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.     

Anxiety in nursing students: The impact of using mobile technology with quick response codes

BackgroundPre-licensure nursing students often experience anxiety, especially during their clinical learning experiences. High levels of anxiety can be disruptive to both clinical learning and safe patient care. Providing students with educational resources via mobile devices to review prior to performing psychomotor skills with real patients may help reduce their anxiety.ObjectivesThe purpose of this study was to evaluate the effect of using mobile devices with a scanning application for quick response codes in the clinical setting on students' anxiety levels in the clinical setting. A secondary aim was to explore the clinical faculty experience with and perceptions of the technology.DesignA one-group, repeated measures, quasi-experimental design was used.SettingThe intervention occurred at 6 rehabilitation centers used for first semester clinical learning experiences at a School of Nursing in the southeast United States.ParticipantsConvenience sampling was used and 42 first semester nursing students participated.MethodsThe State Trait Anxiety Inventory was used to measure self-reported anxiety prior to and following the use of mobile devices with quick response codes during an 8-week clinical learning experience. One focus group was conducted with the 4 clinical faculty members who taught the students.ResultsThe State Trait items indicated reduced anxiety for performing psychomotor skills. Median scores for positive feelings items significantly increased from 22.74 to 30.49 (p < .001), while median scores for negative feelings items decreased from 31.83 to 13.71 (p < .001). The faculty expressed that student anxiety was reduced with technology and they recommended integration throughout the curriculum.ConclusionsStudent anxiety for performing psychomotor skills was reduced following use of mobile technology with quick response codes. More research is needed; however, clinical faculty may consider integrating this technology into students' clinical learning experiences to assist with reducing their anxiety.     

Association between COVID-19-related stress and self-directed learning ability among Korean nursing students

PurposeTraditional face-to-face classes for nursing students due to the COVID (Coronavirus Disease)-19 pandemic around the world made it inevitable to operate education delivery method using remote/hybrid fashion. This study was aimed to validate the Korean version of the Student Stress Inventory-Stress Manifestations (SSI-SM) and assess the association between COVID-19 pandemic related stress level and self-directed learning ability competence in nursing students.DesignThis research was a cross-sectional study design.MethodsThe study was conducted from December 2020 to January 2021, with a convenience sample of 172 nursing students in the 3rd and 4th grades in South Korea. The Korean version of SSI-SM(K-SSI-SM) was translated and adapted according to standard guideline, and tested construct validity and reliability. In addition, a multiple linear regression analysis was used to examine the associations between the COVID-19 related stress level and the self-directed learning ability.ResultsAn exploratory analysis showed that K-SSI-SM composed of 13-item in three factors (uncertainty, non-sociability, and somatization) accounted for 68.73% of the total variance after it was modified. The internal consistency was good with 0.91. Multiple linear regression analysis revealed that higher self-directed learning ability was associated with lower stress levels (β = −0.19, p = 0.008), positive toward online learning (β = 0.41, p = 0.003) and scored higher in theory (β = 0.30, p < 0.001) in nursing students.ConclusionThe K-SSI-SM is an acceptable instrument for assessing stress levels in Korean nursing students. And nursing faculties need to pay attention to related factors of self-directed learning ability, in order to achieve the course's self-directed learning goal in students attending online classes.     

Nursing students’ evaluation of clinical learning environment and supervision in a Norwegian hospital placement – A questionnaire survey using CLES+T scale

AimThe clinical learning environment and supervisor-student relationship play vital roles in the learning outcomes of nursing students. The aim of this study is to evaluate nursing students’ experiences with the clinical learning environment and supervision in a hospital placement organised with a dual preceptor team – preceptors holding dual positions both in the clinic and the nursing faculty in addition to the standard one-to-one supervision by a clinical preceptor.DesignThe study is a paper-based survey based on a validated questionnaire developed and tested in hospital settings in various European countries, including Norway.MethodThe Norwegian version of the CLES+T Evaluation Scale, was distributed to all second-year students in three different years (2015–2017) at a nursing faculty.ResultsA total of 61% students (n = 261) returned the questionnaire. Overall, the students considered that their hospital placement provided a good clinical learning environment. The results suggest that the dual preceptor team on top of one-to-one supervision did not interfere negatively with the clinical learning environment Nevertheless, the dual preceptor model did not compensate for a poor relationship with the clinical preceptor. Thus, the association between a reported ‘strained relationship’ with the clinical preceptor and low scores on the CLES+T, reported on by other studies, remained in our data.ConclusionsTo better grasp the complexity in this area, various methods are needed, such as in-depth interviews with students, nurse teachers and clinical preceptors. Further studies need to elaborate on students’ experiences of clinical learning environment according to how supervision is organised.     

An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students

BackgroundWhile numerous theoretical and conceptual models suggest social evaluation anxiety would likely influence performance in simulation-based learning environments, there has been surprisingly little research to investigate the extent to which this is true.MethodsFinal-year Bachelor of Science (Nursing) students (N = 70) were randomly assigned to complete one of three clinically identical simulation-based scenarios designed to elicit varying levels of social evaluation anxiety by manipulating the number of other people present with the student during the simulation (1, 2 or 3 others). Rises in acute stress were measured via continuous heart-rate and salivary cortisol. Performance scores were derived from the average of two independent raters' using a structured clinical checklist (/16).ResultsStatistically different increases were found within the first minute of the simulation between those students with one versus three other people in the room (+ 4.13 vs. + 14.01 beats-per-minute respectively, p = 0.01) and salivary cortisol measures suggested significantly different changes in anxiety between these groups (− 0.05 vs. + 0.11 μg/dL respectively, p = 0.02). Independent assessments suggested students with only one other person accompanying them in the simulation significantly outperformed those accompanied by three others (12.95 vs. 10.67 respectively, p = 0.03).DiscussionStudents accompanied by greater numbers during simulations experienced measurably greater anxiety and measurably poorer performances. These results demonstrate the ability to manipulate social evaluation anxiety within high-fidelity simulation training of undergraduates in order to help students better acclimatise to stressful events prior to practising in real clinical settings.     

Clinical learning environment and supervision of international nursing students: A cross-sectional study

BackgroundPreviously, it has been shown that the clinical learning environment causes challenges for international nursing students, but there is a lack of empirical evidence relating to the background factors explaining and influencing the outcomes.ObjectiveTo describe international and national students' perceptions of their clinical learning environment and supervision, and explain the related background factors.DesignAn explorative cross-sectional design was used in a study conducted in eight universities of applied sciences in Finland during September 2015–May 2016.MethodsAll nursing students studying English language degree programs were invited to answer a self-administered questionnaire based on both the clinical learning environment, supervision and nurse teacher scale and Cultural and Linguistic Diversity scale with additional background questions. Participants (n = 329) included international (n = 231) and Finnish (n = 98) nursing students. Binary logistic regression was used to identify background factors relating to the clinical learning environment and supervision.ResultsInternational students at a beginner level in Finnish perceived the pedagogical atmosphere as worse than native speakers. In comparison to native speakers, these international students generally needed greater support from the nurse teacher at their university. Students at an intermediate level in Finnish reported two times fewer negative encounters in cultural diversity at their clinical placement than the beginners.ConclusionTo facilitate a successful learning experience, international nursing students require a sufficient level of competence in the native language when conducting clinical placements. Educational interventions in language education are required to test causal effects on students' success in the clinical learning environment.     

Covid-19 vaccine confidence and hesitancy in nursing students and faculty at a large academic medical center

BackgroundLittle is known about nursing faculty and nursing student's confidence or potential hesitancy to receive the Covid-19 vaccine once it was available.MethodsAn anonymous electronic survey of nursing students and faculty was conducted at a large academic center in the eastern U.S.FindingsBoth students and faculty reported they were fairly or completely confident that the vaccine was safe (n = 235, 89.4%) and that it would effectively mitigate their risk (n = 230, 87.5%). There was a 52.6% decrease in vaccine hesitancy from 6 months prior (p <.01); 22% (n = 58) of those currently willing to receive the vaccine reported moderate to high concern about its side-effects and/or long-term efficacy. Access to vaccine research, vaccine education, and watching others be inoculated, had mitigated their concerns from the previous six months.DiscussionWhile both nursing students and faculty reported having high confidence in the efficacy and safety of the Covid-19 vaccine, concerns remained.     

Web-based experiential learning strategies to enhance the evidence-based-practice competence of undergraduate nursing students

BackgroundEvidence-based practice (EBP) is considered a key competence for practicing high-quality and safe nursing. However, undergraduate nursing programs continue to provide traditional classroom teaching strategies that have limitations in facilitating the development of critical competences for engaging in EBP in real clinical contexts.Objective and designThe purpose of this study was to develop a web-based experiential learning program aimed at improving the engagement and experience of nursing students in EBP. A quasi-experimental research with non-equivalent control-group with non-synchronized design was used to describe the process of program development and the innovative learning method, and discuss the outcomes of the program.MethodsThe experimental group was exposed to a web-based experiential learning program, while the control group received traditional learning with written material. Self-reported EBP scores (knowledge and skills, attitude, and practice) and clinical-questioning confidence were evaluated to assess the effects of the program.ResultsThe result showed that web-based experiential learning strategies were effective in significantly improving the EBP knowledge and skills score (F = 12.29, p = .001) and the score for confidence in asking clinical questions (F = 12.14, p = .001). The attitudes toward EBP (F = 0.75, p = .389) and practice score (F = 3.22, p = .076) did not show a significant difference between the experimental group and the control group.ConclusionThe web-based experiential learning was found to be an effective method for enhancing the EBP competence of nursing students. Based on the study results, we suggest using web-based experiential learning to supplement the traditional learning method or as the mainstream learning method for nursing students.     

Can student-peers teach using simulated-based learning as well as faculty: A non-equivalent posttest-only study

BackgroundPeer-assisted learning has an important place in the delivery of health care education with benefits for both the learners and the peer teachers. Simulation-based learning (SBL) is evolving in healthcare professions training and academic programs as a modality that conveys realism and fidelity through immersion.ObjectivesThe primary aim was to compare physiotherapy student's motivation to learn between a conventional faculty-led SBL activity and the same SBL activity delivered by trained final year physiotherapy peer tutors.MethodsPhysiotherapy students from two Universities (n = 226) undertook a SBL learning activity (either faculty led or peer led) and completed the Instructional Materials Motivation Scale questionnaire to assess motivation to learn.ResultsThere was a high level of learner motivation in all learning groups, with significantly higher learner satisfaction (p < 0.001) and lower attention (p < 0.001) in student-led SBL than faculty-led SBL.ConclusionsThis study has highlighted the potential to incorporate peer-assisted and simulation-based learning together in the development of future educational activities in health care training.     

A prospective cohort study examining the preferred learning styles of acute care registered nurses

ObjectivesThis paper reports on the preferred learning styles of Registered Nurses practicing in acute care environments and relationships between gender, age, post-graduate experience and the identified preferred learning styles.MethodsA prospective cohort study design was used. Participants completed a demographic questionnaire and the Felder-Silverman Index of Learning Styles (ILS) questionnaire to determine preferred learning styles.ResultsMost of the Registered Nurse participants were balanced across the Active-Reflective (n = 77, 54%), and Sequential-Global (n = 96, 68%) scales. Across the other scales, sensing (n = 97, 68%) and visual (n = 76, 53%) were the most common preferred learning style. There were only a small proportion who had a preferred learning style of reflective (n = 21, 15%), intuitive (n = 5, 4%), verbal (n = 11, 8%) or global learning (n = 15, 11%). Results indicated that gender, age and years since undergraduate education were not related to the identified preferred learning styles.ConclusionsThe identification of Registered Nurses' learning style provides information that nurse educators and others can use to make informed choices about modification, development and strengthening of professional hospital-based educational programs. The use of the Index of Learning Styles questionnaire and its ability to identify ‘balanced’ learning style preferences may potentially yield additional preferred learning style information for other health-related disciplines.     

The effects of a virtual learning environment compared with an individual handheld device on pharmacology knowledge acquisition,satisfaction and comfort ratings

BackgroundVirtual reality is reported to improve post-intervention knowledge and skills outcomes of health professionals compared to traditional teaching methods or digital online media. However, providing equitable access to high quality virtual reality resources for large, diverse nursing and midwifery student cohorts within multi-campus settings remains challenging.ObjectivesThis study compared the effect on student learning, satisfaction and comfort following exposure to a three-dimensional pharmacology artefact in a virtual facility (CAVE2™)¹ with viewing of the same artefact using a mobile handheld device with stereoscopic lenses attached.DesignThe study used a pretest-posttest design.SettingSchool of Nursing and Midwifery in a regional university in Southeast Queensland, Australia.ParticipantsTwo hundred and forty-nine second year undergraduate nursing and midwifery students.MethodsOnline multiple choice tests were deployed to measure knowledge acquisition. Self-reported satisfaction scores and comfort ratings were collected using questionnaires.ResultsParticipants were not disadvantaged in terms of knowledge acquisition by using either CAVE2™ or the mobile handheld visualisation mode (P = 0.977). Significant differences in favour of the CAVE2™ environment were found in between students' satisfaction scores for clinical reasoning (P = 0.013) and clinical learning (P < 0.001) compared to the handheld mode, and there were no significant differences in their satisfaction with debriefing and reflective practice processes (P = 0.377) related to undertaking visualisation activities. A small number of students using handheld devices with stereoscopic lenses reported greater discomfort in relation to the visualisation that negatively impacted their learning (P = 0.001).ConclusionThree-dimensional artefacts using mobile devices is promising in terms of cost-effectiveness and accessibility for students with restricted access to on-campus teaching modes.     

An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study

BackgroundThe use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5 years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, further study that tracks what influences students' clinical performance in actual clinical sites is vital.ObjectiveThe aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement.DesignThis study used a correlational and longitudinal study design.MethodsThe 80 nursing students, who ranged in age from 19 to 21 (mean = 20.38, SD = 0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2 months (Phase 2) and 4 months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model.ResultsThe findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β = − 0.14, p < 0.05) and on self-reflection with insight (SRI; β = − 0.52, p < 0.01). Self-reflection also had a significant positive effect on simulation learning effectiveness (β = 0.37, p < 0.01). Anxiety had a significant negative effect on students' nursing competence during the first 2 months of practice in a clinical nursing site (β = − 0.20, p < 0.01). Simulation learning effectiveness and self-reflection and insight also had a significant positive effect on nursing competence during the first 2 months of practice in a clinical site (β = 0.13; β = 0.16, p < 0.05), respectively; and (2) when students practice in a clinical setting, their previous experience of nursing competence during the first 2 months of clinical care and their self-reflection and insight have a significant positive effect on their 4-month nursing competence (β = 0.58; β = 0.27, p < 0.01). Anxiety, however, had a negative effect on 4-month nursing competence but not significantly. Overall, 41% of the variance in clinical nursing performance was accounted for by the variables in the integrated model.ConclusionThis study highlights that self-reflection with insight and clinical experience may help students to deflect anxiety that may influence the development of clinical competence. Of note is that real-life clinical experience has a stronger effect on enhancing clinical performance than does a simulation experience.     

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.     

Collaborative Learning in Practice (CLIP): Evaluation of a new approach to clinical learning

BackgroundThere are challenges in creating positive clinical learning environments. A new model of practice learning for pre-registration nurse education was pilot-tested in the East of England. The Collaborative Learning in Practice model (CLIP) was developed from a similar model of practice learning used in the Netherlands.ObjectivesWe undertook an evaluation of a new approach to clinical learning. The aims of the project were to consider the challenges of implementation; consider the perception of gains and losses of students and stakeholders experiencing the new model of practice learning; and consider the sustainability of the new model in the context of service delivery.MethodsMixed methods were used. Data were collected in three forms: (1) a survey of students undertaking the CLIP model and those learning within the existing mentorship model to assess the supervisory relationships and pedagogical atmosphere experienced; (2) student focus groups; and (3) qualitative one-to-one interviews with key stakeholders in the provision of practice learning environments.ResultsA total of 607 questionnaires were returned out of the 738 distributed, five focus groups of a total of 30 students were undertaken, and 13 stakeholders were interviewed. Students who had experienced CLIP reported lower supervisory relationship scores compared with those without experience (mean difference = −0.24 points, 95% CI −0.21 to −0.094, p = 0.001). There was no difference in pedagogical atmosphere scores (mean difference −0.085 points, 95% CI −0.21 to 0.040, p = 0.19). Analysis of qualitative data produced two themes: ‘Adapting the environment’ illustrated the importance of learning context and ‘learning to fly’ highlighted the process of students gaining greater autonomy.ConclusionOur findings suggest that collaborative learning in practice offers many benefits as an approach to clinical learning but with important caveats. Attention needs to be paid to particular aspects of the model such as sufficient numbers of students, and an acknowledgement of perceived losses as well as gains.     

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.