Changes in evidence-based practice self-efficacy among nursing students and the impact of clinical competencies: Longitudinal descriptive study

Acknowledging: A classic grounded theory explaining how nurses' employ clinical judgement when complying with early warning system protocols

BACKGROUND

Recognition and response to clinical deterioration of hospitalised patients is a worldwide health priority area. In response to this concern, international bodies have implemented early warning systems to help clinicians keep people safe and prevent patient deterioration. Registered nurses hold a significant role in managing care provision and utilise early warning system tools to support their clinical judgement when making decisions about patient care.

OBJECTIVE

To generate a theory explaining how registered nurses employ their clinical judgement when complying with an early warning system protocol.

DESIGN

Classic grounded theory.

PARTICIPANTS

Participants included twenty registered nurses working with early warning systems who are currently employed in a state health care system within Australia. Data were collected via interviews generated from a grand tour question in line with classic grounded theory.

METHODS

Classic grounded theory methodology and methods were used. This approach facilitated the identification of the participants main concern and supported the generation of a theory explaining how the participants resolved this issue.

RESULTS

Analysis of data, including associated field notes and memos, identified participants often experienced unease when complying with an early warning system protocol and employing clinical judgement. The mental discomfort participants voiced in the interviews described internal conflicts that are reflective of the term 'cognitive dissonance'. How the participants sought to resolve their cognitive dissonance, revealed participants' main concern as: Compliance with early warning systems is sometimes incongruent with nurses' use of clinical judgement. The outcome of this study is a grounded theory that explains how nurses resolve this concern through 'Acknowledging'. Nurses acknowledge the efficacy of early warning systems, whilst valuing their clinical judgement and the importance of patient safety, through the subcategories of Acting and Pausing.

CONCLUSION

The Theory of Acknowledging explains how nurses overcome their main concern when employing clinical judgement and complying with early warning systems, whilst acknowledging the importance of ensuring patient safety. Reconciling the dissonance caused by trusting their clinical judgement and remaining compliant with early warning systems, enables nurse-led assessment of the patient, promoting patient safety. Tweetable abstract The theory of Acknowledging - How nurses employ clinical judgement when complying with early warning systems @Jusconnor25.

Scoping Review of Vicarious Post-Traumatic Growth Among Nurses: Current Knowledge and Research Gaps

Background

Nurses frequently experience both direct and indirect trauma, leading to significant psychological challenges. While much research has focused on the negative impacts of such trauma, less attention has been given to vicarious post-traumatic growth (VPTG). Given the high levels of indirect trauma that nurses face, understanding VPTG is crucial for mitigating its adverse effects and enhancing mental health and work efficiency.

Objective

To map and synthesize the literature on vicarious post-traumatic growth and identify key knowledge gaps in vicarious post-traumatic growth research.

Methods

This scoping review follows the approach proposed by Arksey and O'Malley. We conducted this scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework. We searched 7 databases and gray literature on May 19, 2023 to obtain relevant research.

Results

Finally, we included 29 studies from 9 countries. There are currently no reliable data on the incidence of vicarious post-traumatic growth among nurses worldwide. There are multiple instruments available to investigate vicarious post-traumatic growth in nurses, and the vicarious post-traumatic growth inventory is more recommended. Factors affecting nurses' vicarious post-traumatic growth include coping styles, psychological factors, and social support. Indirect trauma exposure and vicarious post-traumatic growth coexist. There are currently three intervention strategies for vicarious post-traumatic growth, but none have been proven in clinical trials.

Conclusion

This is the first scoping review on vicarious post-traumatic growth, there are a lot of research deficiencies and gaps in current research on vicarious post-traumatic growth for nurses. In view of the impact of secondary traumatic events on nurses, future research should pay more attention to nurses' vicarious post-traumatic growth and promote the development of vicarious post-traumatic growth.

The influence of the personality traits of newly graduated nurses on the knowledge, skills and professional self-efficacy in standardized training: a cross-sectional study

BACKGROUND

New graduate nurses often have certain potential safety hazards for patients due to insufficient knowledge and lack of clinical practice ability. To address these challenges, China has implemented a standardized training strategy. The improvements in the quality of this training involve not only the intervention of teaching methods but also the consideration of personality traits.

METHODS

The application software based on the BFI-2 Chinese scale was utilized to administer personality tests to nursing students; nursing students were invited to scan the QR code and voluntarily fill in a questionnaire, including basic information, personality test results, and a professional self-efficacy test scale; offline paper-based theoretical examination results of nursing students were collected before and after training. The data was then analyzed using SPSS software version 26.0, which involved descriptive analysis, one-way between-groups analysis of variance (ANOVA) and Spearman correlation analysis.

RESULTS

Based on the data, there were no observable differences in the theoretical results before and after training across different personality traits. In terms of skill assessment, conscientiousness exhibited the highest score at 78.91 ± 2.98 points, while negative emotionality showed the lowest score at 74.59 ± 2.12 points. These differences between different personality traits are statistically significant (P < 0.001). In terms of professional self-efficacy, conscientiousness scored the highest at 98.48 ± 12.69, while negative emotionality scored the lowest at 85.89 ± 11.71, with significant differences between different personality traits (P < 0.001). Professional self-efficacy was negatively correlated with agreeableness (r = -0.150, P = 0.044) and positively correlated with conscientiousness (r = -0.310, P < 0.001). Skill scores were negatively correlated with negative emotionality (r = -0.257, P < 0.001) and positively correlated with conscientiousness (r = 0.182, P = 0.014).

CONCLUSIONS

This study shows that personality traits affect the skills test results and professional self-efficacy of nursing students. Conscientiousness scored the highest in this study, while negative emotionality scored the lowest. Therefore, personalized training plans are recommended to improve the quality of care for such nursing students and to further enhance patient safety.

Effectiveness of Training in Evidence-Based Practice on the Development of Communicative Skills in Nursing Students: A Quasi-Experimental Design

BACKGROUND

Communication skills (CSs) and evidence-based practice (EBP) are key foundations for offering personalized and quality nursing care. CS that results in open communication is fundamental for applying EBP.

OBJECTIVES

The objective of the study was to assess the relationship between the acquisition of EBP competencies and learning CS after taking an EBP course in the nursing degree.

METHODS

Pre-test-post-test quasi-experimental study without a control group. The study population comprised fourth-year undergraduate nursing students. Before and after an EBP course, students completed a questionnaire on CS competence (HP-CSS) and EBP competence (EBP-COQ). The EBP course lasts for 15 weeks, with 150 h of work for the student. Out of these 150 h, 60 are conducted in person, while the remaining 90 h are for independent or group work, utilizing the flipped classroom methodology. Bivariate, correlational, pairwise Student's t-test, and linear regression multivariate analyses were performed.

RESULTS

The sample was composed of 153 students. After completing the EBP course, there was a statistically significant improvement in informative communication (p = 0.046) and assertiveness (p = 0.018). However, there were no observed changes in empathy, respect, and the total score of the CS competence. The results from the multivariate analysis showed that the dimensions of attitude towards EBP and EBP knowledge had a positive relation to three of the four dimensions of the CS and overall competence. Regarding the students' variables and characteristics, admission through special programs for athletes and older students (p < 0.001) and being female (p = 0.004) were positively statistically associated with empathy.

CONCLUSIONS

EBP training positively affects the development of CS in nursing students, as shown by significant improvements in the total scores of the CS and the dimensions of informative communication and assertiveness after the intervention. This study demonstrates the initial applicability and usefulness of an EBP training program for the development of CS in nursing students.

Cultural adaptation and reliability testing of the Chinese version of evidence-based practice knowledge assessment in nursing: A cross-sectional study

Objective

The EKAN is a reliable and validated tool for objectively measuring the evidence-based practice (EBP) knowledge of nurses. Thus, we set out to translate and culturally modify the Evidence-Based Practice Knowledge Assessment in Nursing (EKAN), and then evaluate its validity and reliability among Chinese practicing nurses.

Methods

This cross-sectional study consisted of two phases. The first phase involved translating the EKAN into Chinese (EKAN-Chinese), using a process of forward translation, back translation, review, cultural adjustment as well as a pilot study. The second phase aimed to assess the psychometric properties of the EKAN-Chinese and establish a baseline measure of EBP knowledge among 120 nurses from a large general hospital in Beijing, China. Data were collected from August to November 2022 and analyzed with Rasch software. This study was reported using the cross-sectional STROBE checklist.

Results

The newly translated, EKAN-Chinese was pilot-tested after slight modification of four items without altering the intended meaning. The outfit unweighted mean square was 1.03 (SD = -0.13), the infit weighted mean square was 1.00 (-0.17), and the mean difficulty index ranged from -3.43 to 2.85 according to validity indices. The results of the reliability indices revealed low person reliability (0.49), high item reliability (0.96), moderate person separation index (0.99), and sufficient item separation index (4.71). The mean EKAN-Chinese sum score was 9.8 (max score = 20, SD = 2.9).

Conclusion

The newly translated EKAN-Chinese showed sufficient psychometric evidence to support use in practicing Chinese nurses. The EKAN-Chinese can be used by nurse leaders in China as a potential screening tool to 1) objectively identify nurses who need educational training in evidence-based nursing practice, and 2) gauge the effectiveness of education and training programs to improve EBP knowledge and ultimately, evidence-based care.

The Relationship Between On-Site Clinical Practice, Nursing Professional Value, and Nursing Clinical Self-Efficacy During COVID-19: A Cross-Sectional Study

Background

During COVID-19, nursing students experienced variations in on-site clinical practice, such as a combination of on-site and non-face-to-face clinical practice. Although on-site clinical practice is critical for increasing nurses' clinical self-efficacy and developing professional nursing values, there is a lack of knowledge that reflects the current clinical practice environment.

Aim

To examine the relationship between on-site clinical practice, nursing professional values, and nursing clinical self-efficacy during the COVID-19 pandemic.

Methods

This study is a cross-sectional correlational study design. Demographic characteristics, on-site clinical practice, nursing professional values, and nursing clinical self-efficacy were assessed using an online survey from October 3, 2022, to November 6, 2022. Data were analyzed using descriptive statistics, ANOVA, t-test, Pearson's correlation coefficient, and multiple regression.

Results

Of the 86 participants, 18 (20.9%) were male and 68 (79.1%) were female. The duration of the participants' average participation in on-site clinical practice was 39.67 days (61.04%). Nursing professional values significantly influenced clinical self-efficacy (β=0.379, p<0.001). However, on-site clinical practice was not significantly related to clinical self-efficacy (β=0.051, p=0.611). In terms of nursing clinical self-efficacy, measuring blood glucose had the highest score. On the other hand, establishing and maintaining intravenous catheters had the lowest scores.

Conclusion

Nursing students' professional values were significantly associated with nursing clinical self-efficacy; however, the extent of involvement in on-site clinical practice during the pandemic did not have a significant impact on nursing clinical self-efficacy. Given that this study focused on a single university, it is imperative to replicate this research using diverse samples in the future. In addition, there is a need to establish a range of teaching and learning approaches for clinical practice, including simulation, online learning, and the use of state-of-the-art technology for faculty-student feedback strategies, in anticipation of the need for alternative practices.