Clinical Competence and Learning Environment of Primary Care Medical Students Amid Covid-19 Pandemic: Online Distance Learning Versus Face-to-Face Teaching

@#Introduction: The COVID-19 pandemic has significantly changed the learning environment for medical students and affected their academic achievement. This study aims to determine the student’s clinical competency, learning environment, and its associated factors during the primary care medicine posting amid the COVID-19 pandemic. Methods: This is a cross-sectional study among medical students who had completed primary care medicine posting during the COVID-19 pandemic. Data on socio-demographic, posting characteristics, and students’ learning environment using the Dundee Ready Educational Environment Measure (DREEM) questionnaire and their objective structured clinical examination (OSCE) marks were collected. Independent t-test was used to compare DREEM scores between face-to-face and online groups. Multivariate analysis was used to determine factors associated with clinical competency and DREEM scores with p <0.05 considered significant. Results: A total of 205 students were recruited. Only 9.8% failed OSCE. Face-to-face teaching delivery (OR=3.61, 95 CI =1.03,11.30), face-to-face precept method (OR=1.24, 95 CI =1.12,12.51) and integrated curriculum (OR=5.23, 95 CI =1.03,26.47) were associated with good clinical competency. The total mean DREEM score was 72.94 (SD 28.8), with 89.3% having poor DREEM scores. Students who received face-to-face teaching scored higher in the Student’s Perceptions of Teacher domain compared to online teaching (p =0.036). Conclusion: Face-to-face teaching is preferred for good clinical competence and a learning environment. The impact of experiential learning was huge in our study, and it cannot be replaced by online learning. Furthermore, retraining teachers will improve the online learning experience for the students.

The multidimensional model of hope as a recovery-focused practice in mental health nursing / O modelo multidimensional de esperança como uma prática focada no recovery em enfermagem de saúde mental / El modelo multidimensional de la esperanza mientras práctica dirigida por el recovery en enfermería de salud mental

ABSTRACT Objective: To analyze the theoretical dimensions of hope as a recovery-oriented practice in mental health nursing. Method: This is a reflective and discursive study based on theoretical and experiential aspects of hope in the recovery process of people facing mental health disorders. Results: Maintaining hope in adverse situations, especially while facing mental suffering, requires skills to manage the factors that promote and inhibit hope. This balance can be tricky to reach without the presence of high-skilled professionals. The study presents the concept of hope-inspiring competence and its main dimensions. The nurse's hope-inspiring competence is recognized as a crucial advanced practice that optimizes mental health by providing motivational resources. Final Considerations: Hope-inspiring competence should be a core principle for recovery-oriented mental health professionals. Despite this recognition, the promotion of hope in mental health nursing specialized practice lacks evidence and visibility.

RESUMO Objetivo: Analisar as dimensões teóricas da esperança enquanto prática orientada pelo recovery em enfermagem de saúde mental. Métodos: Estudo reflexivo e discursivo baseado nos aspectos teóricos e vivenciais da esperança no processo de recovery de pessoas que enfrentam transtornos mentais. Resultados: Manter a esperança em situações adversas, principalmente no sofrimento mental, requer habilidades para gerenciar os fatores que a promovem e a inibem. Esse equilíbrio pode ser difícil de alcançar sem a presença de profissionais qualificados. Apresentamos o conceito de competência inspiradora de esperança e suas principais dimensões. A competência do enfermeiro inspirador de esperança é uma prática avançada crucial que otimiza a saúde mental ao fornecer recursos motivacionais. Considerações finais: A competência inspiradora de esperança deve ser um princípio fundamental para profissionais de saúde mental orientados para o recovery. Apesar desse reconhecimento, a promoção da esperança na prática especializada de enfermagem em saúde mental carece de evidências e visibilidade.

RESUMEN Objetivo: Analizar dimensiones teóricas de esperanza mientras práctica dirigida por recovery en enfermería de salud mental. Métodos: Estudio reflexivo y discursivo basándose en aspectos teóricos y experiencias de la esperanza en el proceso de recovery de personas que enfrentan trastornos mentales. Resultados: Mantener la esperanza en situaciones adversas, principalmente en el enfrentamiento del sufrimiento mental, requerir habilidades para administrar factores que proveen e inhiben. Ese equilibrio puede ser difícil de alcanzar sin la presencia de profesionales altamente cualificados. Presentamos concepto de competencia inspiradora de esperanza y sus principales dimensiones. Competencia del enfermero inspirador de esperanza es reconocida como una práctica avanzada crucial que optimiza la salud mental al fornecer recursos motivacionales. Consideraciones finales: Competencia inspiradora de esperanza debe ser un principio fundamental para profesionales de salud mental dirigidos por recovery. Aunque ese reconocimiento, la promoción de esperanza en práctica especializada de enfermería en salud mental carece de evidencias y visibilidad.

Competencies in health promotion by nurses for adolescents / Competências na promoção da saúde de enfermeiros a adolescentes / Competencias en promoción de la salud de enfermeras a adolescentes

ABSTRACT Objective: to describe the health promotion competency domains, performed by nurses, for adolescents, according to the Galway Consensus. Method: a qualitative study based on the Galway Consensus theoretical methodological framework. Fifteen nurses from northeastern Brazil participated. Data were collected between April and May 2017 through pre-structured interviews, submitted to the content analysis technique and analyzed according to the Galway Consensus dimensions. Results: the following competency areas were found: catalyzing changes, leadership, needs assessment, planning, implementation, and partnerships. These competencies were contemplated from embracement of adolescents at health unit, guidance, teamwork, educational activities and lectures, as well as active search. Conclusion: most health promotion domains were observed; however, it is still suggested that there are challenges to an effective performance of health promotion among adolescents because some competency domains in health promotion have not been evidenced.

RESUMO Objetivo: descrever os domínios das competências da promoção da saúde, realizados por enfermeiros, para com adolescentes, segundo o Consenso de Galway. Método: estudo qualitativa à luz do Consenso de Galway. Participaram 15 enfermeiros de um município da Região Nordeste, Brasil. Os dados foram coletados entre abril e maio de 2017, por meio de entrevista semiestruturada, submetidos à técnica de análise de conteúdo e analisados segundo as dimensões de Consenso de Galway. Resultados: evidenciaram-se os seis domínios do Consenso. Essas competências foram contempladas a partir da recepção do adolescente na unidade de saúde, orientações, trabalho em equipe, realização de ações educativas e palestras, e busca ativa. Considerações finais: a maioria dos domínios de promoção da saúde foram contemplados. No entanto, ainda sugere-se que ainda há desafios para o desempenho efetivo da promoção da saúde junto ao adolescente, pois alguns domínios da competência de promoção da saúde não foram evidenciados.

RESUMEN Objetivo: describir los dominios de las competencias de promoción de la salud, realizadas por enfermeras, para adolescentes, según el Consenso de Galway. Método: estudio cualitativo a la luz del Consenso de Galway. Participaron quince enfermeras de un municipio de la Región Nordeste, Brasil. Los datos fueron recolectados entre abril y mayo de 2017, mediante entrevistas semiestructuradas, sometidos a la técnica de análisis de contenido y analizados según las dimensiones del Consenso de Galway. Resultados: se evidenciaron los seis dominios del Consenso. Estas habilidades fueron contempladas desde la recepción del adolescente en la unidad de salud, la orientación, el trabajo en equipo, las actividades educativas y conferencias, y la búsqueda activa. Consideraciones finales: se cubrieron la mayoría de los dominios de promoción de la salud. Sin embargo, todavía se sugiere que aún existen desafíos para el desempeño efectivo de la promoción de la salud entre los adolescentes, ya que no se han evidenciado algunos dominios de competencia en la promoción de la salud.

Competências clínicas do aluno de medicina em urgência e emergência: análise evolutiva através do OSCE / Clinical competencies of students in urgent and emergency care: evolutive analysis through OSCE

Resumo: Introdução: Um dos maiores desafios em avaliar a formação médica é mensurar habilidades práticas, transpondo os limites do conhecimento teórico. O OSCE é uma alternativa de avaliação ativa e padronizada das competências clínicas. Apesar da sua crescente implementação, ainda são escassos os estudos longitudinais que subsidiem seu potencial avaliativo. Objetivo: Analisar a curva de aprendizagem dos estudantes de medicina com base na avaliação evolutiva de seus desempenhos nos OSCE de Urgência e Emergência. Método: Estudo retrospectivo a partir da análise de checklists avaliativos de três OSCE consecutivos, aplicados ao longo de 2019 a alunos do sexto ano de medicina da Universidade Positivo, na disciplina de Urgência e Emergência. Resultado: Foram analisados 270 checklists, aplicados a 90 alunos. Desse grupo, 51 (56,7 pontos percentuais) eram do gênero feminino e 69 (76,7 pontos percentuais) tinham entre 23 e 26 anos. Entre o primeiro e terceiro OSCE, 67 alunos (74,4 pontos percentuais) obtiveram um acréscimo significativo na nota final, cuja mediana foi elevada em 1,5 ponto. A partir da análise da evolução por componentes - conduta, reconhecimento, interação e seguimento - observou-se aumento no percentual de acertos em conduta (15,5 pontos percentuais), manutenção em reconhecimento, decréscimo tanto em interação (19,4 pontos percentuais) quanto em seguimento (16,1 pontos percentuais). Conclusão: O estudo aponta uma curva crescente das notas nos exames OSCE, sugerindo um aumento no aprendizado geral em Urgências e Emergência ao longo do ano. No entanto, a análise minuciosa dos componentes revela diferentes curvas de desempenho. Não sendo possível supor as causas destes contrapontos, são sugeridos mais estudos na área.

Abstract: Introduction: One of the major challenges in evaluating medical education is measuring practical skills, crossing the limits of theoretical knowledge. The Objective Structured Clinical Examination (OSCE) is an alternative for active and standardized assessment of clinical competencies. Despite its growing implementation, longitudinal studies that support its evaluative potential are still scarce. Objective: To analyze the learning curve of medical students based on continuous assessment of their OSCE exams and individual performances within the discipline of Urgent and Emergency Care. Method: This retrospective study is based on the analysis of data taken from assessment checklists from three consecutive OSCEs applied to sixth-year Brazilian medical students within the Urgent and Emergency Care program of the 2019 academic year. Result: 270 assessment sheets from a total of 90 students were analyzed. The group was made up of 51 females (56.7 percentage points) and 69 of the students (or 76.7 percentage points) were aged between 23 and 26 years old. Between the first and third OSCE, 67 students (74.4 percentage points) increased their final grade, the median of which increased by an average of 1.5 points. Of the four medical components evaluated - conduct, recognition, interaction and follow-up - there was an improvement of 15.5 percentage points in correct conduct, zero impact on the results concerning recognition and drops of 19.4 and 16.1 percentage points in the areas of communication and follow-up, respectively. Conclusion: The study points to an increasing curve in OSCE scores, suggesting an increase in general learning in Urgent and Emergency Care over the course of the year. However, careful analysis of the components reveals different performance curves. Since it is not possible to presume the causes of these counterpoints, further studies in the area are suggested.

Competency Profile in Genetics for Physicians in Brazil: A Proposal of the Brazilian Society of Medical Genetics and Genomics / Perfil de Competência em Genética para Médicos do Brasil: uma Proposta da Sociedade Brasileira de Genética Médica e Genômica

ABSTRACT Training in genetics is fundamental to understanding the biological aspects of the health-disease binomial. Moreover, with the change in the epidemiological profile, genetically determined disorders have become more relevant as a public health concern. Thus, managing these disorders in an ethical and diligent manner, both in patients and in their families, and considering the logic and policies of the Brazilian Unified Health System (SUS), has become a desirable competency for all physicians, impacting on their undergraduate training. Viewing this issue as relevant, the Brazilian Society of Medical Genetics and Genomics (SBGM) defined the desirable competencies in genetics for Brazilian physicians, tied to the public policies related to medical genetics in Brazil. This paper is a theoretical essay that aims to contextualize and present the competency profile in Genetics for physicians proposed by the SBGM. The proficiency profile, presented and discussed in this essay, was structured based on four essential competencies: (1) to recognise the necessity for continuing education, regularly examining one's own clinical competency, identifying learning gaps and the advances of genetics and of genomics over time; (2) to identify individuals that present or can develop a genetic disorder and know how and when to refer the patient to a specialist in medical genetics; (3) to manage patients with previously diagnosed genetic disorders and/or birth defects, employing established clinical guidelines in the scope of their professional role; and (4) to promote and stimulate clinical and education practices aimed at preventing genetic disorders and birth defects. The knowledge, skills and attitudes required for attaining these four competencies were identified. Therefore, a competency-based theoretical reference is presented to support the teaching of genetics during medical training. It is proposed that this essential competency profile in genetics should be adopted in all Brazilian medical schools with the purpose of training physicians better prepared for the current demands of the SUS. Furthermore, this competency profile can support continuing professional education actions in the area of Genetics, in order to qualify SUS staff in relation to genetic disorders and birth defects.

RESUMO Educação em genética é fundamental para o entendimento dos aspectos biológicos do binômio saúde-doença. Além disso, com a mudança do perfil epidemiológico, as doenças com determinantes genéticos tornaram-se mais relevantes como problema de saúde pública. Assim, manejar estas doenças, tanto em pacientes como em suas famílias, de forma ética, diligente e considerando a lógica e as políticas do Sistema Único de Saúde (SUS), passa a ser competência desejável para todos os médicos, impactando sua formação na graduação. Entendendo esta questão como absolutamente relevante, a Sociedade Brasileira de Genética Médica e Genômica (SBGM) definiu as competências desejáveis em genética para os médicos do Brasil, articuladas às políticas públicas relacionadas à área existentes no País. Este artigo é um ensaio teórico que objetiva contextualizar e apresentar o perfil de competência em genética para médicos proposto pela SBGM. O perfil de competência, apresentado e discutido neste ensaio, foi estruturado com base em quatro competências essenciais: (a) reconhecer a necessidade de educação continuada, examinando regularmente a sua própria competência clínica; (b) identificar indivíduos que apresentem ou possam desenvolver uma doença genética e saber como e quando encaminhá-los para aconselhamento genético; (c) manejar pacientes com doenças genéticas e/ou defeitos congênitos no âmbito da sua atuação profissional; (d) promover e estimular práticas clínicas e de educação em saúde, objetivando a prevenção de doenças genéticas e defeitos congênitos. Conhecimentos, habilidades e atitudes necessários para alcançar essas quatro competências foram elencados. Dessa forma, é apresentado um referencial teórico, baseado em competências, para apoiar o ensino da genética durante a graduação em Medicina. Defende-se a adoção deste perfil de competência mínimo em genética em todas as escolas médicas brasileiras com a finalidade de formar um médico mais adequado às atuais demandas do SUS. Adicionalmente, esse perfil de competência pode subsidiar ações de educação profissional permanente na área da genética, de forma a capacitar o recurso humano do SUS em relação às doenças genéticas e aos defeitos congênitos.

Deliberate Practice as an Effective Remediation Strategy for Underperforming Medical Students Focused on Clinical Skills: a Prospective Longitudinal Study

BACKGROUND: It is critical to develop remedial education for underperforming medical students, but little is known about how to create an effective remediation program. Deliberate practice (DP) is a structured and reflective activity that is designed to optimize performance. Here we applied the concept of DP to create remedial education to improve the clinical practices of medical students. We also analyzed the effectiveness of the remediation program. METHODS: Based on the expert performance approach of DP, we designed a 4-week remedial program for clinical performance that included feedback and reflection. There were 74 student participants in this program from 2014 to 2017. Their clinical performance was re-evaluated after completion, and changes in their clinical performance scores were analyzed. RESULTS: Students who completed the remediation program showed significant improvements in clinical performance scores (P < 0.001). Most students found the program to be instructive and helpful for improving their clinical performance. They reported that role play with peers was the most helpful for improving their skills. CONCLUSION: The DP-based remediation program improved the clinical performance of failing medical students. This remediation program should continue to be offered to underperforming students to ensure that medical school graduates are competent.

Structural Equation Modeling on Clinical Decision Making Ability of Nurses

PURPOSE: The purpose of this study was to construct and test a hypothetical model of clinical decision-making ability of nurses based on the Decision Making Process model and the Cognitive Continuum theory. METHODS: The data were collected from nurses working at 11 hospitals in Busan, Daejeon, and South Gyeongsang Province from June 30 to August 1, 2017. Finally, the data from 323 nurses were analyzed. RESULTS: The goodness-of-fit of the final model was at a good level (χ²/df=2.46, GFI=.87, AGFI=.84, IFI=.90, CFI=.90, SRMR=.07, RMSEA=.07) and 6 out of 10 paths of the model were supported. The clinical decision-making ability was both directly and indirectly affected by task complexity and indirectly affected by experiences, autonomy, and work environment. Specifically, it was strongly directly affected by analytical competency but was insignificantly affected by intuitive competency. These variables accounted for 66.0% of clinical decision-making ability. CONCLUSION: The nurses' clinical decision-making ability can be improved by improving their analytical competency. Therefore, it is necessary to organize nursing work, create a supportive work environment, and develop and implement various education programs.

A Review for Concept Clarification of Critical Thinking, Clinical Reasoning, and Clinical Judgment in Nursing Education / 한국간호교육학회지

PURPOSE: This article is a comprehensive review for concept clarification of critical thinking, clinical reasoning, and clinical judgment, which still lack a consensus and are of mixed use. METHODS: Norris's method of concept clarification was used to review concepts that have no clear definition or conceptualization yet. RESULTS: This review summarized literature from various disciplines, classified each concept based on similarities and differences, and provided hypothetic conceptual schema. CONCLUSION: Clinical reasoning and clinical judgment are clinical situation specific concepts, while critical thinking is a concept applied in general situations. Critical thinking is a broader concept and serves as a foundation for clinical reasoning and clinical judgment. Clinical reasoning precedes clinical judgment. Clinical judgement implies the end point or conclusion of clinical reasoning. Each of critical thinking, clinical reasoning, and clinical judgment is a cognitive and affective process not a psychomotor process. The concept of clinical competency involves action taken after the cognitive processes of clinical reasoning and clinical judgment.

Effects of a Neonatal Nursing Practice Program on Students' Stress, Self-efficacy, and Confidence

PURPOSE: The purpose of this study was to examine the effects of a neonatal nursing practice program for nursing students on students' stress, self-efficacy, and confidence. METHODS: A 1-group pre- and post- study design was used. The participants consisted of 64 nursing students who were in a pediatric nursing clinical practicum at a nursing college in Seoul from September 2015 to May 2016. The program consisted of 3 stages-orientation, practice, and debriefing-and was conducted for 3 hours during a 2-week period of the pediatric nursing clinical practicum. The dependent variables were neonatal nursing practice stress, self-efficacy, and confidence. Data were analyzed using the paired t-test, the Pearson correlation coefficient, the x² test, and descriptive statistics with SPSS for Windows version 22.0. RESULTS: The neonatal nursing practice program was effective at decreasing clinical practice-related stress and increasing confidence and self-efficacy regarding neonatal nursing practice. CONCLUSION: The neonatal nursing practice program may effectively promote the integration of theoretical knowledge and practice. In the future, we propose to develop various educational programs that reinforce basic nursing skills for neonates as part of an effective pediatric nursing clinical practicum.

Reliability and Validity of the Clinical Competency Scale for Nursing Students

PURPOSE: This study was conducted to evaluate clinical competency of nursing students and to examine the validity and reliability of the scale. METHODS: The Clinical Competency Scale was formed through modification of Lee's Clinical Competency Scale that was originally developed in 1990. The Clinical Competency Scale was applied to 203 nursing students. Construct validity, item convergent and discriminant validity, concurrent validity, and internal consistency reliability of the scale were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a five factor solution; that explained 63.6% of the total variance. Concurrent validity was demonstrated with the Nursing Competence Scale (r=.78, p < .001). Cronbach's α coefficient for the scale was .96. CONCLUSION: The results of this study suggest that the Clinical Competency Scale has relatively acceptable reliability and validity and can be used in clinical research to assess clinical competency for nursing students.

Enfermeiros recém-formados e o cuidado intensivo de enfermagem em unidades de pacientes não-críticos: um estudo de representações sociais / Newly-graduated nurses and intensive care nursing in non-critical units: a study on social representations

O cuidado intensivo vem sendo feito cada vez mais fora do ambiente especializado da Unidade de Terapia Intensiva, levando uma parcela significativa de pacientes críticos a ocupar outras unidades. Os recém-formados são a maior fonte de enfermeiros disponíveis para o recrutamento, o que resulta no seu contato com esta clientela em unidades de internação de pacientes não-críticos. Levanta-se o pressuposto de que a sua inexperiência traz um imaginário envolvendo estes cuidados intensivos, o que implica nos seus modos de atuar e pode repercutir na segurança do paciente. Objetivou-se identificar as representações sociais de enfermeiros recém-formados acerca do cuidado intensivo de enfermagem ao paciente crítico em unidades de internação de pacientes não-críticos; caracterizar as práticas de lidar do recém-formado em relação ao cuidado intensivo de enfermagem ao paciente crítico, considerando suas representações sociais; analisar as vulnerabilidades de tais práticas quanto à segurança do paciente. Trata-se de uma pesquisa de campo, descritiva, de abordagem qualitativa e com aplicação da Teoria das Representações Sociais. O cenário de estudo foi uma universidade privada localizada no município do Rio de Janeiro. Os participantes foram 26 enfermeiros recém-formados, e os dados foram produzidos através de entrevista em profundidade com auxílio de um roteiro semiestruturado. Os dados provenientes das entrevistas foram analisados através do software Alceste. A análise lexical produziu dois grandes blocos, cada um composto de três classes lexicais. As representações sociais dos recém-formados são construídas à luz da imagem da Unidade de Terapia Intensiva e dos cuidados que se exercem nesse campo: complexo e especializado; logo, para exercê-lo com segurança, a formação graduada não é considerada suficiente, sendo necessário cursar uma pós-graduação. No entanto, esse tipo de paciente hospitalizado fora do campo especializado confronta o recém- formado aflorando sentimentos de despreparo para cuidar. Tais sensações geram medo e insegurança no profissional, que reage de forma positiva, ao sugerir o aprimoramento de seus saberes técnicos e científicos. Há também aspectos identitários na construção da representação que implicam em identificações e diferenciações em relação ambiente da clínica. Neste entendimento, ao tempo em que a Unidade de Terapia Intensiva é categorizada como um lugar tranquilo, bonito e arrumado, fora dela é desorganizado, estressante e inseguro para o paciente crítico, pela ausência de pessoas capacitadas, recursos materiais e processos de trabalho definidos. As ações caracterizam-se então pela tentativa de transferência do paciente para a Unidade de Terapia Intensiva. Todavia, quando não conseguem, esta categorização exacerba os sentimentos de medo e preocupação advindos da inexperiência do recém-formado, conduzindo ao receio de causar algum erro que prejudique ao paciente na sua segurança e a si mesmo em relação ao exercício profissional. Conclui-se que a formação acadêmica no que tange ao cuidado intensivo na graduação deve ser ressignificada, objetivando garantir experiências mínimas de aprendizagem, bem como considerada pelas instituições quando da admissão do enfermeiro recém-formado para trabalhar. Deve-se intervir sobre aspectos da estrutura curricular e pedagógica para minimizar: o lapso de tempo entre teoria e prática, o choque com a realidade prática sem tempo de adaptação, campos sem experiências efetivas de aprendizagem.

Intensive care has been increasingly delivered out of the intensive care unit's specialized environment, leading a significant part of critical patients to other units. Newly undergraduates are the greatest source of nurses available for recruiting, which results in their contact with this public in non-critical hospitalization units. There is a theory that the lack of experience of these professionals brings an imagery involving this intensive care, which reflects in their ways of doing and may affect patient safety. The objective was to identify social representations of newly- graduated nurses regarding intensive care nursing to critical patients in non-critical hospitalization units; to characterize the newly-graduated nurses' coping practices in relation to intensive care nursing towards critical patients, considering their social representations; and to analyze the vulnerabilities of these practices as regards patient safety. A descriptive field study was conducted, using a qualitative approach and the application of the Theory of Social Representations. The study setting was a private university located in the city of Rio de Janeiro. The study participants were 26 newly-graduated nurses, and data were produced by means of in-depth interviews with a semi-structured script. The data resulting from the interviews were analyzed using the Alceste software. Lexical analysis produced two major blocks, with three lexical classes each. The social representations of the newly-graduated nurses are built in the light of the image of the intensive care unit and the care delivered in this field: complex and specialized; thus, undergraduate education is not considered enough to performing safely, and taking graduate training is needed. However, this type of patient, hospitalized out of the specialized field, confronts the newly-graduate nurse, making feelings of unpreparedness to care emerge.These sensations generate fear and lack of confidence in the professionals, who react positively by suggesting the improvement of their technical and scientific knowledge. There are also identity aspects in the construction of the representation that reflect in identification and differentiation in relation to the clinic's environment. In this understanding, on one hand, the intensive care unit is categorized as a peaceful, beautiful and organized place, but on the other hand, it is disorganized on the outside, stressful and insecure for critical patients due to the lack of qualified personnel, material resources, and well-defined work processes. Actions are characterized by the attempt to transfer patients to the intensive care unit. However, when they fail, this categorization intensifies their feelings of fear and concerns resulting from the lack of experience of the newly-graduated, leading to the fear of making a mistake that can harm patients in their safety and themselves in relation to their professional activity. In conclusion, intensive care in undergraduate education must be resignified, with the aim of ensuring minimum learning experiences, as well as considered by institutions when hiring newly-graduated nurses. An intervention must be conducted on the aspects of the curricular and pedagogical structure to minimize the gap of time between theory and practice, the shock in face of the practice reality without adaptation time, and fields without effective learning experiences.

Se aplican cada vez más cuidados intensivos fuera del ambiente especializado de la Unidad de Terapia Intensiva, haciendo que significativa cantidad de pacientes críticos ocupen otras unidades. Los recién graduados constituyen la mayor fuente de enfermeros disponibles para contratar, resultando en su contacto con estos pacientes en unidades de internación de pacientes no críticos. Se presupone que su inexperiencia determina inquietudes relativas al cuidado intensivo, con implicancias en sus modos de actuar, pudiendo ello repercutir en la seguridad del paciente. Se objetivó identificar las representaciones sociales de enfermeros recién graduados sobre cuidado intensivo de enfermería al paciente crítico en unidades de internación de pacientes no críticos; caracterizar las prácticas de enfrentamiento del recién graduado respecto del cuidado intensivo de enfermería al paciente crítico, considerando sus representaciones sociales; analizar las vulnerabilidades de tales prácticas respecto a seguridad del paciente. Investigación de campo, descriptiva, de abordaje cualitativo, con aplicación de Teoría de las Representaciones Sociales. Estudio realizado en una universidad privada del municipio de Rio de Janeiro. Participaron 26 enfermeros recién graduados; datos recolectados mediante entrevista en profundidad con ayuda de rutina semiestructurada. Los datos obtenidos en las entrevistas fueron analizados utilizándose el software Alceste. El análisis lexical determinó dos grandes bloques, cada uno compuesto por tres clases lexicales. Las representaciones sociales de los recién graduados están construidas en función de la imagen de la Unidad de Terapia Intensiva y del cuidado brindado en dicho campo: complejo y especializado; consecuentemente, para ejercerlo con seguridad, la formación de graduación es considerada insuficiente, siendo necesario cursar un posgrado. Sin embargo, este tipo de pacientes hospitalizados fuera del área especializada desafía al recién graduado, haciendo que afloren sentimientos de falta de preparación para cuidar. Tales sensaciones generan miedo e inseguridad en el profesional, que reacciona positivamente considerando optimizar sus saberes técnicos y científicos. Existen también aspectos identitarios en la construcción de la representación que implican en identificaciones y diferenciaciones respecto del ambiente de la clínica. Entendiendo eso, mientras la Unidad de Terapia Intensiva es considerada un lugar tranquilo, bonito y arreglado, fuera de ella todo es desorganizado, estresante e inseguro para el paciente crítico, ante la ausencia de personal capacitado, recursos materiales y procesos de trabajo definidos. Las acciones se caracterizan por intentar transferir al paciente a la Unidad de Terapia Intensiva. De todos modos, al no conseguirlo, esta categorización exacerba los sentimientos de miedo y preocupación derivados de la inexperiencia del recién graduado, llevándolo al temor de cometer errores que repercutan en la seguridad del paciente y respecto de sí mismos en el ejercicio profesional. Se concluye en que la formación académica, en lo atinente al cuidado intensivo en el curso de grado, debe resignificarse, apuntando a garantizar experiencias mínimas de aprendizaje, y haciendo que el tema sea considerado por las instituciones al contratar enfermeros recién graduados. Debe intervenirse en aspectos de estructura curricular y pedagógica para minimizar: la transición entre teoría y práctica, el choque con la realidad práctica sin tiempo de adaptación, campos sin experiencias efectivas de aprendizaje.

Nursing Competency, Self-Esteem, and Job Stress between Floating Nurses and Clinical Nurses / 임상간호연구

PURPOSE: This study was aimed to compare nursing competency, self-esteem, and job stress between floating nurses and clinical nurses. METHODS: The data were collected between October 1(st) and December 31(st), 2015, from 43 floating nurses and 57 clinical nurses working at a tertiary care hospital in Seoul. The collected data were analyzed with SPSS/WIN 23.0, using descriptive statistics and the t-test, χ2 test, ANCOVA, ANOVA, Scheffé test, Pearson correlation coefficients, and Stepwise multiple regression. RESULTS: The nursing competency of clinical nurses was significantly higher than that of floating nurses (F=4.370, p=.039). For both floating and clinical nurses, nursing competency was positively correlated with self-esteem (floating nurses, r=.47, p=.002; clinical nurses, r=.62, p < .001). Also, For both floating and clinical nurses, the most significant predictor of nursi ng competency was self-esteem(floating nurses, β=0.45, p=.001; clinical nurses, β=0.60, p < .001). CONCLUSION: Efforts are needed to increase the nursing competency of the floating nurse through the improvement of the floating system, the nursing work environment, and continuous education. Also, as self-esteem is the most effective predictor of nursing competence, nursing intervention is needed to improve self-esteem of the floating nurse.

Matrizes para a Aquisição de Competências no Ensino de Urgências Clínicas / Ensino de Urgências Orientado por Competências / Matrixes for Competency-Guided Teaching of Medical Emergency Care

RESUMO A Faculdade de Ciências Médicas e da Saúde (FCMS) da PUC-SP, campus Sorocaba, inseriu o aluno do internato em uma Unidade de Pronto Atendimento no estágio de urgências clínicas com os objetivos de melhorar o processo de ensino-aprendizagem em urgências durante a graduação e preparar o graduando para atuar em todos os níveis de atenção do Sistema Único de Saúde (SUS). Essa experiência levou à análise das competências a serem adquiridas para o atendimento ao paciente clínico nos serviços de urgência, considerando as especificidades desse tema. Para a aquisição de tais competências, foram construídas matrizes de conhecimentos, habilidades e atitudes, baseadas nas demandas por atendimento e nas oportunidades de aprendizagem, enfatizando que os conteúdos e as práticas devem ser oferecidos desde os anos iniciais da graduação. O modelo curricular da FCMS, desenvolvido por meio de módulos, mostrou ser propício a esta construção. Esse arcabouço pode ser estendido a escolas que usam outras estratégias pedagógicas e pode ser desenvolvido por várias disciplinas, conferindo ao ensino de urgências um caráter longitudinal e interdisciplinar.

ABSTRACT The School of Medical Sciences and Health at the Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba campus, inserted its fifth and sixth year students into an Emergency Care Unit during their emergency care internship, aiming to enhance the teaching and learning of emergency care and to prepare them to perform at all care levels of the Unified Health System. This experience led to analysis of the competencies that must be acquired to assist clinical patients in urgent care, taking into account the specific characteristics of this matter. For the acquisition of these skills, matrixes of medical knowledge themes, abilities and attitudes were built, based on the patient’s demands and on the learning opportunities, emphasizing that these contents and practices must be offered as from the beginning of the course. The school’s curricular design, developed through modules, turned out to favor this process. This framework could be adopted by other schools that use different pedagogical strategies and even by other disciplines, bestowing on the teaching of emergency care a longitudinal and interdisciplinary characteristic.

Development and Preliminary Testing of the Nursing Competency Scale in Simulation for Nursing Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to develop and validate a Nursing Competency Scale in Simulation (NCSS) for nursing students. METHODS: A preliminary version of the NCSS of 14 items was derived from the literature. A panel of seven experts reviewed the preliminary version for content validation and developed 15 items scale. A convenient sample of 195 nursing students completed the survey and two evaluators measured the performances of nine teams in a simulation scenario with NCSS. The data were analyzed using exploratory factor analysis, descriptive statistics, independent t-test and Cronbach's alpha. Intraclass correlation coefficient (ICC) was used in order to estimate the degree of inter-rater reliability. RESULTS: An exploratory factor analysis demonstrated that two factor structures of the NCSS explained 51.1% of the total variance. Two factors were named psychosocial skills and cognitive and psychomotor skills. The mean scores of NCSS between third and 4th grade were significantly different providing support for its known-group validity. Cronbach's alpha was .90 and ranged from .79 to .88. The overall ICC for inter-rater agreement was 0.89 (95% CI 0.03 to 0.98). CONCLUSION: This scale shows preliminary evidence for validity and reliability. It could be a useful instrument for measuring learning outcome in simulation for nursing students' clinical competency.

North Korean refugee doctors' preliminary examination scores / 한국의학교육

PURPOSE: Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE). METHODS: The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test. The passing status of the group of NK doctors for KMLE in recent 3 years were investigated. The multiple-choice-question (MCQ) items of which difficulty indexes of NK doctors were lower than those of South Korean (SK) medical students by two times of the standard deviation of the scores of SK medical students were selected to investigate the relevant reasons. RESULTS: The average scores of nearly all subjects were improved in the second exam compared with the first exam. The passing rate of the group of NK doctors was 75%. The number of MCQ items of which difficulty indexes of NK doctors were lower than those of SK medical students was 51 (6.38%). NK doctors' lack of understandings for Diagnostic Techniques and Procedures, Therapeutics, Prenatal Care, and Managed Care Programs was suggested as the possible reason CONCLUSION: The education of integrated courses focusing on Diagnostic Techniques and Procedures and Therapeutics, and apprenticeship-style training for clinical practice of core subjects are needed. Special lectures on the Preventive Medicine are likely to be required also.

Progress in the application of objective structured clinical examination in cultivating and evaluating of nurs-ing clinical competency / 医学研究生学报

How to cultivate and evaluate the nursing students′clinical competency is an important part of the process of higher nursing education .Objective structured clinical examination is regarded as an effective assessment method to evaluate the clinical com -petency of medical students .However , it is still at the initial stage in the nursing education in China .This article presents an overview on the design of nursing objective structured clinical examination , the present application of objective structured clinical examination in cultivating and evaluating the nursing clinical competency and the effectiveness of objective structured clinical examination .

Medical Students' Simlympic Games 2014: / 医学教育

<p>　To encourage the broad use of simulation-based medical education and establish partnerships to promote objective structured clinical examinations after clinical clerkship among medical teachers, we hosted the first team-based clinical skills competition event for medical students in Japan, named ‘Medical Students' Simlympic Games 2014'. Thirty-six (12 teams of three) open-recruited 5th or 6th grade medical students participated in this event. Student teams performed clinical tasks at 6 stations, which actively utilized the strengths of simulators or simulated patients. Contents, composition, difficulty level, and validity were tested by trainee doctors and examined by committee members in advance. In this report, we describe our concept, executive committee formation, a variety of arrangements, the outline on the day of the event, and the results of a questionnaire targeting participants. (126 words)</p>

Report on Mini Symposium “Nursing and Universal Health Coverage - Development of Human resource for nursing to ensure the all people obtain the health services-” / 国際保健医療

  Improvements in the performance of health personnel are being sought in an effort to achieve universal health coverage (UHC). Emphasis has thus been placed on the development of health personnel as part of a national UHC strategy throughout the world. In light of this, we planned the present symposium as a means of reviewing the current nursing trends in Southeast Asia and to investigate the issues facing the practical development of nursing personnel, as well as the future directions of nursing support, with a deliberate focus on UHC.<BR>  At the symposium, changes in health issues in Japan, the contributions of nursing professionals in achieving UHC, and the educational programs required by Japanese nursing personnel for international cooperation were first presented. Next, the status of health personnel in Southeast Asia was reviewed. In particular, the status of the regulatory frameworks regarding nursing personnel and the measures for enhancing the practical ability of nurses through legal means were introduced separately for Laos, Cambodia, Vietnam, and Myanmar. Subsequently, as case examples of emerging countries in Southeast Asia, the nursing policies of Thailand and Indonesia were reviewed, measures for improving the practical ability of nurses through legal means in Indonesia were introduced, and support for enhancing networks within autonomous regions was proposed.<BR>  International cooperation in the field of nursing requires strategic and comprehensive support for the development of nursing personnel in healthcare systems variable to economic growth and the means by which to achieve this are diversifying. Indeed, the symposium indicated the importance of responding to the diversity of support by enhancing networks of Japanese individuals involved in international cooperation and providing support for the enhancement of independent networks in Southeast Asia.

Effects of Head Nurses' Managerial Competencies and Professional Nurse Autonomy in Nursing Performance / 간호행정학회지

PURPOSE: The aim in this study was to identify head nurses' nursing performance according to their managerial competencies and professional nurse autonomy. METHODS: From January 15 to January 31, 2013 a survey was distributed to 200 head nurses working in 5 tertiary hospitals in B city and J city. The response rate was 80% (160 responses). The survey content included the Managerial Competencies Scale (MCS), Schutzenhofer professional nurse autonomy Scale (SPNA), and Nursing Performance Scale (SPNA). RESULTS: The score for MCS was 4.53, for SPNA, 177.05, and for SPNA, 4.62. Nursing performance was related to managerial competencies (beta=0.741; p<.001; SE=0.059) and professional autonomy (beta=0.135; p=.010; SE=0.001). These factors accounted for 64.8~67.3% of the variability in nursing performance. CONCLUSION: Results indicate that head nurses' performance would be improved through increased nursing managerial competencies and expansion of professional autonomy suggesting a need to develop work systems designed to achieve high managerial competency and professional autonomy in head nurses.

Contribuição das linguagens padronizadas para a produção do conhecimento, raciocínio clínico e prática clínica da Enfermagem / Contribution of standardized languages for knowledge production, clinical reasoning and clinical Nursing practice / Contribución de los lenguajes estandarizados para la producción del conocimiento, razonamiento clínico y práctica clínica de Enfermería

Os sistemas de linguagens padronizadas são instrumentos importantes para lidar com a crescente complexidade do cuidado de enfermagem. Neste artigo os autores apresentam os principais benefícios que o uso desses sistemas oferece para o raciocínio clínico requerido no cuidado de enfermagem, para a construção e organização do conhecimento da disciplina e para a prática clínica de enfermagem. As potenciais contribuições dos sistemas de linguagens padronizadas nesses campos derivam do fato de tais sistemas oferecerem estrutura formal para apoiar o raciocínio clínico, organizar o conhecimento e a experiência de enfermagem.

The standardized language systems are important tools for dealing with the increasing complexity of nursing care. In this article the authors present the main benefits that the use of these systems provide for the required clinical reasoning in nursing care, the construction and organization of knowledge of the discipline, and for the clinical practice of nursing. The potential contributions of the standardized language systems in these fields stem from the fact that these systems provide a formal structure for supporting clinical reasoning, organizing knowledge and nursing experience.

Los sistemas de lenguajes estandarizados son herramientas importantes para hacer frente a la creciente complejidad de los cuidados de enfermería. En este artículo los autores presentan los principales beneficios que el uso de estos sistemas ofrece para el razonamiento clínico requerido en los cuidados de enfermería, para la construcción y organización del conocimiento de la disciplina, y para la práctica clínica de la enfermería. Las posibles contribuciones de los sistemas de lenguajes estandarizados en estos ámbitos se derivan del hecho de que estos sistemas proporcionan una estructura formal para apoyar el raciocinio clínico, organizar la experiencia y los conocimientos de enfermería.