Facilitating nursing students' skill training in distance education via online game-based learning with the watch-summarize-question approach during the COVID-19 pandemic: A quasi-experimental study

Assessing educational gaps in Iran's nursing education system: a mixed-method approach to the infectious diseases curriculum

BACKGROUND

Nurses play a significant role in the health system. The outbreak of emerging infectious diseases, such as COVID-19, highlights the need for nursing staff to be aware of the various aspects of these diseases. Therefore, considering the critical importance of infectious diseases, the present study aims to identify the educational needs of the infectious diseases course in nursing in Iran.

METHOD

This mixed-method study was conducted in two phases. First, a qualitative study using a conventional content analysis approach was performed to identify educational needs. Subsequently, in the quantitative phase, a panel of 10 nursing faculty members was asked to prioritize these needs using the Delphi technique.

RESULTS

The qualitative phase identified three main categories of educational needs: (1) enhancing the theoretical content of infectious diseases, (2) strengthening the practical and clinical components of the course, and (3) optimizing educational strategies. The needs assessment questionnaire, developed in the qualitative phase, was analyzed over two rounds using the modified Delphi method with descriptive statistics.

CONCLUSION

The use of a mixed-method (quantitative and qualitative) approach to assess the curriculum needs for infectious diseases, conducted for the first time in Iran, revealed the necessity of revising both theoretical and clinical curricula..

Strategies to improve student engagement in online nursing education: A systematic review

INTRODUCTION

The science of nursing education is shifting from comparisons of online and in-person modalities toward development and testing of online instructional strategies to optimize student learning. We conducted a systematic review (1) to identify instructional strategies designed to improve student engagement in online nursing education and (2) to evaluate the impact of instructional strategies on specific domains of nursing student engagement and learning outcomes.

METHODS

We searched Web of Science, PubMed, Embase, and the Cumulative Index of Nursing and Allied Health Literature for search terms that aligned with our population, intervention, and outcomes of interest. We applied the concept of student engagement by Jennifer A. Fredricks and colleagues to guide inclusion and exclusion criteria, data extraction, and synthesis.

RESULTS

Our search yielded 4847 articles, of which 8 met inclusion criteria and were included in this systematic review. Instructional strategies varied widely across studies and included game-based learning, case-based learning, novel instructor-to-student communication methods, and course redesign. Compared to traditional online strategies, game- and case-based approaches were associated with improvements in behavioral, emotional, and cognitive engagement and learning outcomes. Participant sociodemographic were underreported across all studies.

DISCUSSION

Our findings provide early support for the use of game-based learning or gamification elements and case-based learning to improve student engagement and subsequent learning outcomes. Future research on student engagement in online nursing education should evaluate the effects of different educational levels, incorporation of virtual reality, and report participants' sociodemographic data to examine subgroup effectiveness.

The effect of interprofessional game-based learning on perceived cognitive load and self-efficacy in interprofessional communication and collaboration in patient safety incidents

BACKGROUND

This study aims to investigate the effect of the interprofessional game-based learning method on students' perceived cognitive load and self-efficacy in interprofessional communication and collaboration during patient safety incidents, in comparison to traditional instructional methods.

METHODS

The quasi-experimental study was conducted in 2023-2024. The educational objective was to improve the interprofessional collaboration of the students in patient safety incidents. Students in operating room nursing and anesthesia nursing (n = 60) participated in this study. Interprofessional game-based learning and traditional methods were used in the intervention group and the control group, respectively. Participants completed two questionnaires about cognitive load and self-efficacy two months after intervention. The data were analyzed using descriptive tests (mean, standard deviation, and percentage) and analytical tests (including ANCOVA and Student T-test).

RESULTS

The IP-GBL intervention significantly improved students' self-efficacy in the intervention group compared to the control group (F = 26.51, df = 1.57, p-value = 0.0001, Partial Eta Squared = 0.31). The IP-GBL method enhanced GCL and eliminated ECL and ICL compared to the traditional method. (p = 0.0001).

CONCLUSION

The IP-GBL enhanced germane cognitive load and decreased the intrinsic and extrinsic cognitive load, which facilitated students' learning. Patient safety training using interprofessional game-based learning has a favorable educational effect on students' self-efficacy. The findings indicated that the students' self-efficacy in interprofessional collaboration and communication regarding patient safety incidents in the surgical department significantly improved. Therefore, the interprofessional game-based learning method in formal and informal education of patient safety that requires collaboration between different professions is recommended.

Game-thinking; utilizing serious games and gamification in nursing education - a systematic review and meta-analysis

BACKGROUND

The digital shift in higher education is moving from teacher-focused models to active learning with digital technologies, including the integration of game-based learning strategies. We aim to identify, assess, and summarize the findings of evidence and determine the effectiveness of game-thinking on learning outcomes in nursing education.

METHODS

A comprehensive search for relevant literature was conducted between April and May 2022 Seven databases ERIC, Scopus, ProQuest Education Source, MEDLINE, CINAHL, Web of Science, and Embase were utilized to locate original, peer-reviewed papers published in English. The review was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

RESULTS

Overall, 3302 studies were initially screened based on their titles and abstract. From this selection 281 studies were then assessed for full-text eligibility. In the end, 70 studies, consisting of 27 Randomized Controlled Trials (RCTs) and 43 Quasi-experimental studies were included in the review. These studies encompassed data from a total of 8348 participants. The results from the narrative synthesis of the results revealed consistencies across the included studies and their findings. The meta-analysis suggested that game-thinking could be beneficial in nursing education, notably improving students' academic achievement (Pooled ES = 0.99, [95%CI 0.53, 1.44]). The most significant effect of game-thinking on academic achievement was observed in the academic knowledge performance of nursing students (Pooled ES = 1.06, [95%CI 0.55, 1.57]), followed by academic skill performance (Pooled ES = 0.54, [95%CI 0.06, 1.03]).

CONCLUSIONS

The systematic review and meta-analysis provide evidence supporting the effectiveness of game-thinking in nursing education. The findings highlight the potential of game-based learning in enhancing nursing education through knowledge acquisition, albeit with a nuanced effect on skill development. As nursing education continues to adapt to the digital era, integration of game-thinking strategies could serve as a valuable method for creating engaging and effective learning experiences for nursing students.

Effects of gamification on academic motivation and confidence of undergraduate nursing students: A systematic review and meta-analysis

OBJECTIVES

This review aimed to evaluate the effects of gamification on academic motivation and confidence among undergraduate nursing students and identify the game design elements contributing to these effects.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Comprehensive systematic searches were conducted to retrieve randomized controlled trials (RCTs) and quasi-experimental studies (QES) with control groups published in English and Korean from inception to January 31, 2024, using PubMed, Embase, CINAHL Plus, ERIC, ProQuest Central, Cochrane Library, and RISS.

REVIEW METHODS

Eligible studies, including grey literature, were selected. The quality of the selected studies was evaluated using the Joanna Briggs Institute Critical Tool. Meta-analyses based on a random-effects model were conducted to estimate the standardized pooled effects (SMD). Subgroup analyses were conducted to identify the effect size moderators and game design elements that contributed to the effect size. The grading of recommendations, assessment, development, and evaluation approach (GRADE) was used to evaluate the certainty of evidence.

RESULTS

A total of 22 studies were selected for the systematic review, and 18 studies were included in the meta-analysis. The SMD for academic motivation (SMD of RCTs = 0.86, 95 % CI [0.27, 1.45]; SMD of QES = 1.22, 95 % CI [0.17, 2.26]) and confidence (SMD of RCTs = 1.11, 95 % CI [0.54, 1.68]; SMD of QES = 0.79, 95 % CI [0.40, 1.19]) revealed moderate-to-large effects. The subgroup analysis revealed significant differences in effect sizes across academic years, measurement scales, study areas, study quality, game duration, and game design elements. GRADE assessments for academic motivation and confidence were rated as moderate and low, respectively.

CONCLUSION

This review provides convincing evidence for the positive effects of gamification interventions on academic motivation and confidence among undergraduate nursing students. However, the limited number of RCTs and moderate-to-low certainty of the evidence underscore the need for additional research.

Hybrid Education in Remote Nursing Placements in Australia: A Descriptive Qualitative Study

BACKGROUND

Rural and remote areas offer unique opportunities for undergraduate nurses. Extended placements boost work readiness, improve assessment skills, and increase likelihood of practicing in these areas post-registration. However, hybrid delivery of curriculum content in not well understood. Undergraduate Extended Nurse Placement Program (ENPP) and on campus students, and academics were recruited from a major tertiary institution to understand impact of hybrid delivery for nursing curriculum.

METHOD

Data were obtained from descriptive qualitative design and focus group interviews. A process of thematic analysis generated themes and findings.

RESULTS

There were 12 participants: academics (n = 4), ENPP students (n = 7), and 1 on campus student. The main theme was "Bridging the Hybrid Gap," with two sub-themes: (1) separation, describes ENPP students emotional, experiential, and academic disconnect from on-campus students; and (2) adaptation, describes strategies used to adjust to hybrid learning.

CONCLUSION

Technology has evolved and presents opportunities for nursing education. We must continue to enhance education design in the nursing curriculum context. [J Nurs Educ. 2024;63(11):755-763.].

The effectiveness of serious games on undergraduate nursing students' knowledge and skills: A systematic review and meta-analysis

AIM

To determine the effect of serious games on undergraduate nursing students by the meta-analysis method.

BACKGROUND

There is a need for greater focus on enhancing the knowledge and skills of undergraduate nursing students. Generation Z students desire active engagement in the learning process. When compare with conventional learning approaches, serious games can enhance pupil interest by making the learning process more captivating.

DESIGN

Systematic review and meta-analysis.

METHOD

A total of nine databases were systematically searched from inception to April 2024. The Cochrane RoB-2 tool and the Joanna Brigg's Institute Critical Appraisal Tool for quasi-experimental designs were used to undertake quality appraisal. A narrative synthesis, a meta-analysis and subgroup analysis were conducted to analyze the study outcomes.

RESULTS

In the study, 19 experimental studies included 14 randomized controlled trials and five quasi-experimental studies. When compare with control groups, serious games in RCTs showed significant improvements in knowledge (SMD 1.24, 95 % CI 0.52-1.96; P<0.001) and skills (SMD 0.50, 95 % CI 0.13-0.87; P<0.01). Subgroup analysis for technical skills outcomes demonstrated that serious games in RCTs were more effective than control groups (SMD 0.62, 95 % CI 0.20-1.05; P<0.001).

CONCLUSION

Serious games had a beneficial impact on the knowledge and skills of undergraduate nursing students. In the context of serious game intervention, it is imperative to carefully consider the approach.

Self-efficacy mediates the effect of professional identity on learning engagement for nursing students in higher vocational colleges: A cross-sectional study

BACKGROUND

Learning engagement is a crucial predictor of academic achievement. It is essential to understand the factors influencing learning engagement among nursing students, especially from the learner's perspective, which is notably scarce but vital for designing effective educational interventions.

OBJECTIVES

This study aims to investigate the mediating effect of self-efficacy on the relationship between professional identity and learning engagement for nursing students in higher vocational colleges.

DESIGN

A cross-sectional electronic survey was conducted.

SETTING

The study was conducted in four higher vocational colleges located in Guangdong Province, China.

PARTICIPANTS

A total of 944 first- and second-year nursing students participated in the study between October and November 2022.

METHODS

Data were collected with questionnaires on general information, professional identity, self-efficacy, and learning engagement and analyzed with SPSS 26.0 and PROCESS v4.1 (Model 4), exploring relationships among professional identity, self-efficacy, and learning engagement through Pearson correlations, multivariate regression, and mediation analysis with 5000 bootstrap samples.

RESULTS

The participants exhibited moderate levels of professional identity (85.37 ± 13.52), self-efficacy (25.58 ± 5.74), and learning engagement (71.26 ± 16.17), which were all significantly correlated with each other (P < 0.01). In the model of the mediating effect, professional identity directly (β = 0.811, t = 27.484, P < 0.001) and indirectly [β = 0.112,95%CI (0.074-0.154)] significantly predicts college students' learning engagement; professional identity has a significant positive predictive effect on self-efficacy (β = 0.182, t = 14.459, P < 0.001) and self-efficacy significantly predicts learning engagement (β = 0.614, t = 8.292, P < 0.001). Furthermore, the direct effect of professional identity on learning engagement (0.699) and its mediating effect (0.112) account for 86.19 % and 13.81 % of the total effect (0.811), respectively.

CONCLUSION

Participants exhibited moderate levels of professional identity, self-efficacy, and learning engagement. Professional identity and self-efficacy are interconnected and positively correlated, influencing learning engagement among nursing students, which highlights the need to foster these qualities to enhance education and future practice.

Effects of game-based learning integrated with the self-regulated learning strategy on nursing students' entrustable professional activities: A quasi-experimental study

BACKGROUND

In the field of nursing education, the expertise and knowledge required to perform Leopold's Maneuvers are critical, forming an integral part of Entrustable Professional Activities for nursing students. As a result, mastering Leopold's Maneuvers has become a core component of nursing education. Despite this, the prevailing didactic methods in many nursing courses tend to limit interactive and contextual learning experiences, which can hinder students' ability to engage deeply with the subject matter. This lack of engagement may subsequently affect both the effectiveness of students' learning and students' clinical judgment capacity, essential elements in the competencies of Entrustable Professional Activities.

METHODS

A quasi-experimental design was employed in this study, involving a total of 55 nursing university students, with 28 participants in the experimental group and 27 in the control group. The research incorporated game-based learning integrated with the self-regulated learning strategy, and employed a pretest, posttest, and questionnaires to assess students' learning performance, self-efficacy, and learning motivation. The experimental group participated in game-based learning with the self-regulated learning strategy, whereas the control group experienced game-based learning without the integration of self-regulated learning. Learning performance was analyzed using an independent samples t-test, while Analysis of Covariance was employed to compare the self-efficacy and learning motivation of the two groups.

RESULTS

The findings showed that the integration of game-based learning with the self-regulated learning strategy can significantly improve students' learning performance, self-efficacy, and learning motivation.

CONCLUSION

As an integral part of Entrustable Professional Activities, Leopold's Maneuvers were integrated into an interactive game-based learning environment, coupled with the self-regulated learning strategy in nursing education. This approach aimed at cultivating core competencies among nursing students. This study has demonstrated its efficacy in engaging students effectively, serving as a dynamic resource for immersive learning in Leopold's Maneuvers, aligning well with the design considerations for promoting Entrustable Professional Activities in nursing education.

A game-based multimedia application to improve the ability of clinical nurses to perform geriatric care: A randomized controlled trial

BACKGROUND

Given the realities of global aging, maintaining Comprehensive Geriatric Assessment (CGA) abilities among clinical nurses is very important. Newer methods of continuing education are needed to engage nurses in CGA education. Using multimedia and game-based applications in CGA education (CGA APP) may be an effective method for continuing education.

OBJECTIVES

To test the effectiveness of CGA APP in improving nurses' confidence in their abilities to perform geriatric care.

DESIGN

A randomized, controlled trial were adopted.

SETTING

An 1343-bed tertiary-care medical center in southern Taiwan.

PARTICIPANTS

A total of 1250 nurses met inclusion criteria in 35 adult wards. We employed stratified sampling to recruit a total of 132 nurses proportional to the number of nurses in each ward, from January to March 2019.

METHODS

Based on the Octalysis gamification framework, the CGA APP was developed. Participants were randomly assigned to either an CGA APP or a control group, which received traditional classroom learning of the same content. The main outcome was improvement in confidence in geriatric care ability were measured before and end of the training session, and six months later.

RESULTS

There were no differences in baseline characteristics (except years of experience as a registered nurse), knowledge, attitudes or confidence of geriatric care between the two groups. Clinical nurses in the CGA APP group demonstrated significantly higher confidence in their geriatric care abilities than control group immediately after the intervention (75.85 ± 10.71 vs. 65.93 ± 8.49, p < 0.001) and six-months later (71.13 ± 9.69 vs. 63.57 ± 8.78, p < 0.001). After using GEE to control the confounding variable, the CGA APP group remained significantly higher confidence in their geriatric care abilities than control group.

CONCLUSIONS

Use of multimedia game-based applications my better engage and teach practicing clinical than traditional learning methods. Our findings suggest that such interventions be further developed and tested for a larger variety of continuing education needs.

Digital Educational Tools for Undergraduate Nursing Education: A Review of Serious Games, Gamified Applications and Non-Gamified Virtual Reality Simulations/Tools for Nursing Students

Educational technology has advanced tremendously in recent years, with several major developments becoming available in healthcare professionals’ education, including nursing. Furthermore, the COVID-19 pandemic resulted in obligatory physical distancing, which forced an accelerated digital transformation of teaching tools. This review aimed to summarize all the available digital tools for nursing undergraduate education developed from 2019 to 2023. A robust search algorithm was implemented in the Scopus database, resulting in 1592 publications. Overall, 266 relevant studies were identified enrolling more than 22,500 undergraduate nursing students. Upon excluding multiple publications on the same digital tool, studies were categorized into three broad groups: serious games (28.0%), gamified applications (34.5%), and VR simulations and other non-gamified digital interventions (37.5%). Digital tools’ learning activity type (categories = 8), geographical distribution (countries = 34), educational subjects (themes = 12), and inclusion within a curriculum course (n = 108), were also explored. Findings indicate that digital educational tools are an emerging field identified as a potential pedagogical strategy aiming to transform nursing education. This review highlights the latest advances in the field, providing useful insights that could inspire countries and universities which have not yet incorporated digital educational tools in their nursing curriculum, to invest in their implementation.

Effectiveness synchronous e-learning in nursing education: A meta-analysis and subgroup analysis

AIM

This study aimed to identify the best available evidence of the effects of synchronous e-learning in nursing education through a meta-analysis and to compare mean effect sizes between study subgroups.

BACKGROUND

With the rapid development of synchronous e-learning, adequate preparation is essential, as the formulation of effective educational strategies is crucial for learners' success. However, rather than focusing solely on using technology to implement e-learning, instructors should design education programs that meet learning objectives while considering appropriate technologies and types of interactions.

DESIGN

A meta-analysis and a subgroup analysis were conducted.

METHODS

English and Chinese databases including PubMed, Embase, CINAHL, Web of Science, Cochrane Library and China National Knowledge Infrastructure were searched for relevant articles published between the inception of these databases through May 2023. The search included the establishment of these databases up until May 2023. Using a search strategy, we identified 3273 potentially relevant articles. Ten primary studies were included in the final analysis. We used random effect models to synthesize effect size (ES) and accommodate heterogeneity for the main effect. Sub-group analyses were conducted to analyze the variations in effect size to investigate possible causes of heterogeneity.

RESULTS

We found synchronous e-learning to be more effective compared with the control groups, with a pooled random-effects standardized mean difference of 0.51, which is a medium effect size. Regarding learning outcomes, the effect size of reactions to learning (ES = 0.91, confidence interval [CI] = 0.14, 1.67) was higher than that of the psychomotor domain (ES = 0.57, CI = 0.17, 0.98), cognitive domain (ES = 0.63, CI = 0.11, 1.15) and affective domain (ES = 0.40, CI = 0.03, 0.76). In terms of interaction types and study characteristics were more effective if the studies included learner-learner interaction (ES = 0.83, CI = 0.36, 1.29), developed regions (ES = 0.55, CI = 0.17, 0.94), undergraduate nursing students (ES = 0.56, CI = 0.32, 0.80), no randomization (ES = 0.75, CI = 0.40, 1.10) and funding support (ES = 0.78, CI = 0.41, 1.16).

CONCLUSIONS

Well-designed synchronous e-learning courses should consider learners' motivations and self-directed learning abilities by providing diverse learning resources and environments. Nurse educators should develop synchronous e-learning teaching strategies that include peer interaction. The affective domain of learning in synchronous e-learning needs to be developed and considered in future research.

Technological mediation and humanization of nursing care: a systematic literature review

Introduction

One of the purposes of nursing education is to provide the health system with highly competent professionals oriented to the generation of humane care practices in their daily work. To achieve this purpose, it is essential to identify the needs that arise within the teaching processes and to clearly establish how the pedagogical use of technologies can improve learning environments.

Objective

To investigate and critically evaluate the contribution of technology to the strengthening of the humanization of care in the field of nursing.

Materials and Methods

The methodological approach for systematic literature reviews defined by Okoli, which involves following a rigorous and standardized process to systematically and explicitly identify, evaluate, and synthesize the existing body of research. Initially, 51 articles were selected for analysis. After applying exclusion criteria, 26 studies were extracted and reviewed, identifying categories that highlight the positive influence of technology on cognitive, psychomotor, and affective competencies. Subsequently, the document with the main conclusions was drafted.

Results

The findings reveal the effectiveness of various technological environments in nursing education, highlighting the prioritization of competencies linked to knowing and doing. However, there is an observed tendency to underestimate affective competencies crucial for humane care.

Discussion

The results revealed a diverse landscape regarding the impact of various technologies on the development of nursing competencies, highlighting both strengths and limitations. The ability of these tools to create immersive and realistic learning environments is emphasized, although the need to delve into competencies that promote humane care is acknowledged.

Conclusions

Future research is required to understand the contribution of technologies to the knowledge, attitudes, and values of the professional in training to promote humane nursing care.

Using "board games" to improve the effectiveness of extracorporeal membrane oxygenation care for nurses in intensive care unit

AIM

The purpose of this study was to evaluate the effectiveness of ECMO care board games facilitated teaching approach (ECMO care board games) in enhancing ECMO care knowledge, clinical reasoning and learning engagement among intensive care unit (ICU) nurses.

BACKGROUND

ECMO is a highly complex, relatively low-incidence, high-risk clinical life support device system used in the intensive care unit (ICU). Its usage has increased nearly tenfold over the past 30 years. Traditionally, ECMO education has been delivered through classroom teaching, which has demonstrated limited effectiveness in promoting nurses' learning engagement, clinical reasoning competency and confidence. The literature suggests that well-designed board games can enhance learning engagement, stimulate higher-level thinking and improve the effectiveness and confidence of nurses' learning.

DESIGN

A quasi-experimental study two-group repeated measure design.

METHODS

A purposive sample of 73 ICU nurses from two campuses of one medical center was recruited (37 in the experimental group and 36 in the control group). The experimental group received ECMO care training through ECMO care board games facilitated teaching approach, whereas the control group completed the training through a traditional teaching approach. Instruments used for data collection include a demographic information sheet, ECMO Care Knowledge Scale, Clinical Reasoning Scale (Huang et al., 2023) and Learning Engagement Scale (Ciou , 2020). Both groups completed a pre-test before the training, a post-test one week after the training and a second post-test three weeks after the training.

RESULTS

Prior to the intervention, there were no significant differences between the two groups in ECMO care knowledge and learning engagement. However, there was a significant difference in clinical reasoning. One week after the intervention, the experimental group demonstrated significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement than the control group (p <0.01). Three weeks after the intervention, the experimental group showed significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement (p <0.001).

CONCLUSIONS

The content for ECMO care is complex and difficult. Board games can enhance ECMO care knowledge, clinical reasoning and learning engagement. This teaching strategy may be applied to learning challenging subjects in the future to improve learning effectiveness. The clinical reasoning framework is conducive to guiding nurses' learning. In future continuing education, board games designed based on the clinical reasoning framework and tailored to the focus of in-service education can effectively enhance nurses' learning effectiveness.

Developing student nurses' evaluative judgement in clinical practice tertiary education: A systematic scoping review of teaching and assessment methods

OBJECTIVES

This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to identify features that align with promoting students' evaluative judgement.

INTRODUCTION

Evaluative judgement is a new concept to nursing tertiary education. Currently, there are no published reviews of evaluative judgement in nursing clinical practice education. This review aims to assist nursing educators to operationalise the concept of evaluative judgement in clinical practice education. As such the starting point was to determine features of evaluative judgement in current clinical teaching and assessment designs.

INCLUSION CRITERIA

Peer reviewed qualitative or quantitative studies that have evaluated teaching and/or assessment of tertiary (university/higher education) pre-registration (undergraduate) or post-registration (postgraduate) nursing students' clinical practice.

METHODS

The systematic scoping review was prospectively registered systematic review (OSF DOI 10.17605/OSF.IO/PYWZ6) reported using PRISMA guidelines. A systematic search of five databases (Medline, Scopus, Web of Science, ProQuest, CINAHL) was conducted, limited from 1989 onwards and in English. Two reviewers independently screened titles and abstracts, then full text, with disagreements resolved with a third independent author. Data were extracted, including the frequency and methods of developing students' evaluative judgement across the categories of discerning quality, judgement process, calibration and feedback. A narrative synthesis was performed.

RESULTS

Seventy-one studies were included (n=53 teaching, n=18 assessment). Most of the included studies, included some, but not all, of the features to develop nursing students' evaluative judgment. For teaching methods, the most identified evaluative judgement features in the included studies were discerning quality (n=47), feedback (n=41) and judgement process (n=21). Only three studies included a method of calibration. For the assessment methods, feedback (n=16), discerning quality (n=15), judgement process (n=9) and calibration (n=4) were included. Many clinical practice teaching and assessment methods in nursing included features that develop students' evaluative judgement, with methods relating to discerning quality and feedback well embedded. Further adjustments are required to include methods to assist students to judge and calibrate their own performance.

CONCLUSION

This systematic scoping review identified that evaluative judgement in current nursing clinical teaching and assessment is not an overt aim. With minor adjustment to teaching and assessment design, nursing students could be better supported to develop their ability to judge the value of their own work.

Alternative Clinical Practice Experiences of Korean Nursing Students during the COVID-19 Pandemic

Background: Routine clinical practice (RCP) experiences provide nursing students with the opportunity to gain confidence in their professional roles. The purpose of this study was to explore the alternative clinical practice (ACP) experiences of nursing students during the COVID-19 pandemic using the Q methodology. Methods: Fifty-two nursing students located in four cities across South Korea participated. The participants sorted the order of and ranked 41 Q statements about their experiences with ACP into a Q sort table; the data were analyzed using the PQ method. Results: The following three distinct viewpoints were extracted: (1) ACP helps with balancing learning and life (favorable view of ACP); (2) ACP does not help with balancing theory and clinical field practice (critical view of ACP); and (3) RCP cannot be replaced by ACP (negative view of ACP). Conclusions: The findings of this study indicate that developing a curriculum for clinical practice that can enhance the strengths of ACP while compensating for its weaknesses will help promote learning among nursing students.

Assessment of Readiness Toward Flipped Learning Among Novice Nursing Students on Fundamental Nursing Care in Puducherry, South India

Background This study aimed to assess the readiness toward flipped learning (FL) among novice nursing students in fundamental nursing care in Puducherry, South India.  Methodology A cross-sectional descriptive study was conducted among 176 first-year B.Sc. Nursing students from three private nursing colleges by purposive sampling technique. In theory and practical classes, the students were taught fundamental nursing procedures such as oral medication, intramuscular injection, peripheral intravenous cannulation, and nasogastric tube feeding as FL. The study was conducted from November 2021 to March 2022. The responses were collected using the Nursing Students' Readiness for Flipped Classroom (NSR-FC) scale with four domains such as personal, technological, environmental, and pedagogical readiness. Pearson correlation and chi-square tests were used to analyze data by incorporating IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA). Results Among 176 nursing students, 73.9% were aged between 17 and 19 years, the majority (76.7%) were females, and 98% of them used mobile phones to access online FL content. Of the novice nursing students, 69.88% agreed, 27.84% strongly agreed, and 2.27% were in a neutral state for readiness to adopt FL in their nursing curriculum with a mean (standard deviation, SD) value of 77.02 (6.27). Among the four domains of readiness, a positive correlation was found between personal with technological readiness (P = 0.001; r = 0.446) and pedagogical with personal readiness (P = 0.003; r = 0.223). Statistically, a significant association was found between students' readiness toward FL with the occupation of the head of the family, gadgets used to access the FL materials, and Wi-Fi/internet availability in the institutions with a P-value <0.05. Conclusions The study showed highly positive readiness for FL among nursing students in nursing subjects. It can be leveraged with educational institutions' environmental and technological support by properly utilizing mobile devices, computer laboratories, and access to the internet/Wi-Fi for students from their entry level to enhance FL.

Effects of an online training program on cardiovascular health behavior modification on nursing students' health education competency

OBJECTIVES

The COVID-19 pandemic has forced many healthcare organizations to stop the placement of undergraduate nursing students. As a result, undergraduate nursing students need the necessary training and practice to increase their competency. Therefore, effective strategies are needed to improve the effectiveness of online internships. This study aims to evaluate the impact of online cardiovascular health behavior modification training on nursing undergraduate students' health education competency and clinical decision-making perceptions using the Conceive-Design-Implement-Operate (CDIO) model.

METHODS

This study utilized quasi-experimental research with a non-equivalent control group design. Nursing students undergoing internships at Zhongshan Hospital, Fudan University, Shanghai, China, from June 2020 to December 2021 were enrolled in this study. The participants were allocated into two groups, experimental and control groups. All participants completed a course designed to promote healthy behavior modification. The experimental group participants completed four modules through an online training course based on the CDIO model. The control group was given theoretical lectures on the same topic online. Health education competencies and clinical decision-making perceptions were assessed before and after the training. Statistical analysis was performed using IBM SPSS 28.0.

RESULTS

A significant difference was observed between these two groups in their performance on the theoretical test (t = -2.291, P<0.05) and operational assessment (t = -6.415, P<0.01). The participants in the experimental group scored better than those in the control group. Post-test results indicated that students in the experimental group demonstrated significantly better health education competency (t = -3.601, P<0.01) and clinical decision-making perception (t = -3.726, P<0.01).

CONCLUSION

The study found that online courses based on the CDIO model are compelling. The study concluded that online classes are needed during the pandemic as it does not limit time and space. Nursing students can take their internship from anywhere as long as they can access the internet. Also, the study found that the online course was interactive and collaborative.

Health worker education during the COVID-19 pandemic: global disruption, responses and lessons for the future-a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis identified early evidence quantifying the disruption to the education of health workers by the COVID-19 pandemic, ensuing policy responses and their outcomes.

METHODS

Following a pre-registered protocol and PRISMA/AMSTAR-2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random-effects meta-analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end-year. We assessed risk of bias (Newcastle-Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE.

RESULTS

Of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1% (95% confidence interval 67.9-74.2) and learner redeployment at 29.2% (25.3-33.2). About one in three learners screened positive for anxiety (32.3%, 28.5-36.2), depression (32.0%, 27.9-36.2), burnout (38.8%, 33.4-44.3) or insomnia (30.9%, 20.8-41.9). Policy responses included shifting to online learning, innovations in assessment, COVID-19-specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two-thirds of learners (75.9%, 74.2-77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8%, 66.7-76.7). Learners preferred an in-person component: blended learning 56.0% (51.2-60.7), face-to-face 48.8% (45.4-52.1), and online-only 32.0% (29.3-34.8). They supported continuation of the virtual format as part of a blended system (68.1%, 64.6-71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence.

CONCLUSION

The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.

Influencing factors of self-regulated learning of medical-related students in a traditional Chinese medical university: a cross-sectional study

BACKGROUND

In recent years, self-regulated learning (SRL) has become a hot topic in medical education. However, the factors that affect the SRL ability of medical-related specialties, such as clinical medicine, traditional Chinese medicine (TCM), and nursing specialty in TCM colleges and universities are unclear. Whether the teaching of learning strategies can help improve students' SRL also needs to be further examined.

METHOD

A cross-sectional survey was distributed, and 878 medical-related students who were from a TCM university were recruited for this study. Descriptive statistics illustrated the status quo of SRL and learning strategies, and an independent t-test and analysis of variance were used to analyze the factors associated with SRL. The relationship between SRL and learning strategies was analyzed with multi-linear regression analysis.

RESULTS

The scores of SRL on learning motivation, learning setting, self-regulation, and total scores were 34.76 ± 4.62, 41.14 ± 4.30, 39.26 ± 4.74, and 115.16 ± 12.42, respectively. The metacognitive, emotion, cognitive, resource management and total scores of learning strategies were 58.54 ± 12.02, 43.24 ± 8.42, 35.49 ± 7.34, 22.89 ± 4.20, 160.16 ± 29.45, and the mean was all above the midpoint. Learning strategies were positively correlated with SRL (r = 0.421, P < 0.01). Some factors can predict 32% of the variation of SRL, including whether they liked their specialty, educational system, specialty, score ranking, scholarship, whether they were taught by a tutor in middle school, gender, monthly family income, the father's educational background, metacognitive strategy, resource management strategy, and cognitive strategy.

CONCLUSIONS

The SRL of medical-related students was better. Learning strategies, as well as personal or social factors, can affect SRL. Educators should pay more attention to the cultivation of learning strategies, exercising learning skills, and monitoring, adjustment, and guidance of learning time. It should adopt various methods to improve the SRL of medical-related students according to the different factors.

Effectiveness of game-based virtual reality phone application and online education on knowledge, attitude and compliance of standard precautions among nursing students

Game-based virtual reality phone applications can create a realistic environment to prepare for clinical applications and improve students’ knowledge of and compliance with standard precautions. An experimental study was performed among 126 nursing students’ from the third and fourth nursing levels to determine the effect of online education and game-based virtual reality phone applications related to standard precautions. Students were divided randomly into two groups; the experimental group used online education and game-based virtual reality phone applications, while the control group used traditional education. The study was performed between July and August 2019 to prevent clashes with lectures and midterm and final examinations. A tool package including knowledge, attitude, and compliance with standard precautions was used in pre-and post-tests among nursing students. The results showed that the knowledge of, attitudes towards, and compliance with standard precautions differed between the two groups. The performance of the experimental group of nursing students significantly improved with online instruction and game-based virtual reality phone applications. This study demonstrated the effectiveness of online education and game-based virtual reality phone application among nursing students.

The effect of laughter therapy on nursing students' anxiety, satisfaction with life, and psychological well-being during the COVID-19 pandemic: Randomized controlled study

Background

Changes in routine due to the pandemic have increased nursing students' anxiety about clinical learning. The inadequacy experienced before graduation caused them to experience high levels of anxiety characterized by feelings of insecurity and unhappiness and negatively affected their life satisfaction. Methodological studies are needed to confirm the efficacy of laughter therapy, which is effective in reducing anxiety and stress, on the online platform. The current study protocol was designed to evaluate the effect of online laughter therapy on anxiety, life satisfaction, and psychological well-being.

Methods

Forty students were selected for the intervention group and forty students for the control group by assigning 1:1 with a real random number selector among 140 senior nursing students who made up the universe. The intervention group received ten sessions of online laughter therapy two days a week for five weeks. Participants in the control group did not receive any intervention during the study. Data were obtained at the beginning of the study and after five weeks with the 'State-Trait Anxiety Inventory', 'Satisfaction with Life Scale' and 'Psychological Well-Being Scale'.

Results

After laughter therapy, the intervention result showed a significant increase in life satisfaction and psychological well-being scores (p < 0.001) and a significant decrease in anxiety scores (p < 0.001) in the intervention group compared to the control group.

Conclusion

The study reveals that online laughter therapy significantly positively affects nursing students' anxiety, life satisfaction, and psychological well-being.

A Competition-Based Problem-Posing Approach for Nursing Training

Conventional nursing teaching usually adopts one-way teaching approaches. As such, students cannot think deeply and engage in learning, which results in lower learning motivation and learning achievement. Several studies have indicated that problem-posing is a learning process that has students think about problems and actively construct knowledge, which helps their in-depth thinking and promotes their learning achievement. However, problem-posing is a task with a higher difficulty level; in particular, with insufficient learning motivation, it is not easy for students to pose in-depth questions. Therefore, the present study introduced competition to a problem-posing activity to facilitate students’ motivation. This study adopted a quasi-experimental design and conducted an experiment in the unit of Care of Critically Ill Patients. The results showed that the proposed competition-based problem-posing mobile learning approach could significantly enhance students’ learning achievement and learning motivation and would not cause an excessive cognitive load. Moreover, competition increased students’ learning motivation, and fostered them to actively reflect on and revise their questions, thereby increasing their problem-posing quality and learning achievement. This study can serve as a reference for future clinical practice to enhance the quality and sustainability of apprenticeships.