The Comparison of Lifestyles, Mental Risks, and Physical Indices among Individuals with Ultra-High Risk of Psychosis, Patients with Schizophrenia, and the General Public.

(1) Background: Early interventions may effectively reduce the risk of mental disorders in individuals with ultra-high risk. Specifying the health needs of individuals with ultra-high risk is crucial before the implementation of successful early intervention. This study aimed to explore the differences in lifestyles, mental risks, and physical indices among individuals with ultra-high risk, patients with schizophrenia, and healthy subjects. (2) Methods: A cross-section design applying seven questionnaires with physical examinations for 144 participants aged 13-45 years old was conducted in this study. The questionnaires included one about personal data, four on mental risks, and two for lifestyles. (3) Results: The individuals with ultra-high risk scored similarly in many dimensions as the patients with schizophrenia, but they displayed lower positive symptoms, lower negative symptoms, lower prodromal symptoms, higher interpersonal deficits, lower nutrition intake, and higher levels of exercise than the patients with schizophrenia. Female individuals with ultra-high risk had lower self-esteem, higher positive symptoms, lower nutrition intake, and higher exercise levels than male ones. (4) Conclusions: The study pinpointed specific health needs with interpersonal deficits, nutrition intake, and physical activity for the individuals with ultra-high risk. Future interventions targeted on improving social function, dietary pattern, and exercise will be beneficial.

Effectiveness of Using a Self-Directed Learning Program to Teach Physical Examination and Health Assessment Skills: A Quasi-Experimental Study.

BACKGROUND: Conducting health assessments and physical examinations are essential skills for independent practice. Exploring how to teach these skills effectively is essential. PURPOSE: This study was designed to validate the effectiveness of a self-directed learning program in improving nursing student outcomes in terms of their learning health assessment and physical examination skills. METHOD: A quasi-experimental design was used, and second-year nursing students enrolled in a health assessment and physical examination course at a university of science and technology in central Taiwan were recruited using purposive sampling. Both the control and experimental groups were taught using a traditional teaching method. The experimental group additionally participated in a self-directed learning program. Structured questionnaires, including the Chinese version of the Self-Directed Learning Readiness Scale, Scales of Motivation and Learning Strategies, Interpersonal Skills Assessment Tool, the Course Satisfaction Evaluation Scale, and the Perception of Health Assessment and Physical Examination Competence Scale, were used to collect data at three time points. RESULTS: After controlling for the effects of pretest scores, after the intervention, the experimental group achieved significantly higher scores than the control group for self-directed learning (creative learning and love of learning), learning motivation (goal orientation, work value, expected success, and test anxiety), and cognitive strategies (total score, elaboration strategy, recitation strategy, and monitoring strategy). In addition, the health assessment exercise improved interpersonal and communication skills, and learning satisfaction was significantly higher in the experimental group than the control group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A physical examination and health assessment course designed using the self-directed learning framework can effectively improve student competence in related skills to enhance their ability to assess patient health problems in clinical settings. This study presents an alternative approach to teaching health assessment and physical examination courses and validates the positive effect of this approach on student learning outcomes.

Validation of the psychometric properties of the Self-Directed Learning Readiness Scale.

AIM: The aim of the study was to evaluate the psychometric properties of the Chinese version of the Self-Directed Learning Readiness Scale. DESIGN: A cross-sectional survey was designed. METHODS: A convenience sample of 659 participants was recruited. Exploratory and confirmatory factor analyses were used to evaluate the factorial structure. In addition, the concurrent validity was assessed using the Critical Thinking Disposition Inventory. RESULTS: The exploratory factor analysis revealed that the scale was a 6-factor structure, named love of learning, active learning, effective learning, independent learning, learning motivation and creative learning, which explained 53.30% of the total variance. The findings of the confirmatory factor analysis showed that a 37-item six first-order model produced the best-fit statistics. Internal consistency for the scale was satisfactory, ranging from 0.71 to 0.88. Concurrent and predictive validities also reached significant levels. The utility of the instrument was suggested.

Development and evaluation of a physical examination and health assessment course.

BACKGROUND: Physical examination and health assessment skills are essential components of nursing practice, and the critical elements to be taught merit further investigation. OBJECTIVES: To develop and evaluate a physical examination and health assessment course based on a self-directed learning framework. DESIGN: An action research design was employed. SETTINGS: A baccalaureate nursing program of the university of science and technology in central Taiwan. PARTICIPANTS: A convenience sample comprising 23 teaching faculty members and 41 enrolled second-year students was recruited. METHODS: Structured questionnaires were developed for data collection. A paired t-test and the Kruskal-Wallis test were used for data analysis. RESULTS: The course consisted of four parts: health history taking from a holistic perspective, examination skills in diverse systems, case exercise and discussion, and final objective structured clinical examination. Statistical significance was found in the areas of physical examination skills, critical thinking, and case analysis. Participants with mid-to high-level self-directed learning had significantly higher scores than those with low-level self-directed learning on physical examination skills and problem assessment. Internal and discriminant validity were supported. CONCLUSION: The study results provide evidence supporting the use of self-directed learning framework in curriculum design. The course integrated necessary knowledge and skills enabled students to practice physical examination, and assessment skills may enhance student confidence in approaching patients in clinical encounters. However, the study was a descriptive design. The generalization of the results needs to be further validated by an experimental study.

The Learning Effectiveness of High-Fidelity Simulation Teaching Among Chinese Nursing Students: A Mixed-Methods Study.

BACKGROUND: High-fidelity simulation (HFS) is an interactive and complex experiential learning pedagogy. Given the limited and inconclusive evidence on the effectiveness of HFS in terms of improving student learning outcomes, a more thorough understanding of students' learning experiences and effects of HFS may inform the improvement of nursing training. PURPOSE: The aim of this study was to examine the learning effectiveness score of HFS, its influencing factors, and the learning experience of nursing students. METHODS: A convergent parallel mixed-methods research design was adopted. Five hundred thirty-three third-year undergraduate nursing students completed the Simulation Learning Effectiveness Inventory. Semistructured interviews were used to elicit the opinions of 22 participants regarding their participation in the HFS experience. RESULTS: The quantitative findings showed a moderately high learning effectiveness of HFS among Chinese undergraduate nursing students (121.81 ± 14.93). The learning effectiveness for equipment resources (15.02 ± 2.38), course arrangement (11.18 ± 1.73), and confidence (18.56 ± 3.67) was relatively low. Extroversion and mixed personality (ß = 0.14 and 0.10) and "dislike" or "general like" of the course (ß = -0.45 and -0.33) were found to influence learning effectiveness (F = 54.79, p < .001, adjusted R2 = .29). In addition, the qualitative findings indicated that the participants felt positively regarding the "debriefing," "clinical abilities," and "problem solving" dimensions of the training. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The focus of the education process and curriculum design of HFS activities should be on improving course arrangement, equipment resources, and students' confidence while paying attention to nursing students' personality traits and course preferences.

A predictive model of student nursing competency in clinical practicum: A structural equation modelling approach.

BACKGROUND: Clinical teaching is the most important element in the development of students' nursing competencies. However, students' learning modalities in clinical settings are unclear. OBJECTIVE: To analyse path relationships affecting students' learning outcomes in clinical practicum using LISREL software. DESIGN: A cross-sectional survey was administered. SETTINGS AND PARTICIPANTS: Participants were 392 senior students who had completed their final internship recruited from two nursing programmes in central Taiwan. METHODS: Administration and completion of the following structured questionnaires: the Competency Inventory of Nursing Students, the Teaching Competence of Nurse Preceptor questionnaire, the Student Evaluation of the Clinical Education Environment, Level of Reflective Thinking, and the Metacognitive Inventory for Nursing Students. RESULTS: The results suggested that teaching competence may indirectly affect nursing competence through metacognition and reflection. The clinical learning environment may directly affect nursing competence or indirectly affect nursing competence through metacognition. Both metacognition and reflection have direct effects on nursing competence, and reflection exerts indirect effects on nursing competence through metacognition. The path relationships differed according to the employment plan group. CONCLUSIONS: Reflection and metacognition are essential skills for the development of nursing competence in clinical settings. Clinical instructors must facilitate student learning by fostering a positive learning environment and teach students the reflective and self-regulation skills necessary to achieve favourable learning outcomes in clinical settings.

Learning outcomes of a flipped classroom teaching approach in an adult-health nursing course: a quasi-experimental study.

BACKGROUND: New teaching strategies must be developed not only to enhance nurse's competence but also to allow nurses to respond to the complex health care needs of today's society. The purpose of this study was to explore the learning outcomes of a flipped classroom teaching approach in an adult-health nursing course for students in a two-year Bachelor of Science in Nursing program. METHODS: The study had a quasi-experimental design. An 18-week flipped classroom teaching approach was applied in an adult-health nursing course. In total, 485 nursing students enrolled in the study, with 287 in the experimental group and 198 in the control group. The Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students, Self-Directed Learning Readiness Scale, and self-designed learning satisfaction questionnaire were used to evaluate the students' learning outcomes. RESULTS: The experimental group showed a statistically significant increase in the overall scores for self-evaluated core competencies, the "self-modification" subscale of the Metacognitive Inventory for Nursing Students, and in overall self-directed learning readiness; further, they also showed high levels of course satisfaction. CONCLUSIONS: A flipped classroom teaching approach had a positive impact on student's learning motivation and contributed to better learning outcomes in an adult-health nursing course. The flipped classroom combined with hybrid teaching methods is a suitable and effective learning strategy for a registered nurse (RN) to Bachelor of Science in Nursing (BSN) program to tackle today's complex revolution in nursing curricula, and may enhance nursing students' abilities to address numerous challenges.

Psychometric Testing of the Chinese Simple Version of the Simulation Learning Effectiveness Inventory: Classical Theory Test and Item Response Theory.

BACKGROUND: High-fidelity simulation (HFS) has become a widely used and established pedagogy for teaching clinical nursing skills. Nevertheless, there are few evidence-based instruments that validate the effectiveness of simulation learning in mainland China. METHODS: The Simulation Learning Effectiveness Inventory (SLEI) was adapted and validated for use in this study. Psychometric evaluation, incorporating classical test theory and item response theory (IRT) methods, was performed with 533 third-year undergraduate nursing students who were recruited from May 2017 to July 2018. RESULTS: The findings of exploratory and confirmatory factor analyses revealed that the simplified Chinese version of the SLEI (SLEI-SC) was composed of six factors, namely, course arrangement, equipment resource, debriefing, clinical ability, problem solving, and confidence, which explained 60.84% of the total variance. The Cronbach's α, MIIC, marginal reliability, and test-retest reliability values obtained for the total scale were 0.88, 0.38, 0.96, and 0.88, respectively. Furthermore, the difference between the total scores for learning effectiveness pre- and post-course was statistically significant (t = 2.59, p < 0.05, Cohen's d = 0.60). IRT analysis showed that the SLEI-SC discriminates well between students with high and low levels of learning effectiveness and offers information about a broad range of learning effectiveness measures. The relationship between final course grade and total score on the SLEI-SC was statistically significant (r = 0.63, p < 0.05). CONCLUSION: We demonstrated initial psychometric evidence and support for the 31-item SLEI-SC as a developmentally appropriate instrument for assessing the learning effectiveness of all phases of HFS use with nursing students.

Modeling the antecedents of clinical examination performance: Task characteristics and psychological state in nursing students.

BACKGROUND: Objective structured clinical examinations can be used to understand students' care skill performance and to evaluate courses. Thus, identifying antecedents to improved skill performance in these examinations is crucial for improving students' future care ability. OBJECTIVES: This study examined the antecedents of clinical skill performance in nursing students and determined whether perceived task load and anxiety mediate the relationships between task characteristics and skill performance. METHODS: A quantitative approach was conducted. The questionnaire for this study was comprised of five measures: Simulation Learning Effectiveness Scale, Task Characteristic Subscale, Task Cognitive Loading Scale, State-Trait Anxiety Inventory, and a clinical practice examination. FINDING: Structural equation modeling revealed that students' simulation learning effectiveness was positively associated with three task characteristics (task autonomy; task variety, identity, and significance; and task feedback) during clinical examinations. Further, the effect of learning effectiveness on task feedback was greater than on task autonomy, variety, identity, and significance. In addition, task load mediated the relationship between task variety, identity, and significance and clinical examination performance, whereas anxiety mediated the relationships between all three task characteristics and clinical examination performance. CONCLUSION: Promoting nursing students' simulation learning effectiveness is crucial for improving feedback in regard to the task. Further, those who perceived the task as having more variety, identity, and significance were more likely to perceive the task as having a higher cognitive load and to experience anxiety, which, in turn, led to poorer performance. Interventions should, therefore, managers' aim to reduce students' perceived load and anxiety before they participate in clinical skill examinations.

Critical Thinking Disposition of Nurse Practitioners in Taiwan.

BACKGROUND: Critical thinking disposition (CTD) is crucial for nurse practitioners who face complex patient care scenarios. This study explored the CTD of nurse practitioners and related factors. METHOD: The study was a cross-sectional descriptive design. A purposive sample was recruited from a medical center and its hospital branches in central Taiwan. A structured questionnaire was used to collect data from 210 nurse practitioners. RESULTS: The participants obtained the highest average score on systematicity and analyticity. CTD had a significant positive correlation with fundamental knowledge readiness, professional knowledge readiness, and confidence in making clinical decisions. Professional knowledge readiness, education level, and on-the-job training predicted the score of the participants on overall CTD. CONCLUSION: On-the-job training and education level may influence the CTD of nurse practitioners. Providing formal or on-the-job continuing education training to nurse practitioners may help enhance their CTD. J Contin Educ Nurs. 2017;48(9):425-430.

An exploration of the correlates of nurse practitioners' clinical decision-making abilities.

AIMS AND OBJECTIVES: This study investigated nurse practitioners' clinical decision-making abilities and the factors that affect these abilities. BACKGROUND: Nurse practitioners play an important role in clinical care decision-making; however, studies exploring the factors that affect their decision-making abilities are lacking. DESIGN: A cross-sectional descriptive survey was employed. METHODS: A purposive sample of 197 nurse practitioners was recruited from a medical centre in central Taiwan. Structured questionnaires consisting of the Knowledge Readiness Scale, the Critical Thinking Disposition Inventory and the Clinical Decision-Making Model Inventory were used to collect data. RESULTS: The intuitive-analytical type was the most commonly used decision-making model, and the intuitive type was the least frequently used model. The decision-making model used was significantly related to the nurse practitioners' work unit. Significant differences were noted between the nurse practitioners' clinical decision-making models and their critical thinking dispositions (openness and empathy). The nurse practitioners' years of work experience, work unit, professional knowledge and critical thinking disposition (openness and empathy as well as holistic and reflective dispositions) predicted the nurse practitioners' analytical decision-making scores. Age, years of nurse practitioner work experience, work unit and critical thinking disposition (holistic and reflective) predicted the nurse practitioners' intuitive decision-making scores. CONCLUSIONS: This study contributes to the topic of clinical decision-making by describing various types of nurse practitioner decision-making. The factors associated with analytic and intuitive decision-making scores were identified. These findings might be beneficial when planning continuing education programmes to enhance the clinical decision-making abilities of nurse practitioners. RELEVANCE TO CLINICAL PRACTICE: The study results showed that nurse practitioners demonstrated various clinical decision-making types across different work units. Consideration of nurse practitioners' knowledge readiness and their specific needs while planning on-duty education programmes is necessary.

Effects of Massage on Blood Pressure in Patients With Hypertension and Prehypertension: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Massage may help reduce blood pressure; previous studies on the effect of massage on blood pressure have presented conflicting findings. In addition, no systematic review is available. OBJECTIVE: The aim of this study was to evaluate the evidence concerning the effect of massage on blood pressure in patients with hypertension or prehypertension. METHODS: A search was performed on electronic database records up to October 31, 2013, based on the following medical subject headings or keywords: hypertension, massage, chiropractic, manipulation, and blood pressure. The methodological quality of randomized controlled trials was assessed based on the Cochrane collaboration tool. A meta-analysis was performed to evaluate the effect of massage on hypertension. The study selection, data extraction, and validation were performed independently by 2 reviewers. RESULTS: Nine randomized controlled trials met our inclusion criteria. The results of this study show that massage contributes to significantly enhanced reduction in both systolic blood pressure (SBP) (mean difference, -7.39 mm Hg) and diastolic blood pressure (DBP) (mean difference, -5.04 mm Hg) as compared with control treatments in patients with hypertension and prehypertension. The effect size (Hedges g) for SBP and DBP was -0.728 (95% confidence interval, -1.182 to -0.274; P = .002) and -0.334 (95% confidence interval, -0.560 to -0.107; P = .004), respectively. CONCLUSION: This systematic review found a medium effect of massage on SBP and a small effect on DBP in patients with hypertension or prehypertension. High-quality randomized controlled trials are urgently required to confirm these results, although the findings of this study can be used to guide future research.

Development and validation of the Simulation Learning Effectiveness Inventory.

AIM: To develop and psychometrically test the Simulation Learning Effectiveness Inventory. BACKGROUND: High-fidelity simulation helps students develop clinical skills and competencies. Yet, reliable instruments measuring learning outcomes are scant. DESIGN: A descriptive cross-sectional survey was used to validate psychometric properties of the instrument measuring students' perception of stimulation learning effectiveness. METHODS: A purposive sample of 505 nursing students who had taken simulation courses was recruited from a department of nursing of a university in central Taiwan from January 2010-June 2010. The study was conducted in two phases. In Phase I, question items were developed based on the literature review and the preliminary psychometric properties of the inventory were evaluated using exploratory factor analysis. Phase II was conducted to evaluate the reliability and validity of the finalized inventory using confirmatory factor analysis. RESULTS: The results of exploratory and confirmatory factor analyses revealed the instrument was composed of seven factors, named course arrangement, equipment resource, debriefing, clinical ability, problem-solving, confidence and collaboration. A further second-order analysis showed comparable fits between a three second-order factor (preparation, process and outcome) and the seven first-order factor models. Internal consistency was supported by adequate Cronbach's alphas and composite reliability. Convergent and discriminant validities were also supported by confirmatory factor analysis. CONCLUSION: The study provides evidence that the Simulation Learning Effectiveness Inventory is reliable and valid for measuring student perception of learning effectiveness. The instrument is helpful in building the evidence-based knowledge of the effect of simulation teaching on students' learning outcomes.

Factors associated with gender differences in medication adherence: a longitudinal study.

AIMS: To examine gender differences in the medication adherence of patients with hypertension by applying a longitudinal follow-up. BACKGROUND: Patient views of illness affect their adherence to therapeutic regimens. However, few studies have explored these issues by using a longitudinal design or from a gender perspective. DESIGN: This study used a longitudinal, correlational design. METHODS: A purposive sampling of 118 patients were recruited from cardiovascular clinics of a teaching hospital in Central Taiwan in 2007-2009. Data were collected using the Chinese Illness Perception Questionnaire-Revised and the Medication Adherence Inventory at three time points: at the first clinic visit, 6 and 12 months after the initial survey. Generalized estimating equations were calculated using the STATA software for data analysis. RESULTS: The findings revealed that male patients adhere more effectively to medications than female patients do. The interaction between systolic blood pressure and gender emerged as a significant predictor of adherence. Factors associated with adherence in male patients included less causal attribution to culture, more attribution to risk factors, fewer symptoms and uncertain symptoms related to high blood pressure, lower scores for timeline-cyclical and higher scores for illness consequences and coherence. Medication adherence for female patients was significantly related to more causal attribution to balance and risk factors, less personal control and enhanced illness coherence. CONCLUSION: Factors associated with adherence to antihypertensive medication were relatively gender-specific. Awareness of the differences is crucial for health professionals to provide appropriate advice for patients to cope effectively with their health threat.

Systematic review of clinical practice guidelines in the diagnosis and management of thyroid nodules and cancer.

BACKGROUND: Given the uncertainties regarding thyroid nodule assessment and management, physicians require systematically and transparently developed recommendations. This systematic review assesses the quality and consistency of the recommendations of international clinical practice guidelines (CPGs) for the diagnosis and management of thyroid nodules and cancer to assist physicians in making appropriate recommendations. METHODS: The CPGs on the management of thyroid nodules and cancer published before June 2013 were retrieved. All the reviewed guidelines were in English. Four reviewers independently assessed the rigor of guideline development by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument, and their reported evidence was evaluated. RESULTS: Ten eligible guidelines were included: nine had been developed by professional organizations, and the remaining guideline was endorsed by an independent regional body. Three guidelines achieved a score of greater than 50% in all six AGREE-II domains. Guidelines scored highest on the measurement of 'scope and purpose' (≥61.1% for eight CPGs) and lowest on the measurement of 'applicability' (≤38.5% for five CPGs). The overall quality ranged from 3.0 to 6.25 on a seven-point scale on the AGREE-II tool. Most CPG recommendations on the management of thyroid cancer were relatively consistent. Guidelines varied regarding the indication of fine-needle aspiration for thyroid nodules, as well as in their suggestions for postoperative radioiodine ablation. CONCLUSIONS: Our analysis showed that the current CPGs varied in methodological quality. More effort is needed to improve the quality of recommendations on the diagnosis and management of thyroid nodules and cancer.

[The development and current status of high-fidelity patient simulation teaching].

High-fidelity patient simulation teaching represents one of the most important innovations in healthcare education in the past two decades. In Taiwan, many medical centers and medical colleges now have clinical skill centers equipped with a high-fidelity patient simulator. Practicing clinical scenarios in this simulated environment can help strengthen students' professional essentials and competencies outside of classroom and clinical teaching settings. High-fidelity simulation teaching is an integrated teaching strategy that is continuing to receive greater attention. This article describes the historical development of high-fidelity patient simulation teaching, its current status, and applications in nursing education as a reference for nursing educators.

Using standardized patient with immediate feedback and group discussion to teach interpersonal and communication skills to advanced practice nursing students.

BACKGROUND: Interpersonal and communication skills (IPCS) are essential for advanced practice nursing (APN) in our increasingly complex healthcare system. The Standardized Patient (SP) is a promising innovative pedagogy in medical and healthcare education; however, its effectiveness for teaching IPCS to graduate nursing students remains unclear. OBJECTIVES: We examined the effectiveness of using SP with SP feedback and group discussion to teach IPCS in graduate nursing education. DESIGN: Randomized-controlled study. PARTICIPANTS: First-year APN students in Taiwan. METHODS: Participants were randomly assigned to the experimental (SP assessments with SP feedback and group discussion) or control (SP assessments only) group. There were two outcome indicators: IPCS and student learning satisfaction (SLS). The IPCS were assessed before and after the study in interviews with the SPs. SLS was measured when the study ended. RESULTS: All participants expressed high SLS (94.44%) and showed significant (p ≤ 0.025) improvements on IPCS total scores, interviewing, and counseling. However, there were no significant differences between groups. Qualitative feedback from encounters with SPs is described. CONCLUSIONS: Using SPs to teach IPCS to APN students produced a high SLS. The students learned and significantly improved their IPCS by interviewing SPs, but future studies are needed to confirm the effectiveness of SP feedback and group discussions.

The longitudinal effect of concept map teaching on critical thinking of nursing students.

Concept map is a useful cognitive tool for enhancing a student's critical thinking by encouraging students to process information deeply for understanding. However, there is limited understanding of longitudinal effects of concept map teaching on students' critical thinking. The purpose of the study was to investigate the growth and the other factors influencing the development of critical thinking in response to concept map as an interventional strategy for nursing students in a two-year registered nurse baccalaureate program. The study was a quasi-experimental and longitudinal follow-up design. A convenience sample was drawn from a university in central Taiwan. Data were collected at different time points at the beginning of each semester using structured questionnaires including Critical Thinking Scale and Approaches to Learning and Studying. The intervention of concept map teaching was given at the second semester in the Medical-Surgical Nursing course. The results of the findings revealed student started with a mean critical thinking score of 41.32 and decreased at a rate of 0.42 over time, although not significant. After controlling for individual characteristics, the final model revealed that the experimental group gained a higher critical thinking score across time than the control group. The best predictive variables of initial status in critical thinking were without clinical experience and a higher pre-test score. The growth in critical thinking was predicted best by a lower pre-test score, and lower scores on surface approach and organized study. Our study suggested that concept map is a useful teaching strategy to enhance student critical thinking.

[Symptom experience, causal attribution and adherence to therapeutic regimens: patients with hypertension].

Symptoms are the most important factor leading patients to seek medical help from health professionals. However, symptoms not directly supported by physiological and pathological evidence are often classified as being of emotional or psychological origin. Symptoms reflect an individual's subjective experience of physical-psycho-social functions, perception or cognition. Prior to implementing symptom management strategies, nurses should clarify patient symptom experiences and the meaning of such to patients. Individuals naturally seek symptoms based on physician diagnoses. When experiencing uncomfortable physical symptoms, individuals seek to label symptoms and accept medical advice based on their personal illness perception. In light of such, non-adherence to treatment recommendations may reflect inconsistencies between medical advice and patient symptom or illness diagnosis perception. In this paper, the author addresses relationships among symptom experience, symptom/illness attributions and therapeutic regimen adherence. Results identify the significant role that symptom experience plays in adherence to therapeutic regimens in patients with hypertension and suggests recommended revisions to clinical education in order to reflect such.

Effects of concept map teaching on students' critical thinking and approach to learning and studying.

The purpose of this study was to explore the effects of concept mapping in developing critical thinking ability and approach to learning and studying. A quasi-experimental study design with a purposive sample was drawn from a group of nursing students enrolled in a medical-surgical nursing course in central Taiwan. Students in the experimental group were taught to use concept mapping in their learning. Students in the control group were taught by means of traditional lectures. After the intervention, the experimental group had better overall critical thinking scores than did the control group, although the difference was not statistically significant. After controlling for the effects of age and the pretest score on critical thinking using analysis of covariance, the experimental group had significantly higher adjusted mean scores on inference and overall critical thinking compared with the control group. Concept mapping is an effective tool for improving students' ability to think critically.