Promoting the self-regulation of clinical reasoning skills in nursing students

Exploring the impact of digital concept mapping methods on nurse students' learning anxiety, learning motivation

In involuntary distance education, like during epidemics and wars, students often feel heightened learning anxiety, impacting outcomes. Despite innovative teaching methods, many face hurdles in distance learning. We want to propose specific strategies to solve learning difficulties in distance education.

AIM

This study explored whether using digital concept maps (DCM) in physiology courses can reduce learning anxiety among nursing students.

DESIGN

The study was quasi-experimental, including a pre-and post-test control group.

METHODS

71 nursing students aged 16-18 enrolled in a physiology course were recruited in the study. DCM was the intervention as a tool for in-person learning (first 12 weeks) and distant learning (final six weeks). Each student was required to complete the assignments independently to compare learning outcomes. Questionnaires were administered, and an assignment evaluation was completed before and after the course's different formats.

RESULTS

DCM using software using mobile vehicles (mobile, notebook, pad) is digital learning to help nursing students learn difficult subjects. DCM improved the students' learning motivation and effectiveness more in distance learning than in-person learning, decreasing learning anxiety in both face-to-face and distance learning.

CONCLUSIONS

DCM promoted students' self-regulated learning and positively affected learning outcomes by increasing motivation and reducing stress. This study offers a tailored teaching framework for international settings to reduce student anxiety and improve learning effectiveness.

Impact of professional identity on learner well-being of undergraduate nursing students of "double tops" universities: Mediating effect of self-regulated learning

OBJECTIVES

The pressure of internal competition at the college level has increased in recent years in China with an impact on nursing students' learning and well-being. This study aimed to investigate the current situation and factors affecting professional identity, learner well-being and self-regulated learning of undergraduate nursing students in the Neijuan ecology of the "double tops" universities, and to explore the relationships between these three variables.

METHODS

A cross-sectional design was adopted to conduct an online survey of 322 Chinese undergraduate nursing students from seven "double tops" universities. The survey included socio-demographics characteristics, students' professional identity, learner well-being, and self-regulated learning.

RESULTS

Results of Pearson correlation analysis showed that professional identity was significantly and positively correlated with learner well-being (R = 0.795, p < 0.001); professional identity was significantly and positively correlated with self-regulated learning (R = 0.843, p < 0.001); and, self-regulated learning was significantly and positively correlated with learner well-being (R = 0.852, p < 0.001). After mediation effect testing, self-regulated learning had a mediating effect between professional identity and learner well-being (95 % CI 0.366-0.548, p < 0.001). Professional identity had a positive predictive effect on self-regulated learning (a = 0.570, p < 0.001), and self-regulated learning also had a positive predictive effect on learner well-being (b = 0.798, p < 0.001). The direct effect of professional identity on learner well-being (0.225) and its mediating effect (0.455) account for 33.1 % and 66.9 % of the total effect (0.680), respectively.

CONCLUSIONS

The learner well-being of undergraduate Chinese nursing students is in the middle to upper range, and it is crucial to enhance professional identity and develop students' self-regulated learning to improve their learner well-being. This study provides empirical evidence to support the mediating effect of self-regulated learning on the relationship between professional identity and learner well-being among undergraduate nursing students in "double tops" universities. Universities are expected to strengthen career planning guidance and professional competence training for students as early as possible in order to develop quality nursing education programs that produce graduates who enter and remain in the workforce.

Technology-Supported Guidance Models to Stimulate Nursing Students' Self-Efficacy in Clinical Practice: Scoping Review

BACKGROUND

In nursing education, bridging the gap between theoretical knowledge and practical skills is crucial for developing competence in clinical practice. Nursing students encounter challenges in acquiring these essential skills, making self-efficacy a critical component in their professional development. Self-efficacy pertains to individual's belief in their ability to perform tasks and overcome challenges, with significant implications for clinical skills acquisition and academic success. Previous research has underscored the strong link between nursing students' self-efficacy and their clinical competence. Technology has emerged as a promising tool to enhance self-efficacy by enabling personalized learning experiences and in-depth discussions. However, there is a need for a comprehensive literature review to assess the existing body of knowledge and identify research gaps.

OBJECTIVE

The aim of this study is to systematically map and identify gaps in published studies on the use of technology-supported guidance models to stimulate nursing students' self-efficacy in clinical practice.

METHODS

This scoping review followed the framework of Arksey and O'Malley and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). A systematic, comprehensive literature search was conducted in ERIC, CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science for studies published between January 2011 and April 2023. The reference lists of the included papers were manually searched to identify additional studies. Pairs of authors screened the papers, assessed eligibility, and extracted the data. The data were thematically organized.

RESULTS

A total of 8 studies were included and four thematic groups were identified: (1) technological solutions for learning support, (2) learning focus in clinical practice, (3) teaching strategies and theoretical approaches for self-efficacy, and (4) assessment of self-efficacy and complementary outcomes.

CONCLUSIONS

Various technological solutions were adopted in the guidance models to stimulate the self-efficacy of nursing students in clinical practice, leading to positive findings. A total of 7 out of 8 studies presented results that were not statistically significant, highlighting the need for further refinement of the applied interventions. Nurse educators play a pivotal role in applying learning strategies and theoretical approaches to enhance nursing students' self-efficacy, but the contributions of nurse preceptors and peers should not be overlooked. Future studies should consider involving users in the intervention process and using validated instruments tailored to the studies' intervention objectives, ensuring relevance and enabling comparisons across studies.

Reflective learning conversations model for simulation debriefing: a co-design process and development innovation

BACKGROUND

Health practitioners must be equipped with effective clinical reasoning skills to make appropriate, safe clinical decisions and avoid practice errors. Under-developed clinical reasoning skills have the potential to threaten patient safety and delay care or treatment, particularly in critical and acute care settings. Simulation-based education which incorporates post-simulation reflective learning conversations as a debriefing method is used to develop clinical reasoning skills while patient safety is maintained. However, due to the multidimensional nature of clinical reasoning, the potential risk of cognitive overload, and the varying use of analytic (hypothetical-deductive) and non-analytic (intuitive) clinical reasoning processes amongst senior and junior simulation participants, it is important to consider experience, competence, flow and amount of information, and case complexity related factors to optimize clinical reasoning while attending group- based post-simulation reflective learning conversations as a debriefing method. We aim to describe the development of a post-simulation reflective learning conversations model in which a number of contributing factors to achieve clinical reasoning optimization were addressed.

METHODS

A Co-design working group (N = 18) of doctors, nurses, researchers, educators, and patients' representatives collaboratively worked through consecutive workshops to co-design a post-simulation reflective learning conversations model to be used for simulation debriefing. The co-design working group established the model through a theoretical and conceptual-driven process and multiphasic expert reviews. Concurrent integration of appreciative inquiry, plus/delta, and Bloom's Taxonomy methods were considered to optimize simulation participants' clinical reasoning while attending simulation activities. The face and content validity of the model were established using the Content Validity Index CVI and Content Validity Ratio CVR methods.

RESULTS

A Post-simulation reflective learning conversations model was developed and piloted. The model was supported with worked examples and scripted guidance. The face and content validity of the model were evaluated and confirmed.

CONCLUSIONS

The newly co-designed model was established in consideration to different simulation participants' seniority and competence, flow and amount of information, and simulation case complexity. These factors were considered to optimize clinical reasoning while attending group-based simulation activities.

The Outcome-Present State Test Model of Clinical Reasoning to Promote Critical Thinking in Psychiatric Nursing Practice among Nursing Students: A Mixed Research Study

This study determined whether teaching intervention using the outcome-present state test (OPT) clinical reasoning model can effectively improve critical thinking in nursing students during a psychiatry internship. In addition, it evaluates the experiences of the students using this model in clinical practice.

METHODS

In this interventional study, 19 students were taught critical thinking skills using the OPT clinical reasoning model during a psychiatry clinical practice. Work-learning forms were used in daily 1 h individual and group discussions with students. The critical thinking disposition scale was completed by every student before and after the intervention. Moreover, the students were asked to the complete reflection experience forms.

RESULTS

The average critical thinking disposition pre-intervention score was 95.21, whereas the average post-intervention score was 97.05, indicating an increase of 1.84. There was a significant increase in the fourth dimension of open-mindedness (z = -2.80, p < 0.01). The learning experience has been likened to a process of clearing the fog, and it involves the use of limited known conditions, thinking outside the box, and adaptation to complex care issues.

CONCLUSION

Using the OPT clinical reasoning model as a teaching strategy during a psychiatric nursing internship significantly improved the open-mindedness dimension among the students. The student reflective experience of talking to teachers as peers helped students identify clues and reframe problems related to clinical care. Additionally, the students reported that this led to more harmonious interactions with their teachers.

Self-regulated learning and the future of diagnostic reasoning education

Diagnostic reasoning is a foundational ability of health professionals. The goal of enhancing clinical reasoning education is improved diagnostic accuracy and reduced diagnostic error. In order to do so, health professions educators need not only help learners improve their clinical reasoning, but teach them how to develop expert performance. An evidence-based learning strategy that is strongly associated with expert performance is self-regulated learning (SRL). SRL is the modulation of "self-generated thoughts, feelings, and actions that are planned and cyclically adapted to the attainment of personal goals". At this time, there is little data on the use of SRL to improve diagnostic reasoning. However, there appear to be numerous opportunities to utilize SRL in novel ways to improve diagnostic reasoning given what is already known about this competency. Examples that are discussed include the role SRL can play in simulation, clinical experiences, assessment, and novel technologies such as virtual reality, artificial intelligence, and machine learning. SRL is central to the philosophy that health professionals are life-long learners, as it teaches learners "how to learn". SRL has the potential to help achieve the goal of improved diagnostic accuracy and reduced diagnostic error.

A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula

AIM

This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment.

BACKGROUND

Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used.

METHOD

A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models.

RESULTS

Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation.

CONCLUSION

Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.

The Relationship Between Reflectivity and Self-Regulated Learning in MA Medical Education Students of Shiraz University in 2018 and 2019

Introduction

Reflectivity is one of the fundamental methods of education. This study aimed to investigate the relationship between reflectivity and self-regulated learning in MA medical education students of Shiraz University of Medical Sciences in 2018 and 2019.

Methods

In this descriptive study, 34 full time and virtual MA students of medical education participated, using census method. Data were collected through the Pintrich and DeGroot self-regulated learning and the Kember et al.'s reflectivity questionnaires. Descriptive and inferential statistics were used for data analysis, through SPSS.

Results

The results showed that self-regulatory learning strategies in subjects with good reflectivity were significantly higher than those with poor reflectivity; also, the scores of cognitive strategies and motivational beliefs were significantly higher in the participants with good reflectivity. There was no significant relationship between reflectivity and subscales of self-regulated learning strategies and also between reflectivity and self-regulated learning strategies in the full time and virtual courses.

Conclusion

It was found that there was a positive and meaningful relationship between reflectivity and self-regulated learning. Therefore, it is recommended that the managers and professors in medical universities should provide training programs in this field in order for the students to benefit from the advantages of reflectivity and self-regulated learning.

Self-Esteem: A Concept Analysis

The concept of self-esteem has been discussed in various disciplines. It is necessary to broaden the conceptualization to reach a better understanding in nursing discipline. The purpose of this paper is to explore the concept of self-esteem following Walker and Avant's concept analysis method. The concept analysis method consists of eight linear steps. The author addresses the self-esteem phenomenon from a nursing perspective due to its various uses. The analysis helps to expand the knowledge of self-esteem and enhance nursing science. Roy's adaptation model is used as a philosophical scheme to provide a scientific nursing definition.

Self-Regulated Learning Practice of Undergraduate Students in Health Professions Programs

BACKGROUND

University students are expected to take charge of their learning without being dependent on teachers. Self-regulated learning (SRL) is the process by which students direct their learning to achieve their set targets and goals in a timely and controlled manner. This study was undertaken to explore the practice of SRL by undergraduate students from different programs in a health science focused university during COVID-19 pandemic.

METHOD

Thirty-three undergraduate students of five health professions education programs were recruited to take part in focus group discussions to explore their SRL practice with online learning. Their responses were subjected to thematic analysis.

RESULT

Our students appeared to practice SRL, going through the phases of forethought and goal setting, performance and self-reflection. They set goals for academic as well as personal development in the university. Academic goals like achieving target GPA or marks were achieved by following different study techniques, personal management including time management, and by creating a conducive learning environment. Personal development such as interpersonal skills, social networking was achieved through socializing and participating in extracurricular activities. The students also engaged in self-reflection and analysis of their own performance followed by designing strategies to manage the challenges they faced.

CONCLUSION

Undergraduates of health professions programs appear to show evidence of practicing SRL. Although impacted by COVID-19 induced lockdown and online learning, they seem to have strategized and achieved their goals through individualized SRL processes. Promoting and fostering an atmosphere of SRL in universities to cater to the needs of the students would help them be more successful in their careers.

Effectiveness of Metacognitive Regulation Intervention on Attention-Deficit-Hyperactivity Disorder Students' Scientific Ability and Motivation

This study investigated the effect of metacognitive regulation (McR) intervention on attention-deficit-hyperactivity disorder (ADHD) students' astronomy knowledge acquisition and learning motivation. Through a cognitive-behavioural treatment design, this study selected 97 ADHD learners who had poor academic performance. This study divided ADHD students randomly into one experimental group and one control group. After 15 weeks of intervention, results showed that the experimental group students performed significantly better than the control group in scientific abilities, learning motivation, and metacognition. Results suggested that the McR intervention is an effective approach for improving the ADHD students' science knowledge learning abilities.

A Cross-Sectional Study: What Contributes to Nursing Students' Clinical Reasoning Competence?

Clinical reasoning is a vital competence for nursing students, as it is required for solving problems arising in complex clinical situations. Identifying the factors that influence nursing students' clinical reasoning competence in the social context can help their implicit educational needs. Therefore, this study aimed to determine the factors associated with developing clinical reasoning competency among undergraduate nursing students. In total, 206 senior nursing students were included in this study. Self-reported measures were used to obtain data on participants' clinical reasoning competence, problem-solving abilities, academic self-efficacy, and level of clinical practicum stress. Relationships among continuous variables were analyzed using Pearson's correlation coefficients. A multiple linear regression analysis was conducted to identify factors related to clinical reasoning competence. Our findings show that participants with better problem-solving abilities and academic self-efficacy perceived themselves as having higher levels of clinical reasoning competence. Nursing students with lower clinical practicum stress reported higher clinical reasoning competence. Significant factors identified were younger age and subcategories of problem-solving ability such as problem clarification, alternative solution development, planning/implementation, and self-regulated efficacy. Our findings highlight essential factors necessary for developing a nursing curriculum that contributes to professional nurses' clinical reasoning competence.

Use of standardized terminologies in clinical practice: A scoping review

AIM

To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice.

INTRODUCTION

The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice.

METHODS

A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG.

RESULTS

One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs.

CONCLUSION

Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.

The Effect of Simulation Nursing Education Using the Outcome-Present State-Test Model on Clinical Reasoning, the Problem-Solving Process, Self-Efficacy, and Clinical Competency in Korean Nursing Students

The purpose of this study was to assess the effect of a simulation nursing education program in terms of clinical reasoning, problem-solving process, self-efficacy, and clinical competency using the Outcome-Present State-Test (OPT) model in nursing students. The participants comprised 45 undergraduate nursing students recruited from two universities in Korea. The number of nursing students assigned to the experimental group and control group were 25 and 20, respectively. For a period of two weeks, the experimental group received a simulation nursing education program using the OPT model, while the control group received a traditional clinical practicum. The data were analyzed using prior homogeneity tests (Fisher's exact test and paired t-test); ANCOVA was performed to investigate the differences in dependent variables between the two groups. There was a significant improvement in clinical reasoning (F = 10.59, p = 0.002), problem-solving process (F = 30.92, p < 0.001), and self-efficacy (F = 36.03, p < 0.001) in the experimental group as compared to the control group (F = 10.59, p = 0.002). Moreover, the experimental group showed significantly higher scores in clinical competency than the control group (F = 11.07, p = 0.002). This study demonstrates that the simulation nursing education program using the OPT model for undergraduate students is very effective in promoting clinical reasoning, problem-solving processes, self-efficacy, and clinical competency.

Investigating Learning Challenges from the Perspective of Nursing Students and Educators at a University in Casablanca, Morocco

Background:

Whether in an academic or clinical setting, many students often consider nursing studies to be difficult. Identifying learning challenges could help to improve the quality of the training and students’ skills.

Objective:

This study aimed to identify the main learning challenges of nursing students.

Methods:

The study utilised a two-phase mixed methods design. First, a focus group discussion with nine teachers and tutors was conducted to explore the learning challenges observed by staff. Then, based on the results, a questionnaire was developed for 54 students to explore and estimate the frequency of learning challenges perceived by them.

Results:

The data analysis confirmed 15 major learning challenges, including cognitive challenges, consisting of theoretical gaps, and challenges related to clinical reasoning, and non-cognitive procedural and behavioural challenges. Challenges related to clinical reasoning, such as the difficulty in developing care plans (100%) and choosing care actions (90.2%), remain the most frequent regardless of the level of study.

Conclusion:

Supervisors should consider students’ learning challenges when designing, developing and implementing their educational interventions.

Proceso de Atención de Enfermería como instrumento del cuidado, significado para estudiantes de último curso

Introducción: El Proceso de Atención de Enfermería (PAE) como guía para el cuidado, se aplica desde que inicia la formación académica. Comprender el significado que tiene para estudiantes del último curso permite visualizar la importancia y dificultades que se presentan en su aplicación, para proponer estrategias que fortalezcan la calidad educativa. Objetivo: Comprender el significado del PAE que tienen los estudiantes del último curso de Enfermería. Método: Estudio con enfoque cualitativo. Referencial teórico y metodológico fue el Interaccionismo Simbólico y la Teoría Fundamentada en los Datos. Muestra por saturación teórica. Colecta de datos con entrevistas semiestructuradas en 17 estudiantes del 10° ciclo de una universidad privada de Lima Este. Análisis de datos basado en la codificación de Strauss y Corbin posibilitó la identificación de categorías y subcategorías, y el fenómeno central. Resultados: Emergieron cinco categorías: 1) Cuidado enfermero utilizando el PAE desde el inicio de su formación (Condición causal); 2) Satisfacción o insatisfacción al dar cuidado con el PAE (Contexto); 3) PAE como herramienta de investigación en formación profesional (Condiciones Intervinientes); 4) Dificultades en la aplicación del PAE en el cotidiano de los profesionales (Estrategias de Acción/ Interacción) y 5) Mejora de la práctica al dar cuidado con PAE (Consecuencias). Conclusiones: El fenómeno central es el PAE, instrumento que guía el cuidado de enfermería para brindar a las personas atención integral y con fundamento en evidencia científica; a partir de la experiencia profesional con una proyección positiva al campo laboral, no exenta de limitaciones en su aplicación en el campo hospitalario.  

An Integrative Review of Clinical Reasoning Teaching Strategies and Outcome Evaluation in Nursing Education

BACKGROUND

This study explored teaching strategies used to promote clinical reasoning in nursing education and identify outcomes used to evaluate effectiveness.

METHOD

The integrative review framework by Whittemore and Knafl (2005) was used in this study.

RESULTS

Strategies included simulation (n = 10); active learning strategies such as case studies, reflection, journaling, and collaborative learning (n = 13); teaching strategies such as think aloud or case studies with simulation (n = 12); and experiential or clinical experiences (n = 2). Although most studies used exams, worksheets (n = 19), or observations by clinical instructors (n = 2) to measure effectiveness, some studies (n = 8) also used surveys to measure student satisfaction, engagement, or perception; three studies measured the student's ability to use the instrument.

CONCLUSION

Improving clinical thinking requires development of innovative, effective teaching strategies. Instruments that can accurately evaluate teaching and learning strategies are needed to advance this educational initiative and improve quality of care.

Clinical Reasoning: A State of the Science Report

Clinical reasoning is the cognitive process that nurses use to gather and incorporate information into a larger bank of personal knowledge. This incorporated information guides therapeutic actions, and helps determine client care. Since the process guides therapeutic actions regarding client care, failure to use the process effectively leads to poor clinical decision-making, inappropriate actions, or inaction. Because of the criticality of this process, this paper presents an analysis of the literature that reveals the current state of the science of clinical reasoning, identifies gaps in knowledge, and elucidates areas for future research. A systematic review of the databases the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Educational Resources Information Center (ERIC), PsychInfo, the Education Full Text (H.W. Wilson), and PubMed revealed 873 articles on the topic of clinical reasoning. Quality appraisal narrowed the field to 27 pieces of literature. Appendix A gives the State of the Science Coding Sheet used to identify the selections used in this research. Appendix B contains a summary of this literature. Although analysis of this literature shows that three theories exist on how to utilize most effectively the clinical reasoning process presently; a clear consistent definition is lacking. Additional research should focus on closing gaps that exist in defining the process, understanding the process, establishing linkages to non-clinical reasoning processes, and developing measures to both develop and accurately measure clinical reasoning.

Use of clinical simulation to improve diagnostic reasoning in nursing

Abstract Objectives: Propose a methodology for the construction of simulated scenarios and cases to improve diagnostic reasoning in nursing. Method: A methodological study was conducted using theories and concepts from the dual processing theory to develop cases and scenarios of clinical simulation for diagnostic reasoning in nursing through proper use of analytical and non-analytical reasoning. Results and discussion: This study presents and discusses issues of the theoretical framework and operational elements: structure of scenarios, preparation of simulation, briefing, debriefing, and modeling, incorporating any required content. The methodology articulates content that is compatible with analytical reasoning, non-analytical studies and diagnostic accuracy measurements of clinical validation studies. Conclusion: This study demonstrated the feasibility of modeling simulated cases that combine dual processing with diagnostic reasoning in nursing. Implications: Contribution to learning in a safer simulated environment, adopting theoretical bases from studies on human reasoning.

The Mediating Effect of Listening Metacognitive Awareness between Test-Taking Motivation and Listening Test Score: An Expectancy-Value Theory Approach

The present study investigated test-taking motivation in L2 listening testing context by applying Expectancy-Value Theory as the framework. Specifically, this study was intended to examine the complex relationships among expectancy, importance, interest, listening anxiety, listening metacognitive awareness, and listening test score using data from a large-scale and high-stakes language test among Chinese first-year undergraduates. Structural equation modeling was used to examine the mediating effect of listening metacognitive awareness on the relationship between expectancy, importance, interest, listening anxiety, and listening test score. According to the results, test takers' listening scores can be predicted by expectancy, interest, and listening anxiety significantly. The relationship between expectancy, interest, listening anxiety, and listening test score was mediated by listening metacognitive awareness. The findings have implications for test takers to improve their test taking motivation and listening metacognitive awareness, as well as for L2 teachers to intervene in L2 listening classrooms.

Clinical Judgment Scripts as a Strategy to Foster Clinical Judgments

BACKGROUND

Clinical judgment encompasses how nurses use their knowledge of the patient to generate, assess, and prioritize patient care alternatives. Previous research has identified debriefing as critical to developing clinical judgment. Best practice for debriefing has yet to be identified. The purpose of this research was to investigate whether a standard debriefing script, based on Tanner's clinical judgment model, could foster clinical judgment.

METHOD

Participants were senior nursing students in their final semester of study. Data were gathered and analyzed from three sources: independent raters observing students in simulation, participating students, and the students' clinical instructors.

RESULTS

Students identified the script as an effective debriefing tool, and significant improvements were observed in clinical judgment scores from all data sources.

CONCLUSION

The standardized debriefing script helped students focus on the learning process, resulting in student improvement in all areas of clinical judgment: noticing, interpreting, responding, and reflecting. [J Nurs Educ. 2016;55(12):691-695.].

Iranian Clinical Nurses' Activities for Self-Directed Learning: A Qualitative Study

Background:

Clinical nurses need lifelong learning skills for responding to the rapid changes of clinical settings. One of the best strategies for lifelong learning is self-directed learning. The aim of this study was to explore Iranian clinical nurses’ activities for self-directed learning.

Methods:

In this qualitative study, 23 semi-structured personal interviews were conducted with nineteen clinical nurses working in all four hospitals affiliated to Isfahan Social Security Organization, Isfahan, Iran. Study data were analyzed by using the content analysis approach. The study was conducted from June 2013 to October 2014.

Findings:

Study participants’ activities for self-directed learning fell into two main categories of striving for knowledge acquisition and striving for skill development. The main theme of the study was ‘Revising personal performance based on intellectual-experiential activities’.

Conclusions:

Study findings suggest that Iranian clinical nurses continually revise their personal performance by performing self-directed intellectual and experiential activities to acquire expertise. The process of acquiring expertise is a linear process which includes two key steps of knowledge acquisition and knowledge development. In order to acquire and advance their knowledge, nurses perform mental learning activities such as sensory perception, self-evaluation, and suspended judgment step-by-step. Moreover, they develop their skills through doing activities like apprenticeship, masterly performance, and self-regulation. The absolute prerequisite to expertise acquisition is that a nurse needs to follow these two steps in a sequential manner.

Social networking as a learning tool: nursing students' perception of efficacy

BACKGROUND

The pedagogical use of social networking technology in education is of growing interest to academics as a potential teaching and learning tool. However, the educational use of social networking sites such as Facebook is still under explored. Nursing students often perceive bioscience subjects as difficult and lack self-efficacy in their ability to be successful. In this case, as the final assessment for a bioscience related subject approached, students became increasingly anxious about their ability to perform in the assessment item. To better support students, a Facebook group was formed.

OBJECTIVES

The aim of the study was to examine students' perceptions of the efficacy of using Facebook as a tool to support study.

DESIGN

A convenience sample of BN students (n=533 across 3 campuses), enrolled in the subject Medications and Safe Administration, were invited to join. 373 BN students joined the group (70% of the student cohort). A solution-focussed orientation underpinned the management of the group.

METHODS

A descriptive, online survey was administered following release of students' results for the final assessment item to assess students' perceptions of how effective the group had been in helping them learn. The survey contained both quantitative and qualitative questions. Responses were received from 89 students (24%). Survey data were analysed descriptively and qualitative data were analysed thematically by the academic team.

RESULTS

Students perceived the group to be an innovative method of study support that guided learning by enhancing self-efficacy in their learning. Students also described how it was useful in promoting peer learning and engaging with academics.

CONCLUSIONS

Social media platforms such as Facebook have the potential to enhance students' self-efficacy in learning and can support students to develop their learning to a deeper level.

The relationships between the use of self-regulated learning strategies and depression among medical students: an accelerated prospective cohort study

We conducted this study to determine the relationships between the use of self-regulated learning strategies (SRL) and depression scores among medical students. An accelerated prospective cohort study among 623 students at a public medical university in Vietnam was carried out during the academic year 2012-2013. The Depression, Anxiety and Stress Scales (21 items) was used to measure depression scores as the primary research outcome, and to measure anxiety and stress scores as the confounding variables. Fourteen SRL subscales including intrinsic/extrinsic goal orientation, task value, self-efficacy for learning, control of learning beliefs, rehearsal, elaboration, organization, critical thinking, meta-cognitive strategies, time and study environment, effort regulation, peer learning, and help seeking were measured using the Motivated Strategies for Learning Questionnaire. Data were collected at two points in time (once each semester). There were 744 responses at the first time (95.88%) and 623 at time two (drop-out rate of 16.26%). The generalized estimating equation was applied to identify any relationships between the use of each SRL subscale and depression scores at time 2, adjusting for the effects of depression at time 1, anxiety, stress, within cluster correlation, and potential demographic covariates. Separate multivariate GEE analysis indicated that all SRL subscales were significantly negatively associated with depression scores, except for extrinsic goal orientation and peer learning. Whereas full multivariate GEE analysis revealed that self-efficacyT1, help-seekingT1, time and study environmentT2 were found to be significantly negatively associated with depressionT2, adjusting for the effects of depressionT1, anxiety, stress, and demographic covariates. The results should be used to provide appropriate support for medical students to reduce depression.

Mixed-methods approach to understanding nurses' clinical reasoning in recognizing delirium in hospitalized older adults

A mixed-methods study was conducted to enhance understanding of nurses' clinical reasoning in recognizing delirium in the hospitalized older adult. Paired nurse and researcher ratings of the confusion assessment method in 103 medical-surgical patients were analyzed to determine the rate of agreement in detecting delirium and to identify a purposive sample of nurses to be interviewed about the patients with delirium who were under their care. Nurses' clinical reasoning in recognizing and underrecognizing delirium was investigated using semistructured interviews. The incidence of delirium was 13%, with poor agreement (95% CI [0.05, 0.64], p < 0.05) between the researchers and the nurses in detecting delirium. Sixteen nurses were interviewed and transcripts were analyzed with grounded theory. Confusion was the primary causal factor for recognizing symptoms of delirium. The findings explicated a framework that forms the basis for generating testable assumptions to improve nurses' recognition of delirium.

Creativity and innovation: thought and action

The purpose of this article is to discuss the significance of creativity and innovation in contemporary health care contexts, and to provide nurses and other health care professionals with models, resources, and ways of thinking about creativity that informs the development of an innovation-action and creative thinking mind-set. As the complexity of health care and nursing escalates, health care providers are challenged to think more creatively and develop innovations that advance the knowledge, learning, and service contributions of their discipline to the health care enterprise. Nursing requires creative thought and innovative action in service of the greater good.

Case histories in the education of advanced practice nurses

Case histories--rich, anecdotal narratives--are theorized to support the acquisition of cognitive, social, cultural, and emotional knowledge and motor skills through active learning. This manuscript focuses on the value of case histories in teaching and evaluating acute and critical care advanced practice nursing students. Information about the use of case histories in advanced critical care education and clinical practice is limited. Case histories support student-centered learning and development of clinical reasoning. An exemplar of a case history is provided, and application of case histories to both electronic and classroom settings is explored.

Integration of Innovative Clinical Reasoning Pedagogies Into a Baccalaureate Nursing Curriculum

The significance of good clinical reasoning skills relates to prevention of adverse patient outcomes from failure to diagnose problems, institute appropriate treatments, and/or manage complications. The clinical reasoning pedagogies described in this article are integrated across a baccalaureate curriculum designed to promote a beginner level of competence in solving patient problems. The faculty adopted the content, structure, and process model for integration that includes professional language and content, the Outcome-Present State Test (OPT) model of clinical reasoning, and reflective journaling. These strategies show promise for attaining higher levels of student thinking, focusing attention on patient problems, and promoting situated cognition. As students realize that situations are complex, faculty guidance can influence best judgments and facilitate clinical reasoning with feedback on assignments to promote student growth and competence in solving clinical problems.

Self-efficacy with application to nursing education: a concept analysis

TOPIC

Concept analysis and self-efficacy.

PURPOSE

This article analyzes the concept self-efficacy and its relationship to nursing education using Walker and Avant's methodology.

SOURCES

Published literature.

CONCLUSION

Nursing literature suggests increasing students' perceived self-efficacy will help to narrow the theory-practice gap. Self-efficacy is a cognitive variable that affects performance behaviors and affective processes. Perceived self-efficacy can be influenced by a direct experience, vicarious experience, or verbal persuasion. Individuals with high levels of self-efficacy demonstrate the defining attributes of confidence, perceived capability, and perseverance.

Nurses' clinical reasoning: processes and practices of medication safety

In this article, we describe the depth of knowledge and skill nurses used in making decisions regarding the safe processes and practices of medication administration. Using grounded theory, we identified the essence of medication safety by nurses as the theme of clinical reasoning. Nurses used two medication safety processes within the clinical reasoning theme-maintaining medication safety and managing the environment-together with six categories of patient-focused medication safety practices in the first process and four categories of environmental-focused safety practices within the second process. These processes and practices present an emerging model of safe medication administration developed from the narratives of 50 medical-surgical nurses. This model provides researchers with the basis for the development of systemic policies for safer medication administration for patients. Health care professional educators might also find the results useful in developing curricula focused on patient safety as the foundation of quality care.