Extern Programs Promote Confidence and Reduce Anxiety With Clinical Decision Making in Nursing Students

Exploring the impact of a clinical extern program on readiness to practice

The COVID-19 pandemic created an increased demand for healthcare professionals across all healthcare sectors globally. Attrition, retirement, delayed graduations, and sick leaves resulted in an inadequate supply of knowledgeable, skilled, and experienced nurses to care for hospitalized patients and help address hospital capacity pressures. In response to this health human resource crisis in Canada, the Ontario Ministry of Health offered hospitals funding to support the employment of Clinical Externs (CEs), that is, students in nursing, respiratory therapy, physiotherapy, occupational therapy medicine, and paramedicine, hired to work as unregulated staff, alongside an inter-professional team. This mixed-methods study evaluated the CE program that was implemented in one large academic hospital. The primary aim was to identify the outcomes of the clinical extern program from the perspectives of CEs, CE coordinators, and clinical leaders. Findings indicate the clinical extern program reinforces student confidence and supports their transition to formal nursing and respiratory therapy roles.

The Effects of Nursing Assistant Work on Academics, Anxiety, and Clinical Judgment

BACKGROUND

Nursing students increasingly are working as nursing assistants (NA) while pursuing their nursing education. The literature discusses both the stressors and benefits of students working as an NA during nursing school; however, there is limited research on the direct effects of students having NA experience during nursing school.

METHOD

This repeated measures study examined the effects of NA experience on grade point average, anxiety levels, and clinical judgment in simulation among undergraduate nursing students.

RESULTS

No significant differences were found in grade point average or anxiety levels between nursing students with and without NA experience. However, nursing students with at least 12 months of NA experience demonstrated significantly higher clinical judgment in individual simulations, particularly in the responding phase of Tanner's model.

CONCLUSION

Although NA work experience may not significantly affect grade point average or anxiety, it may enhance nursing students' clinical judgment, particularly when they respond to clinical situations. [J Nurs Educ. 2025;64(2):91-97.].

Effects of a Mobile App on Nursing Students' Clinical Reasoning and Decision-Making

BACKGROUND

Clinical decision-making is a crucial skill for undergraduate nursing students to develop. This study assessed the effects of a mobile clinical decision-support (mCDS) app on clinical reasoning and decision-making in undergraduate nursing students and their perceived acceptance of the app.

METHOD

Following the technology acceptance model, a randomized controlled trial with a pretest-posttest design was conducted. Students in the experimental group used an mCDS app (Medscape) for sepsis and cardiac tamponade scenarios, and students in the control group used traditional tools. Outcomes included perceived usefulness, ease of use, attitudes, clinical reasoning, clinical decision-making skills, satisfaction, and behavioral intent to use the app.

RESULTS

Students in the experimental group had significantly higher posttest clinical reasoning scores (p = .04) and cardiac scenario clinical decision-making scores (p = .01) compared with students in the control group.

CONCLUSION

Integrating mCDS apps into clinical nursing education enhances students' clinical reasoning and decision-making. [J Nurs Educ. 2024;63(12):835-843.].

Early engagement: The value of MRIT student externs in supporting recruitment, retention, and the future of the medical imaging professions

The healthcare system faces critical challenges in recruitment and retention due to increased patient volumes, post-pandemic recovery needs, and a departing experienced workforce. The concept of an 'extern' role, increasingly explored in professions such as nursing, allows healthcare students to take on paid employment in assistive roles in settings relevant to their future profession. The cornerstone of such an initiative is to bridge academic learning with practical clinical support, engaging the future of the workforce in a safe and meaningful way.

METHODS

An extern program was piloted at a major urban multi-site medical imaging department beginning in 2022. Over three cohort years, it has explored two types of extern roles (junior and clinical) across three entry-to-practice MRIT disciplines - radiological technology, nuclear medicine and molecular imaging, and ultrasound. In developing roles, compliance with legislative regulations, considerations in defining roles and eligibility criteria, and aligning work commitment with student learning schedules were paramount in informing the program's structure and success. Seventy-three candidates applied to related roles and 34 externs were hired.

BENEFITS/CHALLENGES

Benefits to the program include engagement in clinical and administrative tasks, facilitation of departmental efficiency, and support for the existing workforce. Specific tasks for clinical externs included supporting staff in patient transfers and positioning, cleaning and restocking rooms, triaging patients and demands, calling inpatients and coordinating porters, and monitoring patients and schedules. For junior externs, tasks involved record-keeping, curating teaching cases, and supporting billing code reviews and quality control exercises like lead apron testing.

IMPACTS/OUTCOMES

The program's value in shaping the future of healthcare professions has been recognized, particularly in enhancing student transition into practice and increasing recruitment opportunities for the host site. Staff overtime hours were reduced, and new graduates who had worked as externs were more quickly able to work autonomously following hire. The program was mutually beneficial to existing staff and future professionals, reinforcing the workforce without sacrificing the higher level learning achieved through university-based preparation for practice.

Effectiveness of caring behaviours course on decision-making and caring behaviours in undergraduate nursing students: An experimental study

BACKGROUND

Although caring is a core principle of the nursing profession, students often lack the knowledge, comprehension and ability to integrate care into all aspects of nursing practice. Students may have few opportunities to practise caring behaviours on patients who create the impression of providing care and elicit a feeling of receiving care. Studies of strategies to enhance caring behaviours in nursing education are limited.

AIM

This experimental study aimed to examine the effect of nursing caring behaviours course based on interactive learning strategies on the caring behaviours and decision-making abilities of nursing students.

METHODS

A purposive sample of 50 undergraduate students was recruited from a faculty of nursing. Students in the intervention group (n = 24) received 2 h of training per week for 14 weeks in accordance with caring behaviours course based on interactive learning strategies including discussion, brainstorming, concept mapping, reflection and simulation training. Nursing students in the control group (n = 26) received training according to other elective courses in the curriculum. Data were measured at the baseline time point, 7th week and 14th week with the Caring Behaviours Inventory and Nursing Decision-Making Instrument. Chi-square test, Mann-Whitney U-test, Friedman test and mixed repeated measures ANOVA were used to assess the data.

RESULTS

No significant difference was determined in terms of baseline caring behaviours and decision-making scores between the intervention and control groups (p > 0.05). A significant difference in caring behaviours between the two groups and time effect was not found (p > 0.05). However, there was a significant interaction between time and groups (F = 3.484, p = 0.047). There was a significant increase in the decision-making in intervention groups over time (F = 9.372, p < 0.001) and interaction between time and groups (F = 4.160, p = 0.019).

CONCLUSIONS

A deliberate strategy to raise students' awareness of caring behaviours and incorporate interactive learning methods into education enhances both caring behaviours and clinical decision-making.

Refining and adapting the measurement properties of evidence-based practice measures for physiotherapy students

OBJECTIVE

There is a lack of reliable and valid evidence-based practice (EBP) measures for physiotherapy students. This study validated EBP-student (EBP-S) measures for physiotherapy students.

METHODS

EBP measures developed from previous research were cross-culturally validated for use by physiotherapy students. The adapted EBP-S consisted of six measures: use of EBP, EBP activities, EBP knowledge, self-efficacy for EBP, attitudes towards EBP, and perceptions of the teaching and assessment of EBP in the curriculum. The final version was completed by physiotherapy students (n = 335). The psychometric properties for each EBP-S measure were estimated, including construct validity using Rasch model, internal consistency reliability using person separation index (PSI), test-retest reliability using intraclass correlation coefficient (ICC), and differential item functioning (DIF).

RESULTS

Two formative measures (use of EBP and EBP activities) were only linguistically modified for use with students. A Rasch model was applied to the other four reflective measures. For knowledge, 55% (6/11) items fit the Rasch model with chi-square fit statistic (χ2) = 34.46, p = 0.08; PSI = 0.85. For self-efficacy, 89% (8/9) items fit the Rasch model with χ2 = 25.11, p = 0.80; PSI = 0.89. For attitudes, 62% (8/13) items fit the Rasch model with χ2 = 61.49, p = 0.00; PSI = 0.71. For perception of the teaching and assessment of EBP in the curriculum, 62% (8/13) items fit the Rasch model with χ2 = 80.99, p = 0.45; PSI = 0.92. perception of the teaching and assessment of EBP in the curriculum showed DIF in three items. The ICCs ranged between 0.80 and 0.98.

CONCLUSIONS

The EBP-S measures were validated for physiotherapy students, including the testing of psychometric properties, which were not tested in the original studies. Further refinements should be considered for the use of the EBP-S with other groups of students or if changes are applied to the current curriculum.

Nurse Externships: Exploring Innovations to Recruit and Mentor Clinical Adjunct Faculty

BACKGROUND

Recruitment and mentoring of clinical preceptors for adjunct clinical faculty positions is essential to easing the nursing faculty shortage. This exploratory study investigated an academic-practice partnership through a summer nursing externship to recruit and mentor clinical preceptors for the clinical educator role.

METHOD

This exploratory longitudinal study examined the success of recruiting and mentoring adjunct clinical educators at a Magnet hospital in the northeast United States. Reflective qualitative survey data from externs, extern faculty, and preceptors in baccalaureate and associate degree prelicensure programs were analyzed.

RESULTS

The findings revealed successes and challenges in recruiting and mentoring 21 adjunct faculty.

CONCLUSION

Nursing externships proved to be successful in recruiting and mentoring clinical adjunct faculty. Implementing new models for recruitment and mentoring are essential for the success of nursing programs and the education of students. [J Nurs Educ. 2023;62(12):728-732.].

Ethics positions of nursing students in clinical decision-making

BACKGROUND

Ethics positions, consisting of the two fundamental dimensions of idealism and relativism, influence individuals' decision-making significantly. Particularly in an applied field such as nursing, the ethics positions of nurses can play a significant role in clinical decisions. Therefore, it is important to know the factors affecting the ethics positions of nurses in clinical decision-making.

AIM

The aim of the study is to examine the factors affecting the ethics positions of nursing students in clinical decision-making.

RESEARCH DESIGN

This is a two-phase sequential explanatory mixed methods study designed in accordance with the COREQ criteria. A participant Information Form and the Ethics Position Questionnaire were used to collect quantitative data. Qualitative data were obtained through focus group interviews.

ETHICAL CONSIDERATIONS

This study was conducted after receiving written permission from X University Ethics Board. Additionally, permission was obtained from the participating nursing faculty.

PARTICIPANTS

Among the fourth-year nursing students, 180 students participated in the quantitative phase and 30 students in the qualitative phase of the study.

RESULTS

The quantitative data analysis showed that the idealism sub-dimension mean scores of the participants were higher than the relativism sub-dimension mean scores. The analysis of the qualitative data resulted in four main themes that influence participants' ethics positions in clinical decision-making: (1) attitudes of role models in clinical practice (staff nurses/mentors/lecturers), (2) resources related to clinical practice (labs, hospitals/classrooms), (3) health system (hospital policies/school policies), and (4) personal differences (act with emotion/act with logic).

CONCLUSION

The results showed that the health system, role models in the clinic, personal differences, and skill-related resources affect the ethics positions of nursing students in clinical decision-making. In this regard, awareness can be raised by providing training to nursing students by academic instructors on ethics positions and the factors that are determined to affect ethics positions in clinical decision-making.

The impact of innovative behaviors on academic misconduct among graduate students: a mediated moderation model

Introduction

Academic misconduct among graduate students poses a significant challenge in graduate education. This study aims to explore the impact of innovative behavior on graduate student academic misconduct and its underlying mechanisms.

Methods

A survey was conducted on 677 graduate students currently enrolled in Beijing universities to assess their innovative behavior, academic misconduct, academic anxiety, employment confidence, educational levels, among other factors. The study analyzed the mediating roles of academic anxiety, employment confidence, and educational levels in the relationship between innovative behavior and graduate student academic misconduct.

Results

Graduate student innovative behavior exerts a negative predictive effect on academic misconduct, with a stronger emphasis on innovative behavior associated with a reduced likelihood of academic misconduct. Academic anxiety plays a mediating role in the relationship between graduate student innovative behavior and academic misconduct. Educational levels and employment confidence each play moderating roles in the latter stages of the mediation effects concerning graduate student innovative behavior, academic anxiety, and academic misconduct.

Conclusion

This study reveals the mediating role of academic anxiety in the relationship between innovative behavior and graduate student academic misconduct. It also identifies the moderating roles of employment confidence and educational levels. These findings deepen our understanding of the relationship between innovative behavior and graduate student academic misconduct and are conducive to preventing such misconduct among graduate students.

The effect of crossword puzzle activity used in distance education on nursing students' problem-solving and clinical decision-making skills: A comparative study

AIM

The study was planned to determine the effect of crossword puzzle activity in distance education on nursing students' problem-solving and clinical decision-making skills.

BACKGROUND

In online education, increasing nursing students' learning skills, motivations and participation is important.

DESIGN

The study is a randomized-controlled trial.

METHOD

The study sample consisted of 132 nursing students registered to the Pediatric Nursing distance course in the 2020-2021 academic year. 20 students who were assigned to the control group did not agree to participate in the study and did not fill in the data form. Accordingly, the study was completed with the participation of 112 students, with 66 students in the experimental group and 46 students in the control group. In the 14-week distance education, 20-question crossword puzzle activity per unit was applied to the students in the experimental group. The standards for reporting consort guidelines for reporting parallel group randomized trials were used to report this research. The students in the control group were taught in the form of presentation. At the beginning and end of the study, CDMNS and PSI were applied to the students. Ethics committee approval (Number: 2021/79) was obtained from the relevant university to conduct the research.

RESULTS

A statistically significant difference was found between pretest and posttest scores of the experimental group in PSI and CDMNS scales (p < 0.001).

CONCLUSION

Crossword puzzle activity used in distance education developed the students' problem-solving and clinical decision-making skills.

Student Employment Models for Undergraduate Nurses and Midwives in Australia: A Scoping Review

Introduction

Evidence has shown that throughout their undergraduate years, many nursing and midwifery students obtain paid employment in a wide variety of clinical and non-clinical positions. Across Australia, inconsistencies exist in the models of clinical employment available to these student groups. Previous Australian studies have described the employment of undergraduate nursing and midwifery students in regulated and unregulated clinical roles. No studies have reported on the various regulated roles available to both student nurses and midwives in Australia. The purpose of this scoping review is to identify and synthesize evidence related to nursing and/or midwifery students employed in regulated and unregulated clinical roles in Australia.

Methods

This scoping review utilized published recommendations for data screening, abstraction, and synthesis. One of the authors, a librarian, undertook systematic searches in CINAHL Complete (1937-present), Emcare on Ovid (1995-present), Scopus (1969-present), and Ovid MEDLINE(R) (including Epub Ahead of Print, In-Process, and In-Data-Review & Other Non-Indexed Citations, 1946-present). The initial searches were completed in April 2019 and repeated in March 2021 and May 2022 to identify any new literature. Manual searching of reference lists in the included papers was also undertaken, together with selected organizational websites. The extracted data included the lead author, date, title, study design, study sample and location, and key findings.

Results

From the 53 items retrieved, 23 peer-reviewed studies met the inclusion criteria and were included in the review. All items were published between 2011 and 2022. Only four of the studies focused upon student midwives. Undergraduate nursing and midwifery students in Australia obtain paid employment in a variety of regulated and unregulated clinical roles.

Conclusion

The literature reported here demonstrates that there are differing models, nomenclature, educational requirements, and pay scales in place for student employment in clinical roles across Australian states and territories.

Hemşirelik Öğrencilerinde Duygusal Zekâ, Eleştirel Düşünme ve Klinik Karar Verme Düzeylerinin İncelenmesi

Amaç: Bu araştırma, hemşirelik öğrencilerinde duygusal zekânın eleştirel düşünme ve klinik karar verme düzeyleri ile ilişkisini belirlemek amacıyla kesitsel, tanımlayıcı ve ilişki arayıcı olarak yapılmıştır.Yöntem: Araştırma, Ocak-Şubat 2020’de yüz yüze ortamda gerçekleştirilmiştir. Bir Vakıf Üniversitesi Hemşirelik bölümünde okuyan ve araştırmaya katılmayı kabul eden 187 öğrenci çalışmanın örneklemini oluşturmuştur. Veriler, araştırmacılar tarafından oluşturulan Bilgi Formu, Schutte Duygusal Zekâ Ölçeği, Kaliforniya Eleştirel Düşünme Eğilimi Ölçeği ve Hemşirelikte Klinik Karar Verme Ölçeği kullanılarak toplanmıştır. Veriler; tanımlayıcı istatistiksel yöntemler, bağımsız gruplarda t testi, Anova testi ve Pearson korelasyon testi kullanılarak değerlendirilmiştir.Bulgular: Araştırmaya katılan öğrencilerin %91,4'ü kadın, %8,6'sı erkek ve yaş ortalaması 20,93±1,26’dır. Katılımcıların ölçek toplam puan ortalamaları sırasıyla duygusal zekâ 142,76±18,18 eleştirel düşünme 195,21±26,15 ve klinik karar verme 96,60±19,94’tür. Katılımcıların duygusal zeka toplam puanı ile eleştirel düşünme eğilimi alt boyutları olan analitik olmak (r=0,278), açık fikirlilik (r=0,386), meraklılık (r=0,293), kendine güven (r=0,293), doğruyu arama (r=0,275), sistematiklik (r=0,329), klinik karar verme toplam puanı (r=0,728) ve alt boyutları olan seçenek ve fikirleri araştırmak (r=0,732), amaçları ve değerleri soruşturmak (r=0,544), sonuçları değerlendirmek (r=0,676), bilgiyi araştırmak ve yeni bilgiyi tarafsız olarak benimsemek (r=588) puanları arasında pozitif bir korelasyon tespit edilmiştir (p&lt;0,05).Sonuç: Araştırma bulguları, öğrencilerin akademik yılı arttıkça duygusal zekâ puan ortalamalarının arttığını, eleştirel düşünme puanlarının ortalamanın üzerinde olduğunu ve ancak klinik karar verme puanlarının ortalamanın altında olduğunu göstermiştir. Hemşirelik öğrencilerinde duygusal zekâ gelişiminin sağlanması, aynı zamanda temel yeterlilikler olan eleştirel düşünme ve klinik karar verme becerilerinin arttırılmasına katkı sağlayabileceği düşünülmektedir. Bu nedenle duygusal zekâyı geliştirmek için öğretim yöntem ve tekniklerinin kullanılması önerilir. 

Fostering empathy and self-efficacy in pharmacy students through service learning

BACKGROUND

Pharmacy student proficiency in direct patient interactions is an integral component of the doctor of pharmacy curriculum. Service-learning experiences offer pharmacy students valuable opportunities to develop self-efficacy and empathy while serving communities with unmet needs. The objective of this review is to evaluate the impact of service-learning experiences on the self-efficacy and empathy of pharmacy and other health professions students.

METHODS

A narrative literature review was conducted using PubMed, ERIC, and CINAHL databases. Articles were included if they described the relationship between any health professions student service-learning experience and changes in self-efficacy and empathy. Articles were excluded if they involved simulation experiences, standardized patients, or international experiences.

RESULTS

A total of 11 relevant articles were identified, seven examined changes in student self-efficacy and six assessed student empathy. Articles included students representing seven health professions, with one eligible article in pharmacy. All articles investigating self-efficacy reported a positive impact of service learning on student confidence. Most articles focusing on empathy found that service learning had a positive impact on student empathy, and only one article noted a negative trend. Students with limited prior direct patient care experience had the greatest improvement in clinical confidence and empathy.

IMPLICATIONS

This review adds a new perspective to the literature by evaluating evidence-based service-learning models in pharmacy education. Offering additional structured service-learning opportunities for pharmacy students fosters self-efficacy and empathy while supporting communities with unmet needs. Future studies evaluating innovative service-learning models and methods of continuous assessment within the pharmacy curriculum are warranted.

Experiences and Perceptions Gained by Student Nurse Externs Working During a Pandemic

ABSTRACT

There are no data available presenting the experiences and perceptions of student nurse externs (SNEs) working during the COVID-19 pandemic. This qualitative study was conducted with 12 SNEs to determine their experiences and perceptions during the summer of 2020. The Colaizzi method was used to identify and analyze statements. Four main themes emerged from the data: 1) appreciating holistic compassionate care, 2) progressing from fear toward hope, 3) desiring ethical decision-making skills, and 4) recognizing communication barriers. Implications include emphasizing communication, ethical decision-making strategies, disaster preparedness, and externships as a way to bridge the gap between education and practice.

Non-academic admission criterion of certified nursing assistant status for undergraduate nursing programs: A comparative case study

BACKGROUND

The number of nursing program graduates does not meet the current demand for nurses. Program faculty relies on the predictive power of admission criteria to admit students who will be successful. Non-academic admission criteria, such as Certified Nursing Assistant (CNA) status, should be considered to complement academic criteria.

PURPOSE

This study aimed to explore nursing students' perceptions and clinical faculty of the non-academic prerequisite of CNA status as an admission criterion. First-year students' preparedness for the clinical setting, self-confidence, and anxiety in clinical decision making (CDM) was considered.

METHOD

A multi-methods comparative case study design was utilized. The setting was two undergraduate baccalaureate nursing programs. Nine faculty and 54 students participated in the study. The researcher collected data through interviews with the participants, observations, document analysis, field notes, and self-report on the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM) scale.

RESULTS

Three themes emerged from the interview data: (a) student preparedness, (b) student learning, and (c) student program success. No statistically significant differences in student anxiety or self-confidence were found in the NASC-CDM scale.

CONCLUSION

The investigation of CNA status could be an essential aspect of the undergraduate nursing program admission process.

A Literature Review of Nursing Extern Program Outcomes

This literature review gathers in one place recent published literature on extern programs. Fourteen extern articles published between 2009 and 2019 were identified, and program information was extracted. Student benefits were increased in confidence, clinical skills, and learning the nursing environment. Organizational benefits were reduced orientation, reduced recruitment costs, and hiring nurses that were a good fit with the organization. For a healthcare organization, extern programs may ease the shortage of available registered nurses.

A quasi-experimental study of specialized training on the clinical decision-making skills and social problem-solving abilities of nursing students

Background: In Asian countries, clinical practice places little emphasis on developing the clinical decision-making skills and social problem-solving abilities of nursing students.Objective: This study explored whether a 3-months-in-1-unit training program improved nursing students' clinical decision-making skills and social problem-solving abilities compared to the 1-month-in-1-unit rotation program.Methods: A quasi-experimental study was conducted. A 3-months-in-1-unit training program was conducted in the intervention group (n = 77), rountine1-month-in-1-unit rotation was conducted in the control group (n = 73). Clinical decision-making skills and problem-solving abilities were measured using the Chinese version of the Clinical Decision-Making Nursing Scale and the Social Problem-Solving Inventory-Revised.Results: Nursing students in the intervention group scored higher clinical decision-making skills (t = 7.677, p < 0.05), positive problem orientation (t = 18.359, p < 0.05), negative problem orientation (t = -3.711, p < 0.05), and rational problem-solving (t = 2.312, p < 0.05) than the control group.Conclusions: The 3-months-in-1-unit specialized training program had a significant positive impact on students' clinical decision-making skills and social problem-solving abilities.