Effect of simulation-based zoom learning on clinical decision-making among undergraduate nursing students and experiences of students and instructors: A mixed methods study.

Aim: To determine the effect of simulation-based Zoom learning (SBZL) on perceived capabilities and clinical decision-making skills among undergraduate nursing students and to explore experiences of the instructors and students participating in SBZL. Background: Nursing is a practice profession and students acquire clinical decision-making skills in clinical settings. However, the COVID-19 pandemic has disrupted conventional clinical learning activities. In this study, the outcomes of implementing SBZL in an undergraduate programme to support students' clinical learning were examined. Design: A mixed methods design was employed. Methods: This study recruited 195 final-year students to participate in the SBZL programme, which was developed based on the NLN Jeffries Simulation Theory to guide its design, implementation and evaluation. Case scenarios were developed and simulated through Zoom. Students' perceived capabilities, perceptions of the learning environment and clinical decision-making skills were assessed before and after SBZL. A historical control group of 226 previous final year students who had received a clinical practicum was included for comparison. Semi-structured interviews were conducted with 11 instructors and 19 students to explore their experiences of participating in SBZL. Results: A total of 102 students completed the post-SBZL questionnaire. An increase in perceived creative thinking (mean difference = 0.24, p < 0.001) was observed post-SBZL. After SBZL, the perceptions of the learning environment were significantly improved. However, the SBZL group demonstrated lower perceived problem-solving capability than the control group (mean difference = 0.14, p = 0.007). Clinical decision-making was significantly improved in the SBZL group than in the control group (p < 0.001). Both the instructors and students reported positive experiences with SBZL, and highlighted challenges and factors for improving its implementation. Conclusions: SBZL showed improvement in perceived creative thinking, perceptions of the learning environment and clinical decision-making. This innovative teaching and learning method can be valuable for nursing education in various regions to prepare students for real-life roles. Tweetable abstract: Simulation-based Zoom learning is better than traditional teaching in improving clinical decision-making skills among undergraduate nursing students.

Impacts of ethical climate and ethical sensitivity on caring efficacy.

BACKGROUND: Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses. RESEARCH AIM: This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy. RESEARCH DESIGN: This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively. PARTICIPANTS AND RESEARCH CONTEXT: The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. RESULTS: Ethical climate was associated with caring efficacy (ß = 0.340, p < .001) and ethical sensitivity (ß = 0.197, p < .001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy (ß = 0.860, p < .001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect. CONCLUSIONS: The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses' caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.

Enhancing generic capabilities and metacognitive awareness of first-year nursing students using active learning strategy.

BACKGROUND: Developing students' generic capabilities is a major goal of university education as it can help to equip students with life-long learning skills and promote holistic personal development. However, traditional didactic teaching has not been very successful in achieving this aim. Kember and Leung's Teaching and Learning Model suggests an interactive learning environment has a strong impact on developing students' generic capabilities. Metacognitive awareness is also known to be related to generic capability development. This study aimed to assess changes on the development of generic capabilities and metacognitive awareness after the introduction of active learning strategy among nursing students. METHODS: This study adopted a quasi-experimental single group, matched pre- and posttest design. It was conducted in a school of nursing at a university in Hong Kong. Active learning approaches included the flipped classroom (an emphasis on pre-reading) and enhanced lectures (the breaking down of a long lecture into several mini-lectures and supplemented by interactive learning activities) were introduced in a foundational nursing course. The Capabilities Subscale of the Student Engagement Questionnaire and the Metacognitive Awareness Inventory were administered to two hundred students at the start (T0) and at the end of the course (T1). A paired t-test was performed to examine the changes in general capabilities and metacognitive awareness between T0 and T1. RESULTS: A total of 139 paired pre- and post-study responses (69.5 %) were received. Significant improvements were observed in the critical thinking (p < 0.001), creative thinking (p = 0.03), problem-solving (p < 0.001) and communication skills (p = 0.04) with the implementation of active learning. Significant changes were also observed in knowledge of cognition (p < 0.001) and regulation of cognition (p < 0.001) in the metacognitive awareness scales. CONCLUSIONS: Active learning is a novel and effective teaching approach that can be applied in the nursing education field. It has great potential to enhance students' development of generic capabilities and metacognitive awareness.

A video-supported nurse-led advance care planning on end-of-life decision-making among frail older patients: Protocol for a randomized controlled trial.

AIM: To examine the effect of a video-supported nurse-led advance care planning to frail geriatric patients on end-of-life decision-making outcomes in patients and their carers. DESIGN: This is a double-blinded randomized controlled trial with parallel arms. METHODS: The protocol was approved by the Institutional Review Board of the participating hospital on 1 August 2018. Frail elders and their carer if any are enrolled during hospitalization, and undergo randomization after discharged. The intervention group receives a 2-week video-supported nurse-led advance care planning programme (N = 149) while the control group receives a 2-week health education program at home (N = 149). Follow-up surveys via telephone at 1 and 6 months measure outcomes regarding end-of-life decision-making from both the patients and the carers. CONCLUSION: Advance care planning discussion is to understand patient's values, preferences and treatment for care on their anticipation of future deterioration. Treatment options for end-of-life care may not be well-received especially elders because in the discussion process, technical medical terms are presented in an abstract, hypothetical way that are hard to understand. The present study aims to evaluate the effect of a nurse-led advance care planning supplementing with a video showing end-of-life treatment options to promote end-of-life care decision-making among frail geriatric patients. IMPACT: The results will help identify effective elements of advance care planning and inform the development of an evidence?based structured advance care planning intervention in response to the need for quality end-of-life care. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IOR-17012341.

Four Es of caring in contemporary nursing: Exploring novice to experienced nurses.

Caring seems to be undervalued in the technologically-advanced and fast-paced clinical environment. To improve nursing practice, it is important to understand the meanings of caring to nurses. The aim of the present study was to explore nurses' perspectives of caring in the contemporary clinical environment. A focus group exploration was employed. Multiple perspectives were elicited from 80 nurses with different backgrounds: nursing students, nurse educators, registered nurses, advanced clinical nurses, and nurse executives. The qualitative data were analyzed using thematic analysis. Nurses' understanding of caring could be described using four Es: engaging in reciprocal relationships, embracing the essence of caring, engendering instances of caring, and embodying caring in practice. Participants described nurses as having the dual roles of caregiver and care recipient. The centrality of caring in nursing and the necessity of caring for caregivers were emphasized. The nurses also described various caring behaviors in daily practice. The present study revealed that nurses need empowerment to sustain their compassion. The findings provide new insights, which indicate that the revitalization of nurses' passion for caring in the contemporary clinical environment should begin with caring for caregivers.

A Phenomenological Study of Hospital Readmissions of Chinese Older People With COPD.

Purpose of the Study: Hospital readmission is prevalent among older people with chronic obstructive pulmonary disease (COPD). Studies in this area have primarily identified the associated factors. A thorough understanding of the issue can be achieved by interpreting the related experiences in its context. This study aimed to explore the lived experience of hospital readmissions of Chinese older people with COPD. Design and Methods: The lived experience of hospital readmissions was acquired through descriptive phenomenology. Unstructured interviews were conducted with 22 Chinese older people readmitted to a hospital for COPD. Narrative descriptions were analyzed using the phenomenological method described by Giorgi. Results: Six constituents emerged from the general structure of the lived experience. "Refraining from unnecessary readmissions" describes how older people manage COPD in relation to hospital readmissions. "Craving for survival" explains why they seek hospital readmissions. "Feeling disregarded and powerless" and "being conscious of relieving burden to families" characterize their experience of hospital readmissions. "Resigning to hospital readmissions" illustrates how they understand the phenomenon, and "living for the moment" illuminates how they live with these experiences. These constituents are interrelated in meaningful ways and comprise the whole phenomenon of hospital readmissions. Implications: The Chinese older people's experience revealed that hospital readmissions are complex experiences shaped by their sociocultural context. Older people appear to accept and cope well with hospital readmissions. However, this study uncovered their unmet needs, which may undermine their dignity. The findings of this study offer implications for promoting wellness among Chinese older people with COPD.