护生临床实习期关键事件应激源及应对行为的调查研究

目的 探讨护生实习期常见关键事件应激源及其应对方式的现状。方法 采用自编护生实习期关键事件开放性调查问卷、护生临床实习压力感知量表(Perceived Stress Scale,PSS)、护生临床实习应对行为量表(Coping Behavior Inventory,CBI)对上海市三所三级甲等医院450名实习护生进行调查。结果 共收集到453件关键事件,析出五大主题,依次为人际关系、突发情况、护理操作、职业损伤、高工作负荷;护生临床实习期压力感知总均分为(40.43±7.04)分,应激源于照顾病人、与教师和其他护理人员的关系以及缺乏专业知识和技能;应对行为频率总均分为(41.50±7.40)分,应对行为效果总均分为(37.90±11.25)分,护生在面临应激时多采取解决问题、乐观应对等应对方式,且其效果最佳。结论 护生临床实习期经历的关键事件是护生应激的主要来源,在临床实习期应采取相应措施以减少应激源,提高护生关键事件应激的自我管理及应对行为效果,降低护生应激水平。     

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

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

Seeking autonomy: Grounded theory of clinical reasoning processes during simulation based experiences

AimTo conceptualize how undergraduate nursing students’ reason and think during Simulation-Based experiences (SBE) and explore the indicators of sound clinical judgment.BackgroundNursing students’ clinical reasoning processes during Simulation Based Experiences (SBE) are not well understood and underexplored. The purpose of this study is to conceptualize how undergraduate nursing students’ reason and think during SBE.DesignA constructivist grounded theory methodology was used to explore nursing students’ clinical reasoning during SBEMethodA grounded theory methodology was used to explore nursing students’ clinical reasoning during SBE. A purposive sample was used to recruit participants including 32 third-year nursing students. Data collection using semi-structured interviews conducted over 9 months in 2020–2021. The interviews were recorded and transcribed verbatim and the data were analyzed using the logic of constant comparison supported by memoing, theoretical sampling and conceptual mapping.ResultsSeeking autonomy is the core category that emerged from the participants’ responses that conceptualizes the students' reasoning process during SBEs.ConclusionEvidence from this grounded theory study adds validation to the practice of using SBEs to support students’ clinical reasoning process and prepare them to be competent in clinical practice.     

Violence experienced by undergraduate nursing students during clinical placements: An online survey at a Scottish University

AimTo assess the prevalence of violence and experiences of violence during clinical placements, among nursing students at a Higher Education Institution (HEI) in Scotland.DesignCross-sectional survey, using an opt-in online questionnaire.ParticipantsAll 950 undergraduate nursing students aged 18 + years were eligible.MethodsThe survey, with 24 open and closed format questions, was advertised over a 6-week period via the students’ virual learning platform. Potential participants were provided with study information before giving (electronic) informed consent. The questionnaire used was adapted from two other surveys and piloted prior to administration. Open-ended questions were fully transcribed and categorised and data analysed using SPSS.ResultsThere were 138 completed questionnaires (approx. 15% response rate); respondents were mainly female (92%). 77% had experienced verbal violence directed at them while on placement, most commonly swearing, shouting and insults. 70% of respondents had experienced physical violence, most commonly hitting, grabbing, kicking and spitting. By the fourth year of study, all 10 students who responded (out of 17 enrolled) had experienced violence. In general, patients (with a mental illness) were perceived to be the most likely perpetrators. The five most commonly reported feelings by respondents during the incident were: anxious (65), understanding (58), vulnerable (54), unsafe (50) and scared (45) and those after the incident were understanding (70), anxious (59), guilty (37), vulnerable (36), incompetent (34). 55 (47.8%) respondents felt supported during this ‘significant’ incident, 23 (20.0%) were unsure and 28 (24.3%) did not feel supported. There was a trend towards younger respondents and those with fewer years of care experience experiencing more violence.ConclusionThis study indicates that there is a high prevalence of violence experienced by student nurses that can have significant emotional consequences. There is scope to provide more training and support for them to deal with frequent incidents of violence.     

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.     

The Acute Incident Response Program: A Framework Guiding Multidisciplinary Responses to Acutely Traumatic or Stress-Inducing Incidents in the ED Setting

BackgroundClinicians working in the ED setting are exposed to traumatic and stress-inducing incidents, which may increase the incidence of psychological sequelae, including burnout and acute stress disorders. The purpose of this project was to develop and implement a novel debriefing program as an early intervention for acutely stress-inducing events in the emergency department.MethodsThe 2-stage Acute Incident Response program was developed and implemented in the emergency department of the John Hunter Hospital to guide an interprofessional response to acutely stress-inducing incidents. This psychological support framework draws on existing concepts of critical incident stress management along with elements of contemporary “hot debriefing” models to create a concise, clinician-led response program incorporating elements of both work group peer support and clinical team performance improvement. The Acute Incident Response program is novel in its concurrent focus on both salient clinical factors and emotional responses of affected clinicians.ResultsThe developed Acute Incident Response program framework predominantly focuses on the wide dissemination of a peer-driven debriefing model. When additional support is deemed necessary by trained clinical champions after the Hot Acute Incident Response process, escalation to a central response coordinator ensures targeted secondary support follow-up for all affected team members.This program has been introduced at 1 site and warrants further targeted investigation to determine its efficacy and utility in a broad range of clinical contexts.ConclusionThe Acute Incident Response program is an accessible and meaningful model to guide a functional, clinician-led response to acute incidents in the ED setting. The model could feasibly be applied in a wide variety of clinical contexts.     

Effects of blended versus offline case-centred learning on the academic performance and critical thinking ability of undergraduate nursing students: A cluster randomised controlled trial

ObjectiveThis study aimed to compare the effect of blended and offline case-centred learning on medical nursing education for undergraduate nursing students.BackgroundTechnological advancements are rapidly changing nursing education in higher educational settings. Educational reform, especially regarding methods of teaching, has been the focus of nursing educators in recent years.DesignThe research was conducted between September 2018 and July 2019 in China.MethodsSecond-year undergraduate nursing students in two classes were enrolled for this study by cluster sampling. The study outcomes were academic performance and critical thinking ability, measured using the Critical Thinking Disposition Inventory-Chinese Version.ResultsStudents in the experimental class showed significantly higher improvements in academic performance than those in the control class. Compared with the control class, the pre-post difference in competency in critical thinking self-confidence in the experimental class was significantly greater (p = 0.037). In the experimental class, there was a significant improvement over the baseline in the dimension of critical thinking self-confidence (p = 0.022). In the control class, there was a significant improvement over the baseline in the total score (p = 0.029) and two of the seven dimensions: truth-seeking (p = 0.016) and systematicity (p = 0.005).ConclusionsThe use of blended case-centred learning showed promising results in improving students’ academic performance. Both blended and offline case-centred learning were indicated to be effective educational approaches to improve the critical thinking ability of undergraduate nursing students and could be implemented for other nursing subjects in the future.     

The effect of laughter yoga applied before simulation training on state anxiety,perceived stress levels,self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AimThis study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students.BackgroundClinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students’ satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training.DesignThe study was designed as a pragmatic randomized controlled trial.SettingThis study was conducted at a university in Turkey.ParticipantsA total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44).MethodsThe intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022.ResultsThis study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05).ConclusionThe findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students’ stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.     

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.     

Comparison of the effectiveness of two styles of case-based learning implemented in lectures for developing nursing students’ critical thinking ability: A randomized controlled trial

PurposeTo explore and compare the effectiveness of two styles of case-based learning methods, unfolding nursing case and usual nursing case, implemented in lectures for developing nursing students’ critical thinking ability.Methods122 undergraduate nursing students in four classes were taught the subject of medical nursing for one year. Two classes were randomly assigned as the experimental group and the other two the control group. The experimental group received the lectures presenting unfolding nursing cases and the control group was taught the usual cases. Nineteen case-based lectures were provided in 8 months in two semesters to each group.ResultsThe two groups started with a similar level of critical thinking ability as tested by the instrument of Critical Thinking Disposition Inventory—Chinese version (CTDI-CV). After receiving 19 case-based learning lectures for 8 months, both groups of students significantly improved their critical thinking ability. The improvement in the experimental group was significantly higher than that in the control group (with the average total score of 303.77 ± 15.24 vs. 288.34 ± 13.94, p < 0.05). The experimental group also had significantly better improvement in six out of seven dimensions whereas the control group showed improvement in only three out of seven dimensions of CTDI-CV.ConclusionsThe study suggests the feasibility of implementing case-based learning in lectures. Unfolding nursing cases appear to be significantly more effective than the usual nursing cases in developing undergraduate nursing students’ critical thinking ability in the subject of medical nursing. Further research can implement the unfolding nursing cases in other nursing subjects.     

Development and Validation of an Instrument for Measuring Parenting Stress among Clinical Nurses

PurposeClinical nurses who are mothers of preschool-aged children experience extreme parenting stress linked to their hospital work environment and shift work, differing from that generally experienced by mothers. This study aimed to develop and validate a parenting stress scale that considers the clinical nurses’ form of work and its characteristics.MethodsThe scale items were initially derived from in-depth interviews and a literature review and were revised and modified based on the results of content validity testing by experts. The developed instrument was evaluated using data from 157 clinical nurses in South Korea who were mothers of preschool-aged children.ResultsIn the instrument validation stage, 19 items categorized in four factors (psychological burden, physical and mental fatigue, work shift, and work environment) were derived from construct validity, and the cumulative explanatory power was 56.6%. Furthermore, the convergent and discriminant validity and external construct were confirmed. Cronbach’s α of the final instrument was .86 (range: .81–.86). The validity and reliability of the newly developed parenting stress scale for clinical nurses were established in this study; it uses a 4-point Likert scale. A higher mean score by factor indicates a higher level of parenting stress experienced by clinical nurses.ConclusionThis instrument would be beneficial to measure the level of parenting stress among nurses who work in hospitals and evaluate factors related to their parenting stress to devise effective interventions.     

Nurses’ experience of incident reporting culture before and after implementing the Green Cross method: A quality improvement project

BackgroundAdverse events are a leading cause of death worldwide, although many are considered preventable. Incident reporting is a prerequisite for preventing adverse events; however, underreporting is common. The Green Cross method is an alternative incident reporting process that includes a daily team meeting to discuss incidents and work on improvements.ObjectivesThe aim of this quality improvement project was to improve the culture of incident reporting by implementing the Green Cross method and to evaluate the improvement by describing nurses’ experience with the culture of incident reporting.MethodsThe project included a three-month implementation of the method in a postanesthesia care unit, which was evaluated by focus group interviews (n = 22 nurses) and analysed by qualitative content analysis.FindingsFour focus group interviews were conducted before implementation (n = 19 nurses) and four after implementation (n = 16 nurses). Before implementation, Theme 1, “Incident reporting with potential for improvement”, was constructed, describing a culture wherein nurses expressed motivation to report incidents but barriers, such as finding the system complicated and experiencing emotional obstacles towards reporting, prevented them. After implementation, Theme 2, “Increased focus on transparency”, was constructed, describing a culture wherein nurses perceived an increased rate of incident reporting but still encountered barriers, such as finding reporting uncomfortable and demanding, experiencing a threatened working environment, and still wanting visible improvement.ConclusionThe nurses in the postanesthesia care unit experienced the Green Cross method as a useful patient safety initiative for improving the rate of incident reporting, but barriers to reporting still existed.