Simulation in nursing education has become a standard method of instruction to provide nursing students with a realistic and safe environment in which to practice and hone clinical skills. There are three components to a nursing simulation: prebriefing, the simulation experience, and debriefing. While there is a list of minimum criteria recommended for the prebriefing experience at the time of this dissertation there were no published frameworks or models for prebriefing. A quasi-experimental pretest/posttest study assessed the impact of a structured prebriefing method on sophomore level nursing students’ (N = 55) clinical judgment, perception of their ability to care for patients, and their perceptions of the prebriefing and simulation experiences when compared to a group that was exposed to only the standard prebriefing criteria. All participants had the same simulation scenario. Participants were placed in groups of four then groups were randomly assigned to the structured prebriefing (intervention) or standard prebriefing (control). The instruments used in this study were the Satisfaction and Confidence in Learning Scale (SCLS), Prebriefing Experience Scale (PES), Lasater Clinical Judgment Rubric (LCJR), and the Perception to Care in Acute Situations (PCAS). This dissertation includes two chapters based on the same study as well as a chapter of lessons learned with commentary on completing nursing education research with postpandemic nursing students. The first dataset reported are results from the SCLS and PES. These instruments are posttest only and were completed after the prebriefing and simulation experience. The second dataset reported are results from the LCJR and the PCAS. The LCJR was used by two faculty members to rate student demonstration of clinical judgment during the simulation scenario. The PCAS was implemented as pretest/posttest; participants completed it upon arrival to their scheduled simulation then again after the simulation scenario was finished. All data were collected prior to debriefing as the groups had different debriefing experiences. The findings of this study indicate that all participants were satisfied with the simulation and prebriefing experiences. No statistically significant differences were found between group perceptions of confidence, satisfaction, or prebriefing. There was a statistically significant increase from pretest to posttest scores on the PCAS on which participants rated themselves higher in their perceptions to care for patients. There was no interaction as there was not a statistically significant interaction between group and time. There were no statistically significant differences between groups for participant clinical judgment scores as rated by two faculty members. Unprecedented attrition and retention were seen in the participant cohort. Though not an aim of this study, this phenomenon is attributed to the changes being seen in the postpandemic learner. More students did not return after their first year than in previous years and 49% were unsuccessful in the Fundamentals of Nursing course compared to the usual 5%. These results show that while participants were satisfied with both interventions, and their confidence in their ability to provide care did increase after the simulation, there may not be a difference between structured and standard prebriefing. Additional studies are needed with different cohorts to determine if structured prebriefing has an effect on nursing student clinical judgment or if the unique variables caused by COVID-19 had lingering effects on these participants.

Healthcare simulation is a teaching strategy rooted in cognitive, constructivist, and social learning theories. Simulation–based learning experiences offer a replacement for traditional clinical learning and are widely used across all levels of nursing education. Most simulation activities are focused on student application of cognitive knowledge to clinical situations or practicing psychomotor skills, with little attention paid to student development of core nursing values such as caring and compassion. In fact, few studies have empirically assessed the usefulness of simulation for helping student nurses develop affective characteristics such as empathy. A quasi–experimental control group study was conducted to evaluate affective learning in student nurses during a simulated clinical activity. Students randomized to the treatment condition watched a lesson on the importance of empathy as a professional nursing value along with a vignette in which an actor playing the simulated patient shared a narrative story that detailed aspects of his social, emotional, and physical well–being. Subjects who received the intervention had a greater and statistically significant increase in empathy score than those in the control condition. Students exposed to the intervention also had higher observed empathy scores, but differences between groups were not statistically significant. Since narratives can be useful for helping health profession students understand patient perspectives on their health and well–being, the concept of narrative transportation (i.e., immersion in narrative accounts or stories) was used to assess student engagement in the simulated learning activity. Students in the treatment condition had higher but non–statistically significant engagement scores in response to the intervention. Last, associations between empathy, emotional intelligence, and nursing competence were assessed. Positive and statistically significant relationships between empathy and emotional intelligence, emotional intelligence and nursing competence, and empathy and nursing competence were observed. Further analysis indicated that emotional intelligence partially mediated the relationship between empathy and nursing competence in this sample. The findings of this study demonstrated that patient narratives were useful for facilitating affective learning during simulated clinical activities. The observed results also provide insight on the relationship between affective characteristics and competency development in student nurses.

Academic integrity, while important for all students, is especially so for those enrolled in nursing programs. Nurses are entrusted by the public to care for those in need from birth through death. A nursing student who graduates through dishonest means jeopardizes the safety of patients in their care. Nursing faculty need to understand the scope of academic integrity violations and develop meaningful, targeted interventions to show students the harm their actions could cause. The purpose of this dissertation is to explore undergraduate nursing students’ knowledge and perceptions of academic integrity and to specifically look at their willingness to report peer violations. This dissertation study was a collaborative effort among three doctoral students. Using a research team-modified version of McCabe’s Academic Integrity Survey as well as a research team-created Knowledge Assessment, 442 nursing students were surveyed. Results confirm a hesitation to report peers for violations of academic integrity. Students’ ability to neutralize their behaviors as harmless, their desire to remain loyal to their peers, and age act as positive predictive variables for willingness to report peer violations. Additionally, participants’ perceptions of the severity of various offenses and their perceptions of their faculty’s support for academic integrity policies are positively correlated with willingness to report peer violations. Program improvement strategies, such as implementing an honor code, were supported by participants and may help foster a culture of academic integrity that promotes peer reporting. Lastly, a targeted intervention designed for nursing students to promote academic integrity and peer reporting is explored.

All prelicensure baccalaureate nursing students are expected to graduate with baseline knowledge and clinical judgment skills that will allow them to provide safe and competent patient care to individuals across the lifespan. Research has shown that clinical judgment in new graduates is at an all-time low. There is an abundance of research on how to cultivate clinical judgment skills in both the didactic and simulations settings; however, very few studies have been conducted exploring how to assess and build clinical judgment skills in students in the clinical setting. A pilot study, followed by a quasi-experimental study, and a related correlational study, were performed to explore how clinical judgment can be assessed and enhanced in the prelicensure baccalaureate clinical setting. These studies included outcome variables of knowledge and self-confidence. The studies were guided by Kolb’s Experiential Learning Theory as well as Tanner’s Clinical Judgment Model.The pilot study used an adapted form of the focus group method and aimed to determine the best way to apply the structured debriefing method of Debriefing for Meaningful Learning (DML) in the clinical setting. The pilot study included clinical faculty (N = 4) in a baccalaureate nursing program at a small college in Upstate N.Y. The study began with training on DML, followed by an asynchronous pre implementation survey where participants provided answers to interviewer questions via Google forms. Next the study involved 3 weeks of implementing DML with clinical groups in the clinical setting and concluded with a post implementation synchronous focus group that met via Zoom©. The results of the pilot study led to a few adaptations in the DML process including the creation of a faculty script, a student guide, a new concept map, and a change to when students were expected to complete the concept map during their clinical day. The quasi-experimental study took place at the same college and included participants (N = 62) in the course NSG 323 – Concepts II in both the Spring 2023 and Fall 2023 semesters. The intervention was DML and took place during three clinical experiences (one per week) in the first half of the semester. Participants and clinical faculty completed pretest measures in the week prior to beginning their clinical experiences. Pretest clinical judgment was measured during a simulation scenario by the participants’ clinical faculty using the Lasater Clinical Judgment Rubric (LCJR). The LCJR is a 4-point Likert-type scale measuring 11 dimensions of clinical judgment under four subscales of noticing, interpreting, responding, and reflecting. Self- confidence was measured using a revision of the NLN Student Self-Confidence subscale of the NLN Student Satisfaction and Self-Confidence in Learning instrument. The revised scale is an 11-item Likert-type scale. The revision involved changing items that include the word “simulation” to the word “clinical experience.” Knowledge was measured, posttest only, using scores on the second Unit Exam of the course. A mixed 2 x 2 Analysis of Variance (ANOVA) followed by simple main effects t tests were used to analyze the clinical judgment and self- confidence data, and independent samples t tests was used to analyze exam scores. Results for clinical judgment did not reveal a significant interaction between groups and time (F (1, 60) = .21, p = .652). There was a statistically significant main effect found for group on LCJR scores overall (F (1, 60) = 7.65, p = .008). Both pretest and posttest mean scores for the LCJR were lower in the intervention group (M = 22.54 and M = 25.88 respectively) than in the control group (M = 27.75 and M = 30.33 respectively). The results for self-confidence did not reveal any significant interaction between groups and time (F (1, 59) = 1.44, p = .235). The mean scores for the posttest were higher in the intervention group (M = 42.65) than in the control group (M = 40.83). Results also showed that while self-confidence scores from pretest to posttest for the intervention group increased, the scores from pretest to posttest for the control group decreased; however, the differences in groups did not reach statistical significance (F (1, 60) = .45, p = .504). An independent samples t test showed no significant difference in Unit II exam scores, measuring knowledge, between groups (p = .451, d = .20). A correlational study was completed exploring the relationships between clinical judgment, knowledge, and self-confidence using the data obtained in the quasi-experimental study. This study also explored the differences between groups for each correlation, and whether having prior health care experience impacted each outcome variable. Results showed no statistically significant correlation between pretest clinical judgment and pretest self-confidence scores (r = .09, p = .502), nor between posttest clinical judgment and self-confidence scores (r = -.22, p = .085) for the entire sample. However, there was a significant negative relationship between posttest self-confidence and clinical judgment in the control group (r = -.36, p = .034). The differences between groups in the pretest correlations of clinical judgment to self-confidence (zobs = .298, p = .764) and in the posttest correlations of clinical judgment to self-confidence (zobs = -1.61, p = .107) were not significant. There was also no statistically significant relationship revealed between both the pretest (r = -.10, p = .439) and posttest (r = -.18, p = .163) self-confidence scores and knowledge, as measured by Unit II exam scores for the entire sample, as well as within groups. The difference in correlations between groups on both the pretest self-confidence scores and exam scores (zobs = -1.29, p = .197) and posttest self-confidence scores and exam scores (zobs = -.643, p = .522) were not statistically significant. However, both pretest (r = .36, p = .004) and posttest (r = .39, p = .002) clinical judgment scores and posttest- only exam scores were revealed to have a positive statistically significant correlation for the entire sample, as well as in the intervention group only (r = .59, p = .002 and r = .632, p < .001 respectively). The difference in correlations between pretest clinical judgment and knowledge was significant (zobs = -2.29, p = .023). The correlation between posttest clinical judgment scores and exam scores for control group was .084, and .632 for the experimental group. The difference in correlations between posttest and knowledge was ~ .55, also statistically significant (zobs = -2.45, p = .0151). There is a long-held understanding in nursing education that the teaching-learning strategies in the clinical environment need to be evaluated and improved. While not revealed to have a statistically significant effect in this initial study, the use of structured debriefing methods should still be further explored in the clinical setting to determine whether the process can be an acceptable pedagogical approach to improve knowledge and clinical judgment in the clinical setting. The moderate positive statistically significant relationship between clinical judgment and knowledge found in this study aligns with Tanner’s (2006) theory that the development of both knowledge and clinical judgment is a related and cyclical process where both should be emphasized. The inverse relationship found between self-confidence and clinical judgment/knowledge, while not statistically significant in this study, suggests that students will benefit from honest and constructive feedback on their performance to accurately evaluate themselves and their ability to perform in the clinical setting.

Submitted in fulfilment of the requirements for the Degree in Master of Technology: Nursing, Durban University of Technology, 2012. / Background : Work Integrated Learning is an educational approach that aligns academic and workplace practices for the mutual benefit of students and workplaces. Work Integrated Learning like in any other nursing course is essential in primary health care as required by the South African Nursing Council. In the clinical setting, students develop clinical and diagnostic reasoning; they also learn how to make the appropriate clinical decisions which they need as qualified primary health care practitioners. This is achieved through instruction and guidance by lecturers, mentors and clinical staff. However it has been noted that the clinical learning environment confronts students with challenges that are absent from the classroom situation. So this study seeks to explore and describe the experiences of post basic nursing students in primary health care clinics so as to address the challenges that are faced within the clinical settings. Aim of the study The aim of the study was to explore and describe primary health care post basic nursing students’ experiences during clinical placements. Methodology : A descriptive exploratory qualitative approach was used to guide the study. In-depth interviews were conducted with ten primary health care post basic nursing students who were allocated for Work Integrated Learning at the clinics in District A and District B in 2011. The main research question for this study was asked: ‘What are the experiences of primary health care post basic nursing students regarding Work Integrated Learning?’ Results : The findings of this study revealed that Work Integrated Learning is vital for the development of clinical skills amongst primary health care post basic nursing students. However, shortage of staff, inadequate material/ non-human resources, lack of supervision in the clinical facilities, distant clinical facilities and insufficient practice in the clinical skills laboratory were identified as challenges that students experience during Work Integrated Learning placement.

The COVID pandemic led to a sudden expansion of telehealth in the delivery of nursing services. At the same time, nursing education was forced to extend clinical learning to online approaches. However, telehealth clinical experiences are limited in the nursing curricula of entry-level programs. Nursing simulation is an educational activity that prepares students for clinical practice by supporting the learning of fundamental clinical competencies. This study was designed to explore prebriefing methods for simulation to prepare entry-level nursing students for telehealth patient care visits. Standardized patient (SP) methodology was used to simulate a telehealth video conferencing call for an infectious disease case interview. Simulations were conducted remotely using Zoom technology with breakout rooms adhering to Healthcare Simulation Standards of Best PracticeTM, and informed by NLN Jeffries Simulation Theory and Experiential Learning Theory. The experiment compared two different methods for prebriefing: traditional prebriefing with a narrated script and structured prebriefing with a narration script plus learners viewed a role modeling video and participated in guided reflection. Participants from one private university in the Northeast (N =126) were randomized and simulations took place over one semester. In conclusion, the standardized patient simulations were an effective teaching strategy for developing fundamental telehealth skills of therapeutic communication and confidence with patient safety. Learners in the structured prebriefing group had significantly higher scores for confidence in quality and safety, faculty assessed therapeutic communication, and simulation effectiveness. There were significant improvements of therapeutic communication scores over time for both groups, but there were no differences between groups. Future research might extend the explanations of how to best prepare learners for telehealth experiences; it is important to further explore telehealth clinical competencies with entry-level nursing students.

Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2013. / South Africa is one of 12 countries where the under-five child mortality rate has increased. In response to this challenge, the WHO and UNICEF in the 1990s developed Integrated Management of Childhood Illness (IMCI), a strategy to reduce child mortality and morbidity. IMCI training was launched in South Africa in 1998. Health care workers trained in IMCI face many challenges when applying the new integrated case management approach. Training settings tend to differ from the actual work environment. Simulation is practiced in an enclosed environment and certain assessments are not possible for example chest in drawing, level of consciousness, oedema amongst others. In South Africa, there has been limited research on IMCI in-service and pre-service training and no research has been conducted regarding the training of student nurses on IMCI and follow up of these learners in the clinical field. Purpose of the study The purpose of this study was to evaluate the IMCI training of learners in the use of IMCI Guidelines in the KwaZulu-Natal College of Nursing (KZNCN). Methodology This study followed a descriptive quantitative approach and evaluates the training of the learners and the facilitation and training of lecturers with regards to IMCI in the KZNCN campuses. Data was collected using questionnaires for facilitators and learners on the three campuses. Results The findings of this study revealed that teaching and learning approaches used to facilitate IMCI were adequate except for clinical practice and theory which was reported to be insufficient.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background - Student nurses indicated that the clinical environment was not conducive to learning because they were part of the ward staff ratio and clinical supervision was inadequate. Upon observations by the researcher and feedback from student nurses’ a study was planned to identify the clinical experiences and supervision. The study itself was conducted within private health care settings in the Western Cape Province of South Africa. Objectives - The objective of this study was to determine the experiences of student nurses of the clinical learning environment. To also identify the support and clinical supervision that the student nurses received from ward staff, clinical facilitators and lecturers. Methods and analysis - The CLES+T is a reliable and valid evaluation scale for the gathering of information on the clinical learning environment and supervision of student nurses. The CLES+T evaluation scale was completed by 234 student nurses within the selected sites. A quantitative, descriptive cross-sectional survey was conducted by making use of the CLES+T evaluation scale. The CLES+T evaluation scale is subdivided into three main sections with additional sub-sections: (1) the Learning environment, (2) the Supervisory relationship and (3) the Role of the nurse teacher (lecturer). Results - The clinical learning environment was experienced as mostly positive by the student nurses; however the format and type of clinical accompaniment and supervision students received varied. Conclusion - This study gave valuable insights into the status of the clinical learning environment, the clinical accompaniment and supervision of student nurses which can be useful to the nursing school in order to enhance existing nursing programmes.

Background: This study derived from the concerns raised by nurse educators, clinical preceptors, and some nursing students in public nursing colleges in Gauteng following the implementation of the provincial selection criteria and processes. While these criteria could be seen as a means of standardising the admission into the Basic Nursing Diploma Programme at public nursing colleges, anecdotal reports from nurses in education institutions and clinical practices indicated a lack of professionalism, high attrition rates among these cohorts of students. The researcher believed that any meaningful selection criteria and processes should be on the views expressed by people who have been through the process as students or educators. Aim: The aim of this study was to analyse the selection criteria and processes followed by nursing colleges in the Gauteng Province to admit students into Basic Nursing Diploma Programme with the view of proposing selection criteria and processes that would secure the admission of the best candidates to this programme in public nursing colleges in Gauteng Province. Design: Quantitative descriptive survey design with self-completion questionnaire was used to generate data for this study. Out of 571 questionnaires distributed, 492 were returned and considered for analysis. Summary descriptive statistics were performed using SPSS version 21. Results: Four of the 13 items analysed were viewed by more than 70% of the respondents as less important and irrelevant to the selection of best candidates for nursing professional education. Proposal for changes supported by the rational for these changes were made by the respondents. Conclusion and Recommendation: The study proposed a framework that could guide the provincial authority in developing admission criteria that will ensure the selection of best candidates for Basic Diploma Nursing Programme in the province. / Health Studies / M.A. (Nursing Science)