Nursing students' engagement in online learning.

Reliance on digital technology may have implications for our social and economic wellbeing, including factors such as health, environmental quality, social interaction, and educational levels. Although there may be concerns, it is important to acknowledge that digital technology also offers immediate, cost-effective and accessible solutions that are transforming various services. The COVID-19 pandemic, through the disruption of educational systems worldwide, has accelerated the transformation of higher education, leading to changes in the way it is perceived. However, there is a lack of understanding regarding the relationship between digital poverty, digital literacy, and students' online experiences. This article aims to explore the engagement of nursing students in online learning post COVID.

Supporting students to return to study following course interruption (SuTuRe).

BACKGROUND: The pre-registration BSc Nursing course in the UK is renowned for being challenging due to its requirement for 2300 hours each for theoretical and practice-based learning. It is therefore inevitable that some students may need to interrupt their study at some point during the course. In many cases, these students do not return and leave the course, which has an impact on the future nursing workforce. AIMS: To examine the reasons why pre-registration student nurses interrupt their studies and consider ways to enable them to return successfully and complete the course. METHODS: The research project was based in one higher education institution (HEI) in the North West region of England. Interrupted students due to return to study in semester 1 of the 2022/23 academic year (n=95) were invited to participate in semi-structured interviews. FINDINGS: Health, including mental health was the dominant factor leading to the interruption of study for the students. CONCLUSION: This research has led the HEI to introduce an improved support package for students. Alongside other recommendations it is hoped the changes will reduce attrition and lead to an improved interruption/return-to-study experience.

Assessing numeracy and medication calculations within undergraduate nursing education: A qualitative study.

AIM: To explore how undergraduate nursing students are assessed on nursing numeracy and medication calculations from the perspective of Australian nurse education leaders. DESIGN: A qualitative study. METHODS: Semi-structured interviews were conducted with 17 nurse education leaders between November 2022 and January 2023. Braun and Clarke's six phases of thematic analysis were used to analyse the data. RESULTS: Five key themes were identified: (i) high expectations to keep the public safe, (ii) diverse assessment formats, (iii) different ways of managing assessment integrity, (iv) assessment conditions incongruent to the clinical setting and (v) supporting struggling students. CONCLUSION: Nurse education leaders set high standards requiring students to achieve 100% in numeracy and medication calculation assessments, thus maintaining the reputation of nursing and patient safety. However, students struggled to meet this expectation. Diverse assessment formats were implemented, with some examination conditions contrary to clinical practice. Currently, there is no benchmark or independent point of registration examination in Australia, hence the problem is each university had a different standard to judge students' competence. Gaining insight into how these assessments are conducted provides an opportunity to work towards an evidence-based model or benchmark for the assessment of numeracy. IMPLICATIONS FOR THE PROFESSION: Dosage errors in clinical practice threaten patient safety and the reputation of the nursing profession. The accuracy rate of calculations by undergraduate and registered nurses is deficient worldwide. This research highlights a major educational issue, that being the wide variation in how numeracy assessments are conducted with no clear pedagogical rationale for a standardised method. Such assessments would establish a national standard, contributing to quality assurance, the development of the nursing profession and improve patient safety.

The perception and association between depression and academic stress among female undergraduate nursing students: a cross-sectional study.

Introduction: Academic demands and stressors put nursing students at increasing risk of depression. The aims of the study examine the perceived level of depression and academic stress and investigate the association between these variables among nursing students in Saudi Arabia. Methods: A cross-sectional design was used in this study. Data was collected using depression subscale from DASS-21 scale and the Academic Stress Inventory scale. Results: A total of 237 students participated in the study. Nursing students perceived normal to mild levels of depression. Students perceived moderate levels of academic stress in all subscales, except for time management and test stress which were high. All academic stress subscales had a positive statistically significant correlation with depression. The regression model explains 49.0% of the variance in the depression scale and indicated that the main significant predictor of depression is studying in group stress, followed by self-inflected stress, study year, and sleep problem. The mean score of depression for first year students was significantly different than students in other study years. Discussion: Nurse educators should facilitate group formation and teach students about time-management, problem-solving, negotiation, and coping strategies to deal with academic expectations and demanding situations. Understanding the causes, limiting the exposure to negative influences, and seeking support as needed are important. To enhance the quality of sleep, students should maintain a consistent sleep schedule, while avoiding stimulating activities before bedtime. Future research should focus on a longitudinal study and other variables such as quality of life, satisfaction with the quality of teaching, and support from others.

Investigation of nursing students' knowledge levels and attitudes in incontinence-associated dermatitis management through game-based learning: a mixed methods study.

PURPOSE: This study aimed to assess nursing students' knowledge levels and attitudes towards the etiology, risk factors, and preventive measures of incontinence-associated dermatitis (IAD) using an escape room game. DESIGN: A mixed-method study. SUBJECTS AND SETTING: The sample size of the study was 32 students. METHODS: Quantitative data obtained with the Knowledge, Attitude and Practice of Nurses in Managing Incontinence-Associated Dermatitis Questionnaire (KAP-IAD-Q) and qualitative data obtained through FGDs following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist were analyzed using a thematic approach. RESULTS: The average age of the participants was 22.63 ± 0.90, 87.5% of them were female (n=28), and 50% were third (n=16) and fourth-year students (n=16). KAP-IAD-Q total posttest score (88.06+7.00) was found to be high. Data obtained from the FGDs were categorized under 3 main themes: main focus areas during participation in the IAD-themed escape room game; advantages and disadvantages of teamwork in IAD management; and the game's contribution to a better understanding and classification of IAD. CONCLUSIONS: The use of the escape room game facilitated high, fast, and efficient learning of IAD knowledge and attitudes. It revealed challenges in collaborative decision-making, accurate diagnosis, distinguishing from other wounds, and attitude development in the management of IAD.

Nurses, midwives and students' reports of effective dedicated education units in five European countries: A qualitative study.

AIM: To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment. DESIGN: A multi-country, phenomenological, qualitative study. METHODS: Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives. RESULTS: Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment. CONCLUSIONS: A close educational-service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment. IMPLICATIONS FOR THE PROFESSION: It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population. IMPACT: Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes. PUBLIC CONTRIBUTION: Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement.

The effect of midwifery students' changing life conditions and e-learning experiences on the state of their anxiety and hopelessness during the Covid-19 pandemic.

Background: Giving the existing formal education through the internet without a planned transition to distance education negatively affected the learning processes of the students. Objectives: The study aims to identify the midwifery students' changing life conditions and e- learning experiences on the state of their anxiety and hopelessness during the Covid-19 pandemic. Methods: Designed as cross-sectional research, the study was performed with the participation of 1,296 midwifery undergraduate students. The survey form comprised of questions that explored the students' demographic characteristics, life conditions changing during the Covid-19 pandemic and distance education experiences, the Generalized Anxiety Disorder Scale-7, and the Beck Hopelessness Scale were used in the data collection. Findings: It was discerned that, of the participant midwifery students, 55.2% spent the period of the pandemic in the province center, 51.7% used smartphones to have access to the distance education, 50.3% had trouble in following up the courses due to the limited computer and internet access, 63.5% failed to follow up the courses because of the infrastructure problems related to the distance education. It was found that, of the participant midwifery students, 54.6% exhibited anxiety symptoms and 26.3% had hopelessness symptoms. It was identified that having trouble in following up the courses increased anxiety by 1.438 times (CI:1.103-1.875) and hopelessness by 1.980 times (CI:1.459-2.687), having tensions in the family relations increased anxiety by 2.362 times (CI:1.780-3.134) and hopelessness by 1.789 times (CI:1.235-2.594), and having psychological support for anxiety and worry increased anxiety by 2.914 times (CI:2.208-3.8477) and hopelessness by 1.875 times (CI:1.083-3.247). It was ascertained that hopelessness increased anxiety by 2.878 times (CI:2.075-3.991) whilst anxiety increased hopelessness by 2.755 times (CI:1.985-3.823) (p<0.05). Conclusion: As well as the Covid-19 pandemic, health, social life, and economic changes; the digital separation that accompanies distance education also affects the students' mental health. Solving the technical problems experienced in distance education, facilitating the follow-up of the courses, and equipping the midwifery students with problem-solving and coping skills will be useful for reducing the midwifery students' hopelessness and anxiety levels.

The influencing factors of stigma towards people with mental illness among nursing students: a mixed-method systematic review.

The stigma of nursing students towards people with mental illness (PMI) creates significant barriers to diagnosis, treatment, and recovery for those with PMI. It can also have a significant impact on the future career choices of nursing students in the field of psychiatry. Current research has found various influencing factors, including personal characteristics and educational influences. However, a comprehensive analysis that encompasses all aspects is lacking. The aim of the study was to conduct a convergent mixed-method systematic review to synthesize the influencing factors of the stigma of nursing students towards PMI according to Framework Integrating Normative Influences on Stigma (FINIS) at micro, meso, and macro levels. PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL and PsycINFO were searched from 1990 to 31 December 2023. The reference lists of the included literature were further checked to identify potentially relevant articles. Two authors independently screened all titles, abstracts, and full-text articles and extracted data. Study quality was assessed by two authors using the Mixed Method Appraisal Tool (MMAT). A total of 4865 articles were initially retrieved, and 73 of these articles were included. The results suggested that the stigma towards PMI by nursing students was influenced by micro, meso and macro levels. At each FINIS level, the most frequent influencing factors are personal characteristics, the treatment system and media images. Numerous interconnected factors exert an influence on the stigma towards PMI among nursing students. Our research can be used to identify barriers and facilitators to nursing students' stigma towards PMI and to provide supporting information for interventions designed to reduce this stigma.

A study of latent profile analysis of empathic competence and factors influencing it in nursing interns: a multicenter cross-sectional study.

Background: Empathy, as one of the fundamental principles of nursing professionalism, plays a pivotal role in the formation and advancement of the nursing team. Nursing interns, as a reserve force within the nursing team, are of significant importance in terms of their ability to empathize. This quality is not only directly related to the degree of harmony in the nurse-patient relationship and the enhancement of patient satisfaction, but also plays a pivotal role in the promotion of the quality of nursing services to a new level. Aim: The objective of this study was to gain a deeper understanding of the current state of nursing interns' empathic abilities. To this end, we sought to examine empathic performance under different profile models and to identify the key factors influencing these profile models. Methods: The study utilized 444 nursing interns from 11 tertiary general hospitals in Inner Mongolia as research subjects. The study employed a number of research tools, including demographic characteristics, the Jefferson Scale of Empathy, and the Professional Quality of Life Scale. A latent profile model of nursing interns' empathy ability was analyzed using Mplus 8.3. The test of variability of intergroup variables was performed using the chi-square test. Finally, the influencing factors of each profile model were analyzed by unordered multi-categorical logistic regression analysis. Results: The overall level of empathy among nursing interns was found to be low, with 45% belonging to the humanistic care group, 43% exhibiting low empathy, and 12% demonstrating high empathy. The internship duration, empathy satisfaction, secondary traumatic stress, only child, place of birth, and satisfaction with nursing were identified as factors influencing the latent profiles of empathy in nursing interns (p < 0.05). Conclusion: There is considerable heterogeneity in nursing interns' ability to empathize. Consequently, nursing educators and administrators should direct greater attention to interns with lower empathy and develop targeted intervention strategies based on the influences of the different underlying profiles.

Lessons learned: Why study-abroad remains a critical component of nursing curriculums.

BACKGROUND: Caring for an increasingly older and multicultural patient population requires nurses and APNs who are able to integrate cultural competency in meeting the needs of their patients while decreasing health care disparities. A study-abroad immersion experience is one way to instill deep learning and cultural competency. PURPOSE: The purpose of this study was to understand the lived experience of baccalaureate nursing students and APN students working together in a study-abroad, service-learning experience. METHOD: Using Interpretive Phenomenological Analysis (IPA) (Smith & Osborn, 2003), we explored the lived experience of Baccalaureate and Advanced Practice Nursing Students in a service-learning, study-abroad experience in Belize. RESULTS: Emergent themes derived from students' journal transcripts were: (1) Allowing learning to take place; (2) Practicing nursing with limited resources (3) A different take on culture; and (4) Kinship with peers. From this theme two sub themes emerged: 1) students' connection with the people and the country, and 2) students' connection with each other. CONCLUSION: Cultural immersion prepared students to work in Belize with different patient groups, having varied perspectives related to their health. Students learned that the core values of dignity and caring require that we, as nurses, go where the patient is-not where we want the patient to be. This is tested when students are confronted with a culture not their own.

Educational and professional experiences of men in nursing: An interpretive description study to guide change and foster inclusive environments for men in nursing.

BACKGROUND: Nursing shortages are occurring due to decreased student enrollment, nurse burnout, staffing deficits, nurse retirements, and increasingly low numbers of nursing faculty. Men are an untapped resource that can offset these crises. However, men's presence in nursing remains underwhelming. Changes aimed at improving diversity and inclusivity related to men's presence is needed in the nursing workforce. PURPOSE: Explore men's experiences in modern nursing environments to identify barriers to men's presence in nursing faculty and clinical workforce roles. METHOD: This study used interpretive description design. Data were collected through individual and group interviews. Interviews were video recorded. Interview questions were semi-structured and open ended. Data were analyzed using thematic analysis. RESULTS: Two themes were identified and reflected men's experiences in nursing: educational and professional change. Subthemes for educational change included increasing numbers of men in student and faculty roles; instructional change; admission, retention, and advising. Subthemes for professional change included inclusive hiring practices; healthy working environments; and leadership outcomes. CONCLUSION: Findings constitute calls for action. Change implementation should address barriers to diversity and inclusivity related to men's presence in nursing. Recommendations and strategies presented can guide change implementation. Change implementation is expected to strengthen the nursing profession.

Technology-based interactive communication simulation addressing challenging communication situations for nursing students.

BACKGROUND: Simulation-based interventions for nursing students addressing challenging communication situations involving geriatric patients and end-of-life care are limited. PURPOSE: This study evaluated the effects of technology-based interactive communication simulations on nursing students' communication knowledge, self-efficacy, skills, compassion, and program satisfaction. METHOD: A randomized controlled repeated-measures design was used with third- and fourth-year nursing students enrolled in five nursing colleges located in five regions in Korea as participants. Participants were randomly assigned to either a technology-based interactive communication simulation or an attention control group. Changes in communication knowledge, self-efficacy, skills, compassion, and program satisfaction were assessed using three self-reported measures and communication skills were measured by the raters. Statistical analyses included descriptive analyses, chi-square tests, t-tests, and a generalized estimating equation model. RESULTS: Eighty students participated in one of the two programs, and 77 in the four-week follow-up test. The intervention group indicated significant improvements in communication knowledge, self-efficacy, skills, and compassion, as well as higher program satisfaction compared with the attention control group. Communication skills as assessed by raters also showed significant change at all assessment time points. CONCLUSION: The technology-based interactive communication simulation program is effective in improving communication skills among nursing students managing geriatric patients and end-of-life care.

Exploring the relationship between grit scores and academic potential in baccalaureate nursing students.

BACKGROUND: An ongoing nursing shortage poses significant challenges to the healthcare industry, prompting nursing education programs to find ways to increase nurse graduates. Unfortunately, the problem of attrition in nursing education is significant. Despite many years of attrition research, educators still seek to find answers to determine what factors cause some students to succeed and others to fail in nursing programs. Noncognitive variables, like grit, have been largely overlooked as potential solutions to the problem of attrition. PURPOSE: The purpose of this study was to explore the extent to which grit predicts academic potential in baccalaureate nursing students. METHODS: This cross-sectional study included a total of 63 baccalaureate nursing students in their first semester of a four-semester nursing program at a mid-sized public university in East Texas. Participants took an electronic survey reporting demographic information, completing the Short Grit Scale (Grit-S), and consenting to release of their pre-admission science grade point average (sGPA), ATI Test of Essential Academic Skills (TEAS) exam scores, and first-semester nursing GPA (nGPA). RESULTS: When added to sGPA and TEAS scores, grit scores were not a statistically significant predictor of nGPA. Students with high grit scores were just as likely to experience attrition as those with low scores, and grit did not statistically significantly predict first-semester attrition. CONCLUSIONS: Nurse educators are encouraged to pursue strategies to address attrition in nursing education. Traditional selection criteria of sGPA and TEAS exam scores were shown to be predictors of nGPA. Additional research is warranted to explore the relationship between noncognitive variables, especially grit, and nursing student academic potential.

Educator-to-student incivility in online nursing education during COVID-19 as reported by nursing students: A descriptive cross-sectional study.

BACKGROUND: Educators' incivility in online nursing education is a serious academic issue; much of it is still unknown as it occurs in a less supervised environment. AIM: This study examined variables and differences in educator-to-student incivility in online nursing education during COVID-19, as reported by nursing students. METHODS: Utilizing the Incivility in Online Learning Environments (IOLE) online survey, a cross-sectional design was used to collect data in 2021 from a convenience sample of 163 nursing students studying in different universities in Jordan. Version 25 of the Statistical Package for the Social Sciences (SPSS) was used to generate descriptive and inferential statistics. RESULTS: As reported by nursing students, there was a low degree of incivility among nursing educators in online nursing education, 45(range 23-92), and a moderate frequency in the past 12 months, 63(range 23-92). Around 37.00 % of students thought incivility in online nursing education was a mild problem. On a scale of 0-100, 63.00 % of the students reported the level of nursing educators' civility in online nursing education ranged from 50.00 % to 70.00 % (an average of 60.00 %). Differences in students' reporting of online nursing educators' incivility and its' frequencies were significantly influenced by students' grade point averages (GPA) and genders, respectively. CONCLUSIONS: Although nursing students have a positive sense of civility among their nursing educators, incivility in online nursing education should be zero-level and disclosed and treated at its early signs.

Registered nurses' perceptions of nursing student preceptorship: Content analysis of open-ended survey questions.

Nursing preceptors play a crucial role in supporting and educating clinical students. Understanding the perceptions and needs of nurse preceptors is essential to enhance their role as preceptors and to improve their teaching practices. This study aimed to explore preceptorship in diverse settings and specific contexts. Content analysis was performed to analyze open-ended responses from a questionnaire based on nurses' perceptions of preceptorship with undergraduate nursing students. Data were collected from two university hospitals, with different healthcare provision levels. Of the 370 responses, 295 (96%) were those of women, and 34.5% were in the age group of 41-50 years. Three main themes were identified: (1) the role of preceptorship as a key component in learning, (2) challenges in student preceptorship, and (3) personal recognition and compensation for teaching work. This study highlights the positive experiences and provides valuable insights into the challenges and opportunities faced by nurse preceptors in their teaching roles, and emphasizes the need for institutional support and educational programs to enhance their teaching responsibilities. Improving communication and collaboration among stakeholders is crucial for improving learning outcomes and satisfaction.

Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences.

There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.

Nursing students' perception: Escape Room use in teaching leadership skills.

OBJECTIVES: to understand nursing students' perception regarding Escape Room use to develop leadership skills. METHODS: a qualitative exploratory-descriptive study, with 97 nursing students. Escape Room game sessions were held, totaling ten. Subsequently, a debriefing and analysis was carried out using the Discourse of the Collective Subject method, through the focus group technique. Ethical procedures were respected. RESULTS: students' perceptions about using this methodology to develop leadership skills were positive and significant. The effectiveness of the game in teaching and developing these skills in nursing practice stands out. FINAL CONSIDERATIONS: the game was an effective active methodology in approaching the proposed content, promoting satisfaction and easy assimilation.

Ontological coaching among nursing undergraduates: a pilot randomized controlled (OCEAN) trial.

To develop and assess the preliminary effectiveness of Ontological Coaching Intervention for nursing undergraduates. Design: A pilot randomized controlled trial with a two-group pre-test and post-test followed by process-evaluation qualitative interviews. An Ontological Coaching Intervention was developed through an integration of prior literature and the collective the research team's experience, consisting of 4-6 sessions over 6-months, each lasting 30-60 minutes. Sessions encompassed exploring ontological coaching concepts, empowering nursing undergraduates to choose topics, and tailoring sessions to individual needs. Sixty undergraduates were recruited; ten were excluded for not completing the baseline questionnaires. Twenty-one nursing undergraduates were randomly assigned to the intervention group and twenty-nine undergraduates to the control group (standard academic support only). Primary (psychological well-being) and secondary (social support quantity and satisfaction, goal-setting, resilience) outcomes were measured at baseline, 3-months, and 6-months. Semi-structured interviews captured post-intervention experiences. Between-group analyses revealed a significant difference in goal-setting scores at 3-months (U = 325.5, p = 0.013), favoring the intervention group (median = 70.50, IQR = 64.25, 76.75). At 6-months, a significant difference in social support satisfaction scores (U = 114.5, p = 0.028) was found between the intervention (median = 33.00, IQR = 29.50, 35.25) and control (median = 30.00, IQR = 30.00, 35.00) groups. However, no significant between-group differences were noted in other outcome measures. Significant within-group differences were found in goal-setting scores at 3- and 6-months in the intervention group and social support quantity scores at 3- and 6-months in the control group. However, no significant within-group differences were noted in other outcome measures. Three themes were identified: Enhanced Holistic Development, Keys to Successful Coaching, and Future Directions for Successful Coaching. There is urgent need to advance research on Ontological Coaching Intervention, particularly, enhancing study rigor, broadening examinations to diverse healthcare student populations and cultural contexts, and addressing identified limitations.

Effect of Tronclass combined with team-based learning on nursing students' self-directed learning and academic performance: a pretest-posttest study.

BACKGROUND: Self-directed learning ability is crucial for lifelong learning. The inadequate self-directed learning ability of nursing students in China may be due to their deficiency in self-management or learning initiative. OBJECTIVE: To explore the effect of online learning platform (Tronclass) combined with team-based learning on nursing students' self-directed learning and academic performance. DESIGN: Pretest-posttest design. PARTICIPANTS: From March to July 2023, 69 undergraduate third-year nursing students from a university in Hunan Province were selected through a whole-group sampling method. METHODS: This study used Tronclass to carry out team-based learning in the teaching process of pediatric nursing courses. It compared the self-directed learning ability nursing students before and after courses, and juxtaposed their academic performance with those of their counterparts who graduated in previous years. RESULTS: When comparing compare motivation, self-management, teamwork and information literacy, which are four subscale aspects of the self-directed Learning Ability Scale, the post-survey scores for these four dimensions are greater than the pre-survey results. The results of the study showed a statistically significant difference (P < 0.05), in the students who engaged in Tronclass combined with team-based learning. Specifically, these students received higher midterm and final grades than to those who had already graduated and did not participate in these activities. (P < 0.05). CONCLUSION: Combining Tronclass with team-based learning enhances nursing students' ability to engage in self-directed learning and improves their performance in midterms and finals, thereby fostering the development of comprehensive competence.

A serial mediation model reveals the association between parental over-protection and academic entitlement among nursing students.

The study aims to explore the influence of parental over-protection on academic entitlement of nursing students, and examine the mediating roles of external locus of control and psychological entitlement. The study sampled two medical universities in Guizhou and Yunnan provinces, China. Participants were nursing students in grades one to four (N = 1003; mean age = 19.51 years; 81.95% female). Using a structural equation model, we examined the mediating effect of external locus of control and psychological entitlement on parental over-protection and academic entitlement. The results show that there was a significant correlation between all variables, and external locus of control and psychological entitlement played a serial mediating role between parental over-protection and academic entitlement. Our findings suggest that academic entitlement of nursing students can be reduced by adjusting parental rearing behaviors, reducing students' psychological entitlement, and teaching them how to form a healthier attribution style.