Schoolchildren's Attitudes Toward Covid-19 Measures Scale: A Scale Development Study

For schools and academic studies to continue, children as well must adhere to the measures taken to prevent the spread of Covid-19. The aim of this study was to develop a scale to assess schoolchildren's attitudes toward Covid-19 measures. The sample of this study, which was designed in a methodological type, consisted of 205 children. This study was conducted at primary schools in Zonguldak, Turkey. The validity of content and construct was examined to evaluate the validity of the Schoolchildren's Attitudes toward Covid-19 Measures Scale. This scale is a valid and reliable measure for assessing the attitudes of schoolchildren toward Covid-19 measures. The results of the factor analysis indicated a scale with 28 items and six factors. Cronbach's alpha value for the overall scale is 0.928. According to the results of the analysis, the developed scale was found to have excellent content and construct validity and reliability for schoolchildren.

Cross-sectional Analysis of Zoom Fatigue on Clinical Decision-making in Nursing Students

Zoom fatigue may affect nursing students, as there has been an increase in the use of videoconferencing for academic as well as clinical applications. Fatigue can negatively interfere with clinical decision-making and lead to clinical errors. This study aimed to explore the association between Zoom fatigue and perceived clinical decision-making ability of nursing students. This cross-sectional study assessed self-reported sociodemographic characteristics, Zoom fatigue, and clinical decision-making. Nursing students reported a medium level of Zoom fatigue (2.50 ± 0.78) and moderate effects on clinical decision-making (150.924 ± 12.561). Statistically significant differences were found between Zoom fatigue, the number of videoconferences held in the last month ( rs = 0.065, P = .030), prolonged use of electronic devices ( χ23 = 12.817, P = .005), and sex of the participants ( U = 4043.500, P = .046). In addition, a negative relationship was observed between Zoom fatigue and clinical decision-making ( rs = -0.519, P < .001). Nursing students have shown a moderate level of Zoom fatigue. The number of videoconferences attended as well as the prolonged use of electronic devices could increase students' level of Zoom fatigue. Students' perception of their clinical decision-making is moderate. As the Zoom fatigue levels of nursing students increased, their perception of clinical decision-making ability decreased. In the academic and clinical settings, there is a need to develop strategies to prevent Zoom fatigue in nursing students and improve the quality of care provided to patients.

The level of nursing students' self-regulated learning and academic locus of control predicting self-confidence and anxiety in clinical decision-making

AIM

This study examined the extent to which nursing students' self-regulated learning and academic locus of control predict self-confidence and anxiety in clinical decision-making.

DESIGN

This study was a cross-sectional, descriptive, and correlational study.

METHODS

The study sample was 627 undergraduate nursing students. Data were collected with the Student Introductory Information Form, Self-Regulated Learning Scale for Clinical Nursing Practice, Academic Locus of Control Scale, and Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM). Multiple linear regression analysis evaluated the predictive level of the variables on the self-confidence and anxiety scale subscale scores in clinical decision-making.

RESULTS

The external locus of control and learning strategies significantly explain all sub-dimensions of the self-confidence scale in clinical decision-making. The internal locus of control and learning strategies meaningfully explain the sub-dimensions of the anxiety scale in clinical decision-making using resources to obtain information, fully listening, and knowing and taking action.

CONCLUSION

Self-regulated learning levels of nursing students affect clinical decision-making. It was determined that students with an internal locus of control had higher self-confidence in clinical decision-making and lower anxiety levels.

Effect of NGN-Style Case Studies on Nursing Students' Anxiety and Self-Confidence With Clinical Decision-Making

BACKGROUND

The Next Generation National Council Licensing Examination (NCLEX) uses the Clinical Judgment Measurement Model in unfolding case studies to assess graduate nurses' clinical judgment.

PURPOSE

This study explored the impact of Next Generation NCLEX (NGN)-style case studies on baccalaureate nursing students' self-confidence and anxiety with clinical decision-making.

METHODS

Seventy-six second-year baccalaureate nursing students participated in this 1-group convergent mixed-methods study. Students completed 7 NGN-style case studies during a Nursing Essentials course. Data were collected at the beginning and end of the semester.

RESULTS

Anxiety with clinical decision-making significantly decreased, and self-confidence with clinical decision-making significantly increased from pretest to posttest. Five qualitative themes derived from open-ended responses: realistic application of theory to practice, critical thinking, feedback, collaboration, and NCLEX preparation.

CONCLUSIONS

This study provides preliminary evidence that formative NGN-style case studies are well received by students and result in positive outcomes. Further research is needed to more fully understand the effects of NGN-style case studies.

Development and evaluation of a collaborative reflection-based debriefing strategy for simulation-based education using virtual simulations in practical nursing: A randomized controlled trial

AIM

To develop and validate a debriefing strategy for simulation-based education in practical nursing that fosters collaborative reflection and enhances nursing competencies. The study assesses the effects on knowledge, problem-solving skills, self-confidence in clinical decision-making, reflective thinking and student satisfaction.

BACKGROUND

Advancements in medical technology and the evolving healthcare landscape have increased nurses' expectations, prompting nursing education to emphasize practical skills in addition to theoretical knowledge. The shortage of clinical practice wards, increased nursing school enrollments and a focus on patient rights have expanded traditional simulation-based education to include virtual clinical scenarios.

METHOD

A randomized controlled trial was conducted with 66 fourth-year nursing students (34 in the experimental group and 32 in the control group) at Dongseo University, Pusan, Republic of Korea (IRB No. 2021-023-HR-02). The collaborative reflection-based debriefing comprised four phases: pre-debriefing, emotional relief, exploration of alternatives and expansion of thinking. The experimental group had three intervention sessions; the control group underwent individual debriefing after completing a structured reflective questionnaire. Outcomes were assessed post-intervention and at four and eight weeks. Data were analyzed using independent t-tests and repeated-measures analysis of variance (mixed model).

RESULTS

The experimental group exhibited significantly greater improvements in knowledge, problem-solving skills, self-confidence in clinical decision-making, reflective thinking and satisfaction than the control group.

CONCLUSION

Collaborative reflection-based debriefing in simulation-based education can improve the nursing competency required in clinical settings.

Responding to In-hospital Cardiac Arrests During Times of System-wide Strain: A Code Refresher Training

BACKGROUND

Pandemic conditions of system-wide strain are associated with increased rates of in-hospital cardiac arrest (IHCA). During normal times, medical-surgical nurses may forget cardiopulmonary resuscitation (CPR) skills as soon as 3 months after training, leaving them unprepared and anxious about managing cardiac arrests. During pandemic surges, heightened anxiety can also impact concentration and confidence.

METHOD

Clinicians offered a 45-minute mock code training refresher for medical-surgical nurses to improve confidence performing CPR while adhering to pandemic-related safety procedures. In this pre-post clinical education project, nurses' confidence was measured with the Nursing Anxiety and Self-Confidence with Clinical Decision Making© Scale.

RESULTS

Although the results were not statistically significant, participants verbally reported increased confidence to initiate resuscitation, collaborate with team members, and use personal protective equipment during the posttraining debrief.

CONCLUSION

A high percentage of RNs do not have adequate confidence and/or competence in performing CPR, particularly during times of system-wide strain, and this brief, inexpensive refresher training warrants further study. [J Contin Educ Nurs. 2024;55(9):442-448.].

Development and effectiveness of online teaching on practical skills among nursing students: A systematic review and meta-analysis

OBJECTIVE

The purpose of this meta-analysis was to assess the effects of online education for practical skills among nursing students.

METHODS

This research was done by searching PubMed, Embase, CINAHL, and Web of Science electronic databases from inception to August 18, 2023, to identify English-language articles. Data extraction, quality assessment, and literature screening were carried out independently by two researchers. The Cochrane risk of bias tool and the Methodological Items for Nonrandomized Studies (MINORS) tool were used to assess the risk of bias of the included studies. Meta-analysis was carried out using Review Manager (RevMan) version 5.3 software.

RESULTS

Eighteen studies involving 2274 nursing students met the inclusion criteria. Nursing students' skills (SMD = 0.43, 95 % CI [0.33, 0.54], P<0.00001), knowledge (SMD = 0.16, 95 % CI (0.02, 0.30], P = 0.02), satisfaction (SMD = 0.29, 95 % CI (0.10, 0.47], P < 0.01), and confidence (SMD = 0.56, 95 % CI [0.29, 0.83], P < 0.0001) were all significantly improved by the online teaching intervention compared with traditional face-to-face instruction. Self-efficacy (SMD = 0.1, 95 % CI [-0.13, 0.33], P = 0.41) was also improved, but the difference was not statistically significant.

CONCLUSION

Online learning is a novel and efficient approach to teaching practical skills to nursing students. Online education can enhance students' knowledge, skills, confidence, and learning satisfaction, and it is superior to traditional classroom instruction. The findings of this study can serve as a basis for the development of standardized online teaching techniques and assessment metrics.

The effect of simulation on auscultation skills, self-confidence and anxiety levels in nursing students: A randomized controlled trial

AIM

This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels.

BACKGROUND

Auscultation is an essential topic in nursing education and patient care. Simulation is efficacious in improving auscultation skills and self-confidence and reducing anxiety levels. It is a valuable educational approach whose effects should be evaluated and disseminated in the context of auscultation.

DESIGN

This study had a randomised controlled trial design.

METHODS

The study was conducted with second-year nursing students enrolled at a university in Turkey. One group of students studied auscultation of heart, lung and bowel sounds with a simulated patient (n = 28), the second group with a high fidelity simulator (n = 30) and the third group with traditional education (n = 28). Data were collected using a demographic information form, auscultation control list and Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale. The students' psychomotor auscultation skills, self-confidence and anxiety levels were evaluated. Data on auscultation skills were assessed after the intervention, while data on self-confidence and anxiety levels were collected at baseline, after the intervention and after clinical practices throughout the academic year.

RESULTS

Anxiety and self-confidence levels showed statistically significant differences in intragroup evaluation. The self-confidence levels of the groups working with simulation did not change much in the follow-up test conducted after the end of clinical practices. The mean skill scores in the auscultation control list showed a statistically significant difference between the groups.

CONCLUSIONS

Simulation and traditional approaches are effective in learning auscultation skills. However, the positive effects of simulation, particularly in enhancing students' self-confidence and reducing anxiety levels, appear to be more permanent and impactful than traditional education. Therefore, it is recommended that simulation be prioritized for teaching auscultation skills.

Nursing Students' Perception of Just Culture and Development of Self-Confidence With Clinical Judgment: A Scoping Review

AIM

The aim of this study was to determine what is currently known about just culture's impact on nursing students' development of self-confidence with clinical judgment.

BACKGROUND

Graduates of nursing programs must execute sound nursing judgment to provide safe client care.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided the scoping review. The review elicited 1,411 sources and included 18 data sources.

RESULTS

Just culture was found to provide elements of trust, fairness, and psychological safety needed by nursing students to be self-confident in learning and executing clinical judgments that promote client safety.

CONCLUSION

Just culture promotes client safety in nursing education. Limited information exists on just culture's influence on student self-confidence with clinical judgment; more research is therefore required.

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.

Self-doubt in Nursing Students: An Evolutionary Concept Analysis

Self-doubt may negatively affect the development of prelicensure nursing students as they prepare to become practice-ready members of the workforce. Walker and Avant's method of analysis was used to explore generalized self-doubt as well as within the context of a contemporary nursing education framework: Aller's Development of Decision-Making and Self-Efficacy Model (ADD-SEM). Results indicate that several attributes of generalized self-doubt, as a form of low psychological capital, were consistent with this construct of the ADD-SEM and should be considered as nurse educators strive to ensure new nurses are prepared for the complexity of today's health care systems.

Growing Novice Nurses to Perianesthesia Care: Formation of a Post-Anesthesia Care Unit (PACU) Fellowship

PURPOSE

To provide a proof of concept of a structured, replicable perianesthesia fellowship program for nurses with less than 2 years of experience and new graduate nurses.

DESIGN

An immersive learning experience was implemented as a pilot quality improvement project using the Plan-Do-Study-Act method.

METHODS

This 24-week fellowship program used blended learning approaches and the Tiered Skill Acquisition Model (TSAM) to develop foundational Post Anesthesia Care Unit (PACU) skills. Nurse Fellows (4) acquired knowledge in stages, with each week in the program reinforcing and building upon the prior week's learnings. Settings included an initial 10 weeks in the ambulatory PACU, then the acute care PACU (weeks 11-20), and the final 4 weeks were spent in the primary unit where the Fellow would transition into a PACU Staff RN. Through each phase, the Professional Practice Department's Clinical Mentor Nurse promoted preceptor development, facilitated learning experiences and provided bimonthly evaluations of the Nurse Fellow's progress via our institution's clinical rounding tool. We used the Nursing Anxiety and Self-Confidence Associated with Clinical Decision Making (NASC-CDM) scale to assess novice nurses' anxiety and self-confidence associated with making clinical decisions at designated intervals.

FINDINGS

All Nurse Fellows completed the program and remained in PACU positions 2 years post-fellowship. They reported discomfort and increased stress transitioning to different PACUs; however, they later indicated reduced anxiety and greater confidence in clinical decision-making, as noted in subsequent evaluations of the NASC-CDM scale.

CONCLUSIONS

Perianesthesia fellowship programs incorporating blended learning, skill reinforcement, and formal mentoring on a primary PACU unit build confidence and competence in the novice nurse, making this once-excluded population of nurses a viable option for recruitment directly into the PACU environment.

Development and Implementation of a Mobile-Integrated Simulation for COVID-19 Nursing Practice: A Randomized Controlled Pretest-Posttest Experimental Design

This study developed and evaluated the effects of a mobile-integrated simulation training program on infection prevention and nursing practices based on past experiences of coronavirus disease (COVID-19) care. We developed mobile videos for the experimental group and an educational booklet for the control group based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. The effects of the simulation program with the use of mobile videos on knowledge of COVID-19 management, infection prevention practice confidence, and clinical decision-making anxiety and confidence were analyzed through a randomized controlled pretest-posttest experimental design. Data from 109 participants were analyzed. Five mobile videos were developed with a total duration of 43 min and 13 s. The experimental group showed significantly greater improvement in knowledge of COVID-19 management (p = 0.002) and infection prevention practice confidence (p < 0.001). Using the mobile-integrated COVID-19 nursing practice simulation program, nurses who have no experience with emerging infectious diseases can increase their infection control knowledge and infection prevention practice confidence. In conclusion, the mobile-integrated COVID-19 nursing practice simulation program was effective in increasing infection control knowledge and infection prevention practice confidence in nurses without COVID-19 care experience.

Measuring Nursing Student Development Through Computer-Based Simulation Activities

BACKGROUND

New nurse attrition jeopardizes patient safety, devastates career plans, and negatively impacts costs to hospitals and patients. Employers and educators recognize the widening transition-to-practice gap in meeting expectations for practice-ready, resilient nurses.

PURPOSE

The purpose of this study was to test the use of computer-based simulation activities (CBSAs) to measure processes in Aller's Development of Decision-Making and Self-Efficacy Model (ADD-SEM).

METHODS

BSN students (N = 50) in a multisite, cross-sectional study used CBSAs to provide data on decision making (Virtual Patient Lasater's Clinical Judgment Rubric), psychological capital (Nursing Anxiety and Self-Confidence in Decision-Making Scale©), and reflection.

RESULTS

Repeated-measures analysis of variance and reflexive thematic analysis revealed that decision-making (DM) scores were highest in noticing and lowest in interpreting with significant differences in cohorts (DM) (juniors: P < .001; seniors: P = .013) and self-confidence/anxiety ( P < .001).

CONCLUSION

The CBSAs are an effective means of measuring student development of DM and psychological capital needed to retain resilient nurses.

Pilot Testing of Evidence-Based Symptom Management Telehealth Simulation-Based Experiences in an Oncology Nursing Seminar

ABSTRACT

Telehealth simulation-based experiences (T-SBEs) offer one approach to prepare nursing students with the requisite skills to deliver oncology evidence-based symptom management (EBSM) using telecommunication technology. Fourteen baccalaureate nursing students participated in this one-group, pretest/posttest, convergent mixed-methods pilot study with questionnaire variant. Data were collected before and/or after two oncology EBSM T-SBEs using standardized participants. The T-SBEs resulted in significant increases in self-perceived competence, confidence, and self-confidence in clinical decision-making related to oncology EBSM. Qualitative themes included value, application, and preference for in-person SBEs. Future research is warranted to definitively determine the effect of oncology EBSM T-SBEs on student learning.

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.

Readiness to Practice in Health Care: An Empirical Definition Based on a Content Analysis of the Literature

BACKGROUND

Health care services require practitioners to be ready to practice (R2P), but evidence shows new graduates vary in R2P. Unfortunately, there is a lack of clarity about what R2P entails.

METHOD

A content analysis of the empirical literature (Gaur & Kumar, 2018) was used to quantify the elements and higher-order categories of R2P.

RESULTS

Across 108 articles, professional development activities, communication, previous experience, confidence, clinical skills, patient-centered care, integration of knowledge, teamwork, competency, management, and interpersonal skills were used to define R2P at least 25% of the time. We identified seven domains of R2P: clinical experience, social experiences, professional development experiences, personal attributes, cognitive aspects, onboarding experiences, and educational experiences.

CONCLUSION

Our study empirically defined what is associated with health professionals who were perceived as or perceived themselves as R2P in health care. Our results inform training, preparation, research, and the transition from medical training to the workplace. [J Contin Educ Nurs. 2023;54(7):302-312.].

The Effects of a Simulation-Based Experience with Standardized Participants on Learning and Clinical Decision-Making Related to Nursing Management of Oncologic Emergencies

Upon entry-to-practice, graduate nurses must be able to effectively manage oncologic emergencies to ensure best patient and family outcomes. Thus, nurse educators must develop active teaching strategies to prepare prelicensure nursing students with appropriate nursing oncology knowledge and skills. The purposes of this study were to determine the effect of simulation-based experiences (SBEs) with standardized participants (SPs) involving a patient and family member on baccalaureate nursing students' confidence and competence, anxiety and self-confidence with clinical decision-making, and satisfaction and self-confidence in learning using SBEs related to management of oncologic emergencies within a seminar-style course. A longitudinal, one-group, convergent mixed-methods design was used. Baccalaureate nursing students enrolled in a senior seminar participated in two SBEs. Study data were collected pre-seminar, pre-SBE, and post-SBE. Twenty-five senior nursing students participated in this study. There was a significant increase in students' confidence and self-perceived competence, and a significant decrease in anxiety and increase in self-confidence with clinical decision-making related to the nursing management of oncologic emergencies over time. All seven student groups in the hypercalcemia SBE, and five student groups in the hypersensitivity reaction SBE demonstrated objective competence. Qualitative themes identified included: realism, critical thinking, and benefits for professional practice. Study findings support the use of SBEs with SPs to enhance nursing students' confidence and competence, and to increase self-confidence and reduce anxiety with clinical decision-making related to the management of oncologic emergencies in a seminar-style course. The inclusion of a family member enhanced the realism of complex SBEs.

Is Virtual Patient Simulation Superior to Human Patient Simulation: A Randomized Controlled Study

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores.

Effect of Multiple-Patient Simulation on Baccalaureate Nursing Students' Anxiety and Self-confidence: A Pilot Study

BACKGROUND

Multiple-patient simulation (MPS) allows nursing students to develop leadership skills. Limited research examining student outcomes following MPS exists.

PURPOSE

This pilot study investigated the impact of MPS on (1) anxiety with transition to practice, (2) anxiety with clinical decision-making, (3) self-confidence with clinical decision-making, and (4) perceptions about MPS as a learning strategy.

METHODS

Twenty-two senior baccalaureate nursing students participated in this 2-group mixed-methods study. Data were collected before and after a leadership course using the State-Trait Anxiety Inventory, Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale, and a researcher-developed perceptions survey.

RESULTS

Self-confidence with clinical decision-making significantly increased for all participants regardless of group assignment. Anxiety and anxiety with clinical decision-making decreased without significant changes. No significant differences were found between groups. Qualitative findings yielded 3 themes: preparation for clinical practice, overcoming anxiety, and confidence.

CONCLUSION

Research investigating additional student outcomes after MPS with larger, more diverse samples is needed.

Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study

AIM

To evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulation-based training in emergency nursing on final-year nursing students' generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants' satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module.

BACKGROUND

Following the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of high-fidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated.

DESIGN

A mixed methods study incorporating quasi-experimental and qualitative components.

METHODS

We recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decision-making skills. We also explored the participants' post-intervention satisfaction, experiences and opinions.

RESULTS

Post-intervention, the participants reported significant improvements in generic capabilities, self-confidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings.

CONCLUSIONS

This study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students' learning outcomes. Further studies should include a control group, evaluate students' knowledge and skills, and retention of knowledge to confirm the true impact of such training.

Pilot Testing of Virtual Simulation-Based Experiences in an Oncology Nursing Seminar

BACKGROUND

The coronavirus disease 19 (COVID-19) pandemic challenged nurse educators to develop teaching strategies to engage students in a virtual classroom. This pilot study examined the effect of virtually delivered video-recorded (VDVR) simulation-based experiences (SBEs) with standardized participants on the management of clinical emergencies in patients and families affected by cancer on nursing student learning outcomes.

METHOD

A pre- and posttest, one-group, convergent mixed-methods design with questionnaire variant was used. Data were collected before and after SBEs.

RESULTS

Nineteen senior baccalaureate nursing students participated in this pilot study. The VDVR SBEs resulted in a significant increase in self-perceived competence. Participants had positive perceptions about the use of VDVR SBEs as a teaching strategy. Qualitative themes included realism, critical analysis, and preference for hands-on learning.

CONCLUSION

The VDVR SBEs were well-received by prelicensure nursing students as a supplemental teaching strategy to enhance self-perceived competence. Additional research is needed about the effects of VDVR SBEs on learning outcomes. [J Nurs Educ. 2023;62(3):167-170.].

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.

Achieving nursing students' clinical practice hours during the COVID-19 pandemic: Effects of alternative and nonstandard practicum methods

AIM

The aim of this study is to examine nursing students' experiences of alternative and nonstandard practicum methods used during the Coronavirus Disease 19 (COVID-19) pandemic and the associations between these experiences and nursing students' anxiety with clinical decision-making.

BACKGROUND

Nursing students experiencing alternative clinical practice methods during the COVID19 pandemic have expressed regrets about being unable to experience direct nursing care and doubts about their clinical decision-making in actual clinical settings as a nurse in the future.

METHODS

Online surveys were distributed to 239 third-year nursing students through a link in an email. Data were collected from December 2020 to January 2021.

RESULTS

Approximately 80% of participants in the Fall 2020 semester experienced an alternative clinical practice method. The extent of time spent experiencing alternative clinical practice methods and satisfaction with the clinical practicum were associated with anxiety about clinical decision-making.

CONCLUSIONS

Although the pandemic continues, nursing students' clinical practice is needed in a clinical setting as much as possible to reduce the anxiety about clinical decision-making. During the pandemic, clinical nurse educators and clinical managers should work and communicate more closely to facilitate the students' clinical practice.

The Impact of Perinatal Loss Nursing Simulation among Undergraduate Students

Providing careful and proper care for women experiencing perinatal loss is essential. Nurses and nursing students must be sufficiently prepared to provide adequate care. Caring for women who experienced a perinatal loss requires special education and instruction, but little is provided to nursing students. This study aimed to investigate the impact of simulation education directed toward caring for women with perinatal loss. A single-group pretest posttest study design was adopted. A convenience sample of 77 undergraduate students participated in the study. The nursing students’ nursing anxiety, confidence for clinical decision-making, communication competence, and simulative effectiveness were measured before and after the simulation. In addition, we asked students open-ended questions. No significant differences were noted in variables. However, the rank order of simulation effectiveness and result of open-ended questions had some noteworthy implications. Although there was no significant effect in results, simulation education about the perinatal loss was helpful for nursing students. Nursing students reflected on perinatal loss situation and learned that they should provide empathetical therapeutic communication based on needs of women with perinatal loss. To assure its effectiveness and to include optimal program content, a need exists to measure student reflection before and after the simulation. To fully guide and support women and their families with perinatal loss, providing standardized care is needed and in order to do that, standard for educational program regarding perinatal loss needs to be developed and delivered to nursing students as well as nurses.

Evaluating the Clinical Reasoning of Student Health Professionals in Placement and Simulation Settings: A Systematic Review

(1) Background: Clinical reasoning is essential to the effective practice of autonomous health professionals and is, therefore, an essential capability to develop as students. This review aimed to systematically identify the tools available to health professional educators to evaluate students' attainment of clinical reasoning capabilities in clinical placement and simulation settings. (2) Methods: A systemic review of seven databases was undertaken. Peer-reviewed, English-language publications reporting studies that developed or tested relevant tools were included. Searches included multiple terms related to clinical reasoning and health disciplines. Data regarding each tool's conceptual basis and evaluated constructs were systematically extracted and analysed. (3) Results: Most of the 61 included papers evaluated students in medical and nursing disciplines, and over half reported on the Script Concordance Test or Lasater Clinical Judgement Rubric. A number of conceptual frameworks were referenced, though many papers did not reference any framework. (4) Conclusions: Overall, key outcomes highlighted an emphasis on diagnostic reasoning, as opposed to management reasoning. Tools were predominantly aligned with individual health disciplines and with limited cross-referencing within the field. Future research into clinical reasoning evaluation tools should build on and refer to existing approaches and consider contributions across professional disciplinary divides.

The Effect of Serious Games for Nursing Students in Clinical Decision-Making Process: A Pilot Randomized Controlled Trial

Background: Serious games (SGs) have been proposed as a type of technology-enhanced simulation that may provide nursing students with an opportunity to practice their clinical reasoning and decision-making skills in a realistic and safe environment. Materials and Methods: The aim of this study is to determine the effect of serious play on nursing students' self-confidence (SC) and anxiety in clinical decision making. The randomized controlled trial evaluated the efficacy of SGs for undergraduate nursing students using pre- and posttests. The study was conducted during nursing students' clinical practice and teaching. All undergraduate nursing students (n = 120) attending internal medicine nursing lesson were approached. Sixty students out of 120 answered the questionnaires at both baseline and follow-up (30 in the experimental group [EG] and 30 in the control group). The students answered the questionnaire after taking the first clinical practice, taking the endocrine course. In the 1 week, the EG played the game and both groups returned to clinical practice. Questionnaire data were collected after clinical application. Results: SC and two subdimensions, using the information in hand to determine the problem, and knowing and taking action, were improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. Anxiety scores between groups were not statistically significant differences. Conclusions: Nursing professional educators can adopt SGs to improve cognitive and attention skills, strengthen judgment, require making time efficient, practice making safe decisions, and encourage the exploration of decision.

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.

By utilizing technology can nursing students gain more confidence and decrease anxiety when communicating with chronically ill patients about their sexual relationship?

INTRODUCTION

Effective communication is an essential part of nursing care. Nurses need to effectively communicate with patients, families, providers and staff. The purpose of this study was to show how the use of technology (i.e., video conferencing on an electronic device) could assist nursing students to gain more confidence and reduce anxiety when discussing difficult topics such as sexual intimacy.

METHODS

Pre-licensure nursing students were recruited to participate as part of regular class activities. A pre- and post-survey asking about their confidence and anxiety in communicating with patients was completed; then subjects were randomly placed into groups of 4 to 5 utilizing an electronic device. Student groups were able to communicate with a patient diagnosed with a medical condition that affected their intimacy by video conferencing in a breakout session for 15-20 min.

RESULTS

A total of 112 students participated. The majority of students stated that communicating about relationships and intimacy issues with chronically ill patients was not as difficult as they anticipated. About 82% of students liked using a video conferencing tool although about half (n = 62) reported they still preferred a face-to-face in-person interaction. Results demonstrated a significant increase in confidence and decrease in anxiety score (p = .001) before and after the intimacy communication activity.

CONCLUSIONS

In conclusion, the use of technology can be an effective learning tool to teach pre-licensure nursing students on how to communicate with patients effectively, especially for those difficult topics such as sexual intimacy.

Embracing the Value of Confidence and Intention in Program Design

Assessing participants' degree of confidence and intention related to use of knowledge and skill gained during continuing education programming provides insight into the effectiveness of methodologies used during program delivery. An analysis of participant confidence and intention levels from two programs demonstrates how using active learning strategies can positively influence the confidence and intention levels of learners. [J Contin Educ Nurs. 2021;52(1):5-7.].

A mixed-methods feasibility study to assess the acceptability and applicability of immersive virtual reality sepsis game as an adjunct to nursing education

BACKGROUND

Virtual Reality (VR) simulation has been a topic of interest in recent years as an innovative strategy for healthcare education. Although there are a handful of studies evaluating VR simulation on knowledge, motivation, and satisfaction; there is a paucity of evidence to evaluate the effectiveness, acceptability and usability of 'Immersive' VR (IVR) simulation in nursing students.

OBJECTIVES

A two-stage sequential mixed-methods feasibility study underpinned by gaming theory investigated; (1) the impact of IVR sepsis game on pre-registration nurses' self-efficacy and, (2) their perceptions of the acceptability and applicability of IVR sepsis game as an adjunct to nursing simulation education.

METHODS

The IVR simulation intervention was designed in collaboration with serious game specialists. Stage one collated pre and post-intervention self-efficacy scores with 19 pre-registration nurses using the validated instrument, Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale. Stage two used a descriptive qualitative approach to explore student nurses' perceptions of the game.

RESULTS

In stage one, pre and post-test scores revealed significant increase in self-confidence (26.1%, P < 0.001) and a significant decrease in anxiety (23.4%, P < 0.001). Stage two qualitative responses revealed four over-arching themes: acceptability, applicability, areas of improvement of IVR sepsis game and limitations of IVR game.

CONCLUSION

IVR simulation show promise as an adjunct for nurse simulation and it appears to increase self-efficacy in pre-registration nursing students. Further testing with a sufficiently powered sample size will ratify findings and provide effective solutions to distance and online learning.

A medical play experience: Preparing undergraduate nursing students for clinical practice

BACKGROUND

Undergraduate nursing programs are required to prepare nursing students to care for people across the lifespan, however due to limited paediatric nursing content in undergraduate nursing curricula and limited paediatric clinical placements, nursing graduates may lack competence and experience in caring for children.

OBJECTIVES

The aim of this study was to enhance undergraduate nursing students' work readiness and confidence to care for children by immersing them in a mock paediatric ward experience where students could practice using medical play to communicate and engage with children.

PARTICIPANTS

Participants (n = 22) were undergraduate nursing students recruited across all years from a Bachelor of Nursing program.

DESIGN

Participants were involved in a mock paediatric hospital experience providing them the opportunity to engage with children from 2 to 8 years.

METHODS

A mixed methods approach was used. Participants completed a confidence scale questionnaire pre and post the mock paediatric ward experience and a satisfaction scale post the experience. Inductive thematic analysis was used to analyse qualitative data. Quantitative data was analysed using the Wilcoxon Signed-Ranked Test.

RESULTS

Findings indicated a marked improvement in paediatric nursing skills and work readiness among the student nurses post intervention. Participants developed confidence in the use of medical play in the mock paediatric nursing setting. Improvements in paediatric nursing skills in relation to clinical learning, clinical reasoning and clinical confidence were reported.

CONCLUSIONS

The mock children's ward provided a real time paediatric experience for undergraduate nursing students to practice using medical play to communicate and engage with children. Nursing students had the opportunity to experience children's play, practice age related communication and provide explanations to children about hospital related procedures that children may encounter. With the lack of paediatric placements, it is necessary that nursing curricula examine strategies to enhance the learning for undergraduate students about paediatrics.

Megacode Simulation Training in Undergraduate Nursing Education

ABSTRACT

The use of simulation to prepare new graduates to enter a dynamic workforce is an effective strategy to improve skill acquisition, critical thinking, and the training needed to care for complex patients. Megacode simulation was implemented in the undergraduate curriculum during the last semester prior to graduation. Students (n = 52) completed the Clinical Decision-Making Self-Confidence Scale; 95 percent were satisfied with the megacode experience and perceived the simulation training as beneficial in content knowledge and skill acquisition. Megacode simulation provided senior-level nursing students the opportunity to develop in their new role as graduate nurse.

Preliminary Data on Trauma Knowledge, Confidence, and Stress During Navy Trauma Training

INTRODUCTION

The Navy Trauma Training Center (NTTC) is a military-civilian partnership that provides advanced trauma training for application across the range of military operations while exposing military medical personnel to high-volume and high-acuity trauma. Few published data evaluate the outcomes of military-civilian partnerships, including NTTC. The purpose of this study is to evaluate the knowledge, confidence, and stress of NTTC participants before, at mid-point, and after completion of the program. Participants include corpsmen (HM), nurses (RNs), physician assistants (PAs), and physicians (MDs).

MATERIALS AND METHODS

These are preliminary data from an ongoing prospective, observational study with repeated measures. Included are participants that complete NTTC training. Pre-training measures include a demographic questionnaire, trauma knowledge test, Confidence survey, and the Perceived Stress Scale. These same instruments are completed at mid-training and at the conclusion of the NTTC curriculum. Data were analyzed using paired t-tests and linear mixed models.

RESULTS

The sample was composed of 83 participants (49 HM, 18 RNs, 4 PAs, and 12 MDs. Knowledge and confidence increased from baseline to post-NTTC for each clinical role (P < .05). Stress for all roles was low and stable over time (P > .05).

CONCLUSIONS

These preliminary data suggest that, as expected, trauma-related knowledge and confidence increase significantly with training at NTTC. Stress was low and stable over time. These data from a small sample of participants indicate NTTC training is increasing participants' trauma knowledge and confidence to care for trauma casualties. Continued collection of data in the ongoing study will allow us to determine whether these early findings persist in the overall study sample and may help inform the optimal length of training needed.

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

PURPOSE

This study was conducted to investigate the affect that metacognitive awareness in nursing students has on self-confidence and anxiety with respect to clinical decision-making.

DESIGN AND METHODS

The sample for this descriptive, correlational, and cross-sectional study consisted of 186 nursing students who voluntarily participated. Data were collected using the Metacognitive Awareness Inventory and Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale. Correlation and regression analyses were then performed on the data.

FINDINGS

Nursing students' metacognitive awareness level explained the three subdimensions of self-confidence in clinical decision-making by 26.7% (r²  = 0.267, p < 0.01), 24.6% (r²  = 0.246, p < 0.01), and 26.8% (r²  = 0.268, p < 0.01), respectively. Nursing students' metacognitive awareness level explained the three subdimensions of anxiety in clinical decision-making by 3.7% (r²  = 0.037, p < 0.01), 3.2% (r²  = 0.03, p < 0.05), and 2.4% (r²  = 0.024, p < 0.05), respectively.

IMPLICATIONS FOR NURSING PRACTICE

Clinical decision-making skills can be supported by increasing students' metacognitive awareness.

Readiness to Practice in Generation Z Nursing Students

BACKGROUND

Generation Z nursing students born after 1995 have been described as true digital natives with a short attention span and tendencies toward boredom. The purpose of this pilot study is to compare readiness for practice and anxiety and self-confidence during decision making between Generation Z students who completed a 4-week immersive clinical and those in a 14-week immersive clinical.

METHOD

A convenience sample (n = 46) of Generation Z graduating baccalaureate nursing students was surveyed.

RESULTS

Independent samples t tests were conducted, with no statistical differences between groups on any measures.

CONCLUSION

Findings suggest that extended periods of time in an immersive clinical do not influence readiness to practice or anxiety and self-confidence during decision making in the next generation of students. [J Nurs Educ. 2019;58(10):604-606.].

Clinical placement anxiety in undergraduate nursing students: A concept analysis

OBJECTIVE

The primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education.

DESIGN & METHODS

We utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students.

DATA SOURCES

A review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety.

RESULTS

The literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted.

CONCLUSIONS

Insights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.

Emotional Intelligence and Critical Thinking in Nursing Students: Integrative Review of Literature

BACKGROUND

Emotional intelligence (EI) and critical thinking (CT) are positive attributes for nursing students throughout their nursing education and in future professional practice.

PURPOSE

The purpose was to review the literature investigating both EI and CT in prelicensure nursing students.

METHODS

A systematic literature search of original research articles published between 2003 and 2018 was conducted using electronic databases. Emerging themes were identified using integrative review methodological strategies.

RESULTS

Three themes emerged: (1) EI and CT are interdependent; (2) EI and CT are critical for success in nursing education; and (3) nursing education should enhance EI and CT. Findings are mixed regarding the usefulness of screening applicants for EI prior to admission.

CONCLUSIONS

Developing EI and CT skills in nursing students deserves thoughtful consideration. Further research is warranted regarding integrating strategies to enhance EI and CT skills as well as adopting EI as an adjunct admissions criterion for entrance into a prelicensure program.

[Reliability and Validity of Korean Version of Nursing Students' Anxiety and Self-Confidence with Clinical Decision Making Scale]

PURPOSE

The purpose of this study was to adapt, modify, and validate the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©) for Korean nursing students.

METHODS

Participants were 183 nursing students with clinical practice experience in two nursing colleges. The construct validity and reliability of the final Korean version of the NASC-CDM© were examined using exploratory and confirmatory factor analyses and testing of internal consistency reliability. For adaptation and modification, the instrument was translated from English to Korean. Expert review and a cross-sectional survey were used to test the instrument's validity.

RESULTS

The Korean version of the NASC-CDM© (KNASC-CDM) was composed of 23 items divided into four dimensions: (i) Listening fully and using resources to gather information; (ii) Using information to see the big picture; (iii) Knowing and acting; and (iv) Seeking information from clinical instructors. The instrument explained 60.1% of the total variance for self-confidence and 63.1% of the variance for anxiety; Cronbach's α was .93 for self-confidence and .95 for anxiety.

CONCLUSION

The KNASC-CDM can be used to identify anxiety and self-confidence in nursing students' clinical decision-making in Korea. However, further research should be done to test this instrument, as it is classified differently from the original NASC-CDM© version.

Does an orthopaedic workshop improve the confidence of nurses transitioning into the specialty of orthopaedics?

BACKGROUND

Nurses transitioning into the specialty of orthopaedics gradually develop the skills required to provide care for patients with musculoskeletal conditions or injuries, but during the early stages this can be challenging and lead to a lack of confidence. Strategies aimed at developing confidence in these nurses to make sound decisions and clinical judgements in their professional practice will assist in strengthening their practice and delivery of quality care.

AIMS

This study aimed to investigat if the delivery of an orthopaedic workshop improved the ongoing confidence of advanced beginner nurses, as recognised in Benner's exploration of skill acquisition, to undertake skills required to assess and manage patients with musculoskeletal injuries or conditions and assist in their decision making to achieve optimal patient outcomes.

METHODOLOGY

A quasi experimental pre-test, post-test study was chosen to measure nurses' confidence to undertake the scope of practice in orthopaedics at the advanced beginner level of expertise.

METHODS

A questionnaire was designed and administered to measure the level of confidence pre-intervention, immediately post intervention and twelve weeks following participation at an orthopaedic workshop. The workshop was designed specifically for nurses transitioning into the specialty of orthopaedics.

FINDINGS

The intervention had a positive impact on the confidence of advanced beginner nurses. The measurement prior to participation at the workshop indicated confidence levels were generally low. Immediately post participation the level of confidence had increased for all participants. When measured again at twelve weeks' post intervention the level of confidence had been maintained or continued to increase in the majority of orthopaedic practice areas. The overall level of confidence between pre-interven tion to twelve weeks post intervention demonstrated a clear improvement in all areas of practice.

CONCLUSION

It was evident that nurses transitioning into the speciality of orthopaedics had lower confidence levels in relation to specialty-specific skills and knowledge. The use of an education workshop improved the confidence of nurses, not only immediately post intervention, but also in the longer term. Supporting a pathway to transition in the specialty which includes specific education delivered at key times is recommended as it could beneficial to advanced beginner nurses, the specialty, patients and the profession.

Could complementary health approaches improve the symptom experience and outcomes of critically ill adults? A systematic review of randomized controlled trials

OBJECTIVE

The purpose of this systematic review was to critically evaluate the safety and effectiveness of various complementary health approaches (CHAs) in treating symptoms experienced by critically ill adults.

METHODS

The review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Electronic databases (PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Education Resources Information Center, Medline, PsychInfo) were searched for studies published from 1997-2017. Randomized controlled trials (RCTs), in English with terms ICU/critical care, music, Reiki, therapeutic touch, healing touch, aromatherapy, essential oil, reflexology, chronotherapy, or light therapy were eligible for inclusion. Studies conducted outside the ICU, involving multiple CHAs, or enrolling pediatric patients were excluded. Data were extracted and assessed independently by two authors and reviewed by two additional authors. The Cochrane risk of bias tool was used to assess study quality.

RESULTS

Thirty-two RCTs were included involving 2,987 critically ill adults. CHAs evaluated included music (n = 19), nature based sounds (NBSs) (n = 4), aromatherapy (n = 3), light therapy (n = 2), massage (n = 2), and reflexology (n = 2). Half of all studies had a high risk of bias for randomization but had low or unclear biases for other categories. No study-related adverse events or safety-related concerns were reported. There were statistically significant improvements in pain (music, NBSs), anxiety (music, NBSs, aromatherapy, massage, reflexology), agitation (NBSs, reflexology), sleep (music, aromatherapy, reflexology), level of arousal (music, massage), and duration of mechanical ventilation (music, reflexology).

CONCLUSIONS

Evidence suggests CHAs may reduce the symptom burden of critically ill adults.

Online Palliative and End-of-Life Care Education for Undergraduate Nurses

The curricula of undergraduate nursing programs lack education in palliative and end-of-life care. If the topic is covered, it is generally within isolated lectures and rarely as a full course. With the growing demand for nursing competence in palliative care, curricula must adapt to also place emphasis on this important topic. The release in 2016 of the American Association of College of Nursing (AACN) Palliative Competencies and Recommendations for Educating Undergraduate Nursing Students (CARES) drew attention to the need for expanded undergraduate education on this topic. This paper describes the development and delivery of an undergraduate-level online nursing elective course in palliative and end-of-life care offered through a large public university. Innovative elements of the course include practicing difficult conversations using technology to enable active student engagement in an online environment, a serious game involving individual role play for treatment decision making, and special topic weeks allowing a deeper dive into seldom discussed populations such as the homeless, which the students described as playing an important role in contributing to their learning.

Utilizing an SBAR Workshop With Baccalaureate Nursing Students to Improve Communication Skills

This study evaluated the effectiveness of the Situation-Background-Assessment-Recommendation (SBAR) technique to reduce anxiety and increase self-confidence levels regarding health care communication among undergraduate nursing students. Baccalaureate nursing students (n = 35) completed anxiety and self-confidence questionnaires before and after an SBAR communication workshop and subsequent simulation. A statistically significant increase in postintervention self-confidence scores was noted with no significant difference in anxiety levels. The findings support the use of SBAR as an organizing tool to promote nursing students' self-confidence during communication; however, further efforts are needed to qualitatively examine how this tool promotes these changes.

Sound clinical judgment in nursing: A concept analysis

OBJECTIVE

The intent of this concept analysis is to offer a clear understanding of the definition, defining attributes, antecedents, and consequences of sound clinical judgment pertaining to nursing practice.

BACKGROUND

Sound clinical judgment is essential in nursing because decisions made influence patient outcomes.

DESIGN

This concept analysis guided by Walker and Avant's framework, dissects the concept to promote clarity and consensus.

DATA SOURCE

CINAHL, ProQuest for Nursing and Allied Health, ERIC, and Health Source/Nursing Academic Edition databases were searched using the keyword clinical judgment.

REVIEW METHODS

Articles in peer reviewed, scholarly journals written in English were considered from 1984 to 2017.

RESULTS

The author concluded that decision-making is a surrogate term for clinical judgment. The attributes, antecedents, and consequences are discussed and supported by evidence. Cases illustrate the essence of the concept.

CONCLUSIONS

Clinical judgment is an ambiguous term that is synonymous with the term decision-making. It results from critical thinking and clinical reasoning. Using these findings, educators and administrators can use valid and reliable methods to identify the presence, foster the development, and measure the existence of clinical judgment in novice nurses with an ultimate goal to improve patient care.

Innovation in Clinical Course Delivery and Impact on Students' Clinical Decision-Making and Competence

The purpose of this study was to explore the differences in clinical decision-making and clinical competence between two different cohorts of graduating baccalaureate nursing students from a traditional prelicensure program in the United States. A quasi-experimental design was used to compare students who had substituted their traditional medical-surgical clinical experiences with simulation (Cohort 1, n = 35) with students who had supplementary simulation in addition to their traditional clinical experiences (Cohort 2, n = 36). The findings demonstrated that when simulation was used as a supplement to traditional clinical experiences, participants performed better patient assessments.