A concept analysis of clinical judgment in undergraduate nursing students.

AIM: To offer a clear understanding of the definition, attributes, antecedents, and consequences of undergraduate nursing students' clinical judgment in the nursing education context. BACKGROUND: Clinical judgment is a concept with broad uses among healthcare professionals. Its definitions and attributes vary across contexts. There is no established understanding of clinical judgment in nursing students. DESIGN: This concept analysis was performed using the eight steps of Walker and Avant's framework. DATA SOURCES: A literature search was conducted using search engines and included peer-reviewed articles related to clinical judgment in nursing students. RESULTS: Clinical judgment in nursing students was defined as the cognitive process exhibited via a nursing action by observation, patient assessment, interpreting, and prioritizing data that lead to responding using the appropriate nursing practice with the patient. Reflection was used to evaluate nursing students' clinical judgment to revise nursing practice. Antecedents included nursing education curriculum, student's knowledge, previous clinical experience, critical thinking, and clinical reasoning. The consequences of clinical judgment were clinical judgment ability, safe nursing practice, nursing care quality, and patient safety. CONCLUSIONS: This concept analysis gives clear insights into the definition, attributes, antecedents, and consequences of undergraduate nursing student's clinical judgment.

Nursing students' and faculty members' experiences of online education during COVID-19 across Southeast Asia: A Photovoice study.

BACKGROUND: The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach. OBJECTIVES: To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic. DESIGN: A descriptive qualitative design using Photovoice was adopted. SETTING: The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong). PARTICIPANTS: Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic. METHODS: Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards. RESULTS: Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not. CONCLUSION: Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum.

Wellness among nursing students: A qualitative study.

Nursing students typically experience high levels of stress and anxiety in nursing schools, and this is often compounded by having to combine complex classroom theories with practice. Healthy behaviors are subsequently neglected, diminishing academic efficiency and personal wellbeing. Student nurses need to adopt healthy lifestyles since wellness has been shown to promote positive health outcomes. Nonetheless, studies on the perception of wellness, and descriptions of its facilitators and barriers in wellness promotion among nursing students remain limited. This qualitative descriptive study aimed to explore facilitators and barriers to promote wellness among nursing students in Thailand. Data was gathered using focus groups with 80 undergraduate third and fourth-year nursing students, comprising 64 females and 16 males. Four themes emerged from content analysis regarding the facilitators of promoting wellness: healthy living; belief in animism; self-optimism; and receiving support. Barriers to wellness were three themes of stressors involved in students' lives: pressure from instructors; behaviors of staff nurses; and being perceived as untrustworthy. It is vital to promote wellness among nursing students to encourage their health care choices and to support them through their studies.

Effects of Litsea cubeba (Lour.) Persoon Essential Oil Aromatherapy on Mood States and Salivary Cortisol Levels in Healthy Volunteers.

Aromatherapy is one of the complementary therapies to improve health. The aromatic essential oils have been used in the treatment procedure through inhalation of essential oil vapor, massage, and herbal bathing. Litsea species are generally used in traditional medicine, and Litsea cubeba (Lour.) Persoon is a potent fumigant plant, used in cosmetics and foods as essence. The chemical composition of the essential oil of different parts of L. cubeba has been found to be varied. L. cubeba essential oil (LEO) is known for the treatment of cognition-associated discomforts. The current study assessed the impact of inhalation of LEO on mood states and salivary cortisol levels of healthy people. Fifteen healthy volunteers were involved in the study. The Profile of Mood States (POMS) Questionnaire and ELISA methods were employed to determine the mood states and salivary cortisol level, respectively. (-)-ß-pinene, ß-citral, cis- and trans-citral, citronellal, limonene, linalool, and 6-methyl-5-hepten-2-one were detected in LEO by GC-MS analysis. The heart rate and blood pressure were not affected significantly during LEO exposure. The inhalation of LEO significantly improved the total mood disturbance and reduced the confusion among the healthy human subjects. LEO inhalation reduced the salivary cortisol level at a notable level. The results of the current study warrant further studies on the beneficial effect of LEO aromatherapy in healthy and diseased subjects to uncover the therapeutic nature of the L. cubeba plant.

Essential clinical skill components of new graduate nurses: A qualitative study.

Today it is a growing challenge for nursing schools to prepare students with quality education to provide them with essential clinical skills to practice as graduates. A number of studies report that graduate nurses feel underprepared with adequate skill levels to perform in the real world of clinical practice. In Thailand, these matters are of great concern, hence this first-time study on the topic. We report on the qualitative phase of a larger mixed methods study. A qualitative descriptive approach was used with the sample, 12 nursing educators, 24 registered nurses, 24 new graduate nurses, and four members of the Thailand Nursing and Midwifery Council committee. The participants were purposely selected for 12 semi-structured focus group discussions, and 12 were later invited for in-depth interviews. Using content analysis, four skills themes were extracted: fundamental, health promotion and disease prevention, rehabilitation, and skills in specialty areas. These skill components can be used to inform the development of a framework of essential clinical skills of graduate nurses for generating nursing practice to ensure patient safety and quality of care. Furthermore, these components can inform training guidelines for nursing student practice activities in subjects and policies to support nursing students in practice.

Identifying the essential components of cultural competence in a Chinese nursing context: A qualitative study.

This qualitative study using semi-structured interviews was conducted to identify the essential components of cultural competence from the perspective of Chinese nurses. A purposive sample of 20 nurse experts, including senior clinical nurses, nurse administrators, and educators in transcultural nursing, was recruited. Using thematic analysis, four themes: awareness, attitudes, knowledge, and skills, with two subthemes for each, were identified. Notably, culture in China was understood in a broad way. The participants' responses focused upon demographic attributes, individuality, and efforts to facilitate quality care rather than on the cultural differences of ethnicity and race and developing the capacity to change discrimination or health disparities. A greater understanding of cultural competence in the Chinese nursing context, in which a dominant cultural group exists, is essential to facilitate the provision of culturally competent care to diverse populations.

The journey into fatherhood: A grounded theory study.

The objective of this study was to explore the process of transition into fatherhood for Thai men from childbirth to the postpartum period. Forty-one first-time Thai fathers were voluntarily recruited from two hospitals in Chiang Mai, Thailand, from December 2012 to June 2013. In-depth interviews were used to collect the data, which were analyzed based on grounded theory methodology. The basic social process that emerged as the core category was termed: "the journey into fatherhood." This process was divided into three phases: labor, delivery, and family beginning. Within this process, there were various situations, challenges, and pressures, which caused many changes of mood and feelings for the first-time fathers. Throughout this process, they applied various strategies to manage their concerns and needs, in order to develop into masterly fathers. Identifying the process of the journey into fatherhood provides nurses and midwives insight into the new fathers' experiences, which will enable them to be more sensitive, respectful, and effective caregivers.

Thai nursing students' adaption to problem-based learning: a qualitative study.

Student-centred forms of learning have gained favour internationally over the last few decades including problem based learning, an approach now incorporated in medicine, nursing and other disciplines' education in many countries. However, it is still new in Thailand and being piloted to try to offset traditional forms of didactic, teacher-centred forms of teaching. In this qualitative study, 25 undergraduate nursing students in northern Thailand were interviewed about their experiences with problem-based learning in a health promotion subject. Content analysis was used to interrogate interview data, which revealed four categories: adapting, seeking assistance, self-development, and thinking process development. Initially participants had mixed emotions of confusion, negativity or boredom in the adaption process, but expressed satisfaction with creativity in learning, group work, and leadership development. They described increased abilities to problem solve and think critically, but struggled to develop questioning behaviours in learning. Socio-culturally in Thai education, students have great respect for teachers, but rarely question or challenge them or their learning. We conclude that problem-based learning has great potential in Thai nursing education, but educators and systems need to systematically prepare appropriate learning environments, their staff and students, to incorporate this within curricula.

Role model behaviors of nursing faculty members in Thailand.

Being a role model is very important in order for nurse teachers to promote students' competence and confidence. This descriptive study aimed at exploring the role model behavior of nursing faculty members in Thailand. The Self-Evaluation Scale on Role Model Behaviors for Nursing Faculty (Thai version) was used to collect data from 320 nursing faculty members in eight schools of nursing, four university nursing schools, one college under the Ministry of Public Health, one under the Bangkok Metropolitan Administration, and two private schools of nursing. The results revealed that the mean score of the overall items in the role model behaviors of nursing faculty members in Thailand, as perceived by themselves, was at a high level. The scores on each subscale of the role model behaviors also were high and related to respect for students, enthusiastic and high-quality teaching activities, showing the value of nursing practice and the nursing profession, social appropriateness, and ongoing professional development. The results can be used to further develop nurse professionals and to improve the effectiveness of clinical teaching in Thailand.

Readiness for self-directed learning among nursing students in Thailand.

This study took place in Thailand where didactic and lecture-driven teaching styles are beginning to transform into student-centered methods. At Chiang Mai University Faculty of Nursing in Thailand, the readiness of 272 undergraduate students to undertake self-directed learning was investigated using two instruments: a demographic data questionnaire and Guglielmino's Self Directed Learning Readiness Scale. The study found that the overall self-directed learning readiness of participants was at a high level in the categories of openness to learning opportunities, self-concept as an effective learner, initiative and independence in learning, informed acceptance of responsibility for one's own learning, creativity, and the ability to use basic study and problem-solving skills. The findings provide encouragement to nurse educators to further apply self-directed learning in nursing courses, to improve teaching and learning methods, and promote life-long learning for nurses within Thailand and elsewhere.

Asia-Pacific nursing scholarship development: qualitative exploration of nurse scholars in Taiwan (Republic of China).

AIM: From the perspective of scholars, to describe a contemporary view of the development, facilitators of and barriers to nursing scholarship in Taiwan, to enhance policy-making about research, education and practise development. BACKGROUND: Nursing scholarship in the Asia-Pacific region is in different stages of development, depending on in-country resources and socio-economic conditions. Little is known about the facilitators or barriers to nursing scholarship in some of these countries, including Taiwan, where nursing education has changed considerably over the last decade. DESIGN: A qualitative exploratory design. METHOD: The study used snowballing to identify scholars who underwent semi-structured in-depth interviews. These were digitally recorded, transcribed verbatim and subjected to content analysis. RESULTS: Interviews were held with 12 scholars and six major themes arose: 'fulfilling our missions'; 'active research productivity'; 'low levels of collaborative research'; 'increasing demands on time'; 'gender issues' and 'developing effective collaborative networks across Taiwan and Asia'. Participants described Taiwanese scholarship development in terms of fulfilling the missions of universities; trying to balance work and culturally relevant family responsibilities, against a background of decreasing pressures to produce more qualified nurses and being more research productive in rapidly changing and challenging work environments. CONCLUSIONS: Taiwan's nursing scholarship is in a dynamic early stage of development, with increasing graduate programmes and research productivity, evidenced by rising international publications and the research productivity indexes of academics. However, scholars are facing increasing pressure because of high workloads and balancing family and work responsibilities. RELEVANCE TO CLINICAL PRACTICE: Understanding scholarship development and its facilitators and barriers in Taiwan helps inform policy makers, the higher education sector and nurses in the country and across the region about what needs to be done to improve nursing practice, raise health outcomes and enhance nursing research productivity and education.

Thai men becoming a first-time father.

The purpose of this study was to understand the process of Thai men becoming a first-time father. Twenty expectant fathers were voluntarily recruited from the antenatal clinics of three hospitals in Chiang Mai, northern Thailand. The data were collected by in-depth interviews and analyzed on the basis of grounded theory methodology. The findings demonstrated that "protecting the unborn baby" was the basic social process that emerged as the core category. This process was divided into three phases: confirming and accepting, perceiving the unborn baby as a human being, and ensuring the health of the mother and baby. Throughout this process, the Thai expectant fathers applied many strategies to manage their concerns, needs, and emotions and to develop themselves into fathers. The process of protecting the unborn baby provides insight into the expectant fathers' experiences, which will enable nurses and midwives to assist and care for men as they become fathers.

Nursing values in China: the expectations of registered nurses.

Abstract The purpose of this study was to identify the essential professional values of Chinese nurses and their manifestations in the current health-care environment. Data were collected from 29 nurse experts by semi-structured individual interviews or focus groups in Beijing and Shanghai, China. Thematic analysis was used to analyze the data. Seven themes were identified: altruism, caring, trustworthiness, dignity, responsibility for the development of the profession, autonomy, and justice. On the whole, these values were in accordance with the codes of the International Council of Nurses and the Chinese Nursing Association. Additionally, culture and socioeconomic trends were found to have an influence on nurses' understanding and explanation of professional values. The findings of this study provided insight into Chinese nurses' professional values and might contribute to the future development of a culturally sensitive scale to measure nursing values in China.

Improvement of nursing students' critical thinking skills through problem-based learning in the People's Republic of China: a quasi-experimental study.

A quasi-experimental, two-group pretest-post-test design was conducted to examine the effect of problem-based learning on the critical thinking skills of 46 Year 2 undergraduate nursing students in the People's Republic of China. The California Critical Thinking Skills Test Form A, Chinese-Taiwanese version was used as both a pretest and as a post-test for a semester-long nursing course. There was no significant difference in critical thinking skills at pretest, whereas, significant differences in critical thinking skills existed between the problem-based learning and lecture groups at post-test. The problem-based learning students had a significantly greater improvement on the overall California Critical Thinking Skills Test, analysis, and induction subscale scores compared with the lecture students. Problem-based learning fostered nursing students' critical thinking skills.

Symbolic interactionism in grounded theory studies: women surviving with HIV/AIDS in rural northern Thailand.

Although it is generally acknowledged that symbolic interactionism and grounded theory are connected, the precise nature of their connection remains implicit and unexplained. As a result, many grounded theory studies are undertaken without an explanatory framework. This in turn results in the description rather than the explanation of data determined. In this report, the authors make explicit and explain the nature of the connections between symbolic interactionism and grounded theory research. Specifically, they make explicit the connection between Blumer's methodological principles and processes and grounded theory methodology. In addition, the authors illustrate the explanatory power of symbolic interactionism in grounded theory using data from a study of the HIV/AIDS experiences of married and widowed Thai women.

Buddhism, the status of women and the spread of HIV/AIDS in Thailand.

The common-sense construction of Buddhism is that of a general power for good; the less positive aspects of Buddhism's power, especially when reinforced by folklore and ancient superstition, is infrequently recognised. In this article we make explicit Buddhism's less positive power, particularly as it relates to the status of women and, by implication, its role in the human immunodeficiency (HIV)/acquired immune deficiency syndrome (AIDS) epidemic in Thailand. The Buddhist, folklore, and superstitious bases of Thai misogyny are explored, together with its expression in the differential gender roles of women and men. In addition, the attitudes of both women and men to commercial sex workers (CSWs) and condom use is discussed. The implications of these attitudinal analyses to the epidemiology of HIV/AIDS in Thailand is outlined. We argue that the current spread of HIV/AIDS in Thailand is primarily a function of the inferior status of women, which, in turn, is a function of Buddhism and Thai cultural beliefs. In light of this, some realistic strategies to address the problem also are discussed.

"Hanging in" with HIV/AIDS in the rural north of Thailand: a grounded theory study.

A study was undertaken in 1997 through 2000 in the rural north of Thailand to describe and theorize the HIV/AIDS experiences of wives and widows there. Participants confronted four causally interrelated problems in their struggle to survive with HIV/ AIDS: physical, economic, psychoemotional, and sociocultural, and they used two social processes to manage them: namely, "hiding out" and "hanging in" with HIV/AIDS. This report describes and discusses the second of these basic social processes through which wives and widows in the rural north of Thailand cope with their HIV/AIDS infection. Hanging in involves a range of very active strategies derived from both traditional Thai culture and Western medicine and aimed at allowing participants to make the best of their predicament. In addition, this report renders explicit what is typically left implicit in grounded theory research; that is, that culture is the source both of the problems participants experienced and the means to their effective amelioration.