Theoretical foundations of educational strategies used in e-learning environments for developing clinical reasoning in nursing students: A scoping review

Effects of an unfolding case study on clinical reasoning, self-directed learning, and team collaboration of undergraduate nursing students: A mixed methods study

BACKGROUND

Clinical reasoning is an essential nursing competency that students must develop to provide safe patient care. Developing and utilizing unfolding case studies, which present constantly changing patient conditions to improve students' clinical reasoning and to foster communication and self-reflection, can help to achieve that imperative.

OBJECTIVES

To develop an unfolding case study and to test its effectiveness in improving clinical reasoning, team collaboration, and self-directed learning.

DESIGN

A mixed methods design.

SETTING

One university in Southern Taiwan.

PARTICIPANTS

Forty nursing students.

METHODS

An unfolding case study was developed based on the clinical reasoning model and unfolding cases model. The Nurses Clinical Reasoning Scale, Self-Directed Learning Instrument, and Questionnaire of Group Responsibility and Cooperation in Learning Teams were used. Forty nursing students completed questionnaires and nine of them participated in focus group discussions. Wilcoxon signed-rank, Spearman correlation, regression, and inductive content analysis were used to analyze data.

RESULTS

Students' abilities in clinical reasoning, self-directed learning, and team collaboration were statistically significantly improved after implementation of the unfolding case study. Emergent themes included "patient-centered communication," "group inspiration and learning," "thinking critically and reflecting on oneself," and "applying theoretical knowledge in care to meet patients' changing needs."

CONCLUSIONS

Unfolding case studies provide a safe environment in which nursing students may learn and apply knowledge to safe patient care.

Clinical reasoning skill of nurses working in teaching medical centers in dealing with practical scenarios of King's model concepts

BACKGROUND

The present study was conducted to determine clinical reasoning of nurses working in teaching medical centers in dealing with practical scenarios of King's concepts.

METHODS

The study population in this cross-sectional descriptive-analytical study comprised 133 nurses. Data were collected using scenarios based on the King's model. Data were analyzed in SPSS-16.

FINDINGS

Mean age of the participating nurses was 27.71 ± 8.1 years.The clinical reasoning score was less than average in most participating nurses, and had a significant relationship with education(P < 0.05), service ward(P < 0.001)and organizational position(P < 0.05). In the multivariate analysis of factors relating to clinical reasoning, higher education level (B = 9.5, P = 0.018) and organizational position (B = 4.3, P = 0.017) were predictors of clinical reasoning score.

DISCUSSION

Existing nursing models such as King's, which is closely related to clinical reasoning, can be used more in educational and clinical systems, and as a clinical guide for promoting the clinical reasoning of nurses and students.

What characterizes the use of digital technology in bachelor-level practice placements in health programs?

AIM

The study aimed to investigate what characterizes the use of digital technology in bachelor-level practice placements in health programs.

BACKGROUND

Practice placement for health students in higher education is complex and suffers from a lack of personnel and scant resources. However, the requirements and expectations of the students in managing an evidence-based practice are increasing. This decade, digital transformation in society and higher education can potentially improve students learning in higher education and practice placement due to increased availability for closer communication and collaboration.

DESIGN

A systematic review of reviews was conducted based on Joanna Briggs Institute Framework.

METHODS

Bibliographical databases were searched for studies published between 2010-2022. Out of 4891 screened articles, 15 met eligibility criteria and were included in this review.

RESULTS

The analysis revealed three main topics that elucidate what characterises the use of digital technology in placements: Leveraging digital solutions for enhanced practical learning; Empowering student learning and confidence in practice placement; and The value of interactive collaboration.

CONCLUSIONS

The findings show that digital technology used in a structured pedagogical framework may support and enhance students learning in practice placement. However, further work needs to be done to keep up with the rapid development of digital technology in practice placement in health work environments.

Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics

OBJECTIVE

to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics.

METHOD

methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8).

RESULTS

the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content.

CONCLUSION

the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.

The Self-Perceived E-Learning Environment Scale: Development and Psychometric Properties in a Nursing Students Samples

AIM

E-learning is increasingly used in education, creating a learning environment that needs to be studied thoroughly for developing new learning opportunities.

BACKGROUND

Drawing from the community of inquiry framework, the present work provides the theoretical foundation and measurement validation of the Self-Perceived E-Learning Environment Scale (SEES). The SEES measures core aspects of the e-learning context: autonomous strategic planning, social interaction, and teacher feedback.

METHOD

Through two studies carried out in sample of nursing students, an exploratory (n = 302) and confirmatory (n = 245) factor analysis revealed a three-factor structure.

RESULT

The results provide empirical evidence of appropriate psychometric properties (i.e., reliability, validity).

CONCLUSION

The SEES can be used in a higher education context, particularly in nursing education programs. Theoretical, methodological, and practical implications for exploring the e-learning environment in nursing educational settings are discussed.

Co-creating digital educational resources to enhance quality in student nurses' clinical education in nursing homes: Report of a co-creative process

AIM

To report a methodological, co-creative approach for developing an interactive digital educational resource to enhance the quality of student nurses' clinical education in nursing homes and to elucidate the lessons learned from this approach.

DESIGN

This study applied a co-design methodology that builds on participatory design principles.

METHODS

Co-creating the digital educational resource included multiple sequential and interactive phases inspired by the design thinking framework. Workshops were employed as the primary co-creative activity.

RESULTS

Seven separate homogenous or joint heterogeneous workshops were conducted with student nurses, nurse educators, registered nurse mentors and e-learning designers (n = 36) during the active stakeholder engagement phases to inform the educational content, design and functionality of the digital educational resource. These were informed by, and grounded in, learning theory and principles.

CONCLUSION

Co-creative approaches in nursing education are an essential avenue for further research. We still lack systematic knowledge about the impact and benefits of co-created initiatives, stakeholders' motivations, barriers, facilitators to participation and the role of context in supporting effective co-creative processes to increase the quality of nursing education.

IMPACT

This paper demonstrates how digital educational initiatives to enhance quality in clinical nursing education can be co-created with key stakeholders through a novel methodological approach inspired by design thinking. To date, the methodological development process of co-created educational interventions has received limited attention and compared with the content and theoretical underpinnings of such interventions, has rarely been addressed. Therefore, this paper facilitates knowledge exchange and documents vital aspects to consider when co-creating digital educational initiatives incorporating multistakeholder perspectives. This promotes a stronger academic-practice partnership to impact and enhance the quality of clinical nursing education in nursing homes.

PUBLIC CONTRIBUTIONS

Student nurses, nurse educators, and registered nurse mentors worked alongside researchers and e-learning designers in the co-creative process.

Using the community of inquiry as a framework to promote online teaching and learning in advanced practice nursing education

ABSTRACT

As advanced practice nursing education continues to shift toward a distance and hybrid format, it is important that nurse educators engaged in distance learning create and facilitate an online environment that successfully incorporates critical thinking, problem-solving skills, collaboration, and a sense of community. Although many learning theories and frameworks exist, there is a lack of literature on the applicability of these theories and frameworks to online teaching and learning in advanced practice nursing education. The purpose of this article is to describe the Community of Inquiry (CoI) framework and how it can be applied to online teaching and learning activities in advanced practiced nursing courses. This CoI is an effective framework for online learning and has been successful in promoting student engagement, an important factor in and predictor of academic success.

The effectiveness of designing and evaluating i-STAR applications in pediatric nursing courses

To apply the App to the curriculum could improve students' motivation and concentration, and also strengthen the effectiveness of professional knowledge of nursing students.

OBJECTIVES

To construct and evaluate the effectiveness of smartphone applications (i-STAR) in pediatric nursing courses.

METHODS

Quasi-experimental study and two-group repeated-measure design were used to evaluate the effectiveness of smartphone applications (i-STAR) in pediatric nursing courses. The "i" means "interactive", students had to log into App and finish four steps, including "Situation(S), Task(T), Action(A), and Reflection(R). A total of 163 nursing students in the third grade of associate's degree in nursing (ADN) participated in the study. The experimental group consisted of 77 participants, whereas the control group consisted of 86 participants. The instruments included the clinical reasoning readiness scale (CRRS), self-directed learning instrument (SDLI), and learning satisfaction of students. The 1st phase was the development, construction, and testing of the "i-STAR App", including hyperbilirubinemia, pneumonia, and urinary tract infection (UTI). In the 2nd phase, students operated and applied the App in the classroom. The 3rd phase was to evaluate the effectiveness of the "i-STAR App" in the course.

RESULTS

The average scores of CRRS and SDLI were not significantly different between the two groups in the T0 andT1 (p > .05). The experimental group of CRRS and SDLI were better than the control group in T0-T1, T1-T2, and T0-T2 (p < .001). The experimental group showed better CRRS and SDLI scores than the control group in T0-T1, and T0-T2 with Repeated measures ANOVA. Also, the experimental group showed prolonged learning effectiveness. The experimental group (41.22 ± 6.08) was more satisfied than the control group (37.29 ± 7.40) (p < .05), although their academic performance was about the same (p > .05).

CONCLUSION

"i-STAR App" could enhance students' interest in pediatric nursing courses, strengthen nursing students' clinical reasoning and self-directed learning ability.

Current Practices for Teaching Clinical Judgment: Results From a National Survey

BACKGROUND

Safe patient care is closely linked to clinical judgment. Concerns about inadequate practice readiness and the impending inclusion of clinical judgment items on the NextGen NCLEX have resulted in increasing interest and publications about teaching clinical judgment. However, little is known about actual current practices for teaching this skill.

PURPOSE

This research describes findings about current strategies to teach clinical judgment used in US prelicensure nursing programs.

METHODS

Cross-sectional methodology was used to survey program deans and directors across the United States.

RESULTS

Programs are using multiple strategies to teach clinical judgment. The most common strategies used include case studies and simulation. Participants believed strategies have a positive impact on student thinking, practice readiness, and program outcomes. They described insights into implementation of teaching for clinical judgment.

CONCLUSION

The results of this research provide foundational data to inform current teaching practices and further research for this essential skill.

Theories informing technology enhanced learning in nursing and midwifery education: A systematic review and typological classification

BACKGROUND

Learning is a complex process involving internal cognitive processes and external stimuli from curricula, pedagogical strategies, and the learning environment. Theories are used extensively in higher education to understand the intricacies of adult learning and improve student outcomes. Nursing and midwifery education uses a range of technology enhanced learning (e-learning) approaches, some of which are underpinned by theoretical frameworks.

OBJECTIVE

Synthesise literature on theories that inform technology enhanced learning in nursing and midwifery education.

DESIGN

A systematic review.

DATA SOURCE

CINAHL, ERIC, MEDLINE and PubMed were searched for relevant studies (2000-2021). Reference lists of related literature reviews were hand searched.

REVIEW METHODS

Title and abstract, followed by full texts were screened by two reviewers independently using predefined eligibility criteria. Quality appraisal was not undertaken. Data were extracted and Merriam and Bierema's typology of adult learning theories used to categorise theories in each study.

RESULTS

Thirty-three studies were included, incorporating twenty-nine distinct learning theories from the behaviourist, cognitivist, constructivist, and social cognitivist domains, with constructivist being the most widely used. Kolb's Experiential Learning Theory and Driscoll's Constructivist Learning Theory were the most commonly reported theories. The population of learners were mainly undergraduate nursing students who used a range of online, mobile, blended or computerised learning, virtual reality, or digital forms of simulation, primarily in university settings. Theories were employed to inform the technology enhanced learning intervention or to help explain how these could improve student learning.

CONCLUSION

This review highlighted a range of theories, particularly constructivist approaches, that underpin research on technology enhanced learning in nursing education, by informing or explaining how these digital interventions support learning. More rigorous research that examines the myriad of theoretical frameworks and their effectiveness in informing and explaining technology enhanced learning is needed to justify this approach to pedagogical nursing research and practice.

Comparing the effects of demonstration, video display, and virtual social networks on nursing students' learning of hemodialysis clinical skills: An interventional and comparative study

BACKGROUND

Applying new methods of clinical education seems to provide nursing students with educational opportunities. The present study aimed to compare the effectiveness of training through demonstration, video display, and virtual social space on the learning of clinical skills among nursing students.

MATERIALS AND METHODS

In this semi-experimental research with posttest that was performed in 2019, thirty nursing students of the seventh semester were randomly assigned to three groups of demonstration, video display, and the social virtual space education with ten people in each group. The research was conducted in the hemodialysis ward of university hospitals. Each group was trained and evaluated during 10 days with 5-h sessions continuously. Participants' skills were evaluated using eight self-made, valid and reliable checklists, and the three groups were compared. For data analysis such as the means and standard deviations and inferential statistics, Mann-Whitney test, Kruskal-Wallis likelihood-ratio, and Chi-squared test in SPSS version 16 were used.

RESULTS

The results indicated that practical skill levels in the group of virtual social network were significantly higher than the two groups of video display (P = 0.045) and demonstration (P = 0.03). In addition, the group of virtual space had significantly higher scores than those of the other two groups only in two skills of "prime" and "disconnecting the patients from the machine" (P < 0.05).

CONCLUSION

Proper use of networks and social virtual space for clinical training, along with conventional methods of learning, provides good learning opportunities and is affordable in terms of time, cost, and process.

The value of a redesigned clinical course during COVID-19 pandemic: an explorative convergent mixed-methods study

Background

The COVID-19 lockdown in March 2020 had a significant consequence for nursing students worldwide including limited access to learning situations in clinical rotation. Therefore, this study aims to explore how an innovative redesign of a clinical course in a time of pandemic supported nursing students in learning the fundamentals of care in their first year. The redesign involved the transformation of a traditional hands-on clinical course into a technology-enhanced learning environment.

Design

This was an explorative convergent mixed-methods study using both quantitative and qualitative methods.

Methods

Twenty-four first-year nursing students responded to an online questionnaire with open-ended questions. Two nursing students and one faculty member participated in individual online interviews, and three faculty members participated in an online focus group interview. All the data were collected in June 2020. The quantitative data were analyzed using descriptive statistics and the qualitative data using content analysis. The GRAMMS guideline was applied.

Results

The students achieved the learning outcomes regarding fundamental care, basic physical assessment skills, and clinical reasoning with the help of academic assignments, multimedia learning resources, and virtual patients. Further, six central aspects of the facilitator role in the virtual simulation were identified. The aspect that was considered most valuable involved uncovering the “red thread” between different areas of knowledge in the first year of nursing education; this supported the students to better understand how to think and talk like a nurse.

Conclusion

This study offers insight into how a technology-enhanced clinical course can foster the learning of fundamental nursing care, basic physical assessment skills, and clinical reasoning skills; enhancing students’ preparedness for clinical hours. Virtual patients’ scenarios contributed to integrating different types of knowledge and skills that are important when providing nursing care for patients in clinical practice. This study also highlighted a gap in pedagogical competence among faculty members with regards to facilitating learning in a technology-enhanced learning environment. Study findings suggest promising pedagogical strategies that should be further developed post-pandemic, in response to the call for a renewal of nursing education using more technologically supported learning designs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00872-8.