A Crisis in Competency: The Strategic and Ethical Imperative to Assessing New Graduate Nurses' Clinical Reasoning

Relationship between work readiness, transition shock, and job competency among new nurses in oncology hospitals - A longitudinal study based on a latent growth model

BACKGROUND

Nursing job competency is critical for talent development both globally and in China, relating to work readiness and transition shock. Previous studies, which have typically relied on average measurements at fixed time points, have not provided comprehensive longitudinal insights.

AIM

This study aimed to investigate the developmental trajectories of transition shock in new nurses at oncology specialty hospitals. Furthermore, we sought to explore the longitudinal mediating role of transition shock in the relationship between work readiness and the development of nursing job competency.

DESIGN

Longitudinal follow-up study.

METHODS

We conducted three follow-up surveys over 8 months using the Work Readiness Scale, the Transition Shock Scale, and the Nursing Job Competency Scale to assess 252 novice nurses at two high-volume oncology centers. The surveys were conducted at 0, 4, and 8 months, with demographic information collected during the first survey. Data were analyzed using R 4.1.2 and Mplus 8.0.

RESULTS

(1) Over the 8-month period, transition shock exhibited a linear decrease. Notably, nurses with a higher initial transition shock experienced a slower rate of decline. (2) There were positive correlations between work readiness and nursing job competency at all three measurement points. Conversely, transition shock was negatively correlated with both work readiness and nursing job competency. (3) Transition shock functioned as a longitudinal mediator in the relationship between work readiness and nursing job competency.

CONCLUSION

This study clarified the longitudinal mediating role of transition shock in the relationship between work readiness and job competency in oncology settings. Targeted interventions are necessary to mitigate excessive transition shock, thereby improving the nursing job competency of new nurses in oncology hospitals.

REGISTRATION

23/313-4055.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluating the Application of an EMS Clinical Judgment Theoretical Framework

OBJECTIVES

Clinical judgment (CJ) encompasses clinical reasoning (process of evaluating a problem) and clinical decision-making (choice made). A theoretical model to better define emergency medical services (EMS) CJ has been developed but its use has not been evaluated in EMS training and assessments. Our objective was to evaluate the performance of this EMS CJ model to assess clinical reasoning and decision-making in a simulated environment.

METHODS

In this evaluation, EMS clinician teams (2-3 members) were directed to care for a simulated older adult patient in their home following a fall. Simulations were video recorded, clinician team actions coded, and evaluated for whether proper CJ reasoning and decisions were made. We evaluated CJ in two ways: 1) EMS medical directors' (MD) determination of whether the CJ questions were addressed (MD score) and 2) objective rubric evaluation of CJ questions using the EMS CJ model focused on recognition of appropriate cues, performance of actions, and revaluation after action (rubric score). The CJ questions addressed in this simulation included: 1) Is the patient stable/unstable?, 2) Are interventions necessary before movement?, 3) How should the patient be transferred from the floor?, and 4) Does the cause of the fall require hospital evaluation? Descriptive statistics were calculated, and concordance between the two assessments was evaluated (mean, 95% CI). Percent concordance was calculated with a validity threshold set at 70%.

RESULTS

Four EMS MDs reviewed 20 videos addressing 80 clinical judgment decisions. Overall concordance between MD score and rubric score for CJ decisions was above the threshold at 88.1% (85.0, 91.2). Concordance between MD score and rubric score for each CJ decision was 92.0% (87.3, 96.7) for question 1, 79.9% (71.5, 88.3) for question 2, 95.0% (90.4, 99.6) for question 3, and 85.4% (79.5, 91.2) for question 4.

CONCLUSION

An objective evaluation of CJ decisions using a rubric derived from an EMS CJ theoretical framework demonstrated high concordance to subjective evaluations of CJ made by EMS MDs. This approach may allow for reproducible and objective CJ evaluations that could be used for competency assessment in EMS.

Identification of statewide core competencies for new graduate nurses at the beginning of practice and after a 12-month nurse residency program

AIM

To inform the development of statewide core competencies for new graduate nurses at the beginning of their professional career and after completing a 12-month nurse residency program.

BACKGROUND

Although studies have attempted to clarify the expected core competencies of new graduate nurses at the beginning of their professional career, results are mixed. Additionally, nurse residency program competency expectations vary.

DESIGN

A retrospective cross-sectional study using a purposive sample of a national nurse residency program database.

METHODS

Wilcoxon Signed Rank tests compared retrospective self-report data between January 1st 2017 and December 31st 2019, from 2916 acute care hospital new graduate nurses working in the state of Maryland, USA, to examine their perceptions of competency at hire and after completing a nationally standardized 12-month nurse residency program. The study used six domains from the Casey Fink Graduate Nurse Experience Survey© 2006 and the Vizient/AACN Nurse Residency Program™ Progression survey.

RESULTS

New graduate nurses' self-report of competency increased from a mean score of 4.81 at the beginning of a nurse residency program to 6.67 after completion of 12-month nurse residency program (scale of 0-10). At the beginning of a nurse residendy program, new graduate nursesreported a low level of comfort in three of the six survey domains: communication and leadership, high-intensity skills and patient safety. At 12 months, new graduate nurses reported higher levels of comfort in all six survey domains, with statistically significant increases (Wilcoxon Signed Rank test, α =0.05).

CONCLUSIONS

Four domains for ongoing competency development were identified for the nurse residency program curriculum-communication and leadership, patient safety, complex patient assignments and end-of-life care-with the expectation that new graduate nurses achieve competency at program completion. New graduate nurses' perceptions corroborated findings from a statewide study of academicians and practice leaders, thus helping to develop realistic core competencies for new graduate nurses entering the workforce and after completing a 12-month nurse residency program.

Factors associated with newly graduated nurses' work readiness during a pandemic: A cross-sectional study

BACKGROUND

Newly graduated nurses may experience reality shock and leave the career early, if not adequately prepared. The pandemic has significantly impacted nursing education, clinical placements, working conditions and employment opportunities, leaving newly graduated nurses' work readiness unknown.

AIM

To investigate the work readiness and its associated factors of newly graduated nurses who studied and graduated during a pandemic.

DESIGN

A descriptive, cross-sectional correlational study design was employed.

SETTINGS

The study was conducted at a large public health service in Victoria, Australia.

PARTICIPANTS

Newly graduated registered nurses who studied during the pandemic and graduated between January 2022 and June 2023 (N = 206).

METHODS

Participants were recruited between November 2022 and June 2023. Participants' self-perceived work readiness was measured using the Work Readiness Scale for Graduate Nurses, covering personal work characteristics, work competence, social intelligence and organisational acumen. Pearson correlation, multiple regression and hierarchical logistic regression analysis were applied to test the relationship between explanatory variables and participants' work readiness.

RESULTS

Mean (SD) values were 50.7 (14.6) for personal work characteristics, 100.5 (18.8) for work competence, and 58.2 (12.4) for social intelligence. Median (IQR) for organisational acumen was 145.5 (18.0). Prior Australian registered nurse or enrolled nurse experience significantly predicted personal work characteristics (β = 0.16, p = 0.037), while previous overseas registered nurse experience significantly predicted work competence (β = 0.14, p = 0.049). Participants who were native-English speakers had a significantly lower work competence (β = -0.15, p = 0.032). Being a female (p = 0.002, 95 % CI = 1.75, 13.21) and the length of a final clinical placement (p = 0.033, 95 % CI = 1.02, 1.59) significantly predicted organisational acumen.

CONCLUSION

Despite challenges encountered during the pandemic, participants reported a relatively high self-perceived work readiness. Influencing factors include individual characteristics, clinical placement experiences, and previous healthcare employment.

The impact of unfolding case studies combined with think-aloud strategies on the clinical reasoning and self-directed learning abilities of postgraduate students: A mixed methods study

AIM

To conduct unfolding case studies and test their effectiveness in improving clinical reasoning, teamwork and self-directed learning among postgraduate students.

BACKGROUND

Postgraduate students, as advanced nursing professionals in clinical settings, are the driving force behind the rapid development of the nursing profession. Effective clinical reasoning is a fundamental nursing skill that postgraduate students must cultivate, having a direct impact on patient health outcomes. The development and usation of unfolding case studies, which reflect the evolving conditions of patients, combined with think-aloud teaching methods, can enhance postgraduate students' clinical reasoning abilities and foster communication and self-reflection, thereby achieving this goal.

DESIGN

Mixed methods design.

METHODS

The Nurses' Clinical Reasoning Scale and the Nursing Students' Self-Directed Learning Ability Scale were used to evaluate the clinical reasoning and self-directed learning abilities of nursing students. A qualitative exploratory design with a think-aloud interview technique was employed to explore the clinical reasoning process of nursing students in unfolding cases. Twenty-one nursing students completed the questionnaire survey. Data analysis was conducted using Wilcoxon signed-rank tests, Spearman correlations, regressions and inductive content analysis.

RESULTS

After implementing the case study, there was a statistically significant improvement in students' clinical reasoning, self-directed learning and teamwork abilities. Think-aloud analysis revealed that the cognitive strategies most employed by students in clinical reasoning were 'Making choices', 'Forming relationships', 'Searched for information' and 'Drawing conclusions'.

CONCLUSION

Unfolding case studies combined with think-aloud strategies provide a conducive learning environment for postgraduate students, effectively enhancing their clinical reasoning and self-directed learning abilities.

The Impact of Nurse Residency Programs on Patient Quality and Safety Outcomes: A Review of the Literature

Schools of nursing are struggling to prepare registered nurses to practice in today's complex healthcare settings. Nurse residency programs are a good solution to support the transition to practice. Nursing education leaders must be informed of the nursing quality and safety outcomes of nurse residency programs. This literature review provides insight and evaluation of the evidence related to the impact of nurse residency programs with substantial evidence of nurse outcomes and minimal patient outcomes.

Promoting Academic Success in Nursing Education Through Academic Coaching: A Scoping Review

BACKGROUND

Academic support services can improve undergraduate and graduate nursing program outcomes such as program completion and passing the NCLEX. Academic success coaching complements traditional support strategies by providing study skills and time management tools, promoting goal setting and self-efficacy, and referring students to support resources. This review examined interventions that academic success coaches use to improve student success and retention, licensing examination pass rates, and academic success.

METHOD

A scoping literature review identified types of interventions that resulted in significant improvement in student academic and holistic success.

RESULTS

Four classes of interventions were identified as effective in supporting student success: (1) academic support; (2) social and emotional support; (3) clinical guidance; and (4) course and program design.

CONCLUSION

Academic coaches are educated to identify student needs, provide support, and refer students to resources to improve academic outcomes. Future research should evaluate the need for academic success coaches to promote academic nursing student success. [J Nurs Educ. 2024;63(8):515-524.].

Outcomes of Concept-Based Curricula: An Integrative Review

BACKGROUND

Complexity and change in health care environments, the rapid pace of knowledge generation, and changing education policy have led to national calls for change in nursing education. Many nursing programs have adopted a concept-based curriculum (CBC) to address these challenges. Yet, much is still uncertain about the outcomes and effectiveness of CBC, which requires large scale, time-consuming, and resource-intensive change.

METHOD

This integrative review assesses the outcomes of CBC in nursing higher education with a focus on the comparison of CBC to traditional curricula.

RESULTS

The four relevant themes that emerged after an extensive literature review were critical thinking/clinical judgment, NCLEX-RN© (National Council Licensure Examination for Registered Nurses) pass rates, graduation rates, and student satisfaction scores. Overall, the evidence base is not robust. A valid and reliable tool to measure clinical judgment is needed. The review specifically addresses CBC effects on student critical thinking and clinical judgment, traditional outcome metrics, (NCLEX-RN success, graduation rates, and student satisfaction), and other perceived benefits.

CONCLUSION

The authors found promising results on the effect CBC may have on critical thinking and clinical judgment and other perceived benefits. Findings were inconclusive on traditional outcome metrics. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Preparing for the Next Generation NCLEX Using a Virtual Simulation

BACKGROUND

Virtual clinical simulation is a digital innovation that augments clinical reasoning and clinical judgment, narrowing the theory-practice gap, preparing new graduates for the Next Generation NCLEX (National Council Licensure Examination), and mitigating the demand for clinical placement and clinical faculty.

METHOD

The purpose of this article is to describe an educational innovation employing a virtual clinical simulation using the tenets of Tanner's Clinical Judgment Model and a National League for Nursing Advancing Care Excellence for Seniors unfolding case.

RESULTS

A virtual clinical simulation successfully served to replace direct care clinical for 86 undergraduate nursing students enrolled in a foundation nursing course, augmenting the students' ability to transfer and apply theoretical knowledge to clinical practice.

CONCLUSION

This virtual clinical simulation served as a viable platform for teaching clinical reasoning and clinical judgment, mitigating the education-practice gap for new graduate registered nurses. [J Nurs Educ. 2024;63(7):485-489.].

The Pathway to Developing a Competency-based Tool for Entry-level Nursing Simulation: A Delphi Study

BACKGROUND

Simulation-based learning experiences allow undergraduate nursing students to develop competence and confidence through deliberate practice with immediate feedback on the learner's performance through debriefing. With the transition to competency-based nursing education, nursing faculty need more guidance in implementing competency-based evaluations in the simulation setting.

PURPOSE

This Delphi study aims to inform the future development of a competency-based tool - SimComp - based on the American Association of Colleges of Nursing (AACN) Essentials.

METHODS

A Delphi framework was used to recruit expert nursing faculty to complete the surveys via an online platform. Data analysis occurred through open-ended questions and quantitative methods to ensure that the responses from expert panelists were used to form the results.

RESULTS

After four rounds of this Delphi study, a consensus was achieved on 111 appropriate items for assessing competence in the simulation-based learning environment.

CONCLUSION

While further research is warranted, this study provides insight for nursing institutions considering implementing or increasing the use of simulation within their program for competency-based evaluations.

Test Analysis Through the Lens of Objective Compassion

ABSTRACT

Test construction and test reviews are responsibilities nursing faculty arduously undertake, with an obligation to give appropriate effort and time to prepare and review exams. During test review, item analysis and statistical analysis offer valuable empirical information about the exam. However, objective compassion is also needed and can be demonstrated through careful test question construction and item analysis. Furthermore, compassion is needed in preparing students for the Next Generation NCLEX-RN (NGN) and constructing exams that appropriately test students' clinical judgment.

Transforming Nursing Education: Developing Augmented Reality Procedural Training

The shortage of nursing faculty and the scarcity of clinical placements have compelled researchers to investigate innovative solutions for procedural development to bridge the gap between didactic teaching and clinical experiences. This feasibility study uses augmented reality (AR) with Microsoft HoloLens2 and Dynamics 365 Guides to train graduate nursing students on advanced nursing procedures, focusing on lumbar puncture. A convenience sample of 24 nurse practitioner students participated in the study. The System Usability Scale, Acceptability Scale, and Engagement Scale were used to assess participant's experiences and perceptions. The results are positive for the feasibility and acceptance of AR technology for procedural training. Participants found the HoloLens2 device easy to use and showed confidence in its functionality. The step-by-step instructions provided by Microsoft 365 Guides were understandable, useful, and satisfactory. The students reported high levels of engagement and found the AR experience to be helpful and motivating for learning. Faculty time was significantly reduced using the HoloLens2 for procedural training compared to traditional methods. This study demonstrates the potential for AR as an effective and efficient modality for nursing education. The findings support the integration of AR technology to enhance procedural development, address the challenges of limited clinical sites, and provide students with an immersive and self-paced learning experience. Additional studies will need to explore the impact of AR on clinical competency, patient outcomes, and cost-effectiveness. Overall, the use of AR technology may be useful and effective for nursing pedagogy.

Effects of an unfolding case study on clinical reasoning, self-directed learning, and team collaboration of undergraduate nursing students: A mixed methods study

BACKGROUND

Clinical reasoning is an essential nursing competency that students must develop to provide safe patient care. Developing and utilizing unfolding case studies, which present constantly changing patient conditions to improve students' clinical reasoning and to foster communication and self-reflection, can help to achieve that imperative.

OBJECTIVES

To develop an unfolding case study and to test its effectiveness in improving clinical reasoning, team collaboration, and self-directed learning.

DESIGN

A mixed methods design.

SETTING

One university in Southern Taiwan.

PARTICIPANTS

Forty nursing students.

METHODS

An unfolding case study was developed based on the clinical reasoning model and unfolding cases model. The Nurses Clinical Reasoning Scale, Self-Directed Learning Instrument, and Questionnaire of Group Responsibility and Cooperation in Learning Teams were used. Forty nursing students completed questionnaires and nine of them participated in focus group discussions. Wilcoxon signed-rank, Spearman correlation, regression, and inductive content analysis were used to analyze data.

RESULTS

Students' abilities in clinical reasoning, self-directed learning, and team collaboration were statistically significantly improved after implementation of the unfolding case study. Emergent themes included "patient-centered communication," "group inspiration and learning," "thinking critically and reflecting on oneself," and "applying theoretical knowledge in care to meet patients' changing needs."

CONCLUSIONS

Unfolding case studies provide a safe environment in which nursing students may learn and apply knowledge to safe patient care.

Evaluating a Shared Reflective Practice to Develop Nursing Student Clinical Judgment

BACKGROUND

Self-reflection is a valuable method that nurse educators can use to develop clinical judgment skills among prelicensure nursing students. Little research exists on improving clinical judgment in second-degree nursing students in the clinical setting.

PURPOSE

To determine the implications of increasing clinical judgment skills in prelicensure nursing students using a shared structured reflection teaching innovation within a required baccalaureate clinical course.

METHODS

This educational innovation used qualitative descriptive methods to evaluate its effectiveness in the clinical setting among students in the final semester of an accelerated prelicensure nursing program.

RESULTS

Students reported increased accountability for their learning, a sense of intentionality with their nursing practice, and a deeper sense of community with their peers.

CONCLUSIONS

Shared reflective practices in the clinical setting show promise for increasing clinical judgment and supporting a competency-based curriculum.

Exploring clinical judgment ability in second-degree baccalaureate of science nursing students: A mixed methods study

BACKGROUND

As they have not yet embarked on clinical practice, most students who already have a bachelor's degree but require a bachelor's degree in nursing occasionally perceive the educator's instruction on clinical situations as abstract and challenging for making accurate clinical judgments.

OBJECTIVES

This study aims to implement a clinical judgment model and case scenarios in classroom teaching to evaluate improvements in students' clinical judgment and critical thinking abilities.

DESIGN

A mixed-method design.

SETTING

A second-degree Bachelor of Science in Nursing at a university in Taiwan.

PARTICIPANTS

First-year undergraduate nursing students.

METHODS

This mixed-methods study featured a survey at the beginning and end of a course, followed by one-on-one online interviews. A purposive sample of sophomore nursing students was recruited from a university in northern Taiwan between March 2020 and May 2021. Semi-structured interviews were conducted after a preliminary analysis of the collected quantitative data.

RESULTS

In total, 48 participants completed the study questionnaire, and 20 were interviewed. The results show that the students' ability to make clinical judgment and identify individual health problems from case scenarios significantly improved after completing the course. However, critical thinking did not differ significantly after the course. Qualitative data analysis revealed three key themes relevant to the participants' learning experiences: (1) establishing the context of clinical judgment, (2) building a bridge between basic medical science and clinical nursing, and (3) having a broader perspective.

CONCLUSIONS

Incorporating clinical judgment measurement model and case scenarios in the curriculum may benefit second-degree Bachelor of Science in Nursing students who have not yet begun their clinical practice. Additionally, the result provides educators with valuable learning goals and evaluation strategies in the classroom and clinical practice.

Effect of Unfolding Case-Based Learning on Clinical Judgment Among Undergraduate Nursing Students

BACKGROUND

To prepare students for Next Generation National Council Licensure Examination-Registered Nurse (NCLEX-RN), nurse educators need to develop teaching strategies to foster students' clinical judgment.

PURPOSE

This study examined the effects of unfolding case-based learning (CBL) on baccalaureate nursing students' clinical judgment upon graduation.

METHODS

A prospective cohort design was adopted. Students' self-reported responses to the Lasater Clinical Judgment Rubric were compared between the unfolding CBL (n = 140) and non-CBL (n = 126) cohorts at a school of nursing in the United States.

RESULTS

While students' responses were similar between the study cohorts, a trend was noted for improved clinical judgment among students in the unfolding CBL cohort. Furthermore, unfolding CBL significantly enhanced students' perceived proficiency in conducting focused observation.

CONCLUSIONS

The findings support early introduction and consistent use of the unfolding CBL throughout the undergraduate nursing program so that students have ample opportunities and contexts to cultivate clinical judgment skills in the classroom.

Exploring work readiness: A qualitative descriptive study of self-perceptions among new graduate nurses

Background

Reduced work readiness is associated with elevated turnover rates, necessitating efforts to enhance the positive work readiness of newly graduated nurses to alleviate the shortage in the nursing workforce. Research into the work readiness of recent nursing graduates in China is still in its infancy. Most studies employ quantitative research methods, and further exploration of the self-perception of work readiness among new nurses in China is required.

Objectives

This study aimed to investigate genuine experiences and self-perceptions of work readiness among new graduate nurses.

Design

A qualitative descriptive study.

Methods

Sixteen new nurses from a provincial tertiary hospital in China were included in this study, which adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist for reporting. The data collection process involved conducting semi-structured interviews from September to October 2021. Inductive content analysis was employed to analyze the interview data.

Results

The study identified four themes encompassing new nurses' real-life experiences and self-perceptions of work readiness: psychological stress, emotional conflict, empathy fatigue, and ethical dilemmas. Psychological stress comprised three subthemes: knowledge and skill deficits, communication barriers, and fear. Empathy fatigue was primarily characterized by psychological and physical symptoms. Ethical dilemmas involved conflicts over differences in values and between clinical reality and standardized nursing practice.

Conclusion

Drawing from the self-perceptions of work readiness among new nurses found in this study, nursing administrators and educators must enhance the existing transition support program for new nurses. Additionally, the establishment of individualized training programs is recommended to further improve the work readiness of new nurses.

The impact of comprehensive licensure review on nursing students' clinical competence, self-efficacy, and work readiness

This study aims to assess the effectiveness of comprehensive licensure reviews and adaptive quizzing assignments on nursing students' clinical competence, self-efficacy, and work readiness-an under-researched topic. Additionally, it seeks to explore the mediating effect of self-efficacy in the relationship between students' clinical competence and work readiness. A quasi-experimental (pre- and post-test), single-group design was employed. The study was conducted in a public university in Saudi Arabia and included a total of 293 senior nursing students in their last year of the bachelor program. An intervention was developed based on the blueprints of the Saudi Nursing Licensing Exam and NCLEX-RN and consisted of a weekly 3-h synchronous comprehensive licensure review bundled with 23 adaptive quizzing assignments over 15 weeks. Data were collected prior to and after the intervention using three scales: clinical competence, self-efficacy, and work readiness. The mean scores of clinical competence, self-efficacy, and two subscales of work readiness (work competence and social intelligence) increased significantly post-intervention. Self-efficacy (β = 0.353, p < 0.001) and clinical competence (β = 0.251, p < 0.001) influenced work readiness (F [5, 226] = 21.03, p < 0.001) and accounted for 31.8% of the explained variability in work readiness. In the mediation analysis, clinical competence had a significant and indirect effect on work readiness through self-efficacy (B = 0.464, p < 0.001, 95% CI 0.250 to 0.699). The proportion of mediation indicated that 37.2% of the total effect of clinical competence on work readiness was due to the indirect effect of self-efficacy. Comprehensive licensure review and adaptive quizzing assignments improve students' perceptions of clinical competence and self-efficacy. Such interventions could ease the transition of senior nursing students to clinical practice.

Evolving Licensure Examination: Assessing Student Confidence and Accuracy With Next Generation NCLEX

BACKGROUND

The Next Generation NCLEX (NGN) includes new item types. Little is known about nursing students' confidence and accuracy in answering these questions.

METHOD

A descriptive comparative study examined prelicensure nursing students' confidence and accuracy in answering NGN-style items versus multiple-choice questions (MCQs) of the same content via a 12-item quiz.

RESULTS

Less than one third of students (n = 194; 32.1%) reported feeling confident in answering NGN questions. Students' confidence levels had no relationship on scores with NGN items. When comparing NGN-style items to MCQs, students' (n = 221) scores on NGN-style items were lower with bowtie or a select-all-that-apply questions but higher with highlight table or matrix multiple-choice questions.

CONCLUSION

Students' lack of confidence with certain item types suggests faculty should incorporate these item types into classroom activities or course assignments. NGN test-taking strategies also should be incorporated and frequently reinforced throughout the curriculum. [J Nurs Educ. 2024;63(4):252-255.].

Inquiry in uncertainty-nursing students' learning experience in challenge-based learning: A qualitative study

BACKGROUND

Currently, nursing students face a significant lack of preparedness in efficiently addressing complex issues. The use of challenge-based learning, a student-centred situational learning method that utilizes practice scenarios to solve complex problems, can help alleviate the challenges in nurse education. However, there remains to be more extensive exploration on the application of challenge-based learning in nurse practice education.

OBJECTIVES

This study aims to explore the learning experiences of nursing students in challenge-based learning to gain a deeper understanding of the ways and mechanisms through which challenge-based learning enhances specific learning abilities.

DESIGN/METHODS

This study utilized a hermeneutic phenomenological design, employing semi-structured interviews and thematic analysis.

SETTINGS

A university in Hunan, China, hosted the nursing skills competition based on the principles of challenge-based learning, targeting senior students from nursing schools in Hunan province.

PARTICIPANTS

A total of 24 fourth-year students from six colleges, including one male and twenty-three female students.

RESULTS

Two themes and seven sub-themes emerged from the study. Theme 1 Constructing a knowledge system in complex scenarios with sub-themes: Case-based education centred on comprehensive knowledge promotes knowledge linkage; Reverse reasoning promotes knowledge differentiation; Making mistakes helps finding the correct path of knowledge; Traps inspire identification of potential problems. Theme 2 Inquiry in uncertainty with sub-themes: Unexpected changes promote exploration of general principles; Combining knowledge with diverse case scenarios promotes flexible thinking; The uncertainty of knowledge fosters independent thinking.

CONCLUSIONS

The complexity and variability inherent in challenging learning situations promote the construction of students' knowledge systems and the cultivation of an inquisitive spirit. The identification of these mechanisms contributes to the optimization of instructional environment design, the development of a culture of continuous learning and innovation, and effectively tackling complex issues within an ever-evolving global context.

Effects of the First Wave of the COVID-19 Pandemic on the Work Readiness of Undergraduate Nursing Students in China: A Mixed-Methods Study

Background

Newly graduated nurses with strong work readiness are more likely to smoothly transition from school to clinical settings. However, even before the pandemic, this transition from nursing graduate to clinical nurse was often challenging. Therefore, this study aims to investigate the impact of the initial wave of COVID-19 on the work readiness of nursing students.

Methods

A convergent mixed-method design was employed. For the quantitative study, an online cross-sectional survey was conducted among 500 graduating nursing students from four Chinese public higher education institutions. The questionnaire comprises three parts: socio-demographic information, the Chinese version of the Work Readiness Scale for Graduate Nurse, and a questionnaire on the socio-behavioral impact of COVID-19 on the general population. In the qualitative study, a semi-structured interview was carried out with 8 students who took part in the survey. The results from both parts were integrated using the "Pillar Integration Process".

Results

The study identified six key pillars: "Graduating nursing students possess fundamental knowledge, skills, and a preparedness in terms of attitude and psychology"; "Specialist knowledge and skills and soft skills for transition from nursing students to clinical nurses need to be strengthened"; "The most obvious impact of COVID-19 on nursing students are the adoption of preventive measures and the limitations in study and daily life due to household confinement"; "Growth in both personal and professional awareness"; "Negative effects of fear and anxiety"; and "Negative effects of household confinement".

Conclusion

Graduating nursing students require additional preparation in specialized nursing knowledge, skills, and soft skills to make a successful transition from students to clinical nurses. It is important to acknowledge that the impact of COVID-19 on students' work readiness has both positive and negative aspects. Therefore, whether during the pandemic or post-graduation, these students will benefit from increased support from universities and hospitals.

The nurses' perception of the factors influencing professional misconduct: A qualitative study

BACKGROUND

Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors.

AIM

This study aimed to explain the factors influencing professional misconduct in nurses.

RESEARCH DESIGN

This qualitative study was conducted using the conventional content analysis method.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach.

ETHICAL CONSIDERATIONS

The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality.

FINDINGS

Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics).

CONCLUSION

This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.

Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum.

Reflective Clinical Judgment Questions to Educate the Next Generation of Nurses

BACKGROUND

The complexity of health care requires entry-level nurses to have competent clinical judgment skills. In response, a nursing program created Reflective Clinical Judgment Questions (RCJQ) to guide students in the development of clinical judgment.

METHOD

The RCJQ incorporates the Clinical Judgment Measurement Model, the National Council of State Boards of Nursing's action questions, and the American Association of Colleges of Nursing's core competencies for professional nursing education. The RCJQ includes cognitive process questions and self-reflection questions aligned to the prelicensure subcompetencies to direct student thinking and build a routine for clinical decision making.

RESULTS

The RCJQ provides faculty with a framework to teach clinical judgment and incorporates self-reflective questions to guide decision making for safe and effective client care.

CONCLUSION

The RCJQ streamlines the clinical judgment process and guides students to achieve essential outcomes in classroom, clinical, and simulation settings to prepare for clinical practice. [J Nurs Educ. 2024;63(3):182-185.].

Evaluating the Importance of Clinical Judgment in Entry-Level Nursing

BACKGROUND

This study investigated the extent to which clinical judgment is important in entry-level nursing practice.

METHOD

A task analysis linkage study methodology based on a large-scale, comprehensive practice analysis was used for the study. The practice analysis validated more than 200 entry-level nursing tasks, and the linkage study sought to evaluate the importance of clinical judgment overall and for each specific task expectation.

RESULTS

The results provide confirmatory evidence of the importance of clinical judgment. In addition, the work provides a comprehensive list of entry-level tasks and their associated clinical judgment importance.

CONCLUSION

Clinical judgment is a vital skill at entry into the profession and is expected to grow over time. This study offers insights on the extent to which clinical judgment is a necessary skill and provides direct evidence of its importance for specific entry-level tasks. [J Nurs Educ. 2024;63(3):156-162.].

Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review

OBJECTIVE

To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice.

DESIGN

Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

DATA SOURCES

Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment.

METHODS

Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics.

RESULTS

Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study.

CONCLUSION

In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.

Using the Clinical Judgment Measurement Model to Promote Nurse Education and Competency: An Exemplar

Nurses in all settings need the clinical judgment ability to care for clients with fluid and electrolyte imbalances. An educational activity was developed using the Clinical Judgment Measurement Model to provide nursing professional development specialists with a tool to support the competency of nurses caring for these clients. [J Contin Educ Nurs. 2024;55(2):59-61].

A systematic review and quality appraisal of interprofessional behavioral assessment instruments for nursing education

Instruments to assess interprofessional behaviors in prelicensure interprofessional education (IPE) lack validity and reliability data. No individual behavioral assessment instrument met all standards of the Quality Appraisal of Interprofessional Learning Scales (QuAILS) checklist (Oates & Davidson, 2015). The IPA and iSOFT instruments provided the most substantial validity and reliability evidence. Future validation research studies of interprofessional education (IPE) behavioral instruments that evaluate interprofessional professionalism (IPP) domains are needed in nursing education.

Exploring factors that affect nurse staffing: a descriptive qualitative study from nurse managers' perspective

BACKGROUND

The appropriate nurse staffing reflects the situation of nursing management of human resources. Nurse managers have a pivotal role in determining a competent and sufficient number of nurses. It is important to understand the factors influencing nurse staffing to promote appropriate staffing levels. The study aimed to explore the factors affecting nurse staffing from the perspective of nursing managers.

METHODS

Purposive sampling was adopted to recruit 14 nurse managers from secondary and tertiary hospitals located in the central region of China, and semi-structured interviews via telephone were conducted from April to May 2022. Interview transcripts were analyzed and collated using thematic analysis.

RESULTS

This research identified four themes and ten subthemes influencing nurse staffing. Extracted themes include: government level (inadequacy of mandatory policies, budgetary constraints), hospital level (hospital characteristics, the control of nurse labor costs, inadequate support on nursing), patient level (patient characteristics, increasing care needs), and nurse level (nurse shortage, skill-mix, individual high-level needs).

CONCLUSION

The findings indicate that it is crucial for decision-makers or policymakers to legislate for safe nurse staffing and establish effective supervision and funding incentives. Tailored interventions are also needed to improve the organizational context, address the nurse workforce and balance the structure of nurse staff.

Implementation of a Competency-Based Clinical Tracking Document in an Undergraduate Nursing Program

ABSTRACT

New nurse graduates are ill prepared to fulfill the roles and responsibilities of being competent, practice-ready registered nurses. This article describes one college of nursing's journey in the creation of a clinical tracking document (CTD) to track, in real time, essential subbehavior actions that assist students in achieving the four main competencies of assessment, communication, critical thinking, and safety listed on the Creighton Competency Evaluation Instrument. The CTD is an innovative tracking tool used to ensure students are practice-ready and competent upon completion of their nursing program.

Early Prelicensure Nursing Students' Perceptions of Case Studies Through the Lens of the Clinical Judgment Measurement Model

BACKGROUND

Research indicates new nursing graduates struggle with clinical reasoning, despite some related skill development throughout their education. The question remains, "Could an earlier focus on clinical reasoning in nursing programs enhance nursing students' clinical reasoning?"

PURPOSE

This pilot study investigated how first-semester nursing students perceive the use of case studies in clinical reasoning skill development and the perceived benefits of case studies related to the NCSBN Clinical Judgment Measurement Model (NCJMM).

METHODS

Case studies and written reflections were introduced to a convenience sample (n = 45) of first-semester nursing students. Qualitative analysis was conducted on written reflections.

RESULTS

Students found case studies enhanced their knowledge and prepared them for clinical practice as a nurse.

CONCLUSIONS

Findings suggest early introduction of case studies is a meaningful teaching strategy to develop clinical reasoning aligned with the NCJMM.

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.

Development of clinical decision-making among undergraduate nursing students: the effect of unfolding case-based learning

OBJECTIVES

This prospective cohort study evaluated the effect of unfolding case-based learning on undergraduate nursing students' self-perceived clinical decision-making ability.

METHODS

Students' self-reported responses to Jenkins's Clinical Decision Making in Nursing Scale were compared between the unfolding case-based learning cohort (n=140) and the comparison cohort (n=126) at a school of nursing in the United States.

RESULTS

The results revealed similar students' responses between the two study cohorts. However, unfolding case-based learning significantly increased students' perceived proficiency in "search for information and unbiased assimilation of new information".

CONCLUSIONS

Findings from the present study highlight possibilities presented by unfolding case-based learning in undergraduate nursing education. The study supports that unfolding case studies can be introduced early on, and then nurtured throughout the undergraduate program to influence the development of nursing students' clinical decision-making skills.

Effect of Virtual Simulation on Nurse Residents' Prioritization and Delegation Skills: A Pilot Study

Data indicate a widening academic-practice gap. Utilizing a single-group pre-post interventional design, the purpose of this project was to determine if repeated participation in Sentinel U Patient Management and Delegation virtual simulations influenced new graduate nurses' prioritization and delegation. Increased confidence in ability to complete patient care assignments on time and transferability of learning outcomes to practice were identified. There may be value in nurses receiving virtual simulations within their residency program to close the academic-practice gap.

Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study

Background

The transition of nursing education from traditional methods to more advanced approaches is crucial for adequately preparing students to deliver competent care in tertiary care centers. Moreover, clinical faculty in nursing plays a key role in guiding nursing students through their clinical training in various healthcare settings.

Purpose

This study aims to describe the perceptions of undergraduate nursing students regarding the effectiveness of the learning environment and clinical teaching in clinical areas across various countries.

Methods

The study, conducted using a descriptive, cross-sectional research design, gathered data from 215 nursing students using the Clinical Learning Environment Inventory and Clinical Teaching Effectiveness Instrument. Data analysis included frequencies, percentages, mean, standard deviation, t-tests, analysis of variance, and correlation assessments to comprehend the impact of clinical teaching and learning environments.

Results

Nursing students' perceptions of the clinical learning environment produced mean scores between 2.03 and 3.38 on a scale from 1 to 4, resulting in an overall mean score of 2.72 across 42 items. This indicates a general satisfaction with their clinical learning experiences. Regarding effective clinical teaching, the mean student responses varied from 3.02 to 3.40 out of a possible 5 points, with a total mean of 3.22. The study revealed notable correlations in the context of effective clinical teaching, particularly with demographic variables and the clinical learning environment. Specifically, a significant correlation with age (r = .177, p = .009) and the clinical learning environment (r = .572, p < .001) was identified.

Conclusion

The study concludes that students expressed overall satisfaction with their clinical learning experiences. They recognized the importance of participating in clinical training, fulfilling clinical responsibilities for assigned patients, exerting extra effort for learning, receiving support from preceptors in clinical settings, and being attentive to communications from staff. The collaboration between clinical preceptors and academic nursing lecturers is crucial in providing a positive learning environment for students to complete clinical tasks effectively.

Electronic health record competency in graduate nurses: A grounded theory study

BACKGROUND

The use of electronic health records is ubiquitous in healthcare settings, yet newly graduated nurses struggle with developing electronic health record competency prior to entry into nursing practice. Insufficient electronic health record knowledge, skills, and attitudes among newly graduated nurses are contributing to patient harm, clinical burn-out, and unsafe practices. In this study, we interviewed electronic health record educators to identify how newly graduated nurses develop electronic health record competency characteristics and to learn about their educational approaches for teaching electronic health record proficiency.

METHOD

This study used a constructive grounded theory approach to develop a theoretical model to make sense of electronic health record educators' experiences working with newly graduated nurses during electronic health record education and training sessions.

FINDINGS

Electronic health record educators found that in the newly graduated nurse population, practicing builds competency in electronic health record knowledge, skills, and attitudes. The research revealed that it is the combination of teaching through modeling, working hard as a new graduate, and understanding charting to standards requirements that impacts the development of electronic health record competency characteristics.

CONCLUSION

Electronic health record competency characteristics are developed when an educator is modeling documentation knowledge, skills, and attitudes, the newly graduated nurse is working hard to learn, and there is clarity by nursing leadership related to charting to standards requirements. It is the success or failure in these core areas that impacts a newly graduated nurse's ability to achieve electronic health record competency. A level of competency and proficiency in electronic health record is required to provide care that is safe and patient centered.

When caring becomes an art - how clinical gaze are perceived to be developed

PURPOSE

This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze.

METHODS

This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ).

RESULTS

Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context.

CONCLUSIONS

Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Engaging Clinical Partners in Curricular Initiatives to Improve Practice Readiness

BACKGROUND

The release of the American Association of Colleges of Nursing's updated Essentials creates an opportunity for nursing programs and clinical partners to collaborate on strengthening curricula and improving new graduate practice readiness. This scoping literature review examined published models for collaborating with clinical partners on curricular initiatives to guide this process.

METHOD

Three electronic databases were searched for peer-reviewed articles describing models for collaborating with clinical partners when revising nursing curricula to improve practice readiness. The final sample included seven articles representing five models developed for prelicensure undergraduate education.

RESULTS

Themes identified among the models were creating a shared mission, leadership support and involvement, representative committees with regular meetings, clear role expectations, collaboratively determining concepts and competencies, and developing training and resources for consistent implementation of changes.

CONCLUSION

These themes provide recommendations for engaging clinical partners in the process of integrating the new Essentials in curricula and improving graduates' practice readiness. [J Nurs Educ. 2023;62(12):706-710.].

Trends, Future Directions, and Questions for Preparing Successful Nurse Faculty

BACKGROUND

Many nurse educators enter the faculty role with little academic teaching experience. Although there is evidence that providing clear expectations and targeted training on teaching and learning is beneficial for new faculty members, inconsistencies and content gaps in orientation programs and prerequisite knowledge for nurse educators still pose challenges to faculty success.

METHOD

This article reviews the current state of preparation for nurse educators, describes new knowledge and skills nurse educators need to prepare nursing students for practice, and suggests approaches to continuous growth and professional development.

RESULTS

In addition to knowledge of foundational teaching concepts, nurse educators need advanced knowledge of technology, global health, and climate change. Today's learners are diverse and require equity-focused teaching and pedagogy responsive to individual learner characteristics and backgrounds.

CONCLUSION

Ensuring nurse educators are prepared to deliver a high-quality education program requires up-to-date professional development, a comprehensive orientation, and ongoing faculty support. [J Nurs Educ. 2023;62(12):661-667.].

The Relationship between Moral Sensitivity and Professional Behaviour and Its Comparison in First- and Last-Year Undergraduate Nursing Students

Background

Nursing students should be equipped with ethical sensitivity and professional behaviour because they will face challenging ethical issues in their future work environment. This study aimed to determine the relationship between moral sensitivity and professional behaviour and compare it in first- and last-year undergraduate nursing students.

Methods

This study was a cross-sectional, correlational study that was conducted at Isfahan University of Medical Sciences in 2019. The sample size of this study was 238 nursing students. The tools used in this study were the Persian versions of the moral sensitivity questionnaire and the professional behaviour questionnaire. The data were analyzed using SPSS 18 software.

Results

Linear regression showed that the total score of moral sensitivity of nursing students had a significant relationship with their professional behaviour (p  <  0.05). The result of the univariate analysis showed that the mean total score of moral sensitivity and professional behaviour was significantly higher in the last year than in first-year students (p  <  0.05).

Conclusion

Considering the relationship between moral sensitivity and the professional behaviour of nursing students, the promotion of moral sensitivity can become the basis for the development of the professional behaviour of nursing students. Therefore, it is suggested to focus on teaching the principles of nursing ethics to develop the moral sensitivity of undergraduate nursing students.

Professional Success: Utilizing Simulation to Remediate and Retain Nursing Staff

Nursing education focuses on nursing theory and the ability to perform tasks. There is a lack of education related to prioritization of nursing tasks. Therefore, new nurses transitioning into their roles sometimes struggle and, as a result, leave their units or, often enough, our facility. We developed a Professional Success Program that includes cognitive prioritization exercises and simulation scenarios to assist these nurses. After utilizing the program, our facility has seen an increase in nurse retention.

The impact of tutoring on nursing students' clinical judgment: A quasi-experimental study

BACKGROUND

Nurses' lack of clinical judgment often leads to adverse patient outcomes due to failure to recognize clinical deterioration, intervene, and manage complications. Teaching clinical judgment through a nursing process can help nursing students provide safe and competent patient care with improved health outcomes and to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

AIMS

The aim of this study was to examine the effect of tutoring on clinical judgment of undergraduate nursing students utilizing Lasater's Clinical Judgment Rubric (LCJR). This study also compared the clinical judgment of male and female nursing students and students from different semester levels.

METHODS

This quasi-experimental study utilized a single group pretest, posttest design. A convenience sample of n = 40 undergraduate nursing students from the Los Angeles County College of Nursing and Allied Health participated in the study. The participants underwent a pretest simulation, four sessions of the Clinical Judgment Model (CJM)-based tutoring, and a posttest simulation.

RESULTS

The posttest clinical judgment scores (35.70 ± 3.6) were significantly different from the pretest scores (25.78 ± 5.20). The tutoring had a significant effect on the clinical judgment of nursing students t(39) = -11.64, n = 40, p < .001, at 95% CI of the mean difference.

LINKING EVIDENCE TO ACTION

Enhancing nursing students' clinical judgment is crucial to provide high-quality, safe patient care with improved health outcomes. The CJM-based tutoring is an effective strategy for developing clinical judgment in nursing students. This new teaching approach can train students to critically think, develop clinical judgment, and prepare for the complex healthcare environment. Therefore, nurse educators should focus on integrating clinical judgment into the prelicensure nursing program curriculum as a priority.

The implementation of Tanner's Clinical Judgment Model and the Indonesian version of the Lasater Clinical Judgment Rubric in the clinical setting

A critical component for nurses to provide safe and quality care with strong patient outcomes is clinical judgment. This study aimed to identify the difference in the clinical judgment score in newly graduated nurses by implementing Tanner's Clinical Judgment Model. This study followed an experimental design with a pretest-posttest and involved thirty-two newly graduated nurses from three private hospitals in Indonesia. The intervention group had a scheduled post-conference with their preceptors using Tanner's Clinical Judgment Model's guidelines with high-level, open-ended questions for two consecutive weeks. Independent samples t-test was used to compare pre-and post-test scores utilizing the valid and reliable Indonesia version of the Lasater Clinical Judgment Rubric. There was no significant difference between the pre-test results of the intervention and control groups, with a significance value of 0.647. The results indicated a significant difference in the mean clinical judgment scores between the intervention and control groups after two weeks of intervention, where the intervention group's scores were higher than the control group's with a significance value of <0.001 with a mean difference of 6.75 and CI of 95 % (4.18-9.31). Tanner's Clinical Judgment Model showed a significant impact in increasing clinical judgment scores. The Indonesia version of the Lasater Clinical Judgment Rubric is a valuable tool for assessing and evaluating the development of clinical judgment and provides detailed targeted areas needing improvement. Preceptors and nursing leaders in the clinical setting should continue to use this model and tools to assist newly graduated nurses in developing clinical judgment skills during their transition period.

A Scoping Review of Nurse Educator Competencies: Mind the Gap

BACKGROUND

Unclear guidance continues faculty role preparation for promoting students' successful transition to practice.

OBJECTIVES

To examine nurse educator competencies and their role in students' transition to practice.

DESIGN

This study utilized Arksey and O'Malley's methodological framework for conducting a scoping review. The review is reported using the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR), including the PRISMA-ScR checklist.

METHODS

A comprehensive systematic search of MEDLINE, EMBASE, PsycINFO, ERIC, and CINAHL was performed for nurse educator competency. For the original search, no limitations were placed on dates. Two authors independently assessed eligibility via abstract review. The reference lists of the included studies were also examined.

RESULTS

Eleven articles were included in the review dating from 1992 to 2021. Three themes in the literature were identified by the authors: (1) the need for appropriate mentorship, (2) lack of preparation of educators who transition directly from clinical practice, and (3) lack of use and/or vague operationalization of the National League for Nursing nurse educator competencies.

CONCLUSION

Evidence regarding requisite competencies of nurse educators is limited. Further research on the competencies required for nurse educators to facilitate successful student transitions to practice is needed.

Mapping Critical Thinking, Clinical Reasoning, and Clinical Judgment Across the Curriculum

BACKGROUND

Critical thinking, clinical reasoning, and clinical judgment are skills nurses use when caring for clients. However, teaching and evaluation of clinical judgment are challenging for faculty.

PROBLEM

Before revising a curriculum, it is necessary to map current practices and determine a framework for revisions.

APPROACH

Faculty mapped critical thinking, clinical reasoning, and clinical judgment activities across the 5-semester traditional baccalaureate program. Use of an external consultant helped faculty to determine additional activities that could be used to assess clinical judgment in classroom and clinical settings. Faculty worked together to develop teaching strategies and Next Generation National Council Licensure Examination (NCLEX) item types for assessing clinical judgment.

CONCLUSION

Using the National Council of State Boards of Nursing Clinical Judgment Model as an educational framework can guide faculty in curriculum mapping, revisions, and development of clinical judgment activities and assessment.

Effects of Expert Modeling Videos on the Development of Nursing Students' Clinical Competence

BACKGROUND

Nurse educators are called to develop innovative teaching strategies to build clinical competency. Expert modeling videos (EMVs) promote clinical competency by demonstrating exemplar nursing care.

METHODS

A quasiexperimental research study was conducted using a prebriefing intervention of a nursing process video for demonstration (experimental) and discussion (control) groups of nursing students. Simulation competency was measured using the Creighton Competency Evaluation Instrument (CCEI).

RESULTS

Students in the experimental group demonstrated a statistically significant improvement in simulation competency (p = .001) and performed significantly better in the CCEI domains of communication (p = .009) and patient safety (p = .002).

CONCLUSION

The use of EMVs in simulation prebriefing is an innovative teaching strategy to prepare undergraduate nursing students with the knowledge and skills required to enter the simulated environment. Through watching an exemplar demonstration of desired behaviors, students significantly improved their simulation performance and demonstrated clinically competent care of an acutely ill simulated patient. [J Nurs Educ. 2023;62(8):454-460.].