1
|
Yu Y, Qiao Y, Zhu Y, Pei H, Wang Y, Zhu Q, Liu S. The impact of unfolding case studies combined with think-aloud strategies on the clinical reasoning and self-directed learning abilities of postgraduate students: A mixed methods study. Nurse Educ Pract 2024; 80:104132. [PMID: 39276650 DOI: 10.1016/j.nepr.2024.104132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/17/2024]
Abstract
AIM To conduct unfolding case studies and test their effectiveness in improving clinical reasoning, teamwork and self-directed learning among postgraduate students. BACKGROUND Postgraduate students, as advanced nursing professionals in clinical settings, are the driving force behind the rapid development of the nursing profession. Effective clinical reasoning is a fundamental nursing skill that postgraduate students must cultivate, having a direct impact on patient health outcomes. The development and usation of unfolding case studies, which reflect the evolving conditions of patients, combined with think-aloud teaching methods, can enhance postgraduate students' clinical reasoning abilities and foster communication and self-reflection, thereby achieving this goal. DESIGN Mixed methods design. METHODS The Nurses' Clinical Reasoning Scale and the Nursing Students' Self-Directed Learning Ability Scale were used to evaluate the clinical reasoning and self-directed learning abilities of nursing students. A qualitative exploratory design with a think-aloud interview technique was employed to explore the clinical reasoning process of nursing students in unfolding cases. Twenty-one nursing students completed the questionnaire survey. Data analysis was conducted using Wilcoxon signed-rank tests, Spearman correlations, regressions and inductive content analysis. RESULTS After implementing the case study, there was a statistically significant improvement in students' clinical reasoning, self-directed learning and teamwork abilities. Think-aloud analysis revealed that the cognitive strategies most employed by students in clinical reasoning were 'Making choices', 'Forming relationships', 'Searched for information' and 'Drawing conclusions'. CONCLUSION Unfolding case studies combined with think-aloud strategies provide a conducive learning environment for postgraduate students, effectively enhancing their clinical reasoning and self-directed learning abilities.
Collapse
Affiliation(s)
- Yuehai Yu
- College of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China.
| | - Yuanjing Qiao
- College of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China.
| | - Yaoyao Zhu
- College of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Hao Pei
- College of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Yuting Wang
- College of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Qingyang Zhu
- College of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Shuo Liu
- College of Nursing, Shandong University of Traditional Chinese Medicine, Shandong, China
| |
Collapse
|
2
|
Nazari P, Parsai-Manesh E, Kazemi Z, Soleimani B, Yarmohammadinezhad E. Evaluation of advanced multi-purpose trauma moulage-based training on clinical skills for dealing with trauma-affected individuals in undergraduate nursing students. Int J Emerg Med 2024; 17:116. [PMID: 39243053 PMCID: PMC11380189 DOI: 10.1186/s12245-024-00704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Simulation-based training courses have been developed and widely accepted.The use of simulators can prevent bitter consequences that may sometimes put human lives in danger. Increasing the skill of nursing students in dealing with trauma patients is of great importance. The aim of this study is to evaluate the effectiveness of the simulation-based trauma training program for the management of trauma patients in nursing students. METHOD It is an observational approach that focuses on improving the learning of trauma care skills. For this study, 6th and 8th semester nursing students were selected by appropriate sampling method. Previously, these students completed the trauma training course without simulation. Training of trauma skills was done using multi-purpose trauma mollage And we subsequently analyzed the effectiveness of the trauma simulation training program using the OSCE test. In the inferential statistics section, after examining the data distribution (Kolmogrove-Smirnov and Shapiro-Wilk tests), the Wilcoxon test was used to measure significance. SPSS 22 software was used. RESULTS The results indicated that the lowest mean score obtained based on a scale of zero to one hundred was for the movement limitation of the injured long bone and the highest was in the skill of oral-nasal intubation and ventilation. The results of the paired t-test showed that clinical skills for dealing with trauma-affected individuals in undergraduate nursingafter simulation training was significantly higher . CONCLUSION The implementation of the simulation is accompanied by an increase in the skills of the participants, which leads to the application of the acquired knowledge in real-life scenarios and positive changes. In the learning of the participants, the evaluation of conventional trauma training in Iran, like other countries, shows the need for specialized training through simulation. To ensure the continued effectiveness of simulation-based trauma training courses, it is recommended that administrators and policymakers encourage regular faculty participation in the program. Long term effects of trauma simulators training in nursing student requires further study.
Collapse
Affiliation(s)
- Peyman Nazari
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Esmail Parsai-Manesh
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Zahra Kazemi
- Faculty of Nursing, Gerash University of Medical Sciences, Fars, Iran
| | - Bita Soleimani
- Health care and treatment department of the oil industry of Bushehr, Bushehr, Iran
| | | |
Collapse
|
3
|
Wong FMF. How Students Learn during the Pre-Briefing and Observation of Facilitation in a High-Fidelity Patient Simulation: A Narrative Analysis. Healthcare (Basel) 2024; 12:1761. [PMID: 39273785 PMCID: PMC11394704 DOI: 10.3390/healthcare12171761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 08/30/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
The rapid development of technology has led to the emergence of innovative teaching approaches, such as high-fidelity patient simulation (HFPS). HFPSs have been shown to significantly enhance students' decision-making and intellectual skills. This study aimed to investigate how students learn from the pre-briefing to observation period of the facilitation of the HFPS based on the original quasi-experimental studies. This study analyzed the narratives from 92 students in the intervention group about their learning during the pre-briefing and observation of facilitation. The results indicated that the students learned more independently, received better support and resources for learning, were provided with more appropriate and safe care for the simulated case, and developed higher-level intellectual skills, such as self-directed learning, critical thinking, and clinical reasoning. Importantly, the structured guidelines provided roles and responsibilities and guiding questions or aspects for observation that directed the students to learn more actively and effectively while performing their roles in the HFPS. The structured guidelines serve as a roadmap to instruct students on learning during pre-briefing and applying what they have learned during the facilitation of the HFPS. This roadmap includes the learning journey from novice to competence in knowledge and skills and also from knowing to application. Therefore, this study's results have contributed important knowledge about well-structured HFPS guidelines for all stages of the HFPS, addressing the need for adequate guidance and learning support during the pre-briefing and observation of facilitation. The elements identified during the pre-briefing and observation of facilitation are crucial for directing students to learn and significantly enhance their understanding and application of knowledge and skills, ultimately promoting the development of higher-level intellectual skills, professionalism, and engagement. Nurse educators can incorporate these elements into HFPS training in curricula to enhance students' involvement and optimize the HFPS as an effective teaching tool with structured guidelines providing guidance and support throughout various stages of HFPS training.
Collapse
|
4
|
Görücü S, Türk G, Karaçam Z. The effect of simulation-based learning on nursing students' clinical decision-making skills: Systematic review and meta-analysis. NURSE EDUCATION TODAY 2024; 140:106270. [PMID: 38924975 DOI: 10.1016/j.nedt.2024.106270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Simulation-based education methods improve nursing students' clinical decision-making skills. It allows students to experience situations they may not encounter in a real clinical environment. OBJECTIVES The aim of this systematic review was to better understand the effectiveness of simulation-based education on clinical decision-making skills in undergraduate nursing students. DESIGN Meta-analysis of randomized controlled trials and quasi-experimental studies. DATA SOURCES The review included fourteen studies obtained by scanning the PubMed, EBSCO (Medline, CINAHL), OVID, Web of Science, and Cochrane databases. REVIEW METHODS Three authors independently screened the literature, extracted data, and assessed the quality of the included studies. The methodological quality of the studies was assessed with the Critical Appraisal Checklists for experimental and quasi-experimental studies developed by the Joanna Briggs Institute. Standardized mean difference with 95 % confidence interval was used to facilitate direct comparisons between studies. All statistical tests were performed with Review Manager 5.4 software. RESULTS In this study, 1614 records were reached as a result of the first screening. After examining the titles and removing duplicate articles and other articles that did not meet the research criteria according to the abstracts, 48 articles were included in the full-text analysis. Three researchers read the studies (n = 48) eligible for evaluation, and 14 (n = 14) studies suitable for full-text review met all of the listed inclusion criteria and were included in the meta-analysis. CONCLUSION The analysis revealed that simulation-based educational practices appeared to improve undergraduate nursing students' clinical decision-making skills.
Collapse
Affiliation(s)
- Selçuk Görücü
- Akdeniz Üniversity, Faculty of Kumluca Health Science, Nursing Department, Antalya, Turkey.
| | - Gülengün Türk
- Aydın Adnan Menderes University, Faculty of Nursing, Department of Fundamentals of Nursing, Aydın, Turkey.
| | - Zekiye Karaçam
- Aydın Adnan Menderes University, Faculty of Health Science, Department of Midwifery, Aydın, Turkey.
| |
Collapse
|
5
|
Cole B. Enhancing clinical reasoning and student confidence through pediatric simulation. J Pediatr Nurs 2024; 78:e432-e437. [PMID: 39122581 DOI: 10.1016/j.pedn.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/03/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The education-to-practice gap is magnified in pediatric nursing due to decreasing pediatric content offered in undergraduate programs, including less pediatric clinical time and inconsistent and inadequate clinical experiences. PURPOSE Examine student perceptions of learning and confidence by comparing a high-fidelity pediatric simulation series and acute care pediatric clinical. METHODS The SET-M tool compared settings and included open-ended questions to add insight. SAMPLE In an undergraduate nursing program in a university in the Midwest United States, 124 students completed the anonymous survey rating each experience for learning and confidence in assessment, clinical decision-making, communication, and safety. RESULTS Students rated the simulation series higher than clinical for all categories except patient communication. CONCLUSION Student perceptions of learning in high-fidelity simulation revealed increased confidence and competence and the belief that simulation complements the clinical experience and bridges the theory and clinical courses.
Collapse
Affiliation(s)
- Britt Cole
- Department of Nursing, Miami University, 1601 University Blvd., Hamilton, OH 45011, United States of America.
| |
Collapse
|
6
|
Vangone I, Arrigoni C, Magon A, Conte G, Russo S, Belloni S, Stievano A, Alfes CM, Caruso R. The efficacy of high-fidelity simulation on knowledge and performance in undergraduate nursing students: An umbrella review of systematic reviews and meta-analysis. NURSE EDUCATION TODAY 2024; 139:106231. [PMID: 38701671 DOI: 10.1016/j.nedt.2024.106231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students. DESIGN Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results. DATA SOURCES Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies. REVIEW METHODS The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). Random-effect meta-analyses of meta-analyses were performed to estimate the pooled effects of high-fidelity simulation on knowledge and performance. Further random-effect meta-analyses of primary studies were conducted, with overlapping studies excluded (12 %). Subgroup analyses were performed to provide a more comprehensive analysis of the findings. Trim-and-fill analyses were conducted to adjust for potential publication bias. RESULTS Six systematic reviews were included and encompassed 133 primary studies (2767 and 3231 participants concerning performance and knowledge, respectively). The adjusted pooled effects for knowledge (SMD = 0.877, 95 % CI: 0.182 to 1.572) and performance (SMD = 0.738, 95 % CI: 0.466 to 1.010) closely aligned with those obtained from meta-analyzing the primary studies for knowledge (SMD = 0.980) and performance (SMD = 0.540), both showing high statistical heterogeneity. Traditional lectures represented the more common comparison. The subgroup analysis revealed significant differences in effect sizes across geographic locations, topics, types of control, and how interventions were reported. CONCLUSIONS The results provide robust evidence supporting the integration of high-fidelity simulation into undergraduate nursing programs to enhance students' knowledge and performance. The high reported heterogeneity may be attributed to variations in study contexts or methodologies. Future research should explore the optimal use of high-fidelity simulation in different educational and cultural contexts.
Collapse
Affiliation(s)
- Ida Vangone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Sara Russo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Silvia Belloni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy
| | - Alessandro Stievano
- Centre of Excellence for Nursing Scholarship, OPI of Rome, 00133 Rome, Italy; Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Celeste M Alfes
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, United States of America
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy.
| |
Collapse
|
7
|
Notarnicola I, Duka B, Lommi M, Prendi E, Ivziku D, Rocco G, Stievano A. An Observational Cross-Sectional Analysis of the Correlation between Clinical Competencies and Clinical Reasoning among Italian Registered Nurses. Healthcare (Basel) 2024; 12:1357. [PMID: 38998891 PMCID: PMC11241108 DOI: 10.3390/healthcare12131357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
Ability, knowledge, aptitude, and skill are the terms identified in the literature as the attributes of the concept of clinical competence. This implies that in order to act competently in their own context, the nurse must be able to make decisions which mainly depend on the ability to put clinical reasoning into practice. However, the evaluation of clinical reasoning in the various clinical-care activities of nursing competence is a necessary operation to prevent routine attitudes. From the perspective of an assessment of nursing competences, the aim of this study is to validate the relationship between the degree of competence recognized in a specific clinical setting and the amount of clinical reasoning executed by nurses. The study design was a cross-sectional observational design, following the guidelines of the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) of observational studies. Both the Italian Nurse Competence Scale and the Nurse Clinical Reasoning Scale were used. The data was collected between 25 January and 5 March 2022. Four hundred twenty-four clinical nurses participated by completing and returning the questionnaires. The instruments underwent assessment to ensure internal consistency and test-retest reliability. Their validity was tested with the validity of known content, construct, and groups. This is supported by statistically significant correlations between the different variables examined and the scores of the different dimensions of the Italian Nurse Competence Scale and the Italian Nurse Clinical Reasoning Scale. The data collected showed an excellent average level of competencies and clinical reasoning, M = range of 72.24 and 63.93, respectively. In addition, we observed satisfactory scores across all dimensions of I-NCS (significance range: 0.000-0.014) and I-NCRS (significance range: 0.000-0.004). The understanding and development of clinical reasoning has also brought out new aspects that require further research. This study provides a fresh perspective on the correlation between clinical competences and clinical reasoning, representing a novel attempt to analyze their relationship.
Collapse
Affiliation(s)
- Ippolito Notarnicola
- Centre of Excellence for Nursing Scholarship, OPI, 00146 Rome, Italy
- Faculty of Medicine, University "Our Lady of the Good Counsel", 1001 Tirana, Albania
| | - Blerina Duka
- Faculty of Medicine, University "Our Lady of the Good Counsel", 1001 Tirana, Albania
| | - Marzia Lommi
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza", 00157 Rome, Italy
| | - Emanuela Prendi
- Faculty of Medicine, University "Our Lady of the Good Counsel", 1001 Tirana, Albania
| | - Dhurata Ivziku
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship, OPI, 00146 Rome, Italy
- Faculty of Medicine, University "Our Lady of the Good Counsel", 1001 Tirana, Albania
| | - Alessandro Stievano
- Centre of Excellence for Nursing Scholarship, OPI, 00146 Rome, Italy
- Faculty of Medicine, University "Our Lady of the Good Counsel", 1001 Tirana, Albania
| |
Collapse
|
8
|
Wang 王 X晓, Yang 杨 L丽, Hu 胡 S莎. Teaching nursing students: As an umbrella review of the effectiveness of using high-fidelity simulation. Nurse Educ Pract 2024; 77:103969. [PMID: 38642526 DOI: 10.1016/j.nepr.2024.103969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/16/2024] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Abstract
AIM To conduct an umbrella review of the effectiveness of using high-fidelity simulation in nursing student teaching, thereby supporting continuous improvement in teaching practitioners' implementation of high-fidelity simulation intervention strategies. BACKGROUND Several systematic reviews have investigated the effectiveness of high-fidelity simulation in nursing student teaching in recent years. However, conclusions vary and a systematic assessment is lacking. DESIGN This review encompasses an umbrella review. METHODS A search of PubMed, Embase, Cochrane Library, Web of Science and OVID databases was conducted to retrieve data on an umbrella review of high-fidelity simulation effectiveness in nursing student teaching from database inception to November 2023. The quality of the included systematic reviews was independently assessed by two reviewers using the AMSTAR 2 and PRISMA scales. Outcome indicators from the included systematic reviews were graded using the GRADE system. RESULTS Twelve systematic reviews focusing on high-fidelity simulation effectiveness in nursing student teaching were included. Notably, all 12 systematic reviews exhibited very-low methodological quality, with 9 exhibiting some degree of reporting deficiencies, 2 exhibiting severe information deficiencies and 1 reporting relatively complete information. A total of 22 outcome indicators and 53 pieces of evidence were included. The results revealed 15 pieces of low-quality evidence and 38 pieces of very-low-quality evidence. Mounting evidence suggests that high-fidelity simulation teaching effectively enhances nursing students' theoretical performance, practical skills and various clinical comprehensive abilities, highlighting a positive teaching effect. However, further validation through high-quality, large-sample studies is warranted. CONCLUSION The overall evidence quality of the current systematic reviews evaluating high-fidelity simulation effectiveness in nursing student teaching is low. Additionally, the methodological quality and the degree of reporting standardization require further improvement. Therefore, high-quality, large-sample randomized controlled trials are essential for further substantiating high-fidelity simulation effectiveness in nursing student teaching.
Collapse
Affiliation(s)
| | | | - Shasha 莎莎 Hu 胡
- The First Ward of the Department of Gynecology, the First Hospital of Lanzhou University, Lanzhou 730000, PR China.
| |
Collapse
|
9
|
Park H, Lee YJ, Moser DK, Lee J. Relationship of high-fidelity simulation experience, clinical reasoning, and clinical competence of new nurses: A cross-sectional study. Int Nurs Rev 2024. [PMID: 38686495 DOI: 10.1111/inr.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
AIM This study aimed to determine which high-fidelity simulation (HFS) experiences were associated with clinical reasoning and clinical competence among new nurses. BACKGROUND HFS has been actively used in nursing education. It is necessary to verify the effects of HFS transfer to the clinical environment. DESIGN A cross-sectional study reported following STROBE criteria. METHODS Data were collected on new nurses (n = 224) who experienced HFS in their fourth-year undergraduate courses. The number of HFSs, the inclusion of simulation elements, the importance of elements to learning, clinical reasoning, and clinical competence were measured. Hierarchical regression models examined factors associated with clinical reasoning and clinical competence. RESULTS Feedback was the most sufficiently included element of the HFS learning, and participants perceived it as the most important. A significant factor associated with clinical competence was clinical reasoning, and HFS design indirectly affected clinical competence through clinical reasoning. CONCLUSIONS HFS learning is one of the best ways to improve clinical reasoning. Improving students' clinical reasoning should be an important goal of HFS learning in undergraduate courses to prepare students to be clinically competent nurses. IMPLICATIONS FOR NURSING The ultimate goal of nursing education is to prepare nursing students to be competent nurses. Validating the outcomes of nursing education in the clinical environment setting is an essential task to improve clinical practice. IMPLICATIONS FOR NURSING POLICY Nurse educators and leaders can increase nurses' clinical competence by emphasizing education to foster nurses' clinical reasoning in nursing education policies.
Collapse
Affiliation(s)
- Hyeran Park
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seodaemoon-gu, Seoul, South Korea
| | - Young Joo Lee
- The Research Institute of Nursing Science, College of Nursing, Daegu Catholic University, Daegu, South Korea
| | - Debra K Moser
- University of Kentucky, College of Nursing, Lexington, Kentucky, USA
| | - JuHee Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Saban M, Dubovi I. A comparative vignette study: Evaluating the potential role of a generative AI model in enhancing clinical decision-making in nursing. J Adv Nurs 2024. [PMID: 38366690 DOI: 10.1111/jan.16101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
AIM This study explores the potential of a generative artificial intelligence tool (ChatGPT) as clinical support for nurses. Specifically, we aim to assess whether ChatGPT can demonstrate clinical decision-making equivalent to that of expert nurses and novice nursing students. This will be evaluated by comparing ChatGPT responses to clinical scenarios to those of nurses on different levels of experience. DESIGN This is a cross-sectional study. METHODS Emergency room registered nurses (i.e. experts; n = 30) and nursing students (i.e. novices; n = 38) were recruited during March-April 2023. Clinical decision-making was measured using three validated clinical scenarios involving an initial assessment and reevaluation. Clinical decision-making aspects assessed were the accuracy of initial assessments, the appropriateness of recommended tests and resource use and the capacity to reevaluate decisions. Performance was also compared by timing response generations and word counts. Expert nurses and novice students completed online questionnaires (via Qualtrics), while ChatGPT responses were obtained from OpenAI. RESULTS Concerning aspects of clinical decision-making and compared to novices and experts: (1) ChatGPT exhibited indecisiveness in initial assessments; (2) ChatGPT tended to suggest unnecessary diagnostic tests; (3) When new information required re-evaluation, ChatGPT responses demonstrated inaccurate understanding and inappropriate modifications. In terms of performance, the mean number of words utilized in ChatGPT answers was 27-41 times greater than that utilized by both experts and novices; and responses were provided approximately 4 times faster than those of novices and twice faster than expert nurses. ChatGPT responses maintained logical structure and clarity. CONCLUSIONS A generative AI tool demonstrated indecisiveness and a tendency towards over-triage compared to human clinicians. IMPACT The study shows that it is important to approach the implementation of ChatGPT as a nurse's digital assistant with caution. More study is needed to optimize the model's training and algorithms to provide accurate healthcare support that aids clinical decision-making. REPORTING METHOD This study adhered to relevant EQUATOR guidelines for reporting observational studies. PATIENT OR PUBLIC CONTRIBUTION Patients were not directly involved in the conduct of this study.
Collapse
Affiliation(s)
- Mor Saban
- Nursing Department, Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Dubovi
- Nursing Department, Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Wang HY, Huang CY, Hu SH, Cheng SF. Using "board games" to improve the effectiveness of extracorporeal membrane oxygenation care for nurses in intensive care unit. Nurse Educ Pract 2024; 75:103895. [PMID: 38232676 DOI: 10.1016/j.nepr.2024.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
AIM The purpose of this study was to evaluate the effectiveness of ECMO care board games facilitated teaching approach (ECMO care board games) in enhancing ECMO care knowledge, clinical reasoning and learning engagement among intensive care unit (ICU) nurses. BACKGROUND ECMO is a highly complex, relatively low-incidence, high-risk clinical life support device system used in the intensive care unit (ICU). Its usage has increased nearly tenfold over the past 30 years. Traditionally, ECMO education has been delivered through classroom teaching, which has demonstrated limited effectiveness in promoting nurses' learning engagement, clinical reasoning competency and confidence. The literature suggests that well-designed board games can enhance learning engagement, stimulate higher-level thinking and improve the effectiveness and confidence of nurses' learning. DESIGN A quasi-experimental study two-group repeated measure design. METHODS A purposive sample of 73 ICU nurses from two campuses of one medical center was recruited (37 in the experimental group and 36 in the control group). The experimental group received ECMO care training through ECMO care board games facilitated teaching approach, whereas the control group completed the training through a traditional teaching approach. Instruments used for data collection include a demographic information sheet, ECMO Care Knowledge Scale, Clinical Reasoning Scale (Huang et al., 2023) and Learning Engagement Scale (Ciou , 2020). Both groups completed a pre-test before the training, a post-test one week after the training and a second post-test three weeks after the training. RESULTS Prior to the intervention, there were no significant differences between the two groups in ECMO care knowledge and learning engagement. However, there was a significant difference in clinical reasoning. One week after the intervention, the experimental group demonstrated significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement than the control group (p <0.01). Three weeks after the intervention, the experimental group showed significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement (p <0.001). CONCLUSIONS The content for ECMO care is complex and difficult. Board games can enhance ECMO care knowledge, clinical reasoning and learning engagement. This teaching strategy may be applied to learning challenging subjects in the future to improve learning effectiveness. The clinical reasoning framework is conducive to guiding nurses' learning. In future continuing education, board games designed based on the clinical reasoning framework and tailored to the focus of in-service education can effectively enhance nurses' learning effectiveness.
Collapse
Affiliation(s)
- Hsin-Yi Wang
- Department of Nursing, Mackay Memorial Hospital, 3F., No. 9, Aly. 12, Ln. 3, Minquan Rd., Tamsui Dist., New Taipei City 251033, Taiwan, ROC
| | - Chu-Yu Huang
- School of Nursing, Cedarville University, 251 N. Main St., Cedarville, OH 45314, USA
| | - Sophia H Hu
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd., Beitou District, Taipei City 11219, Taiwan, ROC.
| |
Collapse
|