Student nurses' perceptions of clinical decision-making in the final year of adult nursing studies

This paper focuses upon an exploration of undergraduate students' perceptions of clinical decision-making skills in their final year of a baccalaureate adult nursing programme. A phenomenological study was carried out, with a sample of 21 students undertaking their nursing management module. They produced a consensus concept mapping of clinical decision-making and completed self-assessment questionnaires exploring their personal confidence and understanding of clinical decision-making. Twelve students from this group also participated in a focus group interview to further explore their conceptualisation of clinical decision-making. Although the students demonstrated a complex theoretical conceptualisation of clinical decision-making, they tended to focus on the impact of clinical decision-making, and the value of concrete experience rather than the value of cognitive skills in the process and application of decision-making theory to practice. They linked their level of clinical knowledge and experience with their level of skill in clinical decision-making, rather than their cognitive ability. The students identified the patient as the focus of clinical decision-making, and reflected concerns about the personal impact of clinical decision-making on themselves, and the quality of care as the main factors influencing their decisions.     

临床实习中师生沟通情况及其影响因素的调查分析

目的 调查护理专业学生与临床带教教师之间的沟通情况,并分析其影响因素,为临床护理教学提供参考.方法 自行设计问卷,采用方便抽样的方法对155名护理本科实习学生和45名带教教师进行师生沟通现状及影响因素调查.结果 临床师生沟通状况得分为(12.58±10.93)分(学生问卷)和(15.24±17.33)分(带教教师问卷).在对师生间沟通的影响因素认知上,学生认为带教老师的性格、自身性格、带教教师忙碌是主要影响因素,带教教师认为学生性格、自身性格、学生态度差、学生不重视实习、工作忙碌是主要影响因素.结论 临床实习中师生沟通状况有待进一步提高,主要影响因素包括师生双方性格、工作忙碌、学生态度差、学生不重视实习,应关注其对师生沟通状况的影响,并开展相应的教育和培训,以促进师生沟通.     

高职实习护生关怀行为表现的调查

目的 探讨高职实习护生关怀行为表现及影响因素.方法 自行设计护生关怀行为调查问卷对435名高职实习护生进行调查.结果 高职实习护生关怀行为平均得分为（44.34±10.18）,得分最高的项目为“我能帮助满足病人的需求”,为（2.21 ±1.63）分,得分最低的项目为“我能正确解释病人的非语言表达的信息”,为（1.65 ±0.80）分,属中等偏上水平.97.93％的学生认同在临床实习中表现出关怀行为非常重要,61.15％的同学表示对学习护理知识技能有兴趣或者非常有兴趣,66.44％的学生表示对参加临床实习感兴趣或者非常感兴趣.影响关怀行为表达的相关因素有护生对关怀行为的认同度、对护理专业感兴趣程度、身边榜样的作用、带教老师的教学技巧以及实习环境的支持程度.结论 高职护生关怀行为仍然有待提高,加强关怀理念的传达、强化沟通技巧的训练及加强老师的角色模范作用可能有助于改善护生关怀行为.     

Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study

AimTo evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulation-based training in emergency nursing on final-year nursing students’ generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants’ satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module.BackgroundFollowing the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of high-fidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated.DesignA mixed methods study incorporating quasi-experimental and qualitative components.MethodsWe recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decision-making skills. We also explored the participants’ post-intervention satisfaction, experiences and opinions.ResultsPost-intervention, the participants reported significant improvements in generic capabilities, self-confidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings.ConclusionsThis study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students’ learning outcomes. Further studies should include a control group, evaluate students’ knowledge and skills, and retention of knowledge to confirm the true impact of such training.     

西南多民族地区低年级护生学习热情及其影响因素调查

目的了解和分析低年级护理本科生学习热情及其影响因素,以构建针对性教育方案,提高学习热情。方法采用横断面调查的方法,对94名护生进行问卷调查。用非条件Logistic回归分析其学习热情及影响因素。结果合格回收问卷94份,护生学习热情较高者71名,占75．53％;较差者23名,占24．47％。护生对专业理论知识、操作技能以及现有的课程设置的评价两者比较无统计学差异（P〉0．05）;就是否改换专业以及就业态度的比较两者差异有统计学意义（P〈0．05）;多因素分析结果显示,学生来源、专业的作用及意义、工作辛苦程度是影响护生学习热情的主要因素。结论低年级护生专业认同感较差;影响学习热情的主要因素是学生来源、专业的作用及意义、工作辛苦程度。     

Exploring the meaning of undergraduate nursing students' experiences and confidence in clinical skills using video

BackgroundStudents and health care faculty staff report a lack of confidence in graduating nurses' clinical skills practice. Traditional approaches to support nursing students' clinical skills development have relied on small group, face-to-face, practice-based learning in clinical laboratories. However, with changing curricula, increased numbers of students, and pressure on laboratory timetables and availability, alternate methods of delivery are necessary to ensure students gain confidence in the development of their clinical skills. Video podcasting is an innovative approach that is being used to stimulate active and ongoing learning of clinical skills.DesignA hermeneutic phenomenological approach.MethodData were collected through in-depth interviews with 10 second-year, undergraduate nursing students about their experiences using three clinical skills video podcasts and their perceptions of how this impacted on their learning of these clinical skills and confidence in practice.FindingsThree themes emerged from the data: ‘Accessibility for learning the skill’; ‘Preparation for learning and practice’; and ‘Student-directed learning’. These themes provided an insight into the students' engagement with video podcasts, demonstrating their sense of confidence was increased in clinical skills development.ConclusionThe findings of this study provide an insight into the students' engagement with video podcasts in relation to their confidence in clinical skills development, and indicate that undergraduate nursing students value the use of video podcasts in their learning of clinical skills. However, it was evident that students still value face-to-face delivery to guide their study, which suggests that video podcasts could be used as an adjunct to teaching to support learning.     

Psychomotor skills laboratories as self-directed learning: a study of nursing students'' perceptions

Fifty-nine baccalaureate nursing students were surveyed regarding their preferred method of learning psychomotor skills necessary for clinical practice. In addition, 12 faculty members were also asked to express their opinions of the best way for students to learn psychomotor skills. The use of a self-directed clinical laboratory was supported by both students and faculty in this study. Hands on and visual pre-clinical experiences with adequate equipment were the major factors influencing the students' requests for clinical laboratories. Faculty expressed the same concerns about equipment and human resources, but their support of the laboratory was tempered and based on the presence or absence of adequate human resources and equipment available to students in the clinical setting.     

Nursing students learning to utilize nursing research in clinical practice

The purpose of the study was to examine the significance of a learning assignment in relation to research skills and learning of nursing students in clinical practice. The learning assignment included an oral presentation of a nursing research article, which the students gave to their fellow students and ward nurses. The students also chaired the discussion after the presentation. The target group for the study was nursing students of a Finnish polytechnic who had been studying for 2-2 1/2 years and had accomplished a minimum of 120 ECTS credits of the total of 210 ECTS credits. When participating in the study, the students were completing a six-week clinical practice of optional studies. The data were collected with a questionnaire designed for the study. It consisted of six open-ended questions. Three of the questions were related to learning of research skills. Two questions were concerned with learning during the ongoing clinical practice. The final question inquired the students' views on the development of the learning assignment. The students received the questionnaire before the commencement of their clinical practice, and they returned it to the other researcher after their clinical practice. The questionnaire was given to 80 students, of which 50 returned it; the response rate was 63%. The data were analysed by content analysis question by question. According to the results, the learning assignment advanced the understanding of research concepts for the majority of the students. In particular, the students reported that the oral presentation clarified the research concepts, and the structure of a scientific article was also elucidated. The students stated that the assignment generated ideas concerning the development of nursing care. In relation to the ongoing clinical practice, the assignment advanced patient encounters and interaction, and bearing responsibility the most. Proposals for the further development of the learning assignment were expressed by more than half of the nursing students. Half of them suggested ensuring the interest in the topic from the ward.     

Nursing students' perceptions about clinical learning environment in Turkey

Clinical education has a vital role in nursing curriculum. Clinical education environment can be enhanced by feedbacks provided by students. The purpose of this research was to search factors that affect the clinical learning environment. A qualitative approach was used. 36 nursing students were recruited from school of nursing in Turkey. It was found that students are negatively affected by communication errors and feedbacks given in the presence of patients by instructors. The constant presence of instructors may be the source of stress for some students. Besides peer support and favourable communication with peers have a positive impact on student learning. Communication with hospital staff and instructors are important. The study revealed that student learning is affected by the level of confidence and support displayed by patients. In order to ensure the most favourable learning environment for students, it is essential that cooperation should be increased between school staff and clinical staff, instructor skills should be developed, and students should be supported in the clinical environment.     

Developing clinically savvy nursing students: an evaluation of problem-based learning in an associate degree program

Faculty in an associate degree nursing program at a community college in NewYork City noted that nursing students lacked critical analysis, problem-solving, and decision-making skills and the reflective ability essential to applying nursing knowledge in clinical situations. This study reports on the use of problem-based learning as a teaching strategy and its impact on the development of critical thinking and communication skills in nursing students.     

情景模拟法在高职高专护生护理实践教学中应用现状与分析

目的:了解情景模拟法在高职高专护生护理实践教学中的应用现状,分析其存在的问题,提出提高情景模拟教学效果的对策。方法:采用自制问卷,对我院212名高职高专护生进行情景模拟教学作用、效果及可能影响因素的调查。结果:90%以上护生认为情景模拟教学能激发护生的学习兴趣,提高护理实践水平,有助于沟通能力和团队合作精神的培养。情景模拟教学效果可能的影响因素调查中,88.68%的护生认为影响教学效果的因素是模拟的主题和内容对护生吸引力不够;82.55%的护生认为模拟环境气氛不够逼真,缺乏临床气氛;74.06%的护生认为课堂时间不够充足;71.23%的护生认为教师对操作没有及时作出评价等。结论:情景模拟是开展护理实践教学的重要手段;提高情景模拟教学效果的关键在于教师精心设计和组织情景模拟教学及课后开放护理实验室。     

Paradigm case analysis and stimulated recall: strategies for developing clinical reasoning skills

Development of clinical reasoning skills was a major objective of a collaborative venture between a university school of nursing and a tertiary care teaching hospital. Two elective courses and an 8-month practicum were offered at the graduate level to students specializing in perinatal nursing. Through analysis of their own cases and those of clinical experts, students gained expertise in tracing the development of their decision-making skills. In the clinical practicum, where it was less feasible for the student and preceptor to withdraw from the clinical setting to discuss the decision-making process, "stimulated recall" was employed. This strategy uses segments of nurses' actual practice, on site, at the time of care delivery. In this way, the total context of the clinical reasoning process of nurses can be examined. In this paper, the two strategies are discussed with illustrations from the actual teaching/learning situations.     

Learning to nurse in China--structural factors influencing professional development in practice settings: a phenomenological study

This paper describes findings from a stratified phenomenological investigation into Chinese nursing students' experiences of learning in practice placements. The investigation was undertaken in China whilst studying at an English University for a post-graduate degree. With the transition of Chinese nursing education into higher education institutions, clinical nursing experience remains a fundamental factor in students' preparation for qualification. This small phenomenological study sought to understand the kinds of experiences students encounter, the factors that supported or inhibited their learning and the ways in which learning in practice could be enhanced. This paper concentrates on the structural factors that influenced students' learning. These structural factors included; the opportunities available for students to learn, students' participation in clinical nursing activities; the relationship that placement staff were willing to engage in with the students and the prevailing learning climate of the placement setting.     

A comparison of the cooperative learning and traditional learning methods in theory classes on nursing students' communication skill with patients at clinical settings

The purpose of this study was to compare the effect of traditional learning and cooperative learning methods on nursing students' communication skill with patients. This was an experimental study in which 34 nursing students in their 2nd semester of program participated. They were divided randomly into two groups, a control group who were taught their medical/surgical nursing course by traditional learning method and an experimental group, who were taught the same material using cooperative learning method. Before and after the teaching intervention, the students' communication skills with patients at clinical settings were examined. The results showed that no significant difference between the two groups in students' communication skills scores before the teaching intervention, but did show a significant difference between the two groups in the interaction skills and problem follow up sub-scales scores after the teaching intervention. This study provides evidence that cooperative learning is an effective method for improving and increasing communication skills of nursing students especially in interactive skills and follow up the problems sub-scale, thereby it is recommended to increase nursing students' participation in arguments by applying active teaching methods which can provide the opportunity for increased communication skills.     

新疆不同民族实习护生自主学习能力及其影响因素研究

目的了解新疆不同民族实习护生自主学习能力及其影响因素。方法采用护生自主学习能力调查表对新疆3所高等护理院校的466名实习护生进行问卷调查。结果新疆各民族实习护生自主学习能力总分为(91.39±11.24)分,得分率从高到低的维度分别是学习合作能力、自我管理能力和信息能力;影响汉族实习护生自主学习能力的因素为学历、喜欢本专业程度、对临床带教方式的满意程度及实习过程中有无自主学习和评判性思维培训经历;影响回族实习护生自主学习能力的因素为学历、工作是否有成就感、有无自主学习和评判性思维培训经历;影响维吾尔族和哈萨克族实习护生自主学习能力的因素是有无自主学习培训经历。结论新疆护理教育部门应针对不同民族实习护生的自主学习能力特点制订灵活的指导方法,才能有效提高新疆各民族护生的整体水平。     

护理专业学生对临床情境下基于问题的学习问诊体验的研究

目的探讨学生对临床情境下基于问题的学习(problem-based learning,PBL)问诊的体验。方法对12名完成临床PBL问诊学习的学生进行半结构式访谈,了解学生的体验,用Colaizzi内容分析法对资料进行分析。结果共提取"压力与挑战""应对方式""感知的教师支持""收获与反思"4个主题。结论基于临床PBL的问诊学习有助于培养学生的问诊技能、提升护理专业认同感。建议下一步在学生进入临床问诊前增加基于标准化病人的模拟问诊教学和病历书写教学。