From disobedience to struggle for adaptation: ​​nursing students' experiences of attending the clinical learning environment during Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic has affected the clinical education of nursing students all over the world. Considering the importance of clinical education and clinical learning environment (CLE) in the education of nursing students, identifying the challenges and problems faced by these students during the covid-19 pandemic helps to plan more effectively in this regard. The aim of this study was to investigate the experiences of nursing students in CLEs during the Covid-19 pandemic. METHODS: A descriptive qualitative research was conducted, which used a purposive sampling technique to recruit 15 undergraduate nursing students from Shiraz University of Medical Sciences between July 2021 and September 2022. Data were collected through in-depth semi-structured interviews. For data analysis, conventional qualitative content analysis based on Graneheim and Lundman approach was used. RESULTS: The data analysis led to emergence of two themes of "disobedience " and "struggle for adaptation". The disobedience theme consists of two categories: "objection to attend CLE" and "patient marginalization". The theme of struggle for adaptation includes two categories: "using support sources" and "applying problem-oriented strategies". CONCLUSION: At the beginning of the pandemic, the students were unfamiliar due to the disease, as well as fear of contracting themselves and infecting others, so they tried not to be in the clinical environment. However, they gradually tried to adapt to the existing conditions by applying support resources and using problem-oriented strategies. Policymakers and educational planners can use the results of this study to plan for solving the challenges of students during future pandemics and improve the condition of CLE.

Nursing students' learning strategies for e-learning during the Covid-19 pandemic in Iran: a qualitative study.

BACKGROUND: In response to the emergency brought about by the Covid-19 pandemic, many universities around the world had to change their teaching methods from in-person classes to e-learning. The purpose of this study was to identify the learning strategies of nursing students in e-learning during the pandemic. METHODS: This study had a qualitative design and used content analysis approach to collect and analyze the data. Sixteen semi-structured interviews were conducted with 12 Iranian undergraduate nursing students who were selected using purposive sampling method. RESULTS: Most nursing students in this study generally used two different strategies for e-learning, namely self-centered learning strategies and collaborative learning strategies. Some students, on the other hand, adopted a passive approach in which they did not take any effective action to contribute to their learning. CONCLUSION: In e-learning during the pandemic, students adopted different learning strategies. Therefore, designing teaching strategies tailored to the students' strategies can promote their learning and academic achievement. Also, knowledge of these strategies helps policy makers and nursing educators to take necessary measures in order to optimize and facilitate student learning in an e-learning environment.

Implementation of a virtual student placement to improve the application of theory to practice.

BACKGROUND: The primary aim of undergraduate, pre-registration nursing education is to prepare students to be nurses who can apply theory to practice, with clinical placements to support the practice element of the clinical programme. However, the theory-practice gap is a longstanding problem within nurse education, as nurses continue to practise with incomplete knowledge to support their actions. PROBLEM: In April 2020, the COVID-19 pandemic caused a reduction in clinical placement capacity that affected student learning opportunities. APPROACH: Based on Miller's pyramid of learning, a virtual placement was created using evidence-based learning theories and an array of multimedia technologies with the intention of replicating real-life experiences and promoting problem-based learning. Scenarios and case studies were collated from clinical experiences and mapped against student proficiencies to produce an authentic and immersive learning environment. CONCLUSION: This innovative pedagogy provides an alternative to the placement experience while enhancing the application of theory to practice.

[Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students].

PURPOSE: This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students. METHODS: A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. RESULTS: The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning. CONCLUSION: The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

Using Collaborative Online International Learning to Support Global Midwifery Education.

BACKGROUND AND LOCAL PROBLEM: The COVID-19 pandemic created a gap in global health learning, requiring creative solutions to bridge the divide. Collaborative online international learning (COIL) is a program between universities located in different geographic areas that aims to build cross-cultural learning and collaboration. INTERVENTION: Faculty members from Uganda and the United States worked collaboratively to plan a 2-session COIL activity for nursing and midwifery students. Twenty-eight students from the United States and Uganda participated in the pilot quality improvement project. MEASURES: Students completed a 13-question REDCap survey measuring satisfaction, time commitment for the activity, and increase in knowledge about differently resourced healthcare systems. Students also were asked to provide qualitative feedback in that survey. RESULTS: Survey results indicate a high level of satisfaction and an increased understanding of a new healthcare system. The majority of students wanted more scheduled activity times, the opportunity to meet face to face, and/or more robust sessions in the future. CONCLUSION: This COIL activity between students in the United States and Uganda was a no-cost activity that provided global health learning opportunities for students during the global pandemic. The COIL model is replicable, adaptable, and customizable for a variety of courses and time spans.

The Use of Structured, Active, In-Person Learning to Connect Didactic Content with Clinical Scenarios in a Senior Level Nursing Leadership Course.

BACKGROUND: The senior leadership course at the University of Pennsylvania School of Nursing includes both didactic and clinical components. The didactic portion delves into leadership topics and during clinical rotations the students witness nurses and patients navigate through complicated and emotional patient care experiences. METHOD: Structured, active, in-class learning (SAIL) activities in a classroom were used to connect didactic content with clinical scenarios. Different specialty-related clinical scenarios were presented to the students, and they were allocated a certain amount of time for discussion in small groups before sharing their outcomes with the whole group (think-pair-share). RESULTS: Student evaluations showed that the percentage of students who rated each session as excellent increased each semester and feedback remained overwhelmingly positive; the consistently identified area for improvement is the timing and we plan to lengthen the sessions to address that. CONCLUSION: Our team discovered that by shifting most of our simulation scenarios to SAIL, we provided the students with ample opportunities to speak in a dialectically rich environment about clinical scenarios while maintaining the interrelation between theory and practice. [J Nurs Educ. 2023;62(4):257-262.].

Knowledge, anxiety, stress and COVID-19 guidelines practice among nursing students: A cross-sectional study.

Objectives: To analyse the relationship of knowledge, anxiety and stress with the practice of coronavirus disease-2019 guidelines among nursing students. Method: The cross-sectional study was conducted in June-July 2020 after approval from the ethics review board of Universitas Nahdlatul Ulama, Surabaya, Indonesia, and comprised undergraduate nursing students in their second, third and fourth years of studies at various universities in the East Java region. Data was collected using the Depression, Anxiety, Stress Scale-21 questionnaire. Knowledge about coronavirus disease-2019 guidelines was assessed using a self-developed questionnaire in line with World Health Organisation advisory. Data was analysed using SPSS 25. RESULTS: Of the 227 subjects, 204(90%) were women and 23(10%) were men. The overall mean age was 20.10±1.5888 years. There was no significant association of knowledge, anxiety and stress with the practice of coronavirus disease-2019 guidelines (p>0.05). CONCLUSIONS: Adequate knowledge of coronavirus disease-2019 did not make the nursing students follow the relevant guidelines.

The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students.

BACKGROUND: Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS: Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS: One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION: The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.

The Perception of Preparedness in Undergraduate Nursing Students During COVID-19.

BACKGROUND: The purpose of this study was to explore the perception of preparedness in nursing students who transitioned to online and virtual learning platforms brought about by Coronavirus disease 2019 (COVID-19). DESIGN: Descriptive, correlational, nonexperimental research design. METHOD: Data collection was attained through Facebook groups using the Casey-Fink Readiness for Practice Survey and questions about comfort in nursing skills and multiple patient assignments. The sample size of 103 included nursing students and those with less than two years of experience. RESULTS: As school support during the transition increased, comfort in performing nursing skills improved. As the number of patients within a nurse's assignment increased, comfort decreased. Participants expressed a desire for more hands-on in person education and postgraduate support. With the reduction in clinical hours during COVID-19, Learning Techniques and Trials and Tribulations revealed diminished readiness. Low scores within the Trials and Tribulations subgroup impacted feelings of comfort when performing nursing skills independently. CONCLUSION: COVID-19 dramatically changed how undergraduate nurses were educated. The transition from live didactic instruction and in person clinical experience to online learning and simulated clinical experience impacted nursing students' readiness for practice. As this topic is still evolving, additional research will be needed to fully understand the impact on healthcare.

Unfolding Case Studies for Nursing Leadership.

Background: The education of nursing students has changed radically during the COVID-19 pandemic, with more content being delivered virtually. With less face-to-face (F2F) contact with educators, content translation to real-world scenarios is diminished. Objective: To determine if an educational seminar using unfolding case studies will improve students' understanding of concepts. Method: A pilot study of senior-level nursing students of an intensive unfolding case study application was conducted to focus on concept application. Results: Pre- and post-tests were compared with the increase in understanding of the focused topics, delegation, advanced directives, and safety, which was statistically significant (t[55] = 6.92, p < .001). Conclusion: Using real-world clinical problems through case studies facilitates understanding concepts and developing critical thinking skills/problem-solving abilities. The results of this study provide an impetus for the use of unfolding case studies to help nursing students understand leadership concepts.

Application of flipped classroom based on CDIO concept combined with mini-CEX evaluation model in the clinical teaching of orthopedic nursing.

BACKGROUND: After the COVID-19 epidemic, the state has paid more attention to the clinical teaching function of affiliated hospitals of colleges and universities. Strengthening the integration of medicine and education and improving the quality and effect of clinical practice teaching are critical challenges facing medical education. The difficulty of orthopedic teaching lies in the characteristics of a wide variety of diseases, strong professionalism, and relatively abstract characteristics, which affect the initiative, enthusiasm, and learning effect of nursing students. In this study, a flipped classroom teaching plan based on the CDIO (conceive-design-implement-operate) concept was constructed and practiced in the orthopedic nursing student training course to improve the effect of practical teaching, and it is convenient for teachers to implement more effective and targeted teaching in the flipped classroom of nursing education and even medical education in the future. METHODS: Fifty undergraduate nursing students who practiced in the Orthopedics Department of a tertiary hospital in June 2017 were enrolled in the control group, while 50 undergraduate nursing students who practiced in the same department in June 2018 were enrolled in the intervention group. The intervention group adopted the flipped classroom teaching mode of the CDIO concept, whereas the control group adopted the traditional teaching mode. After finishing the department practice task, the students in the two groups completed the evaluation of theory, operation skills, independent learning ability, and critical thinking ability. They completed the evaluation of clinical practice ability in eight dimensions, including four processes of nursing procedures, humanistic care ability, and evaluation of clinical teaching quality for two groups of teachers. RESULTS: After teaching, the clinical practice ability, critical thinking ability, autonomous learning ability, theoretical and operational performance, and evaluation of clinical teaching quality in the intervention group were significantly higher than those in the control group (all p < 0.05). CONCLUSION: The CDIO-based teaching mode can stimulate the independent learning ability and critical thinking ability of nursing interns, promote the organic combination of theory and practice, improve their ability to comprehensively use theoretical knowledge to analyze and solve practical problems, and improve teaching effectiveness.

Social media literacy among nursing students during the COVID-19 pandemic - does year of study matter? A nationwide cross-sectional study.

INTRODUCTION AND OBJECTIVE: Research to date indicates that student competencies in various dimensions of social media use vary depending on, for example, the field of study or stage of education. The aim of the study was assessment of social media literacy in a group of undergraduate nursing students, based on the year of study. MATERIAL AND METHODS: Respondents: 679 nursing students from 11 Polish medical universities who began or continued their education during the COVID-19 pandemic. First-year students (N = 397, 58.73%) and women (N = 589, 87.13%) constituted the largest group. The Perceived Social Media Literacy Scale was used. Statistical analysis used the Kruskal-Wallis one-way analysis-of-variance-by-ranks to analyse differences in PSML scores, and Dunn's test to analyse differences in PSML scores between individual years of study (α= 0.05). RESULTS: The level of social media literacy between students differed significantly (p < 0.001). Students rated their technical competency the highest (H = 29.722, p < 0.001), social relationships (H = 20.946, p < 0.001) and informational awareness (H = 21.054, p < 0.001) the lowest. The lowest scores in the self-assessment of social media literacy were noted among first-year students (M = 55.85, Max = 70.0; p < 0.001), and the highest among second-year students (M = 60.99, Max = 70.0; p < 0.001). CONCLUSIONS: Nursing students rated their competency lowest in the sphere related to verifying the content of messages appearing on social media, which may have a significant impact on their professional competencies. Differences in the level of social media literacy among students of different years of study should be taken into account when designing training in this field.

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.

NCLEX Pass Rates Drop Again.

Remote learning forced by the COVID-19 pandemic may have been a factor.

Jordanian nursing students' engagement and satisfaction with e-learning during COVID-19 pandemic.

BACKGROUND: Nursing education was affected by the COVID-19 pandemic as most institutions shifted to e-learning. The aim of the current study was to examine students' engagement and satisfaction levels with e-learning during the COVID-19 pandemic. METHODS: A descriptive correlation design was used to guide this study. A voluntary response sampling method was used to recruit undergraduate nursing programs in Jordan. Data were collected using an electronic link to a self-reported questionnaire. RESULTS: A total of 1,562 undergraduate nursing students responded to the questionnaire. The study showed that most students have high engagement in the emotional, skills, and performance subscales and low engagement in the participation subscale. Further, they were moderately satisfied with e-learning during the COVID-19 pandemic. CONCLUSIONS: Students identified several issues regarding their e-learning, which must be considered to improve their engagement and satisfaction. Further, the study revealed several shortcomings in preparing students to attend e-learning classes.

Global Health Competencies and Educational Needs for Nursing Students in South Korea.

BACKGROUND: Despite the increasing demand for global health education, relatively few global health courses currently are offered in Korea. METHOD: This mixed-methods study examined the need for global health competency and global health education experience for nursing students. A survey of 208 nursing students was conducted from May 2020 to August 2020, and three focus groups were conducted with 12 nursing students. RESULTS: The average score of global health nursing competencies was 2.8 ± 0.7 on a scale ranging from 1 to 4. Female, higher academic achievement, fluent English, and higher global health education experience had a significant effect on global health competency. The most influential factor was more experience with global health education. Nursing students' perceptions and educational needs related to global health education were classified into four subthemes. CONCLUSION: The development of global health education programs for nursing students is needed. [J Nurs Educ. 2023;62(2):75-82.].

Effectiveness of Preparedness Training Delivered to Pre-final and Final Year Nursing Undergraduates to Combat COVID-19: A Need-based Initiative.

A major concern during the COVID-19 pandemic has been the shortage of manpower for patient care. The recommendation of various authorised bodies encouraged the training of students from medical, nursing, and allied fields to manage COVID-19 cases by tele-consultation and monitoring of mild cases under the supervision of faculty. Anticipating a further shortage of human resources, leading to dire consequences, preparedness training for the final year and pre-final nursing undergraduates was initiated. The current study was conducted to evaluate the effectiveness of and feedback on COVID-19 preparedness training delivered to final-and pre-final-year undergraduate nursing students. A 3-day training was given to pre-final and final year nursing undergraduates on ECG, COVID-19 management protocols, personal protective equipment "donning and doffing", "hand hygiene", "biomedical waste management", "contact tracing" and cleaning and disinfection and simulation-based skills. Scores before and after training were conducted and mean scores were compared using a paired t-test. In total, 154 nursing students participated in the training program. Mean pre-test and post-test scores included: general instructions (21.69±2.5 and 25.09±3.29); skill procedures (5.4±1.21 and 6.3±1.2) and COVID management (22.84±3.26 and 26.48±2.06). There was a statistically significant improvement in knowledge and skills in all training sessions (p=0.0001). The mean post-test scores obtained at the OSCE stations for cardiac monitoring, prone positioning, compression-only CPR, airway, ECG and ABG ranged from 97.0% to 100.0% and all participants scored >70.0%. About 92.8% of the students felt that hands-on training enhanced their learning experiences. A need-based initiative of training final-and pre-final-year nursing students in COVID-19 support care effectively and efficiently created a skilled workforce.

Preparing Students for Post-COVID Nursing Careers: The Value of International Clinical Placements.

BACKGROUND: Prior to the coronavirus disease 2019 (COVID-19) pandemic, international clinical placements (ICPs) for nursing students were used to build cultural humility and global awareness. This study explored the influence of ICPs on nursing students' career planning and views of the nursing role; the findings were considered against the evolving pandemic context. METHOD: A qualitative, descriptive longitudinal study was conducted with 25 preregistration nursing students who participated in an international placement. Semistructured individual interview data were examined using thematic analysis. RESULTS: Participants were interested in patient equity and empowerment, high acuity and variety, health policy, and primary care. Participants developed resilience and nursing confidence. They saw the effects of poor health equity and health policy decisions on population health. CONCLUSION: ICPs expanded participants' understanding of global interconnectedness and also identified new career possibilities. Postpandemic, nursing education should continue to maintain a global focus on health. [J Nurs Educ. 2023;62(4):207-214.].