Challenges nurse educators experience with development of student nurses’ clinical reasoning skills

Real-world and game-based learning to enhance decision-making

BACKGROUND

The evolving healthcare landscape necessitates highly qualified nurses equipped with a myriad of soft skills, including decision-making. Traditional teaching models have led to innovative, active methods that prioritise student participation and enhance crucial soft skill development, such as decision- making. Considering the recognised importance of improving clinical decision-making skills and the need for innovative training, a literature gap is present in assessing the effect of real world and game-based learning on decision-making abilities.

OBJECTIVES

This study aimed to investigate the effect of real-world and game-based learning, specifically using case-based learning and escape room, on decision-making competence in postgraduate nursing students in academic and clinical settings.

DESIGN

A descriptive, cross-sectional, quantitative intervention study was conducted, combining case-based learning and escape room methods sequentially.

SETTINGS

The study was conducted among postgraduate nursing students at the University of Navarra in Spain.

PARTICIPANTS

Sixty-six postgraduate nursing students, mostly women, participated in the study.

METHODS

The study integrated case-based learning and escape room sequentially. Data were collected through an ad hoc online questionnaire, recorded escape times from the escape room, and academic scores.

RESULTS

The study enrolled 66 participants with an average professional experience of 4.2 years. Academic results showed high scores in case resolution (average: 8.34) and knowledge tests (average: 9.21). Out of 11 groups, 81.8 % successfully escaped the escape room within 30 min, with positive questionnaire responses indicating enthusiasm, enjoyment and perceived effectiveness of the activities.

CONCLUSIONS

Real-world and game-based learning significantly enhanced decision-making competence in postgraduate nursing students across academic and clinical settings, demonstrating the importance of diverse teaching methods. Further research, including comparative studies and longitudinal analyses, is needed to evaluate the educational benefits of integrating case-based learning and escape room methods in nurse education and to refine assessment tools while monitoring long-term student progress.

Current challenges in teaching healthcare-associated infections prevention and control in nursing education in Vietnam and Cambodia: a qualitative study

Background: There is an insufficient understanding of factors that impede nursing students' learning of healthcare-associated infection prevention and control in developing countries. This study aimed to explore current challenges in healthcare-associated infection control and prevention education in the nursing curriculum in two Vietnamese and two Cambodian universities. Methods: Exploratory research was conducted through consultation of education programs and a qualitative study design utilizing interviews and focus group discussions. Data collection was conducted through interviews with university board members and focus group discussions with lecturers and tutors. The data were analyzed by using content analysis methods. Results: The research results indicated that there were three generic themes of challenges in teaching HAIs-PC in nursing education in Vietnam and Cambodia. They were Implementation of healthcare associated infections prevention and control education into nursing curriculum, Positive aspects fostering healthcare associated infections prevention and control learning, Negative aspects hindering healthcare associated infections prevention and control learning. Conclusions: The study results provided evidence of challenges in healthcare associated infections prevention and control education in some Asia higher education institutions. To improve professional safety, universities should pay more attention to developing appropriate teaching methods for healthcare-associated infections prevention and control education to improve students' practice outcomes.

Teaching and Learning Clinical Reasoning in Nursing Education: A Student Training Course

Clinical reasoning is an essential component of nursing. It has emerged as a concept that integrates the core competencies of quality and safety education for nurses. In cooperation with five European partners, Instituto Politécnico de Setúbal (IPS) realized the "Clinical Reasoning in Nursing and Midwifery Education and Practice" project as part of the Erasmus+ project. As a partner, our team designed a multiplier event-the student training course. The aim of this report is to describe the construction and development of this clinical reasoning training course for nursing students. We outline the pedagogical approach of an undergraduate training course on clinical reasoning in 2023, which we separated into four stages: (i) welcoming, (ii) knowledge exploration, (iii) pedagogical learning, and (iv) sharing experience. This paper presents the learning outcomes of the collaborative reflection on and integration of the clinical reasoning concept among nursing students. This educational experience fostered reflection and discussion within the teaching team of the nursing department regarding the concept, models, and teaching/learning methods for clinical reasoning, with the explicit inclusion of clinical reasoning content in the nursing curriculum. We highlight the importance of implementing long-term pedagogical strategies in nursing education.

Nursing Students' Operating Room Experiences: A Qualitative Metasynthesis

PURPOSE

This study was conducted to analyze the findings of qualitative studies about nursing students' experiences with operating room (OR) practices. There is a need to conduct metasynthesis studies to highlight the overarching dimensions of nursing students' experiences in the OR learning environment, identify and summarize key elements, draw attention to the professional implications of the experience, and then help define the future research agenda. This original study is the first metasynthesis of qualitative studies focusing on nursing students' OR practice experiences.

DESIGN

A qualitative metasynthesis.

METHODS

This metasynthesis study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and registered with PROSPERO (International prospective register of systematic reviews) (CRD42021252129). This metasynthesis consists of qualitative studies that included themes, were conducted with nursing students with OR experience, and were published in English between December 2000 and June 2022. Data were analyzed using the two-step metasynthesis procedures proposed by Sandelowski and Barroso.

FINDINGS

This metasynthesis study was carried out by analyzing 12 qualitative studies that met the inclusion criteria, reflected the results of a total of 244 nursing students, and were conducted in 7 different countries. As a result of the analysis of the studies, two main themes and seven subthemes were determined about the OR experiences of nursing students. The main themes of the study included (1) the OR environment and (2) professionalism and career choices.

CONCLUSIONS

The synthesis of studies in this research revealed nursing students' OR experiences and provided evidence about the association between these experiences and their professionalism and career goals. The research drew attention to the limitations and facilitators of the OR learning environment for nursing students and provided guidance for a positive interactive learning environment.

Nursing Students' Perception of Missed Perioperative Nursing Care: Hermeneutic Phenomenology

PURPOSE

Missed nursing care is a condition that is likely to be encountered frequently in the surgical care process and is generally related to the educational and emotional needs of the patients. Perception of and witnessing missed care can affect nursing images, expectations, and experiences by causing nursing students to experience professional disappointment. The purpose of the study was to explore nursing students' perception of perioperative missed nursing care (PMNC) according to "role theory" and Benner's "novice to expert" theories.

DESIGN

The study used a qualitative design based on Heidegger's hermeneutical phenomenological approach.

METHODS

Study data were collected using a semistructured interview form prepared by the researchers through face-to-face interviews lasting approximately 50 minutes. The analysis of the data was conducted using van Manen's thematic analysis. The Standards for Reporting Qualitative Research checklist was used in reporting the study.

FINDINGS

This study, which was conducted to explore awareness of PMNC, consisted of 12 students, including five males and seven females. It was understood that nursing students noticed PMNC in clinical practice, experienced internal conflict about the issue, were concerned about the image of nursing, and experienced role and professional identity confusion. The themes of the study were formed in light of these experiences of nursing students. Three themes and 11 subthemes emerged in the study. The themes of the study were (1) perceived PMNC application-behavior patterns, (2) internal reflections of PMNC-its impact on professional identity development, and (3) perceptions of professionalism in perioperative nursing.

CONCLUSIONS

This study provided important data about the awareness of PMNC in the surgical clinical practice of nursing students in Turkey and the effects of this awareness on the professional roles and professional identity process. Students were aware of the behavioral patterns of PMNC and that they experienced internal conflict, anxiety about the nursing image, role confusion, and professional identity confusion due to this awareness. Some students justified the PMNC behaviors of the nurses and others saw themselves as the power to change the PMNC behaviors.

Over twenty years of pedagogical research from Nurse Education in Practice: A bibliometric analysis from 2001 to 2023

AIM

To present a bibliometric overview of pedagogical research from Nurse Education in Practice from its inception in 2001 up until 2023.

BACKGROUND

Bibliometric methods are useful in analysing and understanding the characteristics of scientific publications in a particular field and the influence of specific journals. However, no bibliometric analysis of a nurse education journal has been undertaken to date which would highlight important research trends in this area of nursing and midwifery.

METHODS

A total of 2231 publications (articles and reviews only) from Nursing Education in Practice were retrieved from the Scopus database between 2001 and 2023. Several software applications including Microsoft Excel and VOSviewer were used to undertake bibliometric analysis on this dataset. Publication trends such as country analysis, author analysis, keywords analyses (cluster, content and trend analysis) were generated to help understand the volume and scope of pedagogical nursing and midwifery research in this journal.

RESULTS

There has been a steady increase in pedagogical research from Nurse Education in Practice since its launch in 2001 up until 2018, with a dip in publications in 2022 most likely due to the impact of restrictions during the coronavirus pandemic. The most prolific institutions publishing in the journal are mainly from the United Kingdom, Australia and the United States, with over eighty countries represented demonstrating its global reach and impact. Nursing students, nursing education, simulation and learning are some of the most frequent author keywords.

CONCLUSION

The diversity of pedagogies in nursing and midwifery education, clinical learning and supervision in practice environments, and competence and confidence when transitioning to practice are the most popular research areas in Nurse Education in Practice. This study informs nurse and midwife educators and scholars about the volume and scope of pedagogical research in nursing and midwifery. It also makes recommendations on how to improve aspects of scholarship in education and areas for future pedagogical research.

Development of collaboration guidelines for nursing education and related healthcare services

Background

A theory-practice gap in nursing education often occurs, and the staff from the nursing education institution and the associated healthcare services should find ways to improve their collaboration to reduce the gap during the training of nursing students.

Aim

This study aimed to develop context-specific collaboration guidelines for a nursing education institution and associated healthcare services.

Setting

Private hospital in the Gauteng province of South Africa.

Methods

Guidelines were developed from the findings of an integrative literature review. Thereafter, it was contextualised in a qualitative study with focus group discussions (FGDs) involving 9 theoretical lecturers and 10 clinical facilitators.

Results

In the partnership between the nursing education institution and the associated healthcare services, bilateral communication, cooperation between the theoretical lecturers and the clinical facilitators in delivering evidence-based patient care, intensified innovation in teaching and learning practices and an environment conducive to theory-practice integration should be emphasised.

Conclusion

A set of context-specific guidelines was developed to enable the theoretical lecturers and the clinical facilitators to collaborate in supporting nursing students to apply their theoretical knowledge in the development of clinical competencies.

Contribution

The guidelines can be adjusted to suit the context of other nursing education institutions and their associated healthcare services to improve collaboration between theoretical lecturers and clinical facilitators to the benefit students' skills development in theory-practice integration.

An integrative review of teaching strategies to support clinical judgment development in clinical education for nurses

OBJECTIVES

Historically, emphasis on task-completion and lack of intentional approaches that develop students' thinking skills have dominated clinical education. One contributing factor may be the limited literature about teaching to develop clinical reasoning and clinical judgment in the clinical environment. This integrative review accessed available literature to answer the question, What strategies are used to develop clinical judgment in the clinical education environment?

DESIGN

The Whittemore and Knafl approach framed the integrative review. The framework includes the following steps 1) problem identification, 2) literature search, 3) data evaluation, 4) data analysis, and 5) presentation.

DATASOURCES

The data bases CINAHL Plus with Full Text, OVID, and ProQuest were searched through the period of January 2000 through July of 2022.

REVIEW METHODS

The PRISMA protocol informed review and screening of the literature. Authors assessed articles for eligibility via first screening by abstract review, followed by review of the full text. Both authors reviewed the articles, assessing qualification for inclusion and evaluating the content. Data from eligible articles were analyzed and synthesized to answer the research question.

RESULTS

Of the initial 427 articles, a total of 20 articles met inclusion criteria for final analysis. Five general themes emerged for clinical judgment during clinical education. The findings identified the teaching strategies nurse educators use. Many of the teaching methods include deliberateness and intentionality in planning and implementing the strategies. In addition to evaluating clinical judgment, nurse educators guided and mentored student thinking. Finally, this review identified reported outcomes and results of the teaching strategies and methods.

CONCLUSIONS

A limited number of articles describing teaching for clinical judgment in clinical environment were found. The articles analyzed found that nurse educators used a variety of teaching strategies for the purpose of developing students' clinical judgment. More research is needed to guide best-practices in clinical education. We must move the science forward to transform and leverage clinical education more deliberately to teach thinking in practice and decision-making about patient care.

Barriers and Facilitators Experienced by Undergraduate Nursing Faculty Teaching Clinical Judgment: A Qualitative Study

Background

Clinical judgment is declining in new graduate nurses, which affects patient safety and is therefore tested on the Next Generation NCLEX. There is limited research describing barriers and facilitators impacting nursing faculty's experiences teaching clinical judgment.

Aims

The purpose of this study was to explore barriers and facilitators affecting undergraduate nursing faculty's clinical judgment teaching methods.

Methods

Sixteen qualitative interviews were conducted with full-time nursing faculty at seven universities in the Northeast and Southeast regions of the United States.

Results

The findings revealed program, student, and faculty factors affecting clinical judgment teaching methods. Subthemes included time, class size, students' class preparation, critical thinking, task orientation, professional development, and faculty resistance.

Conclusion

Minimizing barriers and strengthening facilitators based on participants' practices and previous research can support more effective clinical judgment pedagogy, which has the potential to achieve Next Generation NCLEX success and potentially increase patient safety.

Effectiveness and learning experience from undergraduate nursing students in surgical nursing skills course: a quasi- experimental study about blended learning

BACKGROUND

Blended learning is increasingly being adopted, and yet a gap remains in the related literature pertaining to its skill performance, learning engagement and inner experience in undergraduate surgical nursing skills course.

OBJECTIVES

To investigate the changes in skills performance and learning engagement in the application of blended learning, and what it actually brings to nursing students.

DESIGN

The study uses a historical control, two-armed, mixed and quasi-experimental design.

METHODS

The blended learning version of the course was offered to the 2019 class of 334 nursing undergraduates. Quantitative and qualitative data were collected after the course to obtain a comprehensive understanding of the course effects compared with the 304 nursing undergraduates of grade 2017 who adapted traditional learning. Quantitative data were analyzed by descriptive and inferential statistics using IBM SPSS 26.0, and qualitative data were encoded using Nvivo11.0.

RESULTS

There were significant differences in skill performance and learning engagement between the class of 2017 and 2019 (p < 0.001). Combined with further analysis of the interview data, 3 first-level nodes and 8 secondary nodes were determined. Students' opinions, comments and suggestions on the application of blended learning are refreshing.

CONCLUSION

Moving forward with blended learning: opportunities and challenges go hand in hand. Researchers need to continually modify their research designs to respond to variable educational environments.

Effects of electronic fetal monitoring simulation with problem-based learning on nursing students' performance confidence, clinical judgment, and knowledge

AIM

This study aimed to determine the effects of an electronic fetal monitoring simulation with problem-based learning (EFM SPBL) program based on the Clinical Judgment Model.

METHODS

Third-year nursing students were randomly allocated to the control (n = 46) or experimental groups (n = 46). The control group participated in the conventional clinical practice, while the experimental group participated in the EFM SPBL program. The students completed a structured questionnaire on Google surveys.

RESULTS

Nursing performance confidence (t = 10.72, p < .001) and clinical judgment (t = 2.53, p = .015) increased significantly in the experimental group.

CONCLUSIONS

This study recognized improvement in students' clinical judgment in the context of learning transfer. A standardized SPBL with various cases is recommended.

Effects of simulation with problem-based learning (S-PBL) on nursing students' clinical reasoning ability: based on Tanner's clinical judgment model

BACKGROUND

Clinical reasoning ability, a complex cognitive and metacognitive process, is a crucial core competency required in nursing practice. Therefore, undergraduate nursing students should be provided with nursing education to strengthen their clinical reasoning ability based on real-life nursing scenarios.

METHODS

This study was conducted using a quasi-experimental single-group pretest-posttest design. Three sessions (lasting three hours each) of Simulation with Problem-Based Learning (S-PBL) using high-risk obstetrics-gynecology scenarios were provided to 71 third-year nursing students of a university. The sessions were conducted from September to December 2022, and they aimed to strengthen their clinical reasoning ability. For data collection, an online survey was conducted using Rubric for Clinical Reasoning and learning satisfaction evaluation tool. Data were analyzed using descriptive statistics and repeated measures analysis of variance in SPSS.

RESULTS

The mean score of clinical reasoning ability significantly increased from 29.42 (standard deviation: 4.62) out of 40 points in the pre-test to 32.28 (4.36), 33.44 (5.35), and 33.80 (5.91) after the first, second, and third S-PBL sessions, respectively (F = 61.668, p < .001). The learning satisfaction score was as high as 107.04 (12.66) out of 120 points.

CONCLUSION

This S-PBL program is an effective nursing education strategy to strengthen nursing students' clinical reasoning ability. Future studies must examine learner variables and standardize the S-PBL design and operation process by comparison to a traditional teaching approach and a higher range of clincal reasoning ability.

The effectiveness of high-fidelity simulation on undergraduate nursing students' clinical reasoning-related skills: A systematic review

BACKGROUND

High-fidelity simulation is used widely in the education of healthcare professionals; however, its effectiveness in teaching undergraduate nursing students clinical reasoning skills is not known. The objective of this systematic review is to synthesise findings from current literature about the effectiveness of high-fidelity simulation on the development of clinical reasoning-related skills in undergraduate nurses.

METHODS

A systematic review of the effectiveness of high-fidelity simulation was conducted, guided by the Joanna Briggs Institute methodology. Studies included were experimental and quasi-experimental study designs published in English between 2014 and 2020 that investigated clinical reasoning-related skills for undergraduate nursing students. Databases searched included Medline, CINAHL, Embase and the Joanna Briggs Institute of Evidence-based Practice database.

RESULT

A total of 1980 studies were identified and 15 studies met the inclusion criteria. Seven studies were randomised controlled trials, and eight studies were quasi-experimental. The 15 included studies reported 19 outcomes, as studies examined one or more outcomes of clinical reasoning-related skills. Statistically significant results favouring the simulation groups were reported in the following outcomes: clinical reasoning skills (three studies of three studies), critical thinking skills (four out of eight studies), problem-solving (two of four studies), decision-making skills (one of two studies), and clinical judgment skills (two of two studies).

CONCLUSION

High-fidelity simulation was reported to be effective alone and in combination with traditional teaching or other simulation types in improving undergraduate nursing students' clinical reasoning-related skills acquisition. Limitations included cost and availability of high-fidelity simulation to large numbers of students, which have implications for practice. Further research is needed to determine the actual effect of high-fidelity simulation compared to other simulation types on undergraduate nursing students' clinical reasoning-related skills.

Using unfolding case scenarios to promote clinical reasoning for nurse practitioner students

ABSTRACT

This article describes how an unfolding case study can be used to promote the development of clinical reasoning through students' self-reported perceptions, although at the same time facilitating collaboration among providers from various specialties. An unfolding case (evolving case) provides sequential information about a patient's illness trajectory as they experience the illness and related symptomology. An unfolding case study was implemented during a college skills laboratory immersion experience for 33 nurse practitioner (NP) students who were in their final year of the NP program. Students were invited per email to complete a confidential REDCap survey after the case presentation and discussion. Twenty-three students completed the survey. More than half of the students (52%) stated the review of the unfolding case offered "significant learning value" and 78% rated the unfolding case as being "very to extremely" helpful in creating opportunities for critical thinking and engagement in clinical reasoning. Implementing unfolding case studies in NP student program curricula promotes critical thinking, clinical reasoning, and allows opportunities to engage in interprofessional collaboration.

The Essential Elements of the Clinical Reasoning Process

BACKGROUND

Clinical reasoning is an important skill that enables health care professionals to identify and evaluate patients' real or potential problems, implement appropriate interventions, solve clinical problems, and improve the quality of health care and patient outcomes.

PURPOSE

The goal of this study was to go beyond individual professions and seek consensus across health care professions on the essential elements of the clinical reasoning process.

METHODS

This study used a traditional Delphi methodology to seek consensus from clinical reasoning experts from the fields of nursing, medicine, and physical and occupational health.

RESULTS

The experts reached a consensus on 56 essential elements identified from the clinical reasoning literature. This is the first time health care professions have reached a consensus on the essential elements of the clinical reasoning process using a Delphi study.

CONCLUSIONS

Achieving consensus on the essential elements of the clinical reasoning process is essential to better understanding, improved teaching, and evaluation of clinical reasoning skills.

Barriers to the Development of Clinical Reasoning Skills among Coronary Care Nurses: A Qualitative Study

Background

Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses.

Materials and Methods

Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi-structured interviews and were analyzed using conventional content analysis.

Results

The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self-efficacy.

Conclusion

There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses' CR skills.

Exploration and prioritization of strategies to improve clinical reasoning skills among coronary care nurses: A qualitative study

INTRODUCTION

Clinical reasoning (CR) is the most important competency for safe and quality care delivery in coronary care unit (CCU). Nonetheless, evidence shows that nurses in CCU do not have the necessary CR skills to manage challenging situations and provide quality care in these units. Identifying the possible strategies for CR skill improvement is a key step in improving nurses' CR skills.

AIM

The aim of the study was to explore and prioritize strategies for CR skill improvement among nurses in CCU.

DESIGN

A qualitative design was used.

METHODS

This qualitative study was conducted in 2020 in the CCU of a subspecialty heart hospital. Participants were nurses, head nurses, nursing supervisors, nursing manager, clinical nursing instructors, and cardiologists. Initially, necessary data to identify strategies for CR skill improvement were collected through semistructured interviews with 16 participants and were analyzed through conventional content analysis. Then, the determined strategies were prioritized through quantitative scoring by 24 participants in three focus group discussions. The Suitability, Feasibility, and Flexibility matrix was used for scoring.

RESULTS

The main three strategies of CR skill improvement were improvement of the efficiency of nursing education, effective management in nursing, and development of professional nursing. The mean scores of these categories in the possible range of 3-9 were 8.20, 8.04, and 7.83, respectively.

CONCLUSION

This study provides a firm scientific basis for strategies to improve CR skills among nurses in CCU. Strategies determined in the present study can be used to develop interventions to improve nurses' CR skills and promote strength-based nursing.

Formulation of teaching strategies for graduation internship based on the experiential learning styles of nursing undergraduates: a non-randomized controlled trial

PURPOSE

To formulate scientific and effective teaching strategies for the graduation internship of nursing undergraduates, in order to improve their holistic clinical competence.

METHOD

A before-after self-controlled study with cluster sampling was performed on the 78 senior nursing undergraduates that underwent a graduation internship at the department. Students were required to fill in the Kolb's Learning Style Questionnaire and Holistic Clinical Assessment Tool on the date of admission to assess their learning style characteristics and holistic clinical competence, according to which targeted teaching strategies for their graduation internship were formulated. When leaving the department, the students were required to fill in the Holistic Clinical Assessment Tool again to assess the changes in their learning skills after rotation.

RESULTS

In terms of learning methods, nursing students scored 23.87 ± 6.11, 29.57 ± 5.03, 37.85 ± 6.87, and 28.73 ± 6.70 in Concrete Experience, Reflective Observation, Abstract Conceptualisation, and Active Experimentation, respectively. When the learning styles were ranked by composition ratio, 46 students (58.9%) were assimilators, 18 (23.1%) were convergers, 9 (11.5%) were divergers, and 5 (6.4%) were accommodators. The holistic clinical competence of students after rotation was significantly improved compared to before rotation (P < 0.01).

CONCLUSION

Clinical teaching strategies for graduation internship that are formulated according to the experiential learning style of nursing undergraduates can effectively improve their learning skills and holistic clinical competence.

Integrating Clinical Reasoning Skills in a Pre-professional Undergraduate Human Anatomy Course

Clinically integrated curricula in health science education has been shown to promote the development of problem-solving schema and positively impact knowledge acquisition. Despite its' purported benefits, this type of curricula can impose a high cognitive load, which may negatively impact novice learners' knowledge acquisition and problem-solving schema development. Introducing explicit clinical reasoning instruction within pre-professional undergraduate basic science courses may limit factors that increase cognitive load, enhance knowledge acquisition, and foster developing clinical problem-solving skills. This study, conducted over the Fall and Spring semesters of the 2018-2019 school year, sought to evaluate whether the implementation of a clinical reasoning instructional intervention within a clinically integrated pre-professional undergraduate general human anatomy course influenced students' acquisition of anatomical knowledge and development of clinical problem-solving skills. Results of the study were mixed regarding the acquisition of anatomical knowledge. Both the intervention and comparison groups performed similarly on multiple choice examinations of anatomical knowledge. However, the clinical reasoning intervention positively impacted students' ability to apply clinical reasoning skills to anatomically based clinical case studies. Results from M\mixed between-within subjects analysis of variance comparing scores on Written Clinical Reasoning Assessments revealed a significant interaction between time and group affiliation, with the groups receiving the interventions outperforming the comparison groups: Fall, P < 0.001; Spring, P < 0.001. The results of this study may imply that explicit clinical reasoning instruction within a clinically integrated undergraduate Human Anatomy course could hold potential for fostering students' early clinical reasoning skills.

Effects of a simulation-based nursing process educational program: A mixed-methods study

AIMS

To examine the effects of a simulation-based nursing process educational program on nursing students' confidence in communication and foundational understanding of the nursing process.

BACKGROUND

The nursing process is a core component of patient-centered nursing care that is underpinned by effective communication. However, learning how to engage patients and carry out the distinct steps of the nursing process can be challenging if students are not able to apply knowledge to practice. Simulation-based learning programs can provide an immersive opportunity for students to enhance their understanding of the nursing process as well as improve their communication skills.

DESIGN

A mixed methods randomized controlled trial METHODS: Two Fundamentals of Nursing classes were recruited from a university in northern Taiwan. The experimental group (n = 58) engaged with the simulation-based nursing process educational program, which consisted of an online interactive animation and a standardized patient simulation. The control group (n = 49) was assigned a case-study. Confidence in Communication surveys, assignment and examination scores, satisfaction questionnaires and post-simulation reflection logs were used for data collection. Data were analyzed using SPSS 22.0 and qualitative content analysis.

RESULTS

Both groups showed statistically significant improvement in Confidence in Communication (p < .001). The experimental group performed better on the assignment than the control group (p < .001). No significant difference was seen between either groups' examination performances. The animation's high usage rate (mean 5.91 interactions per-user) and the results of the satisfaction questionnaires indicate the program's positive reception from the experimental group. The following themes emerged: effective communication skills, problem solving, confidence, feeling prepared and novel learning experience.

CONCLUSION

The results demonstrate that the simulation-based nursing process educational program increased students' self-confidence in communication and non-verbal communication skills as well as foundational understanding of how to carry out the nursing process. The use of interactive simulation-based learning experiences is recommended to improve nursing students' understanding of how to apply abstract concepts into practice.

Implementation of active learning methods by nurse educators in undergraduate nursing students' programs - a group interview

BACKGROUND

Modern and active learning methods form an important part in the education of Nursing students. They encourage the development of communication and critical thinking skills, and ensure the safe health care of patients. Our aim was to obtain naturalistic data from nurse educators regarding want the use and effects of implementing active learning methods (Peyton's Four-Step Approach, Mind Mapping, Debriefing and Objective Structured Clinical Examination methods) in the study process of students of Nursing after a completed education module, Clinical skills of mentors, as part of the Strengthening Nursing in Bosnia and Herzegovina Project. We wish to learn about the perception of nurse educators regarding the use of active learning methods in the study process of Nursing in the future.

METHODS

Qualitative research was conducted and a group interview technique was used for data collection. Beforehand, research participants were included in a two-day education module, Clinical skills of mentors, as part of the Strengthening Nursing in Bosnia and Herzegovina Project. Content analysis of the discussion transcriptions was conducted.

RESULTS

Fourteen nurse educators participated. Group interviews were conducted in September 2019. The obtained categories form four topics: (1) positive effect on the development of students' communication skills (2) positive effect of learning methods on the development of students' critical thinking skills (3) ensuring a safe learning environment (4) implementation of active learning methods.

CONCLUSIONS

The use of various active learning methods in simulation settings improves the Nursing students' critical thinking and communication skills. Therefore, we believe that Peyton's Four-Step Approach, Mind Mapping and Debriefing methods should be included as tools for effective student learning and as preparation for directly performing safe nursing interventions with a patient. Effective approaches to the assessment of Nursing students may ensure quality patient health care in accordance with the vision of the nursing profession.

The effect of instructors' clinical experience on professional socialization from the perspective of nursing students: A phenomenological qualitative study

Nursing students spend efforts to be familiar with their professional roles and professional values and to understand professional behaviors, functions, and values correctly in clinical practices. First and second-year nursing students are in the early stages of professional socialization in clinical practice. In the third year, students start to reach a level at which they are aware of the professional behaviors of instructors in clinical practice in terms of professional socialization. This study aimed to determine how the effect of instructors on the professional socialization of students in clinical practice was perceived by the students. The study used a qualitative design based on Heidegger's hermeneutic phenomenological approach. First, the content of the questions in the interview form and the aim of the study were explained to the students, and then the interviews were conducted with 10 students who agreed to participate in face-to-face in-depth interviews. The data were analyzed using van Manen's thematic analysis and three themes and seven sub-themes were determined. The themes of the study were as follows: (1) It may make professional socialization easier or difficult (subthemes: "It is important to be aware of my presence"; "Unfair practices related to marks and threat with marks"), (2) Instructors' communication with nurses affects us (subthemes: "Positive atmosphere of care", "Acceptance in the clinic"), (3) I am aware of our instructors with clinical experience (subthemes: "Like someone in the clinic", "Role model with care behaviors", "Like carrying water in your palms"). In light of the results of this study, it has been understood that the clinical experience of the instructors is important. In addition, the importance of clinical experience in the employment of instructors has emerged.