Development and effectiveness of online teaching on practical skills among nursing students: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this meta-analysis was to assess the effects of online education for practical skills among nursing students. METHODS: This research was done by searching PubMed, Embase, CINAHL, and Web of Science electronic databases from inception to August 18, 2023, to identify English-language articles. Data extraction, quality assessment, and literature screening were carried out independently by two researchers. The Cochrane risk of bias tool and the Methodological Items for Nonrandomized Studies (MINORS) tool were used to assess the risk of bias of the included studies. Meta-analysis was carried out using Review Manager (RevMan) version 5.3 software. RESULTS: Eighteen studies involving 2274 nursing students met the inclusion criteria. Nursing students' skills (SMD = 0.43, 95 % CI [0.33, 0.54], P<0.00001), knowledge (SMD = 0.16, 95 % CI (0.02, 0.30], P = 0.02), satisfaction (SMD = 0.29, 95 % CI (0.10, 0.47], P < 0.01), and confidence (SMD = 0.56, 95 % CI [0.29, 0.83], P < 0.0001) were all significantly improved by the online teaching intervention compared with traditional face-to-face instruction. Self-efficacy (SMD = 0.1, 95 % CI [-0.13, 0.33], P = 0.41) was also improved, but the difference was not statistically significant. CONCLUSION: Online learning is a novel and efficient approach to teaching practical skills to nursing students. Online education can enhance students' knowledge, skills, confidence, and learning satisfaction, and it is superior to traditional classroom instruction. The findings of this study can serve as a basis for the development of standardized online teaching techniques and assessment metrics.

Comparing didactic approaches for practical skills learning in Scandinavian nursing simulation centres: A qualitative comparative study.

AIM: To explore and compare the didactic approaches to practical skills learning at simulation centres in Scandinavian universities and university colleges. BACKGROUND: Academic simulation centres are an important arena for learning practical nursing skills which are essential to ensure competent performance regarding patient safety and quality of care. Knowledge of didactic approaches to enhance learning is essential in promoting the provision and retention of students' practical nursing skills. However, research on didactical approaches to practical nursing skills learning is lacking. DESIGN: A qualitative comparative design was used. METHODS: During November and December 2019, interviews were conducted with a total of 37 simulation centre directors or assistant directors, each of whom possessed in-depth knowledge of practical skills in teaching and learning. They represented bachelor nursing education in Denmark, Norway and Sweden. A qualitative deductive content analysis was conducted. RESULTS: The results revealed all five predetermined didactical components derived from the didactical relationship model. Twenty-two corresponding categories that described a variation in didactic approaches to practical skills learning in Scandinavian nursing simulation centres were identified. The didactical components of Learning process revealed mostly similarities, Setting mostly differences and Assessment showed only differences in didactic approaches. CONCLUSION: Although various didactic approaches were described across the countries, no common approach was found. Nursing educational institutions are encouraged to cooperate in developing a shared understanding of how didactic approaches can enhance practical skills learning. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Cross-country comparisons of practical nursing skills learning in Scandinavian countries highlight the importance of educator awareness concerning the impact diverse didactic approaches may have on competent performance in nursing education. Competent performance is pivotal for ensuring patient safety and the provision of high-quality care. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. REPORTING METHOD: This study followed the Consolidated Criteria for Reporting Qualitative Research reporting guidelines.

Learning experiences of first year graduate entry nursing students in New Zealand and Australia: a qualitative case study.

BACKGROUND: Graduate entry nursing programmes provide students with an accelerated pathway to becoming a registered nurse. Motivations for study, together with commonly shared characteristics of students enrolling in such programmes is becoming well documented, however, their experiences of studying for a professional qualification in this manner is less understood. As a means of maintaining the relevance of these fast-tracked programmes in the future, an understanding of graduate entry nursing students' experiences of academic teaching and clinical placements is imperative. OBJECTIVE: To explore the academic and clinical experiences of students enrolled in the first year of graduate entry nursing programmes in New Zealand and Australia. METHODS: A qualitative case study approach was taken. Here we report the experiences of nine students enrolled in their first year of a two-year graduate entry nursing programme during 2020. Semi-structured interviews were used for data collection and analysed using Braun and Clarke's thematic analysis. FINDINGS: Three overarching themes were developed-affirmation, reflections on expectations and clinical experiences. CONCLUSION: This study highlights the experiences of first year graduate entry nursing students, with many experiencing affirmation that their altruistic career visions came to fruition. The findings indicate that these graduate-entry nursing students interviewed for this study tended to be flexible and adaptable in their approach to study as a means of meeting the challenges of the programme, all of which are key characteristics for a registered nurse; with personal growth and the development of the self, providing preparation for their second year of study.

Report on fraying resilience among the Ontario Registered Practical Nurse Workforce in long-term care homes during COVID-19.

AIM: Registered Practical Nurses (RPNs) are frontline healthcare providers in Ontario long-term care (LTC) homes. Throughout COVID-19, RPNs working in LTC homes experienced prolonged lockdowns, challenging working conditions, and inadequate resource allocation. This study aimed to describe the personal and professional resilience of RPNs working in LTC during the COVID-19 pandemic. DESIGN: An open cross-sectional online survey containing the Connor-Davidson Resilience Scale, Resilience at Work Scale®, and Resilience at Work Team Scale®. METHODS: The survey was distributed by the RPN Association of Ontario (WeRPN) to approximately 5000 registered members working in Ontario LTC homes. RESULTS: A total of 434 respondents participated in the survey (completion rate = 88.0%). Study respondents scored low on measures of resilience and reported extreme levels of job (54.5%) and personal (37.8%) stress. Resources to support self-care and work-life balance, build capacity for team-based care practice(s) are needed.

Use of the clinical care classification in South Korean nursing practice: Challenges and opportunities.

BACKGROUND AND OBJECTIVES: A government-driven standardization of nursing terminology including the Clinical Care Classification (CCC) was endorsed in South Korea in 2015, but the number of hospitals who have adopted this standard terminology remains unknown. This study aimed to determine the CCC awareness, adoption, and utilization statuses and its association with patient experience in South Korea. DESIGN, SETTING, AND PARTICIPANTS: A nationwide telephone survey was conducted from January 13 to February 12, 2022 among 217 tertiary and secondary hospitals participating in the health information exchange network. The survey questionnaire included 22 items in 3 categories: current status of electronic nursing records, awareness and adoption of standard terminology, and open-ended questions regarding standard usage and dissemination. General characteristics and experience scores of the patients of the surveyed hospitals were collected from the publicly available data sources. Data analysis was performed using descriptive statistics, t-test, and generalized linear regression. MAIN OUTCOMES AND MEASURES: The rates of awareness and adoption in hospitals to the nursing terminology standard of the CCC were calculated, and the current status of electronic nursing records used in practice was examined. The relationships between CCC awareness and the characteristics of hospitals in their patient experiences of health services were also identified. RESULTS: The survey response rate was 24.9 % (54/217). Two out of three hospitals (68.5 %) were aware of the CCC. These hospitals had 800 beds or more, and higher scores for patient experience. CCC awareness was significantly related to increases in the overall scores for patient experiences (t = 2.70, p =.0103), but no significance with sub-score for nursing service (t = 1.23, p =.1594). CONCLUSIONS: With a high adoption rate of electronic medical record systems, two-third hospitals acknowledged their CCC awareness, but were still lagged in adoption and usage of it in practice with operational challenges. The CCC awareness has potential relationships with positive patient experience.

Nursing Students' Perception and Attitude towards Objective Structured Clinical Examination in Oman.

Objectives: This study aimed to explore undergraduate nursing students' perception and attitude towards the Objective Structured Clinical Examination (OSCE). Methods: This cross-sectional descriptive study was conducted between April-May 2020 among undergraduate nursing students at the College of Nursing at Sultan Qaboos University, Muscat, Oman. Two self-administered questionnaires were utilised to obtain data on students' perception and attitude towards OSCE. Students' feedback on OSCE was collected using open-ended questions about OSCE strengths, weaknesses and recommendations for improvement. Survey responses were based on a five-point ordinal scale, ranging from strongly disagree to strongly agree. Students' feedback on OSCE was analysed as descriptive data by identifying the common themes and categorising them in groups. Results: A total of 160 students completed the study questionnaires. Most did not find the atmosphere of OSCE to be pleasant (66.3%) and preferred more modes of practical examination (40.6%). Moreover, 64.4% believed the time limitation to be inadequate. The data depict that 33.1% of the examinees deemed the OSCE more stressful than the full practical examination. In addition, a few students confirmed that the OSCE improved their communication skills and confidence in nursing skills. Conclusion: The findings of this study appear alarming in regard to students' perception regarding the overall process and validity of OSCE as an assessment method. Nursing educators must consider further evaluation and improvement of the OSCE in order to improve students' acceptance and appreciation of OSCE as an important form of clinical learning and assessment.

Application of individualized teaching based on the good-will preposing theory in the teaching of practical nursing students in the department of oncology / 中华医学教育探索杂志

Objective:To analyze the effectiveness of individualized teaching based on the good-will preposing theory in the teaching of practical nursing students in the department of oncology.Methods:Eighty practical nursing students who were accepted by the department of oncology from January 2019 to October 2020 were selected, and they were randomly divided into routine group and research group with 40 students in each group. The routine group was taught by conventional methods and the research group was taught by individualized teaching methods based on the good-will preposing theory, respectively. The scores of theory and practice assessment and the changes of willingness and confidence of practical nurses in the department of oncology before and after the teaching, and the satisfaction with the teaching mode were compared between the two groups. SPSS 25.0 was used for t test and rank sum test. Results:The scores of theoretical and practical assessment in the two groups after teaching were higher than those before teaching ( P<0.05), and the scores of theoretical and practical assessment in the study group were higher than those in the routine group ( P<0.05). There were statistically significant differences in the grade distribution of willingness and confidence to undertake the career of oncology between the two groups of practical nursing students after teaching compared with that before teaching ( P<0.05). In the study group, the satisfaction scores of meeting learning willingness, improving learning enthusiasm, improving teaching efficiency, and strengthening the interaction between teachers and students in study group were higher than those in routine group ( P<0.05). Conclusion:Application of individualized teaching based on the good-will preposing theory among practical nursing students in the department of oncology may improve assessment performance, enhance their willingness and confidence to undertake the career of oncology, and improve their teaching satisfaction.

Application of teaching based on task-driven joint feedback mechanism in the teaching of practical nursing students in department of obstetrics and gynecology / 中华医学教育探索杂志

Objective:To explore the effect of teaching based on task-driven joint feedback mechanism on improving the quality and satisfaction of teaching practical nursing students in department of gynaecology and obstetrics.Methods:A total of 203 practical nursing students who had internship in the Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Hainan Medical University from June 2019 to June 2020 were selected as the research objects. They were divided into a control group ( n=96) and a study group ( n=107) according to the order of admission. The control group used traditional teaching, and the study group used task-driven joint feedback mechanism-based teaching. After the teaching, the teaching effect of the two groups of practical nursing students was evaluated through theoretical assessment, skill operation assessment and teaching satisfaction. SPSS 22.0 was used for t test and non-parametric rank sum test. Results:The theoretical assessment scores [(93.51±4.22) vs. (89.62±4.08)] and the total scores of the skill operation assessment [(93.20±4.14) vs. (82.06±3.82)] of the practical nursing students in the study group were better than those of the control group, and the difference was statistically significant ( P<0.05). The results of teaching satisfaction evaluation (teacher's ability and execution ability, teaching content and task design, teaching task completion, feedback mechanism execution and improvement after feedback) of the study group were better those of the control group, and the difference was statistically significant ( P<0.05). Conclusion:The teaching based on the task-driven joint feedback mechanism can effectively improve the teaching quality and teaching satisfaction of the practical nursing students in the department of obstetrics and gynecology.

Factores estresores, Inteligencia Emocional y Engagement en los estudiantes de enfermería durante sus prácticas clínicas / Stressor factors, Emotional Intelligence and Engagement during clinical practice in nursing students

Objetivo principal: Analizar la percepción de estrés, inteligencia emocional y engagement en los estudiantes de grado en Enfermería del Campus de Ponferrada durante el desarrollo de sus prácticas clínicas. Metodología: estudio cuantitativo, descriptivo, correlacional de corte transversal. La muestra fue de 73 estudiantes. Se utilizaron los cuestionarios: KEZKAK, TMMS-24 y UWES-S y datos sociodemográficos. Resultados principales: El 78,1% de los alumnos presentaron estrés siendo las mujeres las que alcanzaron puntuaciones más elevadas. Los estudiantes procedentes de fuera de Ponferrada percibieron mayores tasas de estrés. La puntuación media de la Inteligencia Emocional fue de 78.92±15.11. Las dimensiones de la Inteligencia Emocional correlacionan positivamente con las dimensiones del engagement. Conclusión principal: Los estudiantes de Grado en Enfermería perciben estrés durante el desarrollo de las prácticas clínicas, sin embargo, presentan una adecuada Inteligencia Emocional y niveles altos de engagement.(AU)

Objective: To analyze the perception of stress, emotional intelligence and engagement in Nursing Degree students from the Ponferrada Campus during the development of their clinical practices. Methods: quantitative, descriptive, correlational cross-sectional study. The sample was 73 students. The questionnaires were used: KEZKAK, TMMS-24 and UWES-S and sociodemographic data. Results: 78.1% of the students presented stress, with women reaching the highest scores. Students from outside Ponferrada perceived higher rates of stress. The mean Emotional Intelligence score was 78.92±15.11. The dimensions of Emotional Intelligence positively correlate with the dimensions of engagement. Conclusions: Nursing degree students perceive stress during the development of clinical practices, however they present adequate Emotional Intelligence and high levels of engagement.(AU)

Nursing Interventions Aimed at Persons with Venous Ulcers: an Integrative Review / Intervenciones de enfermería dirigidas a las personas con úlceras venosas: una revisión integrativa / Intervenções de Enfermagem dirigidas às pessoas com úlceras varicosas: uma revisão integrativa

ABSTRACT Objectives: This work sought to identify and describe the theoretical foundations, components, duration, delivery mode, and results of the nursing interventions aimed at persons with venous ulcers as available in the literature. Materials and method: Integrative review between 2000 and 2018 in the Pubmed, Ovidnursing, and EBSCOhost electronic databases. Results: This review includes 16 articles. Most of the interventions were of educational nature; three were developed in the community (through the Leg Club model) and the other ones were delivered by a nursing professional, face to face. The minimum time of duration for these was eight weeks, with telephone follow up. The most-common result variables were venous ulcer healing and reduction of the wound area. Conclusions: Diversity existed in relation with the components of the interventions and the results expected. Report of the interventions must be reinforced, along with the use of nursing theories that support their design.

RESUMEN Objetivos: identificar y describir los fundamentos teóricos, los componentes, la duración, el modo de entrega y los resultados de las intervenciones de enfermería dirigidas a personas con úlceras venosas disponibles en la literatura. Materiales y método: revisión integrativa entre los años 2000 y 2018 en las bases de datos electrónicas Pubmed, Ovidnursing y EBSCOhost. Resultados: esta revisión incluye dieciséis artículos. En su mayoría, las intervenciones fueron de carácter educativo, tres se desarrollaron en la comunidad (bajo el modelo Leg Club) y el resto de intervenciones fueron entregadas personalmente, cara a cara, por una enfermera profesional. El tiempo mínimo de duración de aquellas fue de ocho semanas, con seguimientos telefónicos. Las variables de resultados más comunes fueron la cicatrización de la úlcera venosa y la reducción del área de la herida. Conclusiones: hubo diversidad en relación con los componentes de las intervenciones y los resultados esperados. Se debe reforzar el reporte de las intervenciones y el uso de teorías de enfermería que respalden su diseño.

RESUMO Objetivos: identificar e descrever os fundamentos teóricos, os componentes, a duração, o modo de entrega e os resultados das intervenções de Enfermagem dirigidas a pessoas com úlceras varicosas disponíveis na literatura. Materiais e método: revisão integrativa entre 2000 e 2018 nas bases de dados eletrônicas PubMed, Ovidnursing e EBSCOhost. Resultados: esta revisão inclui 16 artigos. Em sua maioria, as intervenções foram de caráter educativo; três foram desenvolvidas na comunidade (com o modelo Leg Club) e o restante foi entregue pessoalmente por uma enfermeira profissional. O tempo mínimo de duração foi de oito semanas, com seguimento telefônico. As variáveis de resultados mais comuns foram a cicatrização da úlcera varicosa e a redução da área da ferida. Conclusões: houve diversidade quanto aos componentes das intervenções e dos resultados esperados. Deve-se salientar o relato das intervenções e o uso de teorias de Enfermagem que apoiem seu desenho.

Quality improvement: A practical nursing program's admission test.

INTRODUCTION: Academic institutions are under pressure to maintain a nearly flawless retention rate, while graduating successful students. The use of standardized admission tests to provide data driven decisions regarding applicant selection is common. The varying reliability and validity of current standardized tests inspired a large Canadian academic institution to use a faculty developed admission test for admission to its practical nursing (PN) program. METHODS: The target population for this project was a purposive, convenience sample of graduated PN students from a large publically funded polytechnic institution in southern Ontario, Canada, who had completed the Canadian Practical Nurse Registration Examination (CPNRE) within 2014-2016 (n = 293). Data was obtained retrospectively, and included program entry grade-point average (GPA) and CPNRE result, as well as chemistry, English, biology, and math admission test scores. RESULTS: The predictors of chemistry, English, math admission test scores, and program entry GPA did not have an effect beyond the effects of the model's predictors. In this model, the R2 suggests that 9% of the variance can be explained, and 91% not explained. In consideration of all independent variables, findings indicate that mean biology admission test scores (M =74.96) are a predictor of student CPNRE success. Additionally, students who pass the CPNRE have a higher program GPA. CONCLUSIONS: Academic factors including program entry GPA, English, math, biology and chemistry admission scores are a fragment of the characteristics to be considered when determining the predictability of success in PN students. Therefore, it is imperative that program admission processes identify and measure nonacademic program entry criteria, as academic criterion have limited predictability. Furthermore, in isolation, academic admission criteria could be used to identify at-risk-students for appropriate remediation/counselling or as a placement test.

Crossing the "Ascent to Competence" Borders Into Privileged Belongingness Space: Practical Nursing Students' Experiences in Clinical Practice.

BACKGROUND: There is substantial evidence that students' sense of belonging in clinical practice influence their motivation, learning, and acquisition of skills. Despite the importance of belongingness in clinical education, not many studies have been done in the Canadian context in general and practical nurse education in particular. PURPOSE: The main objective of this study was to explore practical nursing students' experiences in clinical education with regard to their sense of belongingness. In addition, we also examined clinical instructors' experiences in fostering a sense of belongingness to students in clinical settings. METHODS: Ascent to competence conceptual framework was used as an analytic lens in this study. Students enrolled in a two-year diploma in practical nursing and their instructors participated in the study. A total of 12 students and 4 clinical instructors participated in the in-depth semistructured one-on-one interviews. Inductive and deductive thematic analysis was used to analyze the data. Deductive analysis used predetermined themes as per ascent to competence framework. Inductive thematic analysis allowed us to provide additional themes on concepts that could not be effectively explained by the predetermined themes. RESULTS: Students described the uniqueness of their instructors and clinical sites as important attributes that enable them to cross various "borders" as they gain access to a "belongingness space" of acceptance, respect, and competency. Productive learning experiences were achieved by students who felt supported and "granted permission" to enter the belongingness space. The instructors highlighted their perceived roles in providing scaffolding supports they thought would help students feel a sense of belonging. CONCLUSIONS: Students cross several borders as they persevere to gain access to the revered belongingness space. Clinical instructors play a major role in assisting students to enter the belongingness space where meaningful learning occurs.

Career Exploration Process of Nursing Student in Clinical Practice: A Voyage to Find the Authentic Nurse of Pre-registration Nurses / 한국간호교육학회지

PURPOSE: The purpose of the study is to understand the experiences of career exploration among nursing students during their clinical practice and to develop a theoretical framework for the career exploration process. METHODS: From February 2 to 28, 2015, data were collected through focus group interviews from 24 participating fourth-year nursing students. The data were analyzed using grounded theory. RESULTS: The central phenomenon of 'confusion between the ideal and the reality of nursing' occurred in contexts for various reasons of choosing one's major, nurses in the ideal, a vague fear of the field, arduous nursing assignments in the field, and severe adversity in the nursing field. Nursing students tried to deal with their confusion by using interaction strategies such as pursuing the intrinsic value of nursing, finding role models, trying to project oneself, and preparing for adapting to reality. The career exploration process in clinical practice was a voyage to discover the authentic nurse of the pre-registration nurse. CONCLUSION: This result shows that nursing students were to gain confidence in their career choices by finding the value of nursing and interacting with patients. Therefore, opportunities for learning experiences about interaction with patients and various positive experiences in clinical practice should be provided for nursing students.

Desenvolvendo competências ao cuidar em UTI: vivência da enfermeira / Developing skills in ICU care: the nurse's experience

Resumo: A Unidade de Terapia Intensiva (UTI) e um ambiente complexo, que requer da enfermeira um cuidado com expertise para atender as demandas do paciente grave. Para tanto, e preciso um envolvimento genuíno na pratica que promova o desenvolvimento de competência da enfermeira. Assim, tem-se como objetivos: compreender o significado da vivencia da enfermeira da UTI no desenvolvimento de competências; elaborar uma teoria substantiva que explicite essa vivencia; e, propor contribuições para o desenvolvimento de competências da enfermeira da UTI. Utilizou-se o referencial teórico do Modelo de Aquisição de Competências aplicado a Enfermagem, e a Teoria Fundamentada nos Dados como referencial metodológico. A coleta de dados ocorreu em um hospital universitário do Sul do Brasil e dividiu-se em duas fases. A primeira, para definição dos grupos amostrais, ocorreu em dezembro de 2015 a fevereiro de 2016, e obteve a participação de 47 enfermeiras, das quais seis eram noviças ou iniciantes avançadas; 14, competentes; 16, proficientes; e 11, experts. Na segunda fase, de fevereiro de 2016 a abril de 2017, realizaram-se 30 entrevistas, com 29 participantes, sendo cinco noviças ou iniciantes avançadas; 11, competentes; seis, proficientes; e sete experts. A analise de dados baseou-se em Glaser e utilizou a System Parts como codificação teórica, elucidando a teoria substantiva "Desenvolvendo competência ao cuidar na UTI: vivencia da enfermeira", cujo conceito central, 'O desenvolvimento de competências da enfermeira na pratica clinica da UTI se sustenta no conhecimento pratico, na aprendizagem experiencial e no contexto de cuidado', amparou-se em 11 conceitos e 28 evidências. A teoria, ao funcionar como um sistema, dividiu-se em três fases: inicial, de desenvolvimento (ações cotidianas para o cuidado, estratégia e reverberações do cuidado), e a de resultantes. Com sua explicitação confirmou-se a tese proposta de que o desenvolvimento de competências esta interligado ao conhecimento que se constroi na prática por meio do aprendizado com as experiências relacionadas a colaboração da equipe e ao envolvimento genuíno da enfermeira na busca pela resolutividade para o paciente em quaisquer situações de cuidado da prática clinica; os objetivos foram alcançados, e fez-se as seguintes recomendações: a utilização da teoria nos cursos de graduação e pós-graduação como guia para o ensino do desenvolvimento de competência; e a aplicação da teoria nos contextos de cuidado junto as enfermeiras como uma ação da gestão das instituições. Para as chefias e supervisões de Enfermagem elaborou-se um algoritmo para admissão e acompanhamento das enfermeiras segundo o nível de competência e uma ficha de avaliação, com atividades a serem realizadas de acordo com o nível. Compreender o desenvolvimento de competência ultrapassa o impacto na formação da enfermeira, auxilia na promoção da qualidade de cuidado e assertividade nas ações em prol do paciente.

Abstract: An Intensive Care Unit (ICU) is a complex environment which demands expert care from nurses in order to meet critical patients' demands. Therefore, real involvement in practice is required in order to promote the development of nurses' competence. Thus, the objectives were as follows: to apprehend the meaning of ICU nurses' experience in order to develop competences; to elaborate a substantive theory to elucidate such an experience; and to propose contributions for the development of ICU nurses' competence. The theoretical framework used was Application to Nursing of the Model of Skill Acquisition, and The Grounded Theory as the methodological framework. Data collection was carried out at a teaching hospital in Southern Brazil, and was divided in two steps. The first step, in order to define the sampling groups, was held between December, 2015 and February, 2016 with 47 participating nurses, among them, six were novices or advanced beginners; 14 were competent; 16 were proficient; and 11 were expert nurses. In the second step, between February, 2016 and April, 2017, 30 interviews were carried out with 29 participants, among them, five were novices or advanced beginners; 11 competent nurses; six proficient nurses; and seven expert nurses. Data analysis was grounded in Glaser and the System Parts was used as theoretical coding, elucidating the "Developing caring competence at an ICU: nurses' experience" substantive theory, whose core concept, 'The development of nurses' competences in ICU clinical practice is grounded in practical knowledge, practice-based learning and caring context', supported by 11 concepts and 28 evidences. The theory, working as a system, was divided in three steps: initial, development (daily caring actions, caring strategy and outcomes), and results. By elucidating it, the proposed thesis was confirmed: competence development is correlated to practice-based knowledge by means of learning with the experiences related to team collaboration and the real involvement of nurses while pursuing patients' problem-solving in any care situations of the clinical practice; the objectives were achieved, and the following recommendation was made: the use of the theory in graduation and post-graduation courses as a teaching guide for competence development; and the theory application in caring contexts among nurses as a management action in the institutions. For Nursing heads and supervisors, an algorithm for nurses' admission and follow-up was elaborated, according to their level of competence, as well as an assessment form with activities to be carried out, according to that level. Apprehending the development of competence goes beyond the impact of nursing training, helps the promotion of quality care and assertiveness in actions for patients.

Resumen: La Unidad de Terapia Intensiva (UTI) es un ambiente complejo, que requiere por parte de la enfermera un cuidado con pericia (expertise) para atender las demandas del paciente grave. Para ello, es preciso un involucramiento genuino en la practica que promueva el desarrollo de especialista de la enfermera. De esta manera se tienen como objetivos: comprender el significado de la vivencia de la enfermera de la UTI en el desarrollo de competencias; elaborar una teoria sustantiva que explicite esa vivencia; y, proponer contribuciones para el desarrollo de competencias de la enfermera de la UTI. Se utilizo el referencial teorico del Modelo de Adquisicion de Competencias aplicado a la Enfermeria, y la Teoria Fundamentada en los Datos como referencial metodologico. La recoleccion de datos se realizo en un hospital universitario del Sur de Brasil y se dividio en dos etapas. La primera, para definir los grupos muestrales, se realizo de diciembre de 2015 a febrero de 2016, y conto con la participacion de 47 enfermeras, de las cuales seis eran novicias o principiantes avanzadas; 14 competentes; 16 habiles; y 11 experts. En la segunda etapa, de febrero de 2016 a abril de 2017, se realizaron 30 entrevistas, con 29 participantes, cinco novicias o principiantes avanzadas; 11 competentes; seis habiles; y siete expertas (experts). El analisis de datos se baso en Glaser y utilizo la System Parts como codificacion teorica, dilucidando la teoria sustantiva "Desarrollando competencia al cuidar en la UTI: vivencia de la enfermera", cuyo concepto central, 'El desarrollo de competencias de la enfermera en la practica clinica de la UTI se sustenta en el conocimiento practico, en el aprendizaje experimental y en el contexto de cuidado', se amparo en 11 conceptos y 28 evidencias. La teoria, al funcionar como un sistema, se dividio en tres etapas: inicial, de desarrollo (acciones cotidianas para el cuidado, estrategia y repercusiones del cuidado), y la de resultantes. Con su explicitacion se confirmo la tesis propuesta de que el desarrollo de competencias esta correlacionado con el conocimiento que se construye en la practica por medio del aprendizaje con las experiencias relacionadas con la colaboracion del equipo y al envolvimiento genuino de la enfermera en la busqueda resolutiva para el paciente en cualesquier situaciones de cuidado de la practica clinica; los objetivos fueron alcanzados, y se hicieron las siguientes recomendaciones: la utilizacion de la teoria en los cursos de formacion universitaria y de postgrado como guia para la ensenanza del desarrollo de competencia; y la aplicacion de la teoria en los contextos de cuidado junto a las enfermeras como una accion de la gestion de las instituciones. Para las jefaturas y supervisiones de Enfermeria se elaboro un algoritmo para admision y acompanamiento de las enfermeras segun el nivel de competencia y una ficha de evaluacion, con actividades a realizar de acuerdo con este nivel. Comprender el desarrollo de competencia sobrepasa el impacto en la formacion de la enfermera, auxilia en la promocion de la calidad de cuidado y asertividad en las acciones en pro del paciente.

The Effects of an Interactive Nursing Skills Mobile Application on Nursing Students' Knowledge, Self-efficacy, and Skills Performance: A Randomized Controlled Trial.

PURPOSE: Clinical nursing practice is important because it helps nursing students experience realities of clinical nursing that cannot be learned through theoretical education. This study aimed to evaluate the effect of an interactive nursing skills mobile application for nursing students. METHODS: Sixty-six senior nursing students were randomly assigned to experimental or control groups. The experimental group used an interactive nursing skills mobile application for 1 week. The control group was provided with a mobile application containing noninteractive nursing video contents for 1 week. Before (pre-test) and 1 week after (post-test) using the mobile application, participants' knowledge of clinical nursing skills, self-efficacy of nursing practice, and nursing skills performance were assessed. RESULTS: The experimental group showed a significantly higher value for knowledge after 1 week of treatment via their mobile application than the control group (t = 3.34, p = .001). In addition, they showed significantly improved self-efficacy before and after intervention (t = 2.46, p = .017) than the control group. The experimental group's nursing skills performance was also significantly enhanced after intervention (t = 7.05, p < .001), with a significant difference in the degree of improvement (t = 4.47, p < .001). CONCLUSION: The interactive learner-centered nursing education mobile application with systematic contents was an effective method for students to experience practical nursing skills. Developing and applying a mobile application with other nursing contents that can be effectively used across all range of nursing students is recommended.

Effects of a Neonatal Nursing Practice Program on Students' Stress, Self-efficacy, and Confidence

PURPOSE: The purpose of this study was to examine the effects of a neonatal nursing practice program for nursing students on students' stress, self-efficacy, and confidence. METHODS: A 1-group pre- and post- study design was used. The participants consisted of 64 nursing students who were in a pediatric nursing clinical practicum at a nursing college in Seoul from September 2015 to May 2016. The program consisted of 3 stages-orientation, practice, and debriefing-and was conducted for 3 hours during a 2-week period of the pediatric nursing clinical practicum. The dependent variables were neonatal nursing practice stress, self-efficacy, and confidence. Data were analyzed using the paired t-test, the Pearson correlation coefficient, the x² test, and descriptive statistics with SPSS for Windows version 22.0. RESULTS: The neonatal nursing practice program was effective at decreasing clinical practice-related stress and increasing confidence and self-efficacy regarding neonatal nursing practice. CONCLUSION: The neonatal nursing practice program may effectively promote the integration of theoretical knowledge and practice. In the future, we propose to develop various educational programs that reinforce basic nursing skills for neonates as part of an effective pediatric nursing clinical practicum.

The Effects of an Interactive Nursing Skills Mobile Application on Nursing Students' Knowledge, Self-efficacy, and Skills Performance: A Randomized Controlled Trial

PURPOSE: Clinical nursing practice is important because it helps nursing students experience realities of clinical nursing that cannot be learned through theoretical education. This study aimed to evaluate the effect of an interactive nursing skills mobile application for nursing students. METHODS: Sixty-six senior nursing students were randomly assigned to experimental or control groups. The experimental group used an interactive nursing skills mobile application for 1 week. The control group was provided with a mobile application containing noninteractive nursing video contents for 1 week. Before (pre-test) and 1 week after (post-test) using the mobile application, participants' knowledge of clinical nursing skills, self-efficacy of nursing practice, and nursing skills performance were assessed. RESULTS: The experimental group showed a significantly higher value for knowledge after 1 week of treatment via their mobile application than the control group (t = 3.34, p = .001). In addition, they showed significantly improved self-efficacy before and after intervention (t = 2.46, p = .017) than the control group. The experimental group's nursing skills performance was also significantly enhanced after intervention (t = 7.05, p < .001), with a significant difference in the degree of improvement (t = 4.47, p < .001). CONCLUSION: The interactive learner-centered nursing education mobile application with systematic contents was an effective method for students to experience practical nursing skills. Developing and applying a mobile application with other nursing contents that can be effectively used across all range of nursing students is recommended.

Primary health care: the experience of nurses / O cuidado na Atenção Primária à Saúde: a vivência de enfermeiras / El cuidado en la Atención Primaria de Salud: vivencia de las enfermeras

ABSTRACT Objective: to understand the meaning of nursing care in primary health care from the perspective of Chilean nurses. Method: this was a qualitative study based on the social phenomenology of Alfred Schutz. Data was collected between January and April 2013, through interviews with 13 primary health care nurses in Chile. Results: the nurses perceived primary care as a gratifying experience, considering it an encounter of subjectivities. However, they felt burdened with multiple functions and by the hierarchical pressure to achieve targets. They strived to implement innovative care, expressed by the desire to go beyond traditional care practices, and improve the efficiency of management at the various levels of health care. Conclusion: it is important to discuss the results of the present study in the context of health care and especially nursing education, with the goal of better preparing nurses who will deliver care at the primary health care level.

RESUMO Objetivo: compreender o significado atribuído aos cuidados de enfermagem na Atenção Básica de Saúde por enfermeiras chilenas. Método: pesquisa qualitativa baseada na fenomenologia social de Alfred Schutz. Os dados foram coletados entre janeiro e abril de 2013, por meio de entrevistas com 13 enfermeiras de unidades de Atenção Básica em uma cidade do Chile. Resultados: as enfermeiras percebem o cuidado prestado como uma experiência gratificante, considerando-o um encontro de subjetividades. No entanto, elas se sentem sobrecarregadas pelas múltiplas funções que realizam e pelas pressões hierárquicas para cumprir metas. Elas se esforçam para implementar cuidados inovadores que possam superar o cuidado tradicional e aumentar a eficiência da gestão nos vários níveis de atenção à saúde. Conclusão: é importante discutir estes resultados no contexto da assistência e especialmente na formação, com o objetivo de melhorar a preparação de enfermeiros trabalhando nesse nível de atenção.

RESUMEN Objetivo: comprender el significado de realizar cuidados de enfermería en la Atención Primaria de Salud desde la perspectiva de las enfermeras chilenas. Método: investigación cualitativa con enfoque desde la fenomenología social de Alfred Schütz. La recolección de datos fue realizada entre enero y abril del 2013, a través de entrevista con 13 enfermeras de Atención Primaria en Chile. Resultados: las enfermeras perciben el cuidado como una experiencia gratificante considerando un encuentro de subjetividades. Sin embargo, se sienten sobrecargadas por múltiples funciones a realizar y por presiones jerárquicas en el logro de las metas. Aspiran implementar cuidados innovadores manifiestados por el deseo de superar el cuidado tradicional y la eficiencia de la gestión de los diversos niveles de atención de la salud. Conclusión: es importante discutir estos resultados en el contexto de la asistencia y especialmente en la formación, con el fin de preparar mejor a las enfermeras que brindarán cuidados en este nivel de atención.

Competencia clínica del profesional de enfermería en la atención del paciente en Código Infarto puerta-balón-primaria / Clinical competence of the nursing professional in the care of the patient in Code Infarction door-to-balloon time

Resumen

Introducción: la estrategia Código Infarto garantiza el diagnóstico temprano y el tratamiento oportuno al paciente con infarto agudo al miocardio. En dicha estrategia el profesional de enfermería fundamenta sus intervenciones en colaboración con el equipo multidisciplinario.

Objetivo: evaluar el nivel de competencia clínica del profesional de enfermería en la atención del paciente con Código Infarto puerta-balón-primaria.

Metodología: estudio transversal analítico, en una muestra de 57 enfermeras de los servicios de Urgencias y Hemodinamia de un hospital de tercer nivel. Con base en el protocolo Código Infarto se diseñaron tres instrumentos: un cuestionario y dos listas de cotejo, las cuales incluyeron 42 ítems, validados por expertos (2 de 2). Se hizo un análisis descriptivo y se también se usaron pruebas no paramétricas.

Resultados: el nivel de competencia clínica fue eficiente en el 74%. En relación con el grado académico y el nivel de competencia, fue más eficiente el personal con formación profesional técnica (35%) que el personal con formación de licenciatura (28%). Se correlacionó el nivel de competencia con el grado académico y la capacitación (p < 0.005).

Conclusiones: la competencia del profesional de enfermería en la atención del paciente con Código Infarto fue eficiente, en razón de la oportunidad y el tiempo de la reperfusión coronaria.

Abstract

Introduction: The Infarct Code (Código Infarto) strategy guarantees early diagnosis and timely treatment of patients with acute myocardial infarction. In this strategy, the nursing professional bases his interventions in collaboration with the multidisciplinary team.

Objective: To evaluate the level of clinical competence of the nursing professional in the care of the patient with a primary infarction.

Methods: It was carried out a cross-sectional analytical study in a sample of 57 nurses from the services of Emergency and Cardiac Care Unit. Based on the Infarct Code protocol, three questionnaires and two checklists (these included 42 items) were designed and validated by experts (2/2). We made a descriptive analysis and we also used non-parametric tests.

Results: The level of proficiency was efficient in 74%. With regards to the academic degree and the level of competence, the personnel with technical professional training (35%) were more efficient than the personnel with a bachelor's degree (28%). The level of competence was correlated with the academic degree and the training (p = <0.005).

Conclusions: The competence of the nursing professional in the care of the patient with Infarction Code was efficient, due to the timing and the time of the coronary reperfusion.

Nursing knowledge and practices regarding subcutaneous fluid administration / Conocimientos y prácticas de enfermería en la administración de fluidos por vía subcutánea / Conhecimentos e práticas da enfermagem na administração de fluidos por via subcutânea

ABSTRACT Objective: To describe the evidence in the literature regarding the knowledge and practices of the nursing team about subcutaneous administration of drugs and fluids in adults. Method: Integrative review of the literature using the descriptors "nursing", "hypodermoclysis", "drug administration routes", "adult health," and "knowledge," in English, Spanish, and Portuguese, with no publication deadline. Of the 569 articles found, eight made up the sample. Results: A predominance of international journals (75%) with more than five years of publication (62.5%). The analysis of the methodological characteristics showed a predominance of literature reviews (25%), quantitative studies (62.5%), cross-sectional studies (50%), and non-experimental studies (50%). Conclusion: Although it is an old technique with proven efficacy, hypodermoclysis is still little used, a puzzling fact due to its advantages and indications for any age.

RESUMEN Objetivo: Describir las evidencias, en la literatura, acerca de los conocimientos y prácticas del equipo de enfermería sobre administración de medicamentos y fluidos por vía subcutánea en adultos. Método: Revisión integrativa de la literatura, utilizando los descriptores: enfermería, hipodermoclisis, vías de administración de medicamentos, salud del adulto y conocimiento; en idiomas inglés, español y portugués, sin fecha límite de publicación. Fueron encontrados 569 artículos, de los cuales 8 integraron la muestra. Resultados: Predominio de revistas internacionales (75%), y con más de cinco años de publicación (62,5%). Al analizarse las características metodológicas, predominaron: revisiones de literatura (25%), estudios cuantitativos (62,5%), estudios transversales (50%) y no experimentales (50%). Conclusión: A pesar de tratarse de una técnica antigua de comprobada eficacia, la hipodermoclisis es aún poco utilizada, hecho inexplicable, dadas sus ventajas e indicaciones para cualquier edad.

RESUMO Objetivo: descrever as evidências, na literatura, sobre os conhecimentos e as práticas da equipe de enfermagem na administração de medicamentos e de fluidos por via subcutânea no adulto. Método: revisão integrativa da literatura utilizando os descritores enfermagem, hipodermóclise, vias de administração de medicamentos, saúde do adulto e conhecimento; nos idiomas inglês, espanhol e português, sem data limite de publicação. Dos 569 artigos encontrados, oito compuseram a amostra. Resultados: predomínio de revistas internacionais (75%) e com mais de cinco anos de publicação (62,5%). Ao analisarem-se as características metodológicas, predominaram: revisões de literatura (25%), estudos quantitativos (62,5%), estudos transversais (50%) e não-experimentais (50%). Conclusão: apesar de se tratar de uma técnica antiga com eficácia comprovada, a hipodermóclise ainda é pouco utilizada, fato incoerente pelas suas vantagens e suas indicações para qualquer idade.