临床推理与决策课程对护理本科生评判性思维能力的影响

目的探讨内地首门“临床推理与决策”课程对护理本科生评判性思维能力的影响。方法采用前后对照设计。在“临床推理与决策”课程开设前后,组织选修该门课程的38名护生填写评判性思维态度倾向量表一中文版（CTDI—CV）,进行前后对照分析。结果教学后护理本科生的评判性思维能力总分为（318．05±24．87）分,高于教学前的（308．49±22．96）分,组间比较差异具无统计学意义（t=-1．839,P=0．074）。7个评判性思维维度中,寻找真相、系统化能力以及批判性思维的自信心得分增加,差异有统计学意义（t分别为-2．727,～2．622,-2．417;P〈0．05）。结论在护理本科生中推行临床推理与决策课程有助于提高学生的评判性思维能力。     

Responding to responsive behaviours: A clinical placement workshop for nursing students

As our population ages, it is important for the next generation of nurses to feel prepared to care for people with dementia. Communicating with a person with dementia who is experiencing responsive behaviours can be challenging. Furthermore, new graduate nurses may experience a phenomenon called reality shock when they do not feel prepared for the reality of nursing. Reality shock can lead to nurse turnover and poor retention rates. This study evaluated a workshop for first-year practical nursing students focusing on applying a person-centered communication framework when caring for people with dementia experiencing responsive behaviours. The results suggested that training students during their clinical placements on dementia communication may be effective in helping prepare nurses to care for this patient population.     

Experiences after international clinical placement as nursing students in a paediatric ward

AimThe aim of this study is to investigate nurses’ experiences after participating in an international clinical placement programme as nursing students while staying for one to three weeks in a paediatric ward.BackgroundStudent mobilisation is expected to increase the quality of education. Hence, offering international clinical placement programme in low- and high-income countries is a commonly used learning activity in bachelor programmes in nursing. Many studies have mainly examined the general experiences gained from international clinical placement programme but have not specifically focussed on the setting of paediatric wards in hospitals. Nursing students are required to acquire knowledge of paediatric nursing with children as patients.Design and methodIn this qualitative study, a hermeneutic, phenomenological approach was adopted. Data were collected through individual interviews with eight nurses after they participated in an international clinical placement programme as nursing students in a paediatric ward.ResultsMeetings with children’s destinies as patients were overwhelming, being an observer provided insights into and an overview of paediatric nursing, access to the resources required for treating children is limited, nurses had a different role and parents had an extended caring role.ConclusionAll participants gained knowledge of children as patients at a hospital and also gained knowledge of the parents’ and nurses’ roles and the treatment methods of various diseases that are relevant to paediatric nursing. This helped provide them with the cultural knowledge, awareness and sensitivity required, given the contrasting situation at their home country.     

Clinical Coaching – An innovative role to improve marginal nursing students' clinical practice

In order for undergraduate nursing students to demonstrate their ability to achieve the required level of competency with practice they must be able to integrate both the clinical skills and knowledge that are pivotal to safe and competent nursing practice. In response to ongoing concerns about students' level of competency expressed by the supervising clinical staff, one School of Nursing and Midwifery created a Clinical Coach (CC) role. The purpose of this paper is to present the data collected including outcomes achieved and the coaching strategies used when a CC role was implemented to support and develop nursing practice for the marginal performer or ‘at risk’ student. A literature review of the application of coaching to nursing, a detailed analysis and discussion of the outcomes identified from auditing of collected data and the specific coaching strategies that resulted in successful outcomes for students is presented. This model of Clinical Coaching for nursing students could readily be adopted by other Schools of Nursing and Midwifery. This account of the regime of coaching practices may also offer a transferable, adaptable and flexible approach for other health professions who require their undergraduate students to complete clinical placements in preparation for professional practice.     

Seeking autonomy: Grounded theory of clinical reasoning processes during simulation based experiences

AimTo conceptualize how undergraduate nursing students’ reason and think during Simulation-Based experiences (SBE) and explore the indicators of sound clinical judgment.BackgroundNursing students’ clinical reasoning processes during Simulation Based Experiences (SBE) are not well understood and underexplored. The purpose of this study is to conceptualize how undergraduate nursing students’ reason and think during SBE.DesignA constructivist grounded theory methodology was used to explore nursing students’ clinical reasoning during SBEMethodA grounded theory methodology was used to explore nursing students’ clinical reasoning during SBE. A purposive sample was used to recruit participants including 32 third-year nursing students. Data collection using semi-structured interviews conducted over 9 months in 2020–2021. The interviews were recorded and transcribed verbatim and the data were analyzed using the logic of constant comparison supported by memoing, theoretical sampling and conceptual mapping.ResultsSeeking autonomy is the core category that emerged from the participants’ responses that conceptualizes the students' reasoning process during SBEs.ConclusionEvidence from this grounded theory study adds validation to the practice of using SBEs to support students’ clinical reasoning process and prepare them to be competent in clinical practice.     

Practices of caring for nursing students: A clinical learning environment

ObjectiveThe 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.MethodsQualitative 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.ResultsThe 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.ConclusionsThe 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.     

Virtual patients for assessment of clinical reasoning in nursing -- a pilot study

In different nursing programmes, one important learning outcome is clinical reasoning (CR) skills. However, to date, there is limited number of methods available for assessment of CR skills; especially for distance-based courses. This study investigates students' opinions about the feasibility of using Virtual Patients (VPs) for assessing CR in nursing education. VPs were introduced as an assessment tool in three different nursing courses at two universities, comprising 77 students in total. Students' overall acceptance of this assessment tool, including its applicability to the practise of nursing and the potential of VP-based assessment as a learning experience, were investigated using questionnaires. Course directors used the Web-SP system to assess students' interactions with VPs and their answers regarding diagnoses, caring procedures and their justifications. Students' found the VP cases to be realistic and engaging, and indicate a high level of acceptance for this assessment method. In addition, the students' indicated that VPs were good for practising their clinical skills, although some would prefer that the VP system be less "medical" and asked for more focus on nursing. Although most students supplied correct diagnoses and made adequate clinical decisions, there was a wide range in their ability to explain their clinical reasoning processes.     

Teaching and supporting nursing students on clinical placements: Doing the right thing

Problem

Pre registration nursing students do not always feel supported by Registered Nurses during their clinical placements. To help develop and refine clinical skills, in order to deliver safe, competent nursing care, nursing students rely on Registered Nurses to teach and support them in their clinical learning.

护理专业学生临床见习模式的研究进展

见习是护理专业学生接触患者、培养实践能力很重要的一个阶段，近几年来，护理教育者们对护理专业学生临床见习模式进行了大胆的实践，并取得了一定的效果，现综述如下，以期对护生见习模式的选择起到借鉴作用。     

以护生为主体的实习指导对其自我效能与临床实践行为的影响

目的：了解不同实习指导方法对实习护生的自我效能和临床实践行为的影响,为提高护生的临床实习水平提供理论依据。方法选取某三级甲等教学医院的2008级和2009级本科实习护生413名为研究对象,2008级护生采用常规实习教学指导方法,2009级护生采用以学生为主体的实习教学指导方法,在实习结束后进行一般自我效能及临床实践行为情况的问卷调查,比较其差异。结果2009级本科护生实习后自我效能得分为（2．79±0．46）分,高于2008级实习护生的（2．58±0．53）分,差异有统计学意义（t＝4．344,P＜0．01）。2009级本科护生实习后临床实践行为总分为（3．84±0．51）分,高于2008级实习护生的（3．69±0．45）分,差异有统计学意义（t＝3．299,P＜0．01）。结论以学生为主体的实习教学指导方法可以有效提高学生的自我效能和临床实践行为水平,可广泛应用于实习护生的教育中。     

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

护理操作风险量化表在护生临床带教中的应用

目的 探讨护理操作风险量化表在护生临床带教中应用的效果.方法 设计护理操作风险量化表,将2008年6月至2009年4月进入我院实习的106名护生作为对照组,实施原有护理操作风险管理办法;将2009年6月至2010年4月进入我院实习的105名护生作为观察组,应用量化表,对护理风险实施量化的管理办法.比较2组护生的风险意识、护理缺陷发生情况等指标.结果 观察组护生在风险意识、操作考核、护理缺陷及血源性暴露发生例数等方面显著优于对照组.结论 量化表的应用有利于提高护生的风险意识,提高教学质量,保障护理安全.     

支架式教学对专科实习护生临床沟通能力影响的研究

目的 探讨神经内科运用支架式教学在实习护生临床沟通能力中的应用效果。 方法采用方便抽样法选取淄博市某医学院校在A医院神经内科实习的20名护生为干预组,实习期间在传统带教基础上采用支架式教学开展沟通技能培训,同时选取同校在B医院神经内科实习的20名护生为对照组,采用传统带教模式,实习时间为2个月。在干预前后同时进行沟通能力测评和沟通技能自信问卷调查。 结果 实习2个月后,干预组临床沟通能力明显好于对照组(t=4.763,P<0.01)。干预组沟通自信得分高于对照组(t=2.184,P<0.05)。 结论 支架式教学模式能有效提高实习护生的临床沟通能力和沟通自信心。     

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

Aim/objectiveTo report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.BackgroundClinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.DesignA scoping review was conducted using the framework developed by Arksey and O’Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.MethodsThe studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.Results1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.ConclusionsAmong the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.