Using computer assisted learning for clinical skills education in nursing: integrative review

Title.  Using computer assisted learning for clinical skills education in nursing: integrative review.
Aim.  This paper is a report of an integrative review of research investigating computer assisted learning for clinical skills education in nursing, the ways in which it has been studied and the general findings.
Background.  Clinical skills are an essential aspect of nursing practice and there is international debate about the most effective ways in which these can be taught. Computer assisted learning has been used as an alternative to conventional teaching methods, and robust research to evaluate its effectiveness is essential.
Data sources.  The CINAHL, Medline, BNI, PsycInfo and ERIC electronic databases were searched for the period 1997–2006 for research-based papers published in English. Electronic citation tracking and hand searching of reference lists and relevant journals was also undertaken.
Findings.  Twelve studies met the inclusion criteria. An integrative review was conducted and each paper was explored in relation to: design, aims, sample, outcome measures and findings. Many of the study samples were small and there were weaknesses in designs. There is limited empirical evidence addressing the use of computer assisted learning for clinical skills education in nursing. Computer assisted learning has been used to teach a limited range of clinical skills in a variety of settings.
Conclusion.  The paucity of evaluative studies indicates the need for more rigorous research to investigate the effect of computer assisted learning for this purpose. Areas that need to be addressed in future studies include: sample size, range of skills, longitudinal follow-up and control of confounding variables.     

Evaluating clinical competence during nursing education: A comprehensive integrative literature review

This paper explored concepts, definitions and theoretical perspectives evaluating clinical competence during nursing education. The questions were: (i) How is clinical competence evaluated? and (ii) What is evaluated? An integrative review of 19 original research articles from 2009 to 2013 was performed. Results showed that evaluation tools were used in 14, observations in 2 and reflecting writing in 3 studies. The students participated in all but one evaluation alone or together with peers, faculty members or preceptors. Three themes were found: (i) professional practice with a caring perspective; (ii) clinical skills and reflective practice; and (iii) cognitive, affective and psychomotor skills both with a nursing perspective. This review shows an emphasis on structured methods with a risk reducing nursing to tasks and skills why combinations with qualitative evaluations are recommended. A holistic view of competence dominated and in designing evaluations, explicit perspectives and operationalized definitions of clinical competence became evident.     

客观结构化临床考试在护理教育评价中的应用现状

对客观结构化临床考试从概念、应用现状、操作程序及人员组成(尤其是标准化病人的使用)等方面进行了阐述,对其在护理教育评价中的应用进行综述,并探索其在护理学科理论及技能考核中的应用。     

客观结构化临床考试在我国护理教育中的应用现状分析

目的分析客观结构化临床考试在护理教育中的应用现状。方法在中国生物医学文献数据库、中国知网、万方数据库、中文科技期刊数据库中检索1996²012年客观结构化临床考试的文献,进行文献分析。结果共检出文献49篇,主要用于本科生毕业考试(22.45%)、单一课程考核(14.29%)、出科考核(14.29%)等方面。结论客观结构化临床考试在我国护理教育领域尚处于起步阶段,其应用的有效性和应用范围有待进一步研究。     

客观结构化临床考试在ICU专科护生临床能力评价中的应用研究

[目的]探讨ICU专科护生的培训及考核方法,推进护理教学改革,培养ICU专业学生临床能力。[方法]在查找文献的基础上自行设计调查问卷和成绩考核评分标准,对90名ICU专业护生进行传统教学方法与客观结构化临床考试（OSCE）教学方法的前后对照研究,对两种教学方法的考试成绩和问卷调查结果进行统计分析。[结果]确定了本次OSCE考试的10个考试站点、考试具体内容、各考站的评分标准;采用OSCE教学前后笔试成绩差异有统计学意义;在OSCE考试成绩中,考生技能操作方面的得分率较高,问诊、体格检查、团队合作（急危重病人救护）等考站的得分率较低;问卷调查结果表明OSCE考试模式得到了学生和教师的一致认可。[结论]OSCE客观评价了ICU专科护生临床能力的真实水平,可以作为评价ICU专科护生临床能力的有效工具;应用OSCE教学模式可提高ICU专业护生临床能力。     

客观结构化临床考试在ICU专科护生临床能力评价中的应用研究

[目的]探讨ICU专科护生的培训及考核方法,推进护理教学改革,培养ICU专业学生临床能力。[方法]在查找文献的基础上自行设计调查问卷和成绩考核评分标准,对90名ICU专业护生进行传统教学方法与客观结构化临床考试(OSCE)教学方法的前后对照研究,对两种教学方法的考试成绩和问卷调查结果进行统计分析。[结果]确定了本次OSCE考试的10个考试站点、考试具体内容、各考站的评分标准;采用OSCE教学前后笔试成绩差异有统计学意义;在OSCE考试成绩中,考生技能操作方面的得分率较高,问诊、体格检查、团队合作(急危重病人救护)等考站的得分率较低;问卷调查结果表明OSCE考试模式得到了学生和教师的一致认可。[结论]OSCE客观评价了ICU专科护生临床能力的真实水平,可以作为评价ICU专科护生临床能力的有效工具;应用OSCE教学模式可提高ICU专业护生临床能力。     

TSP/OSCE模式在康复护理本科学生临床实践教学指导与考核中的应用

目的:探讨教师标准化病人(teachers standardized patients,TSP)结合客观结构化临床考试(objective structured clinical examination,OSCE)在康复护理本科学生临床实践教学与考核中的应用效果。方法:采用类实验研究方法选取2018年6月—2019年5月在康复科进行临床实习的护理本科学生39人为对照组,采用传统带教;2019年6月—2020年5月在康复科进行临床实习的护理本科学生46人为观察组,在传统带教基础上增加TSP/OSCE带教。两组学生均在康复科接受6周临床实习,采用TSP/OSCE模式考核得分评价两组学生专业核心能力,采用自制问卷调查两组学生的临床教学满意度。结果:观察组学生专业核心能力得分高于对照组(P<0.05),观察组学生对临床教学的满意度高于对照组(P<0.05)。结论:在康复护理本科学生临床实践教学中采用TSP/OSCE模式,能提高本科学生专业核心能力和临床教学满意度。     

应用客观结构化临床考试评价护理本科毕业生的临床能力

目的 采用客观结构化临床考试(objective structured clinical examination,OSCE)评价护理本科毕业生的临床能力.方法 设置OSCE考站,对2010届护理本科145名毕业生进行考核和成绩分析.结果 在本次考试中毕业生成绩分布均匀,分数在合理范围内,考试的信度及效度较好.结论 OSCE能够客观地反映毕业生的临床能力,但其考站的设置有待于进一步完善.     

客观结构化临床考试在护理管理者临床实践能力中的应用

目的探讨客观结构化临床考试在护理管理者临床实践能力考核中的应用效果。方法选取206名护理管理者为研究对象,通过组建客观结构化临床考试考评团队,设置"六站式"现场考评,对各站点考试成绩、难度系数、区分度等指标进行评价。结果考核难度系数为0.169,区分度为0.431,各考站得分率在73.93%~86.32%之间,真实展现被考核者业务能力水平,基本达到考核目的。结论运用客观结构化临床考试模式考核护理管理团队,能够客观有效评价护理管理者业务素质能力,提升团队协作水平,具有可行性。     

Using the OSCE to measure clinical skills performance in nursing

The measurement of clinical skills performance continues to pose a challenge for nurse educators. This paper will report on the use of the objective structured clinical examination (OSCE) to measure the psychomotor learning outcomes of a programme designed to assist students to learn to conduct a nursing neurological examination. The OSCE has a tradition in medicine, having been developed by Ronald Harden in Scotland and first reported in the British Medical Journal in 1975. The University of Ottawa has the longest North American experience with this type of evaluation procedure and there is an increasingly rich medical literature referring to the OSCE. Although the OSCE appears to be a promising method for evaluating competence in the performance of clinical skills, there are no studies in the nursing literature examining the use of the OSCE as a method for evaluating the performance of clinical skills by nurses. Our experience suggests that the OSCE may be a powerful tool in the evaluation of clinical competence in nursing and that it may also be an effective facilitator for learning to perform clinical skills in nursing.     

在真实临床情境中护理本科生综合临床技能的评价

目的：介绍在真实临床情境中护理本科生综合临床技能的评价。方法：本研究通过在真实临床情境中客观结构化临床考试,采用《综合临床护理技能评核表》直接观察、评价180名护理本科四年级学生的综合临床技能。结果：绝大部分学生能完成护理评估、病例分析、给予护理干预并进行健康教育。但存在护理评估不全面、不深入,健康教育内容不完整、不恰当,操作步骤紊乱等现象。教师及学生对OSCE评价较好。结论：在真实临床情境中的OSCE,增强了情境的逼真度,可以客观地测试学生的综合临床技能。     

学生标准化病人在内科护理学客观结构化临床考试中的应用

目的了解内科护理学客观结构化临床考试（OSCE）中学生标准化病人（SSP）的模拟水平，分析SSP在模拟病人方面存在的问题，从而为进一步改进SSP提供依据。方法自行设计问卷，以我院参加内科护理学出科考试的74名学生作为调查对象，评价SSP的模拟水平。结果学生对SSP模拟病人逼真程度评价总分为（15．69±1．951）分，其中SPP能自然地回答学生提出的问题评价评价得分为（3．24±0．463）分。所有学生均认为运用SSP考核学生的临床能力是有效的，97％学生认为与传统考试模式相比标准化病人考核模式更能真实地反映学生的临床实际水平。结论培训护理专业学生为sP用于内科护理学OSCE考试可行性好，但需要进一步采取措施提高SSP模拟体征的逼真程度及各站SSP表演的协调一致性程度。     

在客观结构化临床考试中评价护理本科毕业生沟通能力的探索

[目的]探讨护理本科毕业生在客观结构化临床考试(OSCE)中学生沟通能力的评价方法。[方法]通过采用OSCE多站点考试,设置考察护生沟通能力的考试站点。[结果]考试成绩呈正态分布。[结论]OSCE多站点考试能够科学、客观地评价护生沟通能力,对教学改革和培养学生的沟通能力有重要的促进作用。     

Qualitative case study methodology in nursing research: an integrative review

Title.  Qualitative case study methodology in nursing research: an integrative review.
Aim.  This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research.
Background.  Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology.
Data sources.  In 2007, a search for case study research (published 2005–2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria.
Methods.  Whittemore and Knafl's integrative review method guided the analysis.
Results.  Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research.
Conclusion.  Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility.     

高仿真模拟教学对护理本科生临床能力影响的研究

目的探讨高仿真模拟教学对护理本科生临床能力的影响。方法将实习前的60名护理本科生随机分为试验组和对照组,各30名,试验组采用高仿真模拟教学,对照组采用普通教学(案例讨论与护理技能操作训练),各培训20学时,并利用客观结构化临床考试(objective structured clinical examination,OSCE)分别在培训前后对学生进行考核。结果培训后,试验组的11项成绩比培训前均有提高(P<0.05);培训后,试验组在小组综合能力、护理问诊、护理体检、健康教育口试、职业态度考核成绩上高于对照组(P<0.05)。结论高仿真模拟教学可显著提高学生的临床能力,比普通教学具有优势。     

Pain assessment tools for unconscious or sedated intensive care patients: a systematic review

Title.  Pain assessment tools for unconscious or sedated intensive care patients: a systematic review.
Aim.  This paper is a report of a systematic review describing instruments developed for pain assessment in unconscious or sedated intensive care patients.
Background.  Intensive care patients who are unconscious or sedated are unable to communicate and therefore recognition and assessment of the pain is difficult. To assess these patients' pain, it is important to use a valid and reliable pain assessment tool.
Data sources.  A systematic bibliographical review was conducted, based on seven databases, covering the period from January 1987 to February 2007. A total of 1,586 abstracts was identified and reviewed, 58 papers were selected for full-text review and nine papers were included in the review.
Methods.  Two researchers independently reviewed the abstracts and three reviewers extracted the papers. The included papers were evaluated using a quality assessment instrument previously developed to evaluate pain assessment tools.
Results.  Five different pain assessment tools were identified that had been used with unconscious or sedated intensive care patients. All five instruments included behavioural indicators and three included physiological indicators. Their psychometric properties varied and it was not possible to deduce their clinical utility.
Conclusion.  All instruments were reasonably new. In most of them psychometric testing was in an early stage or even absent. Before any of the reported instruments can be chosen in preference to others, it is essential to test their validity, reliability and feasibility further.     

Evaluation of empathy measurement tools in nursing: systematic review

Title.  Evaluation of empathy measurement tools in nursing: systematic review.
Aim.  This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a 'gold standard' for application in future studies.
Background.  Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves.
Data sources.  An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords 'empathy', 'tool', 'scale', 'measure', 'nurse' and 'nursing'. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review.
Method.  Twelve measures were critically reviewed and analysed. A 7-criterion framework was developed to appraise the rigour of the empathy measures, with a score range of 0–14 for each measure.
Results.  Quality scores obtained were low (2–8 of 14). Validity and reliability of data were commonly reported, but responsiveness to change was tested in only three measures. None of the measures were psychometrically robust or covered all the domains of empathy. User involvement was limited and only five were developed in nursing settings.
Conclusion.  Most measures have undergone rigorous development and psychometric testing, although none is both psychometrically and conceptually satisfactory. Empathy measures need to cover all relevant domains reflecting users' own perspectives and be tested with appropriate populations in relevant care settings.     

护理本科毕业生客观结构化临床考评模式的实施效果及评价

目的探讨护理本科毕业生客观结构化临床考评(objective structured clinical examination,OSCE)模式的实施效果。方法便利抽样法选取已完成1年临床实习即将毕业的滨州医学院护理学院2011届五年制护理本科生(以下简称护生)335名为调查对象。采用OSCE模式,设病例分析、护理评估、健康教育、操作技能、模拟急救、科研能力等6个考站进行考评,分析考评结果;并调查护生和主考教师对各考站难易度的评价及对OSCE模式的评价。结果 335名护生平均成绩为(77.77±4.52)分,成绩总体呈正态分布。6个考站难度指数为0.69～0.83,平均难度指数为0.78。各考站区分度指数为0.40～0.56,考评总区分度指数为0.36。考评方案难度适中,区分度指数较高。220名护生认为护理评估考站为最难考站,大部分师生均认为考站结构安排合理。结论 OSCE模式能够客观评价护生的临床护理综合能力。考评可靠性良好,站点设置较为合理。护理教育工作者应不断优化考评方案,建立护生综合能力评价体系与标准,以增加考评的客观性、真实性和规范性。     

Mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination to assess their competence in medicine administration

The aim of this study was to evaluate mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10‐item survey questionnaire was used, comprising open‐ and closed‐response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE‐induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE‐related stress, and questioned the validity of the OSCE as a real‐world assessment. The OSCE has an important role in the development of student nurses' administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.