Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

BackgroundThe clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date.ObjectivesThe aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available.DesignA systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines).Data sourcesThe Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016.Review methodsThe included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used.ResultsThe search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated.ConclusionsClinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.     

PBL教学法对临床护理带教有效性的Meta分析

目的 采用Meta分析评价以问题为基础的教学法(problem-based learning,PBL)对临床护理带教的效果。 方法 计算机检索国内外主要医学数据库中有关PBL教学的干预性研究。由2名研究者对文献的质量进行严格评价后采用RevMan 5.3软件进行数据分析。 结果 共纳入12篇文献。Meta分析结果显示:PBL教学法在提高护理专业实习生的理论、操作技能及评判性思维能力方面好于传统教学法。 结论 PBL教学法应用于临床护理带教的效果好于传统教学法。但因纳入文献的研究质量不高,未来有必要开展大样本高质量的随机对照试验进一步验证。     

Factors related to readiness for practice among undergraduate nursing students: A systematic review

AimThis systematic review identifies the factors and effective strategies related to nursing students’ readiness for practice.MethodA search was conducted from 2012 to 2022 in PubMed, CINAHL, SCOPUS, PsycInfo and EMBASE databases, using a combination of predetermined keywords. Four authors made the selection independently and the methodological quality was assessed using the RoBANS, Analytical cross-sectional studies Critical Appraisal Tool and MMAT tools. Information was extracted using a matrix and analyzed through the thematic synthesis approach.ResultStudies (14,000) were identified from the search and 11 met the predetermined inclusion criteria. The main identified themes were personal characteristics, education-related factors, cognitive factors, psychological characteristics and social factors influencing readiness to practice. Some barriers also affect readiness for practice among undergraduate nursing students.ConclusionMultiple personal, educational and community factors interact in diverse ways to influences nursing students readiness to practice.RegistrationThe protocol for the conduct of this study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020222337     

Collaborative learning in practice: A systematic review and narrative synthesis of the research evidence in nurse education

Collaborative Learning in Practice is a model of placement learning for student nurses that is currently being implemented in the United Kingdom, apparently originating in Amsterdam. Potential benefits are reported to be increased placement capacity, reduced burdens on mentors as practice assessors, improvements in qualified nurses’ job satisfaction, recruitment and retention, and better-developed preparedness for registrant practice amongst student nurses. We conducted a thorough, rigorous systematic review between October and December 2018 of the literature on Collaborative Learning in Practice to discover whether there was a research evidence base for these claims. We found nothing published in English in peer reviewed journals. We found 14 related papers, although these were about the Dedicated Education Unit concept, and we have conducted a narrative synthesis of them. Key findings support the assertions related to Collaborative Learning in Practice, albeit in different models of placement learning. Further research is necessary with Collaborative Learning in Practice stakeholders including staff and students, and regarding patient care metrics, to demonstrate benefits or otherwise and until that research takes place potential gains remain unproven.     

The effectiveness of problem-based learning on development of nursing students’ critical thinking: A systematic review and meta-analysis

Objectives

The objective of this systematic review and meta-analysis was to estimate the effectiveness of problem-based learning in developing nursing students’ critical thinking.

Data sources

Searches of PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Proquest, Cochrane Central Register of Controlled Trials (CENTRAL) and China National Knowledge Infrastructure (CNKI) were undertaken to identify randomized controlled trails from 1965 to December 2012, comparing problem-based learning with traditional lectures on the effectiveness of development of nursing students’ critical thinking, with no language limitation. The mesh-terms or key words used in the search were problem-based learning, thinking, critical thinking, nursing, nursing education, nurse education, nurse students, nursing students and pupil nurse.

Review methods

Two reviewers independently assessed eligibility and extracted data. Quality assessment was conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Tool. We analyzed critical thinking scores (continuous outcomes) using a standardized mean difference (SMD) or weighted mean difference (WMD) with a 95% confidence intervals (CIs). Heterogeneity was assessed using the Cochran's Q statistic and I² statistic. Publication bias was assessed by means of funnel plot and Egger's test of asymmetry.

Results

Nine articles representing eight randomized controlled trials were included in the meta-analysis. Most studies were of low risk of bias. The pooled effect size showed problem-based learning was able to improve nursing students’ critical thinking (overall critical thinking scores SMD = 0.33, 95%CI = 0.13–0.52, P = 0.0009), compared with traditional lectures. There was low heterogeneity (overall critical thinking scores I² = 45%, P = 0.07) in the meta-analysis. No significant publication bias was observed regarding overall critical thinking scores (P = 0.536). Sensitivity analysis showed that the result of our meta-analysis was reliable. Most effect sizes for subscales of the California Critical Thinking Dispositions Inventory (CCTDI) and Bloom's Taxonomy favored problem-based learning, while effect sizes for all subscales of the California Critical Thinking Skills Test (CCTST) and most subscales of the Watson–Glaser Critical Thinking Appraisal (WCGTA) were inconclusive.

Conclusions

The results of the current meta-analysis indicate that problem-based learning might help nursing students to improve their critical thinking. More research with larger sample size and high quality in different nursing educational contexts are required.     

Experiences of undergraduate nursing students with faculty incivility in nursing classrooms: A meta-aggregation of qualitative studies

Faculty-to-student incivility can have detrimental impacts on both the individual students and the nursing profession. This study synthesized the current qualitative research evidence on the experiences of undergraduate nursing students with faculty incivility in nursing classrooms. A meta-aggregation approach was applied in a systematic review of qualitative studies based on the guideline of the Joanna Briggs Institute. The analysis of 11 qualitative studies identified four synthesized findings: (1) faculty incivility included a wide range of uncivil behaviors from disruptive to threatening behaviors, (2) pedagogical incompetence, including ineffective teaching, unresponsiveness, and unfairness, was perceived as uncivil, (3) faculty incivility negatively impacted on psychological well-being and learning, and (4) adaptation efforts included seeking support from family and friends and voicing the need for an official support system. Nursing faculty members need to be aware of the malicious impacts of faculty incivility, have formal teaching preparation, and develop pedagogical competency. The students and faculty members should be empowered by establishing official support systems for students and training faculty members to be role models for civility, respectively. Faculty perspectives of their incivility to students, interventions for cultivating faculty civility, and the long-term effects of faculty incivility are suggested as areas for further research.     

Blended learning vs traditional teaching: The potential of a novel teaching strategy in nursing education - a systematic review and meta-analysis

AimThe primary goal of this analysis is to determine the effectiveness of blended learning versus traditional face-to-face teaching in nursing education from the three aspects of knowledge, skills and satisfaction.BackgroundWith the rapid development of health care, traditional teaching has been unable to meet the learning needs of nursing education. With the development of Internet technology, blended learning seems to be a new available choice to solve the current predicament. However, the effectiveness of blended learning is still controversial. In addition, most studies have primarily evaluated the teaching effect unilaterally.DesignSystematic review and meta-analysis.MethodsWe searched PubMed, Embase, Web of Science, CINAHL and the Cochrane Library for publications in English from inception to April 2021. Two researchers independently screened the eligibility of each publication and extracted the data. The Cochrane risk-of-bias tool and the MINORS (methodological items for non-randomized studies) were used to evaluate the quality of the studies. The statistical heterogeneity was analyzed by the meta-regression and subgroup analysis. Publication bias was assessed by Egger's test.ResultsThe search strategy identified a total of 3682 potentially relevant articles. We finally included 13 randomized controlled trials (RCTs) and 12 quasi-experimental studies (QRs), with a total of 2706 nursing students. The meta-analysis results showed that blended learning is more effective than traditional teaching in terms of knowledge, skill performance and learning satisfaction (SMD=0.64, z = 3.237, p = 0.001; SMD = 0.37, z = 2.58, p = 0.010; SMD = 0.32, z = 2.347, p = 0.019). Egger's test showed no significant publication bias. In addition, sensitivity analysis suggested that the results are relatively reliable. Through subgroup analysis and meta regression, we found that although the heterogeneity could not be significantly reduced or eliminated, the publication year, the study design and the duration of the intervention time and the number of items in the intervention may be the potential factors affecting heterogeneity of knowledge and learning satisfaction.ConclusionsThe research results showed that blended learning may be an effective teaching strategy and appears to have excellent long-term developmental potential. Although its initial construction may require specific investment to improve the teaching resources and standardize the design of blended learning, in the long term, this new teaching strategy can not only improve nursing students' professional ability and learning satisfaction but also save nursing education resources to promote the balanced development of nursing education. The results of this study can lay a foundation for establishing standardized blended teaching strategies and evaluation indicators in the future.     

Instruments evaluating the quality of the clinical learning environment in nursing education: An updated systematic review

ObjectivesThe clinical learning environment offers meaningful learning opportunities for nursing students to apply theoretical knowledge to practice on actual or simulated patients. A previous systematic review assessed the quality of several instruments that evaluated the quality of clinical learning environments. This updated systematic review aimed to identify: any additional instruments that have been researched in the last 5 years, ii) the psychometric properties of available instruments and iii) the estimated comparable psychometric properties of the available instruments.Data sourcesMedline, CINAHL and Cochrane databasesReview methodsDatabases were searched from January 2016 to January 2023. Studies were included if they: a) validated instruments evaluating the experience and quality of clinical learning environments; b) assessed the pre-licensure nursing student experience; c) were published in English; and d) were published after April 2016. Two independent reviewers conducted title and abstract screening, full text screening, data extraction and methodological quality assessment. Any disagreements were resolved by consensus. A summary of the findings was tabulated using the same format as the initial review.ResultsAn additional 18 studies were found, which used seven different clinical learning environment evaluation instruments. Internal consistency and structural validity were the most frequently reported psychometric properties. In almost all studies, methodology for these properties were of sufficient quality according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) tool evaluation. Other properties were inconsistently reported, with differing qualities in the methodology. Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) remains the most translated and validated instrument across several countries.ConclusionsInstruments developed and validated using a systematic, transparent and high-quality methodology assist in accurately assessing the skills, attitudes and decision-making abilities of the preregistration level nursing student. These tools can be used in clinical placement accreditation and quality improvement of nursing education. The methodology for evaluation of the psychometric properties of instruments should be clearly described.     

Simulation-based learning in nurse education: systematic review

Title.  Simulation-based learning in nurse education: systematic review.
Aim.  This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies.
Background.  Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown.
Review methods.  A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were 'simulation' and 'human simulation'. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria.
Results.  Twelve studies were included in the review. These used experimental or quasi-experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7–11%). The validity and reliability of the studies varied due to differences in design and assessment methods.
Conclusion.  Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement.     

The effectiveness of spiritual intelligence educational interventions for nurses and nursing students: A systematic review and meta-analysis

AimTo synthesize the best available research evidence regarding the effectiveness of spiritual intelligence educational interventions on spiritual intelligence and professional outcomes in nurses and nursing students.BackgroundSpiritual intelligence is a form of intelligence with which individuals can deal with a crisis, alter situations, solve problems and achieve goals through a set of capacities and abilities. Possessing spiritual intelligence contributes to professional practice and competence in the workplace and has been seen to be beneficial for nurses and nursing students. Nursing interventions to teach and increase understanding of spiritual intelligence have been explored in the literature, but the effectiveness of spiritual intelligence training for nurses and nursing students remains uncertain.DesignA systematic review and meta-analysis.Data sourcesA three-step systematized search of sixteen electronic English and Persian databases was conducted to identify randomized and non-randomized trials published in English and Persian from January 2000 to November 2021.MethodsThe methodological quality of eligible studies was undertaken by two independent reviewers using the Medical Education Research Study Quality Instrument. Meta-analyses were undertaken where appropriate using STATA v16.ResultsSeven studies involving 512 participants were included. Pooled results demonstrated that those who received the educational intervention had significantly higher spiritual intelligence scores at 2 weeks (MD 13.38, 95 % CI: 5.76, 20.99) and one month follow up (MD 20.03, 95% CI: 6.61, 33.45) compared with those who did not. No difference in spiritual intelligence scores was observed among those who received spiritual intelligence education or life skills training (MD 7.52, 95 % CI −1.78, 16.82). Significantly higher communication skills (MD 5.41, 95 % CI: 2.16, 8.66), job satisfaction (MD; 11.30, 95 % CI: 8.63, 13.97) and spiritual care competence (MD; 28.55, 95 % CI: 26.08, 31.02) and decrease in overall stress (MD; 10.30, 95 % CI: 6.84, 13.76) among those who received the educational interventions were reported at the one-month follow-up. Significantly higher job satisfaction levels were also reported at 2-month follow-up among those who received the educational interventions (MD; 16, 95 % CI: 11.06, 20.94).ConclusionsThe evidence from this review demonstrates that spiritual intelligence educational interventions have a positive effect on spiritual intelligence and professional outcomes in nurses and nursing students. We noted that the outcomes in the studies included were mostly measured at one-month follow-up and with subjective measures. Longer trials with objective measures are required to provide higher levels of evidence. The results of this review are largely based on single trials and were limited in terms of the number of outcomes. Conducting further trials is warranted to identify the influence of such education on various professional outcomes in nursing practice.Tweetable AbstractSystematic review and meta-analysis shows spiritual intelligence educational interventions have a positive effect on nurses' and nursing students’ spiritual intelligence, work-related stress and professional practice.     

Teaching and learning about dementia care among undergraduate nursing students: A scoping review

AimReview available evidence on teaching methods and learning outcomes among undergraduate nursing students regarding care for people with dementia. Background: The debilitating nature and the rapidly growing number of dementia cases will cause significant increase in the demand of healthcare services. Nurses play an essential role in improving the quality of care for people with dementia, although some evidence suggests that training in dementia care among nurses is poor.DesignA scoping review of the literature. following the Joanna Briggs Institute methodology for scoping reviews. The source of evidence selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review.MethodsData sources were Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Education Resources Information Centre and Scopus. Inclusion criteria were studies found through database search up to 15th December 2020, published in English or Spanish with data regarding any method used for dementia education among undergraduate nursing students.Results19 studies were included in this review. The identified methods were simulation (n = 5), awareness-raising activities (n = 4), placement (n = 3), home visits (n = 3), combined activities (n = 3) and service learning (n = 1). Learning outcomes were measured in terms of knowledge, attitudes, preparedness, empathy, self-confidence, self-efficacy, awareness and students´ perceptions.ConclusionsThis scoping review has found high heterogeneity among dementia education programs and learning outcomes. Nursing education can be enhanced by designing and measuring effective and evidence-based educational interventions so that nursing students develop competencies which make it easier to deliver quality care for people with dementia.     

Blended learning via distance in pre-registration nursing education: A scoping review

Prior to the Covid-19 global pandemic, we reviewed literature and identified comprehensive evidence of the efficacy of blended learning for pre-registration nursing students who learn across distances and/or via satellite campuses. Following a methodological framework, a scoping literature review was undertaken. We searched six databases (EBSCOHOST (CINHAL plus; Education research Complete; Australia/New Zealand Reference Centre); Google Scholar; EMBASE (Ovid) [ERIC (Ovid); Medline (Ovid)]; PubMed: ProQuest Education Journals & ProQuest Nursing & Allied Health Source) for the period 2005–December 2015. Critical appraisal for critiquing qualitative and quantitative studies was undertaken, as was a thematic analysis. Twenty-eight articles were included for review, which reported nursing research (n = 23) and student experiences of blended learning in higher education (n = 5). Four key themes were identified in the literature: active learning, technological barriers, support, and communication. The results suggest that when delivered purposefully, blended learning can positively influence and impact on the achievements of students, especially when utilised to manage and support distance education. Further research is needed about satellite campuses with student nurses, to assist with the development of future educational practice.