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.

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.

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.

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.

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.

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.

Graduating Nurses in the Time of COVID-19

Nursing has been a leader in online education for more than two decades. Nursing students have taken advantage of the flexible scheduling and variety of online nursing programs to pursue their education due to distance, family, or work demands;however, since the outbreak of COVID-19, nursing schools in the United States have adapted by implementing an online alternative to assess students’ clinical skills required to graduate. Nursing faculty have been forced into this new learning culture, navigating the online landscape, learning new technologies and teaching methods, and adapting to clinical social distance education. Nursing is a performance-based profession in which the clinical learning environment plays an important role in developing skills and professional abilities. The purpose of this evidence-based teaching project is to, based on National League for Nursing (NLN), not only contribute to improvement but ensure educational quality for undergraduate nursing students by examining how online simulation compared to clinical experience with an actual patient, affects nurses’ clinical competence. Therefore, after reviewing 14 peer-reviewed articles, evidence shows benefits for undergraduate nursing students to retain better clinical competence when virtual simulation and clinical sites are combined;however, further research is recommended. Articles were selected as the evidence base for this project, following specific inclusion criteria. Inclusion criteria for evidence were articles within six years, including undergraduate nurse students with online clinical education;the exclusion criteria were studies including graduate nurse students and articles older than six years. Based on the project’s outcome, it is suggested that a nurse residency should follow online simulations to complete clinical hours. .

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.

Electroconvulsive Therapy in the Eyes of Undergraduate Nursing Students

Despite the fact that electroconvulsive therapy (ECT) is an established safe and effective procedure, its use has continued to attract controversy with considerable stigma associated with it. This often overshadows the established effectiveness. Poor knowledge, negative attitude and bias towards ECT by the nurses may translate to poor education and support to patients from whom they are expected to obtain informed consent before an ECT procedure. This study assessed the perception of undergraduate nursing students of a Nigerian university about ECT. A total of 81 students who had completed all relevant lectures and practical/clinical exposures in psychiatry as prescribed in their academic curricular participated in the study. All the consenting students were administered the socio-demographic questionnaire and modified questionnaire on attitude and knowledge of electroconvulsive therapy (QuAKE). Majority of the students responded appropriately to the principal uses of ECT. Few believed that ECT was an out-moded form of treatment, that the procedure was cruel and barbaric, that psychiatrists who still administered ECT were wicked and not responsible physicians, and that it caused permanent brain damage. The total mean score of the students was 7.53 ± 2.65. Fifty eight (71.6%) students observed an ECT procedure and followed up the patients during the posting. They scored 7.17 ± 2.55 while 23 (28.4%) students who had not observed the procedure scored 6.98 ± 1.92 on the QuAKE (t =?-0.36, p = 0.72). Thirty one (38.3%) students who would accept the procedure if indicated scored 7.14 ± 2.21 while 50 (61.7%) of them who would not allow ECT carried out on them scored 6.88 ± 1.96 (t = 0.56, p = 0.58). The mean score of 29 (35.8%) students who might pursue psychiatry as a career was 8.10 ± 1.90 while 52 (64.2%) of them who would not specialise in psychiatry scored 6.05 ± 1.79 (t = 5.00, p < 0.001). The total mean score on the QuAKE was low among the student nurses. Therefore, there is a need to improve undergraduate nursing education on ECT.

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.

Relationship between clinical belonging,professional identity,and nursing information ability among nursing interns:Model construction

BACKGROUND Clinical belonging refers to the feeling that clinical medical staff feel recognized and accepted by others or groups.The level of clinical belonging of nursing interns affects students’learning motivation and confidence,which in turn affects their clinical practice behavior.AIM To explore the effects of professional identity and nursing information ability on clinical belonging among nursing interns and establish a relationship model for these factors.METHODS The researchers used the convenience sampling method to select 682 nursing interns from China.The survey was conducted using a general information questionnaire,clinical sense of belonging scale,nursing information ability self-assessment scale,and a nursing student professional identity questionnaire.The mediating effect of nursing information ability between their professional identity and clinical sense of belonging was analyzed using SPSS 21.0 and the path analysis in structural equation modeling.RESULTS The total scores of clinical belonging,professional identity,and nursing information ability of nursing interns were(104.29±13.11)points,(57.89±7.16)points,and(70.29±6.20)points,respectively.Nursing information ability had a direct effect on the clinical sense of belonging(effect value=0.46,P<0.05).Occupational identity had a direct effect(effect value=0.52,P<0.05)and an indirect effect(effect value=0.21,P<0.05)on clinical belonging.CONCLUSION Nursing administrators in nursing colleges and hospitals should take effective measures to improve the professional identity and nursing information ability of nursing interns,as well as the clinical sense of belonging among nursing interns.

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. .

Impact of self-directed learning readiness and learning attitude on problem-solving ability among Chinese undergraduate nursing students

Objective: To explore the effects of self-directed learning readiness and learning attitude on problem-solving ability among Chinese undergraduate nursing students. Methods: A convenience sampling of 460 undergraduate nursing students was surveyed in Tianjin, China. Students who participated in the study completed a questionnaire that included social demographic questionnaire, Self-directed Learning Readiness Scale, Attitude to Learning Scale, and Social Problem-Solving Inventory. Pearson’s correlation analysis was performed to test the correlations among problem-solving ability, self-directed learning readiness, and learning attitude. Hierarchical linear regression analyses were performed to explore the mediating role of learning attitude. Results: The results showed that learning attitude (r=0.338, P<0.01) and self-directed learning readiness (r=0.493, P<0.01) were positively correlated with problem-solving ability. Learning attitude played a partial intermediary role between self-directed learning readiness and problem-solving ability (F=74.227, P<0.01). Conclusions: It is concluded that nursing educators should pay attention on students’ individual differences and take proper actions to inspire students’ self-directed learning readiness and learning attitude.

The Teaching of Sign Language in Undergraduate Nursing Courses: A Descriptive Study as an Attribute to the Integrality of Care

Background: Current and future generations of nurses must be prepared to communicate and properly care for deaf patients. The objective of this study is to describe how Brazilian Sign Language is taught in undergraduate Nursing courses. Method: This was a descriptive study with a qualitative approach, performed with fifteen professors from four universities, two public and two private and in the metropolitan region of Rio de Janeiro, through individual interviews with an analysis procedure guided by Content Analysis. Results: The teaching is restricted to the adoption of planned and established approaches to sign language and procedures to assess theoretical contents and practical domains sign language teaching exclusively in elective course often offered through the online platform. Conclusion: We conclude that professors are not prepared for the teaching of sign language and that curricula need to be appropriate to the demand of full and indistinct assistance to the population’s needs.

Analysis of licensure examination anxiety and its influencing factors among undergraduate nursing students

Background:Examination anxiety is a concern for educational policymakers because of the impact it can have on the overall outcome of the performance of the candidates who partake in such examinations.Aim:The aim of this study is to determine the examination anxiety level of students of Nursing and Midwifery College,Agogo,and Presbyterian University College and to evaluate the factors affecting them.Materials and Methods:A total of 160 undergraduate nursing students comprising 80 degree and 80 diploma students were conveniently sampled for the study.The study was conducted in September 2019 using a descriptive cross-sectional design.The Westside Test Anxiety Scale was used to measure examination anxiety among the participants.A researcher-designed questionnaire in which participants responded to a three-point Likert scale was used to assess factors influencing examination anxiety.Results:The findings of the study showed that test anxiety was higher among the diploma candidates(M=3.60)than the degree candidates(M=2.95)and the difference was statistically significant(P=0.024).Demographic characteristics such as age(P=0.009),sex(P=0.003),study hours per day(P=0.001)were found to be significantly associated with test anxiety.The factors found to influence examination anxiety among students were volume of materials to study(P=0.044),level of preparation(P=0.005)perceived difficulty of the questions(P=0.033)and myth about examinations(P=0.000).The perceived importance of the examination(P=0.057)and schedule of the exams(P=0.68)did not influence examination anxiety.Conclusion:Candidates for the licensure examination organized by the Nursing and Midwifery Council of Ghana should be assessed for test anxiety and offered the necessary psychological support where necessary.

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.

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.

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.

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.