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.

Problems and Instruction Needed in Relation to Nursing Students’ Handling of Patient Information—From a Survey of Nurses Coordinating Clinical Practicums in Japan

The purpose of this study was to clarify and consider the instruction that is needed in relation to nursing students’ handling of patient information, as felt by the people in charge of student clinical practicums in hospitals. Semi-structured interviews were conducted with 7 people in charge of organizing practicums at hospitals where they are carried out. These subjects were asked about problems they had experienced in relation to nursing students’ handling of patient information and the instruction that is needed so that problems related to nursing students’ handling of information do not occur. Various problems were shown to occur in relation to nursing students’ handling of patient information, such as handling the information outside of the practicum setting. Many students receive no instruction with regard to the ethics of handling patient information in their classroom work, and their awareness regarding information is cannot be considered high, indicating the need for more consistent and reliable education in this area. The findings also suggest that instruction is needed with regard to the handling of sensitive information in accordance with the circumstances of individual patients.

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.

Clinical Supervision and Non-Technical Professional Development Skills in the Context of Patient Safety—The Views of Nurse Specialist Students

The aim of the study was to evaluate nurse specialist students’ views of clinical supervision (CS) and its influence on their professional competence development. An additional aim was to interpret the results and link them to non-technical skills and Patient Safety (PS) topics. The research question was: What are the benefits of clinical supervision focusing on non-technical skills in the area of PS? A cross-sectional study of 46 nurse specialist students was conducted by means of questionnaires and exploratory factor analysis. Factors that influenced the nurse specialist students’ competencies were: interpersonal, professional and communication skills in addition to awareness of ethical skills, the importance of teamwork and the benefit of involving patients and their family members in safe care. The results were linked to non-technical skills and PS competencies. Clinical supervision is crucial for the development of non-technical skills and PS competencies among nurse specialist students. However, finding time to reflect and learn from the supervision was reported to be a problem. Over half of the students stated they did not have enough time for supervision. Thus, there is a potential for quality improvement. We recommend that universities should provide formal educational programmes for supervisors focusing on the professional development of students, especially in the area of non-technical skills. In conclusion, CS should be prioritised by management and clinical leaders as it enhances PS.

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.

Evaluation Nursing Students’ Views of Improved Competence Development after Clinical Supervision: An Educative Approach to the WHO Patient Safety Model

Bachelor of Science Nursing (BSN) students’ education comprises both theories and practical aspects. Access to resources is required for the development of a professional identity, which includes gaining technical knowledge and receiving feedback, guidance as well as social and emotional support from clinical supervisors. The aim of this study was to evaluate BSN students’ views of professional development after clinical supervision (CS) during their undergraduate education. An additional aim was to illuminate how competence development was related to the WHO Patient Safety Educational Model. A cross-sectional study was conducted, in which CS was measured as part of a survey completed by a sample of nursing students after their clinical placement at two time-points, namely 2012 and 2013. Statistical descriptive and inferential analyses were used and differences in the responses between Time 1 and Time 2 compared. The benefit of CS for nursing students’ competence development revealed a positive significant relationship between students’ Interpersonal skills and the factor Improved care/skills. There were differences in terms of variables related to the Importance value of CS and Professional skills. The results can be used to inform undergraduate nursing education leaders, teachers and practice partners on individual, group and organisational level in order to enhance patient safety and highlight the importance of CS for BSN students’ professional development.

Stress and coping styles among nursing students during the initial period of the clinical practicum:A cross-section study

Objectives:This study aimed to explore the level of stress,types of stressors,type of coping styles,and factors influencing stress levels and coping styles among nursing students during the initial period of the clinical practicum.Methods:A cross-sectional survey design was used.In September 2017,participants were recruited from a tertiary hospital in Zhejiang Province,China,using a convenience sampling method.A demographic characteristics questionnaire,the Intern Nursing Student Stressor Scale,and the Simple Coping Style Questionnaire were used to collect data.Data were analyzed using descriptive analysis,independent sample t-tests,one-way analysis of variance,Pearson’s correlation analysis,and multiple linear regres-sion analysis.Results:A total of 158 nursing students were recruited,most of whom were female,undergraduates,and from rural areas.The nursing students perceived a moderate level of stress during the initial period of the clinical practicum.The need for knowledge and skills was the most common source of stress.Positive coping styles were most commonly adopted.Nursing students who were undergraduates,only children,and chose nursing major involuntarily experienced higher stress levels than those who were junior college students,not only children,and chose nursing major voluntarily.Nursing undergraduates were more likely to use positive coping styles than junior college students.Male nursing students and those experiencing higher stress levels related to the“environment and equipment of the wards”and the“nature and content of the work”were more likely to use negative coping styles.Conclusion:Nursing educators should offer targeted guidance based on the stress reported during the clinical practicum and the demographic characteristics of the nursing students.Guidance should be provided to encourage nursing students to adopt effective coping strategies and reduce stress.

Students’ perception of effective clinical teaching and teacher behaviour

Learning in the clinical environment is an integral part of nursing education programme. In tertiarybased nursing courses, students spend time learning in the clinical setting as they do in their classroombased studies. The purpose of this study was to explore teaching skills considered by undergraduate student nurses as effective in the clinical setting as well as qualities that make a clinical teacher effective. A descriptive design was employed using questionnaires to collect data. Respondents comprised year four undergraduate student nurses admitted through direct entry (DE) and university matriculation examination (UME) results. Using validated structured questionnaire, data were collected from 101 students who had completed their six months consolidated clinical experience on their perception of teaching skills and teacher qualities considered effective in the clinical setting. Data were analyzed using both descriptive and inferential statistics. Specifically, frequencies, percentage and standard deviation were used for descriptive analysis of scores while chi square and Mann-Whitney tests were used to test the mean differences in the teaching skills and to test whether there was a significant difference in their perception of teacher behaviours respectively at 0.05 level of significance. The result showed that having both clinical (professional) and teaching knowledge were the most important teaching skills for effective clinical teaching. Five qualities ranked by students as teacher behaviours important for effective teaching include being honest with students, motivation to teach, willingness to listen and using good communication skills, supervising students effectively and being positive role model. These factors could be considered when recruiting future clinical teachers and when planning inservice education programmes for clinical teachers to promote student learning.

Clinical competency:perceptions of nursing interns and clinical mentors

Objective:To assess the clinical competency of nursing interns and the perception of clinical nurse mentors toward student nurses'clinical competency.Methods:A study was carried out among 104 nursing interns and 26 clinical nurse mentors using the purposive sampling technique.A self-repor ted perception scale was used to collect the data.Results:In general,most nursing interns perceived themselves as clinically competent during the internship.The clinical nurse mentors too repor ted that the current internship is helping the nursing interns in becoming competent.Conclusions:Frequent clinical evaluation,buddy system,provision of stipends,good leadership,and coordination between the academic institute and hospital are repor ted as the critical motivating factors for improving the clinical competency of student interns.

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.

Nursing students’experiences of horizontal violence and occupational belonging during clinical placements

Background:Horizontal violence has negatively affected the students’active learning,interpersonal relationship,and occupational belonging.However,little attention has been paid to the relationship between horizontal violence and occupational belonging among nursing students.Objective:The objective of this study was to explore the frequency,types,perpetrators,effects,and responses of horizontal violence experienced by nursing students and the relationship between occupational belonging and horizontal violence.Materials and Methods:The present study used a descriptive,cross-sectional survey design.The data were collected from the 277 undergraduate nursing students selected by convenience sampling method using personal characteristics form,horizontal violence survey,and occupational belonging subscale at nursing faculty in Istanbul.Results:The first three horizontal violence behaviors experienced by nursing students were found,respectively:being forced to do trivial and unimportant work which are not the students’responsibility(84.1%),being exposed to sarcastic remarks by nurses(80.9%)and unwillingness of the nurse to help and lack of support(80.9%)and being ignored by nurses(77.3%).Nearly half of the students(48.4%)considered leaving nursing profession as a result of horizontal violence.There was a negative relation between horizontal violence and occupational belonging(P<0.05).As horizontal violence scores increased,occupational belonging scores decreased.Conclusions:Findings from this study shown that horizontal violence decreasing occupational belonging,and so nursing students consider leaving nursing profession or education.Further studies are needed to better demonstrate addressing the horizontal violence bilaterally and the effective preventive interventions.

Investigation on Psychological Health and Resilience of Clinical Nursing Students in “Post-Pandemic Era”

The study aims to learn about the psychological health and counseling situation of nursing students in the post-pandemic era through investigation on the psychological health, resilience and counseling demand of nursing students by randomly selecting clinical nursing students interned in a Grade III Level A hospital in Guangzhou from June 2020 to January 2021 as the objects of study. The internship can be divided into three stages: initial (1st - 3rd month), middle (4th - 7th month) and final (8th - 12th month). The investigator educated the nursing students about psychological health in the initial stage to improve their adaptability to clinical practice. Then they were given questionnaires including Symptom Checklist 90 (SCL-90), Connor-Davidson Resilience Scale (CD-RISC) and general questionnaires. And this study further completed difference analysis on psychological health and resilience in gender, educational background, internship stages and non-only/only children. It turned out that all factors scored above the national norm except anxiety in nine symptom clusters and three dimensions of CD-RISC. As for the scores of four factors of somatization, interpersonal relationship, hostility and bigotry and three dimensions of tenacity, optimism and strength in the CD-RISC, the difference was considered to indicate statistical significance (P < 0.001). Among factors affecting the psychological health of clinical nursing students, score differences involving somatization and compulsion (P < 0.001, P < 0.05) under different educational backgrounds showed statistically significant. With regard to different clinical stages, there were significant differences in somatization, compulsion, tenacity and strength (P < 0.001, P < 0.05). Finally, the conclusion is drawn that, during the period of pandemic prevention and control, the overall psychological status of clinical nursing students was good, but there remain part of cases with mild psychological problems that cannot be ignored. In the post-pandemic era, it is necessary to strengthen the awareness of teaching groups of clinical hospitals to psychological counseling for nursing students.

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.

The Impact of Internships on the Skill Acquisition Among Nursing Students in Vocational Colleges of Shandong Province

This research investigates the impact of internships on skill acquisition among nursing students in vocational colleges in Shandong Province.By employing a mixed-methods approach involving surveys and interviews,the study re-veals the positive influence of internships on students’clinical competencies,professional qualities,and readiness for the workforce.Survey findings indicate heightened practical capabilities and increased confidence among students.Interviews emphasize the pivotal role of mentors in guiding skills development and professional growth.However,challenges such as resource constraints and workload imbalances during internships are also highlighted.These insights contribute to the en-hancement of nursing education and the preparation of competent nursing professionals in the region.

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.

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.

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.

Constructing the Training Curriculum of Standardized Patients for OSCE Examination for Undergraduate Nursing Students in Shanxi Medical University

Objective: The objective of this study is to construct the simulated patient training curriculum for OSCE examination for undergraduate nursing students and to explore the theoretical and practical foundation. Methods: To establish TSP training curriculum and SSP training curriculum, 30 experts were invited to finish the questionnaires which were proved by Delphi Method. Findings: We established the training curriculum of TSP and SSP, and set the weight of various curricula and teaching contents. Conclusions: The experts considered that the degree and importance of these two training curricula were comparable. This conclusion lays the foundation for applying these curricula to teaching practice and clinical practice, and enhancing the teaching outcome of undergraduate nursing students. Implications: This study provided a new way of assessing the clinic ability of nursing students.

Exploring internship nursing students’ perception of gerontological nursing competencies: A descriptive study at Cairo University Hospitals

Objective:This research study explores the perceptions of gerontological nursing competencies,attitudes toward older individuals,and the willingness to provide care for the elderly among internship nursing students.Materials and Methods:A convenience sample of 350 internship nursing students from Cairo University Faculty of Nursing participated in the study.Data were collected using a set of comprehensive tools,including personal data and work experience assessment,the Hartford geriatric nurse competency tool,Kogan’s attitudes toward old people scale,and the modified elderly patient care inventory.Results:Descriptive analysis revealed balanced gender representation,with 60%identifying as female.Seventy percent of participants reported prior experience in gerontological care.Self-assessed competency scores indicated moderate proficiency in communication,physiological changes,and functional status assessment.Areas such as pain management and restraint use demonstrated potential gaps in self-perceived skills.Attitudes toward older individuals were predominantly positive,and the willingness to provide care showed positive tendencies,with a minor degree of hesitation noted.Conclusion:The findings underscore the need for targeted interventions in nursing education to address competency gaps,enhance positive attitudes,and alleviate potential hesitations in caregiving for older individuals.As the elderly population continues to grow,nursing education programs must prepare future practitioners to deliver comprehensive and compassionate care tailored to the unique needs of older adults.