Challenges Experienced by Nurse Educators in Promoting Acquisition of Clinical Reasoning Skills by the Undergraduate Nursing Students: A Qualitative Exploratory Study

Background: Clinical reasoning is an essential skill for nursing students since it is required to solve difficulties that arise in complex clinical settings. However, teaching and learning clinical reasoning skills is difficult because of its complexity. This study, therefore aimed at exploring the challenges experienced by nurse educators in promoting acquisition of clinical reasoning skills by undergraduate nursing students. Methods: A qualitative exploratory research design was used in this study. The participants were purposively sampled and recruited into the study. Data were collected using semi-structured interview guides. Thematic analysis method was used to analyze the collected data The principles of beneficence, respect of human dignity and justice were observed. Results: The findings have shown that clinical learning environment, lacked material and human resources. The students had no interest to learn the skill. There was also knowledge gap between nurse educators and clinical nurses. Lack of role model was also an issue and limited time exposure. Conclusion: The study revealed that nurse educators encounter various challenges in promoting the acquisition of clinical reasoning skills among undergraduate nursing students. Training institutions and hospitals should periodically revise the curriculum and provide sufficient resources to facilitate effective teaching and learning of clinical reasoning. Nurse educators must also update their knowledge and skills through continuous professional development if they are to transfer the skill effectively.

Assessing the Levels of Clinical Reasoning Skills Using Self-Assessment of Clinical Reflection and Reasoning in Undergraduate Nursing Students: A Descriptive Comparative Study

Background: Clinical reasoning is a critical cognitive skill that enables undergraduate nursing students to make clinically sound decisions. A lapse in clinical reasoning can result in unintended harm to patients. The aim of the study was to assess and compare the levels of clinical reasoning skills between third year and fourth year undergraduate nursing students. Methods: The study utilized a descriptive comparative research design, based on the positivism paradigm. 410 undergraduate nursing students were systematically sampled and recruited into the study. The researchers used the Self-Assessment of Clinical Reflection and Reasoning questionnaire to collect data on clinical reasoning skills from third- and fourth-year nursing students while adhering to ethical principles of human dignity. Descriptive statistics were done to analyse the level of clinical reasoning and an independent sample t-test was performed to compare the clinical reasoning skills of the student. A p value of 0.05 was accepted. Results: The results of the study revealed that the mean clinical reasoning scores of the undergraduate nursing students were knowledge/theory application (M = 3.84;SD = 1.04);decision-making based on experience and evidence (M = 4.09;SD = 1.01);dealing with uncertainty (M = 3.93;SD = 0.87);reflection and reasoning (M = 3.77;SD = 3.88). The mean difference in clinical reasoning skills between third- and fourth-year undergraduate nursing students was not significantly different from an independent sample t-test scores (t = −1.08;p = 0.28);(t = −0.29;p = 0.73);(t = 1.19;p = 0.24);(t = −0.57;p = 0.57). Since the p-value is >0.05, the null hypothesis (H0) “there is no significantno significant difference in clinical reasoning between third year and fourth year undergraduate nursing students”, was accepted. Conclusion: This study has shown that the level of clinical reasoning skills of the undergraduate nursing students was moderate to low. This meant that the teaching methods have not been effective to improve the students clinical reasoning skills. Therefore, the training institutions should revise their curriculum by incorporating new teaching methods like simulation to enhance students’ clinical reasoning skills. In conclusion, evaluating clinical reasoning skills is crucial for addressing healthcare issues, validating teaching methods, and fostering continuous improvement in nursing education.

Progress in the Application of Reflective Education on Undergraduate Nursing Interns

Objective:To explore the implementation methods and effects of reflective education,and to provide references for the development of reflective education in Chinese nursing schools.Methods:Relevant literature was searched from China National Knowledge Infrastructure,Wanfang Database,Wipro Chinese Science and Technology Journal Database,and PubMed Database,and the included studies were analyzed descriptively.Results:The implementation of reflective education included work-site education,group discussion,video teaching,self-reflection,and expert lectures;the interventions mainly included study groups,role-playing,individual instruction,peer cooperation,demonstration and observation,field simulation,and video presentations.The implementation of reflective education can improve the sense of professional identity and professional competence of nursing interns,and reduce nursing errors and adverse events.Conclusion:Currently,nurses in China lack self-awareness and critical thinking skills,it is recommended that reflective education be incorporated into the teaching content of undergraduate nursing students during their internship in order to promote the development of professionalism and humanistic caring skills of nursing students.

Attitudes of undergraduate nursing students toward Objective Structure Practical Examination: An Exploratory study

Background: Objective Structured Practical Examination (OSPE) is a method of assessment of clinical competence.The examination is conducted at multiple stations.Besides practical and problem-solving skills,theoretical knowledge is also tested.OSPE can be traced back more than 40 years.OSPE has been included more than two decades,as a part of assessment in the College of Nursing,All India Institute of Medical Sciences (AIIMS),New Delhi.Objectives: This study was carried out to determine nursing students' attitudes towards OSPE as an assessment tool.Participants: The responses of all the 252 Undergraduate nursing students studying at the College of Nursing,AIIMS were obtained for this study (77 from B.Sc.(H) Nursing first year,61 from the second year,69 from the third year and 45 from the fourth year).Methods: The students attitudes towards OSPE were assessed by using a validated questionnaire containing 28 item statements on Likert's 5-point scale (LS) and 11 bipolar adjectives on Osgood's 7-point Semantic'Differential Scale (OSDS).Result: Most of the students approved of OSPE and felt that it was fair,useful,good,effective,exciting,interesting,practical,skill oriented but also taxing.The study also revealed that amongst the second years' students there was a strong correlation between Overall Rank in the Class and Assessment of OSPE.Conclusion: The study supports the introduction of OSPE as one of the methods of assessment of B.Sc.(Hons.) Nursing students.

Mediating effect of undergraduate nursing students’ professional commitment on positive psychological capital and learning burnout

Objective:The objective of this study is to explore the mediating role of professional commitment of undergraduate nursing students between positive psychological capital(PsyCap)and learning burnout.Materials and Methods:A cluster sampling method was used to survey 442 students of a bachelor’s degree in freshman to the junior in a medical college in Shaanxi Province.Results:Professional commitment was positively related to positive PsyCap(=0.487,P<0.01),while positive PsyCap and professional commitment were negatively related to learning burnout(r=−0.456,r=−0.411,P all<0.01).There are certain mediating effects of professional commitment in the relationship between positive PsyCap and learning burnout.The mediating effect value of professional commitment is−0.065,accounting for 16.08%of the total effect.Conclusion:Nursing educators in medical colleges and universities should focus on developing and training the positive PsyCap of undergraduate nursing students,thereby enhancing and stabilizing their professional commitment level and reducing the risk of learning burnout.

Do the Application of Problem-Based Learning on Undergraduate Nursing Students’ Is Effective? A Case Study Review

Objectives: The study’s aims to determine and assess the application of problem-based learning to undergraduate nursing students. Background: Nursing students are the upcoming health care delivery system;according to their standard of learning, it will affect their clinical training. Method: The study design is a case study review, the data was collected using many articles related to problem-based learning collected from E-books and E-journals websites like CINAHEL, Google Scholar, etc. After that, the data was analyzed and evaluated related to the application of problem-based learning on undergraduate nursing students. Result: The result appeared that most of the research proved and supported that the application of problem-based learning is effective for undergraduate nursing students, and students can solve patients’ problems in a better way. Conclusion: In conclusion, problem-based learning is an essential part of the nursing diagnosis process that will increase knowledge, and performance, and merge it with the nursing concepts.

Analysis on the status and influencing factors of undergraduate nursing students’ online learning engagement in the context of the pandemic

Objective:This project has mainly studied the online learning engagement of undergraduate nursing students and analyzes influencing factors of online learning and teaching mode during the Novel Coronavirus(COVID-19).This research has significant references for improving the efficiency and quality of the online learning mode of students.Methods:In this study,212 undergraduate nursing students were selected from a comprehensive university in Jilin Province by combining convenience sampling and cluster sampling methods.And these students were conducted with a general information questionnaire,Online Academic Emotion Scale,and Online Learning Engagement Scale.The influencing factors of this teaching mode were analyzed by multiple linear stepwise regression.Results:The total score of online learning engagement of undergraduate students was 53.85±7.38,which positively correlated with positive high arousal emotion and negative high arousal emotion,but weakly negatively correlated with negative low arousal emotion(r=0.661,0.246,-0.187,P<0.001).Grade,type of online class,online learning time,and positively high arousal emotion were mainly affected the online learning engagement of undergraduate nursing students,which explained 78.5%of the total variation(P<0.001).Conclusion:The online learning engagement of undergraduate nursing students was above the middle level under the background of the COVID-19 pandemic.Lectures and professors who teach undergraduate nursing students,should integrate the individuation characters of nursing students,and motivate their positively high arousal emotion to improve online learning engagement of students to ensure the quality of online teaching mode.

Challenge, opportunity and development： Influencing factors and tendencies of curriculum innovation on undergraduate nursing education in the mainland of China

Background： As the deep influence of traditional medical education, many undergraduate nursing colleges and universities in China still keep the traditional disease-focused curriculum system. However, it became outdated as the Chinese high nursing education developed. Meanwhile, the increasing demand of nursing human resources stimulates the enrollment expansion of colleges. All of these bring more difficulties and opportunities for nurse educators who are endeavoring to reform the undergraduate curriculum. Methods： The authors retrospectively reviewed the related literature, illustrated the existing challenges and opportunities during the curriculum renewal process in China. This paper also analyzed the ten- dencies of Chinese baccalaureate curriculum innovation. Results： Chinese current undergraduate nursing curriculum has larger proportion of basic medical courses, which brings great challenge for nursing educators. In the meantime, the expansion of enroll- ment brings conflicts with existing nursing education resources in China. Integration, humanization, internationalization and diversification are main tendencies leading the future nursing curriculum innovation in China. Conclusions： The more effective teaching innovations in the nursing education system are in great demand.

The effects of Professional Commitment and Patient Safety knowledge-attitude-practice on Undergraduate nursing students’ Humanistic Care Ability in clinical practice

Objective:To describe the status quo of humanistic care ability,the knowledge-attitude-practice of Patient Safety and professional commitment among Undergraduate Nursing Students in clinical practice,and to determine the effects of professional commitment and patient safety knowledge-attitude-practice on humanistic care ability.Methods:Two hundred and thirty-two undergraduate nursing students in clinical practice were investigated with the general questionnaire,Caring Ability Inventory(CAI),Patients Safety knowledge-attitude-practice(KAP)Questionnaire and the Nursing Professional Commitment Scale.Results:The score of humanistic care ability of nursing undergraduates was 185.19±20.95,patients safety KAP score was 106.94±11.62,professional commitment score was 74.93±10.44.Undergraduate nursing students’humanistic care ability were positively correlated with professional commitment and patients safety KAP(P<0.05).Multiple Linear regression analysis showed that professional commitment,patient safety KAP entered the humane care equation(F=24.051,P<0.001),and explained 39.1%of the total variation in humane care.Intermediate effect analysis shows that patient safety played a partial mediating role in professional commitment and humane care.Conclusion:The professional commitment and patient safety KAP of undergraduate nursing students were positively related to their humanistic care ability.Improving the professional commitment and knowledge and patients safety KAP of nursing students can strengthen their humanistic care ability to provide high-quality nursing for patients.

Cultivation Path of Nursing Undergraduates’Scientific Research and Innovation Ability

Objective: The cultivation of the innovation ability and scientific research is one of the nursing learning objectives for undergraduate students. To explore the method and effect of training system of scientific research innovation ability of nursing undergraduates based on “3332”. Methods: Three course learning modules are constructed: stage-based course learning module, systematic project practice training module and comprehensive practice training module. A practical training platform for scientific research innovation projects is built, and undergraduate scientific research innovation ability training is carried out from both in-class and out-of-class lines. Results: Since 2017, the students have obtained 7 national innovation and entrepreneurship training programs, 52 university-level undergraduate scientific research projects, published more than 10 academic papers, and obtained 2 patent authorization. Conclusions: The training system of scientific research innovation ability of nursing undergraduates based on “3332” is conducive to the development of scientific research innovation ability of nursing students, and to cultivate nursing talents who can adapt to the development of the new era and have better post competence.

Cultivation Path of Nursing Undergraduates’ Scientific Research and Innovation Ability

Objective:The cultivation of the innovation ability and scientific research is one of the nursing learning objectives for undergraduate students.To explore the method and effect of training system of scientific research innovation ability of nursing undergraduates based on“3332”.Methods:Three course learning modules are constructed:stage-based course learning module,systematic project practice training module and comprehensive practice training module.A practical training platform for scientific research innovation projects is built,and undergraduate scientific research innovation ability training is carried out from both in-class and out-of-class lines.Results:Since 2017,the students have obtained 7 national innovation and entrepreneurship training programs,52 university-level undergraduate scientific research projects,published more than 10 academic papers,and obtained 2 patent authorization.Conclusions:The training system of scientific research innovation ability of nursing undergraduates based on“3332”is conducive to the development of scientific research innovation ability of nursing students,and to cultivate nursing talents who can adapt to the development of the new era and have better post competence.

The Impact of Simulation Education on Self-Efficacy in Pre-Registration Nursing Students

This literature review primarily aims to explore and synthesise the previous studies in simulation education research conducted over the past five years related to the effects of simulation training on the self-efficacy of undergraduate pre-registration nursing students. The second aim of this study is to explore additional outcome variables that were examined in the previous studies. Five electronic databases were searched systematically. These databases were MEDLINE, CINAHL Plus, Scopus, Embase and PsycINFO. The PICO model was employed to identify the search terms, with a thesaurus being used to provide synonyms. Reference lists of relevant articles were examined and hand searches of journals were also undertaken. The quality of each study was assessed using the Simulation Research Rubric (SRR). A total of 11 studies were included. All studies explored the impact of simulation education on undergraduate pre-registration nursing. Six studies explored nursing students’ competence and performance and two papers examined their critical thinking. Problem solving, learning motivation, communication skills and knowledge acquisition were examined once. The majority of studies indicated that simulation training has a positive impact on pre-registration nursing students’ self-efficacy and other outcome variables. Furthermore, the study results indicate that simulation training is more dependable than traditional training, and students were extremely satisfied with the simulation training. However, most of the studies included in this review had several gaps, including study design, sample size and dissimilarities between the scales used. Further research with large samples, reliable and valid instruments, and outcomes measures (such as critical thinking and transferability of skills) is required to provide better insight into the effectiveness of simulation in undergraduate nursing education. .

Evaluation of the Effect of Assessment Method Reform in “Nursing Research” Course

Objective:This paper aims to evaluate the implementation effect of the diversified course assessment method reform.Methods:A diversified assessment method was implemented for 196 undergraduate nursing students.Students’mastery of key knowledge in“Nursing Research”was assessed through group reports on topic selection and literature retrieval,as well as the proposition level of the final examination.Results:81.6%of the students agreed with the course assessment method,and 97.9%believed studying“Nursing Research”would be helpful for future scientific research applications.Conclusion:Diversified assessment methods can help improve undergraduate nursing students’scientific research skills and comprehensive quality.

Relationship between self-directed learning readiness, learning attitude, and self-efficacy of nursing undergraduates

Objective: The purposes of this study were to analyze the influencing factors of self-directed learning readiness(SDLR) of nursing undergraduates and explore the impacts of learning attitude and self-efficacy on nursing undergraduates.Methods: A total of 500 nursing undergraduates were investigated in Tianjin, with the Chinese version of SDLR scale, learning attitude questionnaire of nursing college students, academic self-efficacy scale, and the general information questionnaire.Result: The score of SDLR was 149.99±15.73. Multiple stepwise regressions indicated that academic self-efficacy, learning attitude, attitudes to major of nursing, and level of learning difficulties were major influential factors and explained 48.1% of the variance in SDLR of nursing interns.Conclusions: The score of SDLR of nursing undergraduates is not promising. It is imperative to correct students' learning attitude, improve self-efficacy, and adopt appropriate teaching model to improve SDLR.

Evaluating the confidence level of Traditional Chinese Medicine in nursing undergraduates at Chinese medical university

Objective:To observe the confidence level prevailing with regard to the practice of Traditional Chinese Medicine(TCM)among undergraduate nursing students who have undertaken TCM courses at Shanxi Medical University.Methods:This cross-sectional study was conducted at Shanxi University of Chinese Medicine.A questionnaire survey was administered through the Questionnaire Star website(https://www.questionstar.com/).The confidence level was examined from 6 aspects,namely cognition of TCM culture and theory,advantages and characteristics of TCM diagnosis and treatment,feelings about TCM achievements,personal behaviors related to TCM,attitudes toward Western medicine,and the future of TCM.The mean score of the observed items was calculated,and was found to be positively related to the confidence level concerning TCM(the score was between 1 and 5).Results:A total of 120 participants voluntarily enrolled themselves in the study.The results showed that the mean score of observed items were generally about 4.A relatively strong confidence was shown in understating TCM advantages and characteristics in diagnosis and treatment,and also in feelings toward TCM achievements.Conclusions:The majority of nursing undergraduates had confidence in TCM.However,some aspects such as the understanding of TCM culture and the correlation between TCM and Western medicine may need to be improved through education.

An investigation on compiling opinions on and suggestions for a biochemistry textbook from nursing undergraduates

Objective： To compile nursing undergraduates＇ opinions and suggestions for biochemistry textbook to improve the readability and applicability of a textbook of biochemistry. Methods： This investigation involved 279 nursing undergraduates through delivery of a self-made questionnaire, which was to be used to analyze and study the students＇ suggestions and opinions on the content of the biochemistry textbook. Results： The investigation revealed that the textbook＇s difficulty was associated negatively with stu- dents＇ interest （P 〈 0.05）, and the textbook＇s importance was associated positively with students＇ interest （P 〈 0.05）. Students suggested that the textbook should be closely related to nursing. The contents, difficulty, structure and charts of the textbook should be adjusted properly. Conclusions： The content of the nursing version of the biochemistry textbook should be driven by the needs of the nursing major and should focus on simplifying the textbook＇s content, and making it practical. This will make the textbook vivid and readable, enhancing the interest of students to accept and benefit from the textbook.

The construction and practice of humanistic care teaching model based on 5C care theory

Objective:To construct a scientific and feasible teaching mode based on 5C caring theory and evaluate it,so as to provide a reference basis for future study about nursing humanistic quality education.Methods:Based on the 5C caring theory,the teaching design and teaching content were revising and implementing in the intervention group.Before and after the implementation of the course,a questionnaire survey was conducted using the Caring Ability Inventory(CAI).The results of the surveys were collected,and the data were statistically analysis using SPSS.Results:After the implementation of the course,the cognitive dimension,patience dimension,and humanistic caring ability scores of the nursing students in the intervention group improved compared with those before the implementation of the course(P<0.05).There were no significant difference in the control group(P>0.05).Conclusion:The humanistic caring teaching model based on 5C caring theory has a positive effect on improving nursing students'humanistic caring ability.In the future nursing teaching,the modules with the characteristics of humanistic caring ability can be increased,and carry out the educational reform throughout the humanistic caring ability.Actively guiding nursing students to establish the awareness of humanistic caring,so as to lay a solid foundation for high-quality clinical nursing work.

Comparison of Clinical Thinking Ability in Nursing Students of Different Grades

Objective： This study investigated and compared the clinical thinking ability of undergraduate nursing students of different grades, and searched for influencing factors of clinical thinking ability of nursing undergraduate students. Methods： The convenience sampling method was used to select the Subject of the study. In total, 180 third-year, fourth-year, and fifth-year nursing undergraduate students were enrolled in this study. A self-designed scale of clinical thinking ability was used to collect the data. SPSS17.0 was used to analyze the data. Results： The average scores of clinical thinking ability of undergraduate nursing students were 68.14±9.13. In addition, 71.1% of the students have a higher level of clinical thinking ability, and only 7.2% of the students have the best level. The ANOVA test showed that the fourth-year students had the highest scores（72.96±8.64）, and the third-year students had the lowest scores（62.35±8.09）, which indicated a significant difference in the scores of the three groups（ F= 26. 79, P〈0.05）. Multiple linear regression analysis indicated that the frequency of academic activities and the frequency of department rounds were significantly correlated to clinical thinking ability（P〈0.05）. Conclusion： We must pay attention to the changes and influencing factors of clinical thinking ability of nursing undergraduate students. Thus, traditional teaching methods need to evolve and be revised to host the capacity of clinical practice most effectively and, eventually, promote the development of clinical thinking ability of nursing undergraduate students.

Feelings and Thoughts of Infected Nursing Undergraduates with COVID-19 in China: A Qualitative Study

Background: COVID-19 had become much less virulent but still infectious, and China had loosened controls on its prevention after three years of zero-COVID policy. Nursing students were faced with infection. However, the symptoms of the vast majority of them were not serious. Objectives: To understand the feelings and thoughts of nursing undergraduates first infected with COVID-19 after implementing the policy of loosening controls on COVID-19 prevention in China. Methods: A semi-structured in-depth interview was adopted to collect data from 19 nursing undergraduates in a nursing school in China in January 2023, which were then analyzed using the Colaizzi analysis method. Results: Two main themes and seven sub-themes were induced: feelings after the diagnosis of being infected (feeling calm by professional confidence, feeling afraid of the consequences of being infected, feeling depressed, feeling relieved/lucky/happy), and thoughts brought by COVID-19 infection (becoming more active in learning, committed to a nursing career, and feeling shaken about becoming a nurse). Conclusions: Schools and hospitals should pay attention to infected nursing students’ mental reactions and changes in study motivation and professional intention. Targeted measures, such as education for epidemic prevention and education for cultivating the professional spirit, should be taken to promote their mental health and reserve their talents for nursing.

Role of academic self-efficacy in the relationship between self-directed learning readiness and problem-solving ability among nursing students

Objective: Problem-solving should be a fundamental component of nursing education because It is a core ability for professional nurses. For more effective learning, nursing students must understand the relationship between self-directed learning readiness and problem-solving ability. The aim of this study was to investigate the relationships among self-directed learning readiness, problemsolving ability, and academic self-efficacy among undergraduate nursing students.Methods: From November to December 2016, research was conducted among 500 nursing undergraduate students in Tianjin, China,using a self-directed learning readiness scale, an academic self-efficacy scale, a questionnaire related to problem-solving, and selfdesigned demographics. The response rate was 85.8%.Results: For Chinese nursing students, self-directed learning readiness and academic self-efficacy reached a medium-to-high level,while problem-solving abilities were at a low level. There were significant positive correlations among the students' self-directed learning readiness, academic self-efficacy, and problem-solving ability. Furthermore, academic self-efficacy demonstrated a mediating effect on the relationship between the students' self-directed learning readiness and problem-solving ability.Conclusions: To enhance students' problem-solving ability, nursing educators should pay more attention to the positive impact of self-directed learning readiness and self-efficacy in nursing students' education.