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Bussard ME, Jessee MA, El-Banna MM, Cantrell MA, Alrimawi I, Marchi NM, Gonzalez LI, Rischer K, Coy ML, Poledna M, Lavoie P. Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review. NURSE EDUCATION TODAY 2024; 134:106078. [PMID: 38184981 DOI: 10.1016/j.nedt.2023.106078] [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: 04/13/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice. DESIGN Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment. METHODS Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics. RESULTS Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study. CONCLUSION In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.
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Affiliation(s)
- Michelle E Bussard
- School of Nursing, Bowling Green State University, 924 Ridge St., Bowling Green, OH 43403, USA.
| | - Mary Ann Jessee
- School of Nursing, Vanderbilt University, 461 21(st) Avenue South, Nashville, TN 37240, USA.
| | - Majeda M El-Banna
- School of Nursing, George Washington University, 45085 University Drive, Innovation Hall, Ashburn, VA 20147, USA.
| | - Mary Ann Cantrell
- College of Nursing, Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA.
| | - Intima Alrimawi
- School of Nursing, Georgetown University, St. Mary's Hall, 3700 Reservoir Rd. NW, Washington, DC 20057, USA.
| | - Nadine M Marchi
- Inova Health System, 3300 Gallows Road, Falls Church, VA 22042-3300, USA.
| | - Lisa I Gonzalez
- College of Southern Maryland, 8730 Mitchell Rd, La Plata, MD 20646, USA.
| | - Keith Rischer
- KeithRN, 6417 Penn Ave S, Ste 8, iPMB 1383, Minneapolis, MN 55423, USA.
| | - Michelle L Coy
- Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Mari Poledna
- Arizona State University, 411 North Central Ave, Phoeniz, AZ 85004, USA.
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada.
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Oliveira Silva G, Oliveira FSE, Coelho ASG, Fonseca LMM, Vieira FVM, Campbell SH, Aredes NDA. Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis. J Clin Nurs 2023; 32:5668-5692. [PMID: 36894868 DOI: 10.1111/jocn.16681] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/11/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
AIM To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning. DESIGN Systematic review with meta-analysis. DATA SOURCES Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation. REVIEW METHODS This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods. RESULTS Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence. CONCLUSIONS Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions. RELEVANCE TO CLINICAL PRACTICE These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.
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Alshehri FD, Jones S, Harrison D. The effectiveness of high-fidelity simulation on undergraduate nursing students' clinical reasoning-related skills: A systematic review. NURSE EDUCATION TODAY 2023; 121:105679. [PMID: 36542870 DOI: 10.1016/j.nedt.2022.105679] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/29/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND High-fidelity simulation is used widely in the education of healthcare professionals; however, its effectiveness in teaching undergraduate nursing students clinical reasoning skills is not known. The objective of this systematic review is to synthesise findings from current literature about the effectiveness of high-fidelity simulation on the development of clinical reasoning-related skills in undergraduate nurses. METHODS A systematic review of the effectiveness of high-fidelity simulation was conducted, guided by the Joanna Briggs Institute methodology. Studies included were experimental and quasi-experimental study designs published in English between 2014 and 2020 that investigated clinical reasoning-related skills for undergraduate nursing students. Databases searched included Medline, CINAHL, Embase and the Joanna Briggs Institute of Evidence-based Practice database. RESULT A total of 1980 studies were identified and 15 studies met the inclusion criteria. Seven studies were randomised controlled trials, and eight studies were quasi-experimental. The 15 included studies reported 19 outcomes, as studies examined one or more outcomes of clinical reasoning-related skills. Statistically significant results favouring the simulation groups were reported in the following outcomes: clinical reasoning skills (three studies of three studies), critical thinking skills (four out of eight studies), problem-solving (two of four studies), decision-making skills (one of two studies), and clinical judgment skills (two of two studies). CONCLUSION High-fidelity simulation was reported to be effective alone and in combination with traditional teaching or other simulation types in improving undergraduate nursing students' clinical reasoning-related skills acquisition. Limitations included cost and availability of high-fidelity simulation to large numbers of students, which have implications for practice. Further research is needed to determine the actual effect of high-fidelity simulation compared to other simulation types on undergraduate nursing students' clinical reasoning-related skills.
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Affiliation(s)
- Fadiyah D Alshehri
- Department of Nursing, The University of Melbourne, Australia; The University of Bisha, Kingdom of Saudi Arabia.
| | - Sophie Jones
- Department of Nursing, The University of Melbourne, Australia; The Royal Children's Hospital Melbourne, Australia.
| | - Denise Harrison
- Department of Nursing, The University of Melbourne, Australia; The Royal Children's Hospital Melbourne, Australia; Murdoch Children's Research Institute, Australia; The University of Ottawa, Canada.
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Oliveira Silva G, Oliveira FSE, Coelho ASG, Cavalcante AMRZ, Vieira FVM, Fonseca LMM, Campbell SH, Aredes NDA. Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression. Int J Nurs Stud 2022; 133:104282. [DOI: 10.1016/j.ijnurstu.2022.104282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 01/18/2023]
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Mulyadi M, Tonapa SI, Rompas SSJ, Wang RH, Lee BO. Effects of simulation technology-based learning on nursing students' learning outcomes: A systematic review and meta-analysis of experimental studies. NURSE EDUCATION TODAY 2021; 107:105127. [PMID: 34482208 DOI: 10.1016/j.nedt.2021.105127] [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: 07/05/2021] [Revised: 08/21/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Gaps between theory and clinical practice represent challenges for nursing students during their learning processes. Providing simulation technology-based learning for nursing students is essential for modern nurse education, but evidence of efficacy remains scarce. OBJECTIVES To determine the effects of simulation technology-based learning for nursing students. DESIGN A systematic review and meta-analysis. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Five databases (CINAHL, Embase, MEDLINE, PubMed, and Web of Science) were electronically searched through May 30, 2021. Eligibility criteria included nursing students, simulated technology-based learning as the primary intervention, and randomised controlled trials or quasi-experimental studies published in English. The methodological quality of included studies was evaluated by the Cochrane risk-of-bias tool. Comprehensive Meta-Analysis Version 3.0 was used to conduct a meta-analysis using the random-effects model. Begg's and Egger's tests were performed to assess publication bias, and sensitivity analysis performed using a remove one study method. RESULTS A total of 17 studies were included in this study. Simulated technology-based learning significantly increased nursing student knowledge acquisition (standard mean difference [SMD]: 0.72, 95% confidence interval [CI]: 0.25-1.18, p < 0.001), enhanced student's confidence (SMD: 0.50, 95% CI: 0.02-0.99, p = 0.043), and increased student's satisfaction in learning (SMD: 0.81, 95% CI: 0.61-1.00, p < 0.001). Subgroup analyses showed that receiving simulation by manikins simulator had a greater effect on knowledge acquisition (SMD: 1.01, 95% CI: 0.27-1.74, p = 0.007). CONCLUSIONS Simulation technology use may meet the expectations of undergraduate nursing students and prepare them for clinical practice, representing an opportunity to fill gaps between theory and clinical practice while simultaneously developing new teaching scenarios.
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Affiliation(s)
- Mulyadi Mulyadi
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia.
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia.
| | | | - Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
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