The effectiveness of the fully online flipped classroom for nursing undergraduates during the COVID-19: Historical control study.

AIM: Evaluate the fully online flipped classroom's effects during the pandemic. DESIGN: A comparative descriptive study with historical control design. METHODS: In an internal medicine nursing course, the fully online flipped classroom instruction was used with 53 undergraduates in 2020. Their final examinations were compared with the 50 students taught with traditional offline methods in 2019. Online interactions and students' experiences were described. Pass rates in both classes were over 90% (Χ2 = 0.276, p = 0.60), but the median score in 2019 was higher than in 2020 (Z = -2.491, p = 0.01). There were 996 online interactions and 734 valid interactions in total. All 49 students believed the online flipped classroom schedule was reasonable and all but three said it was helpful. However, 19 students (39%) felt traditional teaching is more effective. CONCLUSIONS: The fully online flipped classroom method was fairly effective during the pandemic. This model also did increase class participation and sufficient faculty-student interactions in remote education. However, fewer students earned outstanding scores, with possible reasons including the online flipped classroom, lack of clinical practice, stress from COVID-19 and the shortened exam time. Overall, the method is worth recommending under public health emergencies like COVID-19, and future research exploring potential concerns about scores is necessary.

Influence of empathy and professional values on ethical decision-making of emergency nurses: A cross sectional study.

INTRODUCTION: Emergency nurses are likely to experience serious ethical dilemmas and conflicts because of the dangerous and unpredictable care situations. Nursing ethical decision-making ability is therefore a core competence. Empathy and professional values may be the important variables that influence ethical decision-making. However, for emergency nurses, there is a lack of empirical evidence to support presently. This study aimed to explore the influence of empathy and professional values on nursing ethical decision-making of emergency nurses. METHODS: A convenience sample of 236 emergency nurses from 10 general hospitals in China were surveyed. Their ethical decision-making ability, empathy and professional values were measured using the Judgment About Nursing Decision scale, Jefferson Scale of Empathy-Health Professionals, and Nursing Professional Values Scale-Revised, respectively. Additionally, their sociodemographic data were collected. Univariate analysis, Pearson analysis, and multiple linear regression were performed. RESULTS: The mean ethical decision-making score of emergency nurses was 295.06 ± 26.49, which was medium level. Their average ethical choice score was higher than that of ethical action (P < 0.001). The multiple linear regression results showed that professional values (Standardized coefficients (ß) = 0.295, 95% confidence interval (CI): 0.618-1.618), empathy (ß = 0.210, 95% CI: 0.620-1.613), job title (ß = 0.253, 95% CI: 0.357-2.800) and number of forms of in-service training on ethical decision-making (ß = 0.243, 95% CI: 0.254-3.942) were the independent factors significantly influencing the ethical decision-making ability. The multivariate linear regression model had an F statistic of 32.153 (P < 0.001) and an R2 = 0.588. CONCLUSIONS: Strengthening nurses' empathy and professional values can help nurses make ethical decisions. More clinical experience and in-service training on ethical decision-making can help emergency nurses better handle ethical dilemmas and conflicts.

History-taking level and its influencing factors among nursing undergraduates based on the virtual standardized patient testing results: Cross sectional study.

BACKGROUND: History-taking is an essential skill for nurses. In nursing education, it is necessary to objectively assess history-taking skills in a way that accurately reflects differences among students. Current history-taking evaluation methods lack objectivity, consistency and standardization, which makes it difficult to identify factors that influence history-taking skill. A virtual standardized patient (VSP) can provide history-taking practice with repeatability and consistency. It can make objective and standardized assessment possible by eliminating the subjectivity of different teachers and patients. PURPOSE: To evaluate the history-taking skills of nursing undergraduates using a VSP, and to explore its independent influencing factors. METHODS: A cross-sectional design was employed with a sample of convenience from 3 universities. All 174 nursing undergraduates had their history-taking level evaluated using one VSP via computer or mobile terminal. For each query raised by the students, the VSP could give a preset response. The responses were assigned corresponding scores according to their importance, with a total score of 100. The students' general demographics were documented, and their self-efficacy, critical thinking and communication skills were measured online with the Nursing History-taking Self-Efficacy Questionnaire, Yoon's Critical Thinking Disposition Instrument and the Supportive Communicative Scale. Univariate analysis, Pearson correlation analysis and multiple linear regression were performed. RESULTS: The mean total history-taking score was 58.53 ± 14.32. History-taking scores were well discriminated among the students tested, with 10% of the students scoring above 80, 37% between 60 and 80, 22% between 50 and 60 and 31% scored below 50. The history-taking level of the nursing students was significantly associated with ethnicity, previous academic performance, and Supportive Communicative Scale scores. CONCLUSIONS: Using the VSP as a history-taking assessment method is an effective way to achieve a relatively objective, standardized and consistent assessment of history-taking education. Ethnicity, previous academic performance and supportive communication skills independently influenced the students' history-taking level. Mature history-taking skills require not only solid theoretical knowledge but good communication skills.

The effects of using virtual patients on the history-taking ability of nursing interns: A non-randomized controlled study.

OBJECTIVES: The aim of this study was to examine the effects of the SYSU-NEP virtual patients (VPs) on the history-taking ability and self-efficacy of nursing interns. BACKGROUND: An easy to use, freely accessible and objective training software program on WeChat named Sun Yat-sen University Nursing Education Platform (SYSU-NEP) was developed to help nursing students improve their history-taking skills. DESIGN: This was a non-randomized controlled study. METHODS: A total of 90 nursing interns (44 in the intervention group and 46 in the control group), who practiced in internal medicine departments at a single teaching hospital, were recruited between July 2017 and December 2018. The data collected comprised demographic and academic data, Nursing History-taking Assessment Scale (NHTAS) and Academic Self-Efficacy Scale (ASES) scores. The chi-square test, t test and Wilcoxon test were used to test the differences in the variables between the two groups. The t test or Wilcoxon test was used to compare the differences between pre-intervention and post-intervention NHTAS and ASES scores in each group and to compare the changes (post-intervention - pre-intervention) in NHTAS and ASES scores between the control and intervention groups. RESULTS: Both the control and intervention groups had higher post-intervention NHTAS scores compared with their pre-intervention scores (control group: 83.50 VS 61.00, P < 0.001; intervention group: 106.00 VS 77.00, P < 0.001). However, the intervention group had a much greater improvement in the NHTAS score than the control group (29.00 VS 9.00, P < 0.001). There were no significant differences in the ASES score within groups (control group: 80.50 VS 80.00, P = 0.292; intervention group: 81.50 VS 79.00, P = 0.979) or between groups (2.00 VS 0.00, P = 0.430). The most frequently used VPs were associated with the respiratory, gastroenterology and cardiovascular systems, accounting for 70.4% among all VP cases. CONCLUSIONS: The SYSU-NEP VPs can improve the history-taking ability of nursing interns. They can provide autonomous, repeatable training opportunities for nursing interns and help them prepare well for real clinical encounters.