The meaning and application of student-centered learning in nursing education: An integrative review of the literature.

AIM: The aim of this study was to review empirical articles to explore the meaning and the application of student-centered learning in nursing education. BACKGROUND: Teachers in higher education are encouraged to adopt student-centered learning principles, but research shows that many still apply teacher-centered methods. There is therefore a need to clarify the meaning of student-centered learning, including how it is performed and the reasons to apply it in nursing education. DESIGN: This study employed an integrative review method, following Whittemore and Knafl's framework. METHODS: The databases CINAHL, Education Database and Education Research Complete were searched for related literature published from 2010 to 2020. The initial search located 308 articles. After screening and checking for eligibility, 25 articles were critically appraised. Data were extracted from the articles and displayed in matrices to be categorized and compared. RESULTS: Three themes with attendant sub-themes emerged through the analysis: foundation, using core concepts to define and explain student-centered learning, eligibility, enhancing student knowledge, developing student abilities and supporting student self-reliance and realization, learning in interaction with peers, learning individually and learning in interaction with the teacher. CONCLUSION: Student-centered learning in nursing education is an approach where the teacher is a facilitator of student learning and students are empowered to take control of their own studies. Students study together in groups; they are listened to by the teacher and their needs are taken into consideration. The main reasons to apply student-centered learning are to enhance students' theoretical and practical learning; to improve their generic competencies, such as problem-solving and critical-thinking abilities; and to strengthen students' self-reliance.

Antibiotic use in children under 5 years of age in Northern Tanzania: a qualitative study exploring the experiences of the caring mothers.

BACKGROUND: Antimicrobial resistance is a serious threat to the global achievements in child health thus far. Previous studies have found high use of antibiotics in children in Northern Tanzania, but the experiences of the primary care-givers, who play a key role in accessing and administering antibiotics for the sick child, have remained largely unknown. Therefore, the aim of this study was to understand mothers' conceptions of antibiotic use in their children, which is of importance when forming strategies to improve antibiotic use in the community. METHOD: A qualitative study including eight focus group discussions with mothers of under-five children in Moshi urban and rural districts, Northern Tanzania, was performed during 2019. The discussions were recorded, transcribed verbatim, translated into English and analysed according to the phenomenographic approach. FINDINGS: Three conceptual themes emerged during analysis; (1) conceptions of disease and antibiotics, (2) accessing treatment and (3) administering antibiotics. Antibiotics were often perceived as a universal treatment for common symptoms or diseases in children with few side-effects. Although mothers preferred to attend a healthcare facility, unforeseen costs, long waits and lack of financial support from their husbands, posed barriers for healthcare seeking. However, pharmacies were perceived as a cheap and convenient option to access previously used or prescribed antibiotics. Some mothers sought advice from a trusted neighbour regarding when to seek healthcare, thus resembling the function of the community health worker. CONCLUSIONS: To improve antibiotic use in children under 5 years of age in Northern Tanzania, the precarious situation that women often find themselves in as they access treatment for their sick children needs to be taken into consideration. It is necessary to improve structures, including the healthcare system, socioeconomic inequalities and promoting gender equality both in the household and in the public arena to reduce misuse of antibiotics. Meanwhile, equipping community health workers to support Tanzanian women in appropriate healthcare seeking for their children, may be a feasible target for intervention.

Framing healthcare professionals in written adverse events: A discourse analysis.

Healthcare professionals have a major responsibility to protect patients from harm. Despite vast efforts to decrease the number of adverse events, the progression of patient safety has internationally been acknowledged as slow. From a social construction perspective, it has been argued that the understanding of patient safety is contextual based on historical and structural rules, and that this meaning construction points out different directions of possible patient safety actions. By focusing on fact construction and its productive and limiting effect on how something can be understood, we explored the discourses about healthcare professionals in 29 written reports of adverse events as reported by patients, relatives, and healthcare professionals. Through the analysis, a discourse about the healthcare professionals as experts was found. The expert role most dominantly included an understanding that adverse events were identified through physical signs and that patient safety could be prevented by more strictly following routines and work procedures. We drew upon the conclusion that these regimes of truth brought power to the expert discourse, to the point that it became difficult for patients and relatives to engage in patient safety actions on their terms.

Visual arts and drawings to communicate and explore authentic life situations, a data collection method in caring science - a hermeneutic perspective.

This methodological article aims to describe three methodological strategies for using drawings as a part of qualitative data collection methods in caring research based on hermeneutics. In some research interview situations, participants may have difficulties to express their experiences and feelings in words. The consequences may be that the descriptions in research reports will become superficial and not authentic, meaning, "telling it as it is". Drawn pictures may facilitate and support reflection related to the deepening of experiences and thoughts, and communicate and express more than words can do. It may also reveal thoughts and feelings the person drawing the picture was not aware of. Three methodological strategies are described: (1) Drawing a picture as an introduction or starting point for an interview, (2) During an ongoing interview, encouraging the participant to draw a picture when further explanation or description is needed for deepening the communication and (3) Drawing something in a pre-existing picture. The theoretical foundation of Gadamer's hermeneutic philosophy is discussed in relation to what a drawing is representing and presents. The interpretation of the drawn picture depends primarily on the creator of the picture, but at the same time the interpretation and understanding is a movement between the interviewer's and the participant's horizons, and thus is open for preunderstanding and new understanding. In contrast to an ordinary interview between two parties, an interview involving a drawing adds something specific to the conversation as it becomes a "trialogue" and not only a dialog. The drawn picture stands on its own. Using the participant's drawing can, therefore, be understood as an ongoing process with three parties involved: (1) the participant, (2) the researcher and (3) the drawing.

Managing conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play.

AIM: To describe and illuminate conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play. BACKGROUND: Conflicts are common in healthcare settings and affect patient care and the wellbeing of nurses. To be able to manage complex practice situations, conflict management is an essential competence for nurses and should be highlighted during education. The aim of the study was to describe and illuminate conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play. DESIGN: The study was designed as a summative qualitative analysis of written group assignments related to nursing students' participation in a drama workshop. METHOD: A summative qualitative content analysis of written group assignments related to nursing students' participation in a drama workshop, focusing on conflict management. During the workshop the students explored conflict situations they had encountered during clinical practice, through Forum Play. After the workshop, the students handed in a mandatory written group assignment where they described one of the conflict situations. RESULTS: The findings are presented in three categories; Parties; Arenas; Situations, one main theme; "Who knows best" and two subthemes; Difficulties to adapt to the new and Difficulties reaching a mutual understanding. CONCLUSION: Conflict situations that nursing students encounter during their clinical practice often stem from the health care staff's difficulties in adapting to the new and difficulty reaching a mutual understanding. Conflict management can be implemented as a powerful learning strategy in nursing education.

Learning Outcome After Different Combinations of Seven Learning Activities in Basic Life Support on Laypersons in Workplaces: a Cluster Randomised, Controlled Trial.

BACKGROUND: The goal for laypersons after training in basic life support (BLS) is to act effectively in an out-of-hospital cardiac arrest situation. However, it is still unclear whether BLS training targeting laypersons at workplaces is optimal or whether other effective learning activities are possible. AIM: The primary aim was to evaluate whether there were other modes of BLS training that improved learning outcome as compared with a control group, i.e. standard BLS training, six months after training, and secondarily directly after training. METHODS: In this multi-arm trial, lay participants (n = 2623) from workplaces were cluster randomised into 16 different BLS interventions, of which one, instructor-led and film-based BLS training, was classified as control and standard, with which the other 15 were compared. The learning outcome was the total score for practical skills in BLS calculated using the modified Cardiff Test. RESULTS: Four different training modes showed a significantly higher total score compared with standard (mean difference 2.3-2.9). The highest score was for the BLS intervention including a preparatory web-based education, instructor-led training, film-based instructions, reflective questions and a chest compression feedback device (95% CI for difference 0.9-5.0), 6 months after training. CONCLUSION: BLS training adding several different combinations of a preparatory web-based education, reflective questions and chest compression feedback to instructor-led training and film-based instructions obtained higher modified Cardiff Test total scores 6 months after training compared with standard BLS training alone. The differences were small in magnitude and the clinical relevance of our findings needs to be further explored. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03618888. Registered August 07, 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03618888. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-020-01160-3.

Characteristics and outcome after out-of-hospital cardiac arrest with the emphasis on workplaces: an observational study from the Swedish Registry of Cardiopulmonary Resuscitation.

BACKGROUND: Characteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied. AIM: To describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces. METHODS: Data on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs. RESULTS: Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92-12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07-4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16-0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location. CONCLUSION: Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.

Tanzanian primary healthcare workers' experiences of antibiotic prescription and understanding of antibiotic resistance in common childhood infections: a qualitative phenomenographic study.

BACKGROUND: Antibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers' experiences of antibiotic prescription for children under 5 years of age and their conceptions of antibiotic resistance in Northern Tanzania. METHODS: A qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach. FINDINGS: Four conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics. CONCLUSIONS: To increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship.

Professional Competence Among Registered Nurses Working in Hospitals in Saudi Arabia and Their Experiences of Quality of Nursing Care and Patient Safety.

INTRODUCTION: The Kingdom of Saudi Arabia (KSA) plans to become self-sufficient, generating a national nursing workforce. The study's purpose was to assess nurses' self-reported professional competence and illuminate experiences of the quality of nursing care and patient safety. METHODOLOGY: A cross-sectional design with 469 nurses working in different units from two public hospitals and Regions of the KSA participated. The Nurse Professional Competence Scale short version including six professional areas of nursing care was used. RESULTS: There are significant relationships between self-reported professional competence and the quality of nursing care, patient safety, nurse's characteristics, and workplace. DISCUSSION: Registered nurses' professional competence is related to the clinical areas in which they work and the nature of their involvement in patient care. The Nurse Professional Competence Scale can identify professional competence areas for further development, which is important for culturally congruent health care in KSA for their transformation process.

Assessing Self-Reported Competence Among Registered Nurses Working as a Culturally Diverse Work Force in Public Hospitals in the Kingdom of Saudi Arabia.

Introduction: Nurses in the Kingdom of Saudi Arabia (KSA) represent a multicultural workforce who are educated in different countries from around the world. The purpose was to assess professional competence among a multicultural workforce of registered nurses in KSA in relation to individual and work-related factors. Method: The Nurse Professional Competence Scale was used in a cross-sectional design. Results: Registered nurses (N = 541) reported highest scores for "nursing care," and "value-based nursing care," and lowest scores for "care pedagogics," and "development, leadership, and organization of nursing care." All CAs achieved 0.80 or more Cronbach's alpha. Known-group validity was verified by comparing nurse managers and staff nurses competence in organization, administration, and leadership of nursing care (p = .000). Discussion: There is room for competence development in care pedagogics, and development, leadership, and organization of nursing care. Assessing registered nurses competence is of importance for planning and implementing cultural congruent nursing care.

Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students.

AIMS: To identify clusters based on graduating nursing students' self-reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students' perceptions of overall quality of the nursing programme, and students' general self-efficacy (GSE). DESIGN: A cross-sectional study combining survey data and results from a national examination. METHODS: Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the GSE scale, and results from the National Clinical Final Examination. A two-step cluster analysis was used to identify competence profiles, followed by comparative analyses between clusters. RESULTS: Three clusters were identified illustrating students' different competence profiles. Students in Clusters 1 and 2 passed the examination, but differed in their self-assessments of competence, rating themselves under and above the overall median value, respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher. CONCLUSION: The study illustrates how nursing students' self-assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self-evaluation is a key learning outcome and is, in the long run, essential to patient safety. IMPACT: The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their GSE lower than other students. The findings illuminate the need for student-centred strategies in nursing education, including elements of self-assessment in relation to examination to make the students more aware of their clinical competence.

Supplementary dataset to self-learning training compared with instructor-led training in basic life support.

In this article, we present supplementary data to the article entitled "Self-learning training versus instructor-led training in basic life support: a cluster randomised trial" [1]. In three supplementary files, we present the informed consent of the included participants, the modified instrument to calculate the total score for practical skills called "the Cardiff Test of basic life support and automated external defibrillation" and the questionnaire to obtain background factors, theoretical knowledge, self-assessed knowledge and confidence and willingness to act, distributed directly after training and six months after training. The results of comparisons between "directly after intervention" and "six months after intervention", for each training group separately, are presented in three tables. We also present two tables showing the reasons why the participants were not prepared to perform compressions and/or ventilations in the event of a sudden out-of-hospital cardiac arrest.

Effectiveness of web-based education in addition to basic life support learning activities: A cluster randomised controlled trial.

BACKGROUND: Effective education in basic life support (BLS) may improve the early initiation of high-quality cardiopulmonary resuscitation and automated external defibrillation (CPR-AED). AIM: To compare the learning outcome in terms of practical skills and knowledge of BLS after participating in learning activities related to BLS, with and without web-based education in cardiovascular diseases (CVD). METHODS: Laymen (n = 2,623) were cluster randomised to either BLS education or to web-based education in CVD before BLS training. The participants were assessed by a questionnaire for theoretical knowledge and then by a simulated scenario for practical skills. The total score for practical skills in BLS six months after training was the primary outcome. The total score for practical skills directly after training, separate variables and self-assessed knowledge, confidence and willingness, directly and six months after training, were the secondary outcomes. RESULTS: BLS with web-based education was more effective than BLS without web-based education and obtained a statistically significant higher total score for practical skills at six months (mean 58.8, SD 5.0 vs mean 58.0, SD 5.0; p = 0.03) and directly after training (mean 59.6, SD 4.8 vs mean 58.7, SD 4.9; p = 0.004). CONCLUSION: A web-based education in CVD in addition to BLS training enhanced the learning outcome with a statistically significant higher total score for performed practical skills in BLS as compared to BLS training alone. However, in terms of the outcomes, the differences were minor, and the clinical relevance of our findings has a limited practical impact.

Written reports of adverse events in acute care-A discourse analysis.

Adverse health care events are a global public health issue despite major efforts, and they have been acknowledged as a complex concern. The aim of this study was to explore the construction of unsafe care using accounts of adverse events concerning the patient, as reported by patients, relatives, and health care professionals. Twenty-nine adverse events reported in an acute care setting in a Swedish university hospital were analyzed through discourse analysis, where the construction of what was considered to be real and true in the descriptions of unsafe care was analyzed. In the written reports about unsafe events, the patient was spoken of in three different ways: (a) the patient as a presentation of physical signs, (b) the patient as suffering and vulnerable, and (c) the patient as unpredictable. When the patient's voice was subordinate to physical signs, this was described as being something that conflicted with patient safety. The conclusion was that the patient's voice might be the only sign available in the early stages of adverse events. Therefore, it is crucial for health care professionals to give importance to the patient's voice to prevent patients from harm and not unilaterally act only upon abnormal physical signs.

Self-learning training versus instructor-led training for basic life support: A cluster randomised trial.

AIM: To compare the effectiveness of two basic life support (BLS) training interventions. METHODS: This experimental trial enrolled 1301 lay people in BLS training. The participants were cluster randomised to either self-learning training or to traditional instructor-led training. Both groups used the Mini-Anne Kit (Laerdal Medical, Stavanger, Norway) and standardised film instructions. After training, the participants practical skills were measured on a Resusci Anne manikin and an AED trainer with the PC SkillReporting system (Laerdal Medical, Stavanger, Norway). The primary outcome was the total score from the modified Cardiff Test of basic life support with automated external defibrillation (19-70 points), six months after training. The secondary outcomes were total score directly after training and quality of individual variables, self-assessed knowledge, confidence and willingness to act, directly and six months after training. RESULTS: For primary outcome six months after training there was no statistically significant difference (p = 0.44) between the total score for the self-learning group (n = 670; median 59, IQR 55-62) compared with the instructor-led group (n = 561; median 59, IQR 55-63). The instructor-led training resulted in a statistically significant higher total score (median 61 versus 59, p < 0.0001), self-assessed knowledge and willingness to act, directly after training (secondary outcomes) compared with the self-learning training. CONCLUSIONS: There was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.

Learning About Conflict and Conflict Management Through Drama in Nursing Education.

BACKGROUND: In the health care settings in which nurses work, involvement in some form of conflict is inevitable. The ability to manage conflicts is therefore necessary for nursing students to learn during their education. METHOD: A qualitative analysis of 43 written group assignments was undertaken using a content analysis approach. RESULTS: Three main categories emerged in the analysis-to approach and integrate with the theoretical content, to step back and get an overview, and to concretize and practice-together with the overall theme, to learn by oscillating between closeness and distance. CONCLUSION: Learning about conflict and conflict management through drama enables nursing students to form new knowledge by oscillating between closeness and distance, to engage in both the fictional world and the real world at the same time. This helps students to form a personal understanding of theoretical concepts and a readiness about how to manage future conflicts. [J Nurs Educ. 2018;57(4):209-216.].

Nursing students experiences of learning about nursing through drama.

The ability to understand, interact and create a caring relationship with the patient is a core component in nursing. A shift in nursing education from traditional classroom teaching towards more experiential approaches should be encouraged as this will support learning that links theory with practice. The aim of this study was to describe nursing students' experiences of learning about nursing through drama. This qualitative study was conducted at a university in Sweden. Four focus group interviews were conducted with a total of 16 nursing students and the data was analyzed using a phenomenographic approach. Three themes with their attendant categories emerged through the analysis: "To explore the future professional self", "To develop an understanding of the patient perspective", and "To reflect on the nature of learning". In conclusion this study shows that the use of drama in nursing education can provide opportunities to explore interactions with others which can increase students' self-awareness and ability to reflect on their future professional identity. Acting in role as a patient can provide an opportunity to experience the patient perspective. Also clear was the importance of commitment and engagement of the students as a prerequisite for optimizing this form of learning experience through drama.

Disaster nursing: Self-reported competence of nursing students and registered nurses, with focus on their readiness to manage violence, serious events and disasters.

The World Health Organization and the International Council of Nurses recognises the importance of nurses' involvement in disaster preparedness and response. The aim of this study was to describe and compare self-reported disaster nursing competence (DNC) among nursing students (NSs) and among registered nurses (RNs) with professional experience. Further to investigate possible associations between self-reported DNC and background factors. A cross-sectional study was conducted of 569 NSs and 227 RNs. All respondents completed the 88-item Nurse Professional Competence Scale, including three items assessing DNC. Significant differences were found among the NSs depending on which University/University College they had attended. RNs reported significantly higher overall DNC and better ability to handle situations involving violence, and to apply principles of disaster medicine during serious events. RNs working in emergency care reported significantly better DNC ability, compared with RNs working in other areas of healthcare. Multiple linear regression analysis showed that working night shift and working in emergency care were positively associated with high self-reported overall DNC. The results indicate that workplace experience of serious events increase the readiness of registered nurses to handle violence, to act in accordance with safety regulations, and to apply principles of disaster medicine during serious events.

The Nurse Professional Competence (NPC) Scale: Self-reported competence among nursing students on the point of graduation.

BACKGROUND: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. OBJECTIVES: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. METHODS AND PARTICIPANTS: The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1 [20-56]years, 87.3% women) from 11 universities/university colleges participated. RESULTS: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (93.2% vs 87.5% of NSPGs). SUMMARY AND CONCLUSION: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.