Clinical decision-making in senior nursing students in Iran

Nursing students' self-efficacy and clinical decision-making in the context of medication administration to children: A descriptive-correlational study

BACKGROUND

It is crucial for nursing students to possess self-efficacy in medication administration to children for correct drug implementation. It is expected that nursing students enhance their clinical application skills in the pediatric field before graduation, execute the clinical decision-making process, and acquire self-efficacy in medication administration.

AIM

This research was conducted to examine the self-efficacy and clinical decision-making levels of nursing students in the context of medication administration to children.

METHODS

This descriptive-correlational study was conducted with 368 students. The data were collected using the "Participant Information Form", the "Medication Administration Self-Efficacy Scale in Children for Nursing Students", and the "Clinical Decision-Making in Nursing Scale". Number, percentage, minimum and maximum values, mean and standard deviation, Independent Samples T-Test, ANOVA, and Pearson correlation test were used in the analysis of the data. In addition, Cronbach's Alpha coefficient was calculated to evaluate the reliability of the scales. The research report of the study followed the STROBE guidelines.

RESULTS

In the study, the mean score of the students on the Clinical Decision-Making in Nursing Scale was slightly low; the mean score of the Medication Administration Self-Efficacy Scale in Children for Nursing Students was found to be moderate; and a significant and negative relationship was determined between the two scales. The clinical decision-making levels of the male students, the fourth-year nursing students, and those who did not experience anxiety during medication administration were found to be significantly higher. The self-efficacy of the students who did not experience anxiety during medication administration to children was found to be significantly higher than the others.

CONCLUSION

Nursing students need to possess self-efficacy in administering medication to children and be able to make clinical decisions. Given the significant impact of the clinical decision-making process on patient outcomes and safety, it is necessary to develop educational programs to enhance the clinical decision-making abilities of nursing students. Different educational methods that will increase students' self-efficacy in medication administration to children need to be implemented.

Clinical Decision Making in Forensic Nursing: A Cross-Sectional Study From an Emergency Nursing Perspective

BACKGROUND

Appropriate clinical decision making (CDM) is very important for emergency nurses when working with forensic patients with violence-related injuries and can improve patient outcomes. Therefore, it is essential for emergency nurses to have the basic skills to make the right clinical decisions when working with forensic patients.

AIM

The aim of this study was to evaluate the CDM of emergency nurses when caring for forensic patients.

METHODS

This study was conducted using a cross-sectional design. Nurses working in the seven emergency departments of Rasht hospitals, Guilan Province, Iran, were recruited to take part in the study. Data collection was performed via census sampling from September to November 2019. Data were collected via a two-part questionnaire developed by the researcher(s) that addressed (a) demographic characteristics and (b) simulated scenarios that assessed their CDM in caring for forensic patients.

FINDINGS

One hundred ninety-two emergency nurses participated in this study. The mean score of CDM in forensic nursing was moderate (56.46; 95% CI [54.49, 58.43]). Of the participants, 60.42% of the emergency nurses had moderate CDM knowledge related to forensic nursing, whereas only 2.8% had desirable knowledge of CDM. There was a statistically significant relationship between CDM in forensic nursing and the history of encountering forensic patients ( p = 0.008).

CONCLUSION

CDM scores regarding emergency nurses' knowledge of forensic nursing were moderate. Knowledge of and CDM in forensic nursing is very important and provides high-quality safe care for forensic patients.

IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE

This study highlights the importance of additional education and professional development in forensic nursing, for emergency nurses, and should be considered further by nursing administrators and nursing educators.

Achieving nursing students' clinical practice hours during the COVID-19 pandemic: Effects of alternative and nonstandard practicum methods

AIM

The aim of this study is to examine nursing students' experiences of alternative and nonstandard practicum methods used during the Coronavirus Disease 19 (COVID-19) pandemic and the associations between these experiences and nursing students' anxiety with clinical decision-making.

BACKGROUND

Nursing students experiencing alternative clinical practice methods during the COVID19 pandemic have expressed regrets about being unable to experience direct nursing care and doubts about their clinical decision-making in actual clinical settings as a nurse in the future.

METHODS

Online surveys were distributed to 239 third-year nursing students through a link in an email. Data were collected from December 2020 to January 2021.

RESULTS

Approximately 80% of participants in the Fall 2020 semester experienced an alternative clinical practice method. The extent of time spent experiencing alternative clinical practice methods and satisfaction with the clinical practicum were associated with anxiety about clinical decision-making.

CONCLUSIONS

Although the pandemic continues, nursing students' clinical practice is needed in a clinical setting as much as possible to reduce the anxiety about clinical decision-making. During the pandemic, clinical nurse educators and clinical managers should work and communicate more closely to facilitate the students' clinical practice.

Hemşirelik Öğrencilerinde Duygusal Zekâ, Eleştirel Düşünme ve Klinik Karar Verme Düzeylerinin İncelenmesi

Amaç: Bu araştırma, hemşirelik öğrencilerinde duygusal zekânın eleştirel düşünme ve klinik karar verme düzeyleri ile ilişkisini belirlemek amacıyla kesitsel, tanımlayıcı ve ilişki arayıcı olarak yapılmıştır.Yöntem: Araştırma, Ocak-Şubat 2020’de yüz yüze ortamda gerçekleştirilmiştir. Bir Vakıf Üniversitesi Hemşirelik bölümünde okuyan ve araştırmaya katılmayı kabul eden 187 öğrenci çalışmanın örneklemini oluşturmuştur. Veriler, araştırmacılar tarafından oluşturulan Bilgi Formu, Schutte Duygusal Zekâ Ölçeği, Kaliforniya Eleştirel Düşünme Eğilimi Ölçeği ve Hemşirelikte Klinik Karar Verme Ölçeği kullanılarak toplanmıştır. Veriler; tanımlayıcı istatistiksel yöntemler, bağımsız gruplarda t testi, Anova testi ve Pearson korelasyon testi kullanılarak değerlendirilmiştir.Bulgular: Araştırmaya katılan öğrencilerin %91,4'ü kadın, %8,6'sı erkek ve yaş ortalaması 20,93±1,26’dır. Katılımcıların ölçek toplam puan ortalamaları sırasıyla duygusal zekâ 142,76±18,18 eleştirel düşünme 195,21±26,15 ve klinik karar verme 96,60±19,94’tür. Katılımcıların duygusal zeka toplam puanı ile eleştirel düşünme eğilimi alt boyutları olan analitik olmak (r=0,278), açık fikirlilik (r=0,386), meraklılık (r=0,293), kendine güven (r=0,293), doğruyu arama (r=0,275), sistematiklik (r=0,329), klinik karar verme toplam puanı (r=0,728) ve alt boyutları olan seçenek ve fikirleri araştırmak (r=0,732), amaçları ve değerleri soruşturmak (r=0,544), sonuçları değerlendirmek (r=0,676), bilgiyi araştırmak ve yeni bilgiyi tarafsız olarak benimsemek (r=588) puanları arasında pozitif bir korelasyon tespit edilmiştir (p<0,05).Sonuç: Araştırma bulguları, öğrencilerin akademik yılı arttıkça duygusal zekâ puan ortalamalarının arttığını, eleştirel düşünme puanlarının ortalamanın üzerinde olduğunu ve ancak klinik karar verme puanlarının ortalamanın altında olduğunu göstermiştir. Hemşirelik öğrencilerinde duygusal zekâ gelişiminin sağlanması, aynı zamanda temel yeterlilikler olan eleştirel düşünme ve klinik karar verme becerilerinin arttırılmasına katkı sağlayabileceği düşünülmektedir. Bu nedenle duygusal zekâyı geliştirmek için öğretim yöntem ve tekniklerinin kullanılması önerilir. 

Clinical decision-making of bachelor and clinical internship (professional) nursing students in Indonesia

Background: Clinical decision-making is an essential element of every professional nursing career. A nurse’s aptitude for clinical decision-making influences the quality of the healthcare they provide. This research aims to describe the clinical decision-making among nursing students at Universitas Indonesia.

Design and Methods: This research employed a cross-sectional design by sampling 216 students across several types and level of students’ programs in the University. The samples were selected using a stratified random sampling technique and met the inclusion criteria. The instrument of this research was the 2014 Nursing Decision Making Instrument. The survey instrument was translated from English into Indonesian, and its validity and reliability were tested (α Cronbach value = 0.816).

Results: The results of the univariate analysis revealed that students’ clinical decision-making abilities vary; 59.2% in the analysis category, 40.3% in the quasi-rational category, and 0.5% in the intuitive category.

Conclusion: This research concludes that the clinical decisionmaking ability of bachelor and professional nursing students’ program is in the analysis category that indicate that students’ clinical decision-making abilities involve their explicit-theoretical knowledge and are supported by evidence-based practices. Therefore, their clinical decision-making can be logically defended, though it requires a longer duration of time to strengthen those abilities. The students’ clinical decision-making must continuously be improved to enable them to create precise decisions based on various situations and clinical conditions.

"It's beyond the pale to smoke hookah": perceptions of Iranian adolescents on social unacceptability of hookah smoking

Introduction

Globally, the popularity of hookah smoking, as a social and entertaining behavior, is increasing among adolescents and youths. The present study aimed to explore the perceptions of high school students on Social Unacceptability (Arabic/Persian term = Qabahat) of Hookah Smoking (SUoHS) in an Iranian context.

Methods

In this qualitative study, 31 student adolescents in Tabriz, Iran, were invited to participate in semi-structured individual interviews and focus group discussions (FGDs). Data were analyzed using interpretative thematic analysis.

Results

The unacceptability of hookah smoking was viewed at the “disreputability of hookah smoking and hookah smokers”. The students also explained SUoHS in the “incivility of hookah smoking and smokers in the society”, “disrespectfulness of hookah smokers and their families”, and “the consequences of hookah smoking”.

Conclusions

The SUoHS is rooted in the social values and norms within communities. To decrease hookah smoking levels among adolescents, school health nursing interventions should be tailored to bridge the gap between their recognition of SUoHS and subsequent behavior change through creating group dynamics highlighting the domains of social unacceptability of the behavior.

Nursing Educators' Experiences Regarding Students' Mistakes in Clinical Settings

Background:

There is always the possibility of mistakes for nursing students, given the nature of the clinical wards. Nursing educators are the primary figures responsible for the nursing students' performance in clinical wards. The present study intended to describe nursing educators' experiences in relation to clinical mistakes made by nursing students.

Materials and Methods:

The present research was conducted using a descriptive phenomenological approach in 14 nursing educators. Deep semistructured interviews were performed to gather data, and triangulation and member checking were utilized to ensure data integrity. The data were analyzed using Colaizzite seven-stage method.

Results:

The themes extracted through comparison and analysis included three main themes “encountering an unpleasant event“, “internal confrontation“ and “the change in the effectiveness of teaching“ besides 6 sub-themes including “emotional excitement“, “honest reaction to the issue“, “struggling with the fear of recurrence of the mistake“ “coping with the event“, “passive teaching“ and “trying to be enhance one's capabilities in teaching“

Conclusions:

Regardless of the possibility of gaining fruitful experiences from a clinical mistake, its occurrence could be followed by negative experiences and consequences for the educators. It is thus essential that appropriate packages in this regard be provided in the empowerment programs for young educators to prepare them for correct confrontation with mistake occurrence. It is suggested that further qualitative studies be conducted to extract the steps educators take in confrontation with nursing students' clinical mistakes.

Experiences of Spouses of Women with Breast Cancer: A Content Analysis

Introduction:

In addition to the affected person, diagnosis and treatment of breast cancer also severely affects her husband. Therefore, it is worth paying attention to the needs of husbands of women with breast cancer. Therefore, the aim of the present study was to explain the experiences of spouses of women with breast cancer.

Method:

The present study was a qualitative study with conventional content analysis approach. Purposive sampling was carried out by selecting 6 spouses of women with breast cancer. Data were collected through semi-structured interview. The recorded interviews were transcribed verbatim. Content analysis was used to reduce and name the data, obtain analytical codes, and finally recognize the theme.

Results:

Data analysis resulted in the extraction of 4 categories of couples’ mental challenges, multifaceted romantic meditation, multifaceted traumas caused by the disease, dual energies (inductions) of relatives, and 12 subcategories.

Conclusion:

In spite of suffering from all the challenges and traumas, husbands of women with breast cancer have not left their wives alone and have done their best to improve their lives; so, we can raise ““Scarifying your life to save your wife’s life”” as an extract from the experience of spouses of women with breast cancer. Knowing and understanding this point by clinical staffs and policy makers can provide pave the way for planning to provide comprehensive support to these men.

Improving student nurses' confidence in managing the acutely ill patient

AIM

the Acute Illness Management (AIM) course was introduced into NHS trusts across Greater Manchester in 2002/03 for registered nurses. In preparation for the transition from student to registered nurse, the AIM course was then included in the final year of the undergraduate nursing programme. The aim of this study was to evaluate the impact of the AIM course on student nurses' confidence in managing the acutely ill patient.

METHOD

a quantitative approach was adopted. Ethical approval was granted by the Research and Ethics committee at the University of Salford.

RESULTS

a total of 192 student nurses attended the AIM course; 94% of the students completed a pre-course questionnaire and 100% completed the post-course questionnaire.

CONCLUSION

the evidence suggests a significant increase in the student nurses' confidence in recognising, responding and managing an acutely ill patient following the one-day course.

Strengthening ethical decision-making: the experience of Iranian nurses

AIMS

Ethical decision-making is a complex process that nurses perform daily. The aim of this study is to explain how ethical leaders in Iran strengthen ethical decision-making in their nursing teams.

METHOD

Data were collected using deep and semi-structured interviews with 20 Iranian nurses in 2015. Analysis was based on constant comparative analysis.

RESULTS

Ethical leaders strengthen ethical decision-making by promoting ethical commitment, developing an ethical atmosphere and guiding ethical decision-making.

CONCLUSION

The development of ethical decision-making in nursing can improve ethics-based nursing care.

The impact of combining concept-based learning and concept-mapping pedagogies on nursing students' clinical reasoning abilities

BACKGROUND

Integrating contemporary teaching strategies into the nursing curriculum is an effective approach to enhance undergraduate clinical-judgment and reasoning abilities.

OBJECTIVE

This study aims to document the impact of blending the teaching strategies of concept-based learning and concept-mapping to enhance nursing students' clinical-reasoning abilities.

DESIGN

A quasi experimental design is used to guide data collection from second year students.

SETTING AND PARTICIPANTS

A consecutive sample of all students undertaking adult health nursing courses at a private university in Jordan and meeting the eligibility criteria resulted in (N = 40).

METHOD

Data was collected via a questionnaire and observation to reveal students' independence in both clinical-reasoning and clinical-judgment. General Clinical-Reasoning Behavior Scale, Independence in Clinical-Reasoning and Clinical-Judgment scales were completed by the students at the beginning and end of the courses.

RESULTS

Despite requesting extensive preparation time, concept-based learning and concept-mapping as student-centered approaches enabled the move away from a content laden approach towards constructing criteria against which various patients' encounters were reflected. This study documented enhancement in students' independence in clinical-reasoning and clinical-judgment as they learned to take command of the elements of their clinical-reasoning. Significant improvement in students' general clinical-reasoning behavior was also documented.

CONCLUSION

The data collection tools utilized in this study can be used as clinical teaching aides, hence maximizing the impact of blended teaching strategies by providing the faculty with specific feedback regarding students' clinical reasoning and judgment abilities. Institutionalizing these processes by initiating relevant policies and guidelines is essential to help students take command of their clinical-reasoning, maturity, and responsibility in a practice area that is constantly changing and evolving.

Authentic practice environments to support undergraduate nursing students' readiness for hospital placements. A new model of practice in an on campus simulated hospital and health service

This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-campus simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive sampling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.

Concerns of nursing students beginning clinical courses: A descriptive study

BACKGROUND

Students harbor fears related to the clinical environment that influence their participation and learning. Some studies have addressed general anxieties in undergraduate nursing students, but few have asked students to report their fears and concerns prior to entering the clinical environment. Therefore, this study examined the fears and concerns of undergraduate nursing students beginning clinical courses as well as their continued concerns upon completion of the first year of instruction. The study also assessed their confidence in physical assessment skills.

METHODS

Ninety-six junior nursing students enrolled in a generic baccalaureate nursing program completed a survey, two items of which asked about their fears and concerns related to beginning clinical experiences and their confidence in physical assessment. A follow up survey was completed at the end of the junior year by 72 students.

RESULTS

Making a mistake, lack of course success, and not knowing how to do something were students' major concerns prior to the start of clinical experiences. Bad experiences with a nurse or instructor, freezing up, and uncomfortable patient/family experiences were also concerns. Not knowing how to do something persisted as a concern at the completion of the first year. Fears about being/feeling left alone in a clinical setting as well as concern about the senior year also emerged on the post survey. Confidence in physical assessment was a mean of 60.46 on a scale of 0-100 at the beginning of clinical instruction and 71.28 at the end of the junior year.

CONCLUSIONS

Faculty should structure learning activities that decrease anxiety and enhance students' confidence prior to initial clinical experiences. Opportunities might include in-depth orientation to clinical settings and various simulations that allow practice of skills and communication. Awareness of predominant student fears and concerns can also guide staff nurses to provide a welcoming environment and enhance learning.

Barriers to Practical Learning in the Field: A Qualitative Study of Iranian Nursing Students' Experiences

Background

Clinical training is an integral part of nursing education; however, some studies have shown that it is not always efficient.

Objectives

This study aimed to find out the factors that can impede nursing students’ clinical learning.

Materials and Methods

In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used, and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method.

Results

Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practice gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest impact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training. The clinical learning environment does not always integrate theory and practice together.

Conclusions

Nursing students did not experience effective clinical learning. Having expert instructors and supportive communication are important factors in creating a clinical learning environment.

An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills

This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution.

Exploring the environment of clinical baccalaureate nursing students' education in Iran; A qualitative descriptive study

INTRODUCTION

Today's students are the nurses of tomorrow. They need appropriate clinical learning opportunities in order to shape their professional identity, attitudes and values. Despite undeniable progresses of nursing education in Iran, the quality of the clinical education in Iran is not favorable. There is a need to explore the environment of clinical baccalaureate nursing students' education for developing, maintaining and enhancing the quality of clinical program.

METHOD

This is a qualitative study and was conducted based on content analysis multimethod design. Data were collected by individual interviews, focus groups and direct observations. 54 nursing students and 8 clinical educators from the four geographically diverse universities in the Iran composed the study sample. A purposive sampling was used.

RESULT

Five themes were emerged from data analysis including; ambiguity in the nursing care role, routine-based nursing care, uncritical and dependent thinking climate, incompetency of clinical educators and patient education as important component of nursing.

CONCLUSIONS

The findings of this study describe a clearer understanding of the real environment of the clinical education in Iran. All of themes that emerged from the study play an important role in student learning and nursing education. It is crucial to pay more attention to reconsider care concept as an operational component of nursing, maximize meaningful learning opportunities, reevaluate clinical instructor as role models and prepare effective operational plan to combine theoretical and evidence based knowledge with clinical practice.

Humanistic approach to nursing education: lived experiences of Iranian nursing students

The nurse teachers tried to have a complete understanding of the educational contents, to transfer knowledge to nursing students better, and to facilitate the process of education. The purpose of this study was to explore the lived experiences of Iranian nursing students regarding the characteristics of academic nurse teachers. In this hermeneutic phenomenological study, data were collected via in-depth, semi-structured interviews with 12 Iranian nursing students and the audio-taped and transcribed interviews analyzed according to Van Manen´s method. The main theme emerged during data analysis, was “humanistic approach to nursing education”. The theme was extracted from 2 sub-themes including ‘ethical necessities’ and ‘effective interaction’. The findings present greater understanding of humanistic approach to nursing education.

College student stressors: a review of the qualitative research

A total of 40 qualitative studies were reviewed and coded according to the college student stressors they represented. These studies utilized a variety of qualitative methods to examine stressors representing the following themes: relationships, lack of resources, academics, the environment, expectations, diversity, transitions and other stressors. Relationship stressors were the most commonly reported theme and covered areas including stress associated with family, romantic, peer and faculty relationships. Three of the themes (relationships, diversity and other) are novel categories of stressors compared with quantitative reviews on the topic, highlighting the importance of gathering both quantitative and qualitative pieces of information. This review contributes to the stress literature by synthesizing and identifying trends in the qualitative student stress research.