What is provided and what the registered nurse needs--bioscience learning through the pre-registration curriculum

Content Coverage as a Persistent Exclusionary Practice: Investigating Perspectives of Health Professionals on the Influence of Undergraduate Coursework

STEM undergraduates navigate lengthy sequences of prerequisite courses covering volumes of science content. Given that these courses may contribute to attrition and equity gaps in STEM, research is needed to test the assumption that prerequisite content benefits students in their future studies and careers. We investigated the relevance of prerequisite course content for students' careers through semistructured interviews with practicing nurses regarding their undergraduate anatomy and physiology (A&P) courses. Nurses reported that A&P content does not align with the skills and knowledge needed in the nursing profession. Interviewees averaged 39% on a brief A&P assessment, suggesting A&P prerequisites failed to impart a high degree of long-term A&P knowledge among nurses. Further, practicing nurses perceived overcommitment to A&P content coverage as an exclusionary practice that eliminates capable individuals from the prenursing pathway. These findings challenge assumptions surrounding the justification for prerequisite course content and raise questions of whether content expectations actively exclude individuals from STEM or healthcare careers. We aspire for this study to stimulate conversation and research about the goals of prerequisite content, who is best positioned to articulate prerequisite content objectives, and the influence of content coverage on equity and justice in undergraduate STEM education.

Integration of anatomy and physiology into nursing practice as perceived by undergraduate students and registered nurses: a scoping review

OBJECTIVE

The current study aimed to determine perceptions of registered and student nurses regarding the integration of anatomy and physiology into nursing practice.

METHODS

This scoping review was conducted following the checklist provided in the Reporting Items for Systematic reviews and Meta-Analysis extension for scoping reviews. Articles published in PubMed, ERIC, and CINAL from January 1, 2002 to September 30, 2022 were included.

RESULTS

A literature review of 20 articles that matched the indicative criteria revealed that both undergraduate student and registered nurses recognized knowledge of anatomy and physiology as important to nursing practice. Student nurses recognized that such knowledge is related to understanding patient pathophysiology, patient observation, treatment selection, and patient safety and forms the basis for nursing practice. Registered nurses who were confident in their knowledge of anatomy and physiology also reported that they were able to explain the rationale for their nursing practice. They also reported that this knowledge is necessary for communication with multiple professions, which promotes patient/family trust in nurses and is the basis for building trusting relationships with patients and their families.

CONCLUSIONS

Although undergraduate student and registered nurses recognized the importance of learning anatomy and physiology, the integration of anatomy and physiology into nursing practice was not the same for all student and registered nurses. This suggests the need to investigate the overall perceptions of nurses regarding the integration of anatomy and physiology into nursing practice and for faculty to discuss how to facilitate critical thinking among students.

Horizontal integration of bioscience and nursing in first-year nursing curricula: A systematic review

OBJECTIVES

To systematically identify, appraise and summarise available evidence related to the horizontal integration of bioscience and nursing in first-year nursing curricula; to examine students', nurses' and academics' perceptions of the integration and provide recommendations for future curriculum development, practice and research priorities.

DESIGN

A systematic review.

DATA SOURCES

An online search of Ovid Medline, Ovid Emcare, CINAHL, Embase Classic + and Embase, ERIC, A+Education, Scopus (Elsevier) and Google Scholar was conducted between July and September 2021. A manual search of the reference list of included articles was also undertaken.

REVIEW METHODS

This systematic review followed The PRISMA Statement. The study selection process was managed using the Covidence software platform and quality was assessed using JBI Critical appraisal tools and Mixed Methods Appraisal tools. A narrative synthesis of included studies was undertaken.

RESULTS

Six articles were identified which met the inclusion criteria. The study population included students, academics and registered nurses. Four studies used clinical scenarios as a method of horizontally integrating bioscience and nursing content. The integration outcomes were measured by student understanding and learning, satisfaction and motivation. Students', nurses' and academics' perceptions of integration challenges were: i) depth of bioscience content; ii) structure of bioscience content; and iii) knowledge and experience.

CONCLUSIONS

This systematic review did not identify a wide range of methods to integrate bioscience in first year nursing curricula. The use of clinical scenarios increased student understanding and learning. However, teaching academics needed to be cognizant of both nursing and bioscience to achieve the required depth of bioscience content and demonstrate integration of bioscience in nursing practice. There is a need for further investigations of methods of horizontal integration of bioscience and nursing in the first-year nursing curricula.

Nurses' perspectives on the application of humanistic anatomical knowledge in clinical practice

Knowledge of human anatomy is vital for nurses. Medical educators use a variety of educational pedagogies, including the use of cadavers, to cultivate nursing students into competent and professional care providers and to help them gain authentic experience and knowledge before entering the workplace. Studies have provided numerous examples of students with positive learning experiences in human-centric (humanistic) anatomy courses; however, whether these positive experiences translate into effective clinical practice remains largely unknown. This study explored nurses' perspectives on the effects of a humanistic anatomy program on their nursing practice. Focus groups with semi-structured interview guidelines were conducted to collect data. Twenty-one nurses working in hospitals in Taiwan participated and divided themselves into four groups on the basis of willingness to participate and availability. The interviews were recorded using smartphones, and the recordings were transcribed using a computer. The transcriptions were then checked word by word artificially and analyzed by hand. Three main themes emerged during the analysis: adapting to the professional journey, managing time when providing humanistic care, and cultivating professionalism. The results demonstrate educators' expectations that humanistic anatomy education for nursing students expands students' professional knowledge and helps them develop humanistic competencies as professional nurses.

Nursing students' perceptions of clinical relevance and engagement with bioscience education: A cross-sectional study of undergraduate and postgraduate nursing students

BACKGROUND

Bioscience in nursing education covers a broad range of disciplinary areas (anatomy, physiology, pathophysiology and pharmacology) and underpins clinical assessment and critical thinking in nursing practice. This is imperative for patient safety and favourable patient outcomes. In nursing programs for registration, most bioscience content is taught during the early phases of the program and little incorporated into postgraduate nursing programs.

OBJECTIVES

The aim of this study was to explore student's perceived relationship between clinical relevance and engagement (attention and time) with bioscience content, by surveying undergraduates and postgraduate nursing students.

DESIGN

This sequential mixed methods study included two phases.

METHODS

The first phase comprised of focus group interviews from one Australian University. Thematic analysis of these data, coupled with existing literature, informed the second study phase; a quantitative questionnaire.

PARTICIPANTS

Focus group interviews included N = 30 students from one tertiary site; 10 from each year level. The questionnaire was administered to nursing students undertaking undergraduate nursing studies (1st, 2nd & 3rd years), and postgraduate nursing studies.

RESULTS

Nursing students (n = 406) across three Australian universities (four programmes) completed the questionnaire. The clinical relevance of bioscience was widely appreciated; 91.6% of undergraduate nursing students and 98.5% of postgraduate nursing students indicated that every nurse must have a good understanding of bioscience. However, there was an inverse relationship between engagement with bioscience and timing in the curriculum, as 50% of undergraduate nursing students indicated that bioscience content took up too much of their time, compared to only 20% of postgraduate nurses (odds ratio 0.27 [0.16-0.46], p < 0.001).

CONCLUSION

Nursing students' perceptions of the clinical relevance of bioscience for their career strongly corresponds with their progression through their studies. Unfortunately, as students progress to the later years of their nursing education, their engagement with formal bioscience education decreases. This poses the question 'Are we delivering bioscience content to nursing students at the appropriate time?'

Second-Year Nursing Students' Retention of Gross Anatomical Knowledge

Human anatomy is a foundational course in nursing education, however, there is growing concern that students do not retain enough anatomical knowledge to successfully apply it in clinical settings. The aim of this study was to determine retention level of anatomy knowledge among second-year nursing students from their first-year anatomy class, and to determine if there is a difference in level of retention based on organ system. For each system, second-year students were asked to answer 9 to 11 multiple-choice questions (MCQs), and the scores from these quizzes were compared to matched test items from their first-year anatomy examinations. There was a significant decrease in the overall mean score from 83.05 ± 8.34 (±SD) in first year to 54.36 ±12.9 in second year (P = 0.0001). Retention levels were system specific. System-specific knowledge retention was highest for the gastrointestinal system (89.7%), respiratory system (88.5%), and genitourinary system (83.6%). This was followed by the integumentary system (80.1%), special senses (79.4%), nervous system (74.9%), and musculoskeletal system (69.3%). Retention was lowest for the lymphatic system (64.3%), cranial nerves (58.8%), vascular system (53.9%), and head and neck (42.6%). The present study shows that nursing students' anatomy knowledge retention was comparatively higher than rates reported by others in medical and allied-health students. The researchers are now investigating knowledge retention in third- and fourth-year nursing students. Further investigation into why retention is higher for specific systems and intervention strategies to improve knowledge acquisition and retention in nursing students is recommended.

A Roadmap to Implementing Antimicrobial Stewardship Principles in Long-term Care Facilities (LTCFs): Collaboration Between an Acute-Care Hospital and LTCFs

Effective 28 November 2017, the Centers for Medicare & Medicaid Services (CMS) mandated long-term care facilities (LTCFs) to have antimicrobial stewardship programs (ASPs) in place. Although guidance exists for establishing ASPs in LTCFs, limited data exist on the "how." As comprehensive ASPs already exist in many acute-care hospitals (ACHs) and with the known "sharing of patients" between both settings, extending ACH ASP expertise to LTCFs will not only aid LTCFs in complying with the CMS mandate but will likely also facilitate in decreasing multidrug-resistant organisms and Clostridium difficile infection rates in patients at both organizations. Here, we provide a roadmap on how to implement ASPs in LTCFs, using examples from our own ACH's collaboration with local LTCFs to develop and sustain LTCF ASPs. We discuss critical elements to achieving successful LTCF ASPs, including the potential barriers and how to overcome them.

Digital explanations and nursing students' perception of learning science

A thorough understanding of human physiology and anatomy are pivotal in the preparation of competent nursing students for clinical practice. However, anatomy and physiology are among the most conceptually perplexing subjects that nursing students will encounter throughout the duration of their course. Research in other science-based contexts has demonstrated a positive relationship between student-generated digital media and learning scientific concepts. Therefore, the aim of this study was to explore nursing students' experience in learning science concepts through a formative assessment task which was based on making a 'digital explanation'. Our work was guided by semiotic theory and the study design was a mixed method study where 428 first-year nursing students across five campuses volunteered to complete self-reported surveys during the first and last week of the academic session. Students who consented for an interview were invited to attend one of five focus groups. More than half of the participating cohort had prior experience with science (66%), but only 24% had previous experience with making digital media. After completion of the assessment task, two-thirds of the students strongly agreed or agreed that they learned more about science and fewer students agreed that searching for scientific knowledge could be boring. The qualitative findings confirmed the presence of learning about science and four themes were identified: 'learning about science', 'linking knowledge to practice', 'using technology', and 'making it real'. A key point was that the students began to see connections between science knowledge and nursing practice. But many students were challenged by the technology and the fact that the task was ungraded. Although the digital explanation was an overall positive experience for the nursing students, there is a need for a flexible and graded assessment task to achieve its potential benefits as a teaching and learning task in nursing. We conclude that additional intervention studies are warranted.

Nurses' perspectives on pharmacology: why, what and at which point of the curricula should education be delivered?

AIMS AND OBJECTIVES

the study aimed to capture the views of nursing students and qualified nurses about pharmacology education and at which point the subject should be taught.

BACKGROUND

drug errors are common in clinical practice. However, the presence of pharmacology education in nursing curricula varies, with few higher education institutes focusing on the topic in pre-registration years.

DESIGN

a cross-sectional survey was carried out with 46 pre-registration, 18 post-qualification and 15 post-qualification nurse prescribing course students.

RESULTS

most agreed that pharmacology education was crucial for practice. Post-qualification participants ranked the topics of ethics and law as applied to pharmacology higher than pre-registration students. Qualified nurses ranked the topic of pharmacokinetics statistically higher than pre-registration students. Equal numbers of qualified participants favoured having pharmacology education as part of pre- and post-qualification programmes, either as a discrete module or incorporated in core modules. Pre-registration participants thought pharmacology education should be integrated throughout the programme. Most participants thought it should be taught face to face in the classroom.

CONCLUSION

pharmacology education is valued by all nurses. Respondents mostly favoured a gradual integration of the subject in a programme of study, face to face.

New Zealand nursing students' perceptions of biosciences: A cross-sectional survey of relevance to practice, teaching delivery, self-competence and challenges

BACKGROUND

Bioscience subjects are one of the most discussed nursing curricula contents in terms of the longed known teaching and learning challenges for nursing students. Recent studies examined the specific use of technology as teaching strategies. However, there are still significant gaps around nursing students' perception of biosciences within nursing education and the significance of teaching delivery methods to these perceptions.

OBJECTIVE

The study examined students' overall perception of biosciences within New Zealand undergraduate nursing programmes in terms of relevance to practice, teaching delivery, self-competence and challenges encountered.

METHOD

A descriptive, cross-sectional survey design on perceptions of New Zealand nursing students on biosciences was undertaken.

RESULTS

Five hundred and forty students were included. Fifty-five percent (55%) preferred biosciences papers be taught classroom - based but using a blended learning delivery instead of an exclusively traditional classroom setting (55% vs. 21%). Perception towards the biosciences was positive and the mean perception of older students and those in Year 3 was higher compared to the other students. Overall, students believed biosciences had relevance to the practice of nursing.

CONCLUSION

Positive perceptions of bioscience become more evident when nursing students reach their final year in the nursing programme. The contemporary profile (age) of students studying nursing are sensitive to their preferred teaching delivery. A fully online teaching approach to biosciences for nursing students will most likely require a robust approach and careful decision making for implementation.

Final year pre-registration student nurses perceptions of which taught theoretical knowledge is important for practice

This research illuminates the perceptions of eighteen final year undergraduate pre-registration student nurses, to understand what theoretical knowledge was perceived to be useful during their pre-registration nursing education, and what was not. The research adopted a qualitative phenomenological approach, and utilised a sample size of eighteen final year student nurses as the data source. The data collection method consisted of semi-structured interviews and the study took place at a Higher Education Institution within the North West of England approved to provide pre-registration nurse education. Participants provided their data during their final year of their undergraduate pre-registration nursing programme, via semi-structured, digitally recorded interviews, which were transcribed verbatim. The transcribed interviews were then analysed using Interpretive Phenomenological Analysis. The findings generated three themes, these were; important knowledge to learn for everyday practice, irrelevant for my future role, and, can we have some more? Findings demonstrate what aspects of the taught curriculum student nurses perceive to be of use to their practice, and why they perceive this to be the case. This affects how student nurses approach their learning during their nursing education. In addition it was clear what participants perceived was not useful for their practice and why this was the case. Additionally, participants offered suggestions of what they would also like adding to their curriculum, and provided insights for what they would like adding to the curriculum, which can be used for enhancing this. This is useful when developing future curricula to understand which aspects student nurses learn in a deep and superficial way. This can provide a useful insight for to ensure that patient care is not compromised.

Microbiology Education and Infection Control Competency: Offering a New Perspective

Healthcare-associated infections (HAIs) have become a significant and costly problem for healthcare institutions worldwide. Despite the crucial role of infection prevention and control (IC) procedures, there is a substantial body of evidence to indicate that IC knowledge and practices of health professional graduates is, however, sub-optimal. This paper presents a discussion of the critical role microbiology plays in infection control education and practice, arguing that without an ability to apply microbiology knowledge to IC decision-making, there is an inherent risk of incorrect application of IC practices and thus a risk to patient (and nurse) safety. The authors propose a re-conceptualization of infection control competency, using nursing as an exemplar profession, to reflect practice that is not based on simple memorization of protocols but rather on a sound understanding of microbiology and informed decision-making. The proposal for re-conceptualizing the definition and assessment of IC competence, if adopted, would potentially enhance students' understanding and synthesis of microbiology knowledge and help build students' capacity to apply that knowledge to practice.

The nursification of a bioscience unit and its impact on student satisfaction and learning in an undergraduate nursing degree

Undergraduate nursing students traditionally find bioscience difficult, which can be compounded by an inability to relate bioscience theory to nursing practice. Subsequently, many registered nurses feel they lack knowledge in this area. Several studies have identified this problem and focused on the importance of linking bioscience theory in undergraduate nursing curricula to clinical practice. The aim of this study was to assess whether nursification (the active association of a subject with nursing theory and practice) of the bioscience content of a first year, first semester unit impacts on the students' learning experience. The study compared two student groups' perceptions of their learning experience; one group enrolled before the bioscience unit was linked to nursing practice (pre-nursification) and the other group enrolled after the content was linked to nursing practice (post-nursification). Retrospective, quantitative analysis of the mean scores of the student feedback surveys found no significant difference between the pre and post-nursification responses with respect to the students' overall satisfaction of the unit or their ability to achieve their learning objectives, however the students in the post-nursification group reported significantly higher mean scores with respect to their motivation and inspiration to learn, and to learn effectively. The findings in this study suggest that integration of nursing practice within a bioscience unit can improve the learning experience of undergraduate nursing students.

The Anatomical Society's core anatomy syllabus for undergraduate nursing

The Anatomical Society has developed a series of learning outcomes in consultation with nursing educators delivering anatomical content to undergraduate (preregistration) nursing students. A Delphi panel methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate nursing programmes throughout the UK. Using the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students as a foundation, a modified Delphi technique was used to develop discipline-specific outcomes to nursing graduates. The Delphi panel consisted of 48 individuals (n = 48) with a minimum of 3 years' experience teaching anatomy to nursing students, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 64 nursing specific learning outcomes in anatomy that are applicable to all undergraduate (preregistration) programmes in the UK. The new core anatomy syllabus for Undergraduate Nursing offers a basic anatomical framework upon which nurse educators, clinical mentors and nursing students can underpin their clinical practice and knowledge. The learning outcomes presented may be used to develop anatomy teaching within an integrated nursing curriculum.

A mixed methods evaluation of team-based learning for applied pathophysiology in undergraduate nursing education

BACKGROUND

It is important for nurses to have a thorough understanding of the biosciences such as pathophysiology that underpin nursing care. These courses include content that can be difficult to learn. Team-based learning is emerging as a strategy for enhancing learning in nurse education due to the promotion of individual learning as well as learning in teams.

OBJECTIVES

In this study we sought to evaluate the use of team-based learning in the teaching of applied pathophysiology to undergraduate student nurses.

DESIGN

A mixed methods observational study.

METHODS

In a year two, undergraduate nursing applied pathophysiology module circulatory shock was taught using Team-based Learning while all remaining topics were taught using traditional lectures. After the Team-based Learning intervention the students were invited to complete the Team-based Learning Student Assessment Instrument, which measures accountability, preference and satisfaction with Team-based Learning. Students were also invited to focus group discussions to gain a more thorough understanding of their experience with Team-based Learning. Exam scores for answers to questions based on Team-based Learning-taught material were compared with those from lecture-taught material.

RESULTS

Of the 197 students enrolled on the module, 167 (85% response rate) returned the instrument, the results from which indicated a favourable experience with Team-based Learning. Most students reported higher accountability (93%) and satisfaction (92%) with Team-based Learning. Lectures that promoted active learning were viewed as an important feature of the university experience which may explain the 76% exhibiting a preference for Team-based Learning. Most students wanted to make a meaningful contribution so as not to let down their team and they saw a clear relevance between the Team-based Learning activities and their own experiences of teamwork in clinical practice. Exam scores on the question related to Team-based Learning-taught material were comparable to those related to lecture-taught material.

CONCLUSIONS

Most students had a preference for, and reported higher accountability and satisfaction with Team-based Learning. Through contextualisation and teamwork, Team-based Learning appears to be a strategy that confers strong pedagogical benefits for teaching applied pathophysiology (bioscience) to student nurses.

Shifting the load: Improving bioscience performance in undergraduate nurses through student focused learning

Background

Bioscience has a long history of being challenging to teach and learn within nursing courses and little has been published on new ways to assist students in their learning. The aim of this study was to determine which of three different interventions would assist student performance in a nursing bioscience unit.

Method

To begin, the contribution of recent prior learning in science was investigated by comparing the final exam marks of 182 students in the bioscience unit with the science marks they achieved at high (secondary) school. The effect of recent prior learning was then tested by investigating whether the first intervention, a pre-nursing bioscience workshop of 63 students, would substitute for recent high school science. Two further interventions were tested that used a stronger student-focused contribution to the teaching and learning within the bioscience unit. These were the Human Body Club which was composed of 44 under-performing students and an online learning platform known as LearnSmart that was used by a cohort of 263 students.

Results and discussion

Good and recent high school attainment in the sciences did improve student performance, whilst recent prior learning in the form of a bioscience workshop did not. Both student-focused interventions improved student performance. The longer a student spent using LearnSmart the more their mark increased. However, the Human Body Club which provided additional support and shifted the bulk of the teaching and learning to the students was the most effective of the three interventions in assisting students to pass the bioscience unit.

Nursing students collaborating to develop multiple-choice exam revision questions: A student engagement study

BACKGROUND

Nursing students find bioscience subjects challenging. Bioscience exams pose particular concerns for these students, which may lead to students adopting a surface-approach to learning.

OBJECTIVES

To promote student collective understanding of bioscience, improve their confidence for the final exam, and improve deeper understanding of bioscience.

DESIGN

In order to address exam anxiety, and improve student understanding of content, this student engagement project involved nursing students collaborating in small groups to develop multiple-choice questions and answers, which became available to the entire student cohort.

SETTINGS

This study was conducted at two campuses of an Australian university, within a first year bioscience subject as part of the undergraduate nursing programme.

PARTICIPANTS

All students enrolled in the subject were encouraged to attend face-to-face workshops, and collaborate in revision question writing. Online anonymous questionnaires were used to invite student feedback on this initiative; 79 respondents completed this feedback.

METHODS

Students collaborated in groups to write revision questions as part of in-class activities. These questions were made available on the student online learning site for revision. An online feedback survey was deployed at the conclusion of all workshops for this subject, with questions rated using a Likert scale.

RESULTS

Participants indicated that they enjoyed the opportunity to collaborate in this activity, and almost all of these respondents used these questions in their exam preparation. There was strong agreement that this activity improved their confidence for the final exam. Importantly, almost two-thirds of respondents agreed that writing questions improved their understanding of content, and assisted in their active reflection of content.

CONCLUSIONS

Overall, this initiative revealed various potential benefits for the students, including promoting bioscience understanding and confidence. This may improve their long-term understanding of bioscience for nursing practice, as registered nurses' bioscience knowledge can impact on patient outcomes.

Microbiology Education in Nursing Practice

Nurses must have sufficient education and training in microbiology to perform many roles within clinical nursing practice (e.g., administering antibiotics, collecting specimens, preparing specimens for transport and delivery, educating patients and families, communicating results to the healthcare team, and developing care plans based on results of microbiology studies and patient immunological status). It is unclear whether the current microbiology courses required of nursing students in the United States focus on the topics that are most relevant to nursing practice. To gauge the relevance of current microbiology education to nursing practice, we created a confidential, web-based survey that asked nurses about their past microbiology education, the types of microbiology specimens they collect, their duties that require knowledge of microbiology, and how frequently they encounter infectious diseases in practice. We used the survey responses to develop data-driven recommendations for educators who teach microbiology to pre-nursing and nursing students. Two hundred ninety-six Registered Nurses (RNs) completed the survey. The topics they deemed most relevant to current practice were infection control, hospital-acquired infections, disease transmission, and collection and handling of patient specimens. Topics deemed least relevant were the Gram stain procedure and microscope use. In addition, RNs expressed little interest in molecular testing methods. This may reflect a gap in their understanding of the uses of these tests, which could be bridged in a microbiology course. We now have data in support of anecdotal evidence that nurses are most engaged when learning about microbiology topics that have the greatest impact on patient care. Information from this survey will be used to shift the focus of microbiology courses at our university to topics more relevant to nursing practice. Further, these findings may also support an effort to evolve national recommendations for microbiology education in pre-nursing and nursing curricula.

Introductory anatomy and physiology in an undergraduate nursing curriculum

Using an educational data mining approach, first-year academic achievement of undergraduate nursing students, which included two compulsory courses in introductory human anatomy and physiology, was compared with achievement in a final semester course that transitioned students into the workplace. We hypothesized that students could be grouped according to their first-year academic achievement using a two-step cluster analysis method and that grades achieved in the human anatomy and physiology courses would be strong predictors of overall achievement. One cohort that graduated in 2014 (n = 105) and one that graduated in 2015 (n = 94) were analyzed separately, and for both cohorts, two groups were identified, these being "high achievers" (HIGH) and "low achievers" (LOW). Consistently, the anatomy and physiology courses were the strongest predictors of group assignment, such that a good grade in these was much more likely to put a student into a high-achieving group. Students in the HIGH groups also scored higher in the Transition to Nursing course when compared with students in the LOW groups. The higher predictor importance of the anatomy and physiology courses suggested that if a first-year grade-point average was calculated for students, an increased weighting should be attributed to these courses. Identifying high-achieving students based on first-year academic scores may be a useful method to predict future academic performance.

Advancing student nurse knowledge of the biomedical sciences: A mixed methods study

BACKGROUND

Nursing students' ability to learn, integrate and apply bioscience knowledge to their clinical practice remains a concern.

OBJECTIVES

To evaluate the implementation, influence, and student perspective of a team-teaching workshop to integrate bioscience theory with clinical nursing practice.

DESIGN

The team-teaching workshop was offered prior to commencement of the university semester as a refresher course at an Australian university. This study employed a sequential explanatory mixed methods design incorporating both quantitative and qualitative items.

METHODS

An evaluation survey with quantitative and qualitative items and a focus group were employed. The qualitative data were analysed using a thematic approach. The quantitative data was combined with the emergent themes in the qualitative data.

PARTICIPANTS

Participants were final year nursing students. Nine students attended the workshop. All students completed the evaluation (N=9) and 44.4% (N=4) attended the focus group.

RESULTS

The results revealed six themes: (1) lectures are an inadequate teaching strategy for bioscience; (2) teaching strategies which incorporate active learning engage students; (3) the team-teaching workshop provides an effective learning environment; (4) the workshop content should be expanded; (5) pharmacology should relate to bioscience, and bioscience should relate to nursing; and (6) team-teaching was effective in integrating pharmacology with bioscience, and then translating this into nursing practice. Students had felt there was disjointedness between pharmacology and bioscience, and between bioscience and nursing care within their undergraduate studies. The workshop that was based on team-teaching bridged those gaps, utilised active learning strategies and provided an effective learning environment.

CONCLUSION

Team-teaching that employs active learning strategies is an effective approach to assist nursing students to integrate bioscience knowledge into their nursing practice.

Developing and evaluating effective bioscience learning activities for nursing students

Effective engagement of nursing students in the study of biosciences remains a challenge for many tertiary institutes. In this study we attempted to implement and then evaluate a simple hands-on intervention, consisting of a series of hands-on games and puzzles, to increase nursing student engagement with core concepts and anatomical learning involved in clinical anatomy and physiology. The study used a quazi-experimental longitudinal before and after design, to explore the effect of a learning intervention on student performance. Set across three different campuses of the same University, it included 1320 first year undergraduate nursing students from 2013 to 2014 who were studying Anatomy and Physiology. Students were exposed to the interventions or not, and concomitant academic performance, weekly quiz scores, performance in fortnightly worksheets and, across the semester, exam performance were compared. The results show that while the intervention appeared to increase academic performance in students on one campus (2013) compared to the other two, this difference was not sustained into 2014 when a bigger cohort was examined. Despite significant subjective student satisfaction and enthusiasm about these learning and teaching interventions, the data does not support the capacity of these activities to enhance student academic performance. Tertiary entrance scores, being a non-native English speakers and socio-economic status all had a bigger impact on student performance than engagement with fun anatomy and physiology activities.

Can active learning principles be applied to the bioscience assessments of nursing students? A review of the literature

OBJECTIVES

To explore if active learning principles be applied to nursing bioscience assessments and will this influence student perception of confidence in applying theory to practice?

DESIGN AND DATA SOURCES

A review of the literature utilising searches of various databases including CINAHL, PUBMED, Google Scholar and Mosby's Journal Index.

METHODS

The literature search identified research from twenty-six original articles, two electronic books, one published book and one conference proceedings paper.

RESULTS

Bioscience has been identified as an area that nurses struggle to learn in tertiary institutions and then apply to clinical practice. A number of problems have been identified and explored that may contribute to this poor understanding and retention. University academics need to be knowledgeable of innovative teaching and assessing modalities that focus on enhancing student learning and address the integration issues associated with the theory practice gap. Increased bioscience education is associated with improved patient outcomes therefore by addressing this "bioscience problem" and improving the integration of bioscience in clinical practice there will subsequently be an improvement in health care outcomes.

CONCLUSION

From the literature several themes were identified. First there are many problems with teaching nursing students bioscience education. These include class sizes, motivation, concentration, delivery mode, lecturer perspectives, student's previous knowledge, anxiety, and a lack of confidence. Among these influences the type of assessment employed by the educator has not been explored or identified as a contributor to student learning specifically in nursing bioscience instruction. Second that educating could be achieved more effectively if active learning principles were applied and the needs and expectations of the student were met. Lastly, assessment influences student retention and the student experience and as such assessment should be congruent with the subject content, align with the learning objectives and be used as a stimulus tool for learning.

Attitude to the subject of chemistry in undergraduate nursing students at Fiji National University and Federation University, Australia

Attitude to the subject of chemistry was quantified in first-year undergraduate nursing students, at two geographically distinct universities. A purpose-designed diagnostic instrument (ASCI) was given to students at Federation University, Australia (n= 114), and at Fiji National University, Fiji (n=160). Affective and cognitive sub-scales within ASCI showed reasonable internal consistency. Cronbach's alpha for the cognitive sub-scale was 0.786 and 0.630, and 0.787 and 0.788 for affective sub-scale for the Federation University and Fiji National University students, respectively. Mean (SD) score for the cognitive sub-scale was 10.5 (5.6) and 15.2 (4.1) for students at Federation University and Fiji National University, respectively (P<0.001, t-test). Mean (SD) score for the affective sub-scale was 13.1 (5.1) and 20.7 (4.3) for students at Federation University and Fiji National University, respectively (P < 0.001, t-test). An exploratory factor analysis (n=274) confirmed a two-factor solution consistent with affective and cognitive sub-scales, each with good internal consistency. Quantifying attitude to chemistry in undergraduate nursing students using ASCI may have utility in assessing the impact of novel teaching strategies used in the education of nursing students in areas of bioscience and chemistry. However, geographically distinct populations of undergraduate nurses may show very different attitudes to chemistry.

Tracking undergraduate student achievement in a first-year physiology course using a cluster analysis approach

A cluster analysis data classification technique was used on assessment scores from 157 undergraduate nursing students who passed 2 successive compulsory courses in human anatomy and physiology. Student scores in five summative assessment tasks, taken in each of the courses, were used as inputs for a cluster analysis procedure. We aimed to group students into high-achieving (HA) and low-achieving (LA) clusters and to determine the ability of each summative assessment task to discriminate between HA and LA students. The two clusters identified in each semester were described as HA (n = 42) and LA (n = 115) in semester 1 (HA1 and LA1, respectively) and HA (n = 91) and LA (n = 42) in semester 2 (HA2 and LA2, respectively). In both semesters, HA and LA means for all inputs were different (all P < 0.001). Nineteen students moved from the HA1 group into the LA2 group, whereas 68 students moved from the LA1 group into the HA2 group. The overall order of importance of inputs that determined group membership was different in semester 1 compared with semester 2; in addition, the within-cluster order of importance in LA groups was different compared with HA groups. This method of analysis may 1) identify students who need extra instruction, 2) identify which assessment is more effective in discriminating between HA and LA students, and 3) provide quantitative evidence to track student achievement.

Self-efficacy and relevance of bioscience for nursing, midwifery and healthcare students

AIMS AND OBJECTIVES

To examine nursing, midwifery and allied healthcare students' self-efficacy for science, perceived relevance of bioscience to their studies and expectations for academic success and the changes that occur after completing first-year introductory bioscience subjects.

BACKGROUND

Bioscience is a foundation subject that underpins nursing, midwifery and other allied health courses. Bioscience subjects continue to be source of anxiety for students in those courses. Raising students' self-efficacy and perceptions of the importance and utility of bioscience to practice may be a way of ameliorating students' expectations and confidence in this subject area.

DESIGN

A prospective correlational survey design.

METHODS

Students were surveyed in the first semester of first year and the commencement of the second year. Students were drawn from nursing, midwifery, public health and allied health courses. The surveys contained scales for self-efficacy for science, perceived relevance of bioscience to their course and personal expectations for success in their bioscience subject.

RESULTS

Ninety-seven and 82 students completed survey 1 and 2 respectively. Twenty-six surveys could be matched. Self-efficacy increased from survey 1 to survey 2, but expectations for academic success and task value, a measure for relevance, were lower. This was statistically significant for the matched pair sample. Using a mean split, students with high self-efficacy valued science more and had higher expectations for success in their bioscience courses than those with low self-efficacy.

CONCLUSION

Academic success in bioscience, confidence undertaking science tasks and perceiving bioscience as relevant to their course are interwoven concepts that are important for nursing, midwifery and applied healthcare students and ultimately for their professional practice.

RELEVANCE TO CLINICAL PRACTICE

Literature indicates practitioners may not feel confident in their bioscience knowledge. Assisting undergraduate students to develop confidence in and perceive the relevance of bioscience to their discipline may ultimately impact on clinical practice.

Teaching science content in nursing programs in Australia: a cross-sectional survey of academics

BACKGROUND

Professional nursing practice is informed by biological, social and behavioural sciences. In undergraduate pre-registration nursing programs, biological sciences typically include anatomy, physiology, microbiology, chemistry, physics and pharmacology. The current gap in the literature results in a lack of information about the content and depth of biological sciences being taught in nursing curricula. The aim of this study was to establish what priority is given to the teaching of science topics in these programs in order to inform an understanding of the relative importance placed on this subject area in contemporary nursing education.

METHOD

This study employed a cross-sectional survey method. This paper reports on the first phase of a larger project examining science content in nursing programs. An existing questionnaire was modified and delivered online for completion by academics who teach science to nurses in these programs. This paper reports on the relative priority given by respondents to the teaching of 177 topics contained in the questionnaire.

RESULTS

Of the relatively small population of academics who teach science to nursing students, thirty (n = 30) completed the survey. Findings indicate strong support for the teaching of science in these programs, with particular priority given to the basic concepts of bioscience and gross system anatomy. Of concern, most science subject areas outside of these domains were ranked as being of moderate or low priority.

CONCLUSION

While the small sample size limited the conclusions able to be drawn from this study, the findings supported previous studies that indicated inadequacies in the teaching of science content in nursing curricula. Nevertheless, these findings have raised questions about the current philosophy that underpins nursing education in Australia and whether existing practices are clearly focused on preparing students for the demands of contemporary nursing practice. Academics responsible for the design and implementation of nursing curricula are encouraged to review the content of current programs in light of the findings of this research.

Teaching science content in nursing programs in Australia: a cross-sectional survey of academics

BACKGROUND

Professional nursing practice is informed by biological, social and behavioural sciences. In undergraduate pre-registration nursing programs, biological sciences typically include anatomy, physiology, microbiology, chemistry, physics and pharmacology. The current gap in the literature results in a lack of information about the content and depth of biological sciences being taught in nursing curricula. The aim of this study was to establish what priority is given to the teaching of science topics in these programs in order to inform an understanding of the relative importance placed on this subject area in contemporary nursing education.

METHOD

This study employed a cross-sectional survey method. This paper reports on the first phase of a larger project examining science content in nursing programs. An existing questionnaire was modified and delivered online for completion by academics who teach science to nurses in these programs. This paper reports on the relative priority given by respondents to the teaching of 177 topics contained in the questionnaire.

RESULTS

Of the relatively small population of academics who teach science to nursing students, thirty (n = 30) completed the survey. Findings indicate strong support for the teaching of science in these programs, with particular priority given to the basic concepts of bioscience and gross system anatomy. Of concern, most science subject areas outside of these domains were ranked as being of moderate or low priority.

CONCLUSION

While the small sample size limited the conclusions able to be drawn from this study, the findings supported previous studies that indicated inadequacies in the teaching of science content in nursing curricula. Nevertheless, these findings have raised questions about the current philosophy that underpins nursing education in Australia and whether existing practices are clearly focused on preparing students for the demands of contemporary nursing practice. Academics responsible for the design and implementation of nursing curricula are encouraged to review the content of current programs in light of the findings of this research.

The 'bioscience problem' for nursing students: an integrative review of published evaluations of Year 1 bioscience, and proposed directions for curriculum development

BACKGROUND

The difficulties that nursing students have in learning human biosciences have given cause for concern for over 20 years but the problem remains.

OBJECTIVE

To conduct an integrative review of published primary research into the 'bioscience problem', evaluate their outcomes, and provide a contemporary analysis of potential directions for curriculum planners.

REVIEW METHODS

A systematic search of electronic databases CINAHL, Medline, British Nursing Index and Google Scholar was conducted for empirical research studies, published between 1990 and 2013, designed to either predict performance of students in bioscience assessments in Year 1 of their studies or identify in-course curriculum delivery issues.

RESULTS

The search generated nineteen papers that met inclusion criteria. Twelve papers involved predictive factors for bioscience attainment and seven surveyed student views on curriculum issues. Four others that surveyed reflections of later-year students or qualified nurses on Year 1 outcomes were also retained for additional context. Prediction based on pre-admission academic achievement was not reliable. Student factors including age at entry, self-efficacy in science, and having appropriate study skills in particular appear to be confounding factors. In-course influences such as teaching strategy or lecturer skills are also inconsistent and likely to represent confounders operating at local, institutional level.

CONCLUSIONS

The integrative review approach enabled analysis of incongruencies between studies that have been a barrier to curriculum development. Sound admissions criteria based on pre-university academic performance show promise in resolving the 'bioscience problem' but will likely be contingent on innovative support early in Year 1 for study skills and the fundamentals of human bioscience, plus attention to local quality assurance for curriculum delivery.

The use of team-based, guided inquiry learning to overcome educational disadvantages in learning human physiology: a structural equation model

The study of human bioscience is viewed as a crucial curriculum in allied health. Nevertheless, bioscience (and particularly physiology) is notoriously difficult for undergraduates, particularly academically disadvantaged students. So endemic are the high failure rates (particularly in nursing) that it has come to be known as "the human bioscience problem." In the present report, we describe the outcomes for individual success in studying first-year human physiology in a subject that emphasises team-based active learning as the major pedagogy for mastering subject learning outcomes. Structural equation modeling was used to develop a model of the impact team learning had on individual performance. Modeling was consistent with the idea that students with similar academic abilities (as determined by tertiary entrance rank) were advantaged (scored higher on individual assessment items) by working in strong teams (teams that scored higher in team-based assessments). Analysis of covariance revealed that students who studied the subject with active learning as the major mode of learning activities outperformed students who studied the subject using the traditional didactic teaching format (lectures and tutorials, P = 0.000). After adjustment for tertiary entrance rank (via analysis of covariance) on two individual tests (the final exam and a late-semester in-class test), individual student grades improved by 8% (95% confidence interval: 6-10%) and 12% (95% confidence interval: 10-14%) when students engaged in team-based active learning. These data quantitatively support the notion that weaker students working in strong teams can overcome their educational disadvantages.

Biosciences within the pre-registration (pre-requisite) curriculum: an integrative literature review of curriculum interventions 1990-2012

BACKGROUND

The learning of biosciences is well-documented to be problematic as students find the subjects amongst the most difficult and anxiety-provoking of their pre-registration programme. Studies suggest that learning consequently is not at the level anticipated by the profession. Curriculum innovations might improve the situation but the effectiveness of applied interventions has not been evaluated.

OBJECTIVE

To undertake an integrative review and narrative synthesis of curriculum interventions and evaluate their effect on the learning of biosciences by pre-registration student nurses. Review methods A systematic search of electronic databases CINAHL, Medline, British Nursing Index and Google Scholar for empirical research studies was designed to evaluate the introduction of a curriculum intervention related to the biosciences, published in 1990-2012. Studies were evaluated for design, receptivity of the intervention and impact on bioscience learning.

RESULTS

The search generated fourteen papers that met inclusion criteria. Seven studies introduced on-line learning packages, five an active learning format into classroom teaching or practical sessions, and two applied Audience Response Technology as an exercise in self-testing and reflection. Almost all studies reported a high level of student satisfaction, though in some there were access/utilization issues for students using on-line learning. Self-reporting suggested positive experiences, but objective evaluation suggests that impacts on learning were variable and unconvincing even where an effect on course progress was identified. Adjunct on-line programmes also show promise for supporting basic science or language acquisition.

CONCLUSIONS

Published studies of curriculum interventions, including on-line support, have focused too heavily on the perceived benefit to students rather than objective measures of impact on actual learning. Future studies should include rigorous assessment evaluations within their design if interventions are to be adopted to reduce the 'bioscience problem'.

Development and clinical gains of nurse-led medication monitoring profiles

AIM

This paper reports on the development of an instrument for nurse-led medication monitoring, the West Wales Adverse Drug Reaction profile for respiratory medicines, as part of a strategy to reduce avoidable adverse drug reactions.

BACKGROUND

Preventable adverse drug reactions account for 3.7% hospital admissions. Nurse-led medication monitoring may reduce drug-related harm. However, development of medication monitoring strategies is not reported elsewhere.

METHODS

The profile was developed by: (1) cognitive interviews (n = 4), (2) the content validity index (n = 10) involving academics, clinicians and service users prescribed respiratory medicines, (3) inter-rater reliability (n = 48) and clinical gains in a nurse-led outpatient clinic.

RESULTS

Cognitive interviews prompted more profile changes than either the content validity index or inter-rater reliability testing. Cohen's κ for inter-rater reliability for each item ranged from 0.73-1.00 (good to complete agreement). The profile identified previously unsuspected problems in all participants, including muscular weakness, skin and mouth problems.

CONCLUSIONS

The West Wales Adverse Drug Reaction profile was valid and reliable, and helped to detect and ameliorate drug-related harm.

IMPLICATIONS FOR NURSING MANAGEMENT

The West Wales Adverse Drug Reaction profile offers opportunities to improve care. Medication monitoring provides the structure to concurrently monitor known adverse drug reactions. Practice-based adverse drug reaction profiles benefit from cognitive, content validity and inter-rater reliability testing.

An exploration of student experiences of using biology podcasts in nursing training

BACKGROUND

Students regard biological science as one of the most difficult components of the nursing curriculum. However, a good understanding of this area is essential for effective nursing practice. The aim of this study was to explore nursing students' perceptions of the usefulness of supplementary biology podcasts for their learning.

METHODS

Biological science podcasts (n=9) were made available to first-year nursing students (n=189) as supplementary learning tools. On completion of their first year, students were asked to complete a survey which investigated the frequency of their podcast use, reasons for use and their perception of the usefulness of podcasts as a learning tool. 153 of these students participated in the survey study (80.9%). Two focus groups were conducted with students (n=6) to gain a detailed understanding of student experiences of the usefulness of the podcasts for their learning.

RESULTS

Survey data demonstrated that most students (71%) accessed at least one podcast. The majority of students who reported accessing podcasts agreed that they were useful as learning tools (83%), revision aids (83%) and that they helped promote understanding of course materials (72%). Focus group participants discussed how they found podcasts especially useful in terms of revision. Students valued being able to repeatedly access the lecture materials, and appreciated having access to podcasts from a range of lecturers. Focus group members discussed the benefits of live recordings, in terms of valuing the information gleaned from questions asked during the lecture sessions, although there were concerns about the level of background noise in live recordings. Lack of awareness of the availability of podcasts was an issue raised by participants in both the survey component and the focus groups and this negatively impacted on podcast use.

CONCLUSIONS

Nursing students found the availability of biology podcasts helpful for their learning. Successful implementation of these tools to support learning requires teaching staff to understand and promote the importance of these tools.

Predictors of academic performance of nursing and paramedic students in first year bioscience

The expanding scope of practice of paramedics and nurses demands they possess a sophisticated knowledge of bioscience to enable them to think critically and make rational clinical decisions. It is well documented that nursing students struggle with bioscience but there are no studies examining the performance of paramedic students in this crucial subject. In this study, we compared the academic performance of first year nursing, paramedic and nursing/paramedic double degree students in a bioscience subject. Regression analyses were used to identify predictors of academic success. Data revealed a low success rate in bioscience for all three degree programs (63.2, 58.8, and 67.6% respectively) and a strong correlation between academic success in bioscience and non-bioscience subjects (r(2)=0.49). The best predictors of overall academic success were the University Admission Index score and mature entry into the course. Previous study of biology was associated with an increased bioscience and overall GPA but not with non-bioscience grades. Discriminant analysis was used to develop a model that could predict overall academic success with an accuracy of 78.5%. These criteria may be useful during the admission process and for the early identification of students at risk of failure.