The relationship of social status and social image with the choice of nursing career among the next generation of Turkish youth: A cross-sectional study

AimTo evaluate the nursing image and social status characteristics on young people’s decision to choose nursing as a career.BackgroundLow social status and social image threaten the nursing workforce.DesignA cross-sectional study.MethodsThe study was conducted with 745 high school students and 349 nursing students between 24 March and 10 May 2022. The data were collected through the Nursing Image Scale, Job Satisfaction Scale and Personal Form and analyzed using multiple regression and decision tree analysis.ResultsHigh school (43.1 %) and 73.6 % of nursing students expressed their intention to become a nurse. While the likelihood of choosing nursing as a career decreases among man high school students (p = 0.018) with a high occupation (p = 0.003) and income index (p = 0.003), it increases among low-income female students (p = 0.012), perceiving occupational status more positively (p = 0.002). The possibility of continuing in the profession increases among nursing students who have a higher opinion of the profession's status (p = 0.010) and job satisfaction increases as the image perception improves (r = 0.385, p < 0.01).Conclusion and recommendationsPerception of professional image guides career choice in nursing. The choice of nursing as a future profession differs according to gender and is influenced by social status. The glass ceiling effect should be evaluated in nurses coming from low status.     

Using Exploratory and Confirmatory Factor Analysis to understand the role of technology in nursing education

AimThe study aimed to establish the role played by technology in nursing education through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).Methods150 student nurses participated, with data being collected using a structured questionnaire with 14 items on a 5-point Likert scale. Parallel Analysis (PA) and Exploratory Factor Analysis (EFA) were conducted to identify the factors for the role of technology in nursing education, Confirmatory Factor analysis (CFA) was used to ascertain the model fit. ANOVA, t-test and binary regression analysis were used to identify among the factors the differences within the level of the study, and perceived abilities to use the computer.ResultsThe EFA identified five factors from 14 items, and through the CFA, the results indicated that the model was supported by the following indices: Comparative Fit Index (CFI) = 0.968 (>0.95); Incremental Fit Index (IFI) = 0.969 (>0.95); Tucker-Lewis Index (TLI) = 0.957 (>0.95); Root Mean Squared Error of Approximation (RMSEA) = 0.077 (<0.080); and SRMR = 0.0396 (<0.08). These results were within acceptable ranges, which indicated that the five factors obtained from EFA were validated. However, Chi-square goodness of fit statistics was not statistically significant (χ² = 126.312, d.f = 67, p = .000). Overall, 89.3% (n = 134) nursing students had a positive perception of the role of technology in nursing education. Binary regression analysis indicated that 1st year nursing students positively perceived the role of technology 6.7 times more than other levels (OR = 6.710, 95% CI: 1.33–33.63, p = .021). Students with good ability to use the computers (92.9%) were 5.3 more likely to have a positive perception towards the role of technology in nursing than those with the poor ability (OR = 5.35, 95%CI = 1.76–16.26, p = .003).ConclusionUsing innovative teaching strategies and ensuring that nursing students are skilled is essential to the future of the nursing profession. The five-factor model would be a useful tool to assess the perception of students towards the role of technology in nursing education.     

Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study

AimTo determine the efficacy of an online mindfulness intervention in reducing anxiety and stress levels in nursing students during clinical simulations.BackgroundClinical simulation as a learning strategy has many benefits but the high levels of stress and anxiety it produces in participants can compromise learning, motivation or performance.DesignA quasi-experimental study with a non-equivalent control group design is presented. Forty-two undergraduate nursing students from a natural group were divided into: an experimental group (n = 21) and a control group (n = 21).MethodsBefore conducting a clinical simulation, the experimental group followed a 10-day intensive online mindfulness intervention. All students received the same information and training. Instruments used were: Self-administered Analogue Stress Scale, State-Trait Anxiety Inventory and Five Facet Mindfulness Questionnaire. In addition, physiological data (blood pressure and heart rate) were collected at baseline, pre-briefing and debriefing.ResultsPhysiological variables increased in the prebriefing phase but remained statistically significantly lower in the experimental group (diastolic blood pressure p = .032 and heart rate p = .048). Levels of stress (p = .029) and anxiety (p = .016) were also managed better. Both groups in the debriefing session showed a statistically significant decrease in the different physiological variables, stress and anxiety. No changes in mindfulness were observed.ConclusionsThe clinical simulation is indicated to generate stress and anxiety in nursing students. Therefore, measures must be adopted to control it. The intensive online mindfulness intervention proposed in this study reduced physiological parameters, stress and anxiety in the clinical simulation.     

Clinical environmental stressors and coping behaviors among undergraduate nursing students in Saudi Arabia: A cross-sectional study

ObjectivesThis study aimed to explore the level of stress, stressors sources, and coping strategies used among female Saudi undergraduate nursing students during their clinical practice.MethodsA cross-sectional design was used. Using a convenience sampling technique, female nursing students in Riyadh, Jeddah, and Alahsa who enrolled in clinical courses were recruited from a governmental university from January to May 2022. Data were collected using a self-report questionnaire including socio-demographic characteristics, the Perceived Stress Scale (PSS), and the Coping Behavior Inventory (CBI).ResultsThe degree of stress perceived by the 332 participants ranged from 3 to 99 (54.77 ± 0.95). Stress from assignments and workload was the most common type of stressor perceived by nursing students, with a score of 2.61 ± 0.94, followed by stress from the environment, with a score of 1.18 ± 0.47. Meanwhile, the students used staying optimistic as the most adopted strategy, with a score of 2.38 ± 0.95, followed by the transference strategy, a score of 2.36 ± 0.71, and the problem-solving strategy scored 2.35 ± 1.01. The coping strategy of avoidance is positively correlated with all of the stressor types (P < 0.01), while the problem-solving strategy is negatively correlated with stress from peers and daily life (r = ?0.126, P < 0.05). Transference is positively correlated with stress from assignments and workload (r = 0.121, P < 0.05), and stress from teachers and nursing staff (r = 0.156, P < 0.01). Lastly, staying optimistic is negatively correlated with stress from taking care of patients (r = ?0.149, P < 0.01), and with stress from lack of professional knowledge and skills (r = ?0.245, P < 0.01).ConclusionsThese research findings are significant for nursing educators to identify nursing students’ main stressors and coping strategies used. Effective countermeasures should be taken to promote a healthy learning environment, decrease the level of stressors and improve students’ coping strategies during clinical practice.     

Stress levels and coping strategies among undergraduate nursing students in Greece during economic recession: a cross-sectional study

AimTo identify factors contributing to Greek nursing students’ stress and the coping strategies used.BackgroundStress experienced by nursing students in the context of ongoing economic recession is as yet unexplored.DesignA cross-sectional study .MethodologyUndergraduate nursing students (n = 424) completed the Student Nurse Stress Index (short version) and the Brief COPE questionnaires during the year 2017.ResultsMost of the participants stated that their current financial status (81.7%) contributed towards their experience of stress, and they had higher scores on the interface worries subscale (p < 0.001). Female gender (p < 0.001) seniority (p = 0.005) and stress of transportation from home to university (p = 0.019) significantly increased the SNSI total score as well as most of the stress subscales scores. As far as coping subscales were concerned, higher means were shown in active/positive coping (mean 2.95), seeking support (mean 2.84), expression of negative feelings (mean 2.71) and avoidance (2.47). However, the use of higher maladaptive coping strategies was noted in cases presenting higher SNSI Total score, interface worries and personal problems.ConclusionThe introduction of stress management training and conflict management skills ought to be considered. Fund raising initiatives should be considered to provide financial assistance to those in need.     

Educational environment and approaches to learning of undergraduate nursing students in an Indonesian School of Nursing

The aims of this study were to assess students' perceptions of their educational environment and approaches to learning, and determine if perceptions of learning environment associates with approaches to learning. A survey was conducted to collect data from a regional private university in Indonesia. A total of 232 nursing students completed two questionnaires that measured their perceptions of educational environment and approaches to learning. The measurement was based on Dundee Ready Education Environment Measurement (DREEM) and Approaches and Study Skills Inventory for Students (ASSIST). Five learning environments dimensions and three learning approaches dimensions from two measures were measured. The overall score of DREEM was 131.03/200 (SD 17.04), it was in the range considered to be favourable. The overall score is different significantly between years of study (p value = 0.01). This study indicated that the majority of undergraduate nursing students' adopt strategic approach (n = 139. 59.9%). The finding showed that perceived educational environment significantly associated with approaches to learning. This study implicated the need to maintain conducive learning environment. There is also a need to improve the management of learning activities that reflect the use of student-centered learning.     

Are intensive care units good places for nursing students’ learning compared to other settings? Findings from an Italian national study

ObjectiveTo explore students’ perceived quality of the intensive care unit learning environment during their rotations; to compare these perceptions with that reported by students attending other settings and to assess correlations between the perceptions regarding the quality of the environment and the competences learned.Research methodologyA secondary analysis of data collected by a national cross-sectional study carried out in Italy. A total of 9607 nursing students participated; they ranked the intensive care units’ quality, as assessed by the Clinical Learning Quality Evaluation Index; the perceived competences learned were also ranked with a Likert scale; from 0 = None to 3 = Very much.ResultsA total of 323 (3.5%) participants attended their rotation in an intensive care unit. They perceived the quality of the environment to be significantly higher (n = 2.11 out of 3) than those rotating in non-intensive care unit wards (n = 1.91; p < 0.001). The competences learned by intensive care unit students were significantly higher than that reported by students attending non-intensive care unit wards (n = 2.31 out of 3 vs 2.06 out of 3; p < 0.001).ConclusionIntensive care units are highly appreciated by students, both in terms of their quality learning environment and their capacity to promote learning compared to other settings. Therefore, intensive care units should be considered as a place for clinical rotation to promote positive attitudes regarding critical care patients.     

Effects of blended versus offline case-centred learning on the academic performance and critical thinking ability of undergraduate nursing students: A cluster randomised controlled trial

ObjectiveThis study aimed to compare the effect of blended and offline case-centred learning on medical nursing education for undergraduate nursing students.BackgroundTechnological advancements are rapidly changing nursing education in higher educational settings. Educational reform, especially regarding methods of teaching, has been the focus of nursing educators in recent years.DesignThe research was conducted between September 2018 and July 2019 in China.MethodsSecond-year undergraduate nursing students in two classes were enrolled for this study by cluster sampling. The study outcomes were academic performance and critical thinking ability, measured using the Critical Thinking Disposition Inventory-Chinese Version.ResultsStudents in the experimental class showed significantly higher improvements in academic performance than those in the control class. Compared with the control class, the pre-post difference in competency in critical thinking self-confidence in the experimental class was significantly greater (p = 0.037). In the experimental class, there was a significant improvement over the baseline in the dimension of critical thinking self-confidence (p = 0.022). In the control class, there was a significant improvement over the baseline in the total score (p = 0.029) and two of the seven dimensions: truth-seeking (p = 0.016) and systematicity (p = 0.005).ConclusionsThe use of blended case-centred learning showed promising results in improving students’ academic performance. Both blended and offline case-centred learning were indicated to be effective educational approaches to improve the critical thinking ability of undergraduate nursing students and could be implemented for other nursing subjects in the future.     

Online (versus face-to-face) augmented reality experience on nursing students’ leg ulcer competency: Two quasi-experimental studies

AimThe aim of this study was two-fold. Firstly, to describe the influence of an augmented reality (AR)-based online educational experience on the academic performance and learning determinants of nursing students related to the study of leg ulcer care. We also set out to compare these online results with those obtained in the same experience developed a year before but in a face-to-face design.BackgroundUndergraduate education in nursing aims to train students towards an acceptable level of competence for professional practice. Sometimes, some essential clinical areas of knowledge are particularly challenging for both students and nurse educators. One of these is the care of chronic wounds, particularly in leg ulcers where nurses play a key role. Currently face-to-face teaching methods are evolving to more active contexts and alternative means such as online learning and AR are becoming widely used, garnering encouraging results.DesignA quasi-experimental design was used. Two experiments were carried out to meet the aims of the study, the first one was a pre-test post-test design in one group and the second one a post-test two experimental groups design.MethodsParticipants were undergraduate nursing students from the School of Nursing of the University of Santiago de Compostela (Spain). The two experimental groups received the same training but in different environments: online during 2019/2020 (n = 111) and onsite during 2018/2019 (n = 72). The instruments selected were a knowledge and skills test and two validated questionnaires.ResultsRegarding academic performance, the study demonstrated significant differences towards learning after the AR-based online experience (Z = −9.074; p ≤ 0.001). The participants also showed good results in relation to the learning determinants studied. Compared with students receiving AR-based face-to-face teaching, the students with the online learning approach scored better in the dimensions Autonomous Learning (U=3104.5; p = 0.020) and 3D Comprehension (U=3167.0; p = 0.035). However, the participants in the onsite experience scored higher in the Attention dimension (U=3163.0; p = 0.035).ConclusionsAR positively influences academic performance and diverse educational variables when this experience is carried out online. Since both the online and face-to-face experience show statistically significant benefits in different dimensions of the learning determinants, the need to improve the AR learning experience through blended-learning environments should be promoted.     

Effect of multi-disciplinary teaching on learning satisfaction,self-confidence level and learning performance in the nursing students

AimThe aim of this study was to design a multidisciplinary teaching method that combines game-based learning with a clinical situation–based teaching program and to test learning motivation, learning satisfaction and self-confidence.BackgroundResearch has suggested that game-based learning and clinical situation-based teaching can effectively capture student attention and stimulate student learning motivation as well as increase learning satisfaction and self-confidence.DesignThe randomized and experimental design used in this study was a pretest–posttest control group design.MethodsThis study recruited participants from a technical college in the north of Taiwan. The experimental group (receiving multidisciplinary teaching) comprised 48 participants and the control group (receiving traditional teaching) comprised 50 participants. Participants took a pretest before the multidisciplinary teaching intervention, received a total of 12 weeks of intervention and then took a posttest within 1 week of the end of the course. These participants completed a questionnaire regarding learning satisfaction, confidence and learning performance.ResultsThe multidisciplinary teaching intervention improved learning satisfaction (t = 7.36, p < 0.001), self-confidence (t = 7.34, p < 0.001) and learning performance (t = 6.66, p < 0.001). Multidisciplinary teaching interventions can improve learning satisfaction, self-confidence and learning performance among nursing students.ConclusionsMultidisciplinary teaching should be promoted in the context of nursing teaching and students have the multidisciplinary learning.     

The effect of a brief mindfulness-based stress reduction program on strengthening awareness of medical errors and risks among nursing students

InformationHealthcare professionals' awareness of medical errors and risks results in effective medical error reporting and patient safety. Mindfulness has positive effects on strengthening attention and awareness. However, little is known about the use of mindfulness in patient safety education among nursing students. This study aimed to examine if a brief mindfulness-based stress reduction program would have a beneficial impact on (a) medical error attitudes, (b) the number of medical errors and risks in a simulation environment, and (c) self-confidence and satisfaction among nursing students.MethodsA quasi-experimental design with a control group was conducted with 78 third-year nursing students at a private, accredited, nursing program in Istanbul, Türkiye.ResultsThere was a statistically significant improvement in the intervention group between the pre-test and post-test for medical error attitudes (p < 0.001), and the number of medical errors and risks in a simulation environment (p < 0.001). There was no statistical difference in the intervention and control groups for self-confidence and satisfaction (p > 0.05).ConclusionThese results suggest that a brief mindfulness-based stress reduction program positively strengthens nursing students' awareness of medical errors and risks.     

The effect of laughter yoga applied before simulation training on state anxiety,perceived stress levels,self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AimThis study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students.BackgroundClinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students’ satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training.DesignThe study was designed as a pragmatic randomized controlled trial.SettingThis study was conducted at a university in Turkey.ParticipantsA total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44).MethodsThe intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022.ResultsThis study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05).ConclusionThe findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students’ stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.     

Gaming and anxiety in the nursing simulation lab: A pilot study of an escape room

BackgroundAnxiety accompanying educational simulations is a complex issue impacting nursing students and their learning. Research has provided evidence that some pre-simulation activities can increase student comfort with the simulation environment and may also reduce anxiety. Studies have also provided evidence of promising outcomes for gaming use in nursing education.PurposeThis pilot study explored a medical-surgical escape room game as an introductory simulation experience for nursing students, particularly focused on determining student anxiety levels, and both faculty and student perception of the experience.MethodsA quasi-experimental one group pretest-posttest design was used with a convenience sample to explore student anxiety levels and perceived enjoyment of the game.ResultsStudent anxiety levels significantly decreased (p = .013); however, anxiety levels remained high at posttest. Students reported high enjoyment of the game and provided positive comments.ConclusionEscape rooms can provide an engaging, interactive way to teach nursing concepts in the simulation environment.     

The effect of flipped learning on blood pressure knowledge and self-directed learning skills of first-year nursing students: A randomized controlled trial

AimThis study investigated the effect of flipped learning on first-year nursing students’ blood pressure knowledge levels and self-directed learning skills.BackgroundFlipped learning is an innovative approach that helps nursing students learn about blood pressure and how to measure how to measure blood pressure accurately. Flipped learning also promotes active and student-centered learning settings and encourages nursing students to develop self-directed skills.DesignThis study adopted a pretest-posttest open-label randomized controlled trial.MethodThe sample consisted of 94 first-year nursing students randomized into experimental (n = 48) and control groups (n = 46). The experimental group participants were trained using the flipped learning model. Data were collected using a personal information form, the Blood Pressure Knowledge Test (BPKT) and the Self-Directed Learning Skills Scale (SDLSS).ResultsThere was no significant difference in pretest BPKT scores between the experimental and control groups. However, there was a significant difference in posttest BPKT scores between the experimental and control groups (p = 0.011). Moreover, there was a significant difference between the experimental group's mean pretest, posttest and follow-up SDLSS scores (p = 0.009).ConclusionThe experimental group had a significantly higher mean posttest BPKT score than the pretest score. They had significantly higher mean posttest SDLSS total and “self-monitoring,” “motivation,” and “self-confidence” subscale scores than the pretest score.     

The association of gratitude with perceived stress among nurses in Korea during COVID-19 outbreak

BackgroundDuring the COVID-19 pandemic, nurses might experience added emotional stress. This study examined the relationship between gratitude and psychological stress to explore effective psychological support among nurses.MethodsA cross-sectional survey assessed the level of psychological distress in 646 nurses in Gwangju, South Korea, using the Perceived Stress Scale-10 (PSS-10), Gratitude Questionnaire-6 (K-GQ-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). Sociodemographic factors and COVID-19-related experiences were also examined. A linear regression model was used to determine the factors influencing perceived stress.ResultsThe mean PSS-10 score was 19.0 ± 4.4. Linear regression analyses revealed that the MBI-GS-Exhaustion, PHQ-9, and GAD-7 scores were positively associated with perceived stress, while the MBI-GS-Professional efficacy score was inversely associated with perceived stress. Gratitude disposition using the K-GQ-6 score negatively predicted PSS-10 (β = 0.829, p < 0.001).ConclusionsPsychological interventions that help cultivate gratitude and professional efficacy among nurses can help promote stress resilience throughout the course of the COVID-19 pandemic.     

Effectiveness of a game-based mobile application in educating nursing students on flushing and locking venous catheters with pre-filled saline syringes: A randomized controlled trial

AimThis study aimed to determine the effect of a game-based mobile application on the skill levels of nursing students in respect of flushing and locking of venous catheters with pre-filled saline syringes.BackgroundIn the context of the education of nursing students, a game-based mobile application was used as a motivational aid to improve nursing students’ skills in flushing and locking of venous catheters.DesignA single-blind randomized controlled trial was conducted from August 2020, in a university-affiliated hospital in China.MethodsA total of 154 nursing students were divided randomly into two groups: a control group (n = 77) and an experimental group (n = 77). All the participants received a 30-min theoretical interpretation, 30-min demonstration, and one opportunity to practice. For the next seven days, the participants in the experimental group used a game-based mobile application as a motivational aid to practice their skills in flushing and locking of venous catheters; the control group received no additional intervention. We observed the skill performance and the incidence of errors in the procedural steps of the participants in the two groups at first and seven days later, along with the learning curve of the skills of the experimental group in respect of flushing and locking of venous catheters.ResultsThe final skill performance scores of the nursing students in the experimental group were higher than the average scores of the nursing students in the control group (p = 0.003); The incidence of errors in material preparation rate, hand hygiene, and flushing and locking in the experimental group were lower than that in the control group (p = 0.027, p = 0.035, p = 0.045). Analysis of the learning curve revealed that the experimental group needed an average of 11 repeat practices sessions to master the skills.ConclusionsIn the short term, the game-based mobile application was effective in improving the skills of nursing students in flushing and locking venous catheters with pre-filled saline syringes. It is an effective complement to existing training methods.     

Nursing students’ perceived stress and clinical learning experience

BackgroundStressors among nursing students arise from both academic activities and clinical placement. Understanding how nursing students perceive academic and clinical stressors and the clinical learning environment could help develop useful approaches to reducing levels of stress and contribute to the maintenance of a good learning environment. There is a paucity of studies that investigated associations between the clinical learning environment and the stress of nursing students.ObjectivesTo investigate the relationship between the perception of the clinical learning environment and stress in nursing students; to compare the perception of the clinical learning environment and stress in terms of the year and terms of the organization of supervision.DesignCross-sectional correlation studySettingsUniversityParticipantsThe sample consisted of 155 nursing students in the bachelor's degree program. During the four academic years, students of individual years of the bachelor's study program were included in the study after completing all clinical placements in a given academic year.MethodsThe following instruments were used for the data collection: Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Perceived Stress Scale; Physio-Psycho-Social Response Scale and Coping Behaviour Inventory. Correlation analysis and multiple linear regression analysis using stepwise methods were used to determine the relationships between the variables.ResultsThe clinical learning environment is a strong predictor of students' perceptions of stress related to teachers and nursing staff. Types and degrees of stressful events during clinical practice varied between years of study. The experience with supervision was related to the overall perception of the clinical learning environment, but not to the students' physio-psychosocial status, types of stressful events during clinical practice and coping behaviors. Also, the differences in the students' physio-psychosocial status were not significant in terms of individual years of study and method of supervision.ConclusionsThere is a significant relationship between the clinical learning environment and the perception of academic stress. The attitude of the teacher and the medical staff can thus be important in influencing the level of stress in nursing students.