Factors associated with spiritual care competencies in Taiwan's clinical nurses: A descriptive correlational study.

AIMS AND OBJECTIVES: To determine factors associated with nurses' spiritual care competencies. BACKGROUND: Holistic nursing care includes biopsychosocial and spiritual care. However, nurses are limited by a lack of knowledge, time constraints and apprehension of assessing spiritual issues, which leaves them unable to assess and meet patients' spiritual needs. Thus, when patients experience spiritual distress, clinical nurses lose the opportunity to support spiritual growth and self-actualisation. In Taiwan, spiritual care, religion and culture are unique compared to those in other countries. Overall, factors associated with Taiwanese nurses' spiritual care competencies lack comprehensive exploration. METHODS: This study adopted a descriptive correlational design using cross-sectional survey (see Appendix S1). Cluster sampling was used to select clinical nurses from fourteen units of a medical centre and a regional hospital. Data were collected from January-June 2018 with a 97.03% response rate. Clinical nurses completed a background questionnaire, spiritual care practice questionnaire, spirituality and spiritual care-related scales. Data were analysed using descriptive and linear regression. This report followed the STROBE checklist. RESULTS: Spiritual care competence ranged from 44-123 (mean 84.67 ± 12.88; range 27-135). The majority of clinical nurses rated their spiritual care competence as moderate (64-98). The significant factors associated with nurses' spiritual care competence were education, religion, interest in spiritual care, having role models, past life events, barriers to providing spiritual care of the spiritual care practice score, and spiritual attitude and involvement score. The overall model was significant (p < .001) and accounted for 55.0% of variance (adjusted R2  = .488). CONCLUSIONS: Most clinical nurses have moderate spiritual care competence. Objective factors identified affect clinical nurses' spiritual care competencies. RELEVANCE TO CLINICAL PRACTICE: To improve nurses' spiritual care competencies, objective factors that affect clinical nurses' spiritual care competencies must be emphasised. Multiple strategies for enhancing nurses' own spiritual well-being can be provided via employee health promotion projects and activities, and promoting nurses' spirituality and spiritual care competencies can be explored in clinical settings through bedside teaching, situational simulation, objective structured clinical examinations and self-reflection.

Spreading Depression Promotes Astrocytic Calcium Oscillations and Enhances Gliotransmission to Hippocampal Neurons.

Spreading depression (SD) is a pathophysiological phenomenon characterized by propagating waves of profound neuronal and glial depolarization in central nervous system gray matter. Although SD is primarily mediated by neurons with a subsequent astrocytic response, it remains unclear how astrocytic activity is modulated after SD and how altered astrocyte signaling contribute to neuronal excitability. Here, we report that after the concurrent Ca2+ wave, SD enhanced astrocytic activity by promoting a secondary period of Ca2+ oscillations. SD-induced Ca2+ oscillations did not require the activation of metabotropic glutamate receptors or purinergic receptors; instead, they were mediated by the activation of GABAB receptors and 1,4,5-trisphosphate (IP3) receptors. Furthermore, SD increased the number of NMDA receptor-mediated slow inward currents (SICs) in CA1 pyramidal neurons. The frequency of SD-induced SICs was reduced by blockade of GABAB receptors or by limiting Ca2+ efflux from the ER. Selective inhibition of astrocytic Ca2+ signals by dialysis of BAPTA into astrocytes or by knocking out the astrocytic type of IP3 receptors suppressed SICs after SD. These results demonstrated a causative link between the SD-induced Ca2+ oscillations and the enhanced glutamatergic astrocyte-neuron signaling. Therefore, we conclude that SD enhances the astrocyte Ca2+ signals and further promotes gliotransmission and neuronal excitability.

[A Study of the Self-Assessed Emergency Management Competencies of Emergency Medical Technicians].

BACKGROUND: Emergency medical technicians (EMTs) must be able to assess patient needs for emergency medical services in order to ensure patient safety and optimal prognosis. However, Taiwan currently has no relevant core competency indices or required courses in place for EMTs. The relative inaccessibility of training may seriously compromise the performance of EMTs. PURPOSE: This study investigated self-assessed emergency management competency and related demographic factors in a sample of EMTs. METHODS: This cross-sectional survey used a convenience sample of EMTs working at a fire station in eastern Taiwan. Data were collected using a questionnaire including a new emergency management competency self-assessment scale. A total of 272 of the 295 distributed questionnaires were returned (92.2%). RESULTS: The mean score for emergency management competency was 3.58 points. The highest-scored item was "I know how to use an automated external defibrillator correctly" and the lowest-scored item was "I know how to handle postpartum hemorrhaging (PPT)." The factors that were found to significantly influence self-assessed emergency management competencies included the age, education, EMT qualification, EMT instructor / assistant qualification, and years as an EMT of the respondent and the number of emergency medical tasks handled by their unit per month, average monthly personal workload, and having attended additional emergency medical courses in the previous year. CONCLUSIONS: Future training for EMTs should focus on improving competencies related to pediatric emergencies, obstetric emergencies, and other low-scoring items using proper instructional materials, strategies, and learning-outcome-assessment mechanisms. This training may be expected to improve the quality and appropriateness of future emergency medical treatment through greater EMT confidence and competence.

[A Study of the Evidence-Based Nursing Practice Competence of Nurses and Its Clinical Applications].

BACKGROUND: Nurses must develop competence in evidence-based nursing in order to provide the best practice medical care to patients. Evidence-based nursing uses issue identification, data mining, and information consolidation from the related medical literature to help nurses find the best evidence. Therefore, for medical institutions to provide quality clinical care, it is necessary for nurses to develop competence in evidence-based nursing. PURPOSE: This study aims to explore the effect of a fundamental evidence-based nursing course, as a form of educational intervention, on the development of evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, and outcome expectations of evidence-based practice in nurse participants. Further the competence of these nurses in overcoming obstacles in evidence-based nursing practice. METHODS: This quasi-experimental study used a pre-post test design with a single group of participants. A convenience sample of 34 nurses from a municipal hospital in northern Taiwan received 8 hours of a fundamental evidence-based nursing course over a two-week period. Participants were asked to complete four questionnaires before and after the intervention. The questionnaires measured the participants' basic demographics, experience in mining the medical literature, evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, outcome expectations of evidence-based practice, competence in overcoming obstacles in evidence-based nursing practice, and learning satisfaction. Collected data was analyzed using paired t, Wilcoxon Signed Rank, and McNemar tests to measure the differences among participants' evidence-based nursing knowledge and practice activities before and after the workshop. RESULTS: The nurses demonstrated significantly higher scores from pre-test to post-test in evidence-based nursing knowledge II, self-efficacy in evidence-based nursing practice activities, and outcome expectations of evidence-based practice. Although the differences did not reach statistical significance, the post-test scores were significantly lower than pre-test scores in terms of the measurement of the nurses' obstacles in evidence-based nursing practice, which indicates significant improvements from pre-test to post-test in terms of the competence of participants in overcoming obstacles in evidence-based nursing practice. CONCLUSIONS: The intervention was found to be effective in improving the evidence-based nursing knowledge, self-efficacy in evidence-based nursing practice activities, and outcome expectations of evidence-based practice of participants and effective in reducing their obstacles in evidence-based nursing practice. Medical institutions should provide evidence-based nursing courses on a regular basis as a part of in-service education for nurses in order to help nurses develop the evidence-based nursing knowledge and practical competence required to provide quality clinical care.

[A Study on the Cognitive Learning Effectiveness of Scenario-Based Concept Mapping in a Neurological Nursing Course].

BACKGROUND: The multiple levels of knowledge related to the neurological system deter many students from pursuing studies on this topic. Thus, in facing complicated and uncertain medical circumstances, nursing students have diffi-culty adjusting and using basic neurological-nursing knowledge and skills. Scenario-based concept-mapping teaching has been shown to promote the integration of complicated data, clarify related concepts, and increase the effectiveness of cognitive learning. PURPOSE: To investigate the effect on the neurological-nursing cognition and learning attitude of nursing students of a scenario-based concept-mapping strategy that was integrated into the neurological nursing unit of a medical and surgical nursing course. METHODS: This quasi-experimental study used experimental and control groups and a pre-test / post-test design. Sopho-more (2nd year) students in a four-year program at a university of science and technology in Taiwan were convenience sampled using cluster randomization that was run under SPSS 17.0. Concept-mapping lessons were used as the intervention for the experimental group. The control group followed traditional lesson plans only. The cognitive learning outcome was measured using the neurological nursing-learning examination. RESULTS: Both concept-mapping and traditional lessons significantly improved post-test neurological nursing learning scores (p < .001), with no significant difference between the two groups (p = .51). The post-test feedback from the control group mentioned that too much content was taught and that difficulties were experienced in understanding mechanisms and in absorbing knowledge. In contrast, the experimental group held a significantly more positive perspective and learning attitude with regard to the teaching material. Furthermore, a significant number in the experimental group expressed the desire to add more lessons on anatomy, physiology, and pathology. These results indicate that this intervention strategy may help change the widespread fear and refusal of nursing students with regard to neurological lessons and may facilitate interest and positively affect learning in this important subject area. CONCLUSION: Integrating the concept-mapping strategy and traditional clinical-case lessons into neurological nursing lessons holds the potential to increase post-test scores significantly. Concept mapping helped those in the experimental group adopt views and attitudes toward learning the teaching material that were more positive than those held by their control-group peers. In addition, while 59% of the experimental group and 49% of the control group submitted opinions related to learning attitude in the open-ended questions, positive feedback was greater in the experimental group than in the control group.

Factors affecting metacognition of undergraduate nursing students in a blended learning environment.

This paper is a report of a study to examine the influence of demographic, learning involvement and learning performance variables on metacognition of undergraduate nursing students in a blended learning environment. A cross-sectional, correlational survey design was adopted. Ninety-nine students invited to participate in the study were enrolled in a professional nursing ethics course at a public nursing college. The blended learning intervention is basically an assimilation of classroom learning and online learning. Simple linear regression showed significant associations between frequency of online dialogues, the Case Analysis Attitude Scale scores, the Case Analysis Self Evaluation Scale scores, the Blended Learning Satisfaction Scale scores, and Metacognition Scale scores. Multiple linear regression indicated that frequency of online dialogues, the Case Analysis Self Evaluation Scale and the Blended Learning Satisfaction Scale were significant independent predictors of metacognition. Overall, the model accounted for almost half of the variance in metacognition. The blended learning module developed in this study proved successful in the end as a catalyst for the exercising of metacognitive abilities by the sample of nursing students. Learners are able to develop metacognitive ability in comprehension, argumentation, reasoning and various forms of higher order thinking through the blended learning process.

[The learning experiences of nurse practitioners participating in the NP training program].

BACKGROUND: Training programs for nurse practitioners (NPs) have been provided in Taiwan since 2006. However, little research has been conducted into the development or assessment of these programs. Investigating the learning experiences of NPs in these programs may provide insights to help improve program quality. PURPOSE: This qualitative study used purposeful sampling and semi-structured, in-depth interviews to collect data from 10 NP participants in an NP training programs. METHODS: This qualitative study used purposeful sampling and semi-structured, in-depth interviews to collect data from ten nurse practitioners regarding their learning experiences during training. Data was analyzed using content analysis. RESULTS: Seven themes emerged related to participant learning experiences. These themes were: (1) improvements in professional and personal performance; (2) enhancement of professional decision-making; (3) building-up of self-confidence; (4) fulfillment of clinical service during internship; (5) balance of professional and personal roles; (6) evaluation of training effectiveness; and (7) professional roles, expectations, and actual performance. CONCLUSIONS: Government agencies, institutes of higher education, and the medical profession should cooperate to develop universal standards for NP training and assessments and supervise the administration of NP training properly. In addition, NP training should adopt a learner-oriented approach and be delivered by preceptors with a clear understanding of the professional expectations of the NP role in order to achieve optimal patient care outcomes.

[The effect of a scenario-based simulation communication course on improving the communication skills of nurses].

BACKGROUND: Limited disease knowledge is frequently the cause of disease-related anxiety in myocardial infarction patients. The ability to communicate effectively serves multiple purposes in the professional nursing practice. By communicating effectively with myocardial infarction patients, nurses may help reduce their anxiety by keeping them well informed about their disease and teaching them self-care strategies. PURPOSE: This research evaluates the communication skills of nurses following scenario-based simulation education in the context of communication with myocardial infarction patients. METHODS: This study used an experimental design and an educational intervention. The target population comprised nurses of medicine (clinical qualified level N to N2 for nursing) working at a municipal hospital in Taipei City, Taiwan. A total 122 participants were enrolled. Stratified block randomization divided participants into an experimental group and a control group. The experimental group received clinical scenario-based simulation education for communication. The control group received traditional class-based education for communication. Both groups received a pre-test and a Communication Skills Checklist post-test assessment. Results were analyzed using SPSS 17.0 for Windows software. RESULTS: A t-test showed significant increases in communication skills (p < .001) in the experimental group and ANCOVA results identified significant between-group differences (p < .001) in communication skills following the education intervention. CONCLUSIONS: The results indicate that clinical scenario-based simulation education for communication is significantly more effective than traditional class-based education in enhancing the ability of nurses to communicate effectively with myocardial infarction patients.

[The use of OSCE to evaluate the competency of discharge nurses].

BACKGROUND: Clear directions and explanations from nurses related to health behaviors and discharge procedures have been shown to effectively reduce the risk of patient readmission. Nurses thus need to develop good communication skills in order to ensure that their communications help patients become better-informed and less anxious about discharge procedures. PURPOSE: This research evaluates the communication skills of nurses following two different education interventions. METHODS: Experimental design principles for education interventions were followed in this research. Medical nurses certified at the N to N2 level in a municipal hospital in Taipei City were enrolled as participants (N=78) and divided into an experimental group and control group using stratified purposive randomization. The experimental group received clinical scenario-based simulation education for communication. The control group received standard class-based education for communication. Both groups received a pre-test evaluation and an OSCE post-test evaluation. Results were analyzed using SPSS 17.0 software. RESULTS: Independent t-test results revealed significant increases in communication skills (t=3.406, p<.05) in both groups, with the increase in the experimental group (M=5.00, SD=0.82) significantly greater than the increase in the control group (M=4.11, SD=1.41). However, the mean scores from the post-test standardized patient survey found no significant differences between the two groups in terms of communication skills. CONCLUSIONS: The results indicate that the clinical scenario-based simulation education intervention is more effective than traditional class-based education in enhancing the communication skills of nurses.

Clinical teaching competence inventory for nursing preceptors: instrument development and testing.

The aim of the study was to develop and test the psychometric properties of an instrument which measures clinical teaching competencies of nursing preceptors. It is necessary to investigate what kinds of teaching competencies are required in modern, more student-centered higher education teaching contexts. Nurses need to possess teaching competence to perform the role of preceptor properly. However, empirical studies exploring teaching competence are rare. Psychometric testing was conducted on a sample of 389 clinical nursing preceptors from three hospitals in 2010. Exploratory factor analysis and reliability testing were conducted on the 53-item Clinical Teaching Competencies Scale. Results indicated that principal axis factoring extraction identified four factors through a promax rotation: Student evaluation, goal setting and individual teaching, teaching strategies, and demonstration of organized knowledge. The Cronbach's α values for the four factors ranged from 0.82-0.87. The Clinical Teaching Competence Inventory was found to have adequate construct validity and internal consistency of reliability for clinical nursing preceptors to assess clinical teaching behaviors in practice settings.

The core-independent promoter-specific interaction of primary sigma factor.

Previous studies have led to a model in which the promoter-specific recognition of prokaryotic transcription initiation factor, sigma (σ), is core dependent. Most σ functions were studied on the basis of this tenet. Here, we provide in vitro evidence demonstrating that the intact Bacillus subtilis primary sigma, σ(A), by itself, is able to interact specifically with promoter deoxyribonucleic acid (DNA), albeit with low sequence selectivity. The core-independent promoter-specific interaction of the σ(A) is -10 specific. However, the promoter -10 specific interaction is unable to allow the σ(A) to discern the optimal promoter spacing. To fulfill this goal, the σ(A) requires assistance from core RNA polymerase (RNAP). The ability of σ, by itself, to interact specifically with promoter might introduce a critical new dimension of study in prokaryotic σ function.

The effects of two educational interventions on knowledge and competence of nurses with regard to conveying gastroscopy-related information to patients.

AIM: The study was to compare the effects of two different educational interventions on knowledge and competence of nurses regarding conveying gastroscopy-related information to patients. BACKGROUND: Nurses play an important role in helping patients undergo gastroscopy and must be familiar with the procedure to provide related patient education. DESIGN: A quasi-experimental study. METHODS: This study in 2010 involved a pre-test and two post-tests. The experimental group (n=25) received a multimedia CD-ROM, and the comparator group (n=40) received a pocket booklet. The effects of the two educational interventions were measured using the Knowledge Test Gastroscopy Nursing Instruction Scale, the Self-Evaluation Gastroscopy Nursing Instruction Scale, and the Gastroscopy Nursing Instruction Learning Satisfaction Scale. RESULTS: No overall significant difference in knowledge scores between the two groups was found, but subsequent post hoc analysis showed significantly higher scores in the experimental group than in the comparator group at week 6. A significant within-subjects effect of the self-evaluation gastroscopy nursing instruction scores from baseline-week 6 was dependent on the experimental group or the comparator group. There were significant between-subjects effects overall, at week 3 and at week 6. CONCLUSION: Both educational interventions improved nurses' knowledge and competence in gastroscopy-related information. However, the CD-ROM-based intervention had long-term effects on knowledge and had short-term and long-term effects on competence.

[Self-evaluation of core competencies and related factors among baccalaureate nursing students].

BACKGROUND: Evaluations of higher education programs are increasingly centered on the learner and designed to assess learning effectiveness and core competencies. Although the Taiwan Nursing Accreditation Council (TNAC) has established eight core competencies for college nursing departments, little research has been done to identify the most salient contributors to undergraduate nursing students' perceived competency levels. PURPOSE: This paper investigates the influence of student demographic factors and learning experience on students' development in terms of a selected sample of core nursing competencies and then identifies factors that significantly predicts such development. METHODS: This is a cross-sectional descriptive correlational study. We collected data from a sample of freshmen students currently enrolled in a two-year nursing bachelor degree program at a private vocational university in Taipei, Taiwan. Participants self-assessed abilities in designated core nursing competencies using the Competency Inventory of Nursing Students (CINS). A total of 279 of 290 distributed questionnaires were returned and used in data collection, giving this study a valid return rate of 96.2%. RESULTS: Participants earned a mean CINS score of 5.23 (SD = 0.49). Scale dimensions from highest to lowest mean score rank were: ethics, accountability, caring spirit, communication and cooperation, lifelong learning, general clinical nursing skills, critical thinking, and basic biomedical science. Differentiated analysis revealed that nursing students who expressed a strong interest in nursing, had a clear career plan, held aspirations to pursue higher nursing education, designated "major hospital" as their first workplace of choice, designated a post-college department / workplace preference, had participated in campus activities, were outspoken in classroom discussions and debates, made consistent effort to complete homework assignments and prepare for examinations, and performed relatively strong academically earned CINS scores significantly above the mean. The three factors "having a clear career plan," "having designated a post-college department / workplace preference," and "having participated in campus activities" accounted for 14.4% of variance in subjects' CINS self-rating scores (adjusted R2 = 12.5%). CONCLUSION: The CINS is an effective instrument for assessing the core professional competencies of nursing students. We recommend that nursing education strategies may be adjusted to enhance student interest in nursing, encourage their developing career plans, and encourage greater participation in campus activities and classroom discussions as a way to improve core professional competencies.

Effects of Digital Learning and Virtual Reality in Port-A Catheter Training Course for Oncology Nurses: A Mixed-Methods Study.

In-service education for oncology nurses usually adopts didactic teaching. This study investigated the effects of virtual reality (VR) and a digital learning-based Port-A-catheter educational course for oncology nurses. A mixed-methods research design was employed, with a convenience sample of 43 nurses from a regional teaching hospital in Taiwan participating. Measurements were taken at three time points: pre-test, 1st post-test, and 2nd post-test. The data was analyzed using descriptive statistics and repeated ANOVA tests. Results showed significant improvement in Port-A-catheter knowledge and skill levels (p < 0.0001) and high learning attitude and satisfaction scores of 4.29 ± 0.46 and 4.31 ± 0.58 points, respectively. Five qualitative themes emerged, highlighting the realistic VR scenarios, VR practice's usefulness, willingness to learn with VR, VR system limitations, and the potential for future courses. The study concluded that a VR-based educational course effectively enhanced nurses' knowledge, skills, learning attitude, and satisfaction, recommending the inclusion of diverse clinical scenarios for practical learning.

[A creative approach to teaching diabetic foot examinations].

Foot infections are a common chronic complication and a major reason for hospitalization in patients with diabetes. Performing foot examinations correctly and thoroughly may reduce diabetic foot risks and save patients from amputation and death. To assist professional nurses to learn the procedures and tools involved in foot examination, this study proposes that nurse trainers use creative thinking methods, such as those of Mandala, and mind mapping to conduct divergent thinking and analysis of training content define feasible training strategies. This study also proposes the use of rhymes and graphics such as creative mnemonics to help professional nurses expedite their learning of foot examination and preventive foot care techniques.

[Clinical teaching program: standardized operating procedure for intra-aortic balloon pump support].

Intra-aortic balloon pump (IABP) is one of the most important treatment strategies for patients with heart failure in the intensive care unit (ICU). To ensure quality of treatment, clinical preceptors must employ effective teaching strategies to acquaint nurses with the proper use of IABPs. Many nurses are hesitant to use IABPs due to lack of knowledge regarding their use. Classroom lectures and instruction manual-style materials are often ineffective strategies for teaching novice nurses to use IABPs properly and have resulted in unsatisfactory patient treatment quality. This study developed a creative, pithy rhyme to help nurses remember the key elements of IABP support as part of their IABP learning process. This innovative tool uses rhymes and mental images to instill critical information related to IABP use and help nurses become fluent IABP users.

The Effects of a Scenario-Based Spiritual Care Course on Spiritual Care Competence among Clinical Nurses: A Quasi-Experimental Study.

Across their lifespans, and in many clinical settings, patients have spiritual care needs. Many nurses lack competence related to providing spiritual care. Popular educational strategies, such as simulated educational programs and objective structured clinical examinations (OSCE), have not been widely adopted in nursing spiritual care education. The purpose of this study was to explore the effects of a scenario-based spiritual care course on spiritual care competence in nurses. This quasi-experimental study employed a repeated-measures pre-test/post-test design with assessments immediately before, immediately after, and 3 months post-intervention. Nurses providing direct patient care in diverse clinical settings were recruited from a large medical foundation in northern Taiwan. The intervention was a one day scenario-based spiritual care course and OSCE. The experimental group (n = 53) and controls (n = 85) were matched for their similar units, ages, working experience, and clinical ladder status. The Spiritual Care Competence Scale (SCCS), Spiritual Perspective Scale (SPS), Spiritual Care Perspective Scale-Revised (SCPS-R), and reflection logs were completed by both experimental and control groups. The Course Satisfaction Scale, OSCE Checklist, and Standardized Patient Feedback Scale (SPFS) were completed by the experimental group only. The experimental group had significantly higher SPS scores and self-evaluated SCCS scores, and lower SCPS-R scores (more positive spiritual perspectives), than controls at 3 months post-intervention. The experimental group showed significant within-subject effects at three time points on SPS scores, SCPS-R scores, and self-evaluated SCCS scores. Mean global performance of OSCE was 3.40 ± 0.91, and SP feedback indicated strengths and areas for improvement. In conclusion, the scenario-based spiritual care course effectively enhanced nurses' spiritual care competence, competence, and skills. Blended education techniques can therefore enhance nurses' ability to support patients with spiritual care needs.

Effects of a blended learning module on self-reported learning performances in baccalaureate nursing students.

AIMS: This article is a report of a quasi-experimental study of the effects of blended modules on nursing students' learning of ethics course content. BACKGROUND: There is yet to be an empirically supported mix of strategies on which a working blended learning model can be built for nursing education. METHODS: This was a two-group pretest and post-test quasi-experimental study in 2008 involving a total of 233 students. Two of the five clusters were designated the experimental group to experience a blended learning model, and the rest were designated the control group to be given classroom lectures only. The Case Analysis Attitude Scale, Case Analysis Self-Evaluation Scale, Blended Learning Satisfaction Scale, and Metacognition Scale were used in pretests and post-tests for the students to rate their own performance. RESULTS: In this study, the experimental group did not register significantly higher mean scores on the Case Analysis Attitude Scale at post-test and higher mean ranks on the Case Analysis Self-Evaluation Scale, the Blended Learning Satisfaction Scale, and the Metacognition Scale at post-test than the control group. Moreover, the experimental group registered significant progress in the mean ranks on the Case Analysis Self-Evaluation Scale and the Metacognition Scale from pretest to post-test. CONCLUSIONS: No between-subjects effects of four scales at post-test were found. Newly developed course modules, be it blended learning or a combination of traditional and innovative components, should be tested repeatedly for effectiveness and popularity for the purpose of facilitating the ultimate creation of a most effective course module for nursing education.

Blended learning in ethics education: a survey of nursing students.

Nurses are experiencing new ethical issues as a result of global developments and changes in health care. With health care becoming increasingly sophisticated, and countries facing challenges of graying population, ethical issues involved in health care are bound to expand in quantity and in depth. Blended learning rather as a combination of multiple delivery media designed to promote meaningful learning. Specifically, this study was focused on two questions: (1) the students' satisfaction and attitudes as members of a scenario-based learning process in a blended learning environment; (2) the relationship between students' satisfaction ratings of nursing ethics course and their attitudes in the blended learning environment. In total, 99 senior undergraduate nursing students currently studying at a public nursing college in Taiwan were invited to participate in this study. A cross-sectional survey design was adopted in this study. The participants were asked to fill out two Likert-scale questionnaire surveys: CAAS (Case Analysis Attitude Scale), and BLSS (Blended Learning Satisfaction Scale). The results showed what students felt about their blended learning experiences - mostly items ranged from 3.27-3.76 (the highest score is 5). Another self-assessment of scenario analysis instrument revealed the mean scores ranged from 2.87-4.19. Nearly 57.8% of the participants rated the course 'extremely helpful' or 'very helpful.' This study showed statistically significant correlations (r=0.43) between students' satisfaction with blended learning and case analysis attitudes. In addition, results testified to a potential of the blended learning model proposed in this study to bridge the gap between students and instructors and the one between students and their peers, which are typical of blended learning, and to create meaningful learning by employing blended pedagogical consideration in the course design. The use of scenario instruction enables students to develop critical analysis and problem solving skills through active learning and social exchange of ideas.

The process of acquiring practical knowledge by emergency nursing professionals in taiwan: a phenomenological study.

INTRODUCTION: The emergency department is the front line in the hospital battlefield. Medical staff are frequently tested with highly complex and fast-changing clinical situations. Nurses must acquire practical knowledge in a fast-changing environment in order to provide the most appropriate form of nursing care. This study explores the process of the development of practical knowledge in emergency nurses. METHOD: This study uses a phenomenological approach and in-depth interviews and adopts Moustakas data analysis techniques. In 2007, the researcher interviewed 10 professional nurses with at least 3 years of ED experience and collected 13 interview transcripts. RESULTS: Data analysis identified 4 major themes and 10 sub themes in the process of development of practical knowledge for ED nurses. The 4 major stages in the learning process are (1) matter-of-course apprenticeship, (2) stimulus-response learning, (3) work demand-oriented learning, and (4) self-reflective learning. DISCUSSION: Upon entering the emergency department, nurses began learning by serving as apprentices to seniors. After this, they experienced the stimulus-response learning phase as they responded to stimuli in the form of pressure to grow and learn. As they gradually drifted away from the protection of seniors, they continued to learn in order to meet work demands, hold on to their jobs, and maintain a proper level of professional competence. A small number of participants entered the final stage of self-reflective learning, in which they examined their life experience by self-reflection and developed a proper nursing attitude and knowledge about holistic patient care.