Undergraduate nursing students' use of video technology in developing confidence in clinical skills for practice: A systematic integrative literature review

Aims and objectivesThis review examines the current evidence of the effectiveness of the use of video or video podcast technology produced either commercially or in-house in developing nursing students' confidence in clinical skills for practice.BackgroundThe ability of graduates to provide safe, quality, nursing care is the core of any nursing education curriculum. Developing teaching and learning strategies to enhance skills development and confidence is challenging for educators, particularly with contemporary and diverse student populations requiring student-centred, technology-enhanced learning.DesignAn integrative review framework.Review methodsA systematic search was conducted using the following eight databases: CINAHL, MEDLINE, ProQuest, PubMed, ERIC, Scopus, EMBASE, and Google Scholar. Selection criteria included: published in English, involving undergraduate nursing students, measuring confidence in relation to skills development, and using video or video podcasts.ResultsFour studies met the inclusion criteria, with six themes identified. Four themes emerged: Pedagogy; Skills performance and competency; Student satisfaction and confidence in relation to skills development; Technical constraints. Two additional themes related to the impetus for introducing video podcasts: first, time as an institutional, curricular, and academic/student challenge; and second, meeting the generational needs of students.ConclusionThis review demonstrates that video technology teaching methods and traditional teaching methods used in conjunction with each other create the most positive learning environment. Although video technology methods provide a flexible teaching option for the contemporary student population, developing and delivering videos in a clinical skills program need to be conceptualised within an appropriate pedagogical approach to ensure a purposeful and meaningful learning experience. Whilst student confidence was embedded within other evaluations, it is not clearly reviewed or understood; therefore, further research is required in this area.     

Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing

BackgroundConducting mental status examination and suicide risk assessment is an important skill required of nurses when they are in the clinical setting. With nursing students often expressing the anxiety and lack of confidence in doing so, the use of standardized patients provide an excellent opportunity to practice and become proficient with this skill in a simulated environment.ObjectivesTo explore the learning experience of undergraduate nursing students using standardized patients while practising their mental status examination and suicide risk assessment skills in mental health nursing module.DesignA pre- and post-test, single group quasi experimental design was used in this study. A standard didactic tutorial session and a standardized patient session was conducted to evaluate the learning experience of undergraduate nursing students learning mental status examination and suicide risk assessment. Outcome measures for this study include Student Satisfaction and Self-Confidence in learning scale.Qualitative comments in the form of open-ended questions were also collected in this study.SettingsA University offering nursing program from undergraduate to postgraduate level.ParticipantsA convenience sample of Year 2 undergraduate nursing students undertaking the mental health nursing module was included in this study.ResultsThe use of standardized patient session had significantly increased students' satisfaction and confidence level before they are posted to a mental health setting for their clinical attachment. There was a significant difference on students' self-confidence level for those who have taken care of a patient with mental illness after adjusting for pre-test on score in learning. Qualitative feedback obtained from students showed a positive outlook towards the use of standardized patient as an effective tool in augmenting didactic learning into practical skills.ConclusionsUsing standardized patient in mental health nursing education enhanced the integration of didactic content into clinical setting allowing students to practice their assessment skills learned in classroom and transfer it to the clinical area. The benefits of using standardized patient include allowing students to practice their communication skills and improving their confidence level in conducting mental status examination and suicide risk assessment by reducing anxiety as compared with traditional classroom and textbook-based pedagogy.     

Concerns of nursing students beginning clinical courses: A descriptive study

BackgroundStudents harbor fears related to the clinical environment that influence their participation and learning. Some studies have addressed general anxieties in undergraduate nursing students, but few have asked students to report their fears and concerns prior to entering the clinical environment. Therefore, this study examined the fears and concerns of undergraduate nursing students beginning clinical courses as well as their continued concerns upon completion of the first year of instruction. The study also assessed their confidence in physical assessment skills.MethodsNinety-six junior nursing students enrolled in a generic baccalaureate nursing program completed a survey, two items of which asked about their fears and concerns related to beginning clinical experiences and their confidence in physical assessment. A follow up survey was completed at the end of the junior year by 72 students.ResultsMaking a mistake, lack of course success, and not knowing how to do something were students' major concerns prior to the start of clinical experiences. Bad experiences with a nurse or instructor, freezing up, and uncomfortable patient/family experiences were also concerns. Not knowing how to do something persisted as a concern at the completion of the first year. Fears about being/feeling left alone in a clinical setting as well as concern about the senior year also emerged on the post survey. Confidence in physical assessment was a mean of 60.46 on a scale of 0–100 at the beginning of clinical instruction and 71.28 at the end of the junior year.ConclusionsFaculty should structure learning activities that decrease anxiety and enhance students' confidence prior to initial clinical experiences. Opportunities might include in-depth orientation to clinical settings and various simulations that allow practice of skills and communication. Awareness of predominant student fears and concerns can also guide staff nurses to provide a welcoming environment and enhance learning.     

The diversity of Iranian nursing students' clinical learning styles: A qualitative study

BackgroundNumerous factors, including learning styles, affect the learning process of nursing students. Having insights about students' learning styles helps promoting the quality of education. The aim of this study was to explore the Iranian baccalaureate nursing students' learning styles in clinical settings.MethodsA qualitative design using a content analysis approach was used to collect and analyze data. Semi-structured interviews were conducted with fifteen Iranian baccalaureate nursing students selected using a purposive sample method.FindingsDuring data analysis, it was found that nursing students employed different clinical learning styles such as ‘thoughtful observation,’ ‘learning by thinking,’ and ‘learning by doing’.ConclusionStudents adopt different learning strategies in clinical practice. Designing teaching strategies based on students' learning styles can promote students' learning and maximize their academic and clinical practice success. Nursing educators, curriculum designers, and students can use the findings of this study to improve the quality of nursing education in both the classroom and clinical settings.     

Fourth year nursing students' perceptions of their educational preparation in medication management: An interpretative phenomenological study

BackgroundMedication safety is an integral aspect of patient safety. Nurses, as advocates of patient safety, actively consider medication safety in the course of their daily work. Hence, it is important to consider the educational preparation of nursing students in medication management, as future caregivers. There are inherent links between nurses' undergraduate educational preparation in medication management and patient safety.ObjectiveThis research study identifies fourth-year nursing students' perceptions of their educational preparation in medication management.DesignAn interpretative phenomenological methodological approach underpinned this research study.SettingThis study was conducted at a University in the West of Ireland.ParticipantsParticipants were final year students of three undergraduate nursing programmes, Bachelor of Science in Nursing (General), Bachelor of Science in Nursing (Intellectual Disability) and Bachelor of Science in Nursing (Mental Health).MethodsFourteen semi-structured, face-to-face interviews were conducted with students on a one-to-one basis. Data were analysed using thematic content analysis.ResultsThe voices and interpretations of the participants in this study were fundamental to understanding nursing students' perceptions of their preparation in medication management and provided the foundation for this research. These perceptions were captured in the format of four themes: developing an understanding, embedding knowledge in practice, engaging in practice and accepting professional responsibility.ConclusionsFindings point to the important role of the university and the clinical placement settings in nursing students' medication management education and the need for further collaboration and development across both settings. Teaching and learning strategies which promote the integration of theory and practice throughout the four years of the undergraduate degree programme should be encouraged, such as technology enhanced learning and simulation.     

Can podcasts for assessment guidance and feedback promote self-efficacy among undergraduate nursing students? A qualitative study

BackgroundImproving assessment guidance and feedback for students has become an international priority within higher education. Podcasts have been proposed as a tool for enhancing teaching, learning and assessment. However, a stronger theory-based rationale for using podcasts, particularly as a means of facilitating assessment guidance and feedback, is required.ObjectiveTo explore students' experiences of using podcasts for assessment guidance and feedback.To consider how these podcasts shaped beliefs about their ability to successfully engage with, and act on, assessment guidance and feedbackDesign Exploratory qualitative study.Setting Higher education institution in North-East Scotland.Participants Eighteen third year undergraduate nursing students who had utilised podcasts for assessment guidance and feedback within their current programme of study.MethodsParticipants took part in one of four focus groups, conducted between July and September 2013. Purposive sampling was utilised to recruit participants of different ages, gender, levels of self-assessed information technology skills and levels of academic achievement. Data analysis was guided by the framework approach.FindingsThematic analysis highlighted similarities and differences in terms of students' experiences of using podcasts for assessment guidance and feedback. Further analysis revealed that Self-Efficacy Theory provided deeper theoretical insights into how the content, structure and delivery of podcasts can be shaped to promote more successful engagement with assessment guidance and feedback from students. The structured, logical approach of assessment guidance podcasts appeared to strengthen self-efficacy by providing readily accessible support and by helping students convert intentions into action. Students with high self-efficacy in relation to tasks associated with assessment were more likely to engage with feedback, whereas those with low self-efficacy tended to overlook opportunities to access feedback due to feelings of helplessness and futility.ConclusionsAdopting well-structured podcasts as an educational tool, based around the four major sources of information (performance accomplishments, vicarious experience, social persuasion, and physiological and emotional states), has potential to promote self efficacy for individuals, as well as groups of students, in terms of assessment guidance and feedback.     

Using video podcasting to enhance the learning of clinical skills: A qualitative study of physiotherapy students' experiences

BackgroundVideo podcasts, or vodcasts are increasingly used by a range of healthcare professions in the mastery of new skills. Little is known about the experiences of using vodcasts in physiotherapy education. Traditional pedagogic strategies have been employed in order to master those skills required for physiotherapy practice. There have been advances in the use of technology in medical education in the nursing, dentistry and medical fields. Vodcasts offer great versatility and potential when used as a pedagogical tool, embedded within a physiotherapy curriculum.AimTo explore students' experiences of using technology enhanced learning, namely vodcasts, in the Physiotherapy curriculum to develop the learning of clinical skills.MethodA series of focus groups were carried out with undergraduate and pre-registration physiotherapy students (n = 31).FindingsStudents valued the versatility and audio-visual nature of vodcasts; helpful in revising for practical examinations and practising their skills prior to, during and after taught skills classes. Watching and practising simultaneously allowed students to practice repeatedly and formulate a process for each skill. When learning a new skill, a combination of teaching and learning approaches was favoured, marrying traditional approaches with those that utilise technology.ConclusionsThis study's findings add to the existing body of evidence in skills based teaching and support a multi-media, blended approach in those disciplines involved in the learning and teaching of clinical skills.     

Contextualising numeracy skill development and assessment in a first year undergraduate nursing subject: A mixed methods research study

BackgroundUndergraduate nursing students continue to perform poorly on clinically-related numeracy tasks, making errors that betray fundamental misconceptions about the underlying mathematics. Graduate nurses are also prone to error in this area but they have the benefit of performing their calculations in a real-world setting with the assistance of colleague nurses if required. These conditions are difficult to simulate in a classroom environment, but when effort is made in this direction the effects can be rewarding for students and educators.ObjectivesTo investigate the effect on undergraduate nursing students' learning experience and test performance of a practical, clinically contextualised numeracy workshop featuring individual and collaborative modes of assessment.DesignA mixed methods study using pre and post tests and a survey.SettingsClinical practice classrooms at an Australian university.ParticipantsFirst year undergraduate nursing students undertaking a subject whose curriculum features medication safety and clinically-related numeracy.MethodsAdministration of individual and collaborative short-answer pre and post tests, a survey, and facilitation of team-based, clinically-related numeracy activities over a 1.5 h workshop. All test marking, data collection and analysis were performed by the authors.ResultsPositive responses to survey questions probing students' judgement of the effect of contextualised learning on their confidence, engagement and proficiency in nursing numeracy, as well as the value of working in a clinical setting. Significant improvement in students' performance in pre/post tests.ConclusionsContextualised, practical and collaborative learning and assessment of nursing numeracy is valued by students and has a positive effect on their experience and performance in the content area.     

Impact of experiential dementia care learning on knowledge,skills and attitudes of nursing students: A systematic literature review

AimThe aim of this systematic review was to synthesize evidence on the effect of clinical experiential learning approaches on pre-licensure nursing students' competence in dementia care and to identify associated challenges.BackgroundAs the prevalence of dementia increases, nurse educators must proactively prepare pre-licensure nursing students to care for people living with dementia. The limited number of physical clinical learning settings, especially during the current COVID-19 pandemic, has caused many nursing programs to use alternative experiential learning approaches.DesignSystematic Literature ReviewMethodsIn accordance with PRISMA guidelines, we conducted a systematic search for the literature in Cumulative Index to Nursing and Allied Health Literature, MEDLINE and ProQuest for relevant peer-reviewed studies published between 2010 and 2021. Using the Boolean operator search approach, the keyword "dementia care" was combined with "AND/OR" and other search terms. In addition, a descendent and an ascendent search were conducted to find other relevant studies.ResultsA total of 17 retrieved articles met the inclusion criteria. Five themes emerged, with the main findings being that face-to-face (in person), virtual and simulated experiential learning approaches increased pre-licensure nursing students' dementia care knowledge. However, the face-to-face experiential learning approach that provides physical contact with people living with dementia and clinical staff had more impact on their skills and attitudes.ConclusionThe evidence in this review could inform curriculum development, teaching methods, experiential learning experiences and clinical placements of pre-licensure nursing students with regards to dementia care. More research is needed to explore further the impact of virtual and simulated experiential learning approaches on pre-licensure nursing students' dementia care skills.Tweetable abstractThis systematic literature review synthesizes evidence of clinical experiential learning on prelicensure nursing students' competence in dementia care per PRISMA guidelines. Five themes emerged #dementia #experientiallearning #prelicensurenursingstudents #clinicalsducation     

First year undergraduate nursing students’ perceptions of the effectiveness of blended learning approaches for nursing numeracy

The ability to safely calculate and administer medications are indispensable, core nursing skills in nursing education and practice. Therefore, it is imperative that nursing students are adequately prepared with the necessary numeracy skills during their undergraduate nursing studies. The focus of this study, conducted at a single multi-campus university in the western Sydney region of Australia, was to determine the effectiveness of a suite of blended learning approaches on numeracy self-efficacy from the students' perspective. Surveys were administered as part of the study and included open-ended questions. 525 students provided open-ended responses that were analysed by the research team. Four main themes were identified from the open-ended responses: (i) Self-realisation; (ii) Practice, practice, practice; (iii) Boosting confidence; and (iv) Wanting more. The themes captured students' perceptions of the benefits of having a rigorous learning design in blended learning approaches. The study showed that a structured pedagogical approach to nursing numeracy in undergraduate programs improved students’ self-reported self-efficacy with mathematics and assisted students in realising the importance of learning and applying these skills as nursing clinicians.     

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.DesignExplorative qualitative focus group study.MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.     

Trying on the professional self: nursing students' perceptions of learning about roles,identity and teamwork in an interprofessional clinical placement

AimThis study aims to describe how senior nursing students viewed the clinical learning environment and matured their professional identity through interprofessional learning in a student-led hospital ‘ward’.BackgroundUndergraduate nursing and medical student teams participated in a trial of ward-based interprofessional clinical learning, managing patients over 2 weeks in a rehabilitation ward.MethodsQualitative and quantitative program evaluation was conducted using exit student focus groups and a satisfaction survey.ResultsTwenty-three nursing and medical students in three placement rounds provided positive feedback. Five main themes emerged describing their engagement in ‘trying on’ a professional role: ‘experiencing independence and autonomy’; ‘seeing clearly what nursing's all about’; ‘altered images of other professions’; ‘ways of communicating and collaborating’ and ‘becoming a functioning team’.ConclusionsWard-based interprofessional clinical placements offer senior students authentic ideal clinical experiences. We consider this essential learning for future interprofessional collaboration which should be included in senior nursing students' education.     

Use of a flipped classroom in ophthalmology courses for nursing,dental and medical students: A quasi-experimental study using a mixed-methods approach

BackgroundTraditional teaching is associated with dilemmas, such as low motivation to learn and passive learning. In contrast, use of a flipped classroom with the proper learning design has the potential to promote accelerated learning, bolster transmission of competencies (i.e., critical thinking, communication and problem-solving skills) and improve teamwork capacity, all of which are of great significance in professional healthcare practice, including nursing, dentistry and medicine.ObjectiveThe aim of the study was to examine the effects of using a flipped classroom in ophthalmology courses for undergraduate nursing students, dental students and higher vocational medical students.DesignA quasi-experimental design was used with an intervention (n = 100) and a comparison group (n = 100), pre-/post-testing measures and a mixed-methods approach.SettingA university in China.ParticipantsA total of 200 students were included.MethodsStudents' self-rated learning ability was measured before and after the courses, and skill exams were performed after the courses. In addition, interviews were conducted with the clinical medical students concerning their experiences of the flipped classroom.ResultsStudents' self-rated learning ability improved significantly more in the intervention than in the comparison group, for the total scale and the three factors ‘learning goals’, ‘self-efficacy and social learning’ and ‘problem-solving’. Skill exam scores were statistically significantly better in the intervention than in the comparison group. On the whole, the clinical medicine students felt the flipped classroom had a positive impact and improved their learning ability as well as knowledge in ophthalmology.ConclusionsUse of a flipped classroom for nursing, dental and clinical medical students in ophthalmology courses shows promising results in the form of students' skill exam scores and self-rated learning ability.     

Evaluation of the symptom-focused health assessment and empathy program for undergraduate nursing students: A randomized controlled trial

BackgroundHealth assessments are a vital competency required of nurses. The more traditional ways of teaching and learning this skill require practice and are often limited by time constraints. With the rise of technology-based platforms, students can supplement their learning health assessment skills through other means, such as videos, that not only teach the steps but also allow them to learn in context.ObjectivesThis study describes how a symptom-focused health assessment and empathy (SHAE) program, which primarily involves the use of a case-based health assessment video, was implemented and evaluated.DesignThe study involved a single-centre, single-blind, parallel randomized controlled trial.SettingsThe study was conducted at a university in Singapore.ParticipantsYear one undergraduate nursing students enrolled in the Comprehensive Health Assessment (CHA) module during semester two of the academic year 2018/2019 participated in the study.MethodsParticipants were randomized into one of the two parallel groups: the experimental group or the waitlisted control (WL) group. The experimental group received the SHAE program in addition to conventional learning methods (e-lectures, lab demonstration, and pair practice). The WL group received only the conventional learning methods. Pre- and post-test measures of the study variables such as knowledge, health assessment skills, confidence, empathy, and intention to learn were conducted. The WL group was given access to the SHAE program after the post-test. Analyses of covariance (ANCOVA) were used to compare the means of the study variables between the intervention and WL groups.ResultsParticipants in the intervention group had significantly higher scores on knowledge (p = 0.016), confidence (p = 0.03), and health assessment skills (p = 0.004). No significant differences in intention to learn and empathy between the two groups were found.ConclusionThe use of a case-based video has the potential to be a valuable method of teaching health assessments in context to nursing students. The SHAE program has shown beneficial effects on students' knowledge, health assessment skills, and confidence. However, there was no effect on students' intentions to learn and their empathy. Further refinements of the program will need to focus on improving these domains.