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.

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.

A clinical care competency inventory for nurses in Traditional Chinese Medicine: Development and psychometric evaluation.

The aims of this study were to develop a clinical care competence inventory for Traditional Chinese Medicine nurses and to test its psychometric properties. A cross-sectional survey was conducted in hospitals around Taiwan using a newly developed scale called Clinical Care Competency Inventory for Traditional Chinese Medicine Nurses. A total of 322 participants took the survey, and response rate was 95.7%. An exploratory factory analysis was used to analyze items and confirm the construct validity. Principal Component Analysis is an exploratory factor analysis used to identify the underlying dimension of the constructs of a particular scale. Six factors were determined from this study: evidence-based nursing capability, routine medical auxiliary behavior in acupuncture and moxibustion, medical auxiliary behavior in Traditional Chinese Medicine orthopedics, basic Traditional Chinese Medicine related knowledge and skills, diagnostic questioning and Traditional Chinese Medicine assessment in special conditions, and patient education about Traditional Chinese Medicine nursing which together explained 63.45% of the variance. The findings of this study can assist in the planning of in-service education for Traditional Chinese Medicine nurses. The nurse competence indicators are useful in planning nursing training and letting patients and their families know what to reasonably expect from nurses in relation to traditional Chinese medicine.

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.

An outcome-based educational intervention to improve nursing students' knowledge and competencies in oncology nursing: a randomized controlled Trial.

Background: Caring for cancer patients is a complex process that requires considerable knowledge and a wide range of skills.Aim: The purpose of this study is to demonstrate that outcome-based course design would bring about significant differences in the nursing students' knowledge, confidence, and skills.Method: This was a randomized controlled trial with two-group pretest and post-test experimental study in 2014 involving a total of 213 students. The descriptive and inferential statistics were used to analyze the data.Results: The mean cancer nursing knowledge test score of the experimental group was higher than the control group at the post-test. The mean cognitive load score of the experimental group was lower than the control group at the post-test. The mean learning satisfaction and self-confidence score of the experimental group was higher than the control group.Conclusions: This study demonstrated the feasibility of implementing an outcome-based educational intervention in baccalaureate nursing education.

[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.

Nursing students' experiences of using a smart phone application for a physical assessment course: A qualitative study.

AIM: It is important that nurses possess adequate clinical skills so that the patient receives safe and competent care. Smart phone applications (apps) can promote active learning and the long-term retention of knowledge of undergraduate students. Therefore, the aim of this study was to explore the thoughts and experiences of nursing students who received a smart phone, app-based physical assessment educational intervention. METHODS: A qualitative descriptive approach with in-depth interviews was considered as suitable to obtain a comprehensive understanding of students' experiences of a smart phone-enabled physical assessment course. RESULTS: Based on interviews with 16 nursing students following the intervention, five themes were derived from the analysis of the interview transcripts: "the APP's physical assessment scenarios are very close to real-life clinical situations," "watching physical assessment videos over the APP is a quick way to learn what to do," "the APP is a new way of learning that enhances thinking and reflection," "some nursing students felt that it was out of their depth to analyze the scenarios in the APP," and "the APP needs enhancements in stability and interactivity." CONCLUSION: The findings of this study showed the mobile app as an effective learning aid that promoted transferability of the nursing students' knowledge and past experience. With the help of the APP, the teachers could offer timely guidance to the students.

The family surrogates' psychological experience of making a do-not-resuscitate decision for older relatives: a qualitative study.

BACKGROUND: Many nursing home residents lack autonomous decision-making capacity and rely on family members to make do-not-resuscitate (DNR) decisions. Making DNR decisions can be difficult and complicated for surrogates. However, surrogates' psychological experience in making these decisions for older relatives is not well studied. AIM: To understand the surrogates' psychological experience of making DNR decisions for older relatives in a nursing home. METHODS: The study subjects of this qualitative study were family surrogates of older residents in a nursing home of Taiwan. A self-constructed, semi-structured interview guided in-depth interviews, which were recorded. Content analysis was used to discover themes from verbatim record. RESULTS: Four themes were revealed: lack of psychological preparation, considering issues when making a decision, ambivalent emotional responses and impact of cultural factors. Fifteen subthemes were also found. CONCLUSIONS: Surrogates who must decide whether to make a DNR decision for older relatives experience great emotional conflict. Understanding surrogates' struggles may assist nursing and care staff in managing this difficult situation.

Core neurological examination items for neurology clerks: A modified Delphi study with a grass-roots approach.

BACKGROUND: With the evolution of treatments for neurological diseases, the contents of core neurological examinations (NEs) for medical students may need to be modified. We aimed to establish a consensus on the core NE items for neurology clerks and compare viewpoints between different groups of panelists. METHODS: First, a pilot group proposed the core contents of NEs for neurology clerks. The proposed core NE items were then subject to a modified web-based Delphi process using the online software "SurveyMonkey". A total of 30 panelists from different backgrounds (tutors or learners, neurologists or non-neurologists, community hospitals or medical centers, and different academic positions) participated in the modified Delphi process. Each panelist was asked to agree or disagree on the inclusion of each item using a 9-point Likert scale and was encouraged to provide feedback. We also compared viewpoints between different groups of panelists using the Mann-Whitney U test. RESULTS: Eighty-three items were used for the first round of the Delphi process. Of them, 18 without consensus of being a core NE item for the neurology clerks in the first round and another 14 items suggested by the panelists were further discussed in the second round. Finally, 75 items with different grades were included in the recommended NE items for neurology clerks. CONCLUSIONS: Our findings provide a reference regarding the core NE items for milestone development for neurology clerkships. We hope that prioritizing the NE items in this order can help medical students to learn NE more efficiently.

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.

The effect of integrating constructivist and evidence-based practice on baccalaureate nursing student's cognitive load and learning performance in a research course.

BACKGROUND: Baccalaureate nursing students perceive research as unattractive, doubt the value of nursing research, and do not appreciate the link of research with practice. No studies have examined students' cognitive load during an evidence-based practice research course versus a traditional research course. OBJECTIVES: To assess the effect of integrating constructivist theories and evidence-based practice on student cognitive load and learning performance in a research course. DESIGN: A true experimental study. SETTINGS: A Registered Nurse-to-Bachelor of Science in Nursing program. PARTICIPANTS: Six classes of second-year students. METHODS: Students were randomly allocated to the control group (two classes) or the experimental group (two classes) using cluster randomization. The control group underwent "traditional research"; the experimental group experienced "integrating evidence-based practice into research." Instruments for outcome assessment include the Cognitive Load Scale, cognitive test, team critique paper, and qualitative feedback on course satisfaction. The between-subjects effects were compared by Analysis of Covariance. RESULTS: The experimental group had significantly higher mental load (8.74 vs. 7.27, p<.001), mental effort (11.07 vs. 10.07, p=.009), mental efficiency (0.33 vs. -0.31, p<.001), and research knowledge (70.61 vs. 44.92, p<.001) than the control group. The experimental group had better critique paper scores in introduction (92.80%), literature review (91.70%), and assignment requirement and writing (89.40%). Some experimental learners expressed satisfaction with learning evidence-based practice (17.78%) and critiquing a research article (7.78%). CONCLUSIONS: Integrating evidence-based practice into a research course not only improved the research knowledge of baccalaureate nursing students, but also increased their mental load, mental effort, and mental efficiency. Additional studies may track learners' responses to different learning systems using the developed instrument to measure the three types of cognitive load. These findings may help educators design more effective and interesting curricula for integrating research and evidence-based practice into the studies of student nurses.

Randomized comparison between objective-based lectures and outcome-based concept mapping for teaching neurological care to nursing students.

BACKGROUND: Pre-registration programs have been found to insufficiently prepare nurses for working in the neurosciences specialism. Effective approaches to neurology education are important, not only to enhance motivation to learn, but also for learners to develop basic competence in handling patients with neurological problems. OBJECTIVES: To demonstrate that outcome-based course design using concept mapping would bring about significant differences in the nursing students' competency, cognitive load, and learning satisfaction with the neurological care course. METHODS: A two-group pretest and post-test experimental study was administered. Two of the four clusters of participants were randomly assigned to the experimental group for experiencing an outcome-based course design using concept mapping, and the rest were designated the control group to be given objective-based lectures only. The Competency Inventory of Nursing Students, Cognitive Load Scale of Neurological Nursing, and Learning Satisfaction Scale of Neurological Nursing were used in this study for the students to rate their own performance. In addition, The Concept Map Scoring Scale was used in the experimental group for examining students' concept mapping ability. RESULTS: Significant increases of mean nursing competency scores in both groups from pre-test to post-test were found. There was no statistically significant difference in mean nursing competency score between the experimental group and the control groups at post-test. The mean cognitive load score of the experimental group was lower than the control group at post-test. The mean learning satisfaction scores of the experimental group were higher than the control group. CONCLUSIONS: This article provides that outcome-based concept mapping as educational method could encourage a group of nursing students to take a bio-psycho-social approach to medicine, which might ultimately result in better nursing care quality.

Development of a Needs Scale for Nurses Receiving In-Service Palliative Care Education.

BACKGROUND: Nurses play pivotal roles on palliative care teams and are able to spend more time with patients and their families than are other healthcare professionals. As a consequence, assessing the needs for palliative care education in connection with in-service classes for nurses is clearly extremely important and can help in the planning of appropriate palliative care classes to enhance the quality of care. OBJECTIVES: The goals of this study were to investigate the content needs of nurses with regard to a palliative care in-service education program and to perform exploratory factor analysis on those needs. METHODS: This study used a cross-sectional questionnaire survey. A total of 614 questionnaires were distributed, and 600 valid questionnaires were returned (97.72%). Data analysis was performed by means of descriptive statistics, reliability analysis, factor analysis, and Pearson correlation. RESULTS: The 6 factors discovered by exploratory factor analysis were handling of pain and symptoms, ethical issues concerning terminal patients, hospice preparation and care, the concept of palliative care, communication and counseling, and cultural and spiritual factors, which together explained 77.22% of the variance. CONCLUSION: The results of this study shed light on the program needs for in-service education about palliative care and the 6 factors most associated with those needs. IMPLICATIONS FOR PRACTICE: In order to realize the whole-person concept of care, future efforts should target the planning of palliative care in-service education programs, strengthening of nurse training, coordination of administrative resources, and interteam cooperation.

[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.

[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.

The effects of scenario-based simulation course training on nurses' communication competence and self-efficacy: a randomized controlled trial.

Studies have shown that an underappreciation of the importance of person-centered communication and inappropriate communication training could result in unsatisfactory communication performance from nurses. There are a large number of studies about communication training for nurses, but not so many about communication training in early stages of nursing career. The purpose of this study is to compare the effect of a traditional course versus scenario-based simulation training on nurses' communication competency, communication self-efficacy, and communication performance in discharge planning Objective Structured Clinical Examination (OSCE). A randomized controlled trial was used with a pretest and two posttests. The experimental group underwent the scenario-based simulation course, whereas the control group received the traditional course. A convenience sample of 116 nurses with qualifications ranging from N0 level (novice nurses) to N2 level (competent nurses) in Taiwan's clinical nursing ladder system was recruited from a medical center in northern Taiwan. Analysis of covariance was used to determine between-subjects effects on communication competency and self-efficacy, whereas independent t test and Mann-Whitney U test were used to examine between-subjects effects on learner satisfaction and discharge planning communication performance. Paired t test was used to determine communication self-efficacy. In this study, the nurses and independent raters found scenario-based simulation training more effective than traditional communication course. However, standardized patients reported no significant difference in communication performance between the two groups of nurses. Despite that traditional classroom lectures and simulation-based communication training could both produce enhanced communication competency and self-efficacy among nurses, this study has established that the latter may be better than the former in terms of learner satisfaction and communication performance improvement. Therefore, introduction of simulation-based training to in-service nursing education could enhance nurses' communication performance in clinical practice.

Performance evaluation of nursing students following competency-based education.

BACKGROUND: Competency-based education is known to improve the match between educational performance and employment opportunities. OBJECTIVES: This study examined the effects of competency-based education on the learning outcomes of undergraduate nursing students. DESIGN: The study used a quasi-experimental design. PARTICIPANTS: A convenience sample of 312 second-year undergraduate nursing students from northern and southern Taiwan participated in the study. METHODS: The experimental group (n=163) received competency-based education and the control group received traditional instruction (n=149) in a medical-surgical nursing course. Outcome measures included students' scores on the Objective Structured Clinical Examination, Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students questionnaire, and academic performance. RESULTS: Students who received competency-based education had significantly higher academic performance in the medical-surgical nursing course and practicum than did the control group. Required core competencies and metacognitive abilities improved significantly in the competency-based education group as compared to the control group after adjusting for covariates. CONCLUSIONS: Competency-based education is worth implementing and may close the gap between education and the ever-changing work environment.

[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.

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.

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.