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.

Study on the Construction and Evaluation System of Clinical Midwifery Teaching Faculty under the New Nursing Model

Objective:To explore the impact of the construction of a clinical midwifery teaching faculty and the development of an evaluation system under the new nursing model on the current teaching quality.Methods:From July 2022 to March 2023,10 clinical teaching teachers and 20 midwifery interns from Beijing Anzhen Hospital affiliated with Capital Medical University were selected as the subjects of this study.The clinical teaching teachers and midwifery interns were divided into an observation group and a control group,with each group including 5 clinical teaching teachers and 10 midwifery interns.The observation group received daily management and evaluation under the new nursing model,while the control group received management and evaluation under the traditional nursing model.The teaching quality evaluation of clinical midwifery teaching teachers by midwifery interns,the exit exam scores of midwifery interns,and the scores of clinical teaching teachers’internship lectures and teaching rounds were compared between the two groups.Results:In the observation group,the scores for teaching attitude,teaching skills,and teaching management in the teaching quality evaluation of clinical midwifery teaching teachers were higher than those in the control group.The professional theory scores(91.28±3.64)and overall nursing comprehensive scores(92.56±4.38)of midwifery interns in the observation group were higher than those of midwifery interns in the control group(81.58±2.27 and 80.29±3.33,respectively).The scores for internship lectures(89.32±4.15)and teaching rounds(90.64±5.52)in the observation group were also significantly higher than those in the control group(80.46±3.28 and 81.24±4.38,respectively),and the differences were statistically significant(P<0.05).Conclusion:The management of the clinical midwifery teaching faculty under the new nursing model effectively improved the quality of clinical teaching.It significantly enhanced the teaching effectiveness of clinical teaching teachers and the proficiency of midwifery interns in clinical operations,making it worthy of promotion and use.

Application of Seminar Teaching Method Combined with Case-Based Learning and Problem-Based Learning Teaching Models in Oral Clinical Nursing Teaching

Purpose:To analyze the role of the seminar teaching method+case-based learning(CBL)teaching method+problem-based learning(PBL)teaching method in oral clinical nursing teaching.Methods:13 undergraduate nursing students who entered the department from September 2020 to September 2021 were selected as the control group,adopting conventional nursing teaching methods;13 undergraduate nursing students who entered the department from September 2021 to August 2022 were selected as the observation group,adopting the seminar+CBL+PBL teaching method.The teaching effects were compared between the two groups.Results:All assessment scores of the observation group were higher than those of the control group;all teaching satisfaction levels were higher than those of the control group(P<0.05).Conclusion:Adopting the seminar+CBL+PBL teaching method during oral clinical nursing teaching can improve nursing students’assessment scores,strengthen their core competencies,and enhance teaching satisfaction.

A review of clinical reasoning in nursing education:based on high-fidelity simulation teaching method

Objective： Clinical reasoning is an essential feature of health care practice; it is also a crucial ability for providing patient care of high quality. It has been identified that graduate nurses may lack the clinical reasoning skills to deliver safe and effective patient cam. It is therefore of paramount importance to enhance nursing students＇ clinical reasoning ability. High-fidelity simulation （HFS） is proved to be an effective teaching and learning method, which may also have some advantages over other teaching methods. Methods： The authors retrospectively reviewed the related literature, illustrated the application of high-fidelity simulation teaching method in nursing education, putting the focus on the use of it in teaching with clinical reasoning. Results： The application of high-fidelity simulation to nursing education can simulate the clinical situation, thus to create a safe, continuous and efficient learning environment for students, and it can effectively improve students＇ clinical reasoning ability. Conclusions： high-fidelity simulation is effective for clinical reasoning teaching in nursing education. The extension of its application in China should be of great value. The relevant further study is suggested focusing on how to overcome its own limitations and have it better applied in nursing education in China.

A proposed model for best practice in nursing clinical teaching in China

Objective To explore a corresponding model that would bridge the gap between the practice of clinical teaching of nursing students in clinical settings in China and the clinical instructors' standard teaching of nursing students in clinical settings in the Philippines. Methods A phenomenological-qualitative,non-experimental type of research was utilized to recruit 27 staff nurses/clinical teachers in China. Data was collected by using audio-tapes and taking notes in the interviews. Results A content analysis was conducted and the sorted into four themes:(1) The things that they were able to teach their students;(2) The things that they were not able to teach their students;(3) The difficulties encountered in doing Clinical Teaching for their students;(4) Suggestions to improve Clinical Teaching. Conclusion According to the findings,the "CP's Proposed Nursing Clinical Teaching Model"should be introduced into the clinical set-up for staff nurses/clinical teachers handling nursing students in China.

Observation on the Application of“Online+Offline”Mixed Teaching Mode in Clinical Nursing Teaching

Objective:To observe the application effect of“online+offline”mixed teaching mode in clinical nursing teaching.Methods:A total of 72 clinical nursing workers,who work in PLA General Hospital and participated in the experiment from March 2019 to March 2021,were selected as the subjects of this study.According to the odd numbers assigned to the participants’names,the participants were divided into two groups:the experimental group and the control group,with 36 cases in each group.The experimental group received“online+offline”hybrid teaching,whereas the control group received traditional offline teaching.In order to evaluate the efficacy and safety of the two groups of nursing workers,their assessment scores,teaching satisfaction scores,and teaching evaluation indicators were observed.Results:The experimental group was significantly better than the control group in terms of assessment scores,teaching satisfaction scores,and teaching evaluation indicators(P<0.05).Conclusion:In clinical nursing teaching,the“online+offline”mixed teaching mode plays a unique role in improving students’scores and teaching quality;thus,it should be promoted.

Graduate students as preceptors: Effects on clinical teaching outcomes of medical nursing

Purpose:To explore the feasibility of using graduate students as preceptors in the clinical education of medical nursing students.Methods:Five second-year graduate nursing students were recruited to participate in the clinical teaching of medical nursing for 38 undergraduates in the first semester of the 2010 e2011 academic year,divided into two groups.The first group first received clinical teaching in caring for respiratory diseases from graduate preceptors for six weeks followed by clinical teaching in caring for circulatory diseases from nurse preceptors for six weeks.The second group received clinical teaching in the reverse order,from the nurse preceptors followed by the graduate student preceptors.Following training,all students were examined with a written test and scores were compared.In addition,review meetings were held to evaluate the teaching outcomes.Results:No significant differences in test scores were observed between the two teaching groups.Undergraduate student feedback indicated that the training provided by the graduate students was satisfactory,and the medical nursing course leader was satisfied with the teaching outcome with a few exceptions.Conclusion:These data indicate that graduate students are capable of training undergraduates in medical nursing,although some areas can be improved.

Application of Scenario Simulation Method in Pediatric Clinical Nursing Teaching

Purpose Analysis of Situational Teaching Method Applied in Pediatric Clinical Nursing Teaching.Method The 120 nursing students who studied in our University from 2015 to 2017 were selected as the study subjects and divided into routine group and experimental group.General teaching methods were adopted for the routine group,and the experimental group took a scenario simulation teaching method on this basis.Results The satisfaction of the teaching methods between the experimental group and the routine group were 93.33% and 81.67% respectively,P<0.05;The theoretical and practical results of the experimental group were better than the routine group,P<0.05.Conclusion The application of the situational teaching method in pediatric clinical nursing teaching has a significant effect and can effectively arouse students’interest in learning.

Application Research of Clinical Nursing Teaching Model Based on PBL Mode

Objective:To explore the application effect of PBL mode in clinical nursing teaching model.Methods:40 nursing students who were internships from June 2017 to April 2018 in our hospital were selected as subjects.They were divided into two groups,the control group and the experimental group,with 20 in each group.The control group used the traditional teaching model,and the experimental group used the PBL teaching model to compare the clinical teaching effects of the two groups of nursing students.Results:There was no significant difference between the two groups of nursing students in the basic nursing knowledge,the professional practice operation under the simulated clinical operating environment and the basic nursing operation(P>0.05),in the clinical operation environment,the professional practice evaluation results of the experimental group were significantly better than those of the control group,and the difference was statistically significant(P<0.05).Conclusion:The PBL teaching model has a good teaching effect in clinical nursing teaching,which can effectively improve the professional practice level of nursing students in the clinical environment and meet the requirements of modern clinical nursing professional ability level,therefore,the PBL mode is worthy of popularization and application in clinical nursing teaching.

A Study of Meta-cognitive Strategies Use in Bilingual Teaching Based on a Survey of 2007 Nursing Undergraduates in Guilin Medical University

The present study is based on an investigation conducted with 122 nursing undergraduates in Guilin Medical University on their use of metacognitive strategies in March,2010.Data,collected in the form of questionnaire and interviews,were analyzed.Results show that the strategies use is positively correlated with the degree of satisfaction for bilingual teaching and the expected proportion of English.

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.

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.

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.

Practical Progress of SBAR Communication Model-Related Teaching in Clinical Teaching

This paper elaborates the core and essence of situation,background,assessment,recommendation(SBAR)communication model,clarify the application status of SBAR communication model in the clinical teaching of nursing students,and describe its effectiveness and limitations,so as to provide reference for improving clinical nursing teaching ability.

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. .

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.

Nursing-Mini-CEX联合DOPS教学法在高职实习护生临床教学中的应用

目的:探讨迷你临床演练评估(Nursing-Mini-CEX)与操作技能直接观察评估(DOPS)在高职实习护生临床教学中的应用效果。方法:选取2021年6月-2022年2月在德阳市人民医院感染科实习的60例高职护生作为研究对象,随机分为对照组和观察组,各30例。对照组给予传统教学模式,观察组在对照组基础上给予Nursing-Mini-CEX联合DOPS教学法。比较两组能力考核评分、教学满意度。结果:观察组理论知识测试、操作测试成绩高于对照组,差异有统计学意义(P<0.001)。观察组教学总满意度高于对照组,差异有统计学意义(P=0.010)。结论:Nursing-Mini-CEX联合DOPS教学法在高职实习护生临床教学中的应用效果较好,能够提高实习生理论知识测试、操作测试成绩,实习生教学满意度高。

改良Nursing-Mini-CEX教学模式对本科护生临床实践能力和临床思维的影响

目的:探讨改良Nursing-Mini-CEX教学模式在本科护生实习中的实践效果。方法:整群抽样方法抽取我院2019年7月至2020年3月本科实习护生设为对照组,2020年7月至2021年3月本科实习护生设为试验组。对照组护生实行传统一对一临床带教,试验组护生在对照组基础上采用改良Nursing-Mini-CEX教学模式进行带教。比较两组护生出科考核成绩、改良Nursing-Mini-CEX评估量表和医学生临床思维能力评估量表得分。结果:试验组平时考核成绩、操作考核成绩均高于对照组(P<0.05);试验组改良Nursing-Mini-CEX评估量表各维度得分均高于对照组(P<0.05);试验组医学生临床思维能力评估量表中批判性思维与系统思维得分均高于对照组(P<0.05)。结论:改良Nursing-Mini-CEX教学模式能提高护生实习成绩和临床护理教学质量,提升护生临床实践能力,培养临床思维。

The Effectiveness of a Chronic Obstructive Pulmonary Disease Computer Game as a Learning Tool for Nursing Students

Simulation games that are close to actual clinical situations can assist students in the learning process and, through the active presentation of subject material, help them acquire necessary knowledge. The aims of this study were to develop a computer game focused on caring for patients with chronic obstructive pulmonary disease (COPD) in the outpatient clinic and to evaluate the nursing students’ change in knowledge and their satisfaction score after they played this computer game. This study had a randomized pre-/post-control experimental design. How to assess and care for patients with dyspnea episodes, the use of inhalants, the effects of weather changes, and breathing exercises for patients with COPD were the key content elements of the computer game developed by the study team. The COPD care knowledge test and satisfaction questionnaire were the evaluation instruments. Sixty-eight junior nursing students participated in this study. Of these 68 participants, 35 were randomly assigned to the control group and 33 were randomly assigned to the experimental group. Each group finished the pretest, then played the game for 20 minutes, and then did the post-test questionnaire. The results of this study determined that the COPD care knowledge score was significantly improved after playing the game in the experimental group (t = 2.24, P < 0.05). The experimental group responded that the computer game could help them clearly understand ways to take care of patients with COPD in the outpatient clinic. Important suggestions were to add reflection session after playing the computer game and to modify the fluency of the operation procedures. The experience and results of this study could apply not only to the teaching strategy for nursing students, but also for further developing a game for patient education.