Undergraduate student nurses’ views of online learning

BackgroundThe COVID-19 pandemic and resultant public health restrictions saw the mass movement of higher education to online, remote delivery. There was wide variation in how this was implemented, and for many undergraduate programs, this was the first time teaching was conducted remotely. The aim of this study was to explore undergraduate student nurses’ views of online learning.MethodsReflexive thematic analysis was used to analyse focus group data from undergraduate nursing students.FindingsTwo central themes described student preferences for learning environments and challenges associated with asynchronous learning. Participants reported a preference for face-to-face learning. Suggestions for optimising remote learning include an emphasis on synchronous live sessions rather than asynchronous learning, incentivised learning, and a focus on ongoing formative informal assessment to maintain engagement. Specific challenges related to poor retention, difficulty remaining motivated, and maintaining focus on content and learning outcomes.ConclusionAs more opportunities arise to engage with online pedagogies for undergraduate nursing students, educators need to ensure their approaches are evidence-based and learner-centric.     

Telehealth readiness and its influencing factors among Chinese clinical nurses: A cross-sectional study

Aim/objectiveThis study aimed to assess telehealth readiness among clinical nurses in China and explore the factors that affect their telehealth readiness and the relationships of telehealth readiness and telehealth practice-related variables.BackgroundTelehealth is a new service model that uses information and communication technology to provide professional health care services for resource-poor areas. With the global spread of COVID-19, nurses urgently need to adapt and apply telehealth technology to replace conventional face-to-face treatment. However, nurse-led telehealth services in China are currently only in the pilot phase and the readiness of clinical nurses needs to be assessed to facilitate successful telehealth implementation.DesignA cross-sectional, multicentre study was undertaken with the questionnaire survey method.MethodsData were collected in October-December 2020 used online questionnaires. A convenience sample of 3386 nurses from 19 hospitals in China completed the Chinese version of Telehealth Readiness Assessment Tools.ResultsThe mean score of the telehealth readiness was in the category between 61 and 80 points (mean 61.23, SD 11.61). The percentages of nurses meeting the following levels of telehealth readiness were as follows: low (49.9%), moderate (42.0%) and high (8.1%). Significantly higher domain scores were recorded for nurses in the unmarried, head of responsible nursing group. Moreover, there were positive correlations between telehealth readiness level and service experience, service willingness, mode cognition, manpower allocation and policy guidance.ConclusionsThere are still many factors hindering the successful implementation of telehealth. Nursing educators should formulate telehealth education curriculum and service standards to improve the telehealth readiness of nurses.     

Technology usage for teaching and learning in nursing education: An integrative review

BackgroundThe increasing availability of technology devices or portable digital assistant devices continues to change the teaching-learning landscape, including technology-supported learning. Portable digital assistants and technology usage have become an integral part of teaching and learning nowadays. Cloud computing, which includes YouTube, Google Apps, Dropbox and Twitter, has become the reality of today’s teaching and learning and has noticeably improved higher education, including nursing education.ObjectivesThe aim of this integrative literature review was to explore and describe technology usage for teaching and learning in nursing education.MethodA five-step integrative review framework by Whittemore and Knafl was used to attain the objective of this study. The authors searched for both empirical and non-empirical articles from EBSCOhost (health information source and health science), ScienceDirect and African Journals Online Library databases to establish what is already known about the keywords. Key terms included in literature search were coronavirus disease 2019 (COVID-19), digital learning, online learning, nursing, teaching and learning, and technology use.ResultsNineteen articles were selected for analysis. The themes that emerged from this review were (1) technology use in nursing education, (2) the manner in which technology is used in nursing education, (3) antecedents for technology use in nursing education, (4) advantages of technology use in nursing education, (5) disadvantages of technology use in nursing education and (6) technology use in nursing education amidst COVID-19.ConclusionTechnology in nursing education is used in both clinical and classroom teaching to complement learning. However, there is still a gap in its acceptance despite its upward trend.ContributionThe findings of this study contribute to the body of knowledge on the phenomenon of technology use for teaching and learning in nursing education.     

The process of learning and professional development according to nursing students’ experience during Covid-19: A constructivist grounded theory study

AimThis study explored the experiences of nursing students with respect to learning processes and professional development during internships with COVID-19 patients to build a novel theoretical model.BackgroundThe COVID-19 outbreak had a profound impact on the worldwide learning system and it interrupted the internship experiences of nursing students. After the second wave of COVID-19, to balance academic activities with COVID-19 containment, some Italian universities allowed nursing students’ internships in COVID-19 units. This new experience may have influenced nursing students’ learning processes and professional development, but this is yet to be investigated.DesignA qualitative study using a constructivist grounded theory (CGT) approach.MethodsNursing students were recruited from two hospitals in northern Italy between January and April 2021. Data are gathered from interviews and a simultaneous comparative analysis were conducted to identify categories and codes, according to Charmaz’s (2006) theory.ResultsThe sample consisted of 28 students. The results suggested the core category, that is the ‘Students’ sense of belonging to the nursing profession’ and four main categories: (1) From knowledge to know-how, (2) A new relationship modality, (3) Sharing and socialisation and (4) Responsibilization. Finally, a premise and a corollary, respectively (5) Motivation and the (6) Circularity of the process, were identified.ConclusionOur study proposed a new theory of nursing students’ learning processes in clinical contexts during internships with COVID-19 patients. Despite significant difficulties, the nursing students developed a unique learning process characterised by motivation. Therefore, our study provided insight into the learning process during a pandemic and investigated the support needed for nursing students to continue their internships.     

Flipped versus traditional classroom and student achievement and cognitive engagement in an associate degree nursing fundamental course

BackgroundThere is a call for instructional transformation in nursing education to include an innovative approach. This study aimed to investigate the effects of the flipped classroom method on student achievement and engagement in an associate degree nursing course. This study investigated associate degree nursing studies students’ achievement and cognitive engagement under traditional learning (n = 141) and flipped learning (n = 130). This study was conducted in two first-year cohorts enrolled in their nursing fundamental course, before and during the COVID-19 pandemic respectively at a Hong Kong community college.MethodA mixed methods approach was used with quantitative (examination scores) and qualitative (semi-structured focus group interview) measures applied.ResultsThere was a significant increase in final exam scores for the flipped classroom, all p < 0.01, with a medium-to-large (d = 0.60) effect size. Students commented flipped classroom method promoted their cognitive engagement and the benefits that contributed to such a positive student achievement included more peer interaction and more opportunity to apply their knowledge.ConclusionThis study contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education.     

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

AimTo explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.BackgroundThe World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.DesignCross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.MethodsA cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.ResultsOf 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.ConclusionsStudents were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.     

Virtual versus traditional learning during COVID-19: quantitative comparison of outcomes for two articulating ADN cohorts

AimThe study compared outcomes between articulating nursing student cohorts virtual learning during COVID-19 and traditional learning prior to COVID-19.BackgroundClinical reasoning is vital to developing clinical nursing judgment. During the COVID-19 pandemic, nursing schools replaced traditional classroom and in-hospital clinical with virtual classroom and clinical learning.DesignA quantitative retrospective cohort study compared outcomes of the nursing students virtual learning during COVID-19 (n = 18) with traditional learning methods before COVID-19 (n = 14) at one college in Texas.MethodOutcomes of the study were measured using a standardized Health Education Systems Inc. (HESI®) specialty exam, HESI® end of program (Exit) exam, and HESI® clinical judgment subscales. Independent-samples t-tests and Chi square were conducted to compare outcomes from virtual and traditional learning.ResultsNo statistically significant difference was observed between the traditional group (M = 752.93, SD = 148.88) and virtual learning group (M = 761.72, SD = 152.11); t(30) = ?0.16, p = 0.87 was identified on the HESI® Maternal pediatric Specialty exam. No statistically significant differences were observed on the HESI® Exit exam or clinical judgment subscales; no relationship between the type of learning and NCLEX-RN® pass rates.ConclusionThe study findings are encouraging, yet limited, warranting further investigation of virtual learning.     

Undergraduate nursing students’ experiences of online education: A cross-sectional survey

During the coronavirus pandemic, UK Academics were required to adjust their learning and teaching environment and pedagogical approaches, with little guidance or time. Feelings of frustration and uncertainty around student engagement were commonplace across Higher Education Institutions. This was heightened in professionally regulated courses, such as nursing. The shift to online learning created a situation where academics were frequently faced with a ‘sea of black screens’ and unable to ascertain student engagement.This study investigated undergraduate nursing students’ experience of online education during the COVID-19 pandemic. An anonymous survey was distributed to each year of the undergraduate nursing programme and data subsequently analysed. Responses from 54 students revealed that engagement varied between different year groups. There were significant differences between those with pre-COVID (traditional face-to-face) teaching experience (years 2 and 3) and those without (year 1) in regard to self-reported engagement with online learning. The findings from this study revealed some powerful and emotional insights into the experience of online learning amongst UK students undertaking an undergraduate nursing programme during the COVID-19 pandemic.     

An online 5-week professional identity program for nursing student in clinical rotation practice during the first wave of COVID-19 pandemic: A two-arm randomized trial

AimDevelopment and evaluation of the effectiveness of an online 5-week professional identity program among nursing students in clinical internship practice during the COVID-19 restrictions.BackgroundNurse professional identity is a strong predictor of career commitment. Clinical internship practice is a key stage when nursing students build and rebuild their professional identity. Meanwhile, the COVID-19 restrictions has strongly influenced the professional identity of nursing students as well as nursing education. A well-designed online professional identity program may contribute to nursing students who are in clinical internship practice developing positive professional identity during the COVID-19 restrictions.DesignThe study was a two-armed, randomised, controlled trial conducted and reported based on Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines.MethodsA total of 111 nursing students undergoing clinical internship were randomised into an intervention group and a control group. The five-weekly session intervention was developed based on social identity theory and career self-efficacy theory. The primary outcomes were professional identity and professional self-efficacy and the second outcome was stress. Qualitative feedback was analysed by thematic analysis. Outcomes were assessed before and after the intervention and analysed using an intention-to-treat principle.ResultsThe generalised linear model showed that group-by-time effects were significant for the total score of professional identity and three factors of professional self-image, social comparison and self-reflection and independence of career choice, with small effect sizes (Cohen’s d from 0.38 to 0.48). Only one factor of the capacity of information collection and planning in professional self-efficacy was significant (Wald χ² =0.4.82, P < 0.01) with a medium effect size (Cohen d=0.73). The group effect, time effect and group-by-time effect of stress were not significant. Three themes were: ‘Gaining in professional identity, self-recognition and peer belonging’; ‘Content, self-motivation and intervenor as participation facilitators’; and ‘Combining offline and courses, setting group rules and building mutual trust as recommendations’.ConclusionsThe online 5-week professional identity program effectively promoted the development of professional identity and the capacity for information collection and career planning but did not significantly relieve pressure during the internship.     

Nurse faculty perceptions of readiness for practice among new nurses graduating during the pandemic

BackgroundThe COVID-19 pandemic caused major changes in nursing education, namely a shift to remote learning and significant reduction of clinical practice experience. It is not known how these changes will affect new graduate nurses transitioning to practice.PurposeTo provide guidance to transition-to-practice programs, this study quantitatively described and compared nurse faculty perceptions of readiness for practice among students who graduated pre-pandemic and those who will graduate during the pandemic.MethodsA convenience sample of 116 nurse faculty across North Carolina completed surveys online. Surveys collected information on demographics, professional experience, and teaching changes experienced during the pandemic. The Nursing Practice Readiness Tool was used to measure perceptions of readiness for practice.ResultsNurse faculty reported a wide range of changes due to the pandemic, with limitations in clinical learning prevalent. There was a statistically significant decrease in practice readiness scores for the total scale, six subscales, and all tool items at p < 0.001 for all paired comparisons.ConclusionsWhile there was an overall significant decrease in scores for all competency areas, further analysis of the tool subscales and items can provide guidance for clinical nurses working with new graduates and nurse faculty working with continuing students.     

Cardiovascular nurses' experiences of working in the COVID-19 intensive care unit: A qualitative study

BackgroundCardiovascular nurses’ skills and experiences of cardiac critical care, management of cardiovascular emergencies, and mechanical circulatory support have been considered vital in providing nursing care for COVID-19 patients in intensive care units during the COVID-19 pandemic. To our knowledge, there are no studies have focused on the contribution and experiences of cardiovascular nurses in the critical care of COVID-19 patients.ObjectivesTo explore the experiences of cardiovascular nurses working in a COVID-19 intensive care unit during the pandemic.MethodsThe study was conducted as a qualitative study with phenomenological approach in June-December 2020. Study data were gathered from ten cardiovascular nurses through semi-structured interviews.ResultsSix themes emerged from the interview data: the duties and responsibilities in a COVID-19 intensive care unit; the differences of COVID-19 intensive care unit practices from cardiovascular practices; the transferrable skills of cardiovascular nurses in a COVID-19 intensive care unit; the difficulties encountered working in a COVID-19 intensive care unit; the difficulty of working with personal protective equipment; and the psychosocial effects of working in a COVID-19 intensive care unit.ConclusionCardiovascular nurses made an important contribution to the management of nursing services with their experiences and skills in the COVID-19 pandemic.     

COVID-19 vaccination readiness among nurse faculty and student nurses

BackgroundUnprecedented efforts are underway to develop COVID-19 vaccines, widely seen as critical to controlling the pandemic. Academic nursing leaders must be proactive in assuring widespread faculty and student vaccination uptake.PurposeThe purpose of this study was to describe nursing faculty and student nurse factors associated with COVID-19 vaccine readiness.MethodsCross-sectional online survey of nursing faculty and student nurses at a university affiliated with an academic medical center was conducted.FindingsMost full-time faculty (60%) intended to receive the vaccine; but only 45% of adjunct faculty and students reported intending to get vaccinated. The major reasons for not getting vaccinated were vaccine safety and side effects. Collectively, participants reported a low level of knowledge related to vaccine development.DiscussionAs the most trusted profession, nurses will play a decisive role in counseling patients about COVID-19 risks and benefits. Findings suggest that academic nursing leaders need to consider faculty and student vaccine concerns and provide vaccine development education.     

Impact of COVID-19 on nursing time in intensive care units in Belgium

IntroductionThe COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload.ObjectiveTo assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context.DesignThis study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS).SettingThree Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients.Measurements and main resultsThe study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6–6.4).ConclusionsPatients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.     

Student engagement in flipped classroom in nursing education: An integrative review

AimTo summarize the effect of the flipped classroom method (FCM) on student engagement in nursing education and provide the implications for future practice.BackgroundTechnological advancement of learning approaches including flipped classroom has become increasingly popular in nursing education. However, no integrative review has been published that specially explore the behaviour engagement, cognitive engagement and emotional engagement of flipped classroom use in nursing education.MethodsPopulation, Intervention, Comparison, Outcomes and Study (PICOS) strategies were implemented to investigate the literature from published peer-reviewed papers from 2013 to 2021 in CINAHL, MEDLINE and Web of Science.ResultsThe initial search identified 280 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 16 articles were considered for the final review. Most of articles targeted on undergraduate nursing students and were conducted in the USA and Australia. The review primarily identified positive learning outcomes among nursing students in term of student engagement. However, a few studies reported contrasting findings, possibly due to students are still dependent on traditional lecture-based classroom.ConclusionThis review suggests that use of the FCM in nursing education could promote students’ behavioral engagement and cognitive engagement but yield a mixed outcome in emotional engagement. This review contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education, the strategies for promoting student engagement in future flipped classroom practice and recommendation for future research on flipped classroom.