Alternative Clinical Practice Experiences of Korean Nursing Students during the COVID-19 Pandemic.

Background: Routine clinical practice (RCP) experiences provide nursing students with the opportunity to gain confidence in their professional roles. The purpose of this study was to explore the alternative clinical practice (ACP) experiences of nursing students during the COVID-19 pandemic using the Q methodology. Methods: Fifty-two nursing students located in four cities across South Korea participated. The participants sorted the order of and ranked 41 Q statements about their experiences with ACP into a Q sort table; the data were analyzed using the PQ method. Results: The following three distinct viewpoints were extracted: (1) ACP helps with balancing learning and life (favorable view of ACP); (2) ACP does not help with balancing theory and clinical field practice (critical view of ACP); and (3) RCP cannot be replaced by ACP (negative view of ACP). Conclusions: The findings of this study indicate that developing a curriculum for clinical practice that can enhance the strengths of ACP while compensating for its weaknesses will help promote learning among nursing students.

The effect of objective structured clinical examinations for nursing students.

Twenty core nursing skills have been identified by the Korean Accreditation Board of Nursing Education. Proficiency in these skills is essential for all nursing professions, and many educational strategies exist to develop these skills in nursing students, including the Objective Structured Clinical Examination (OSCE). To date, no study on the effects of the OSCE on nursing education has been published. Therefore, we evaluated the effects of the OSCE on the core nursing skills of 207 pre-licensure nursing students in Korea. We measured the nursing students' confidence, skills, and knowledge acquisition and retention. A one-way analysis of variance and Fisher's least significant difference were used for data analysis. Among the four nursing areas (fall, transfusion, pre-operative, and post-operative), students demonstrated the highest confidence level scores in pre-operative nursing. On the OSCE, students scored the highest in transfusion nursing. Significant differences were found between prior knowledge, knowledge acquisition, and retention. Our findings confirm that the OSCE, after lectures and core nursing skill practice, improved the retention of nursing students' knowledge. Therefore, this program can positively influence nursing students' knowledge level, and implementing the OSCE can strengthen students' clinical competency.

Home-dwelling older adults' attitudes and perceptions of dementia: A Q-methodological study in South Korea.

AIM: Older adult attitudes and perceptions of dementia can have a major impact on early diagnosis, efforts to prevent and appropriately treat it, as well as being a family burden. The aim of this study is to explore attitudes and perceptions of dementia of home-dwelling older adults using Q-methodology. METHOD: A total of 42 adults, age 65 or over, who live in South Korea ranked 37 Q statements about their attitudes and perceptions of dementia into A Q sort table grid. RESULTS: The following three distinct viewpoints were extracted: (1) it is my responsibility to prevent and to care about dementia (family-centered view); (2) there are no ways to treat dementia (despairing views); and (3) dementia is a national responsibility (nation-centered view). CONCLUSION: Based on these results, central and local government and communities should work together with older adults to manage dementia and reflect these three viewpoints when developing systematic dementia management programs.

Effects of hot and cold debriefing in simulation with case-based learning.

AIM: For successful simulation-based learning (SBL), a structured interactive and bidirectional debriefing should be a prerequisite. The purpose of this study is to identify the effects of instructor-led hot debriefing (debriefing immediately after simulation) and cold debriefing (debriefing occurring after a certain period following simulation) in simulation with case-based learning (CBL). METHOD: This study used a nonequivalent control group pretest-posttest design. A sample of 59 fourth-year nursing students in South Korea were invited and randomly divided into two groups, a post-simulation hot debriefing (PSHD, male = 4, female = 26), and cold debriefing (PSCD, male = 3, female = 26). We used clinical performance competency, satisfaction with CBL and SBL, and debriefing tools. The study period was from October to December of 2019. We analyzed the data with SPSS 23.0 software, using descriptive statistics and the t test. RESULTS: Clinical performance competency means that the scores of both groups were significantly improved in the posttest (PSHD = 33.13 ± 5.11, PSCD = 34.10 ± 4.15) as compared to those in the pretest (t = -7.010, p < .001). The knowledge (t = -12.689, p < .001) and skill (t = -5.338, p = .001) scores of clinical performance competency in the PSCD were higher than those in the PSHD. The mean satisfaction scores of the PSHD group with CBL (4.53 ± 0.60) and debriefing (4.66 ± 0.55) was higher than for those in the PSCD group. CONCLUSION: As a result of this study, PSHD and PSCD led by an instructor improved student clinical performance competency. The PSHD method, in particular, might be a positive influence on learner satisfaction with CBL, SBL, and debriefing.

Effects of peer-led debriefing using simulation with case-based learning: Written vs. observed debriefing.

BACKGROUND: Peer-led written debriefing (PLWD) and peer-led observed debriefing (PLOD) are types of peer-led debriefing. Despite their advantages, these methods are sparingly used among debriefing experts. OBJECTIVE: To identify effects of peer-led debriefing (written versus observed) using simulation with case-based learning (CBL) and compare levels of satisfaction with CBL, debriefing, and simulation-based learning (SBL) between the two groups. DESIGN: Quasi-experimental study used a pretest-posttest non-equivalent control group. SETTING: Department of Nursing in C province, South Korea. PARTICIPANTS: Sixty-nine third-year undergraduate nursing students (PLWD, n = 33; PLOD, n = 36). METHODS: Differences in clinical performance competency, and satisfaction of CBL, SBL, and debriefing between the PLWD and PLOD groups were determined. RESULTS: Clinical performance competency scores of posttest in both the PLWD and PLOD groups were significantly higher than those of pretest. There were no significant differences in any item except for item of 'communication' (t = -2.150, p = .047) between the PLWD and PLOD groups. There were no significant differences in satisfaction with CBL (t = -0.874, p = .385), simulation (t = -0.701, p = .485), or debriefing (t = -1.024, p = .309) between the two groups. CONCLUSION: This study suggests that both the PLWD and PLOD could be used to achieve students' learning outcomes when debriefing experts are unavailable.

Experience of nursing students with standardized patients in simulation-based learning: Q-methodology study.

BACKGROUND: Standardized patients (SPs) boost self-confidence, improve problem solving, enhance critical thinking, and advance clinical judgment of nursing students. OBJECTIVE: The aim of this study was to examine nursing students' experience with SPs in simulation-based learning. DESIGN: Q-methodology was used. SETTING: Department of nursing in Seoul, South Korea. PARTICIPANTS: Fourth-year undergraduate nursing students (n = 47). METHODS: A total of 47 fourth-year undergraduate nursing students ranked 42 Q statements about experiences with SPs into a normal distribution grid. RESULTS: The following three viewpoints were obtained: 1) SPs are helpful for patient care (patient-centered view), 2) SPs roles are important for nursing student learning (SPs roles-centered view), and 3) SPs can promote competency of nursing students (student-centered view). CONCLUSION: These results indicate that SPs may improve nursing students' confidence and nursing competency. Professors should reflect these three viewpoints in simulation-based learning to effectively engage SPs.

How clinical nurses in South Korea perceive the status of the nursing profession: A Q-methodological approach.

Professional self-image among nurses is shaped by subjective perceptions, feelings, and tacit views. A perceived positive status reflects and influences the nurse's self-esteem, professional empowerment, and nursing performance. The aim of this study was to examine the perceived status of the nursing profession among clinical nurses in South Korea. Q-methodology was used with data collected from September to December 2014. Forty-four Q statements were selected and scored by the 31 participants on a 9-point scale with normal distribution. The data were analyzed using the pc-QUANL program. Thirty-one nurses were classified into 3 factors based on the following viewpoints: as professional (I am proud of my nursing job), subprofessional (I am not proud of my nursing job), and developmental (advocating for change and improvement). The major finding of this study included clinical nurses' subjective perception toward the status of nursing profession. The results indicated that to raise the status of nursing profession, nurses need to understand the value of nursing and their contribution to patients and public.

Attitudes toward child rearing in female clinical nurses working in three shifts.

The balance between child-rearing and work may be one of the most challenging issues facing female clinical nurses, particularly those who work in three shifts. This study aimed to identify attitudes toward child-rearing in this particular cohort, female clinical nurses working three shifts. Q methodology, a research method concerned with individuals' subjective points of view, was used. Thirty-five selected Q statements from 51 participants were divided into a normal distribution using a nine-point bipolar scale, and the collected data were analyzed using the QUANL program. Three discrete factors emerged: Factor I: child-rearing is natural work (child-rearing and work are separate); Factor II: child-rearing is hard work (child-rearing and work are in conflict); and Factor III: child-rearing requires help from someone (child-rearing and work are balanced). The subjective viewpoints of the three identified factors can be applied to develop diverse strategies to support child-rearing in female clinical nurses.

Comparison of instructor-led versus peer-led debriefing in nursing students.

Despite its widespread support, the most effective simulation-based debriefing method has little evidence to support its efficacy. In this study, we compared the effect of peer-led and instructor-led debriefing among nursing students. The study was conducted with a non-equivalent control group using a pretest-post-test design. A convenience sample of third-year nursing students was used for the study, where 65 students enrolled in a 2-week clinical placement rotation were randomly assigned to the instructor-led group or peer-led group. The quality of cardiopulmonary resuscitation skills, satisfaction with simulation, and quality of debriefing in the peer-led group were compared to those in the instructor-led group. Group differences at each testing interval were analyzed using independent t-test. Nursing students in the instructor-led debriefing group showed better subsequent cardiopulmonary resuscitation performance, more satisfaction with simulation experience, and higher debriefing scores compared to the peer-led group. From our study, instructor-led debriefing is an effective method in improving skills performance, inducing favorable satisfaction, and providing better quality of debriefing among nursing students.

Undergraduate nursing students' subjective attitudes to curriculum for Simulation-based objective structured clinical examination.

BACKGROUND: The objective structured clinical examination (OSCE) is an effective educational method to evaluate the clinical competencies of students. OBJECTIVE: To identify undergraduate nursing students' subjective attitudes to a curriculum for simulation-based OSCE (C-SOSCE). DESIGN: Q methodology was used since it integrates the use of quantitative and qualitative methods. PARTICIPANTS: A convenience P-sample consisting of 44 third-year nursing students. METHODS: Forty selected Q-statements were obtained from each participant and were classified into a normal distribution by using a 9-point bipolar scale. The collected data were analyzed using the pc-QUANL program. RESULTS: Three discrete factors emerged: Factor I (C-SOSCE stimulates self-study; self-directed learning perspectives), Factor II (C-SOSCE promotes self-confidence; practical learning perspectives), and Factor III (C-SOSCE needs proficient personnel; constructive learning perspectives). CONCLUSIONS: Subjective positions of the three factors that were identified can be applied during the planning stages of an effective C-SOSCE. These findings establish a baseline that will lead to further research.

The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing.

Debriefing is an essential component of simulation-based learning and is a constructive teaching strategy for teachers and an effective learning method to consolidate knowledge and skills for students. The purpose of this study was to verify the importance of debriefing in simulation-based learning for students in a nursing program. Participants in this study were 49 second-year nursing students who were enrolled at the Red Cross College of Nursing in Seoul, Korea. Collected data were analyzed using χ test, t test, and independent t test statistics. There were significant differences between students in the debriefing group and those in the no-debriefing group evaluated. The level of clinical performance competency, self-reflection, and satisfaction with simulation-based learning for debriefing group students was higher than that for no-debriefing group. Debriefing was an important factor in simulation-based learning to improve technical and nontechnical skills and facilitate self-reflection. These results suggest that debriefing by a trained instructor is essential for maximizing simulation-based learning success. In absence of a trained debriefing instructor, various alternative forms of debriefing should be considered.

Attitudes towards rotating shift work in clinical nurses: a Q-methodology study.

AIMS AND OBJECTIVES: To identify clinical nurses' attitudes towards rotating shift work. BACKGROUND: Many hospitals worldwide employ rotating shift work patterns to staff their facilities. Attitudes of clinical nurses towards rotating shift work vary. DESIGN: To understand clinical nurses' attitudes towards rotating shift work, Q-methodology, a method for the analysis of subjective viewpoints with the strengths of both qualitative and quantitative methods, was used. METHODS: Forty-six selected Q-statements from each of the 39 participants were classified into a normal distribution using an 11-point bipolar scale. The collected data were analysed using pc-QUANL program. RESULTS: Three discrete factors emerged as follows: factor I (rotating shift work is frustrating: objectionable perspective), factor II (rotating shift work is satisfactory: constructive perspective) and factor III (rotating shift work is problematic, but necessary: ambivalent perspective). CONCLUSIONS: The subjective viewpoints of the three identified factors can be applied in developing various roster designs for nurses engaging in rotating shift work. RELEVANCE TO CLINICAL PRACTICE: The findings provide the baseline for nurse leaders in helping nurses adjust and deal with rotating shift work.

Attitudes toward clinical practice in undergraduate nursing students: A Q methodology study.

BACKGROUND: Clinical practice (CP) provides an opportunity to directly apply nursing theories learned in class to practice, with the aim of improving nursing knowledge and skills. Nursing students' perspectives about CP can be diverse. OBJECTIVE: To identify nursing students' attitudes toward CP. DESIGN: Q-methodology, an integration of quantitative and qualitative methods, was used. PARTICIPANTS: A convenience P-sample consisting of 43 second-year undergraduate nursing students. METHODS: Forty-three selected Q-statements from each of the 43 participants (P-sample) were classified into the shape of a normal distribution using a 9-point bipolar scale. The collected data were analyzed using the pc-QUANL program. RESULTS: Two discrete factors emerged. Factor I comprised a querulous attitude with a critical perspective. Factor II comprised an enthusiastic attitude with a future-oriented perspective. CONCLUSION: The subjective viewpoints of the two identified factors can be applied in planning effective CP for nursing students.

Attitudes toward simulation-based learning in nursing students: an application of Q methodology.

SBL is a highly advanced educational method that promotes technical/non-technical skills, increases team competency, and increases health care team interaction in a safe health care environment with no potential for harm to the patient. Even though students may experience the same simulation, their reactions are not necessarily uniform. This study aims at identifying the diversely perceived attitudes of undergraduate nursing students toward simulation-based learning. This study design was utilized using a Q methodology, which analyzes the subjectivity of each type of attitude. Data were collected from 22 undergraduate nursing students who had an experience of simulation-based learning before going to the clinical setting. The 45 selected Q-statements from each of 22 participants were classified into the shape of a normal distribution using a 9-point scale. The collected data was analyzed using the pc-QUANL program. The results revealed two discrete groups of students toward simulation-based learning: 'adventurous immersion' and 'constructive criticism'. The findings revealed that teaching and learning strategies based on the two factors of attitudes could beneficially contribute to the customization of simulation-based learning. In nursing education and clinical practice, teaching and learning strategies based on types I and II can be used to refine an alternative learning approach that supports and complements clinical practice. Recommendations have been provided based on the findings.

Attitudes toward Video-Assisted Debriefing after simulation in undergraduate nursing students: an application of Q methodology.

BACKGROUND: Video-Assisted Debriefing (VAD) provides an affirmative self-reflection through reviewing what went right, what went wrong, what had to be done, and what should be done in the future. OBJECTIVE: To identify attitudes toward Video-Assisted Debriefing after a simulation in undergraduate nursing students. DESIGN: Q-methodology, which has been identified as a method for the analysis of subjective viewpoints and to have the strengths of both qualitative and quantitative methods, was used. SETTING: College of Nursing in Seoul. PARTICIPANTS: A convenience P-sample consisting of 44 third-year undergraduate nursing students. METHODS: Thirty-nine selected Q-statements from each of 44 participants (P-sample) were classified into the shape of a normal distribution using a 9-point bipolar scale from -4 for strongly disagree to +4 for strongly agree. The collected data were analyzed using the pc-QUANL program. RESULTS: Three discrete factors emerged: Factor I (VAD helps self-reflection; strategic view), Factor II (VAD makes us tired and humiliated; reluctant view), and Factor III (VAD boosts self-confidence; forward view). CONCLUSION: The findings could be used as a cornerstone for application of customized debriefing method to undergraduate nursing students. Debriefing techniques considering student's individual learning style.

[Comparison of learning effects using high-fidelity and multi-mode simulation: an application of emergency care for a patient with cardiac arrest].

PURPOSE: Simulation-based learning has become a powerful method to improve the quality of care and help students meet the challenges of increasingly complex clinical practice settings. The purpose of this study was to identify the learning effects using high-fidelity SimMan and multi-mode simulation. METHODS: Participants in this study were 38 students who were enrolled in an intensive course for a major in nursing at R college. Collected data were analyzed using Chi-square, t-test, and independent t-test with the SPSS 18.0 for Windows Program. RESULTS: There were no statistically significant differences in learning effects between high-fidelity SimMan and multi-mode simulation group. However, skills in clinical performance in the high-fidelity SimMan group were higher than in the multi-mode group (p=.014), communication in clinical performance in multi-mode simulation group was higher than in the high-fidelity SimMan group (p<.001). CONCLUSION: Multi-mode simulation with a standardized patient is an effective learning method in many ways compared to a high-fidelity simulator. These results suggest that multi-mode simulation be offered to students in nursing colleges which cannot afford to purchase a high-fidelity simulator, or offered as an alternative.

Leukotriene-related gene polymorphisms in patients with aspirin-intolerant urticaria and aspirin-intolerant asthma: differing contributions of ALOX5 polymorphism in Korean population.

The pathogenesis of aspirin (acetylsalicylic acid, ASA)-intolerant urticaria (AIU) is still poorly understood but it has recently been suggested that it is associated with the overproduction of leukotriene (LT). This is supported by evidence that cyclooxygenase 2 inhibitor is given safely to patients with AIU. The present study was designed to investigate the role of genetic polymorphism of LT related genes in the pathogenesis of AIU via a case-control study. We screened single nucleotide polymorphisms (SNPs) in genes encoding enzymes involved in leukotriene synthesis in the Korean population with AIU (n = 101), ASA-intolerant asthma (AIA, n = 95) and normal healthy controls (n = 123). Genotype was determined by primer extension reactions using the SNapShot ddNTP primer extension kit. Among 8 SNPs of four LT related genes, the polymorphism of ALOX5 at positions of -1708 G > A showed significant difference in genotype frequency between AIU and AIA (p = 0.01). Furthermore, there were significant differences observed in the frequencies of two ALOX5 haplotypes between the AIU group and AIA group (p < 0.05). However, there were no differences in allele, genotype, or haplotype frequencies of ALOX5 between the AIU group and the normal control group. These results suggested that ALOX5 has a differing contribution in two major clinical pathogenesis related to ASA-sensitivity.