Effects of unfolding case-based learning on academic achievement,critical thinking,and self-confidence in undergraduate nursing students learning health assessment skills

AimTo determine whether using unfolding case-based learning for undergraduate nursing students learning health assessment skills enhanced academic achievement, critical thinking and self-confidence, in comparison to traditional learning methods.BackgroundUnfolding case-based learning is an effective strategy for nursing students to narrow the gap between classroom learning and clinical practice. Little is known about whether unfolding case-based learning can be applied effectively in learning health assessment skills for undergraduate nursing students in China.MethodsA quasi-experimental design was used in this study. One hundred and fifteen undergraduate nursing students were recruited using convenience sampling from a medical university in southern China. They were assigned to an intervention group (n = 54) receiving unfolding case-based learning of health assessment skills, or a control group (n = 61) using traditional learning methods based on students’ choices. Learning outcomes were evaluated by students’ academic achievement, critical thinking and self-confidence. Data for critical thinking and self-confidence were collected before and after using the teaching strategies.ResultsThe academic achievements of undergraduate nursing students in the intervention group were better than those in the control group. The total average scores of critical thinking (272.51 vs. 266.47) and self-confidence (24.92 vs. 21.04) for nursing students in the intervention group were also higher than those in the control group after implementing teaching strategies. There were statistical differences in the theory test (P = 0.041), skill test (P = 0.013), critical thinking (P = 0.008) and self-confidence (P = 0.036) between the two groups. Additionally, the statistical significance of the scores for critical thinking (264.36 vs. 272.51, P < 0.001) and self-confidence (18.76 vs. 24.92, P < 0.001) before and after teaching strategies were also observed among participants in the intervention group, but not in the control group (P = 0.143, P = 0.738).ConclusionsUnfolding case-based learning may be effective and suitable for undergraduate nursing students learning health assessment skills. The findings of this study provide useful information to nursing teachers for the development of unfolding case-based learning when teaching other nursing skills to undergraduate nursing students.     

Effects of web-based concept mapping education on students' concept mapping and critical thinking skills: A double blind,randomized, controlled study

BackgroundUsing concept maps in nurse education improves students' critical thinking skills. Offering web-based concept mapping education can increase motivation for learning in students actively using the Internet.ObjectivesTo examine the effects of web-based concept mapping education on nursing students' concept mapping and critical thinking skills.DesignThis is a double-blind, randomized, controlled, experimental study.SettingsA nursing faculty at a state university in Turkey.ParticipantsSecond-year nursing students taking the course surgical nursing in the spring term of the academic year of 2018/2019.MethodsThe experimental group (n = 201) was offered web-based concept mapping education before starting practicums. Data were collected using a students' information form, concept map evaluation keys, and the Critical Thinking Motivational Scale at the end of the practicums. A structured questionnaire was used to reveal opinions of the students about concept mapping.ResultsThere was a significant difference in concept mapping scores between the students offered web-based concept mapping education (16.45 ± 10.91) and those not receiving this education (12.70 ± 9.31) (p= .000). Also, there was a significant difference in students' scores for the subscales of Critical Thinking Motivational Scale expectancy, attainment and utility between the groups. The students reported that concept maps facilitated their learning and management of nursing processes but that they occasionally experienced difficulty.ConclusionIt can be concluded that web-based concept mapping education improves concept mapping skills and motivation for critical thinking skills. Web-based education could be utilized as a tool to enhance nursing students' concept mapping and critical thinking skills.     

Mock trials and web-based education using malpractice cases: A randomised controlled trial

BackgroundWeb-based education using malpractice cases is increasingly used as an effective program to improve nurses' patient safety competency, and education on legal obligations is vital for nursing students.AimTo evaluate the effectiveness of web-based education using mock trials of medical malpractice cases in improving nursing students' legal obligations, patient safety competency, and critical thinking.MethodsForty-three senior nursing students were randomly assigned to be exposed to blended learning of mock trials (4 weeks) and web-based education (4 weeks) in experimental group (n = 23), and web-based education (4 weeks) alone in control group (n = 20). Pre-test (before randomisation) and post-test (after intervention) data were collected at a university in Korea between October and December 2019.ResultsThere were statistically significant differences in patient safety competencies (t = 3.59, P = 0.001), including skills (t = 2.89, P = 0.006) and knowledge (t = 2.60, P = 0.013), as well as a significant difference in critical thinking disposition (t = 3.09, P = 0.004) between the two groups in the pre−post changes. The two groups had no difference in knowledge and cognition of legal obligation.ConclusionBlended learning of mock trials and web-based education can enhance nursing students' patient safety competency. In particular, mock trials are an active participatory learning method that helps nursing students develop critical thinking skills to ensure patient safety competency compared to web-based education alone. Incorporating mock trial education using medical malpractice cases into the curriculum could enhance nursing students' patient safety competency and critical thinking disposition.     

Effects of high-fidelity simulation on the critical thinking skills of baccalaureate nursing students: A causal-comparative research study

BackgroundCritical thinking has been identified as one of the standards for nursing school accreditation and a long-standing outcome of nursing education and nursing practice. High-fidelity simulation is one method currently used by nursing programs to increase critical thinking in nursing students. Despite these expectations, there is limited empirical evidence which compares the effects of simulation to other teaching strategies.ObjectivesThe purpose of this study was to examine whether statistically significant differences existed in mean critical thinking skill scores within groups (pretest to posttest) and between groups (simulation versus written case studies).DesignA quantitative causal-comparative methodology with a pretest/posttest design.SettingA private university in the midwestern United States which offers a four-year Bachelor of Science Nursing program.ParticipantsBaccalaureate junior nursing students (N = 69) were recruited from a convenience sample and divided into two groups which consisted of a simulation group (n = 36) and a written case studies comparison group (n = 33).MethodsThis research study consisted of a pretest, three weeks of being in either the simulation group or the written case studies group, and a posttest. The Health Science Reasoning Test (HSRT) was the instrument used for the pretest and posttest to measure critical thinking skills of all participants.ResultsA repeated measures mixed analysis of variance (ANOVA) indicated there was no statistically significant difference in participants' mean critical thinking scores within groups (pretest to posttest) or between groups (simulation versus written case studies).ConclusionsThe use of high-fidelity simulation as a teaching strategy versus written case studies to increase critical thinking skills of nursing students was not supported.     

Comparing the effects of problem-based learning and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course

BackgroundProblem-based learning (PBL) is a method used to develop cognitive and metacognitive skills in nursing students.ObjectivesThe present study was conducted to compare the effects of PBL and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course.DesignThe present study was conducted with a quasi-experimental, single group, pretest-posttest design.MethodsA group of third-year nursing students (n = 40) were recruited from Khorramabad School of Nursing and Midwifery in the west of Iran. The lecture method was used in one group over the first eight weeks of the first semester and PBL was adopted in the second eight weeks. Standardized self-report questionnaires including The California Critical Thinking Skills Test-B (CCTST-B) and the Metacognitive Awareness Inventory (MAI) were administered before and after the use of each of the instruction methods. Data were analyzed in SPSS using the paired t-test.FindingsNo significant changes were observed in the students' critical thinking skills and metacognitive awareness after performing the lecture method. However, a significant increase was observed in the overall critical thinking score (P < 0.01) and its sub-scales of evaluation and deduction (P < 0.05) and in the overall metacognitive awareness score (P < 0.001) after performing the PBL method.     

Is Moulage effective in improving clinical skills of nursing students for the assessment of pressure injury?

BackgroundIn wound care simulations, the practice can be performed on 3D-wounds formed by moulage. Moulage helps the student to perceive the etiology, physiology, and healing processes of the wound, and it can also be used to improve the students' wound assessment skills.ObjectiveThe aim of this study is to investigate the effectiveness of moulage in the improvement of pressure injury assessment skills of nursing students.DesignA quasi-experimental study.SettingsA nursing faculty at a public university.ParticipantsAll fourth-year students (n = 73) who take the simulation elective course were invited to participate.MethodsFall semester students (n = 38) constituted the control group and spring semester students (n = 35) formed the intervention group. The coin-flipping method was used to match the education period and student groups. The intervention group simulation was performed using moulage, and the control group simulation was performed using a pressure ulcer visuals. The same simulation scenarios were used for both groups. The data were collected using the Simulation Design Scale, Student Satisfaction and Self-Confidence Scale, and student identification form, knowledge test, performance checklist and feedback form developed by the researchers.ResultsStudents' knowledge scores for pressure injury assessment have improved significantly in both the intervention group (pre-test:61.71 ± 9.77 and post-test 70.57 ± 12.53, t = −4.27, p < 0.001) and the control group (pre-test: 66.81 ± 13.47 and post-test 73.06 ± 15.50, t = −2.34, p = 0.02). Laboratory and clinical pressure injury assessment skill scores of the intervention group students were significantly higher than the control group. Besides, the correct staging percentages of the intervention group students are higher than the control group students during the clinical practice (χ2 = 5.05, p = 0.02).ConclusionsIt can be concluded that the simulation with moulage was effective in improving the skills of nursing students who received training for pressure injury assessment and in transferring what they learned to the clinical setting.     

Impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults: A Quasi-experimental study

BackgroundWith an aging population, it is critical that nurses are educated and prepared to offer quality healthcare to this client group. Incorporating gerontology content into nursing curricula and addressing students' perceptions and career choices in relation to working with older adults are important faculty concerns.ObjectivesTo examine the impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults and career intentions.DesignQuasi-experimental, pre- and post-test design.SettingMedium-sized state university in the Mid Western United StatesParticipantsData were collected from three student cohorts during the spring semesters of 2012 (n = 98), 2013 (n = 80) and 2014 (n = 88) for a total of N = 266 with an average response rate of 85%.MethodsA survey instrument was administered via Qualtrics and completed by students prior to, and following completion of the course.ResultsThere was an overall significant increase (p = 0.000) in positive perceptions of working with older adults among nursing students following completion of the course. The majority of participants (83.5%) reported having previous experience with older adults. Those with previous experience had higher perception scores at pre-test than those without (p = 0.000). Post-test scores showed no significant difference between these two groups, with both groups having increased perception scores (p = 0.120). Student preferences for working with different age groups suggested an overall increase in preference for working with older adults following the course.ConclusionsA course in gerontological nursing, incorporating learning partnerships with community dwelling older adults, promotes positive perceptions of working with older adults, independently of the quality of prior experience. There was some evidence that students changed their preferences of working with different age groups in favor of working with older adults. Further research should be conducted to determine the mechanisms through which this takes place.     

Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students

BackgroundHigh-fidelity simulation (HFS) offers a strategy to facilitate cognitive, affective, and psychomotor outcomes and motivate the new generation of students.ObjectivesThe purpose of this study was to examine the impact of using high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students.DesignA post-test, quasi-experimental design was used.SettingsTwo private universities in Lebanon were targeted to implement the intervention.ParticipantsA convenience sample of 56 nursing students from two private universities in Lebanon were recruited.MethodsData were collected using the Lasater Clinical Judgment Rubric and the Motivated Strategies for Learning questionnaires.ResultsNursing students exhibited significant improvement in clinical judgment and motivation due to exposure to HFS. There was a significant difference post HFS between the intervention group and the control group in clinical judgment intervention (t = 5.23, p < 0.001) and motivation for academic achievement (t = − 6.71, p < 0.001). The intervention group had a higher mean score of clinical judgment (29.5, SD = 5.4) than the control group (22.1, SD = 5.7) and, similarly, students had higher mean scores of motivation (198.6, SD = 10.5) in the intervention group than in the control group (161.6, SD = 20). The analysis related to differences between the intervention and control groups in motivation and clinical judgment; controlling for previous experience in health care services, the analysis showed no significant difference (Wilk's lambda = 0.77, F = 1.09, p = 0.374).ConclusionThere is a need for nursing educators to implement HFS in nursing curricula, where its integration can bridge the gap between theoretical knowledge and nursing practice and enhance critical thinking and motivation among nursing students.     

Bringing simulation to the classroom using an unfolding video patient scenario: A quasi-experimental study to examine student satisfaction,self-confidence,and perceptions of simulation design

BackgroundTeaching strategies to promote experiential learning in the classroom are important to facilitate students' clinical reasoning abilities. Using video to simulate unfolding patient scenarios in the classroom has the potential to engage students through active learning and to enhance their ability to connect theory to practice.ObjectivesStudy objectives were to: (1) Evaluate nursing students' satisfaction and self-confidence in learning and perceptions of the design of a simulated patient scenario delivered via video in the classroom and (2) Compare findings to students' satisfaction, self-confidence, and perceptions of the design of prior high-fidelity simulation experiences in the laboratory.DesignA quasi-experimental approach was used.SettingThe study setting was a nursing classroom at a University in the southeast United States.ParticipantsConvenience sampling was utilized and 54 students in their final semester of a pre-licensure baccalaureate nursing program participated.MethodsThe intervention was an unfolding video patient scenario delivered in the classroom. Prior to the intervention, participants completed two measurement tools to collect information about their satisfaction, self-confidence, and perceptions of the design of prior high-fidelity simulations. After the intervention, these tools were administered again to collect data about the video simulation experience in the classroom.ResultsParticipants had a higher level of satisfaction (p = 0.002) and self-confidence (p < 0.001) following the classroom intervention than for prior high-fidelity simulations in the laboratory. Student perceptions of the simulation design were more favorable for the classroom intervention than for prior laboratory simulations (p < 0.001).ConclusionsUse of unfolding video patient scenarios in the classroom can promote student engagement in learning. Nurse educators should consider this teaching strategy that provides students with opportunities to connect and apply classroom content to patient care.     

The impact of an educational intervention on nursing students' critical thinking skills: A quasi-experimental study

AimIn this study, we identified the impact of educational activities that focused on improving the competence and critical thinking skills of university nursing students.DesignA prospective quasi-experimental study was conducted, and assessments were conducted before and after the educational intervention, which consisted of seminars, lectures, case studies, and problem-solving activities.MethodsThe Critical Thinking Questionnaire was used to collect data before and after the educational intervention between September 2017 and May 2018. The sample consisted of 112 first-year undergraduate students. To examine the data that were collected as a part of this quasi-experimental study, inferential statistics were used, and the results were tested against a significance level of P < 0.05.ResultsThe students obtained higher scores on the substantive dimension than on the dialogic one, and women scored higher than men. The educational intervention led to an improvement in every critical thinking skill across both dimensions, except listening and speaking skills, whereby men demonstrated a greater change in average scores for critical thinking skills.ConclusionsThe educational intervention improved the critical thinking skills of undergraduate students and had a greater impact on men than on women. This finding underscores the need for educational interventions that can enhance critical thinking skills. Developing these skills will improve future nurses' ability to make health care management decisions in a reflective, agile, and evidence-based manner.     

Using branching path simulations in critical thinking of pain management among nursing students: Experimental study

BackgroundNursing education has to promote nursing students' critical thinking skills especially those who are going to work with people with dementia suffering from pain. Therefore, nursing education needs to incorporate new and effective teaching methods in nursing curricula for critical thinking skills promotion. Branching path simulation is an interactive learning tool which helps students; (1) to make decisions about treatment options for patients and get feedback immediately and (2) to demonstrate and promote their critical thinking skills in a safe and supported environment before dealing with complex and real-life case scenarios.ObjectivesThe present study aimed to examine the effectiveness of branching path simulation in promoting the critical thinking skills of undergraduate nursing students.MethodsThis an equivalent control group pretest-posttest experimental study was done in 2019 on 102 undergraduate nursing students who had registered in both practical and theoretical courses of Advanced Adult Health Nursing. A pretest posttest experimental design with concurrent control group and random assignment to the treatment/nontreatment variable was used and a convenience sample of 102 nursing students was recruited in this study. The students were randomly assigned and divided into two equal intervention and control groups and each group attended different training sessions. The control group was trained by traditional lectures while the intervention group was trained by branching path simulation. The researcher used a demographic questionnaire and the Critical Thinking Self-Assessment Scale (CTSAS) for data collection.ResultsAfter the training sessions, the mean scores of the CTSAS and its subscales domain in the intervention group were significantly higher than the control group.ConclusionsBranching path simulation is an effective teaching method to promote students' critical thinking skills. Future studies are recommended to examine the effect of branching path simulation on other nursing students learning outcomes.     

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate

BackgroundNursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession.PurposeUsing a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs.MethodThis was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI).ResultsScores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (β = 0.93, p < .01), CCTIDI (β = 0.13, p < .001), and class climate (β = 5.20, p < .01). An intraclass correlation coefficient was 55.48%.ConclusionThis study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.     

The effect of cooperative learning on critical thinking of nursing students in clinical practicum: A quasi-experimental study

Critical thinking is a core element of higher nursing education that needs to be promoted during university study. However, lecturing as a teaching method is still heavily used by nurse educators, and nursing students have few opportunities to develop critical thinking skills. This study evaluated the impact of cooperative learning on critical thinking. A quasi-experimental study was conducted (n = 50). Students in the experimental group were arranged into small cooperative groups and completed the clinical practice together, whereas those in the control group practiced individually. After the intervention, total and subscale scores of critical thinking dispositions were significantly higher in the experimental rather than in the control group. The percentage for experiencing positive inclinations or strong dispositions toward critical thinking was 100% among the experimental group, whereas it was 85% among the control group. It is concluded that the cooperative learning-based clinical practicum is helpful for promoting students' critical thinking dispositions.     

Effects of a multifaceted neurological assessment educational program in nursing students: A randomized crossover study

AimThis study aimed to verify the effects of a multifaceted neurological assessment educational program on neurological assessment-related knowledge, skills, communication ability and self-efficacy in nursing students.BackgroundNurses should be equipped with optimal neurological assessment competency to ensure quality care for patients with neurological symptoms.DesignThis study involved a waitlist control group with a randomized crossover design.MethodsFourth-year nursing students were randomly assigned to an intervention group (n = 28) or a waitlist control group (n = 27). Pre- and post-intervention differences in neurological assessment knowledge, skills, communication ability and self-efficacy between the intervention and the waitlist control group were analyzed using generalized estimated equations.ResultsThe nursing students in the intervention group showed significantly improved knowledge, skills, communication ability and self-efficacy scores compared with those in the waitlist control group. Scores related to knowledge, skills and communication ability were maintained and self-efficacy scores had further increased at 2 weeks after the educational program in the intervention group.ConclusionsOur multifaceted neurological assessment educational program is useful for improving nursing students' knowledge, skills, communication ability and self-efficacy.     

Use of aromatherapy to promote a therapeutic nurse environment

BackgroundWorkplace stress can affect nurse satisfaction. Aroma therapy as a therapeutic use of essential oil can be beneficial in reducing stress.PurposeAssess perceived stress pre-post introduction of Essential Oil Lavender among registered nurses, charge nurses, and patient care technicians in a trauma intensive care unit, surgical specialty care unit and an orthopedic trauma unit.MethodsPre-post intervention with a quasi-experimental design. After a pre-survey, Essential Oil Lavender was diffused 24 h per day over 30 days in a designated nursing area that all nurses were not required to enter on each unit.ResultsDependent sample t-test for “how often do nurses feel stressed a work in a typical week” revealed pre-survey mean 2.97 (SD = 0.99) which was significantly higher than post-survey mean 2.70 (SD = 0.92) with significance, t(69) = 2.36, p = 0.021, suggesting a difference in how often staff felt stressed at work in a typical week, trending down from “feeling stressed half of time” to “once in a while”. There were no statistically significant differences in pre-post survey scores for TICU, TOU, or SSC as separate units.RelevanceUse of essential oils to decrease work-related stress among nursing staff may improve retention, workplace environment, and increase nurse satisfaction.