Effectiveness of Standardized Patient in Abdominal Physical Examination Education: A Randomized, Controlled Trial

The effect of simulation on auscultation skills, self-confidence and anxiety levels in nursing students: A randomized controlled trial

AIM

This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels.

BACKGROUND

Auscultation is an essential topic in nursing education and patient care. Simulation is efficacious in improving auscultation skills and self-confidence and reducing anxiety levels. It is a valuable educational approach whose effects should be evaluated and disseminated in the context of auscultation.

DESIGN

This study had a randomised controlled trial design.

METHODS

The study was conducted with second-year nursing students enrolled at a university in Turkey. One group of students studied auscultation of heart, lung and bowel sounds with a simulated patient (n = 28), the second group with a high fidelity simulator (n = 30) and the third group with traditional education (n = 28). Data were collected using a demographic information form, auscultation control list and Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale. The students' psychomotor auscultation skills, self-confidence and anxiety levels were evaluated. Data on auscultation skills were assessed after the intervention, while data on self-confidence and anxiety levels were collected at baseline, after the intervention and after clinical practices throughout the academic year.

RESULTS

Anxiety and self-confidence levels showed statistically significant differences in intragroup evaluation. The self-confidence levels of the groups working with simulation did not change much in the follow-up test conducted after the end of clinical practices. The mean skill scores in the auscultation control list showed a statistically significant difference between the groups.

CONCLUSIONS

Simulation and traditional approaches are effective in learning auscultation skills. However, the positive effects of simulation, particularly in enhancing students' self-confidence and reducing anxiety levels, appear to be more permanent and impactful than traditional education. Therefore, it is recommended that simulation be prioritized for teaching auscultation skills.

The effects of mentorship and educational videos on nursing students' physical examination skills: a clinical audit

BACKGROUND

Poor competence in clinical examination skills among nurses has been reported in practice, and there is a strong consensus that physical examination (PE) education must be improved. However, deficiencies cannot be resolved by theoretical training alone, and new training approaches are required to enable nursing students to perform PE accurately. This study aimed to determine and compare the effect of two new educational methods (mentorship and educational video methods) on the physical examination skills of Iranian nursing students.

METHODS

This study was a clinical audit with three group pretest posttest design. Eligible nursing students were recruited through the census method and assigned to three groups (mentorship, educational videos, and control group) using permuted block randomization. Students were taught PE skills in three vital systems through three approaches (mentors, educational videos, and routine educational methods). Data were collected using a two-part instrument consisting of a demographic information questionnaire and a 32-item checklist for assessing the students' skills in examining the respiratory system (10 items), cardiovascular system (13 items), and 12 cranial nerves (9 items). Data were analyzed using SPSS software version 16 and descriptive and analytical statistical tests.

RESULTS

At baseline, students in all groups scored less than half of the possible scores in all three systems, and the mean scores of the three groups were not statistically different (P > 0.05). After the intervention, the mean scores of students in the mentorship group increased significantly in all three systems (P < 0.001), whereas the mean scores of students in the educational video group and the control group did not change significantly (P > 0.05). Furthermore, after the intervention, the mean scores of the educational video group and the control group did not significantly differ in any of the three systems (P > 0.05). The ANCOVA showed that with posttest score as the covariate, PE skills in all three systems improved one week after the intervention in the mentor group compared to the control group and the educational video group. However, PE skills in all three systems did not improve one week after the intervention in the educational video group compared to the control group.

CONCLUSIONS

The mentorship method is more effective than the educational video and routine methods for teaching PE skills to nursing students. Nursing schools can use the mentor method in training nursing students, and it is recommended to revise the PE lesson unit in the nursing curriculum and exchange it from a purely theoretical-based unit to a mixture of theoretical and clinical-based training. Educational videos alone cannot improve nursing students' PE skills; thus, if educational videos are used to teach clinical skills, it is necessary to hold hands-on sessions to provide feedback to students and correct their mistakes.

Developing student nurses' evaluative judgement in clinical practice tertiary education: A systematic scoping review of teaching and assessment methods

OBJECTIVES

This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to identify features that align with promoting students' evaluative judgement.

INTRODUCTION

Evaluative judgement is a new concept to nursing tertiary education. Currently, there are no published reviews of evaluative judgement in nursing clinical practice education. This review aims to assist nursing educators to operationalise the concept of evaluative judgement in clinical practice education. As such the starting point was to determine features of evaluative judgement in current clinical teaching and assessment designs.

INCLUSION CRITERIA

Peer reviewed qualitative or quantitative studies that have evaluated teaching and/or assessment of tertiary (university/higher education) pre-registration (undergraduate) or post-registration (postgraduate) nursing students' clinical practice.

METHODS

The systematic scoping review was prospectively registered systematic review (OSF DOI 10.17605/OSF.IO/PYWZ6) reported using PRISMA guidelines. A systematic search of five databases (Medline, Scopus, Web of Science, ProQuest, CINAHL) was conducted, limited from 1989 onwards and in English. Two reviewers independently screened titles and abstracts, then full text, with disagreements resolved with a third independent author. Data were extracted, including the frequency and methods of developing students' evaluative judgement across the categories of discerning quality, judgement process, calibration and feedback. A narrative synthesis was performed.

RESULTS

Seventy-one studies were included (n=53 teaching, n=18 assessment). Most of the included studies, included some, but not all, of the features to develop nursing students' evaluative judgment. For teaching methods, the most identified evaluative judgement features in the included studies were discerning quality (n=47), feedback (n=41) and judgement process (n=21). Only three studies included a method of calibration. For the assessment methods, feedback (n=16), discerning quality (n=15), judgement process (n=9) and calibration (n=4) were included. Many clinical practice teaching and assessment methods in nursing included features that develop students' evaluative judgement, with methods relating to discerning quality and feedback well embedded. Further adjustments are required to include methods to assist students to judge and calibrate their own performance.

CONCLUSION

This systematic scoping review identified that evaluative judgement in current nursing clinical teaching and assessment is not an overt aim. With minor adjustment to teaching and assessment design, nursing students could be better supported to develop their ability to judge the value of their own work.

How to prepare nursing students for mental health clinical engagement: a qualitative study

BACKGROUND

Since clinical experience is challenging, identifying the factors influencing the learning process and acquiring clinical competence in mental departments is essential. Limited studies have investigated students' concerns regarding attending this clinical setting and how they are mentally and academically prepared.

AIM/QUESTION

Explaining the various aspects of nursing students' preparation to attend the mental clinical environment.

METHODS

This qualitative study was conducted on bachelorette nursing students and college professors using in-depth, semi-structured interviews. Inductive content analysis was used for data analysis, and Lincoln and Guba's criteria were used for the rigor of the data.

RESULTS

The participants' viewpoints regarding how to prepare nursing students to enter mental clinical settings can be summarized in 4 categories: "understanding the students' concerns" "understanding the students' expectations" "the necessity of the students' mental preparation" and "preparing the scientific materials needed to attend in a mental ward".

CONCLUSION

Nursing students have fears and worries about entering mental departments and have expectations of themselves and their instructors. To help students deal with these concerns, psychological and educational preparations should be provided, among which the role of new educational technologies can be mentioned.

Evaluation of the effectiveness of a training programme for nurses regarding augmentative and alternative communication with intubated patients using Kirkpatrick's model: A pilot study

AIM

Communicating with conscious intubated patients who are unable to communicate verbally is one of the challenges faced by intensive care unit (ICU) nurses. The present study was conducted to evaluate the effectiveness of a training programme for nurses regarding augmentative and alternative communication (AAC) with intubated patients using Kirkpatrick's model.

DESIGN

This study had a one-group, before-after, quasi-experimental design.

METHODS

Totally, 45 nurses working in ICUs participated in a blended training programme using AAC strategies to communicate with intubated patients. Their contribution was evaluated based on Kirkpatrick's model at four levels. The study data were collected using the "satisfaction and ease questionnaire," "observation checklist" and "communication knowledge test." Then, the data were analysed using the SPSS 22 software and p < 0.05 was considered statistically significant.

RESULTS

Most participants were satisfied with the implementation of the programme. The nurses' mean score of communication knowledge increased after the intervention (p < 0.05). The results of evaluation of the third and fourth levels of Kirkpatrick's model also showed an increase in the success of communication, use of AAC, and satisfaction with and ease of communication (p < 0.001).

IMPLICATION

Short-term and long-term effects of the blended training programme about AAC were investigated using Kirkpatrick's model. The results indicated the positive effect of the programme on the quality of the nurses' communication with intubated patients, their understanding of the patients' messages and meeting the patients' needs at a more desirable level. Thus, nurses and other staff are recommended to use this simple method of communication with patients to provide better services. In addition, further quantitative and qualitative studies are suggested to assess these communication strategies in other patients with impaired consciousness.

Learning practical nursing skills in simulation centers - A narrative review

Background

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

Objectives

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

Design

Narrative review.

Methods

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

Findings

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

Discussion

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

Conclusion

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

Male Nursing Students' Perception of Gender Barriers in Nursing Curricula in an Iranian University of Medical Sciences

OBJECTIVES

The present study aimed to determine male nursing students' perception of gender barriers in nursing curricula.

METHODS

This descriptive study was conducted on 150 B.Sc. and M.Sc. nursing students at Tabriz School of Nursing and Midwifery, Tabriz university of medical sciences, Tabriz, Iran that were selected through convenience sampling. The study data were collected using Inventory of Male Friendliness in Nursing Programs-Short (IMFNP-S). This scale has 17 items for investigating male nursing students' perception of gender barriers in nursing curricula. Each item is a 5-point Likert-type scale scored from 0 to 4; total scale score could range from 0 to 68, higher scores representing male nursing students' perception of less gender barriers in nursing curricula.

RESULTS

The total mean score of gender barriers was 35.11+6.15. The most important barriers included different requirements/limitations in obstetrics apprenticeship (Median=1), and need for proving oneself because of people's expectation of nurses to be female (Median=2). On the other hand, the least important barriers were lack of important people's support on one's career decisions (Median=3), and lack of opportunity to work with other male nurses (Median=3). The scale score was not associated with the socio-demographic characteristics studied.

CONCLUSIONS

The most male nursing students feel various gender issues in the nursing curriculum in a medium level that may negatively impact on their learning, professional performance and motivation and tendency to nursing. Furthermore, this vicious cycle can lead to lack of professional development, leaving the job and burnout. Thus, creating a gender-neutral environment can make nursing programs more male friendly.

Effect of simulation-based teaching on nursing skill performance: a systematic review and meta-analysis

Objective

To summarize and produce aggregated evidence on the effect of simulation-based teaching on skill performance in the nursing profession. Simulation is an active learning strategy involving the use of various resources to assimilate the real situation. It enables learners to improve their skills and knowledge in a coordinated environment.

Methods

Systematic literature search of original research articles was carried out through Google Scholar, Medline, and Cochrane Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Studies conducted on simulation-based teaching and skill performance among nursing students or clinical nursing staff from 2010 to 2019, and published in the English language, were included in this study. Methodological quality was assessed by Joanna Briggs Institute, and the risk of bias was also assessed by Cochrane risk of bias and the risk of bias assessment tool for non-randomized studies (ROBINS-I) checklists.

Results

Initially, 638 titles were obtained from 3 sources, and 24 original studies with 2209 study participants were taken for the final analysis. Of the total studies, 14 (58.3%) used single group prep post design, 7 (29.1%) used high fidelity simulator (HFS), and 7 (29.1%) used a virtual simulator (VS). Twenty (83.3%) studies reported improved skill performance following simulation-based teaching. Simulation-based teaching improves skill performance among types of groups (single or double), study regions, high fidelity (HF), low fidelity (LF), and standard patient (SP) users. But the effect over virtual and medium fidelity simulators was not statistically significant. Overall, simulation-based teaching improves the skill performance score among the experimental group (d = 1.01, 95% confidence interval [CI] [0.69–1.33], Z = 6.18, P < 0.01, 93.9%). Significant heterogeneity and publication bias were observed during the pooled analysis.

Conclusions

Simulation did improve skill performance among the intervention groups, but the conclusion is uncertain due to the significant heterogeneity. The large extent of difference among original research has necessitated the development of well-defined assessment methods for skills and standardized simulation set-up for proper assessment of their effects.

Translation and Psychometric Assessment of the Postoperative Handover Assessment Tool

PURPOSE

The objective of the present study was to translate and validate the Postoperative Handover Assessment Tool (PoHAT) in the Persian language.

DESIGN

The study used a descriptive, mixed-method design.

METHODS

The present descriptive, mixed-method study was conducted in 2018 at Shahid Rajaee Hospital and Shiraz Nursing and Midwifery School, Shiraz University of Medical Sciences (Shiraz, Iran), to evaluate the psychometric properties of the Persian version of the PoHAT. The original version of PoHAT was translated into the Persian language and then back-translated for comparison. The face validity (qualitative), content validity (qualitative and quantitative), construct validity (experimental intervention method), and reliability (inter-rater reliability, internal consistency) of the Persian version of the PoHAT were assessed. Data were analyzed using SPSS software, version 22. P values less than 0.05 were considered statistically significant.

FINDINGS

The content validity ratio of all the 34 items of the Persian version of the PoHAT ranged between 0.66 and 1. The content validity index for all items was within the acceptable range (between 0.92 and 1). The result of construct validity, using the experimental intervention method, showed a significant difference between before and after intervention (P < .05). The correlation coefficient for inter-rater reliability of all subscales (information, tasks, teamwork) and the total checklist was 0.89, 0.80, 0.94, and 0.85, respectively; the coefficient was significant for all subscales (P < .001).

CONCLUSIONS

The validity and reliability of the 34-item Persian version of the PoHAT were confirmed. The application of the PoHAT to assess the process and quality of postoperative handover in Iran and other Persian-speaking countries is recommended.

The effect of a stress and anxiety coping program on objective structured clinical examination performance among nursing students in shiraz, Iran

BACKGROUND

Evaluation of the competence and practical skills of nursing students, using the objective structured clinical examination (OSCE), is an integral part of the nursing education program. However, their performance could be negatively influenced by a significant level of stress and anxiety prior to the test. The present study aimed to evaluate the effect of an anxiety coping program on the OSCE performance level of first-year nursing students in Shiraz, Iran.

METHODS

The present quasi-experimental study was conducted among 76 nursing students; control group (n = 35) and intervention group (n = 41). To attain the study purpose, the intervention group received a pre-exam anxiety coping program that included relaxation and soothing techniques, diaphragmatic breathing training, and progressive muscle relaxation training accompanied by light instrumental music, while the control group received no intervention before the exam. Data collection instruments included a demographic characteristics form and State-Trait Anxiety Inventory (STAI) questionnaire. Demographic characteristics of the participants indicated an overall homogeneity within the study population. The STAI questionnaire was filled in before and after the OSCE and the results were compared with those of the control group. The data were analysed using SPSS software (version 22.0). P < 0.05 was considered statistically significant.

RESULTS

As a result of the anxiety coping program, a substantial reduction in the anxiety score (by 11.61 units) in the intervention group was observed. There was a significant difference in the pre- and post-exam anxiety scores between the control and intervention groups (P < 0.001). The anxiety coping program improved the examination results of nursing students in the final exam compared to the midterm results (an increase of 0.9487 units, P < 0.001).

CONCLUSION

The anxiety coping program reduced the anxiety level among nursing students and improved their OSCE results. Our findings can be utilized to better evaluate clinical activities in different medical and paramedical groups. Moreover, educators can implement such coping programs prior to evaluations in order to effectively assess the knowledge, attitude, and performance of the students.