Establishing the competences of clinical reasoning for nursing students in Taiwan: From the nurse educators' perspectives.

BACKGROUND: Clinical reasoning is an essential core competence for nurses. Maintaining quality of care and safety of patients results from cultivation of student's clinical reasoning competency. However, the concept of clinical reasoning in nursing students is complex and its meaning and process needs further clarification. OBJECTIVES: The objectives were to explore the meaning of clinical reasoning competency in Taiwanese nursing students and to operationalize the concept in order to structure a framework illustrating the process of clinical reasoning. SETTING AND PARTICIPANTS: Thirteen seasoned nursing experts who had more than ten years of experience in nursing education or clinical practice participated in the interviews. The interviews were conducted in settings that the participants perceived as convenient, quiet and free of disturbance. METHODS: Semi-structured interviews were conducted. The interviews were audio-recorded and field notes were taken. The data were analyzed using Waltz et al.'s (2010) method of content analysis. RESULTS: The data revealed four domains and 11 competency indicators. The four domains include: awareness of clinical cues, confirmation of clinical problems, determination and implementation of actions, and evaluation and self-reflection. Each domain comprises of 2-4 indicators of clinical reasoning competency. In addition, this study established a framework for cultivation of clinical reasoning competency in nursing students. CONCLUSION: The indicators of clinical reasoning competency in nursing students are interwoven, interactive and interdependent to form a dynamic process. The findings of this study may facilitate evaluation of nursing students' clinical reasoning competency and development of instruments to assess clinical reasoning in nursing students.

Using Training Needs Assessment to Develop a Nurse Preceptor-Centered Training Program.

BACKGROUND: Studies reveal that most nurse preceptor preparation programs do not meet nurse preceptors' training needs. This study thus developed a nurse preceptor-centered training program (NPCTP) in Taiwan. METHOD: The ADDIE model was used for the instructional design. On the basis of the nurse preceptors' training needs assessment, the research team developed the NPCTP. Content was adopted from the authentic experiences of preceptors and new graduate nurses (NGNs) using interview data to make 81 videos with computer avatars and 10 live actor films. Each course was taught as nine instructional events. The NPCTP was evaluated using reflection quizzes, preceptors' self-evaluations, NGNs' evaluations, and focus group interviews. RESULTS: The NPCTP enhanced preceptors' clinical teaching behaviors and had a positive influence on NGNs. The NGN evaluation was even better than the preceptors' self-evaluation. CONCLUSION: This article provides the what and how for an NPCTP in Taiwan. J Contin Nurs Educ. 2017;48(5):220-229.

The lived experiences of aboriginal adolescent survivors of childhood cancer during the recovering process in Taiwan: A descriptive qualitative research.

PURPOSE: The purpose of this study was to understand the experiences of Taiwanese aboriginal adolescent survivors of childhood cancer during the process of recovery. METHOD: A snowball sampling strategy was used to recruit participants from the pediatrics unit of a medical center in the eastern region of Taiwan. In-depth interviews were conducted with 11 aboriginal adolescent childhood cancer survivors. The data were analyzed using content analysis. RESULTS: The results revealed three major themes with subthemes within each theme. The three major themes are: roots of resilience, transformation and growth, and meaning of traditional rituals for resilience. The three subthemes within "roots of resilience" include: "feeling secure through company of family, care and financial support", "receiving support from the important others and religion" and "learning to self-adjust". The three subthemes revealed within "transformation and growth" are: restructuring the relationship with peers, "appreciating parents' hard work", and "learning to seize the moment". The two subthemes within "meaning of traditional rituals to resilience" include: "feeling blessed with the power of ancestral spirits" and "strengthening ethnic identity". CONCLUSION: This study provided insight into the experiences of aboriginal adolescents as they recovered from childhood cancer. The experiences made positive impacts by inspiring growth in maturity and consolidating aboriginal ethnic identity. The adolescents were empowered by support from family, friends and clansmen, and by their participation in aboriginal rituals. As healthcare professionals care for the aboriginal adolescents, it is critical to consider this culturally and ethnically specific knowledge/experience of surviving cancer to improve quality of care.

Effects of Home-Based Tai Chi and Lower Extremity Training and Self-Practice on Falls and Functional Outcomes in Older Fallers from the Emergency Department-A Randomized Controlled Trial.

OBJECTIVES: To compare the effects of guided home-based tai chi chuan (TCC) and lower extremity training (LET) and of levels of self-practice on falls and functional outcomes in older fallers. DESIGN: Randomized controlled trial. SETTING: Taipei, Taiwan. PARTICIPANTS: Individuals aged 60 and older who had fall-related emergency department visits at least 6 months before participating in the study and ambulated independently at baseline (N = 456). INTERVENTION: Six months of TCC or LET. MEASUREMENTS: Four types of fall measures (falls, time to first fall, fallers, recurrent fallers) and six functional measures (handgrip strength, balance, mobility, fear of falling, depression, cognitive function). RESULTS: The TCC group was significantly less likely than the LET group to experience any falls during the 6-month intervention (incidence rate ratio (IRR) = 0.30, 95% confidence interval (CI) = 0.15-0.60), and the effects remained significant after 12 months of follow-up (IRR = 0.32, 95% CI = 0.14-0.71). These effects remained significant for injurious falls during the 6-month intervention (IRR = 0.33, 95% CI = 0.16-0.68) and the entire 18-month study (IRR = 0.39, 95% CI = 0.18-0.83). Similar results were obtained when another two fall measures (time to first fall, number of fallers) were used. Moreover, participants who independently practiced TCC or LET seven times per week or more were significantly less likely to experience injurious falls during the 6-month intervention (IRR = 0.41, 95% CI = 0.20-0.83) and the 18-month study (IRR = 0.43, 95% CI = 0.21-0.87) than their counterparts, had a significantly longer time to first injurious fall, and were significantly less likely to have an injurious fall during the 6-month intervention. Cognitive function improved to a greater extent in the TCC group than in the LET group over the 18-month study. CONCLUSION: Home-based TCC may reduce the incidence of falls and injurious falls more than conventional LET in older fallers, and the effects may last for at least 1 year.

The development and validation of the Clinical Teaching Behavior Inventory (CTBI-23): Nurse preceptors' and new graduate nurses' perceptions of precepting.

BACKGROUND: Few studies have examined the perceptions of clinical teaching behaviors among both nurse preceptors and preceptees. PURPOSES: To develop a Clinical Teaching Behavior Inventory (CTBI) for nurse preceptors' self-evaluation, and for new graduate nurse preceptee evaluation of preceptor clinical teaching behaviors and to test the validity and reliability of the CTBI. METHODS: This study used mixed research techniques in five phases. Phase I: based on a literature review, the researchers developed an instrument to measure clinical teaching behaviors. Phase II: 17 focus group interviews were conducted with 63 preceptors and 24 new graduate nurses from five hospitals across Taiwan. Clinical teaching behavior themes were extracted from the focus group data and integrated into the domains and items of the CTBI. Phase III: two rounds of an expert Delphi study were conducted to determine the content validity of the instrument. Phase IV: a total of 290 nurse preceptors and 260 new graduate nurses were recruited voluntarily in the same five hospitals in Taiwan. Of these, 521 completed questionnaires to test the construct validity of CTBI by using confirmatory factory analysis. Phase V: the internal consistency and reliability of the instrument were tested. RESULTS: CTBI consists of 23 items in six domains: (1) 'Committing to Teaching'; (2) 'Building a Learning Atmosphere'; (3) 'Using Appropriate Teaching Strategies'; (4) 'Guiding Inter-professional Communication'; (5) 'Providing Feedback and Evaluation'; and (6) 'Showing Concern and Support'. The confirmatory factor analysis yielded a good fit and reliable scores for the CTBI-23 model. CONCLUSIONS: The CTBI-23 is a valid and reliable instrument for identifying the clinical teaching behaviors of a preceptor as perceived by preceptors and new graduate preceptees. The CTBI-23 depicts clinical teaching behaviors of nurse preceptors in Taiwan.

Effectiveness of an Online Caring Curriculum in Enhancing Nurses' Caring Behavior.

BACKGROUND: A hospital in Taiwan implemented a framework of caring in clinical practice. After the pilot study, the current study was conducted to implement and evaluate the effectiveness of the program. METHOD: One hundred four nurses from two hospitals were recruited for the intervention (n = 50) and comparison (n = 54) groups in a mixed-method, quasi-experimental pre- and postintervention design. Audiovisual materials based on the authentic caring and uncaring experiences of nurses and patients were created as the curriculum content. Role modeling and reflective practice were used as learning strategies. Both groups of nurses and patients completed a pre- and postintervention evaluation of nurse caring behaviors, using the SHARE (Sense patients' needs before they ask, Help patients out, Acknowledge patients' feelings, Respect the dignity and privacy of patients, Explain what is happening) caring behavior measurement. A focus group interview was conducted. RESULTS: The intervention group exhibited higher frequency of caring behavior than the comparison group (p < 0.001). CONCLUSION: Authentic experiences, reflective practice, and online videos were effective teaching strategies in enhancing nurse caring behavior in an online continuing education program.

[Reflection on Nurse Preceptor Training Courses: The Experiences of Nurse Preceptors and Preceptees].

BACKGROUND: The Taiwan Joint Commission on Hospital Accreditation established a nurse preceptor training program in 2012. However, there has been minimal assessment of the nurse preceptor training program from the respective perspectives of nurse preceptors and preceptees. PURPOSES: This study explores the teaching experiences of nurse preceptors and the learning experiences of new nurses, and reflects on the nurse preceptor training program. METHODS: Investigators used a qualitative method to conduct 5 focus group interviews with 15 nurse preceptors and 14 new nurses in a medical center in northern Taiwan. Interview data was analyzed using content analysis. RESULTS: Eight themes were categorized from the teaching experiences of preceptors and two themes were categorized from the learning experiences of preceptees. The analysis of the data shows that this nurse preceptor training program focused on enhancing teaching skills and assessment skills and lacked instruction in teaching affection, guidance skills, and emotion management. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study may be used as a reference for developing training courses for nurse preceptors in Taiwan.

[Constructing indicators of competence for nurse preceptor instruction skills].

BACKGROUND: The professional teaching competence of nurse preceptors must be monitored regularly. However, the existing instruments that are designed to measure nurse preceptor professional teaching competency seldom examine updated indicators such as inter-professional practice (IPP) and evidence-based practice. PURPOSE: This study constructs indicators for assessing the teaching competence of nurse preceptor. METHODS: Phase I used a literature review to identify appropriate indicators of nurse preceptor teaching competence. Phase II conducted focus-group interviews with 10 nurse preceptors and 6 new nurses from a teaching hospital in southern Taiwan. Content analysis was used to construct a preliminary framework of indicators. Phase III invited 15 experts to evaluate the content validity of the preliminary indicators in two rounds using the Delphi method. RESULTS: The teaching-related competence of nurse comprises 36 items in the five dimensions of passionate commitment to teaching, harmonious learning atmosphere, inductive teaching skills, objective feedback and evaluation, and inter-professional practice. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The indicators developed in this study may be used by nurse preceptors to examine their teaching abilities and by healthcare institutions to design preceptor training curricula.

Nurses' perceptions of e-portfolio use for on-the-job training in Taiwan.

Electronic portfolios can be used to record user performance and achievements. Currently, clinical learning systems and in-service education systems lack integration of nurses' clinical performance records with their education or training outcomes. For nurses with less than 2 years' work experience (nursing postgraduate year), use of an electronic portfolio is essential. This study aimed to assess the requirements of using electronic portfolios in continuing nursing education for clinical practices. Fifteen nurses were recruited using a qualitative purposive sampling approach between April 2013 and May 2013. After obtaining participants' consent, data were collected in a conference room of the study hospital by one-on-one semistructured in-depth interviews. Through data analyses, the following five main themes related to electronic learning portfolios were identified: instant access to in-service education information, computerized nursing postgraduate year training manual, diversity of system functions and interface designs, need for sufficient computers, and protection of personal documents. Because electronic portfolios are beginning to be used in clinical settings, a well-designed education information system not only can meet the needs of nurses but also can facilitate their learning progress.

Nurse preceptor training needs assessment: views of preceptors and new graduate nurses.

BACKGROUND: In Taiwan, regulatory bodies mandate that preceptor training programs comprise six mandatory topics used by all teaching hospitals. These programs have little empirical justification. This study explores the training needs of preceptors from the viewpoints of both preceptors and preceptees. METHOD: Investigators used qualitative methods to conduct 17 focus group interviews with 63 preceptors and 24 preceptees from five hospitals in Taiwan. A constant comparative method was used to analyze the data and extract themes and subthemes from participants' experiences. RESULTS: Seven themes were extracted from both preceptor teaching experiences and preceptee learning experiences. Analysis of the empirical data showed that the six mandated topics do not meet the needs of preceptors. This study also documented the concept of "nurses eating their young" for the first time in Taiwan. CONCLUSION: The findings of this study may serve as a reference for redesigning preceptor training programs in Taiwan.

Community based study on married couples' family planning knowledge, attitude and practice in rural and urban Gambia.

BACKGROUND: Family planning services have been free of charge and available in all the health facilities in the Gambia since 1975 yet contraceptive prevalence is only 17.5% and even 6% in some areas. Since the last census in 2003, there existed no available data on married couples' contraception status. OBJECTIVES: To explore married couples' family planning knowledge, attitudes, and practices in rural and urban Gambia and to analyze what factors may affect such knowledge, attitudes and practices. METHODS: Quantitative cross-sectional study design was used. Through convenience sampling, 176 men and 235 women representing a total of 176 couples participated. A structured questionnaire was used for data collection. RESULTS: The mean scores of the married couples family planning knowledge, attitudes, and practices were 19.00 ± 6.11(ranging from 0 to 64), 6.90 ± 3.08 (0 to 14) and 4.69 ± 3.3 (0 to 19) respectively. Urban residents had higher scores on family planning practice than rural residents (p<.05). Attitude is the strongest predictor of practice (accounted for 34.6% of variance). CONCLUSIONS: These findings offer a descriptive answer to "what are married couples' family planning knowledge, attitude and practice in Gambia", as well as suggesting broader health intervention programs in health education and promotion.

Validation of self-directed learning instrument and establishment of normative data for nursing students in taiwan: using polytomous item response theory.

BACKGROUND: Little research has investigated the establishment of norms for nursing students' self-directed learning (SDL) ability, recognized as an important capability for professional nurses. An item response theory (IRT) approach was used to establish norms for SDL abilities valid for the different nursing programs in Taiwan. PURPOSES: The purposes of this study were (a) to use IRT with a graded response model to reexamine the SDL instrument, or the SDLI, originally developed by this research team using confirmatory factor analysis and (b) to establish SDL ability norms for the four different nursing education programs in Taiwan. METHODS: Stratified random sampling with probability proportional to size was used. A minimum of 15% of students from the four different nursing education degree programs across Taiwan was selected. A total of 7,879 nursing students from 13 schools were recruited. The research instrument was the 20-item SDLI developed by Cheng, Kuo, Lin, and Lee-Hsieh (2010). IRT with the graded response model was used with a two-parameter logistic model (discrimination and difficulty) for the data analysis, calculated using MULTILOG. Norms were established using percentile rank. RESULTS: Analysis of item information and test information functions revealed that 18 items exhibited very high discrimination and two items had high discrimination. The test information function was higher in this range of scores, indicating greater precision in the estimate of nursing student SDL. Reliability fell between .80 and .94 for each domain and the SDLI as a whole. The total information function shows that the SDLI is appropriate for all nursing students, except for the top 2.5%. SDL ability norms were established for each nursing education program and for the nation as a whole. CONCLUSIONS: IRT is shown to be a potent and useful methodology for scale evaluation. The norms for SDL established in this research will provide practical standards for nursing educators and students in Taiwan.

Using the ADDIE model to develop online continuing education courses on caring for nurses in Taiwan.

BACKGROUND: A hospital in Taiwan committed to implementing a framework of caring in clinical practice. This study was conducted to develop online courses on caring for the hospital's nurses. METHOD: The ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model was applied to develop and evaluate this caring curriculum. Concrete caring and uncaring behaviors were identified through patient and nurse interviews. These were used to make 72 instructional videos and five live-action movies. Evaluation tools included quizzes, self-evaluations, focus group interviews, and a measurement of caring behavior. Patients used the same instrument to evaluate the nurses. RESULTS: Nurses' self-evaluations showed positive results. No significant difference was found between pre- and postcourse patient evaluations. CONCLUSION: This study shows the usefulness of ADDIE and provides a model for how research data and results can be used to inform administratively mandated organizational change. It also provides evidence on the effects of caring education.

Developing online continuing education content for enhancing caring among Taiwan nurses.

BACKGROUND: To promote the quality of nursing care, a hospital in Taiwan committed to implementing its SHARE framework for clinical practice. This study was conducted to develop caring content for the SHARE framework in the form of online continuing education videos. METHODS: Five focus group interviews were conducted with 19 exemplary nurses. A constant comparative method was used to extract caring themes that were integrated into the five components of SHARE: S: Sense patient's needs; H: Help patient out; A: Acknowledge patient's feelings; R: Respect patient's dignity and privacy; E: Explain what is happening. RESULTS: Concrete caring behaviors consistent with SHARE were identified. Real-world scenarios were used to produce five videos demonstrating the components of SHARE for use in online caring education. CONCLUSION: This project offers a new strategy for strengthening caring behavior in nurse-patient interactions and may help to establish a model for caring in nursing continuing education in Taiwan.

[Clinical nursing education].

Nursing is a clinical profession influenced by social and environmental change. Facing the continuing evolution of the medical practice environment, nursing educators should take into account both current issues and future trends. As nursing clinical education undergoes radical reform, it must address both current and future healthcare demands. Relevant articles in the literature indicate that students continue to face significant difficulties applying classroom knowledge to clinical practice. This article describes the meanings, purposes, elements and models of nursing clinical education as well as relevant factors of influence. We also offer suggestions for meeting future societal demands.

Using clinical caring journaling: nursing student and instructor experiences.

BACKGROUND: Journaling has been incorporated into many nursing courses as an active reflective teaching strategy that can facilitate the learning process, personal growth, and professional development of students. There is limited research support of journaling as an appropriate tool to promote reflection for the purpose of learning caring in nursing education. PURPOSE: The aim of this study was to explore the experiences and perceptions of student nurses and instructors who use clinical caring journaling (CCJ) in their clinical practicum. METHODS: Researchers used a descriptive qualitative research design. The study population was 880 senior student nurses and 90 clinical instructors from a nursing program at a university in Taiwan who used CCJ. After completion of 1 year of clinical practicum, 16 students and 7 instructors participated voluntarily in focus group interviews. Researchers used content analysis to sort interview data into themes. RESULTS: Six themes were categorized that encapsulated student and instructor experiences and perceptions regarding using CCJ in their clinical practicum. These themes were guiding caring behavior toward patients, enabling students' reflective caring abilities, building up students' self-confidence, increasing interaction between students and instructors, enhancing students' self-development, and overcoming writing difficulty. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Research findings may serve as a reference for nursing educators to use CCJ strategy in student nurses' clinical practicum.

Development and preliminary testing of a self-rating instrument to measure self-directed learning ability of nursing students.

BACKGROUND: With the growing trend of preparing students for lifelong learning, the theory of self-directed learning (SDL) has been increasingly applied in the context of higher education. In order to foster lifelong learning, abilities among nursing students, faculties need to have an appropriate instrument to measure the SDL abilities of nursing students. OBJECTIVES: The objectives of this study were to develop an instrument to measure the SDL abilities of nursing students and to test the validity and reliability of this instrument. METHODS: This study was conducted in 4 phases. In Phase 1, based on a review of the literature, the researchers developed an instrument to measure SDL. In Phase 2, two rounds of the Delphi study were conducted, to determine the content validity of the instrument. In Phase 3, a convenience sample of 1072 nursing students from two representative schools across three different types of nursing programs were recruited to test the construct validity of the Self-Directed Learning Instrument (SDLI). Finally, in Phase 4, the internal consistency and reliability of the instrument were tested. RESULTS: The resulting SDLI consists of 20 items across the following four domains: learning motivation, planning and implementing, self-monitoring, and interpersonal, communication. The final model in confirmatory factor analysis revealed that this 20-item SDLI indicated a good fit of the model. The value of Cronbach's alpha for the total scale was .916 and for the four domains were .801, .861, .785, and .765, respectively. CONCLUSIONS: The SDLI is a valid and reliable instrument for identifying student SDL abilities. It is available to students in nursing and similar medical programs to evaluate their own SDL. This scale may also enable nursing faculty to assess students' SDL status, design better lesson plans and curricula, and, implement appropriate teaching strategies for nursing students in order to foster the growth of lifelong learning abilities.

[The development of a caring curriculum in nursing].

Caring is the essence of nursing and the core of nursing education. This paper describes the experience of developing a caring curriculum in a five-year junior college nursing program which included three core courses in caring, in the hope of stimulating further dialogue with fellow educators and cultivating students' caring competencies. The first course was Introduction to Caring, which gave students an understanding of basic concepts of caring, along with the opportunity to practice and experience caring by caring for oneself, one's family and one's peers. The second course was Application of Caring Concepts, which enabled students to learn about caring models, especially the dynamic caring model, and expanded their knowledge of caring behaviors from interpersonal caring to caring for society. The third course was Professional Caring, which explained professional caring and related caring theories, and introduced the caring model used in nursing in Taiwan, showing students how to practice caring in clinical situations. The participating teachers used the action research method to plan, design, implement, and evaluate the caring curriculum. These teachers set the teaching objectives and developed course materials by working together in workshops and participating in teachers' caring groups. They adopted various teaching strategies, such as role modeling, dialogue, caring groups, confirmation, literature, film, caring action projects, reflection, and journaling, which have been proven to be effective at raising students' learning motivation and caring performance.

Action research on the development of a caring curriculum in Taiwan: Part II.

This article presents the development, design, implementation, and evaluation of the third-year course of a caring curriculum being developed for a 5-year associate degree nursing program in Taiwan. The course, titled Application of Caring Concepts, was taught to more than 800 students by 16 instructors recruited from various departments. The instructors attended workshops and seminars on caring and then developed the course materials and teaching strategies. Instructional strategies included role modeling, dialogue, discussions, journaling, simulations, readings, and projects that involved students' applying caring skills outside of the classroom. Students were evaluated by patients in clinical practice using the Caring Behavior Measurement, developed in a previous study, and the course was evaluated by qualitative analysis of student feedback. Student responses to course content and instructional strategies were positive. Patients generally indicated that students always or normally performed caring behaviors. The study showed that with an appropriate curriculum and learning strategies, students can learn caring skills.