Transfer of knowledge and skills: some implications for nursing and nurse education

Nursing students learning transfer from classroom to clinical practice: An integrative review

AIM

The aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice.

BACKGROUND

As nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students' learning transfer has not yet been synthesized.

DESIGN

This integrative review was conducted using the Whittemore and Knafl framework.

REVIEW METHODS

Eight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute's critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.

RESULTS

Twenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students' ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators.

CONCLUSIONS

The information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students' learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.

Interprofessional simulation of acute care for nursing and medical students: interprofessional competencies and transfer to the workplace

BACKGROUND

Teamwork and communication are essential tools for doctors, nurses and other team members in the management of critically ill patients. Early interprofessional education during study, using acute care simulation, may improve teamwork and communication between interprofessional team members on the long run.

METHODS

A comparative sequential quantitative-qualitative study was used to understand interprofessional learning outcomes in nursing and medical students after simulation of acute care. Students were assigned to a uni- or interprofessional training. Questionnaires were used to measure short and long term differences in interprofessional collaboration and communication between the intervention and control group for nursing and medical students respectively. Semi-structured focus groups were conducted to gain a better understanding of IPE in acute simulation.

RESULTS

One hundred and ninety-one students participated in this study (131 medical, 60 nursing students). No differences were found between the intervention and control group in overall ICCAS scores for both medical and nursing students (p = 0.181 and p = 0.441). There were no differences in ICS scores between the intervention and control group. Focus groups revealed growing competence in interprofessional communication and collaboration for both medical and nursing students.

CONCLUSIONS

Interprofessional simulation training did show measurable growth of interprofessional competencies, but so did uniprofessional training. Both medical and nursing students reported increased awareness of perspective and expertise of own and other profession. Furthermore, they reported growing competence in interprofessional communication and collaboration in transfer to their workplace.

Metacognition and learning transfer under uncertainty

OBJECTIVES

This study examined the possible correlation between metacognition and learning experience transfer of nursing students after engaging in an urgent and cognitively demanding clinical situation.

METHODS

This is a one-group post-test- only study design in which participants engaged in an emergency care scenario simulation and completed the Meta-Cognitive Awareness Scale - Domain Specific (MCAS-DS).

RESULTS

Study results revealed that participants' metacognitive awareness is significantly correlated to the learning transfer (p=0.0001) and GPA (p=0.006). There is also a positive correlation between learning transfer and GPA (p=0.04), clinical settings-based training experience (p=0.021) and metacognitive confidence (p=0.0001).

CONCLUSIONS

This study may imply that academic achievement can be used as a potential screening tool to identify students requiring metacognitive training. It may also imply that metacognitive abilities can be enhanced indirectly through considering factors that may influence the transfer of learning such as increasing the hours of clinical training.

Learning practical nursing skills in simulation centers - A narrative review

Background

Practical skills are complex procedures integrating communication and caring, as well as technical and manual aspects. Simulation at a simulation/skills center offers a wide range of learning activities and aims to imitate patient situations.

Objectives

To investigate the international research literature on practical skills learning in simulation/skills centers in nursing education. Research questions: 1. What are the range and type of practical skills studied? 2. What learning activities are focused on in the studies included in the review? 3. What are the learning outcomes and how are they assessed?

Design

Narrative review.

Methods

We searched electronically and included studies from Medline Ovid, CINAHL, Eric, Embase, Academic Search Premiere, and Cochrane. Unique indexing terms and search strategies were developed for each database. The criteria for inclusion were bachelor nursing students as the study population and practical nursing skills learning in simulation/skills centers. We used Rayyan QCRIt for the initial screening and the Mixed Method Appraisal Tool for quality assessment. We used a narrative approach to synthesize the diverse range of studies.

Findings

One hundred and twenty-one studies from 26 countries published between January 2013 and March 2022 were included. The amount of quantitative research was overwhelming (n = 108). A total of 50 different practical skills were represented. The studies focused on which learning modalities resulted in the best learning outcomes. Only 8.5% (n = 7) of the included studies concerned students' learning processes. Skill performance (n = 101), knowledge (n = 57), confidence (n = 34), and satisfaction (n = 32) were the main learning outcomes measured.

Discussion

The quality assessment indicated that 10 of the studies achieved 100% on the mixed method appraisal tool criteria. In many of the studies with quasi-experimental and randomized controlled trial designs, the intervention group received some form of educational treatment while the control group received no treatment. The choice of no treatment for the control group in pedagogical research seems to disregard the inherent purpose and effect of teaching and learning.

Conclusion

Heterogeneity in the use of learning modalities and measuring instruments precludes the possibility of building on other research. Technical skills were the preferred choice of skill, while skills that involved a fair measure of communication and collaboration were only sparingly studied. Students' learning processes were barely touched on in the included studies. More focus should be placed on this area in further research, since the choice of learning modalities may affect the students' learning processes in significant ways.

Comparison of lecture and manipulative teaching methods on learning and application to practice

IMPORTANCE

Manipulatives are hands-on or virtual displays that facilitate teaching and learning and are interactive and engaging to students during the learning activity. Manipulatives have been shown to be effective teaching tools for a wide range of students.

OBJECTIVE

This study examined whether the use of manipulatives in nursing education improved Satisfaction, Learning/Knowledge Retention, Behavior/Transfer of Learning, and Intentions to Change Practice. Underpinning theoretical frameworks included Kirkpatrick's Four Levels of Evaluation Model and Theory of Planned Behavior.

DESIGN, SETTING, AND PARTICIPANTS

A quasi-experimental design comparing lecture to manipulative training was used with a sample of nursing interns and students. The study manipulative was a hands-on tool that demonstrated physiologic changes that occur with fluid imbalances. Data were collected using three questionnaires (1) before training, which included demographics and questions on participants' level of comfort with fluid imbalances, (2) immediately following training, which evaluated Satisfaction, Learning, Behavior, and Intentions, and (3) 6-8 weeks after training, which evaluated Learning, Behavior, and Intentions.

MEASURES

Independent sample t-test, Mann-Whitney U test, and repeated-measure analysis of variance were used to analyze the data.

CONCLUSION

Findings revealed significant differences in Intentions to change practice (p = 0.014), indicating the manipulative had a greater potential effect on clinical practice compared to the lecture.

Nursing Simulation and Transfer of Knowledge in Undergraduate Nursing Programs: A Literature Review

AIM

The purpose of this literature review was to describe what research has been conducted on transfer of knowledge using high-fidelity patient simulation (HFPS) and determine what further research is needed.

BACKGROUND

The use of HFPS has expanded rapidly in recent years. There is research suggesting that HFPS effectively educates nurses for clinical practice.

METHOD

An extensive literature search was conducted and analyzed for themes. Exclusion criteria were studies that focused only on graduate-level nursing education, accelerated programs, medical students, registered nurses, and use of low-fidelity simulation or standardized patients.

RESULTS

Themes that emerged included competence, confidence, safety, timing, method and delivery. Study results varied, with only some showing transfer.

CONCLUSION

More research is needed to determine how HFPS influences knowledge transfer to the clinical setting.

Means-end problem solving in infancy: Development, emergence of intentionality, and transfer of knowledge

Behaviors and performance of 23 typically developing infants were assessed longitudinally at 6, 9, 12, 18, and 24 months in two means-end tasks: pulling a towel or rotating a turntable to obtain a supported object. With age, infants performed more goal-directed behaviors, leading to increased problem-solving success. Intentionality emerged earlier in the towel task than in the turntable task (6.9 vs. 10.8 months). Potential knowledge transfer between the tasks was first observed at 9 months. This study provides insight into the development of means-end learning, the emergence of intentionality, and potential transfer of knowledge in tasks involving a similar concept (support) but requiring different modes of action for success (pulling vs. rotating).

Pedagogical strategies to teach bachelor students evidence-based practice: A systematic review

AIM

The aim of this study is to review international scientific articles about pedagogical strategies to teach nursing students at bachelor degree evidence-based practice (EBP).

METHOD

A literature review including peer reviewed, original, empirical articles describing pedagogical interventions aimed at teaching bachelor's degree nursing students EBP in the period 2004-2014. Theories of discretion, knowledge transfer and cognitive maturity development are used as analytical perspectives.

RESULTS

The main challenge teaching evidence based practice is that the students fail to see how research findings contribute to nursing practice. The pedagogical strategies described are student active learning methods to teach the students information literacy and research topics. Information literacy is mainly taught according to the stages of EBP. These stages focus on how to elaborate evidence from research findings for implementation into nursing practice. The articles reviewed mainly use qualitative, descriptive designs and formative evaluations of the pedagogical interventions.

CONCLUSION

Although a considerable effort in teaching information literacy and research topics, nursing students still struggle to see the relevance evidence for nursing practice. Before being introduced to information literacy and research topics, students need insight into knowledge transfer and their own epistemic assumptions. Knowledge transfer related to clinical problems should be the learning situations prioritized when teaching EBP at bachelor level. Theoretical perspectives of cognitive maturity development, knowledge transfer and discretion in professional practice give alternative ways of designing pedagogical strategies for EBP. More research is needed to develop and test pedagogical strategies for EBP in light of these theories.

Knowledge transfer from an e-learning course to clinical practice

BACKGROUND

Continuing education is essential in improving practical psychiatric nursing skills. However, little is known about how knowledge gained in continuing education is transferred to nurses' daily work.

OBJECTIVES

To describe the transfer of knowledge gained from an e-learning course to daily practice.

DESIGN

Qualitative study design.

SETTINGS

One hospital district in Southern Finland with three specialized psychiatric wards (acute, rehabilitation, geriatric wards).

PARTICIPANTS

Nursing staff (N=53) were recruited and 35 participated voluntarily in the e-learning continuing education course in spring 2009.

METHODS

The data comprised nurses' reflective writing during the e-learning course and course evaluation forms completed after the course. We used qualitative design with inductive content analysis to analyze nurses' writings.

RESULTS

The nurses were willing and able to transfer what they learned to their daily practice including the course themes, communication and co-operation among staff members, understanding of preventive and alternative treatment methods and critical thinking regarding one's own work. After the e-learning course the nurses were able to identify development areas such as issues related to staff members' daily work, the patient's role on the ward, alternative methods to avoid coercion, issues pertaining to the care environment on the ward, psychiatric nurses' education, and making an action plan for aggressive situations. All nurses would recommend the course to other nurses.

CONCLUSIONS

New knowledge is easily adopted and transferred to daily practice.

Critical thinking and creativity in nursing: learners' perspectives

BACKGROUND

Although the development of critical thinking and the development of creativity are major areas in nursing programme, little has been explored about learners' perspectives towards these two concepts, especially in Chinese contexts.

OBJECTIVES

This study aimed to reveal nursing learners' perspectives on creativity and critical thinking.

DESIGN

Qualitative data collection methods were adopted, namely group interviews and concept map drawings.

SETTINGS

The process of data collection was conducted in private rooms at a University.

PARTICIPANTS

36 nursing students from two problem-based learning classes were recruited in two groups for the study.

METHODS

After data collection, content analysis with axial coding approach was conducted to explore the narrative themes, to summarise the main ideas, and to make valid inferences from the connections among critical thinking, creativity, and other exogenous variables.

RESULTS

Based on the findings, six major themes were identified: "revisiting the meanings of critical thinking"; "critical thinking and knowledge: partners or rivals?"; "is critical thinking criticising?"; "revising the meanings of creativity"; "creativity and experience: partners or rivals?"; and "should creativity be practical?".

CONCLUSIONS

This study showed that learners had diverse perspectives towards critical thinking and creativity, and their debate on these two domains provided implications on nursing education, since the voices of learners are crucial in teaching. By closing the gap between learners and educators, this study offered some insights on nursing education in the new curriculum, in particular to co-construct nursing knowledge which is student-driven, and to consider students' voices towards understanding and applying creativity and critical thinking in nursing.

A comparison of critical thinking skills in standard and non-standard entry diploma students

Critical thinking is often seen as the hallmark of the educated professional.The conceptualization and measurement of critical thinking have been topics of much debate for over 70 years. This study reports a small scale comparative study of critical thi nking skills in standard and non-standard entry diploma students. A significantdifference in critical thinking skills between these groups at the point of entry was observed. There were no significant differences in critical thinking skills between the start of the course and the end of the common foundation course for both groups. This finding is consistent with many other studies investigating critical thinking in nurse education. The implications of these findings and the wider issue of the measur ement of critical thinking are discussed.

Opportunities and barriers to successful learning transfer: impact of critical care skills training

AIM

This paper is a report of a study to assess the impact on nursing practice of critical care skills training for ward-based nurses.

BACKGROUND

Following a government review in the UK of adult critical care provision, new ways of working were advocated to ensure that critical care services depended on the needs of the patient, not their location in the hospital. A re-conceptualization beyond service provision in high dependency units and intensive care units was required in order to deliver an integrated service. This has ramifications for training requirements.

METHODS

Semi-structured interviews were used to explore perceived learning and learning transfer from a range of courses. The data were collected from course attendees (n = 47) and line-managers (n = 19) across two sites between 2005 and 2006.

FINDINGS

Learning was closely associated with the clinical application of new skills and knowledge. Commonly, course attendees and line-managers quoted increased knowledge and confidence, better assessment skills and improved interprofessional working. Time with competency assessors, availability of expanding roles, and supernumerary time were key factors for successful learning transfer. Barriers were financial pressures on hospitals, lack of perceived relevance of the course to staff or nursing practice, and lack of time to practice skills or work with clinical skills facilitators.

CONCLUSION

Course design should be a collaborative activity between education providers and commissioners to ensure the impact of training on practice. Relevance of material, time to practise skills and new learning, and organizational, rather than merely individual, support are essential for successful training interventions.

Illuminating the processes of knowledge transfer in nursing

RATIONALE

Over the past 10 years, there has been a propensity to translate research findings and evidence into clinical practice, and concepts such as knowledge transfer, research dissemination, research utilization, and evidence-based practice have been described in the nursing literature.

AIM

This manuscript shows a selective review of the definitions and utilization of these concepts and offers a perspective on their interrelationships by indicating how knowledge transfer processes are the basis of all the concepts under review.

FINDINGS

Definitions and utilization of knowledge transfer in the literature have been influenced by educational and social perspectives and indicate two important processes that are rooted in the mechanisms of research dissemination, research utilization, and evidence-based practice. These processes refer to a cognitive and an interpersonal dimension. Knowledge transfer underlies a process involving cognitive resources as well as an interpersonal process where the knowledge is transferred between individuals or groups of individuals.

CONCLUSION AND IMPLICATIONS

This manuscript can contribute to our understanding of the theoretical foundations linking these concepts and these processes by comparing and contrasting them. It also shows the value and empirical importance of the cognitive and interpersonal processes of knowledge transfer by which research findings and evidence can be successfully translated and implemented into the nursing clinical practice.

The clinical role of nurse lecturers: Past, present, and future

The clinical role of nurse lecturers has been the subject of much debate since the transfer of nurse education into Higher Education Institutions within the United Kingdom. This article provides a critical evaluation of the clinical role of nurse lecturers in terms of policy drivers and strategies for implementing national guidelines. Policies from the initiation of Project 2000, through to recent consultation documents on the support of students in practice, are evaluated. Formal aspects of the nurse lecturer remit, such as link tutor and personal supervisor roles, are discussed in terms of their impact on clinical practice. There is also a brief review of the development of the lecturer practitioner role as a bridge between education and practice. The fundamental arguments in support of nurse lecturers maintaining a clinical role in practice are analysed. This analysis includes consideration of the concept of 'clinical credibility' in terms of the impact on teaching and the closure of the theory-practice gap. The article concludes with suggestions for strategies to resolve the ongoing debate surrounding the clinical role of nurse lecturers. These recommendations include a review of staff:student ratios in nurse education, re-evaluation of the need for a clinical role, and the use of innovative recruitment and development strategies by higher education institutions.

Learning about teamwork in operating room clinical placement

The aim of nursing students' operating room (OR) clinical practice is to gain experience of the perioperative nursing process and to develop skills related to the practice within OR teams in a variety of situations. However, it has previously been problematic to get enough practical experience within OR teams because of the general urgency, e.g. rapid turnover and flow of emergency cases, and preceptors' multiple responsibilities related to their simultaneous need to work as team members. This study describes how Finnish, British and American nursing students (n = 30) experienced learning about teamwork during their OR placement period. The critical incident technique was used for data collection, and data were analysed using a descriptive phenomenological method. Three types of teamwork emerged based on the students' perceptions: functional manifestation of OR teamwork, gaining OR team membership and technical orientation of OR teamwork. The findings are discussed in relation to OR practice, education and research on ways to improve teamwork while maintaining a satisfactory OR learning context and stimulating interest in perioperative nursing.

Do they practise what we teach? A survey of manual handling practice amongst student nurses

Experience of training students of nursing in manual handling suggested that they did not practise the techniques they had been taught. A search of the literature revealed that there was indeed a theory-practice gap. The aim of the project was to answer three questions: do students know what they should be doing, do they do what they should be doing, and if not, why not. A survey design was used, with questionnaires designed specifically for the study. Self report questionnaires were distributed to students of nursing (n = 148) on the adult branch in one higher education institution in England. One hundred and thirty-nine completed questionnaires were returned. Results showed that students' knowledge of whether particular techniques were 'recommended' was fair. They indicated however, that they were frequently unable to use recommended techniques in practice. The most frequent explanation given was the influence of other nurses. Results of this small study indicated that male students and younger students were more susceptible to socialization into poor ward practice than others. Other reasons for not using recommended techniques were unavailability of manual handling aids, lack of time and patient needs. The complexity of relationships within the nursing team emerged, with students ever aware of the impression they were making with regard to their assessment of practice, and their need to be accepted as a member of the team. Changes to training are suggested, to help reduce the theory-practice gap.

Critical care education: an examination of students' perspectives

Specialist nursing education at the tertiary level is a relatively recent occurrence in Australia. With this move to higher education a variety of issues such as course duration, award level and clinical versus theoretical outcomes provided the impetus for this study. This study examined critical care nursing students' perceptions of undertaking post-graduate education within the higher education sector. Four themes arose from analysis of eight focus group interviews with a total of 42 students from 35 courses offered in eight universities across Australia. The first theme, student burden, included subthemes of financial, heavy workload and student-work conflicts. Student benefits, the second theme, encompassed financial and other benefits. The third theme, clinical experience, incorporated clinical capability, synthesizing, support required and clinical learning. The final theme of student attitude included the subthemes of individual, technology and course. Without student evaluations, curricular improvements including assessment and clinical experience will not evolve to the best of their potential.

Social Learning Theory: its application in the context of nurse education

Cognitive theories are fundamental to enable problem solving and the ability to understand and apply principles in a variety of situations. This article looks at Social Learning Theory, critically analysing its principles, which are based on observational learning and modelling, and considering its value and application in the context of nurse education. It also considers the component processes that will determine the outcome of observed behaviour, other than reinforcement, as identified by Bandura, namely: attention, retention, motor reproduction, and motivation.