Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

Advancing Consistency in Education: A Reliability Analysis of the Clinical Reasoning Assessment Tool

INTRODUCTION

Clinical reasoning (CR) is a fundamental component of physical therapist practice in health care. The Clinical Reasoning Assessment Tool (CRAT) was developed to assess CR in Doctor of Physical Therapy (DPT) and residency education. However, the reliability of the CRAT has not been investigated. Our purpose was to investigate the interrater and intrarater reliability of the CRAT.

REVIEW OF LITERATURE

A range of assessment methods are available to assess CR, including didactic-based, simulation learning, and clinic-based assessments. The CRAT is designed to assess CR across learning environments. The CRAT assesses CR across 3 domains: (1) content knowledge, (2) procedural knowledge/psychomotor skills, and (3) conceptual reasoning.

SUBJECTS

Twenty-two faculty participated.

METHODS

Participants completed an electronic survey at 2 timepoints (T1, T2) that included training on use of the CRAT and 2 case videos of DPT students at different performance levels managing a standardized patient. Participants rated student performance with the CRAT for both case videos (T1) and repeated the sequence at least 30 days later (T2). Intraclass correlation coefficient (ICC) estimates and 95% confidence intervals were used to determine the interrater and intrarater reliability for each domain of the CRAT.

RESULTS

Video 1 was consistently rated higher for each CRAT domain (T1: 7.32-8.05; T2: 8.05-8.15) compared to video 2 (T1: 2.91-3.68; T2: 3.00-3.68). There were inverse relationships between CRAT ratings and number of years in DPT education, at an institution, and as a licensed physical therapist. At both timepoints, the interrater reliability for each domain was good to excellent (ICCs 0.60-0.79). The intrarater reliability was fair to excellent for all domains for each video (ICCs 0.45-0.75).

DISCUSSION AND CONCLUSION

The CRAT is a reliable instrument for assessing DPT student CR during a simulated patient encounter. Implementation of the CRAT in DPT education may facilitate improved consistency of CR assessment across the learner continuum.

The effect of game-based scenario writing on the clinical reasoning of internship nursing students in cardiovascular emergencies and critical care units

BACKGROUND

Nurses' failure to properly apply clinical reasoning (CR) can result in diagnostic errors especially in cardiac emergencies and critical care that compromise patient care and threaten patient safety. Therefore, nursing education must employ appropriate teaching approaches, particularly throughout internships, to enhance students' CR skills.

AIM

This study aimed to assess the effect of game-based scenario writing on the CR of internship nursing students in cardiac emergencies and critical care units.

METHODS

An unblinded, randomized, controlled trial with a parallel control group was conducted with 82 nursing students who were experiencing cardiac emergencies and critical care internships from June to September 2023. The participants were randomly assigned to either the intervention group (n = 41), which received game-based scenario writing in the two phases of the pre-internship and internship periods, or the control group (n = 41), which received routine internship training. Data were collected at baseline and the end of the internship course, and the instruments included participants' characteristics, a CR test, and a satisfaction questionnaire.

RESULTS

At the end of the cardiac emergencies and critical care internship course, compared with the control group, the intervention group presented a significant increase in CR (12.30 ± 3.6, 14.57 ± 3.9, p < 0.05). Within-group Comparison of pre-test and post-test CR scores only showed a significant increase in the intervention group (p = < 0.001).

CONCLUSIONS

The current study's findings support the argument that the gamified scenario-writing method can be an effective and dynamic learning method. It appears that employing this approach in nursing education could potentially enhance the CR of nursing students during their internship courses. Therefore, applying this method is recommended to nursing educators, especially for cardiac emergencies and critical care unit internship courses.

Health professional students' evaluation of video resources to improve their communication skills: A co-design study

BACKGROUND

Effective communication facilitates therapeutic relationships and builds trust, therefore leading to positive consumer health outcomes. There is a greater need for undergraduate health professional students to have authentic learning experiences to build their competence and confidence to develop communication skills.

OBJECTIVES

This study sought to explore the learning experiences of health professional students after watching simulated communication videos. The videos were created with consumers to illustrate authentic communication.

DESIGN

A descriptive qualitative co-design study.

SETTING AND PARTICIPANTS

Second and third year Bachelor of Nursing and Bachelor of Nutrition and Dietetics students.

METHODS

Data were collected through group and individual interviews and online questions. Thematic analysis was undertaken.

RESULTS

Twenty-eight students participated in the research, providing insights into how the videos influenced their understanding of communication and consumer partnerships. On a scale one to five, the students gave the videos an average rating of 4.5 Very useful, the video was quite helpful in understanding communication techniques. Four themes emerged from the qualitative data, including: reinforcing learning concepts; navigating communication; authentic learning; and understanding the patient perspective.

CONCLUSIONS

Including consumers in the development of resources enables students to connect theory to practice. Watching genuine conversations and different communication styles, better prepares health professional students to develop effective communication skills for their future practice.

Informal learning of ICU new graduate registered nurses: An interpretive phenomenological analysis

BACKGROUND

New graduate registered nurses (NGRNs) working in the Intensive Care Unit (ICU) face challenges translating theoretical knowledge into clinical practices, especially within the informal learning environment. This study explored NGRNs' experiences with informal learning and its role in addressing complex clinical scenarios.

METHODS

Utilizing Interpretive Phenomenological Analysis (IPA) as its foundational philosophy and methodology, this research employed semi-structured interviews to reveal NGRNs' learning processes.

RESULTS

NGRNs primarily relied on observation and practice, questioning and communication, and feedback during shift changes. These strategies were crucial for their professional development, contributing to skill acquisition, establishing work patterns, and gaining independent working capabilities. However, limitations of informal learning could lead to inconsistent experiences with knowledge and potential patient safety risks.

CONCLUSION

Informal learning is vital for NGRNs' professional development but requires structured support and guidance to ensure patient safety and improve care quality. Managers and educators should create an open, flexible environment for questioning and consultation and enhance educator's feedback skills. High transitional stressors and workload can undermine NGRNs' motivation to continue learning after reaching an advanced beginner level. Future efforts should develop effective interventions to overcome obstacles in informal learning pathways, improving NGRNs' learning efficiency and quality.

Training healthcare professionals to dignity-in-care: A scoping review

BACKGROUND

Despite the wealth of evidence-based practices attesting to the influence of patient dignity on the care relationship, gaps persist in healthcare professionals' abilities to bolster it. Promoting dignity-in-care poses a challenge due to the abstract nature of the concept and its lack of unequivocal definition.

OBJECTIVE

To delineate the scope of training opportunities, identify gaps in dignity-in-care training, excluding the broader concept of dignity beyond healthcare assistance, and propose strategies to address these deficiencies.

DESIGN

Systematic scoping review to determine the range and type of training opportunities for healthcare professionals.

DATA SOURCES

We followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-ScR guidelines. By February 10th 2023, we searched five databases (MEDLINE, Scopus, Embase, Cinahl, PsycINFO) for materials published from 2002 in English and Italian. In addition to the search strategy, we augmented our exploration by scrutinizing the references cited in the included papers. Our scope encompassed studies on healthcare professionals as the target population, specifically physicians, nurses, social workers, psychologists, occupational therapists, chaplains or spiritual care assistants, and students engaged in health-related disciplines.

REVIEW METHODS

Two authors independently assessed the abstracts of the retrieved articles. They discussed discrepancies with a third researcher, an expert in qualitative methodology.

RESULTS

Eleven articles were included in the analysis after the initial screening. Most of the studies were conducted in Europe, indicating an increasing interest in training on dignity and suggesting a potential role of international nursing organizations in driving attention to dignity-in-care education. The training appeared to downplay cultural differences. However, these approaches were not without criticism, as they raised concerns about overlooking the complexities and nuances associated with dignity within cultural contexts. Our analysis suggested that incorporating dignity into the curriculum and continuing education for healthcare professionals is paramount. Finally, limited opportunities emerged for medical students, postgraduate residents, and physicians to enhance dignity within care relationships.

CONCLUSION

Future training programs should prioritize "culturalizing" the concept to ensure a comprehensive approach to dignity-in-care. Moreover, the focus on nursing students and limited representation from other healthcare disciplines emphasizes the need for a broader interdisciplinary approach to integrating dignity-in-care education.

Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Scoping Review

BACKGROUND

Critical thinking is a crucial skill in the nursing profession and must be fostered through nursing education. Simulation-based learning (SBL) with technological modalities is a pedagogical approach to enhance critical thinking skills for nursing students. The use of technology in SBL to achieve critical thinking skills is diverse. No previous scoping review has systematically mapped studies on SBL supported by technology to enhance critical thinking in nursing students.

OBJECTIVE

This scoping review aimed to systematically map research on the use of SBL supported by technology to enhance critical thinking in nursing students.

METHODS

This scoping review was conducted according to the framework by Arksey and O'Malley and was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, Embase, PsycINFO, and Web of Science databases in 2021 and repeated in 2023 and 2024. Pairs of authors independently assessed titles, abstracts, and full-text papers and extracted data from the included studies. The data underwent summative and thematic analysis and were categorized according to the findings.

RESULTS

In total, 4 main categories of technology applied in SBL were identified: computer-based simulations, human-patient simulators, virtual reality or immersive virtual reality, and others. The findings revealed a shift across time in the technology used for SBL to enhance critical thinking, from human patient simulators to computer-based simulations. A dominant part of the included studies published after 2018 (21/44, 48%) incorporated a combination of asynchronous and synchronous learning activities. The theoretical foundation of the studies revealed a range of scientific theories and conceptual frameworks and models. Enablers of or barriers to the enhancement of critical thinking skills in nursing students were identified within the following themes: affinity for and availability of technology, realism, accessibility, engagement and motivation, validation, return on investment, and enhanced critical thinking through SBL using technology.

CONCLUSIONS

There has been a noticeable shift in the technology and use of technology in SBL. Descriptions of the applied technology and pedagogical considerations are pivotal for comparing or synthesizing research results. There has been a trend toward a blended educational approach combining synchronous and asynchronous learning activities. User technological proficiency and the perceived quality of the technology are imperative in the development of critical thinking. Realism, engagement, and motivation play pivotal roles in the enhancement of critical thinking in technologically supported SBL. The establishment of robust theoretical foundations of research and standardized research practices will strengthen the evidence obtained from the research conducted.

Effectiveness of a blended (distance and in-person) simulation education program on advanced cardiac life support for nursing students using the PARTNER model

BACKGROUND

The incidence of acute cardiac arrest is increasing and is directly linked to patient survival, highlighting the critical role of nurses. Advanced nursing skills for cardiac arrest patients, such as self-directed pre-learning applied to various clinical situations, require a systematic blended learning approach to integrate knowledge and enhance clinical performance through face-to-face practice. The purpose of this study is to evaluate the effectiveness of a blended simulation education program for Advanced Cardiac Life Support (ACLS) using the PARTNER model.

METHODS

A nonequivalent control group pretest-posttest design with a time-lagged approach was used to collect data from 34 third-year nursing students. The experimental group(n = 17) received a 480-minute blended simulation education program based on the PARTNER model and flipped learning, while the control group(n = 17) participated in a 480-minute traditional simulation education program.

RESULTS

The study found that knowledge, confidence, performance in advanced cardiac life support, and clinical performance ability were effectively enhanced, although no significant effect was observed in learning satisfaction.

CONCLUSIONS

The program provides a new direction in applying blended simulation using the PARTNER model for advanced cardiac life support nursing education, ultimately contributing to the training of nurses competent in advanced cardiac life support.

Optimizing Clinical Reasoning: Unpacking the Impact of Virtual Patient Educational Duration in Cancer Care and Nursing Students' Experiences

Background

Teaching clinical reasoning to nursing students is essential for professionalizing and improving cancer patient care. This study investigates how training duration with Virtual Patients (VPs) impacts clinical reasoning and learners' evaluation of their experiences.

Materials and Methods

The present semi-experimental study was conducted with a pretest-post-test design and a control group. Through the census sampling method, 74 nursing students from Isfahan University of Medical Sciences, Iran, (in their 4th and 5th semester) who had taken the cancer course were selected (2019-2022) and, upon obtaining their consent, were enrolled in the study. The study began with a pretest, followed by engagement in five VP scenarios over 6 weeks, which was followed by the post-test phase. Data were collected via 23-item tests and the Huwendiek Questionnaire. The collected data were analyzed in SPSS software using correlation tests and t-tests.

Results

The outcomes revealed a noteworthy disparity between the mean scores recorded in the pre-test and post-test stages after training, for both the 4th and 5th semester cohorts (p ≤ 0.001). Moreover, a notable discrepancy surfaced between the duration of training with VPs and the average post-test score (p ≤ 0.001). The correlation coefficient, for the 4th semester, stood at 0.65, while for the 5th semester, it was 0.213. Notably, the participants exhibited contentment with the learning experience through VPs.

Conclusions

The survey found that 85.60% of participants prefer using VPs for clinical reasoning education. Our study underscores the link between the duration of VP interaction and improved clinical reasoning skills in nursing students.

Bridging theory and practice: a scoping review protocol on gamification's impact in clinical reasoning education

INTRODUCTION

In the rapidly evolving field of medical education, gamification has emerged as a promising strategy to enhance clinical reasoning skills among healthcare professionals. By incorporating game-like elements into the learning environment, gamification strives to enhance engagement, motivation and knowledge retention. Given the importance of clinical reasoning in medical decision-making and patient care, this scoping review protocol aims to systematically explore developments, implementations and outcomes of gamification in clinical reasoning education.

METHODS AND ANALYSIS

The scoping review will follow the Arksey and O'Malley methodological framework, enhanced by guidelines from the Joanna Briggs Institute. We will search four major databases: OVID Medline, Scopus and Web of Science using key terms such as "gamification," "clinical reasoning," and "medical education". Studies will be selected based on the participants, concepts and contexts (PCC) framework, focusing on literature published in English. Two independent reviewers will screen studies and extract data on gamification elements used in clinical reasoning education. Any disagreement between the reviewers will be resolved by consulting a third person. We will provide a narrative synthesis of the findings, highlighting the variety of gamified strategies and their effects on clinical reasoning skills. This review will also map out gaps in the current literature and provide direction for future research.

ETHICS AND DISSEMINATION

The scoping review, which aggregates and synthesises publicly available studies, does not require ethics approval due to its nature as a compilation of existing research. The reporting of findings will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, promoting both thoroughness and transparency in our analysis. Our dissemination plan encompasses publication in a peer-reviewed journal and presentations at academic conferences focused on medical education. This strategy is designed to engage educators, curriculum designers and policymakers within the sector, ensuring our insights reach those who can apply them most effectively.

Serious Game for the Nursing Assessment of Home-Dwelling Older Adults: Development and Validation Study

BACKGROUND

The use of serious games (SGs) in nursing education is increasing, with the COVID-19 pandemic significantly accelerating their development. A key feature of SGs is their flexibility, allowing students to train at any place and time as needed. Recently, there has been a shift from developing disease-specific SGs to games focused on broader health issues. However, there has been a lack of proposals to enhance nursing interventions in home and frail care settings. The REACtion project developed a SG to improve students' understanding and clinical reasoning in caring for home-dwelling older adults.

OBJECTIVE

This study aims to describe the development of "REACtion Game" (RG) and explore its validity as an educational tool. A multidisciplinary team created a SG that simulates the assessment process of older adults in home settings by nurses. It features web-based scenarios, clickable objects, and a menu with tools, and medical records to enhance nursing students' knowledge and clinical reasoning skills.

METHODS

A prospective, observational study was conducted using the Dutch Society for Simulation in Healthcare's framework to validate the game. Further, 5 experts in home health care nursing evaluated content validity, while 30 students assessed construct validity, face validity, concurrent validity (by comparing game scores with those from the Nursing Clinical Reasoning Scale), game quality, and usability. Data were collected through self-administered web-based questionnaires and the debriefings of each match played. The students were enrolled in 2 postgraduate nursing programs: a master of science in nursing degree and a first-level continuing education in family and community nursing.

RESULTS

Experts rated the content validity highly after revisions (universal agreement calculation method of scale-level content validity index=0.97). The sample consisted of 30 students, predominantly women (n=20, 67%) and aged younger than 45 years (n=23, 77%) with no prior experience in SG. Almost all students had a positive impression of RG as an attractive and useful method for learning new knowledge. Participants found the cases, scenarios, and dialogues realistic (face validity) and of high quality, though usability aspects such as instructions clarity and intelligibility of game progression were less favored. Construct validity showed general agreement on the game's educational value, with family and community nursing students reporting more consistent alignment with educational goals. Overall, RG scores correlated positively with time spent playing but showed limited correlation with Nursing Clinical Reasoning Scale scores.

CONCLUSIONS

This study developed and validated a nursing education game, especially valuable as simulation is underused in some curricula. Created during the pandemic, it offered a digital learning environment. Although the game shows potential, further testing is needed for usability, concurrent validity, and functional improvements. Future research should involve larger samples to fully validate the game and assess its impact on academic achievement.

Development and Usability Assessment of Virtual Reality- and Haptic Technology-Based Educational Content for Perioperative Nursing Education

BACKGROUND/OBJECTIVES

In perioperative nursing practice, nursing students can engage in direct, in-person clinical experiences in perioperative environments; however, they face limitations due to infection and contamination risks. This study aimed to develop and evaluate educational content for perioperative clinical practice for nursing students using virtual reality (VR) and haptic technology.

METHODS

The program, based on the Unity Engine, was created through programming and followed the system development lifecycle (SDLC) phases of analysis, design, implementation, and evaluation. This program allows nursing students to engage in perioperative practice using VR and haptic technology, overcoming previous environmental limitations and enhancing practical and immersive experiences through multi-sensory stimuli.

RESULTS

Expert evaluations indicated that the developed content was deemed suitable for educational use. Additionally, a usability assessment with 29 nursing students revealed high levels of presence, usability, and satisfaction among the participants.

CONCLUSIONS

This program can serve as a foundation for future research on VR-based perioperative nursing education.

IST Nurse®: development and validity evidence of a mobile application as a support for the clinical management of Sexually Transmitted Infections

OBJECTIVE

to develop and evaluate the validity evidence of a mobile application to support nurses in the clinical management of sexually transmitted infections.

METHOD

methodological study conducted in four steps: analysis and definition of requirements; content definition; computational representation with system design; and coding with testing and refinement. In the first steps, nurses with expertise in the subject participated, and in the last, professionals with education in information and communication technology. Data analysis was performed by calculating the Content Validity Index (CVI), considering the minimum agreement value of 0.78. To confirm the viability of the CVI, the binomial test was used through the R software. Variables with p > 0.05 indicated agreement between the judges.

RESULTS

the CVI was 0.98 for content, 1.0 for usability and 0.85 for functional performance, showing that the developed application has high validity.

CONCLUSION

it is believed that the IST Nurse® application represents an important technological tool in strengthening evidence-based nursing care. Intervention studies are therefore suggested.

An Observational Cross-Sectional Analysis of the Correlation between Clinical Competencies and Clinical Reasoning among Italian Registered Nurses

Ability, knowledge, aptitude, and skill are the terms identified in the literature as the attributes of the concept of clinical competence. This implies that in order to act competently in their own context, the nurse must be able to make decisions which mainly depend on the ability to put clinical reasoning into practice. However, the evaluation of clinical reasoning in the various clinical-care activities of nursing competence is a necessary operation to prevent routine attitudes. From the perspective of an assessment of nursing competences, the aim of this study is to validate the relationship between the degree of competence recognized in a specific clinical setting and the amount of clinical reasoning executed by nurses. The study design was a cross-sectional observational design, following the guidelines of the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) of observational studies. Both the Italian Nurse Competence Scale and the Nurse Clinical Reasoning Scale were used. The data was collected between 25 January and 5 March 2022. Four hundred twenty-four clinical nurses participated by completing and returning the questionnaires. The instruments underwent assessment to ensure internal consistency and test-retest reliability. Their validity was tested with the validity of known content, construct, and groups. This is supported by statistically significant correlations between the different variables examined and the scores of the different dimensions of the Italian Nurse Competence Scale and the Italian Nurse Clinical Reasoning Scale. The data collected showed an excellent average level of competencies and clinical reasoning, M = range of 72.24 and 63.93, respectively. In addition, we observed satisfactory scores across all dimensions of I-NCS (significance range: 0.000-0.014) and I-NCRS (significance range: 0.000-0.004). The understanding and development of clinical reasoning has also brought out new aspects that require further research. This study provides a fresh perspective on the correlation between clinical competences and clinical reasoning, representing a novel attempt to analyze their relationship.

How to undertake a scoping review

RATIONALE AND KEY POINTS

Scoping reviews have become a popular approach for exploring what literature has been published on a particular field of interest. They can enable nurses to gain an overview of the contemporary evidence base relating to a practice area, treatment or specific patient demographic, for example. This article provides a concise guide for nurses planning to undertake a scoping review, explaining the various steps involved. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking a scoping review.• How you could use this information to educate nursing students and colleagues on the appropriate techniques and evidence base required for scoping the literature.

Exploring clinical judgment ability in second-degree baccalaureate of science nursing students: A mixed methods study

BACKGROUND

As they have not yet embarked on clinical practice, most students who already have a bachelor's degree but require a bachelor's degree in nursing occasionally perceive the educator's instruction on clinical situations as abstract and challenging for making accurate clinical judgments.

OBJECTIVES

This study aims to implement a clinical judgment model and case scenarios in classroom teaching to evaluate improvements in students' clinical judgment and critical thinking abilities.

DESIGN

A mixed-method design.

SETTING

A second-degree Bachelor of Science in Nursing at a university in Taiwan.

PARTICIPANTS

First-year undergraduate nursing students.

METHODS

This mixed-methods study featured a survey at the beginning and end of a course, followed by one-on-one online interviews. A purposive sample of sophomore nursing students was recruited from a university in northern Taiwan between March 2020 and May 2021. Semi-structured interviews were conducted after a preliminary analysis of the collected quantitative data.

RESULTS

In total, 48 participants completed the study questionnaire, and 20 were interviewed. The results show that the students' ability to make clinical judgment and identify individual health problems from case scenarios significantly improved after completing the course. However, critical thinking did not differ significantly after the course. Qualitative data analysis revealed three key themes relevant to the participants' learning experiences: (1) establishing the context of clinical judgment, (2) building a bridge between basic medical science and clinical nursing, and (3) having a broader perspective.

CONCLUSIONS

Incorporating clinical judgment measurement model and case scenarios in the curriculum may benefit second-degree Bachelor of Science in Nursing students who have not yet begun their clinical practice. Additionally, the result provides educators with valuable learning goals and evaluation strategies in the classroom and clinical practice.

Instructional and didactic support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings: Creation and validation

OBJECTIVE

To describe the creation and validation process of an instructional, didactic and self-applied support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings.

BACKGROUND

Students frequently face difficulties performing the actions in the proper sequence in Post-Partum Haemorrhage simulated cases. Even in a controlled environment, anxiety, nervousness and fear of making mistakes are evident, which render the simulated experience highly stressful. Having a tool with a guideline can help students perform these actions more assertively.

DESIGN

A methodological study to develop a didactic tool.

METHODS

The creation process of the didactic tool, called Instructional Disk for the Management of Post-Partum Haemorrhage, was divided into five phases: Analysis, Design, Development, Implementation and Evaluation. Nine experts specialised in Obstetrics and Midwifery validated the tool by answering a questionnaire with nine items; in turn, 32 undergraduate Midwifery program students carried out the evaluation using a questionnaire on applicability, functionality, clarity, coherence and usability of the tool in Post-Partum Haemorrhage simulated stations. The data were analysed descriptively, considering absolute agreement when the answers to all questions in the five-point Likert scale corresponded to 5 (I totally agree). The Content Validity Index was calculated for the experts' questionnaires.

RESULTS

In the validation stage, the experts agreed or totally agreed with all nine items, reaching a Content Validity Index = 1. In the total scores assigned by the experts, there was a variation between 80.0% and 100% absolute agreement, with a mean of 95.6%. In the students' assessment, the variation was between 87.5% and 100% absolute agreement, with a mean of 97.7%, in the eight items evaluated. The agreement level above 90% among experts and students was considered high.

CONCLUSIONS

The Instructional Disk for the Management of Post-Partum Haemorrhage was validated by experts with extensive experience in Obstetrics and Midwifery care and teaching, ensuring that the content included in the guidelines for the management of Post-Partum Haemorrhage adopted in Brazil is covered. The students positively evaluated this support tool for learning the care to be provided in Post-Partum Haemorrhage cases in the simulated stations.

The effects of mentorship and educational videos on nursing students' physical examination skills: a clinical audit

BACKGROUND

Poor competence in clinical examination skills among nurses has been reported in practice, and there is a strong consensus that physical examination (PE) education must be improved. However, deficiencies cannot be resolved by theoretical training alone, and new training approaches are required to enable nursing students to perform PE accurately. This study aimed to determine and compare the effect of two new educational methods (mentorship and educational video methods) on the physical examination skills of Iranian nursing students.

METHODS

This study was a clinical audit with three group pretest posttest design. Eligible nursing students were recruited through the census method and assigned to three groups (mentorship, educational videos, and control group) using permuted block randomization. Students were taught PE skills in three vital systems through three approaches (mentors, educational videos, and routine educational methods). Data were collected using a two-part instrument consisting of a demographic information questionnaire and a 32-item checklist for assessing the students' skills in examining the respiratory system (10 items), cardiovascular system (13 items), and 12 cranial nerves (9 items). Data were analyzed using SPSS software version 16 and descriptive and analytical statistical tests.

RESULTS

At baseline, students in all groups scored less than half of the possible scores in all three systems, and the mean scores of the three groups were not statistically different (P > 0.05). After the intervention, the mean scores of students in the mentorship group increased significantly in all three systems (P < 0.001), whereas the mean scores of students in the educational video group and the control group did not change significantly (P > 0.05). Furthermore, after the intervention, the mean scores of the educational video group and the control group did not significantly differ in any of the three systems (P > 0.05). The ANCOVA showed that with posttest score as the covariate, PE skills in all three systems improved one week after the intervention in the mentor group compared to the control group and the educational video group. However, PE skills in all three systems did not improve one week after the intervention in the educational video group compared to the control group.

CONCLUSIONS

The mentorship method is more effective than the educational video and routine methods for teaching PE skills to nursing students. Nursing schools can use the mentor method in training nursing students, and it is recommended to revise the PE lesson unit in the nursing curriculum and exchange it from a purely theoretical-based unit to a mixture of theoretical and clinical-based training. Educational videos alone cannot improve nursing students' PE skills; thus, if educational videos are used to teach clinical skills, it is necessary to hold hands-on sessions to provide feedback to students and correct their mistakes.

The influence of Gamification on medical students' diagnostic decision making and awareness of medical cost: a mixed-method study

BACKGROUND

The gamification of learning increases student enjoyment, and motivation and engagement in learning tasks. This study investigated the effects of gamification using decision-making cards (DMCs) on diagnostic decision-making and cost using case scenarios.

METHOD

Thirty medical students in clinical clerkship participated and were randomly assigned to 14 small groups of 2-3 medical students each. Decision-making was gamified using DMCs with a clinical information heading and medical cost on the front, and clinical information details on the back. First, each team was provided with brief clinical information on case scenarios. Subsequently, DMCs depending on the case were distributed to each team, and team members chose cards one at a time until they reached a diagnosis of the case. The total medical cost was then scored based on the number and contents of cards drawn. Four case scenarios were conducted. The quantitative outcomes including confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical costs were measured before and after our gamification by self-evaluation using a 7-point Likert scale. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using DMCs.

RESULT

Confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical cost were significantly higher after the gamification. Furthermore, comparing the clinical case scenario tackled last with the one tackled first, the average medical cost of all cards drawn by students decreased significantly from 11,921 to 8,895 Japanese yen. In the content analysis, seven advantage categories of DMCs corresponding to clinical reasoning components were extracted (information gathering, hypothesis generation, problem representation, differential diagnosis, leading or working diagnosis, diagnostic justification, and management and treatment).

CONCLUSION

Teaching medical students clinical reasoning using DMCs can improve clinical decision-making confidence and learning motivation, and reduces medical cost in clinical case scenarios. In addition, it can help students to acquire practical knowledge, deepens their understanding of clinical reasoning, and identifies several important clinical reasoning skills including diagnostic decision-making and awareness of medical costs. Gamification using DMCs can be an effective teaching method for improving medical students' diagnostic decision-making and reducing costs.

Mobile learning in nursing education: A bibliometric analysis and visualization

AIM

This study performed a bibliometric analysis of studies related to mobile learning in the field of nursing education.

METHODS

The Scopus database was used to determine the most frequently cited studies on mobile learning in nursing education. VOSviewer and Bibliometrix were employed for bibliometric analysis and visualization. Science mapping and performance analysis was adopted from bibliometric analysis techniques. In addition, a synthetic knowledge synthesis approach was used.

RESULTS

A total of 234 publications were published in 107 sources in 2002-2023. The publications had 8797 citations, an average of 88 citations per publication. In terms of total link strength (TLS), links, a number of articles and citations, the US led all other countries in the field. Regarding authors, Hwang was the most frequently cited authors (n = 348). According to trend topics analysis, the keywords "gamification", "simulation", "attitude", "clinical competence" and "online learning" have emerged in the field.

CONCLUSION

Research on mobile learning in nursing education has been increasing in recent years. The findings of this study can provide new ideas in the applications of mobile learning in nursing education to researchers or nursing faculties in the field.