge in the classroom and clinical setting.

RESULTS

Students' Knowledge about patient safety was expressed significantly higher (p < 0.001) in the classroom (mean = 4.0) than the clinical setting (3.7) (1-5 scale). The knowledge in the dimension "clinical aspects" received the highest score and "working in teams" received the lowest. Also, differences were recorded between countries wıth Cypriot students reporting hıgher level of knowledge than the Greek students in most of the dimensions. CONCLUSıON: The findings revealed the gap between theory and practice and the need for collaboration between the two settings. Also, students reported relatively higher knowledge with regards to the technical aspects of patient safety. Still, they were less knowledgable about the sociocultural aspects of the patient, such as working in teams.

Relationship between sleep habits and academic performance in university Nursing students

Background

Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students.

Methods

This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the ‘Morningness and Eveningness scale’, an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the ‘sleep habits questionnaire’ was assessed with the Cronbach’s alpha test.

Results

Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the ‘sleep habits questionnaire’ was appropriate (Cronbach’s alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01–2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11–2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30–3.98) were independently associated with a higher probability of poor academic performance.

Conclusions

Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00635-x.

COVID-19 Outbreak: Effect of an Educational Intervention Based on Health Belief Model on Nursing Students' Awareness and Health Beliefs at Najran University, Kingdom of Saudi Arabia

This study aimed to investigate the effect of an educational intervention based on the health belief model (HBM) about COVID- 19 on nursing students' awareness and health beliefs. A true-experimental research design was conducted at nursing college, Najran University, KSA. A comprehensive sampling was followed to include all female students at the colleges (164 students). The sample was divided randomly into intervention (82) and control group (82). The educational intervention was designed and conducted based on the HBM through four sequential phases: assessment, planning, implementation, and evaluation. The current study results indicated no statistically significant differences between intervention and control groups concerning their demographic characteristic, awareness, and health beliefs before intervention. After intervention, significant differences (p < 0.05) were observed between intervention and control groups in their awareness and all HBM constructs regarding COVID19. There were positive, statistically significant correlations (P < 0.05) between participants' total HBM score and their total awareness score. This study concluded that HBM is effective in increasing nursing students' awareness regarding COVID-19. It also increases their perceived susceptibility, severity, and benefits. Besides, it may increase their self-efficacy to overcome perceived barriers to practice protective and preventive actions while dealing with COVID-19.

Caring in process: A 3-year qualitative longitudinal study of nursing students

AIM

This paper aims to describe caring perceptions and behaviors among student nurses in Italy as they progress through their nursing education.

BACKGROUND

As nursing students are potential nurses of the future, there is an expectation that in addition to appropriate academic qualifications, they will develop appropriate caring behaviors/attitudes. However, there has been some evidence that the educational process does not always modify their caring perceptions/behaviors or that the direction of the change is not always positive.

DESIGN

A qualitative longitudinal design with three data collection points, was performed from October 2013 to October 2016 at the University of Verona, Trento Campus.

METHODS

Semi-structured interviews were conducted at the time of entry into a 3-year bachelor's degree program in nursing and at the end of the second and third years. Observation of the students during their clinical practice was carried out at the end of each of the three years of education. Thirty students commenced the study and 24 finished. Data were analyzed using a phenomenological approach.

RESULTS

The iterative process of analyzing interviews and observations resulted in nine themes collectively from all three stages: establishing a trusting relationship with the patient, satisfying the patient's needs, paying attention, being respectful, being competent, giving time, being concerned with the emotional dimension, acting within context to facilitate caring actions and giving information.

CONCLUSIONS

At the end of the third year the students' concept of caring was enhanced; their initial generic or lay view of caring turned into an intentional, competent, conscious, accountable and realistic caring approach.

Nursing students' evolving professional values: Capturing their journey through co-operative inquiry

AIM/OBJECTIVE AND BACKGROUND

Despite a worldwide emphasis in nursing codes of practice that state nurses must uphold professional values to be caring and compassionate, evidence continues to emerge of poor-quality care standards. Existing literature attests to a tendency to deteriorating caring values as students' progress through their nursing programme. In response, one university in England exposed pre-registration nursing students to a values-based curriculum which embedded Todres et al.'s (2009) Humanising Values Framework.

DESIGN AND METHODS

This paper describes the later stages of a co-operative inquiry, where students as participants explore their evolving values around person-centred approaches to care as they engaged with clinical practice. Data were collected between 2013 and 2016.

RESULTS AND CONCLUSION

Findings reveal how students developed their confidence and resilience in the face of situations that challenged their value base by internalising a humanised approach to care. They demonstrated this in practice by using problem-based coping strategies, peer and mentor support. Engagement with a curriculum based on humanistic philosophy encouraged students as participants to feel confident in the practice of person-centred care.

Comparing formative and summative simulation-based assessment in undergraduate nursing students: nursing competency acquisition and clinical simulation satisfaction

BACKGROUND

Formative and summative evaluation are widely employed in simulated-based assessment. The aims of our study were to evaluate the acquisition of nursing competencies through clinical simulation in undergraduate nursing students and to compare their satisfaction with this methodology using these two evaluation strategies.

METHODS

Two hundred eighteen undergraduate nursing students participated in a cross-sectional study, using a mixed-method. MAES© (self-learning methodology in simulated environments) sessions were developed to assess students by formative evaluation. Objective Structured Clinical Examination sessions were conducted to assess students by summative evaluation. Simulated scenarios recreated clinical cases of critical patients. Students´ performance in all simulated scenarios were assessed using checklists. A validated questionnaire was used to evaluate satisfaction with clinical simulation. Quantitative data were analysed using the IBM SPSS Statistics version 24.0 software, whereas qualitative data were analysed using the ATLAS-ti version 8.0 software.

RESULTS

Most nursing students showed adequate clinical competence. Satisfaction with clinical simulation was higher when students were assessed using formative evaluation. The main students' complaints with summative evaluation were related to reduced time for performing simulated scenarios and increased anxiety during their clinical performance.

CONCLUSION

The best solution to reduce students' complaints with summative evaluation is to orient them to the simulated environment. It should be recommended to combine both evaluation strategies in simulated-based assessment, providing students feedback in summative evaluation, as well as evaluating their achievement of learning outcomes in formative evaluation.

Factors associated with perceived stress of clinical practice among associate degree nursing students in Taiwan

Background

Clinical placements play an important role in helping nursing students to achieve clinical competence, but these placements can be highly challenging and stressful. It has been shown that stress can be either a trigger or aggravating factor for ill-health in general, but studies have seldom differentiated the impact of general health status on perceived stress.

This study examined factors associated with perceived stress of clinical practice among nursing students with a particular focus on the effect of general health status on stress.

Methods

This was a cross-sectional quantitative study conducted among 724 associate nursing degree students in Southern Taiwan.

Results

Health status scores varied from 28 to 139, with an average of 68.40 (SD = 25.75). Health status was reported to be ‘good’ (scores 28–55) in 35.5% of participants, moderate (scores 56–83) in 24.6%, and poor (Scores ≧ 84) in 39.9% of participants. Perceived stress scores ranged from 0 to 95 points with an average score of 36.65 (SD ± 15.95). The classification and regression tree (CART) analysis showed health status as the most important factor linked to perceived stress with a Normalized Importance value of 100%. Those who reported general health status (measured through General Health Questionnaire (GHQ)-28) score of ≤34.5 perceived mild stress and those with a score of > 34.5–< 84.5 perceived moderate stress. A score of 84.5 was found to be the point of transition to perceptions of severe stress. When health status score was greater than 84.5, perceived stress was at a severe or extremely severe level.

Conclusions

Our findings indicated health status as a potential measure to identify students who were most vulnerable to perceived stress. Given the cross-sectional design of this study and the bidirectional relationship between health and stress, more studies are needed to fully establish the predictive link between general health status and vulnerability to stress.

Are intensive care units good places for nursing students' learning compared to other settings? Findings from an Italian national study

OBJECTIVE

To explore students' perceived quality of the intensive care unit learning environment during their rotations; to compare these perceptions with that reported by students attending other settings and to assess correlations between the perceptions regarding the quality of the environment and the competences learned.

RESEARCH METHODOLOGY

A secondary analysis of data collected by a national cross-sectional study carried out in Italy. A total of 9607 nursing students participated; they ranked the intensive care units' quality, as assessed by the Clinical Learning Quality Evaluation Index; the perceived competences learned were also ranked with a Likert scale; from 0 = None to 3 = Very much.

RESULTS

A total of 323 (3.5%) participants attended their rotation in an intensive care unit. They perceived the quality of the environment to be significantly higher (n = 2.11 out of 3) than those rotating in non-intensive care unit wards (n = 1.91; p < 0.001). The competences learned by intensive care unit students were significantly higher than that reported by students attending non-intensive care unit wards (n = 2.31 out of 3 vs 2.06 out of 3; p < 0.001).

CONCLUSION

Intensive care units are highly appreciated by students, both in terms of their quality learning environment and their capacity to promote learning compared to other settings. Therefore, intensive care units should be considered as a place for clinical rotation to promote positive attitudes regarding critical care patients.

Environmental Awareness and sensitivity of nursing students

OBJECTIVE

Currently, environmental problems have reached alarming levels, constituting a serious problem for public health. This study was conducted in order to evaluate the environmental awareness and sensitivity of nursing students.

METHODS

This descriptive study was conducted on 286 nursing students of a foundation university in Northern Cyprus in the fall term of the 2016-2017 academic year. Data were collected by using the personal information form and Environmental Awareness and Sensitivity Scale. Participants had moderate levels of environmental awareness and sensitivity. Nonsmoking nursing students had higher environmental awareness. Besides, participants who attended lectures on the environment, stayed in dormitories, participated in the activities of environmental organizations, and warned people who polluted the environment had higher environmental awareness and sensitivity.

CONCLUSION

These findings suggest that the number of lectures and social activities on the environment could be increased in order to promote the environmental awareness of nursing students.

Use of academic electronic medical records in nurse education: A scoping review

BACKGROUND

Use of academic electronic medical records is internationally recognised as a means for preparing health professional students for the digital healthcare environment. Reported practice benefits include skills for electronic documentation, health informatics, point-of-care clinical decision support systems, as well as preparation for information technology-enabled clinical settings, while challenges include lack of access to simulation software, faculty-related barriers, limited finances and educational software costs. However, little is known about best practices related to its use within pre-licensure or entry-to-practice nursing curricula and impact on clinical practice outcomes.

OBJECTIVE

This review sought to explore how academic electronic medical records are used in entry-to-practice nursing curricula.

DESIGN

A scoping review guided by the Joanna Briggs Institute three-step search strategy, exploring existing publications and grey literature.

INCLUSION CRITERIA

Quantitative and qualitative studies related to use of academic electronic medical records in pre-licensure nurse education.

INFORMATION SOURCES

A range of databases were searched including CINAHL, Medline, Proquest Central, ERIC, ScienceDirect, PubMed, IOS Press, as well as grey literature, reference lists and handsearching.

REVIEW METHODS

The search yielded 580 articles, from which inductive thematic analysis of 34 included studies was conducted.

RESULTS

Included articles were nine qualitative, 21 quantitative and five mixed methods studies. Most originated from the USA. Academic electronic medical records are mainly used to teach documentation, safe use of health technology, and for clinical preparation. Most are used for fundamental or junior levels courses, with problem-based learning and simulation embedded. Institution's technology resources and faculty capability are essential to implementation.

CONCLUSIONS

There is a need for more research that examines optimal timing and duration of use of academic electronic medical records in curricula, and their impact on critical thinking and clinical performance. Finally, there is a need to explore greater academic-clinical partnerships in the education process.

Factors behind why nursing students do not recognize patient needs occurring while confirming intravenous infusion even when they observe them: A comparative descriptive design study

BACKGROUND

Novice nurses are often unable to watch their surroundings closely when concentrating on their work or recognize them even when observing them closely. However, factors behind this have not been previously explored.

OBJECTIVES

The purpose of this study was to clarify why nursing students did not recognize the patient's needs while checking an infusion.

DESIGN

A comparative, descriptive design study.

SETTINGS

The mock hospital room was set up in a training room of the School of Nursing, University A using partitions. The participants checked an infusion under experimental conditions, and we confirmed whether they recognized the patient's needs, which were signs of discomfort such as "uncomfortable posture," "disheveled pajamas," and "creased sheets."

PARTICIPANTS

A total of 43 students participated, including second- and third-year students of the School of Nursing, University A.

METHODS

The subjects confirmed in an interview whether they had recognized the needs. Their observational behaviors toward the patient and surroundings were measured with an eye mark recorder. Working memory capacity and mental load were measured with Japanese versions of Reading Span Test (RST) and NASA Task Load Index (NASA-TLX).

RESULTS

Seventeen students recognized the patient's needs. Twelve (70.6%) recognized them when entering the room, with no significant differences in their watching behaviors between the Cognitive and Non-cognitive Groups. RST results were significantly high in Non-cognitive Group (P < .02), and only temporal demand among the sub-items of NASA-TLX presented high.

CONCLUSIONS

The nursing students who did not recognize the patient's needs while checking an infusion were watching the patient in the same way as the students who did recognize the patient's needs. We presumed that the factors for being unable to recognize were an over-focus on checking on infusion and time pressure.

Psychometric properties of the Attitudes towards Medical Communication Scale in nursing students

BACKGROUND

Adequate communication skills in healthcare professionals are one of the key elements required for achieving high-quality healthcare. Thus, measurement instruments able to assess the dimensions related to these skills, including attitudes towards communication, are useful and convenient tools.

OBJECTIVES

To (a) cross-culturally adapt and validate a scale to measure attitudes towards communication in a sample of nursing students in the Spanish environment; (b) describe the perceived attitudes of nursing degree students towards communication.

METHODS

We conducted an instrumental study. First, we adapted the scale by applying a standardised linguistic validation procedure. After that, we determined its structural equivalence and evaluated its psychometric properties.

PARTICIPANTS

A total of 255 students participated; their average age was 22.66 years (SD = 4.75) and 82% were female.

RESULTS

The internal consistency of the scale was adequate (0.75), and the data fit well with the model (CFI = 0.99; TLI = 0.99; RMSEA = .01 95% CI [.00-.05]). The overall instrument score poorly correlated with the self-efficacy in communication skills variable.

CONCLUSIONS

The attitudes towards communication scores for these nursing students were high. The Spanish version of the Attitudes Towards Health Communication scale had adequate psychometric properties and this tool could quickly and easily be applied to assess the attitudes of health profession students.

Applying team-based learning in a transnational post registration bachelor of nursing program in Singapore

Background

Team-Based Learning (TBL) is growing in popularity as a method to create active learning within larger group lectures. It is facilitated through phases of individual work, teamwork with immediate feedback and an application exercise, to develop students’ understanding and assessment of conceptual knowledge. A single facilitator can manage many groups within larger lectures. The study aim was to evaluate the impact of TBL on the engagement, learning and satisfaction of students enrolled in a transnational post registration Bachelor of Nursing (BN) program in Singapore.

Methods

A cross-sectional design was employed. The TBL approach was delivered during lecture sessions within a post registration BN program delivered in a Higher Education Institution in Singapore. A sample of BN students was drawn from 305 students undertaking the program. An online anonymous university-delivered student evaluation of course (SEC) survey and an online anonymous survey using the Student Assessment Instrument, were used to collect quantitative and qualitative data. Survey participation was voluntary with informed consent protocols followed. Student performance in the course was also reviewed.

Results

Eighty-two students (27%) completed the SEC scoring a median of 4/5 for satisfaction, and 68 (22%) completed the online survey. As 93 was the neutral score for the survey, there was a moderately positive evaluation with an overall score of 108.5/155 for TBL in accountability for learning, TBL preference and satisfaction with TBL compared to traditional lecture approaches.

Conclusions

Implementation of TBL with this cohort demonstrated evidence of moderately positive engagement, learning and satisfaction when compared to traditional didactic lectures.

Nursing students' expectations of the process of writing a bachelor's thesis in Sweden: A qualitative study

While performing various academic work, such as writing a bachelor's thesis, are known to be challenging for university students, less is known about students' expectations in this regard.

AIM

The aim was to describe students' expectations of the upcoming process of writing a bachelor's thesis.

DESIGN

The study employed an explorative, qualitative approach with a single, written open-ended question design.

METHODS

The data were collected consecutively 2013-2016 in class. A total of 93 final-year students volunteered and provided hand-written accounts which were analyzed using qualitative content analysis.

RESULTS

The students' accounts revealed three generic categories of expectations: Gaining professional knowledge and competency, Planning and organizing the work, and Taking stock of personal resources. Writing a bachelor's thesis was a new challenge for most of the students and the answers testify to mixed feelings about the upcoming work and its supervision.

CONCLUSIONS

The nursing students' expectations included present and future competencies, skills and abilities. In promoting development of transferable skills and knowledge, educators of future health-care professionals would be well advised to invite students to reflect on and discuss, their expectations prior to writing a bachelor's thesis and similar academic student papers. This study adds to the research on students' studying and learning in nursing education by bringing to the fore students' expectations of academic learning tasks as an important aspect to consider in higher education contexts, both nationally and internationally.

Enhancing generic capabilities and metacognitive awareness of first-year nursing students using active learning strategy

Background

Developing students’ generic capabilities is a major goal of university education as it can help to equip students with life-long learning skills and promote holistic personal development. However, traditional didactic teaching has not been very successful in achieving this aim. Kember and Leung’s Teaching and Learning Model suggests an interactive learning environment has a strong impact on developing students’ generic capabilities. Metacognitive awareness is also known to be related to generic capability development. This study aimed to assess changes on the development of generic capabilities and metacognitive awareness after the introduction of active learning strategy among nursing students.

Methods

This study adopted a quasi-experimental single group, matched pre- and posttest design. It was conducted in a school of nursing at a university in Hong Kong. Active learning approaches included the flipped classroom (an emphasis on pre-reading) and enhanced lectures (the breaking down of a long lecture into several mini-lectures and supplemented by interactive learning activities) were introduced in a foundational nursing course. The Capabilities Subscale of the Student Engagement Questionnaire and the Metacognitive Awareness Inventory were administered to two hundred students at the start (T0) and at the end of the course (T1). A paired t-test was performed to examine the changes in general capabilities and metacognitive awareness between T0 and T1.

Results

A total of 139 paired pre- and post-study responses (69.5 %) were received. Significant improvements were observed in the critical thinking (p < 0.001), creative thinking (p = 0.03), problem-solving (p < 0.001) and communication skills (p = 0.04) with the implementation of active learning. Significant changes were also observed in knowledge of cognition (p < 0.001) and regulation of cognition (p < 0.001) in the metacognitive awareness scales.

Conclusions

Active learning is a novel and effective teaching approach that can be applied in the nursing education field. It has great potential to enhance students’ development of generic capabilities and metacognitive awareness.

Learning compassionate care: Experiences of nursing students

Compassion is a core value of the nursing profession which enables nurses to empathize with and help alleviate patient suffering. Literature increasingly reports a lack of compassion in patient care by students and junior nurses; empirical knowledge regarding experiences of compassionate care among nursing students remains understudied. Student experiences in the clinical setting may influence their development of compassion competencies. This study explored the experiences of baccalaureate nursing students in gaining competencies to deliver compassionate care during their clinical practice year. A descriptive qualitative study using semi-structured in-depth interviews was conducted. Thematic analysis was employed, generating six themes. The first three themes depict positive aspects of compassion development, including 'gaining patient acceptance,' 'motivation for professional growth,' and 'establishing an emotional bond with patients.' On the other hand, the other three themes capture the barriers to compassionate care, 'distrust,' 'fear of harm due to violence,' and 'heavy workload.' The positive and negative experiences shared by students indicate that hospital and nursing administrators need to foster a positive practice environment and nursing instructors should become role models to encourage compassionate care.

Investigation of the relationship between nursing students' disgust sensitivity and caring behaviours

AIM

This study aimed to investigate the disgust sensitivity of nursing students, the factors affecting this sensitivity, their caring behaviors and the relationships between these components.

BACKGROUND

Disgust sensitivity has been conceptualized as the degree of disgust felt in response to various stimuli. Nursing students often encounter recognized disgust triggers in clinical practice, such as feces, mucus, urine, foul-smelling wounds and contact with the dead. The nursing students' disgust sensitivity can affect the way they think and may affect their care behaviors.

DESIGN

The study used a descriptive cross-sectional design and was conducted with nursing students in a Turkish university nursing program (n = 577).

METHODS

The study data was collected through the Disgust Sensitivity Scale-Revised Form and the Caring Assessment Questionnaire.

RESULTS

Of the students in the study, 59.6% stated that they experienced disgust while providing care. A negative relationship was found between students' total scores from the Disgust Scale and the Caring Assessment Questionnaire (p < 0.01). The students' disgust sensitivity level was high and the higher the disgust sensitivity, the fewer caring behaviors they exhibited.

CONCLUSIONS

In light of these findings, it can be said that the caring behaviors of nursing students are negatively influenced by disgust sensitivity. Hence, nurse educators need to evaluate students' disgust sensitivity, help students to identify and address their disgust emotions, deal with disgust management strategies together and be aware of when students need support.

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate

BACKGROUND

Nursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession.

PURPOSE

Using a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs.

METHOD

This was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI).

RESULTS

Scores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (β = 0.93, p < .01), CCTIDI (β = 0.13, p < .001), and class climate (β = 5.20, p < .01). An intraclass correlation coefficient was 55.48%.

CONCLUSION

This study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.

Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews

BACKGROUND

In nursing students, high stress levels can lead to burnout, anxiety, and depression. Our objective is to characterize the epidemiology of perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa region.

METHODS

We conducted an overview of systematic reviews. We systematically searched PubMed, Embase, PsycInfo, and grey literature sources between January 2008 and June 2020 with no language restrictions. We included any systematic review reporting measurable stress-related outcomes including stress prevalence, stressors, and stress coping strategies in nursing students residing in any of the 20 Middle East and North Africa countries. We also included additional primary studies identified through a hand search of the reference lists of relevant primary studies and systematic reviews.

RESULTS

Seven systematic reviews and 42 primary studies with data from Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan were identified. Most studies included nursing students undergoing clinical training. The prevalence range of low, moderate, and high perceived stress among nursing students was 0.8-65%, 5.9-84.5%, and 6.7-99.2%, respectively. Differences related to gender, training period, or the type of tool used to measure stress remain unclear given the wide variability in the reported prevalence measures across all stress levels. Common clinical training stressors were assignments, workload, and patient care. Academic training-related stressors included lack of break/leisure time, low grades, exams, and course load. Nursing students utilized problem focused (dealing with the problem), emotion focused (regulating the emotion), and dysfunctional (venting the emotions) stress coping mechanisms to alleviate their stress.

CONCLUSIONS

Available data does not allow the exploration of links between stress levels, stressors, and coping strategies. Limited country-specific prevalence data prevents comparability between countries. Reducing the number or intensity of stressors through curriculum revision and improving students' coping response could contribute to the reduction of stress levels among students. Mentorship, counseling, and an environment conducive to clinical training are essential to minimize perceived stress, enhance learning, and productivity, and prevent burnout among nursing students.

Development of a community outreach project: An interprofessional partnership for thalassemia families guided by nursing students

Children with chronic illnesses have improved physiological and psychosocial outcomes when they are able to identify and converse with others who experience the same challenges. Support groups are one way to enhance this interaction. To facilitate this process, student nurses worked with an interprofessional healthcare team, thalassemia patients, and their families to determine their support needs. The purpose of this article is to describe the innovative development and outcomes of the Thalassemia Patient Support Project, a community engagement partnership. This partnership provided a unique educational clinical experience for nursing students where they had an opportunity to help develop a support group and a pediatric to adult transitional care program. The outcomes could be used as a guide for community nursing education, in US and international settings.

The effects of CPBL + SBAR teaching mode among the nursing students

OBJECTIVE

To investigate the effect of CPBL (Problem Based Learning on Case) combined with SBAR (Situation, Background, Assessment and Recommendation) mode in clinical teaching for nursing students.

BACKGROUND

Clinical internship training is the key step for the nursing education. The clinical thinking ability of Chinese nurses is mostly at the middle or low level. To improve clinical thinking ability, especially critical thinking, is of great significance to the nursing practice education.

METHODS

102 nursing students of the Third Xiangya Hospital, Central South University were selected as the participants from June 2018 to September 2019. We applied the CPBL + SBAR mode to the participants during the practice teaching, and conducted questionnaires and semi-structured interview pre- and post-intervention.

RESULTS

After intervention, the nursing students' scores of critical thinking ability (311.47 ± 22.67) were higher than those before intervention (289.75 ± 19.94); the total score (69.84 ± 6.217) and scores in four dimensions of positive problem orientation (RPO), negative problem orientation (NPO), avoidance style (AS) and impulse neglect style (ICS) were all lower than that before intervention (75.53 ± 6.09); the score of rational problem solving (RPS) (18.38 ± 2.714) was higher comparing to the that of pre-intervention (17.11 ± 2.20); the difference was statistically significant (P < 0.05). The approval rate of nursing students to the positive effect of CPBL + SBAR teaching mode was from 78.43% to 93.13%. The semi-structured interview suggested that the model was worth promoting, but the implementation duration was limited.

CONCLUSION

CPBL + SBAR teaching mode could improve the nursing students' critical thinking and problem-solving ability. The nursing students and teachers' satisfaction to the new teaching mode was high.

Personal values among first-year medical and nursing students: A cross-sectional comparative study

BACKGROUND

Collaboration in healthcare is essential but differences in personal values can be a potential source of disagreements between physicians and nurses.

OBJECTIVES

The purpose of this study was to verify if and to what extent there were divergences in the personal values profile between medical and nursing students at the beginning of their education and training. A second aim was to explore gender differences in personal values.

DESIGN

This is an observational cross-sectional study.

SETTINGS

This study was conducted at one University in northern Italy.

PARTICIPANTS

We compared the personal values of 393 first-year medical students with those of 403 first-year nursing students.

METHODS

The Portrait Values Questionnaire-40 was administered and analyses of variance were performed to assess degree group and gender differences in terms of personal values.

RESULTS

Medical students scored significantly higher than nursing ones on values related to dominance over others and personal success. Female students significantly outscored males on personal values that reflect other-oriented and social focus, whereas male students obtained higher scores than females on personal values related to personal and selfish orientation.

CONCLUSIONS

Schwartz's Theory of Basic Human Values may be a valuable theoretical framework for interprofessional education to promote a common reflection on personal values held by medical and nursing students since the early years of study.