Role of knowledge and ability in student nurses' clinical decision-making

Little is known about the acquisition of decision-making skills in nursing students as a function of experience and academic ability. Knowing how experience and academic skills interact may help inform clinical education programs and formulate ways of assessing students' progress. The aims of the present study were to develop a problem-solving task capable of measuring clinical decision-making skills in novice nurses at different levels of domain-specific knowledge; and to establish the relative impact on decision-making of domain-specific knowledge and general ability as determinants of the acquisition of decision-making skills. Three types of clinical problems of increasing complexity were developed. Sixty second-year and third-year student nurses with high and low academic scores were studied in terms of their ability to generate hypotheses for a hypothetical case, recognize disconfirming information and the need to access additional information, and diagnostic accuracy. The results showed that general academic ability and knowledge function partly independently in the acquisition of expertise in nursing. Academic ability affects decision-making in low complexity tasks, but as case complexity increases, domain-specific knowledge and experience determines decision-making skills. There are important differences in the way novices with different levels of knowledge and ability make clinical decisions and these can be studied by systematically increasing the complexity of the decision task. These results have implications for the way in which clinical education is structured and evaluated.     

Nurses'' perceptions of their problem-solving ability

A problem-solving approach to nursing practice has been advocated in the nursing literature for some time. However, the extent to which nurses perceive themselves as capable problem solvers or improve their problem-solving ability during their nursing education is not generally known. The purpose of this study was to determine the relationship between nurses' perceptions of their problem-solving ability and their course of study. The Problem-Solving Inventory (PSI) was developed by Heppner and colleagues (1982) to assess attitudes towards and perceptions of problem-solving behaviour. The instrument provides a global appraisal of oneself as a problem solver and assesses perceptions of problem-solving ability. In this study, data were collected from 67 pre and post-registration nursing students in two phases; during their course and on completion of their course. Data from each phase were compared to identify changes in perception of problem-solving behaviour over time. While there was no overall improvement in perceptions of problem-solving ability by phase 2, confidence in problem solving had improved significantly (P less than 0.01). There were improvements according to age, experience, and course being undertaken for the likelihood of approaching rather than avoiding problems, and having personal control over problem solving.     

Problem-based learning in an undergraduate nursing programme: a case study

Over the past 15 years, the 'theory-practice gap' has been a recurrent theme in the nurse education literature Numerous explanations are put forward for its existence, along with many suggestions as to how the apparent divide can be bridged A key component of nursing practice is problem-solving but not all nurses are competent at finding suitable solutions to the problems they face in practice settings Therefore ways of developing learner proficiency in problem-solving is crucial and should occupy a substantial part of teacher activity One recent educational method for promoting problem-solving skills is problem-based learning [PBL] using the hypothetico-deductive technique This approach encourages students to work through problem situations, generating hypotheses and testing these against the relevant literature and personal experience The process itself is seen as the essential element in developing problem-solving skills, so that when the students are qualified they can apply the same methods to patient care This paper explores the use of the PBL approach with a group of 11 fourth-year undergraduate students The method employed was a case study design using observation as the main data collection technique Subsequent analysis focused on (a) practice, (b) teaching method, (c) knowledge attainment, and (d) the role of the teacher     

Spica cast care: a collaborative staff-led education initiative for improved patient care

One of the most challenging aspects for nurses caring for incontinent children in spica casts is maintaining healthy skin integrity. Noting an increase in the number of phone calls from parents of discharged children in spica casts concerning diaper rash and skin breakdown, inpatient orthopedics staff nurses lead an interdisciplinary quality improvement and educational initiative. They standardized pediatric spica cast care and education by creating an intranet narrated PowerPoint presentation for staff and parents of children with spica casts. A take-home DVD of this education module is now produced and given to parents, reinforcing nursing discharge teaching and giving parents the opportunity to review these new skills at home as needed. The purpose of this article is to share this experience of improving patient outcomes and empowering other orthopedics nurses to develop creative educational solutions.     

A study of diagnostic reasoning in pediatric nurses.

PURPOSE: To examine the data collecting and interpreting phases of the diagnostic reasoning process used by practicing pediatric nurses and to determine: (a) types of information deemed important for planning nursing care; (b) the functional health patterns addressed; and (c) frequency of validation of early hypotheses. METHOD: Thirty-four registered nurses who attended continuing education pediatric nursing workshops were asked to analyze a written simulated case study discussing maternal-infant interaction. Diagnostic cues in the case study were based on a framework that consisted of a clinical nursing model of maternal-infant interaction and selected nursing diagnoses. Open-ended questions were used to examine subjects' attention to and interpretation of these cues. FINDINGS: All subjects identified information related to the child's physical needs and the mother's responsibility to meet those needs as important for planning nursing care. There was less attention given to the interaction of mother and child. The most common response was identification of cues associated with five functional health patterns (29.4% of subjects). The functional health pattern, coping-stress tolerance, was addressed least often, although all nurses identified cues associated with role relationship. Only 38% of the subjects identified the need for validation of early hypotheses. CONCLUSION: The findings support the need for further research on the diagnostic reasoning of pediatric nurses. Recommendations include methods to enhance pediatric nurses' collection and interpretation of data specific to the pediatric clinical setting.     

Combining the arts: an applied critical thinking approach in the skills laboratory

The quality of care that nurses provide to patients is strongly influenced by the nurses' ability to think critically and to solve problems. In response to the dynamic changes in healthcare and rapid technological advancements, nursing educators must prepare nursing students to meet the challenges. Baccalaureate nursing students must be taught to utilize critical thinking skills for problem solving during the application of the nursing process. Nursing students who use critical thinking skills will provide high quality and efficient patient care in the acute care and community settings. During the simulated laboratory experience, incorporating creative teaching strategies to promote critical thinking and enhance problem-solving skills can enable nursing graduates to enter the workforce feeling confident and competent.     

主责护士带班负责制在儿科的实践与探讨

目的保证儿科的护理质量和护理技术,让患儿家长满意,减轻儿科护士的压力,留住儿科护理人才。方法在儿科尝试了主责护士带班负责制的管理机制。结果实施新的管理机制后,临床带教把关有效;小儿特有的护理难题得到了及时解决;调动了资深护士参与管理的积极性;提高了家长对护士的信任度;科室的各项护理质量上了一个新台阶。结论主责护士带班负责制在儿科的实践,取得了较好的成效,由于优越性显著,值得在临床各科推广。     

A pediatric rehabilitation experience for undergraduate nursing students.

Pediatric rehabilitation is a specialty that will need more nurses in the future. A clinical rotation in this specialty was incorporated into the pediatric experience of junior-year baccalaureate nursing students at the University of Maryland School of Nursing. The experience helped students to learn more about the nursing care involved in pediatric rehabilitation, to appreciate the different disciplines within the specialty, and to view pediatric nursing from a holistic long-range perspective. The experience also strengthened ties between nursing education and practice.     

Swimming without the water: A critical perspective on mental health experience for adult nursing students

Adult nurses and adult field nursing students come into contact with a diverse range of other patient groups in their practice but perhaps none more so than those who have co-existing mental health issues. Consequently adult field student nurses must be equipped with the requisite knowledge and skills to competently care for their patients who also experience mental health problems. Given the pressure on placements many education providers have developed alternatives to direct mental health experiences. The authors review their own experience of some of the modalities that higher education institutes (HEI) use to instruct their students in this field. They argue that, ideally, there is no substitute for the practical experience of placements in the mental health sector, particularly if these include contact with mental health nursing. The paper concludes with some recommendations for nursing education and our professional body that could help equip adult field nursing students with the necessary experience and skills of mental health to support them into their future careers.     

Action now in family planning: the role of nurse

In India, nurses at all organizational levels can play a vital role in the national family planning program. Family planning is an integral component of family welfare, and the control of population growth is crucial for the economic and social development of the country. The goals of the family planning program are to promote the small family ideal, to disseminate family planning information, and to ensure that contraceptive supplies and services are available to all couples. Administrative nurses at the national level can further these goals by 1) advocating appropriate policies and influencing budget allocations, 2) preparing family planning guidelines for state directors of nursing, and 3) ensuring that all senior nurses are provided with in-service family planning education. Administrators in training facilities can ensure that an effective and up-to-date family planning component is a part of all nurses' training programs and that students receive clinical experience in family planning. In hospitals, nursing superintendents can develop family planning seminars and discussion sessions for the nursing staff and provide incentives for nurses to motivate couples toward family planning. Nurses working in pediatric and gynecology wards are in an ideal position to alert mothers to the health problems associated with repeated and closely spaced pregnancies. They can arrange to show family planning films to the mothers, display posters on the ward halls, and organize family planning discussion groups among the patients. Nurses working in prenatal and postpartum clinics can inform the mothers, as well as the factors who frequently accompany their wives to the clinics, about the advantages of family planning. School nurses can familiarize students with the advantages of small family size. Children can sometimes motivate their parents to limit family size. Community health nurses generally play a major role in disseminating contraceptive information and in providing contraceptive services. Many community nurses are involved in the Integrated Child Development Scheme, a program to improve the health and welfare of the poorest segments of the rural population, and family planning is a major component of the program. Community nurses who live in the communities where they work can organize community activities in support of family planning.     

A continuing educational initiative to develop nurses' mental health knowledge and skills in rural and remote areas

At a time of ever increasing mental health problems in Australian society, the nursing profession is beset by problems of an insufficient workforce specialising in this area. Not only is there a shortage of suitable trained specialist mental health nurses, but undergraduate nursing programs inadequately prepare students for practical mental health nursing. Fewer students are enrolling in mental health nursing, and many nurses are leaving the workforce. A particular problem in rural Australia is that there is a lack of specialist mental health services, and nurses are being increasingly relied upon to perform the role of mental health nurse despite lacking the necessary qualifications and experience.This paper aims to describe the development, implementation and evaluation of a mental health continuing education program for nurses employed in rural and remote areas of New South Wales (NSW), Australia. This was a collaborative educational initiative mounted by the NSW Health Department (who funded the project), a rural university and a number of regional health service partners. The paper includes information on how this program was conceived, developed and conducted through distance education mode. It also evaluates the efficacy of this program as perceived by 202 out of 303 participants. Overall the project was rated very favourably, and represents a cost-effective, convenient method of enabling rural and regional nurses to update and improve their skills in mental health nursing.     

Reflections on nursing education in Taiwan and its prospects from the perspective of adult education

Globalization, lifelong learning concepts and increasing numbers of adults in recurrent education programs all underscore the need for nursing education to train students in interpersonal, knowledge acquisition, task accomplishment and personal development skills applicable to both their work and everyday life. Today, our technology-driven world produces and rapidly disseminates vast amounts of information. So-called "academic knowledge" is no longer adequate to teach nurses how to perform routine nursing care duties. Therefore, recurrent education has taken a central role in nursing education. Grounded in adult education theory, this article discusses the current state of nursing education in Taiwan and proposes practical suggestions for the future. Such suggestions include: 1) a recurrent education curriculum should instill in students a commitment to lifelong learning; 2) learning through problem posing, instead of lectures, should be promoted in order to foster an interactive relationship between teacher and student that is characterized by critical thinking and active dialogue; 3) modern technology now permits information technology skills to become a core competency in nursing; and 4) nursing education should foster a global view in order to consider how to use the experience and knowledge of other countries' to enhance domestic nursing knowledge and practices.     

Parent-nursing student communication practice: role-play and learning outcomes

Parents accompanying their child's hospitalization can experience stress associated with the child's illness, treatments, and major alterations in family life. Nurses often serve as the primary communicator and cultural broker because of their constant presence at the child's bedside. Nursing students may not have essential parent-nurse communication competencies. In an innovative method of teaching nursing students about communicating with parents, 64 undergraduate nursing students participated in a parent-led postconference with a nursing instructor. The parents provided background and led role-play activities and debriefing sessions with students. Feedback provided by students before and after the parent session included requests for additional parents' experiences, appreciation and exceeded expectations of hands-on experience, recognized value of information provided, and the recommendation that all students attend. We demonstrate that empathy is a teachable skill, nursing students are apprehensive about communicating with parents, and nursing students do not understand how much families rely on nurses.     

对唇裂婴儿实施协同性护理的探讨

对存在于唇裂婴儿治疗过程中,患儿父母参与生活护理的现状,从形成因素,护、患关系,护士和患者家长的关系以及在护理中发挥的作用,影响护理效果的因素,改进的方法进行了探讨。认为在新护理观指导下,建立融洽的护、患、陪护之间的关系,开展以家属为中心的健康教育,以唇裂婴儿为中心的协同性护理是一种行之有效的方法。     

Using experienced clinicians to facilitate clinical education

Dedicated education units (DEUs) teach nursing students how to provide professional, competent, and safe nursing care using staff nurses as educators and reduce the number of adjunct clinical faculty required by schools of nursing. The authors describe a collaborative clinical partnership between a pediatric healthcare system and a school of nursing to pilot the use of a DEU for one-on-one clinical education of students with expert pediatric nurses.     

Empowering students on medication for asthma to be active participants in their care: an exploratory study.

This article is part of a larger study of young students with asthma. It focuses on the observations of school nurses and comments from parents and students pertinent to school nursing practice. The study shed light on the educational needs of 9- to 11-year-old students with asthma and identified some areas where the school nurse could easily enhance the health management of these students. Responses from students and parents about asthma provided insight into the daily challenges faced by students with asthma. Students with asthma may or may not fully understand the seriousness of their chronic condition or how to recognize and treat symptoms. The purpose of this pilot study was to identify strategies school nurses might use to determine the knowledge level of students and to determine the effects of asthma education programs. School nurses who participated in the study were provided with a comprehensive package containing current asthma information and an education program to update knowledge and skills. These school nurses also received Open Airways for Schools, an American Lung Association education program for students in grades three to five. The study was a two-group exploratory, quasi-experimental design. Questionnaires were prepared for students, school nurses, and parents to collect information on knowledge and perceptions about asthma. Students who participated in the educational program were reported by their school nurses to have increased knowledge and management skills related to their disease.     

Determining problems experienced by student nurses in their work with clinical educators in Turkey

Clinical education is considered an indispensable and vital part of nursing education. Educators have an important role in the successful completion of a student's clinical education. The clinical educator's approach, experience and knowledge have an influence on the students. Students encounter certain problems during their clinical practice under the supervision of educators. This study was conducted to determine the nature of the problems student nurses encounter during clinical training in Turkey. The focus-group interviews were used for this study. Three groups of 8, a total group of 24, composed of students completing their third year were included in the interviews. The students in this study had completed their practical training in the departments of internal medicine, surgery, pediatrics, psychiatry and public health. Among the problems mostly encountered by students, as established by the study, were inadequate assessment by the clinical educator, judgment, negative feedback, communication problems, inadequate guidance and overload. At the end of the research, recommendations were that educators should offer information in the direction of student expectations, increase their positive feedback and lighten the academic workload of these students.     

临床护生分层次管理状况调查

目的：探讨现阶段临床护生分层次管理的状况。方法：选择在该院实习的护生300人和带教老师200人,采用自制的学生自评量表和带教老师评学生用表对研究人群进行调查。结果：不同学历层次的临床护生在学生自评量表和带教老师评学生用表中的总得分比较均具有统计学差异（P〈0．05）。对量表的各个维度进行分析时,不同学历层次的临床护生在学习兴趣、学习态度、慎独精神、解决问题的方法和技巧、主动查阅资料、护理记录书写,以及生活护理技能、基础技能和护理查房等技能方面,比较均具有统计学差异（P〈0．05）。结论：现阶段护理临床实习教育中,各层次护理专业学生的培养目标和培养特色还不够凸显。     

Finnish nurses' and nursing students' mathematical skills

The health care environment requires that practitioners have sufficient mathematical skills to perform accurate, safe and effective medication administration. This is a highly responsible and nursing task, which is performed daily. In this study 364 nurses and 282 graduating nursing students in Finland completed the Medication Calculation Skills Test (MCS Test). According to the findings students lacked accurate mathematical skills, while nurses attained higher scores in the test. Nurses with an upper secondary school education managed better with the calculation problems than nurses with a lower basic education. Students who had an excellent mark (9-10) in mathematics, had studied mathematics longer at high school and were more satisfied with the amount of medication calculation instructions and scored higher in the MCS Test than others. The differences between the nurses' and students' mathematical skills were significant. The MCS Test could be used to measure one's own skills and to give information of the mathematical skill level for constructing a nursing curriculum or additional training for clinical practice.