Registered nurses’ reflections on bioscience courses during the undergraduate nursing programme: an exploratory study

Theory-practice gap: Nursing students' self-reported depth of understanding of bioscience and its relevance to clinical practice

BACKGROUND

Bioscience subjects are essential as they allow nurses to have a clear understanding of the patient's condition and ultimately allow them to provide appropriate and timeous care. However, these subjects remain a significant problem in the endeavour to produce highly competent nurses.

AIM

The study aimed to investigate the nursing students' self-reported depth of understanding of bioscience and its relevance to clinical practice.

METHODS

A quantitative research approach using a descriptive survey design was employed. The sample (n = 211) included second-, third- and fourth-year undergraduate nursing students. A three-part self-administered questionnaire was adapted and used to collect the data. Data were analysed using IBM Statistical Package for Social Sciences software version 25.0 (IBM SPSS-25). Descriptive statistics and Chi-squared test were performed to describe the relationship among the study variables.

RESULTS

Participants rated their understanding of the application of Human Biology (n = 86, 40.76%) and Pharmacology (n = 88, 41.71%) as good, while Physics (n = 80, 37.91%) and Chemistry (n = 85, 40.28%) were rated as adequate. Most participants rated Human Biology (n = 175, 83.73%) and Pharmacology (n = 181, 86.19%) as essential, while Physics (n = 129, 61.72%) and Chemistry (n = 133, 63.64%) were rated as relevant to clinical practice. Physics (n = 112, 60.54%; n = 95, 50.53%) and Chemistry (n = 126, 68.85%; n = 113 61.41%) were rated as not relevant to monitoring a patient's heart rate and blood pressure. Participants' perception of the relevance of Chemistry in monitoring a patient's blood pressure was statistically significant (χ2 = 6.871 (df 2), p<0.05). Most participants (n = 57, 41.91%) performed at Task specific on Akinsanya's Bionursing model, suggesting an overall understanding of the foundational concepts and principles of bioscience.

CONCLUSION

The findings of the study provided evidence of the students' self-reported depth of understanding and perception of the relevance of bioscience and indicate a need for more emphasis on the importance of bioscience integration in clinical practice.

Integration of anatomy and physiology into nursing practice as perceived by undergraduate students and registered nurses: a scoping review

OBJECTIVE

The current study aimed to determine perceptions of registered and student nurses regarding the integration of anatomy and physiology into nursing practice.

METHODS

This scoping review was conducted following the checklist provided in the Reporting Items for Systematic reviews and Meta-Analysis extension for scoping reviews. Articles published in PubMed, ERIC, and CINAL from January 1, 2002 to September 30, 2022 were included.

RESULTS

A literature review of 20 articles that matched the indicative criteria revealed that both undergraduate student and registered nurses recognized knowledge of anatomy and physiology as important to nursing practice. Student nurses recognized that such knowledge is related to understanding patient pathophysiology, patient observation, treatment selection, and patient safety and forms the basis for nursing practice. Registered nurses who were confident in their knowledge of anatomy and physiology also reported that they were able to explain the rationale for their nursing practice. They also reported that this knowledge is necessary for communication with multiple professions, which promotes patient/family trust in nurses and is the basis for building trusting relationships with patients and their families.

CONCLUSIONS

Although undergraduate student and registered nurses recognized the importance of learning anatomy and physiology, the integration of anatomy and physiology into nursing practice was not the same for all student and registered nurses. This suggests the need to investigate the overall perceptions of nurses regarding the integration of anatomy and physiology into nursing practice and for faculty to discuss how to facilitate critical thinking among students.

Factors associated with changes in students' self-reported nursing competence after clinical rotations: a quantitative cohort study

BACKGROUND

The quality of nursing care in different healthcare contexts can be associated with the level of available nursing competence. Physical assessment skills are vital in nurses' assessment of patient care needs. However, in nursing education, using physical assessment skills is challenging for nursing students who struggle to apply these skills comprehensively in a clinical rotation. Therefore, this study explores changes in nursing competence, factors associated with changes after clinical rotations, and whether a Suite of Mobile Learning Tools supports changes in confident use of basic physical assessment skills.

METHODS

A quantitative cohort study with an explorative pre-and post-test design. During autumn 2019 and spring 2020, 72 s-year nursing students and 99 third-year students participated in the study. The Nurse Professional Competence scale short form was used to investigate students' self-reported changes in nursing competence, and a study-specific questionnaire was used to investigate students' confidence concerning performing physical assessments. The students voluntarily used the Suite of Mobile Learning Tools for the learning of physical assessment. Linear regression analysis was used to identify factors associated with changes in nursing competence after clinical rotation. The STROBE guidelines for cohort studies were followed for study reporting.

RESULTS

After the clinical rotation, both student groups reported changes in nursing competence and confidence in performing physical assessment skills, with statistically significant moderate or large changes in all areas. The Suite of Mobile Learning Tools was evaluated as being useful for learning physical assessment. The regression analysis showed that confidence in performing physical assessment skills, the usefulness of the Suite of Mobile Learning Tools, and a higher nursing competence at the start of clinical rotation were positively associated with overall nursing competence.

CONCLUSION

Basic physical assessment skills are an important component of nursing competence and can be considered one of the pillars of person-centered care, as proposed by the Fundamentals of Care framework. Spaced repetition and access to digital resources are suggested pedagogical approaches to enhance student confidence in the use of assessment skills within academic and clinical contexts.

Horizontal integration of bioscience and nursing in first-year nursing curricula: A systematic review

OBJECTIVES

To systematically identify, appraise and summarise available evidence related to the horizontal integration of bioscience and nursing in first-year nursing curricula; to examine students', nurses' and academics' perceptions of the integration and provide recommendations for future curriculum development, practice and research priorities.

DESIGN

A systematic review.

DATA SOURCES

An online search of Ovid Medline, Ovid Emcare, CINAHL, Embase Classic + and Embase, ERIC, A+Education, Scopus (Elsevier) and Google Scholar was conducted between July and September 2021. A manual search of the reference list of included articles was also undertaken.

REVIEW METHODS

This systematic review followed The PRISMA Statement. The study selection process was managed using the Covidence software platform and quality was assessed using JBI Critical appraisal tools and Mixed Methods Appraisal tools. A narrative synthesis of included studies was undertaken.

RESULTS

Six articles were identified which met the inclusion criteria. The study population included students, academics and registered nurses. Four studies used clinical scenarios as a method of horizontally integrating bioscience and nursing content. The integration outcomes were measured by student understanding and learning, satisfaction and motivation. Students', nurses' and academics' perceptions of integration challenges were: i) depth of bioscience content; ii) structure of bioscience content; and iii) knowledge and experience.

CONCLUSIONS

This systematic review did not identify a wide range of methods to integrate bioscience in first year nursing curricula. The use of clinical scenarios increased student understanding and learning. However, teaching academics needed to be cognizant of both nursing and bioscience to achieve the required depth of bioscience content and demonstrate integration of bioscience in nursing practice. There is a need for further investigations of methods of horizontal integration of bioscience and nursing in the first-year nursing curricula.

Nurses' perspectives on the application of humanistic anatomical knowledge in clinical practice

Knowledge of human anatomy is vital for nurses. Medical educators use a variety of educational pedagogies, including the use of cadavers, to cultivate nursing students into competent and professional care providers and to help them gain authentic experience and knowledge before entering the workplace. Studies have provided numerous examples of students with positive learning experiences in human-centric (humanistic) anatomy courses; however, whether these positive experiences translate into effective clinical practice remains largely unknown. This study explored nurses' perspectives on the effects of a humanistic anatomy program on their nursing practice. Focus groups with semi-structured interview guidelines were conducted to collect data. Twenty-one nurses working in hospitals in Taiwan participated and divided themselves into four groups on the basis of willingness to participate and availability. The interviews were recorded using smartphones, and the recordings were transcribed using a computer. The transcriptions were then checked word by word artificially and analyzed by hand. Three main themes emerged during the analysis: adapting to the professional journey, managing time when providing humanistic care, and cultivating professionalism. The results demonstrate educators' expectations that humanistic anatomy education for nursing students expands students' professional knowledge and helps them develop humanistic competencies as professional nurses.

Nursing student learning of biosciences through movies and concept maps: A mixed study

BACKGROUND

acquisition of bioscience knowledge is challenging for nursing students. This calls for teaching methodologies that allow them to acquire this knowledge and add value in the nursing context.

OBJECTIVE

to evaluate a teaching experience using a movie clip and the collaborative use of C-Maps in first-year bioscience learning in nursing students.

DESIGN

embedded mixed methods study.

PARTICIPANTS

143 students.

METHODS

data were collected in two phases: first, collecting quantitative data through a questionnaire on utility, satisfaction and perceived competency development, and collecting qualitative data on learning, teaching materials and developed competencies through an open-question instrument. The second phase consisted of a focus group to explore in greater depth learning experience.

RESULTS

six themes emerged from the qualitative analysis: using C-Maps as a learning process; developing group competencies; knowledge integration and transfer; teacher-student relationship; art as a didactic support; and difficulties encountered and proposals for improvement. Regarding utility, the students highlighted learning and relating concepts. Elements of satisfaction were working in small groups and having the teacher as a guide. Finally, the competencies most developed were teamwork and learning ability.

CONCLUSION

the combination of a movie clip and a C-Map is an innovative strategy motivating and valuable for learning biosciences.

Nursing Students’ Perceived Learning Outcomes, Motivation to Learn and Grade Achieved in a Digital Blended Learning Course: A Norwegian Cross-Sectional Study

The COVID-19 pandemic forced educational institutions to move online, and it is important to understand how students perceive learning in a digital learning environment. We aimed to investigate students’ perceived learning outcomes in a digital learning environment and associations between perceived learning outcomes and grades achieved. An anonymous electronic survey was used (n = 230, response rate 34%). A significant linear relationship between overall perceived learning outcome and grade achieved was found (B 0.644, 95% CI 0.52 to 0.77). Of the different learning activities, attending digital seminars were positively associated with grades (B 0.163, 95% CI 0.002 to 0.32). In particular, participating in voluntary colloquium group (B 0.144, 95% CI 0.03 to 0.26) and motivation to learn (B 0.265, 95% CI 0.13 to 0.41) predicted the students’ grades. Intrinsic motivation was positively associated with grades (B 0.285, 95% CI 0.12 to 0.45), and extrinsic motivation was negatively associated with grades (B-0.213, 95% CI-0.35 to -0.07). Nursing students’ perceived learning outcomes and grades were positively associated. Of the different learning activities, attending digital seminars predicted higher grades. Additionally, attending colloquium groups and being motivated to learn predicted higher grades, while high extrinsic motivation was associated with lower grades.

Nursing students' perceptions of clinical relevance and engagement with bioscience education: A cross-sectional study of undergraduate and postgraduate nursing students

BACKGROUND

Bioscience in nursing education covers a broad range of disciplinary areas (anatomy, physiology, pathophysiology and pharmacology) and underpins clinical assessment and critical thinking in nursing practice. This is imperative for patient safety and favourable patient outcomes. In nursing programs for registration, most bioscience content is taught during the early phases of the program and little incorporated into postgraduate nursing programs.

OBJECTIVES

The aim of this study was to explore student's perceived relationship between clinical relevance and engagement (attention and time) with bioscience content, by surveying undergraduates and postgraduate nursing students.

DESIGN

This sequential mixed methods study included two phases.

METHODS

The first phase comprised of focus group interviews from one Australian University. Thematic analysis of these data, coupled with existing literature, informed the second study phase; a quantitative questionnaire.

PARTICIPANTS

Focus group interviews included N = 30 students from one tertiary site; 10 from each year level. The questionnaire was administered to nursing students undertaking undergraduate nursing studies (1st, 2nd & 3rd years), and postgraduate nursing studies.

RESULTS

Nursing students (n = 406) across three Australian universities (four programmes) completed the questionnaire. The clinical relevance of bioscience was widely appreciated; 91.6% of undergraduate nursing students and 98.5% of postgraduate nursing students indicated that every nurse must have a good understanding of bioscience. However, there was an inverse relationship between engagement with bioscience and timing in the curriculum, as 50% of undergraduate nursing students indicated that bioscience content took up too much of their time, compared to only 20% of postgraduate nurses (odds ratio 0.27 [0.16-0.46], p < 0.001).

CONCLUSION

Nursing students' perceptions of the clinical relevance of bioscience for their career strongly corresponds with their progression through their studies. Unfortunately, as students progress to the later years of their nursing education, their engagement with formal bioscience education decreases. This poses the question 'Are we delivering bioscience content to nursing students at the appropriate time?'

"Connecting the dots" - The transfer of bioscience knowledge by new graduate nurses to the clinical setting: A qualitative study

BACKGROUND

Little is known regarding the transfer of bioscience knowledge gained during undergraduate nursing studies into clinical practice.

OBJECTIVE

To explore the experiences of new registered nurses in applying bioscience concepts in their day-to-day nursing practice.

DESIGN

Descriptive qualitative design.

PARTICIPANTS

Fifteen recently graduated registered nurses (RNs) who were working in acute care settings participated in the study.

METHODS

Semi-structured, face-to-face individual interviews were conducted. Interview data were audio-recorded and thematically analysed.

RESULTS

Four themes were identified from the qualitative interviews. The first and second themes demonstrated nurses' realisation of the relevance of theoretical bioscience knowledge learnt within the classroom to their practice and how this evidence-based knowledge translated into confidence in decisions made. The third and fourth themes revealed the impact bioscience knowledge had on RNs' relationships with patients and family members, which was viewed as providing compassionate care.

CONCLUSIONS

The application of knowledge in biosciences gained during their undergraduate years, provided the basis for RNs to trust in their own clinical judgment and to speak with conviction. 'Connecting the dots' between bioscience knowledge and clinical practice provided the platform for RNs to gain and build trust with their patients. The practical utility of bioscience knowledge in everyday practice allowed RNs to contextualise their nursing care regimen and tailor holistic nursing care delivery to individual patient needs.

Reflection on actions: Identifying facilitators of and barriers to using physical assessment in clinical practice

Current research suggests that nursing students do not apply all sets of physical assessment skills (PAS) learned in their nursing education. The aim of this study was to evaluate third-year nursing students' process of clinical judgment using PAS in clinical rotation. Specific focus was on how the process of clinical judgment affected when the nursing students performed physical assessment, and which types of knowledge were implied in their practice. Ten nursing students performed PAS independently while in clinical rotation; these performances were audiotaped and observed. Shortly after, individual semi-structured stimulated recall interviews (SRI) took place. Regardless of the nursing students' stated level of PAS utilization, self-efficacy or scientific knowledge, clinical judgment was primarily based on contextual factors and personal prerequisites. This study contributes to in-depth knowledge about how nursing students perform physical assessment, how they describe their clinical judgment process and their strategies towards systematically and confidently using PAS. We conclude the paper with pedagogical strategies and learning activities that can facilitate reflection-in-action and reflection-on-action.

Designing and developing core physiology learning outcomes for pre-registration nursing education curriculum

Physiology is a key element of "bioscience" education within pre-registration nursing programs, but there is a lack of clarity on what is included. Physiology and bioscience content and delivery are highly varied across both higher education institutions and the related programs in the United Kingdom (UK). Despite evidence highlighting concerns over nurses' lack of bioscience knowledge and unsafe practice, there is no universally agreed on curriculum with detailed outcomes of minimum levels of knowledge to support nurses in practice and patient care. This study aimed to inform the construction of discipline-specific physiology learning outcomes to clarify relevant physiological topics required in pre-registration nursing. Initially, 360 learning outcomes were identified from various sources. Using a modified Delphi approach, an expert panel from the Bioscience in Nurse Education group reviewed and modified the list to 195 proposed outcomes. These were circulated to universities in the UK who teach nursing (n = 65). Outcomes that had 80% consensus were automatically included in the next round, with others recommended with modification (response rate 22%). The panel reviewed the modifications, and 182 outcomes were circulated in the second questionnaire (response rate 23%), and further panel review resulting in 177 outcomes agreed. These learning outcomes do not suggest how they should be delivered, but gives the basic level required for qualification as a nurse commensurate with the Nursing and Midwifery Council new standards for the "future nurse."

The Anatomical Society's core anatomy syllabus for undergraduate nursing

The Anatomical Society has developed a series of learning outcomes in consultation with nursing educators delivering anatomical content to undergraduate (preregistration) nursing students. A Delphi panel methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate nursing programmes throughout the UK. Using the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students as a foundation, a modified Delphi technique was used to develop discipline-specific outcomes to nursing graduates. The Delphi panel consisted of 48 individuals (n = 48) with a minimum of 3 years' experience teaching anatomy to nursing students, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 64 nursing specific learning outcomes in anatomy that are applicable to all undergraduate (preregistration) programmes in the UK. The new core anatomy syllabus for Undergraduate Nursing offers a basic anatomical framework upon which nurse educators, clinical mentors and nursing students can underpin their clinical practice and knowledge. The learning outcomes presented may be used to develop anatomy teaching within an integrated nursing curriculum.

Nursing students collaborating to develop multiple-choice exam revision questions: A student engagement study

BACKGROUND

Nursing students find bioscience subjects challenging. Bioscience exams pose particular concerns for these students, which may lead to students adopting a surface-approach to learning.

OBJECTIVES

To promote student collective understanding of bioscience, improve their confidence for the final exam, and improve deeper understanding of bioscience.

DESIGN

In order to address exam anxiety, and improve student understanding of content, this student engagement project involved nursing students collaborating in small groups to develop multiple-choice questions and answers, which became available to the entire student cohort.

SETTINGS

This study was conducted at two campuses of an Australian university, within a first year bioscience subject as part of the undergraduate nursing programme.

PARTICIPANTS

All students enrolled in the subject were encouraged to attend face-to-face workshops, and collaborate in revision question writing. Online anonymous questionnaires were used to invite student feedback on this initiative; 79 respondents completed this feedback.

METHODS

Students collaborated in groups to write revision questions as part of in-class activities. These questions were made available on the student online learning site for revision. An online feedback survey was deployed at the conclusion of all workshops for this subject, with questions rated using a Likert scale.

RESULTS

Participants indicated that they enjoyed the opportunity to collaborate in this activity, and almost all of these respondents used these questions in their exam preparation. There was strong agreement that this activity improved their confidence for the final exam. Importantly, almost two-thirds of respondents agreed that writing questions improved their understanding of content, and assisted in their active reflection of content.

CONCLUSIONS

Overall, this initiative revealed various potential benefits for the students, including promoting bioscience understanding and confidence. This may improve their long-term understanding of bioscience for nursing practice, as registered nurses' bioscience knowledge can impact on patient outcomes.