Nursing students' view of critical thinking as 'Own thinking, searching for truth, and cultural influences'.

INTRODUCTION: Students should enhance their ability to think critically as part of a process of whole-person development. BACKGROUND: Within nursing education, students should employ critical thinking to ensure quality of patient care and patient safety. AIM: The aim of this study was to explore the perspectives of nursing students on critical thinking. DESIGN: A descriptive qualitative study. METHODS: This was a focus group study involving 65 nursing students from one school of nursing. A total of eleven focus group interviews were conducted. The semi-structured interview guideline was used. All interviews were audio recorded, transcribed in Chinese and translated into English. Thematic analysis was adopted. RESULTS: Three themes centred on critical thinking were discerned: own thinking, searching for truth, and cultural influences. CONCLUSIONS: It is suggested that future studies be conducted on how these factors might affect critical thinking. In addition, multiple nursing schools could become involved in these studies to obtain rich data and enrich the picture of students' views on critical thinking. If nurses have more time to think about what is going on, they could think critically about what they are actually doing. This would help to protect the safety of patients and to reduce the occurrence of medical accidents.

Academic advising in undergraduate education: A systematic review.

OBJECTIVES: The aim of this review is to describe academic advising schemes at the undergraduate level, examine the perspectives of advisors and advisees towards the schemes, and explore the implications of academic advising in undergraduate and nursing education. DESIGN: A systematic review was conducted of the protocol of PRISMA-P. DATA SOURCES: Six electronic databases were searched for journal articles, namely, Academic Search Premier, CINAHL, ERIC, Medline, Teacher Reference Center, and Scopus. REVIEW METHODS: A total of 6189 articles were examined, and 37 empirical studies were included in the final review. The Mixed Methods Appraisal Tool (MMAT) was used to assess the eligibility of studies for inclusion in the review. RESULTS: The review involved summarizing and categorizing the components of existing academic advising schemes, analysing the perspectives of advisors and advisees, and identifying four aspects of the perspectives of advisees: their experiences, preferences, benefits gained from the scheme, and barriers to seeking help from advisors. Six issues relating to academic advising schemes were discussed: insufficient information about the schemes, the means of communication used in the process of advising, the issue of time management for both advisors and advisees, a lack of training for advisors, the evaluation of the outcomes of advising, and the implications for nursing education. CONCLUSIONS: Advisors and advisees held positive views of the scheme. Academic advising benefited students and advisors, even as some barriers were identified. It is suggested that sufficient training, better time management, and the utilization of different tools for communication are needed to increase the effectiveness of academic advising. Further studies should be conducted to investigate the effects of different elements of the scheme on the outcome of advising.

Self-Stigma Reduction Interventions for People Living with HIV/AIDS and Their Families: A Systematic Review.

Stigma is a primary concern for people living with human immunodeficiency virus (HIV)/AIDS (PLWHA), and has great impact on their and their family members' health. While previous reviews have largely focused on the public stigma, this systematic review aims to evaluate the impact of HIV/acquired immunodeficiency syndrome (AIDS)-related self-stigma reduction interventions among PLWHA and their families. A literature search using eight databases found 23 studies meeting the inclusion criteria. Five types of intervention approaches were identified: (1) psycho-educational intervention, (2) supportive intervention for treatment adherence (antiretroviral therapy), (3) psychotherapy intervention, (4) narrative intervention, and (5) community participation intervention. Overall, the reviewed articles suggested a general trend of promising effectiveness of these interventions for PLWHA and their family members. Psycho-educational interventions were the main approach. The results highlighted the need for more interventions targeting family members of PLWHA, and mixed-methods intervention studies.

Conflicting identities between sex workers and motherhood: A systematic review.

Being a mother is a traditional and central role for women. However, due to criminalization, social stigma and marginalized lifestyles, female sex workers (FSWs) may encounter disadvantages and social inequality. The aim of this review was to synthesize the results of studies focused on the challenges that FSWs face in negotiating their maternal identity with their stigmatized identity as sex workers. A total of 21 studies published from 2002 to 2016 were included in this review. Textual narrative and a thematic synthesis approach were adopted to synthesize key themes. Two common themes across countries were identified: conflicting identities between the jobs as sex workers and motherhood and responses to social expectations of ideal motherhood. Given the challenges that FSWs face with motherhood, comprehensive services, including health, family, social, and legal services, are needed to support FSWs as individuals and as mothers. A more holistic approach is recommended to address their physical, emotional, financial, and social problems faced by FSWs. Services should be offered in a friendly and non-judgmental manner. Further, to advance the health and safety of FSWs and their children, prostitution law may need to move toward decriminalization of sex work and educate the general public about respecting FSWs.

Curriculum design and attrition among undergraduate nursing students: A systematic review.

Attrition rates among nursing students are a global issue, and a possible factor in current nursing shortages. Numerous studies have been conducted to determine why students drop out of nursing programmes. The limitations of previous studies have included overly small sample sizes, being largely descriptive, and not focusing on attrition as an outcome. The aim of this study is to review the issue of attrition among undergraduate nursing students in relation to curriculum design. Five electronic databases, namely CINAHL, Medline, Cochrane Library, British Nursing Index, and PsycINFO, were adopted. Using the Population-Intervention-Comparison-Outcome model, search terms were identified, such as 'student nurse', 'undergraduate programme', 'curriculum design', and 'attrition'. Mixed Method Appraisal Tools were used to evaluate the methodological quality of the identified research papers. A total of 16 publications were reviewed and four themes were identified: pre-enrolment criteria for recruiting nursing students; curriculum content; clinical placement-related policies; and student support services. Institutional-level risk factors that could be reduced were identified, including academic failure, poor clinical performance, stress, and unrealistic expectations of nursing. This review gives insights into how a curriculum for undergraduate nursing programmes can be designed that will engage students and increase the nursing workforce.

Metaphorical interpretations of the educator-student relationship: An innovation in nursing educational research.

Previous research has shown that collecting and analysing metaphors is a useful strategy in seeking data that are difficult to collect via verbal interviews or that cannot be represented by statistics. This study explored nursing students' perceptions of the educator-student relationship using metaphorical interpretation. A qualitative study with a personal essay approach was adopted. A total of 124 students were recruited from a nursing school in Hong Kong. A personal essay form was distributed to the participants. They were asked to give a metaphor with explanations to describe the power dynamics in the educator-student relationship, within 200 words in English or Chinese. After some thought, the participants each gave their own metaphor individually, because the aim of this study was to collect their subjective experiences. The results were presented as follows: a) The overall description of the metaphors; b) The three groups of metaphors; c) The fives natures of metaphors; d) The most significant metaphors; and e) The four thematic meanings - (i) nurturing role; (ii) guiding role; (iii) insufficient connection; and (iv) promoting development. The implications for research methods and nurse education of collecting and analyzing metaphors were discussed. Discrepancies in metaphorical interpretations are to be expected, as interpretations are dependent on the researchers' socio-cultural background, personal experiences, professional training, languages spoken, and other factors.

A qualitative study on communication between nursing students and the family members of patients.

BACKGROUND: When caring for a family as a unit, it is as crucial to communicate with the family members of a patient as it is with the patient. However, there is a lack of research on the views of nursing students on communicating with the family members of patients, and little has been mentioned in the nursing curriculum on this topic. AIM: The aim of this study was to explore nursing students' experiences of communicating with the family members of patients. DESIGN: A qualitative descriptive study. METHODS: A total of 42 nursing students (21 undergraduate year-two students and 21 were master's year-one students) from one school of nursing in Hong Kong participated in in-depth individual interviews. Content analysis was adopted. The trustworthiness of this study was ensured by enhancing its credibility, confirmability, and dependability. RESULTS: Two main themes were discerned. The first, "inspirations gained from nursing student-family communication", included the following sub-themes: (a) responding to enquiries clearly, (b) avoiding sensitive topics, (c) listening to the patient's family, and (d) sharing one's own experiences. The second, "emotions aroused from nursing student-family communication", had the following sub-themes: (a) happiness, (b) anger, (c) sadness, and (d) anxiety. CONCLUSIONS: More studies on the perspectives of nursing students on communicating with family members should be conducted, to strengthen the contents and learning outcomes of nursing student-family communication in the existing nursing curriculum.

A qualitative study on feedback provided by students in nurse education.

BACKGROUND: This study aims to help nurse educators/academics understand the perspectives and expectations of students providing their feedback to educators about teaching performance and subject quality. AIM: The aim of this study is to reveal students' voices regarding their feedback in nurse education in order to shed light on how the current student feedback practice may be modified. DESIGN: A qualitative study using focus group inquiry. METHODS: Convenience sampling was adopted and participants recruited from one school of nursing in Hong Kong. A total of 66 nursing students from two pre-registration programs were recruited for seven focus group interviews: one group of Year 1 students (n=21), two groups of Year 3 students (n=27), and four groups of Final Year students (n=18). The interviews were guided by a semi-structured interview guideline and the interview narratives were processed through content analysis. The trustworthiness of this study was guaranteed through peer checking, research meetings, and an audit trail. The participants' privacy was protected throughout the study. RESULTS: Four core themes were discerned based on the narratives of the focus group interviews: (1) "timing of collecting feedback at more than one time point"; (2) "modify the questions being asked in collecting student feedback"; (3) "are electronic means of collecting feedback good enough?; and (4) "what will be next for student feedback?". CONCLUSIONS: This study is significant in the following three domains: 1) it contributed to student feedback because it examined the issue from a student's perspective; 2) it explored the timing and channels for collecting feedback from the students' point of view; and 3) it showed the preferred uses of student feedback.

The Socio-Ecological Model Approach to Understanding Barriers and Facilitators to the Accessing of Health Services by Sex Workers: A Systematic Review.

Inequities in accessing health care persist among sex workers. The purpose of the review is to understand the health-seeking behaviours of sex workers and their access to health care services with socio-ecological model. Of 3852 citations screened, 30 met the inclusion criteria for this review. The access that sex workers have to health services is a complex issue. A wide range of barriers and facilitators at multiple levels could influence sex workers' utilization of health care services, such as health or service information, stigma, social support, quality of health care, available, accessible and affordable services, healthcare policy. Health services or future intervention studies should take into account the facilitators and barriers identified in this review to improve the health services utilization and health of sex workers, as part of the effort to protect the right of humans to health.

A qualitative study on using concept maps in problem-based learning.

BACKGROUND: The visual arts, including concept maps, have been shown to be effective tools for facilitating student learning. However, the use of concept maps in nursing education has been under-explored. OBJECTIVES: The aim of this study was to explore how students develop concept maps and what these concept maps consist of, and their views on the use of concept maps as a learning activity in a PBL class. DESIGN: A qualitative approach consisting of an analysis of the contents of the concept maps and interviews with students. SETTINGS: The study was conducted in a school of nursing in a university in Hong Kong. PARTICIPANTS: A total of 38 students who attended the morning session (20 students) and afternoon session (18 students) respectively of a nursing problem-based learning class. METHODS: The students in both the morning and afternoon classes were allocated into four groups (4-5 students per group). Each group was asked to draw two concept maps based on a given scenario, and then to participate in a follow-up interview. Two raters individually assessed the concept maps, and then discussed their views with each other. RESULTS: Among the concept maps that were drawn, four were selected. Their four core features of those maps were: a) the integration of informative and artistic elements; b) the delivery of sensational messages; c) the use of images rather than words; and d) three-dimensional and movable. Both raters were concerned about how informative the presentation was, the composition of the elements, and the ease of comprehension, and appreciated the three-dimensional presentation and effective use of images. From the results of the interview, the pros and cons of using concept maps were discerned. CONCLUSIONS: This study demonstrated how concept maps could be implemented in a PBL class to boost the students' creativity and to motivate them to learn. This study suggests the use of concept maps as an initiative to motivate student to learn, participate actively, and nurture their creativity. To conclude, this study explored an alternative way for students to make presentations and pioneered the use of art-based concept maps to facilitate student learning.

Uncovering nursing students' views of their relationship with educators in a university context: A descriptive qualitative study.

INTRODUCTION: Power dynamics is a key element in the educator-student relationship, and can be influential to the learning outcomes of students. BACKGROUND: Power relations are inherent in the interaction between educators and students. The educator-student relationship is still an under-explored area of power dynamics. AIM: The aim of the study was to investigate nursing students' perceptions of the power dynamics in the educator-student relationship in a university learning context in order to offer educators some understanding of how such a relationship was perceived by students. DESIGN: A descriptive qualitative study using focus group inquiry. METHODS: Through convenience sampling, a total of 56 students were recruited and eight focus group interviews were conducted. Thematic analysis was adopted to capture the meanings extracted from the student narratives. RESULTS: Four core themes of the educator-student relationship were identified. Referring to these themes, some implications were drawn, such as the significance of the educator-student relationship; an educator's power matters; and polarized views among the students on whether or not an educator should be a friend. CONCLUSIONS: The power dynamics varied depending on an educator's personality, communication skills, ability to effectively monitor large classes, and teaching style. More efforts are needed to investigate the preferred conceptions and types of educator-student relationships in order to evaluate the impact that these have on learning.

The nurse-patient communication: voices from nursing students.

BACKGROUND: Effective communication skills have been found to be one of the pivotal factors in building positive interpersonal relationships. Little is known about nursing undergraduates' perspectives on communicating with patients. OBJECTIVE: This study aimed to explore nursing students' perspectives and experiences of nurse-patient communication in their clinical placement. METHODS: The participants included 21 second-year undergraduates and 21 first-year master's students. Interviews were conducted in Cantonese and then transcribed in Chinese and translated into English. A content analysis approach was adopted to analyze the data. RESULTS: Five themes emerged from the interview data. 'The necessity of nurse-patient communication' reveals why the students valued nurse-patient communication. 'The conversation contents' describes the content of the conversations that students typically had with patients. The third theme is 'self-reflection on the nurse-patient communication'. The last two themes, 'the communication pattern in different hospital settings' and 'the obstacles impeding nurse-patient communication', are about the students' communication styles in different hospitals and the barriers they encounter. DISCUSSION: To improve students' communication skills, educators and clinical staff should listen to students, enhance students' reflective skills and strengthen their confidence. CONCLUSION: Through understanding students' difficulties in the nurse-patient communication experience and the skills that they lack, educators can provide them with helpful recommendations to improve their communication skills in clinical practice. PRACTICE IMPLICATIONS: The results of this study reveal that students' nurse-patient communication skills need to be improved.

We are different: the voices of psychiatric advanced practice nurses on the performance of their roles.

BACKGROUND: Many studies have affirmed that psychiatric advanced practice nurses (APNs) perform multifaceted roles. However, only a limited amount of research has been conducted on their perceptions of the performance of their roles. AIM: To explore the lived experiences of psychiatric APNs concerning the performance of their roles. DESIGN: Data were collected from individual semi-structured interviews and analysed using the interpretative phenomenological analysis method. METHODS: The study was conducted in a hospital cluster in Hong Kong. Thirteen psychiatric APNs were purposively recruited. RESULTS: Three themes were discerned, namely, 'We are different', 'Who am I?', and 'I am who I am'. CONCLUSIONS: The findings can help psychiatric APNs and nurse administrators to better understand the needs of the role-bearers (APNs) and to develop strategies to support the development of advanced psychiatric nursing practices in Hong Kong and worldwide.

A qualitative study of freshmen's and academic advisors' perspectives on academic advising in nursing.

Many universities have established academic advisor schemes so that academic advisors play a proactive role in supporting freshmen, helping them to achieve both academic goals and personal and professional aspirations. This research aimed to explore freshmen's and academic advisors' perspectives on the academic advisor scheme of a nursing school. A total of 79 participants (74 freshmen and five academic advisors) were recruited to participate in this qualitative research. The freshmen participated in a focus group interview, with 6-10 freshmen per group, and the academic advisors participated in an individual in-depth interview. Both expressed their perspectives on academic advising in four domains: (i) relationship building, (ii) academic development, (iii) personal growth, and (iv) professional goals. Most of the freshmen were satisfied and indicated that they had benefited from the academic advisor scheme, suggesting that academic advisors played a significant role in advising and supporting them. However, the results showed that relationships between freshmen and academic advisors should be further strengthened.

A systematic review on critical thinking in medical education.

BACKGROUND: Critical thinking is the ability to raise discriminating questions in an attempt to search for better ideas, a deeper understanding and better solutions relating to a given issue. OBJECTIVE: This systematic review provides a summary of efforts that have been made to enhance and assess critical thinking in medical education. DESIGN: Nine databases [Ovid MEDLINE(R), AMED, Academic Search Premier, ERIC, CINAHL, Web of Science, JSTOR, SCOPUS and PsycINFO] were searched to identify journal articles published from the start of each database to October 2012. RESULTS: A total of 41 articles published from 1981 to 2012 were categorised into two main themes: (i) evaluation of current education on critical thinking and (ii) development of new strategies about critical thinking. Under each theme, the teaching strategies, assessment tools, uses of multimedia and stakeholders were analysed. DISCUSSION: While a majority of studies developed teaching strategies and multimedia tools, a further examination of their quality and variety could yield some insights. The articles on assessment placed a greater focus on learning outcomes than on learning processes. It is expected that more research will be conducted on teacher development and students' voices.

Student peer reviewers' views on teaching innovations and imaginative learning.

BACKGROUND: Various teaching innovations have been proven effective in promoting students' critical thinking, creativity, problem solving and active learning. However, little attention has been paid to the possibility of including students as peer reviewers to evaluate these innovations in light of imaginative learning. AIM: This study explored the perspective of senior students who played the role of the student peer reviewer on three teaching innovations, namely writing poetry, composing songs and creating role-plays in problem-based learning (PBL), specifically in relation to imaginative learning. DESIGN: A focus group interview. METHODS: Ten senior nursing students who had experienced the conventional PBL approach but not the mentioned teaching innovations were invited to participate in reviewing a video recording of a PBL class using the above teaching innovations with a total of 18 junior year students. RESULTS: Five themes were identified using content analysis: (i) motivation to learn, (ii) increased empathy, (iii) information retention, (iv) development of critical thinking and creativity, and (v) drawbacks of teaching innovations. CONCLUSIONS: It is suggested that student peer reviewers should be considered, as they can bring an outsider-learner's views on understanding the impacts of teaching innovations on imaginative learning. A call should be made to invite student peer reviewers on teaching and learning approaches, and more effort should be devoted to promoting an understanding of how imaginative learning can be achieved via teaching innovations.

Students' and experts' perspectives on three learning and teaching activities.

Nursing is a profession that closely related to human life, and nurses are required to demonstrate critical thinking and creativity in providing health care services. However, traditional teaching approaches usually limit students' autonomy and freedom of expressing their thoughts and feelings. In order to develop the corresponding competence of nursing students, I adopted three teaching innovations, namely writing poems, composing songs, and using role plays in a nursing problem-based learning class in a university in Hong Kong. According to students' reflective notes and comments from two international expert reviewers, participating in these activities is a valuable experience and students were able to develop clinical reasoning, empathy, team spirit, motivation to learn, creativity, and ability to summarise and reconstruct knowledge. It is hoped that more innovative learning activities will be implemented, to prepare professional and ethical nurses in the future. It is also hoped that this study could provide other PBL educators some insights in innovative problem-based learning activities.

Nursing problem-based learning activity: song writing and singing.

The function of song is not only to deliver individual's messages, but also to serve as a learning approach to facilitate students' learning. To observe the effectiveness of songs in facilitating students' learning, a Problem-based Learning (PBL) class with twenty students was divided into four groups with five students per group. Each group was asked to write a song based on two given scenarios, to sing the song out loud, and to participate in a follow-up focus group interview afterwards. The four songs reflected the students' understanding of academic knowledge and their perspectives toward the protagonists in the presented scenarios. Two songs are presented in this paper to demonstrate how the approach was carried out in the nursing PBL class. This paper aims to show the implication of song writing and singing in PBL and shed some light on teaching and learning.

Self-image of male nursing students in Hong Kong: multi-qualitative approaches.

The image of male nurses is closely related to the development of a female-driven nursing occupation. As a minority group in the nursing industry, male nursing students may have a negative self-image in their learning and clinical practicum. This may affect their psychological health and mental status. This study explored the positive and negative self-image of male nursing students. Eighteen participants were recruited from a local nurse-training institute. The participants were undergraduate bachelor's and master's students of nursing. The experience and opinions of the participants were collected by multiple methods. The participants' drawings and audio diaries representing their self-image as nurses were collected in advance of a discussion of ideas raised in the focus group interview. The findings were categorized into three themes: (a) self-roles, functions, and identities; (b) awareness of gender differences; and (c) the future of professional development. The findings of this study provide information on the nurse role, identity, gender differences, and professional development of male nursing students, which will drive the direction of the development of a positive image for male nurses in the future.