The predict of metacognitive awareness of nursing students on self-confidence and anxiety in clinical decision-making

Translation and psychometric validation of the Chinese version of the metacognitive awareness scale among nursing students

Objective

This study endeavors to translate and psycho-metrically validate the metacognitive awareness inventory scale (MAS) for nursing students in China.

Method

A total of 592 nursing students were enlisted from four universities situated in the eastern, southern, western, and northern regions of China. Content validity and reliability were evaluated using the content validity index and item-total correlation coefficient, and Cronbach's alpha coefficients, respectively. Convergent validity examined the goodness of fit among sub-scales through the average extracted variance and composite reliability.

Results

Exploratory factor analysis confirmed the first-order and second-order factor models, contributing to a cumulative variance of 89.4 and 59.5%, respectively. The Cronbach's alpha values were 0.963 and 0.801, respectively. Confirmatory factor analysis outcomes indicated an excellent overall fit index for the model, satisfying the convergent validity criteria and achieving a target coefficient of 96.0%, which is consistent with the original scale structure.

Conclusion

The Chinese version of the MAS (C-MAS) is a reliable and valid instrument for assessing metacognitive awareness among Chinese nursing students. Further research should consider a broader sample of nursing students across China to reinforce the scale's applicability.

Clinical decision making: validation of the nursing anxiety and self-confidence with clinical decision making scale (NASC-CDM ©) into Spanish and comparative cross-sectional study in nursing students

BACKGROUND

Decision making is a pivotal component of nursing education worldwide. This study aimed to accomplish objectives: (1) Cross-cultural adaptation and psychometric validation of the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale from English to Spanish; (2) Comparison of nursing student groups by academic years; and (3) Analysis of the impact of work experience on decision making.

METHODS

Cross-sectional comparative study. A convenience sample comprising 301 nursing students was included. Cultural adaptation and validation involved a rigorous process encompassing translation, back-translation, expert consultation, pilot testing, and psychometric evaluation of reliability and statistical validity. The NASC-CDM© scale consists of two subscales: self-confidence and anxiety, and 3 dimensions: D1 (Using resources to gather information and listening fully), D2 (Using information to see the big picture), and D3 (Knowing and acting). To assess variations in self-confidence and anxiety among students, the study employed the following tests: Analysis of Variance tests, homogeneity of variance, and Levene's correction with Tukey's post hoc analysis.

RESULTS

Validation showed high internal consistency reliability for both scales: Cronbach's α = 0.920 and Guttman's λ2 = 0.923 (M = 111.32, SD = 17.07) for self-confidence, and α = 0.940 and λ2 = 0.942 (M = 80.44, SD = 21.67) for anxiety; and comparative fit index (CFI) of: 0.981 for self-confidence and 0.997 for anxiety. The results revealed a significant and gradual increase in students' self-confidence (p =.049) as they progressed through the courses, particularly in D2 and D3. Conversely, anxiety was high in the 1st year (M = 81.71, SD = 18.90) and increased in the 3rd year (M = 86.32, SD = 26.38), and significantly decreased only in D3. Work experience positively influenced self-confidence in D2 and D3 but had no effect on anxiety.

CONCLUSION

The Spanish version (NASC-CDM-S©) was confirmed as a valid, sensitive, and reliable instrument, maintaining structural equivalence with the original English version. While the students' self-confidence increased throughout their training, their levels of anxiety varied. Nevertheless, these findings underscored shortcomings in assessing and identifying patient problems.

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.

Nursing students' self-efficacy and clinical decision-making in the context of medication administration to children: A descriptive-correlational study

BACKGROUND

It is crucial for nursing students to possess self-efficacy in medication administration to children for correct drug implementation. It is expected that nursing students enhance their clinical application skills in the pediatric field before graduation, execute the clinical decision-making process, and acquire self-efficacy in medication administration.

AIM

This research was conducted to examine the self-efficacy and clinical decision-making levels of nursing students in the context of medication administration to children.

METHODS

This descriptive-correlational study was conducted with 368 students. The data were collected using the "Participant Information Form", the "Medication Administration Self-Efficacy Scale in Children for Nursing Students", and the "Clinical Decision-Making in Nursing Scale". Number, percentage, minimum and maximum values, mean and standard deviation, Independent Samples T-Test, ANOVA, and Pearson correlation test were used in the analysis of the data. In addition, Cronbach's Alpha coefficient was calculated to evaluate the reliability of the scales. The research report of the study followed the STROBE guidelines.

RESULTS

In the study, the mean score of the students on the Clinical Decision-Making in Nursing Scale was slightly low; the mean score of the Medication Administration Self-Efficacy Scale in Children for Nursing Students was found to be moderate; and a significant and negative relationship was determined between the two scales. The clinical decision-making levels of the male students, the fourth-year nursing students, and those who did not experience anxiety during medication administration were found to be significantly higher. The self-efficacy of the students who did not experience anxiety during medication administration to children was found to be significantly higher than the others.

CONCLUSION

Nursing students need to possess self-efficacy in administering medication to children and be able to make clinical decisions. Given the significant impact of the clinical decision-making process on patient outcomes and safety, it is necessary to develop educational programs to enhance the clinical decision-making abilities of nursing students. Different educational methods that will increase students' self-efficacy in medication administration to children need to be implemented.

The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes

This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross-sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of  Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses' lifelong learning level explained the three subdimensions of self-confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision-making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses' lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses' lifelong learning awareness.

Metacognition and learning transfer under uncertainty

OBJECTIVES

This study examined the possible correlation between metacognition and learning experience transfer of nursing students after engaging in an urgent and cognitively demanding clinical situation.

METHODS

This is a one-group post-test- only study design in which participants engaged in an emergency care scenario simulation and completed the Meta-Cognitive Awareness Scale - Domain Specific (MCAS-DS).

RESULTS

Study results revealed that participants' metacognitive awareness is significantly correlated to the learning transfer (p=0.0001) and GPA (p=0.006). There is also a positive correlation between learning transfer and GPA (p=0.04), clinical settings-based training experience (p=0.021) and metacognitive confidence (p=0.0001).

CONCLUSIONS

This study may imply that academic achievement can be used as a potential screening tool to identify students requiring metacognitive training. It may also imply that metacognitive abilities can be enhanced indirectly through considering factors that may influence the transfer of learning such as increasing the hours of clinical training.

Effect of a Nursing Comprehensive Skill Training Course (NCST-C) on Nursing Students' Metacognitive Awareness: A Quasi-experimental Study

PURPOSE

This study explored the effect of a nursing comprehensive skill training course (NCST-C) on the metacognitive awareness of nursing students to provide a scientific foundation for improving metacognitive awareness.

METHODS

This study used a quasi-experimental two-group matched pretest, post-test, and follow-up test. Ninety-six junior nursing students were recruited using convenience sampling and assigned to two groups by drawing lots with odd and even numbers in a nursing school at Huzhou University. The control group received a traditional skill-training course. The intervention group received NCST-C. Nursing students' metacognitive awareness inventory (MAI) was evaluated at the baseline, 16-week, and 20-week follow-up points. A repeated-measures analysis of variance and a simple effect test was used to compare each outcome measure of the two groups three times.

RESULTS

The NCST-C resulted in greater benefits for nursing students' metacognitive awareness as well as various dimensions (knowledge of cognition and regulation of cognition) in the intervention group. Combined with a simple effects test, the MAI and dimension scores of those in the intervention group significantly improved at 16 weeks after the baseline (F = 9.78-44.03; all ps < .01). The sustainable effect of NCST-C lasted 1 month after the intervention (F = 14.24-62.36; ps < .01), reaching statistical significance (p < .05).

CONCLUSIONS

The NCST-C effectively developed metacognitive awareness among nursing students. Its design provides a new type of experimental course for improving metacognitive awareness.

TRIAL REGISTRATION

chictr.org.cn: ChiCTR2200057910. First registration date: 1/11/2020.

Clinical judgment and decision-making of the Undergraduate Nursing students

Abstract Clinical judgment and decision-making are essential competencies in nursing, emerging as expanding learning areas of nursing education. Aiming to characterize the types of clinical judgment and decision-making adopted by nursing students in clinical education, we designed a qualitative, exploratory and descriptive study, with data collection obtained through documental analysis of nursing student’s reflective journals, in clinical education settings. Data analysis was performed according to Bardin using the webQDA software. Thirty-four students participated in the study, while attending the Clinical Learning Curricular Unit: Caring for Clients with Increased Vulnerability and Families in Transition, producing a total of 40 reflective journals. Of the 248 identified registration units, we highlight the evaluation decision-making with 45 registration units and the intervention decision-making, with 55 registration units. It is concluded that student´s reflections in the context of clinical teaching, are mainly about the assessment of the care situation and the decision-making related to the action. This study is intended to guide the learning of these competencies in nursing education.

Clinical judgment and decision-making of the Undergraduate Nursing students

Clinical judgment and decision-making are essential competencies in nursing, emerging as expanding learning areas of nursing education. Aiming to characterize the types of clinical judgment and decision-making adopted by nursing students in clinical education, we designed a qualitative, exploratory and descriptive study, with data collection obtained through documental analysis of nursing student's reflective journals, in clinical education settings. Data analysis was performed according to Bardin using the webQDA software. Thirty-four students participated in the study, while attending the Clinical Learning Curricular Unit: Caring for Clients with Increased Vulnerability and Families in Transition, producing a total of 40 reflective journals. Of the 248 identified registration units, we highlight the evaluation decision-making with 45 registration units and the intervention decision-making, with 55 registration units. It is concluded that student´s reflections in the context of clinical teaching, are mainly about the assessment of the care situation and the decision-making related to the action. This study is intended to guide the learning of these competencies in nursing education.

The effect of the online flipped classroom on self-directed learning readiness and metacognitive awareness in nursing students during the COVID-19 pandemic

Background

The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom’s effect on nursing students’ self-directed learning readiness and metacognitive awareness.

Methods

This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester’s first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software.

Results

There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students’ mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07).

Discussion

Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.

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.