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.

Active Learning Improves Nursing Student Clinical Performance in an Academic Institution in Macao

Objective： To assess the outcome of the application of active learning during practicum among nursing students using clinical assessment and evaluation scores as a measurement. Methods： Nursing students were instructed on the basics of active learning prior to the initiation of their clinical experience. The participants were divided into 5groups of nursing students （ n = 56） across three levels （years 2-4） in a public academic institute of a bachelor degree program in Macao. Final clinical evaluation was averaged and compared between groups with and without intervention. Results： These nursing students were given higher appraisals in verbal and written comments than previous students without interventian. The groups with the invention achieved higher clinical assessment and evaluation scores on average than comparable groups without the active learning intervention. One group of sophomore nursing students （year 2） did not receive as high of evaluations as the other groups, receiving an average score of above 80. Conclusions＂ Nursing students must engage in active learning to demonstrate that they are willing to gain knowledge of theory, nursing skills and communication skills during the clinical practicum.

Engagement in clinical learning environment among nursing students: Role of nurse educators

Student engagement in a clinical learning environment is a vital component in the curricula of pre-licensure nursing students, providing an opportunity to combine cognitive, psychomotor, and affective skills. This paper is significant in Arab world as there is a lack of knowledge, attitude and practice of student involvement in the new clinical learning environment. The purpose of this review article is to describe the experiences and perspectives of the nurse educator in facilitating pre-licensure nursing students’ engagement in the new clinical learning environment. The review suggests that novice students prefer actual engagement in clinical learning facilitated through diversity experiences, shared learning opportunities, student-faculty interaction and active learning. They expressed continuous supervision, ongoing feedback, interpersonal relationship and personal support from nurse educators useful in the clinical practice. However, the value of this review lies in a better understanding of what constitutes quality clinical learning environment from the students’ perspective of engagement in evidence-based nursing, reflective practice, e-learning and simulated case scenarios facilitated by the nurse educators. This review is valuable in planning and implementing innovative clinical and educational experiences for improving the quality of the clinical teaching-learning environment.

Practices of caring for nursing students: A clinical learning environment

Objective:The purpose of this study was to explore,describe and illuminate nursing students'best encounters of caring in the clinical learning environment.Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment.Methods:Qualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry(AI)methodology.Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council(SANC)were purposively sampled from 3 private hospitals within the Western Cape.Data was analysed using Giorgi's method.Results:The main theme included the best and'least best'caring practices embedded in the centrality of the heart.The subthemes comprised of the nursing students'experiences of caring literacy and caring illiteracy.The second theme included the creation of best caring practices within a conducive clinical learning environment.Within this theme,the subthemes comprised of the caring attributes required in reflecting best caring practices,as well the creation of a clinical learning environment to optimise caring.Conclusions:The significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants.Caring was equated to the heart as the core to the nursing students'being.Recommendations for nursing education,management,practice and research were therefore specifically formulated to enhance caring towards nursing students.

The Effect of Simulation-Based Training on Nursing Students’ Communication Skill, Self-Efficacy and Clinical Competence for Nursing Practice

Background: Simulation-based training is a new strategy in teaching that gives the students good opportunities to learn and apply what they learn in nursing care safely. Aim: This study conducted to evaluate the effects of simulation-based training on nursing students’ communication skill, self-efficacy and clinical competence in practice. Subjects and Methods: Quiz-experimental design was used in this study (pre-posttest intervention), it was carried out on 100 nursing students first semester in 2019 using low and high-fidelity simulators. This study was carried out at College of Applied Medical Sciences-Bshia University. Data Collection: demographic data, communication skill, self-efficacy and clinical competence questionnaires. Analysis is done by SPSS version 20 software. Results: Participants who received the simulation-based training, showed statistical significant improvement in communication skill, self-efficacy, and clinical competence scores after participation in the simulation program (t = −32.64, p = 0.001;t = −19.9, p = 0.001;16.4, p = 0.001). Also, there are significant relation between gender and clinical competency (t = 2.768, p Conclusion: Simulation-based training in medical courses is effective in enhancing communication skill, self-efficacy and clinical competence. Multiple-patient simulations as a teaching-learning strategy in the nursing curriculum are highly recommended.

Use of a National Clinical Final Examination in a Bachelor’s Programme in Nursing to Assess Clinical Competence—Students’, Lecturers’ and Nurses’ Perceptions

Objective: The objective of this study was to evaluate the perceptions of students, lecturers, nurses and clinical lecturers regarding the ability of the National Clinical Final Examination (NCFE) to assess clinical competence, and whether the assessment was consistent with the qualifications for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. The NCFE is divided into two parts (written and bedside) and aims to evaluate third-year nursing students’ clinical competence. Methods: Data were collected at 10 universities using study-specific questionnaires. The total response rate was 84% (n = 1652). Results: The clinical lecturers indicated that there was a need for improvement in the written part of the examination in order to adequately assess clinical competence. Regarding the bedside part the clinical lecturers, nurses and students perceived that the bedside part of the examination assessed whether the student had the clinical competence required by a newly registered nurse. Conclusion: The two-part examination described in this study was perceived as useful for assessing clinical competence and for the qualification requirements for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. However, especially the written part requires further development. The model and form of assessment ought to be applicable to graduate nursing programme internationally.

Nursing Students’Clinical Learning Environment in Norwegian Nursing Homes:Lack of Innovative Teaching and Learning Strategies

Background: Nursing students hesitate to choose aged care as a career, and the aged care sectors are on an edge regarding nursing positions. Clinical learning environments may influence nursing students’ career choices. Few studies have explored learning environments in nursing homes, although students increasingly have placements there. Objectives: The aim was to produce information for developing nursing students’ learning opportunities in nursing homes. Design: A cross-sectional survey design was used. Settings: The study was conducted at a university college in southeast Norway. Participants: Students in two cohorts of a bachelor degree program in nursing participated, N = 499. Methods: Data were collected on nursing students’ perceptions of clinical learning environments during placements in five nursing homes. A 42-item validated questionnaire with the subscales personalization, individualization, involvement, task orientation, innovation, and satisfaction was used. Data analysis used descriptive statistics, t-tests, and linear regression analysis. Results: Total scores showed overall satisfaction with clinical learning environments in nursing homes. However, innovation subscale scores were very low. First year students had significantly higher scores than third year students on the total scale, and most subscales. Age was significantly associated with total scale scores and subscale satisfaction scores. Higher education and work experience before entering nursing education were significantly associated with involvement subscale scores. Conclusions: Students are more positive than negative about their clinical learning environments. Low valuation of innovation seems to be a consistent finding in studies in both nursing homes and hospitals internationally. For innovative learning strategies to function they must be anchored at the organizational level. Future research should develop and test more innovative learning strategies for nursing students.

Clinical Supervision of Midwifery Students at the University Teaching Hospital School of Nursing and Midwifery in Lusaka, Zambia

Introduction: Clinical supervision plays a significant role in the acquisition of psychomotor skills by student midwives during training leading to the provision of high quality midwifery care. However, the acquisition of the psychomotor skills required for successful practice and learning can only be acquired if student midwives are supported and guided by clinical supervisors in their learning environments. Main Objective: The main objective of the study was to determine factors influencing clinical supervision of Student Midwives in Lusaka Urban District. Methodology: A cross-sectional study design that employed both quantitative and qualitative methods was used. The study population comprised 124 Nurses and Midwives working in Lusaka urban District. Self-administered questionnaires were used to collect data from the Nurses and midwives and a focus group discussion guide was used to guide discussions with the student midwives at Lusaka College of Nursing and Midwifery and a total of three focus group discussions were conducted. Quantitative data were entered into by Statistical Package Social Sciences (SPSS) version 22 for windows. Chi-square test was used to test associations among variables. The confidence interval was set at 95% with a significance level of 0.05. Qualitative data were analysed using content analysis to classify words into themes and categories by looking for repeated ideas or patterns of thoughts. Results: The findings showed that a high percentage of the clinical supervisors (89.5%) had not been trained in clinical supervision and most respondents had moderate knowledge on clinical supervision of students. Majority of the respondents (63%) exhibited inadequate supervision skills. The attitudes of all the supervisors towards supervision were positive. A large percentage of respondents (73%) were competent in clinical supervision. However the learning environment considered to be poor by most respondents (61%). The study revealed a significant association between clinical supervision and the respondents’ knowledge on clinical supervision (p-value of 0.00). Conclusion: The current study showed that clinical supervision was untrained and had inadequate supervision skills and the learning environment was poor. There is need therefore to train clinical supervisors and improve the students’ learning environment in order to enhance teaching and learning. The study offers a valuable insight into the factors influencing students’ midwives learning in clinical learning environment.

Comparing Basic Social Competencies among Nursing Students before and during the Pandemic

Background: Due to the COVID-19 pandemic, the practical curriculum in over 80% of Japanese nursing universities is shorted. The study aimed to clarify the change in basic social competencies among nursing students by comparing their scores before and during the pandemic. Method: Retrospective data from 235 responses from 3rd-grade nursing students were analyzed. The data were separated into two groups—158 respondents before-pandemic and 77 respondents during-pandemic. Respondents were asked to complete a measurement scale two months after the beginning of the 3rd-grade module. Results: Our results showed the during-pandemic group’s averages were higher than the before-pandemic group’s. During the pandemic, nursing students using home-based online learning could not self-evaluate accurately because they could not practice in the field. Conclusion: Nursing students who were studying during the during-pandemic self-assessed themselves higher than those who were studying during the before-pandemic because they could not compare with the other students, and the results showed that misunderstandings may arise.

Sources of Stress among Undergraduate Nursing Students during Clinical Practice: A Malawian Perspective

Purpose: The purpose of this study was to explore undergraduate nursing students’ perceptions of their clinical learning experience, and the reported findings emerged from narratives of their experience. Design: This was a hermeneutic phenomenological study which took place at a university nursing college in Malawi. Participants for the study were purposively selected from third- and fourth-year undergraduate nursing students and the data were collected through in-depth interviews. A framework developed by modifying Colaizzi’s procedural steps guided the phenomenological analysis. Findings: The study reveals factors which cause stress among undergraduate nursing students during their clinical practice. The following themes emerged from the study: lecturer/nurse interaction with students: stress associated with patient care and stress associated with objective structured clinical examination (OSCE). The lecturer is perceived to significantly induce stress, and this is common when the student perceives that the lecturer’s interaction is in a “policing” manner. The primary stressors associated with patient care include lack of life-saving medication which sometimes leads to death of a patient, taking care of critically ill patients unsupervised, and fear of contracting infections such as HIV and tuberculosis, and death of a patient. Factors associated with stress during OSCE include use of examiners whom students are not familiar with and the conduct of OSCE in the skills lab which has better resources than the clinical settings where students practice. Conclusions: The study reveals sources of stress during nursing students’ clinical practice and its effects on their learning and motivation. Consistent with existing literature, these findings confirm that nursing students experience considerable levels of stress during clinical practice. Recommendations: The study suggests that nursing education can be quite a stressful experience to the learners. It is therefore essential that nurse educators should address the various sources of stress which the study has revealed to enhance students’ clinical learning and provide the student nurses with the needed care.

The effectiveness of shared clinical teaching in nursing

Aim: Clinical learning is a critical component of a nursing curriculum.Student satisfaction in clinical environment is crucial to foster a positive learning experience.Faculty shortages have made clinical teaching more challenging;as such,alternate models of clinical teaching must be explored by nursing programs.The purpose of this study was to measure the perception of student satisfaction in regard tothe effectiveness of shared clinical teaching in nursing.Methods: Utilizing Chan's Clinical Learning Environment Inventory (CLEI),this quantitative comparative study examined nursing students' preferred and actual clinical learning environment.The CLEI contains 42 questions in six subscales: Individualization,Innovation,Involvement,Personalization,Task Orientation,and Satisfaction in both the actual and preferred clinical learning environment.The sample consisted of 202 nursing students in two groups: the first group had 91 students who experienced shared clinical teaching with two faculty,whereas the second group had 111 students who experienced the traditional,single faculty model.The results were analyzed using independent sample T-tests.Results: The preferred learning environment was rated highest in all six subscales.Scores of the Satisfaction subscale and the Innovation subscale for Actual Learning Environment,and the score of the Innovation subscale for Preferred Learning Environment of students experiencing shared clinical teaching with two faculty were higher than the scores of students experiencing traditional,single faculty model,with statistically significance (P< 0.05).Conclusion: The results indicated students preferred the shared clinical teaching model with two faculty over the single faculty model.Nursing programs can utilize this model and apply these results to develop and maintain quality clinical teaching.

Factors Influencing Nursing Students’ Empowerment: A Literature Review

Aim: The purpose of this literature review is to locate the available literature that addresses the factors influencing the nursing students’ empowerment. Background: Nursing students’ empowerment is an essential element to enhance the learning process. Nursing students’ learning experiences in the classroom and in the clinical placement play vital role in their empowerment. Data Source: A review of relevant literature using the following databases: CINAHL, ERIC & EBSCO. Methods: A literature review of, peer-reviewed research, Master/PhD dissertations full text and published on the listed databases between (2003-2019) was done. Results: A final review of 16 studies was included, quantitative and qualitative studies that discussed the factors that may affect nursing students’ empowerment were included in this review. Conclusion: Viewed articles revealed that nursing students’ empowerment may be affected by many factors. According to previous literature and according to the authors’ perspective, the retrieved articles categorized as followings: intrapersonal empowerment, learner orientation to learning, teaching-learning experiences, and the learning environment that influencing the learners’ empowerment.

Exploring factors that motivate nursing students to engage in skills practice in a laboratory setting:A descriptive qualitative design

Objectives:The aim of this study was to explore factors that motivate students to engage in skills practice in a laboratory setting,and to identify their motivation types and the regulatory styles.Methods:Semi-structured interviews were conducted with 23 nursing students from three universities between November 2017 and January 2018.A thematic analysis was used to identify factors associated with students’motivation to engage in skills practice in a laboratory.The types and the regulatory styles of student motivation were identified based on the self-determination theory.Results:Seven motivating factors were identified.These factors included the students’desire“to acquire the skills necessary to work as a nurse”,the“desire to improve skills in preparation for clinical practicum”,and their felt“obligations to patients as a nurse”.Moreover,“the impetus to study arising from the objective evaluation of oneself and others”and“wanting to pass the skills examination”motivated the students to engage in skills practice.A“learning environment that facilitates students’learning”and the“supportive involvement of educators”facilitated their learning.Based on the self-determination theory,the students were found to embrace extrinsic motivation with four regulatory styles of motivation,namely integrated,identified,introjected,and external regulation.Conclusions:Nurse educators should understand the motivating factors of students,and help students embrace a more internally controlled motivation by helping them envision their future careers as nurses,and by fostering their ethical duty to care for patients.

基于BOPPPS模型的5G+智慧课堂在临床护理教学中的应用

目的 探讨基于BOPPPS模型的5G+智慧课堂在胸外科护理临床教学中的应用效果。方法 将胸外科实习的90名本科护生按照实习时间分为对照组43名,试验组47名。对照组采用传统教学方法;试验组采用基于BOPPPS模型的5G+线上、线下、临床实践三位一体智慧课堂教学模式。比较两组护生实习成绩、自主学习能力和对教学模式的满意度。结果 试验组护生实习成绩、自主学习能力得分显著高于对照组(均P<0.05);两组教学满意度比较,差异无统计学意义(P,>0.05)。结论 基于BOPPPS模型的5G+智慧课堂教学模式的应用可提高护生实习成绩及自主学习能力,提升临床教学效果。

“双元育人”模式下护生自主学习能力在职业认同感与岗位胜任力间的中介作用

目的:分析自主学习能力、职业认同和岗位胜任力之间的关系,探讨“双元育人”模式下护生自主学习能力在职业认同感与岗位胜任力之间的中介作用。方法:采用便利抽样方法选取全国11个省份17所高职院校护理专业采用“双元育人”模式的护生1111名作为研究对象,采用一般资料问卷、职业认同感问卷、护理学生自主学习能力量表及临床护士胜任力自评问卷进行调查,应用分层多元回归分析职业认同和自主学习能力对临床护士岗位胜任力的影响,采用Bootstrap法检验自主学习能力在职业认同感与岗位胜任力之间的中介作用。结果:“双元育人”模式下护生岗位胜任力与职业认同感和自主学习能力均呈明显正相关关系(r=0.433、0.619,P<0.01)。多元回归分析显示,职业认同或自主学习能力对岗位胜任力有积极影响(P<0.01)。自主学习能力在职业认同与岗位胜任力的关系中起中介作用,通过自主学习能力创造职业认同的间接效应占总效应的68.4%。结论:自主学习能力在一定程度上调节了职业认同与岗位胜任力的关系,应重视学生的职业认同和自主学习能力,以提高护生的岗位胜任力。

护理临床思维练习系统结合复盘教学在新护士岗前培训中的应用

目的 探索护理临床思维交互体验练习系统结合复盘教学在新护士岗前培训中的应用效果。方法2022年8-10月,采用便利抽样法选取某三级甲等医院2022年度招聘的52名新护士作为研究对象,根据随机数字表法将其分为对照组(n=26)和观察组(n=26)。对照组新护士接受传统岗前培训方式(理论授课+模拟人操作技能培训),观察组则在此基础上应用护理临床思维练习系统(vSim),并在每次练习后进行复盘。2个月的岗前培训结束后,比较两组护士的案例操作考核成绩及临床思维能力评估量表得分情况。结果 岗前培训结束时,两组新护士的案例操作考核成绩及临床思维能力总分均高于干预前(P<0.05),且观察组护士的考核成绩及能力总分均高于对照组,两组比较差异有统计学意义(P<0.05)。结论 在新护士岗前培训中应用护理临床思维练习系统结合复盘教学的模式,能有效提高新护士临床操作技能及思维能力,可帮助护士更快适应角色转变,有助于提升新护士培训效果、促进临床护理质量提升。

微视频反例教学法结合微格教学法对实习护士临床思维及核心能力的影响

目的探讨微视频反例教学法结合微格教学法对实习护士临床思维及核心能力的影响。方法选择2021年1月至12月的20名科室实习护士为对照组(常规护理带教模式),另选取2022年1月至12月的20名科室实习护士为观察组(微视频反例教学法结合微格教学法)。比较两组的出科成绩、临床思维能力、核心能力及教学满意度。结果观察组的理论成绩、技能操作成绩、案例分析成绩高于对照组,差异具有统计学意义(P<0.05)。观察组的中文版批判性思维能力测量表(CTDI-CV)各维度评分明显高于对照组,差异具有统计学意义(P<0.05)。观察组的职业态度、治疗沟通和关系、一般表现、具体的临床表现评分明显高于对照组,差异具有统计学意义(P<0.05)。观察组的教学满意度明显高于对照组,差异具有统计学意义(P<0.05)。结论微视频反例教学法结合微格教学法可提升实习护士的综合素质与临床思维,也能提高核心能力与教学满意度,值得推广应用。

基于自我导向学习能力的实习手账在专升本护生临床带教中的应用

目的探讨基于自我导向学习能力的实习手账应用于专升本护生临床带教的效果。方法选择2021-2022学年滨州市中心医院专升本护生92人作为研究对象,按随机数字表法分为对照组(46人)和实验组(46人),对照组常规方法带教,实验组在常规带教的基础上应用实习手账带教,在护生实习前、实习8个月后,比较两组自我导向学习能力、时间管理能力及实习满意度。结果自我导向学习能力测评比较,实验组学习意识、学习行为、学习策略、人际关系技能评分均显著高于对照组(P<0.05)。实验组在时间监控观及效能感评分显著高于对照组(P<0.05)。两组护生满意度评价显示,实验组在课堂教学、临床教学、实习计划、支持与资源方面评分均显著高于对照组(P<0.05)。结论基于自我导向学习能力的手账应用能有效提高专升本护生自主学习能力、时间监控能力及带教满意度。

基于性格分析DISC理论的临床带教模式对护生核心能力的影响

目的:探讨基于性格分析DISC理论的临床带教模式对护生核心能力的影响。方法:选取2022年1月-12月在江苏省某三级甲等医院全科医学科的96名实习护生为研究对象,根据实习先后顺序分为试验组48人和对照组48人。在临床带教过程中,对照组实施传统带教方法,试验组实施基于性格分析DISC理论的临床带教模式,比较两组的核心能力、理论成绩、护理技能操作成绩、带教管理质量及带教满意度。结果:干预结束后,试验组核心能力、理论成绩、护理技能操作成绩、带教管理质量总分均高于对照组(P<0.05)。结论:将性格分析DISC理论应用于临床实习带教中,有利于培养护生的核心能力和提高其理论成绩、护理技能操作成绩及带教管理质量。

5E学习环教学模式对提升实习护生核心素养的实践研究

目的探究5E学习环教学模式在提升实习护生核心素养中的应用效果。方法选取2021年9月至2022年7月在昆明市某三甲医院泌尿外科实习的92名护生作为研究对象,随机分为试验组和对照组,各46名。试验组采用5E学习环教学模式,对照组采用传统临床实习带教法,比较两组理论考核成绩、护理操作技能、学习满意度及核心素养。结果试验组理论考核成绩、护理操作技能、学习满意度及核心素养均高于对照组,差异有统计学意义。结论5E学习环教学模式有助于提高实习护生的理论水平和操作技能,培养核心素养,值得在临床推广。