An exploratory study of nursing and medical students health promotion counselling self-efficacy

Development and quality assessment of the psychometric properties of the Self-Efficacy in Lifestyle Counselling scale (SELC 20 + 20) using Rasch analysis

BACKGROUND

Globally as well as in Sweden, diseases that are caused by unhealthy lifestyle habits are the most common causes of death and disability. Even though there are guidelines that oblige all health-care professionals to counsel patients about lifestyle, studies have shown that it is not prioritized within healthcare. One reason for this among nurses has been shown to be lack of confidence in knowledge and counselling skills. This study aimed to develop, and quality assess the psychometric properties of an instrument to measure self-efficacy in lifestyle counselling.

METHODS

An instrument inspired by an American instrument, following Bandura's recommendations for development of self-efficacy measures, was developed according to Swedish national guidelines for disease-prevention. The instrument was revised after cognitive interviews with nursing students, university teachers within health sciences, and clinical experts, then administrated to 310 nursing students at different levels in their education. The instrument was tested with Rasch Measurement Theory, with focus on dimensionality, local dependency, targeting, reliability, response category functioning, Rasch model fit, and differential item functioning by age, gender, educational level and previous health care education.

RESULTS

The development of the instrument resulted in 20 + 20 items, 20 items about self-efficacy in knowledge, and 20 items about self-efficacy in ability to counsel persons about their lifestyle. The analyses showed that knowledge and ability are two different, but related, constructs, where ability is more demanding than knowledge. The findings provide support (considering dimensionality and local dependency) for that all 20 items within the knowledge construct as well as the 20 items within the ability construct can be summed, achieving two separate but related total scores, where knowledge (reliability 0.81) is a prerequisite for ability (reliability 0.84). Items represented lower self-efficacy than reported by the respondents. Response categories functioned as expected, Rasch model fit was acceptable, and there was no differential item functioning.

CONCLUSIONS

The SELC 20 + 20 was found to be easy to understand with an acceptable respondent burden and the instrument showed good measurement properties.

Impact Evaluation of An Interdisciplinary Educational Intervention to Health Professionals for the Treatment of Mild to Moderate Child Malnutrition in Mexico: A Difference-in-Differences Analysis

The prevalence of undernutrition in Mexican children younger than 5 years old has been 14% since 2006. There are clinical practice guidelines for mild to moderate malnutrition in children in the Mexican health system; however, they are not applied. In addition, the knowledge and practices of health professionals (HP) to treat malnutrition in health centers are insufficient to perform adequate assessments and correct treatments. An impact evaluation of an interdisciplinary educational intervention was carried out on 78 HPs for the treatment of children with mild to moderate malnutrition of low resources, with 39 in the intervention group and 37 in the counterfactual group, estimated as the comparison group. A Food and Agriculture Organization (FAO)-validated questionnaire adapted to child malnutrition about knowledge, attitudes, and practices was applied before, after, and 2 months after a malnutrition workshop. The difference-in-differences analysis showed that the educational intervention group had a significant improvement in knowledge, attitudes, and practices before and after the intervention (grades of 54.6 to 79.2 respectively, p = 0.0001), compared with the comparison group (grades of 79.2 and 53.4, respectively, p = 0.0001), which was maintained over two months (grades of 71.8 versus 49.8, p = 0.0001, respectively). The multivariate analysis showed that the probability of improvement in learning by 30% was 95-fold higher in the educational intervention group versus the comparison group, OR = 95.1 (95% CI 14.9-603.0), and this factor was independent of sex, age, education, or hospital position. Despite the availability of clinical practice guidelines for the assessment and treatment for child malnutrition, education in malnutrition for HPs is effective and needed to achieve a significant improvement in children's health.

Global Prevalence and Drivers of Dental Students' COVID-19 Vaccine Hesitancy

BACKGROUND

Acceleration of mass vaccination strategies is the only pathway to overcome the COVID-19 pandemic. Healthcare professionals and students have a key role in shaping public opinion about vaccines. This study aimed to evaluate the attitudes of dental students globally towards COVID-19 vaccines and explore the potential drivers for students' acceptance levels.

METHODS

A global cross-sectional study was carried out in February 2021 using an online questionnaire. The study was liaised by the scientific committee of the International Association of Dental Students (IADS), and data were collected through the national and local coordinators of IADS member organizations. The dependent variable was the willingness to take the COVID-19 vaccine, and the independent variables included demographic characteristics, COVID-19-related experience, and the drivers of COVID-19 vaccine-related attitude suggested by the WHO SAGE.

RESULTS

A total of 6639 students from 22 countries, representing all world regions, responded to the questionnaire properly. Their mean age was 22.1 ± 2.8 (17-40) years, and the majority were females (70.5%), in clinical years (66.8%), and from upper-middle-income economies (45.7%). In general, 22.5% of dental students worldwide were hesitant, and 13.9% rejected COVID-19 vaccines. The students in low- and lower-middle-income (LLMI) economies had significantly higher levels of vaccine hesitancy compared to their peers in upper-middle- and high-income (UMHI) economies (30.4% vs. 19.8%; p < 0.01).

CONCLUSIONS

The global acceptance level of dental students for COVID-19 vaccines was suboptimal, and their worrisome level of vaccine hesitancy was influenced by the socioeconomic context where the dental students live and study. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were barriers to vaccination. The findings of this study call for further implementation of epidemiology (infectious diseases) education within undergraduate dental curricula.

Factors affecti̇ng health-promoting behavi̇ors i̇n nursi̇ng students: A structural equation modeling approach

BACKGROUND

The purpose of this study is to evaluate the effectiveness of the Mindfulness-based Stress Reduction program applied to a sample of Turkish nursing students.

METHOD

The study was designed as a randomized controlled trial. Program sessions of 90-95 minutes were given twice a week for 12 weeks. The data were collected using the Nursing Education Stress Scale, the Mindfulness Scale, and the Stress Management Styles Scale.

RESULTS

A statistically significant difference was found in the mean post-test and mean follow-up scores obtained by the control group and the experimental group on the Nursing Education Stress Scale and its sub-dimensions. On the Mindfulness Scale, a statistically significant difference was found between the mean pre-test and post-test scores obtained by the experiment and control groups.

CONCLUSION

The results derived from this study suggest that the mindfulness-based stress reduction program is effective in reducing the stress experienced by students during nursing education, increasing their mindfulness, strengthening their coping mechanisms for stress, increasing their use of self-confident and optimistic approaches, and decreasing their use of the helpless approach.

The Perceived Importance, Emphasis, and Confidence in Veterinary Nutrition Education of First-Year Canadian and US Veterinary Students

Veterinarians play a critical role in providing nutrition consultation and supporting clients to adopt healthy dietary habits for their pets; thus applicable, informative nutrition education in veterinary schools is essential. The aim of this study was to explore incoming veterinary students' perceived importance, emphasis, and confidence in the veterinary nutrition education they will receive. First-year veterinary students at all 5 Canadian and 5 randomly selected US veterinary schools were invited to complete a 31-item questionnaire. Response rate was 34.6% (n = 326). Descriptive statistics and multivariate logistic regression were performed. While most students (92%) considered nutrition education to be an important component of veterinary training, 64% felt it will not be a subject of great emphasis. Veterinary students at schools with a board-certified veterinary nutrition faculty were more likely to perceive higher emphasis on nutrition education (p < 0.001). In the multivariate analysis, academic self-efficacy was a positive predictor of students' perceived confidence in how well they anticipate their nutrition education that will prepare them for their clinical roles (p = 0.003). Examining the perceptions of veterinary students entering veterinary school is an important aspect to consider in the design and delivery of a veterinary nutrition curriculum and maybe equally important for students entering other professional health programs.

Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

OBJECTIVE

To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work.

DESIGN

Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations.

RESULTS

Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised.

CONCLUSIONS

These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve patients' health by helping health students and professionals to appreciate the importance of delivering nutrition care and feel competent to deliver it.

Physical Activity Counseling by Diabetes Educators Delivering Diabetes Self-management Education and Support

PURPOSE

The purpose of this study was to examine factors that influence physical activity counseling of diabetes educators delivering diabetes self-management/support (DSME/S).

METHODS

Diabetes educators were surveyed about their DSME/S counseling at the American Association of Diabetes Educators Pennsylvania State Diabetes Conference to explore (1) time dedicated to physical activity counseling, (2) importance placed on physical activity as a treatment for diabetes, (3) knowledge of the 2008 Physical Activity Guidelines for Americans, (4) level of confidence with physical activity counseling, and (5) barriers associated with physical activity counseling.

RESULTS

A sample of 119 diabetes educators with 13.0 ± 8.6 years of DSME/S experience participated in the survey (95.8% female; 94.1% white; 60.5% nurses; 73.9% Certified Diabetes Educators). Of 4 common DSME/S content areas (healthy eating, taking medications, monitoring blood glucose, and physical activity), physical activity was ranked as the third most important behind healthy eating and taking medications, with 14.5 ± 12.1 minutes per session spent counseling on physical activity. The proportion of educators acknowledging the current physical activity guidelines for moderate-intensity aerobic activity, vigorous-intensity aerobic activity, and resistance training was 74%, 20.5%, and 62.8%, respectively. Being "very confident" for counseling on physical activity was reported by 54.7%, while "inability to engage patients in physical activity" and "time allotted for DSME/S visits" were the most challenging personal and practice barriers reported, respectively. Physical activity is an important lifestyle behavior for the treatment of diabetes.

CONCLUSIONS

Findings suggest that there are challenges to physical activity counseling within DSME/S. Strategies to improve physical activity counseling by diabetes educators warrant attention.

The Psychometric Evaluation of the Revised Clinical Skills Self-Efficacy Scale

BACKGROUND AND PURPOSE

This study's purpose was to psychometrically evaluate the revised Clinical Skills Self-Efficacy Scale (CSES). Self-efficacy is a predictor of an individual's behavior in situations such as learning to implement a new clinical nursing skill.

METHODS

Subjects were nursing students (N = 214). The CSES, an investigator-developed instrument designed to measure nursing students' perceptions of their self-efficacy as it relates to selected clinical skills, was used to measure clinical skills self-efficacy. The instrument consisted of 9 clinical skills.

RESULTS

There was evidence from 2 prior pilot studies both supporting the CSES's reliability and validity.

CONCLUSIONS

Self-efficacy may be one way to explain the relationship between clinical skills instruction and the successful enactment of these clinical skills.

Correlation between Students' Self-Efficacy and Teachers' Educational Leadership Style in Iranian Midwifery Students

BACKGROUND

Self-efficacy is believe in and feeling of ability to complete work. One of these factors is educational teachers ' role. This study aimed to determine relationship between teachers' leadership style and students' self-efficacy in midwifery students.

METHOD

This Study is a cross sectional correlation study. Sampling was conducted in midwifery students in Bachelor Science degree in 2013. Data collection tools were multi leadership questionnaire and self-efficacy clinical performance. After explaining the goals of study, 97 students completed the questionnaire. Scoring the questionnaire was based on a Liker's scale (0-5).Data were analyzed by SPSS 16. Correlation coefficient test was adopted to investigate the relationship and p value was considered 0.05.

RESULT

Mean of self-efficacy scores were 116.12 (24.66.). In 53.3% of the cases, self-efficacy was good, in 42.2% moderate and in 4.3%, it was bad. The majority of the students (88.9%) reported that their teachers had an idealized style in leadership. About 94.6% of the students with good self- efficacy believed that their teachers' leadership style was transformational style. There was a significant correlation between self- efficacy and leadership style (p<0.05).

CONCLUSIONS

Results showed that transformational style is appropriate for midwifery teachers.

Nutrition education in medical school: a time of opportunity

Undergraduate medical education has undergone significant changes in development of new curricula, new pedagogies, and new forms of assessment since the Nutrition Academic Award was launched more than a decade ago. With an emphasis on a competency-based curriculum, integrated learning, longitudinal clinical experiences, and implementation of new technology, nutrition educators have an opportunity to introduce nutrition and diet behavior-related learning experiences across the continuum of medical education. Innovative learning opportunities include bridging personal health and nutrition to community, public, and global health concerns; integrating nutrition into lifestyle medicine training; and using nutrition as a model for teaching the continuum of care and promoting interprofessional team-based care. Faculty development and identification of leaders to serve as champions for nutrition education continue to be a challenge.

Staff representations and tobacco-related practices in a psychiatric hospital with an indoor smoking ban

The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatric hospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% (n = 155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well-being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatric hospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco-related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke-related illnesses (Spearman r = 0.38, P < 0.0001). Compared with non-smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues.

Improving physician clinical documentation quality: evaluating two self-efficacy-based training programs

BACKGROUND

Clinical documentation is critical to health care quality and cost. The generally poor quality of such documentation has been well recognized, yet medical students, residents, and physicians receive little or no training in it. When clinical documentation quality (CDQ) training for residents and/or physicians is provided, it excludes key constructs of self-efficacy: vicarious learning (e.g., peer demonstration) and mastery (i.e., practice). CDQ training that incorporates these key self-efficacy constructs is more resource intensive. If such training could be shown to be more effective at enhancing clinician performance, it would support the investment of the additional resources required by health care systems and residency training programs.

PURPOSES

The aim of this study was to test the impact of CDQ training on clinician self-efficacy and performance and the relative efficacy of intervention designs employing two versus all four self-efficacy constructs.

METHODOLOGY/APPROACH

Ninety-one internal medicine residents at a major academic medical center in the northeastern United States were assigned to one of two self-efficacy-based training groups or a control group, with CDQ and clinical documentation self-efficacy measured before and after the interventions. A structural equation model (AMOS) allowed for testing the six hypotheses in the context of the whole study, and findings were cross-validated using traditional regression.

FINDINGS

Although both interventions increased CDQ, the training designed to include all four self-efficacy constructs had a significantly greater impact on improving CDQ. It also increased self-efficacy.

PRACTICE IMPLICATIONS

CDQ may be significantly improved and sustained by (a) training physicians in clinical documentation and (b) employing all four self-efficacy constructs in such training designs.

How medical students' behaviors and attitudes affect the impact of a brief curriculum on nutrition counseling

OBJECTIVE

To evaluate a nutrition curriculum and explore the influence of medical students' own nutrition practices on its impact.

METHODS

An anonymous survey was given to first-year medical students attending a required course immediately prior to and 2 weeks after a 2-hour interactive nutrition curriculum intervention in a large private urban medical school in New York, New York. Main outcomes included self-reported nutrition counseling confidence, ability to assess diet, and nutrition knowledge measured using 4-point Likert scales.

RESULTS

One hundred eleven students completed surveys pre-curriculum (69%) and 121 completed them post-curriculum (75%). The authors found overall pre-post differences in dietary assessment ability (2.65 vs 3.05, P < .001) and counseling confidence (1.86 vs 2.22, P < .001). In addition to the curricular impact, students' nutrition-related behaviors and attitudes were positively associated with outcomes.

CONCLUSIONS AND IMPLICATIONS

A nutrition curriculum for medical students improves students' nutrition counseling-related confidence, knowledge, and skills even when controlling for personal nutrition-related behaviors.

Bringing evidence-based continuing education on asthma to nurses

PURPOSE/OBJECTIVE

The objective of the study was to demonstrate how the clinical nurse specialist (CNS) in community health effectively responds to community need. RATIONALE/BACKGROUND: A needs assessment revealed high rates of asthma in the community and a request from nurses for more information on the care and management of persons with asthma. PROJECT/INTERVENTION: The intervention brings evidence-based continuing education on asthma to nurses using the Nurse Asthma Care Education program developed by the National Respiratory Training Center and the University of Michigan to increase nursing awareness of the National Asthma Education and Prevention Program Asthma Guidelines and encourage nursing leadership in asthma control activities.

DESIGN

A quasi-experimental study examined the ability of the Nurse Asthma Care Education program to increase nurses' confidence and perception of using the guidelines.

SAMPLE

Thirty-four nurses participated in a Nurse Asthma Care Education seminar.

METHODS

A preintervention and postintervention survey was conducted.

FINDINGS

Significant changes were noted in nurses' perceptions of the helpfulness of the National Asthma Education and Prevention Program Asthma Guidelines (P ≤ .001) and their confidence to use the guidelines (P ≤ .001) regardless of age with some variation by work setting and years of experience.

CONCLUSIONS

Using CNSs to assess populations, including nursing populations, and train nurses, the largest number of frontline providers, may be an effective way to increase patient education and improve outcomes related to asthma and other chronic diseases.

IMPLICATIONS FOR PRACTICE

The CNS can significantly impact community health by identifying and addressing the needs of those who provide care in the community.

HIV care providers' implementation of routine alcohol reduction support for their patients

Screening and brief intervention (SBI) for alcohol reduction is an important health promoting strategy for patients with HIV, and HIV care providers are optimally situated to support their patients' reduction efforts. We report results from analyses that use data collected from providers (n = 115) in 7 hospital-based HIV care centers in the New York City metropolitan area in 2007 concerning their routine use of 11 alcohol SBI components with their patients. Providers routinely implemented 5 or more of these alcohol SBI components if they (1) had a specific caseload (and were therefore responsible for a smaller number of patients), (2) had greater exposure to information about alcohol's effect on HIV, (3) had been in their present positions for at least 1 year, and (4) had greater self efficacy to support patients' alcohol reduction efforts. Findings suggest the importance of educating all HIV care providers about both the negative impact of excessive alcohol use on patients with HIV and the importance and value of alcohol SBIs. Findings also suggest the value of promoting increased self efficacy for at least some providers in implementing alcohol SBI components, especially through targeted alcohol SBI training.

Reviewing health promotion in nursing education

The [World Health Organisation, 2000. Nurse and Midwives for Health: A WHO European Strategy for Nursing and Midwifery Education. WHO Regional Office for Europe, Copenhagen] European Strategy for Nursing and Midwifery Education calls for the explicit inclusion and application of health promotion in all nursing curricula. Prior to this strategy, and subsequently, studies have explored the nature and extent of health promotion in nursing education. This article extensively reviews this body of literature. Overall, the literature, both included in this review and its supporting discussion, presents a picture suggesting that the call for effective inclusion of health promotion has in many cases gone unheeded. The literature also identifies that the educational delivery of broader elements of health promotion is muted in comparison to the 'traditional' constructs of health education. Considerations for wider reform, born out of the literature, are presented.

The Effect of Classroom Simulation on Nursing Students' Self-Efficacy Related to Health Teaching

The purpose of this descriptive study was to investigate the effect of classroom simulation on third-year baccalaureate nursing students' self-efficacy in health teaching. Bandura's self-efficacy model provided the conceptual framework. A nonprobability, convenience sample of 22 students completed the self-efficacy questionnaire before and after the simulation workshop sessions. Students' overall self-efficacy scores increased significantly (p = 0.001) following the two sessions of role-playing case studies, suggesting more perceived confidence in performing health teaching. Recommendations include continuing the use of simulation as a teaching-learning method, applying simulation as a strategy to enhance other learner behaviors, and cultivating faculty's use of simulation in their teaching.

The Effects of a Theory-Based Training Program on Nurses' Self-Efficacy and Behavior for Smoking Cessation Counseling

BACKGROUND

Cigarette smoking continues to put Americans at risk for serious health consequences and early death. Nurses play an important role in disseminating smoking cessation interventions to patients in the hospital. However, nurses are not prepared for smoking cessation counseling.

METHOD

A quasi-experimental design was used. Fifteen nurses participated in the Clinical Practice Guideline "5 A's" brief intervention training program, completing a survey during three time periods.

RESULTS

There were several statistically significant changes in the dependent variables for self-efficacy and behavior for smoking cessation counseling.

CONCLUSION

Results of this study support further research and theory-based training for nurses.

International efforts in tobacco control

OBJECTIVES

To review international nursing involvement in tobacco control and discuss opportunities and challenges to enhance nurses' participation in decreasing tobacco-related morbidity and mortality.

DATA SOURCES

Published literature and published and unpublished material developed by nurses in their tobacco control initiatives.

CONCLUSION

Worldwide, nurses have been involved in tobacco control. However, many opportunities remain for involvement in the areas of education, research, and practice.

IMPLICATIONS FOR NURSING PRACTICE

There are numerous opportunities for nurses throughout the world to enhance their involvement in tobacco control.

The Effects of Family Nursing and Family Medicine Clinical Rotations on Nursing and Medical Students' Self-Efficacy for Health Promotion Counseling

The effects of community-based family nursing and medicine clinical rotations on students' confidence in their knowledge and ability to counsel clients in selected health promotion areas were examined from the perspective of Bandura's (1986) self-efficacy theory. Nursing students (n=66) enrolled in a community family nursing course and medical students (n=71) enrolled in a 6-week family practice clerkship rotation completed questionnaires at three points: prior to, at completion of, and 3 months following their clinical rotations. Nursing and medical students' self-efficacy levels at pretest were similar. At-posttest, nursing students' self-efficacy was significantly higher than that of the medical students. This difference was sustained at 3 months follow up. Students' conception of health (clinical vs. nonclinical) did not have an effect on posttest self-efficacy levels. Self-efficacy scores accounted for 63% of the variance in the nursing students' self-reported use of health promotion principles in their daily practice; but only 11% of the variance in medical students' daily practice. The results of this exploratory study provide information to guide theory-informed curricular decisions to design clinical learning activities that foster the development of health promotion counseling skills in both nursing and medical students.