Thinking strategies of baccalaureate nursing students prompted by self-regulated learning strategies.

The standard in nursing education today is to prepare nurses for future practice through generic programs with a culminating practicum experience. The clinical faculty in this program was interested in evaluating differences in student thinking strategies that occurred as a result of an increase from 60 to 120 clinical hours, coupled with reflective journaling. The Self-Regulated Learning model was used as a conceptual support for the journaling prompts, as well as a structure for narrative analysis. the 120-hour practicum group revealed a greater use of metacognitive self-evaluation strategies versus greater use of behavioral self-monitoring strategies by the 60-hour practicum group. This finding suggests that although self-observation and self-monitoring are important and desired thinking habits to develop in nursing students, an increase to 120 hours is beneficial. It promotes a greater use of self-evaluation of thinking and greater levels of self-efficacy in making decisions to solve clinical problems.

Metacognitive factors that impact student nurse use of point of care technology in clinical settings.

The utility of personal digital assistants (PDA) as a point of care resource in health care practice and education presents new challenges for nursing faculty. While there is a plethora of PDA resources available, little is known about the variables that effect student learning and technology adoption. In this study nursing students used PDA software programs which included a drug guide, medical dictionary, laboratory manual and nursing diagnosis manual during acute care clinical experiences. Analysis of student journals comparative reflective statements about the PDA as an adjunct to other available resources in clinical practice are presented. The benefits of having a PDA included readily available data, validation of thinking processes, and facilitation of care plan re-evaluation. Students reported increased frequency of use and independence. Significant correlations between user perceptions and computer self-efficacy suggested greater confidence in abilities with technology resulting in increased self-awareness and achievement of learning outcomes.

Camp BONES: a partnership initiative to engage underrepresented adolescents in a career in nursing at the baccalaureate level.

The nursing profession is confronted with significant challenges related to the ever-increasing shortage and lack of diversity in the workforce. To address these challenges, a program for underrepresented middle school students was developed collaboratively between local school districts, academia, and health care partners. The program, Camp BONES, included a 2-week summer camp and follow-up weekend and summer camp experiences for students. Experiences were provided to explore critical thinking skills in the simulated laboratories at the university, as well as at clinical practice areas in nursing. The program was guided by the Theory of Planned Behavior and self-efficacy theory. Early evaluation of the program revealed positive accolades and students' increasing interest in pursuing nursing as a career. Collaborative programs between academia and practice areas, such as Camp BONES, provide important opportunities for middle school students to explore and engage in the nursing profession during the formative years.

Debriefing with the OPT model of clinical reasoning during high fidelity patient simulation.

Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.

Use of personal digital assistants to support clinical reasoning in undergraduate baccalaureate nursing students.

The utility of personal digital assistant resources in healthcare practice and education presents new challenges for faculty due to changing device capabilities and software availability. Although there is a plethora of personal digital assistant resources available for use by healthcare providers, little is known about the effect on clinical reasoning in nursing students. The complexity of the healthcare arena precludes reliance on memory as a sole resource for problem solving because it can be unreliable. A personal digital assistant provides instant access to information on medical treatment options so reliance on memory alone is avoided. The aims of this study are to assess clinical reasoning when personal digital assistants are used as an information resource for nursing students. These findings have implications for the future nursing work force, including accurate differential diagnosis and diagnostic reasoning, reduction of medication errors, reduction of healthcare costs, and development of effective treatment protocols.

Effectiveness of nutrition education on fast food choices in adolescents.

Adolescent obesity has become a major health concern in the United States. An increased frequency of fast food restaurant dining is associated with higher intake of calories and calories from fat. The purpose of this study was to gain insight as to how food choices in a "simulated" fast food environment might be influenced by nutrition education in a group of adolescents. Ten adolescents were asked to choose food items from a fast food restaurant menu. Their chosen meals' nutrition make-up (calories, fat, cholesterol, sodium, carbohydrates, protein, and fiber) was calculated. Following a 30-minute nutrition education session, participants were asked again to choose a meal from the same fast food menu. The nutrition make-up of the meal chosen postintervention was compared with the meal chosen before the education session. There was a statistically significant (p < .05) difference in calories, fat, carbohydrate, and fiber content of the meals chosen postintervention. This short nutrition education intervention resulted in healthier fast food choices in this group of adolescents.

Using NANDA, NIC, and NOC (NNN) language for clinical reasoning with the Outcome-Present State-Test (OPT) model.

PURPOSE: To analyze the degree to which standardized nursing language was used by baccalaureate nursing students completing Outcome-Present State-Test (OPT) model worksheets in a clinical practicum. METHODS. A scoring instrument was developed and 100 worksheets were retrospectively analyzed. FINDINGS: NANDA nursing diagnoses were correctly stated in 92% of the OPT models. Nursing Outcomes Classification (NOC) outcomes were explicitly stated in 22%, and implied in 72%. Interventions matched appropriate Nursing Interventions Classification (NIC) activities in 61%. CONCLUSIONS: NANDA, NIC, and NOC (NNN) language was used inconsistently by students in this sample. IMPLICATIONS FOR PRACTICE: If NNN language is to advance nursing knowledge, its promotion, representation in curriculum development, and active use is necessary. Educational research is needed on the facilitators and barriers to NNN language use.

Promoting clinical reasoning in undergraduate nursing students: application and evaluation of the Outcome Present State Test (OPT) model of clinical reasoning.

Promoting clinical reasoning in undergraduate nursing students through application of the Outcome Present State Test (OPT) Model of Clinical Reasoning, is a challenge that can be successfully managed through effective teaching-learning strategies. Empirical evidence to support teaching strategies that foster both cognitive and metacognitive skill acquisition is limited. The purpose of this research was to evaluate the development of clinical reasoning skills among nursing students through the application and evaluation of teaching-learning strategies associated with self-regulated learning and the OPT model (Pesut & Herman, 1998; 1999; Pesut, 2004). The model and self-regulated learning prompts were used to structure learning with junior level baccalaureate nursing students during a ten-week, medical-surgical clinical experience in acute care telemetry units. Data analysis revealed students effectively made gains in learning associated with the OPT model. Qualitative analysis of self-regulated learning prompt journal data revealed students made significant gains in self-observation, self-judgment, knowledge work and use of health care personnel resources during clinical experiences. Results indicated the intentional use of guided reflection coupled with structure and learning tools of the OPT model significantly enhanced clinical reasoning skill acquisition, and provided evidence for the effectiveness of structured teaching learning strategies.

Self-regulated learning during a clinical preceptorship: the reflections of senior baccalaureate nursing students.

This research was conducted to test the efficacy of audiotapes as a method of recording reflections of senior baccalaureate nursing students in a clinical preceptorship. The over-all aim of the research was to promote cognitive and metacognitive thinking processes with self-regulated learning strategies for problem solving in clinical situations. Verbal protocol technique revealed a consistent use of self-regulated learning strategies with a focus on environmental structuring for metacognitive activities. Common themes of thought were found in both clinical experiences and the use of critical thinking skills.

Enhancing metacognition through the reflective use of self-regulated learning strategies.

BACKGROUND: An important concern of nursing practice and education is the difficulty new graduates experience while making the transition from graduate nurse to practicing nurse. METHOD: Using a comparative descriptive design, self-regulated learning strategies were used to enhance metacognitive critical thinking abilities as 32 new graduate nurses reflected during 8-week preceptorship programs. RESULTS: Verbal protocol analysis revealed the majority of noun referents as metacognitive with thinking nouns increasing in rank from Week 1 to Week 8, present tense verbs were used most frequently with lower-level thinking phrases. Common themes in the narrative were knowledge observation, thinking strategies, judgments of self-improvement, judgments of competence, judgments of resources, self-reactions, and self-correction strategies. CONCLUSIONS: New graduate nurses have unique circumstances to overcome in making a transition to the workplace, and having self-regulatory skills would enable this process. The data suggest nursing education and practice consider self-regulated learning prompts with new graduates to promote thinking strategies.