What strategies are effective for clinical nurse instructors to use in developing critical thinking in student nurses? Many clinical strategies have been discussed in, literature, but only a few have been verified through research as to their usefulness.This study used the qualitative research methodology of multiple case studies. Participants were six clinical nurse instructors. Nursing experience ranged from 17-27 years, teaching experience involved 2-24 years. Four instructors had doctorates, one nurse had a masters degree, and the sixth nurse lacked two courses before completing a masters degree. The six instructors were from five areas of nursing: medical/surgical (beginning and intermediate level), maternity, mental health, community health and management.Each instructor was interviewed three times during the same semester, approximately two weeks apart. Interviews were audio recorded and transcribed. Spradley's (1979) domain and taxonomic analyses were used to analyze the data.Data analysis showed that some strategies were used by all instructors, with adaptations made for the specialty. The strategies used by all instructors were questioning, nursing care plans and clinical conferences. More than one instructor used student journals, teaching projects, research articles, milieu assessments, and case studies/scenarios.This research strongly supported the use of questioning to help the student progress in critical thinking. Contrary to some research, the present research found that questioning by the instructors was not detached but was situated in the client setting which helped the student synthesize facts into a whole. The research identified many questions used by the clinical nurse instructors.Instructors identified their role in assisting students toward critical thinking as helper, facilitator, coach and guide. Instructors also identified the following characteristics as necessary to help students: caring attitude, creativity, perseverance, knowledgeable, listener, encourager and learning attitude. The instructors motivated students as they progressed in critical thinking through verbal and nonverbal rewards. Students gained self-confidence as they experienced success in their journey towards critical thinking. Implications for nursing practice are provided. The importance of this research lies in the rich depth of discovering how these strategies, roles, characteristics, and motivators assist nursing students in developing critical thinking skills in different clinical settings.2 / Department of Educational Leadership

The purpose of this naturalistic qualitative inquiry was to determine perceptions of experiences of nontraditional African American nursing students regarding their persistence in or departure from a baccalaureate degree nursing program. The literature reflects that although more people of color are enrolling in higher education, graduation rates remain dismal. Many studies have examined the problem from an institutional viewpoint with a focus on retention and attrition. The present study laid out a blueprint for qualitative research and focused on the individual student so that the problem was approached from the angles of persistence and departure. A bi-polar model of this educational issue was proposed to demonstrate this concept.Convenience sampling was used to identify participants who were assigned to separate focus groups. One group was composed of participants who were departers due to academic dismissal. The second group was composed of participants who persisted and were either currently enrolled or had graduated. Interview guides were developed and participants were interviewed in a focus group setting, followed by individual interviews. Data analysis identified emergent themes from the transcribed interviews that fell into the categories of educational climate, myth of homogeneity, and desire for a level playing field.The findings suggest that African Americans attending predominantly White institutions continue to face racism and oppression, supporting the conclusion of previous researchers on these issues. Implications from this study concluded that to reflect the changing demographics in society, higher education and specifically nursing education must become more inclusive.The conceptual framework for this study was based on the theories of McClusky (1963) from the field of adult education; and Tinto (1975, 1993) prominent in the field of higher education. McClusky's Power/Load/Margin Theory was found to be minimally supportive in describing the experiences of nontraditional African American BSN students. Participants identified barriers that related solely to their status as African Americans and thus eroded the level of Margin. Tinto's longitudinal model of institutional departure was found to be applicable to students who leave due to academic dismissal, an area not previously addressed in the model. Recommendations for further research were given. / Department of Educational Leadership

The purpose of the study was to examine students' perceptions of frequency of clinical teacher behaviors and whether those perceptions change by class level. The theoretical framework for the study was Bevis' paradigm of curriculum revolution.In 1993, Marilyn Simons, DNS gathered data from nursing students enrolled in clinical nursing courses at a Midwestern university. The convenience sample totaled 88 (100%). The data was not analyzed or reported. The current study was a retrospective analysis of that data.Findings of the study showed that students perceived faculty as demonstrating professional competence and interpersonal relationship behaviors in the clinical setting. No significant differences were found in these perceptions by class level on either then total scale or on the subscales.The conclusion from the study was that faculty at this particular university are perceived as practicing emancipatory education as proposed by Bevis. It was also concluded that faculty perform at the same level of competency and use similar approaches without regard to class level, and that students perceived that faculty related to them in similar ways across classes.The study was significant because it helps nurse educators understand the student perspective of clinical teacher behavior. The Clinical Teacher Behavior Tool used in the study could be used to help design a cooperative clinical learning model different from the traditional education approach and in accordance with Bevis' paradigm. / School of Nursing

One of the core issues in distance education has been the adequacy of assessment of student experiences and the interaction between faculty and students. This challenge has become even greater with the increase in the numbers of online courses in nursing. Distance education programs that are delivered totally online have many advantages and some disadvantages. Masters level nursing students are choosing online programs for convenience, flexibility, and quality. The purpose of this study was two-fold: to describe Masters nursing students’ perceptions of online courses between 2005 and 2009, as expressed through word data in a web evaluation survey; and to analyze the student perceptions of the online learning environment for trends and themes. The questions of this investigation were the following: 1. What perceptions do Masters nursing students have of their online courses (2005-2009) as expressed through word data in a web evaluation survey? 2. What recommendations can be made for continuous improvement and best practices in programming and evaluation methods based on student perceptions. This research utilized Constructivist Theory as a theoretical model. There were 1625 student comments and 903 suggestions that were analyzed for themes and placed in categories. A qualitative analysis approach was utilized to create categories and look for trends in the data. There were six categories gleaned from the comments and six more that were found as a result of reviewing the suggestions that were made for future course offerings. The researcher found that there was some overlap between the categories of the comments and those of the suggestions. The perception of the students regarding their online course experience in the graduate nursing program was very positive. The flexibility and independence that the online environment offered was appreciated. Blackboard was viewed very positively and students felt that it was easy to use. Students enjoyed the interaction with peers and with faculty and felt it was a valuable learning experience. Recommendations were identified, based on the findings related to the use of technology, recruitment and retention of faculty, and teaching strategies and learning styles. / Access to thesis permanently restricted to Ball State community only / Department of Educational Studies

Graduate nursing education is a combination of didactic and clinical instruction. Clinical instruction is achieved primarily by pairing a student with either an experienced physician or certified nurse practitioner (NP) who will serve as a preceptor. The student/preceptor relationship may be initiated by nursing faculty or by the student. The quality of clinical instruction is crucial to the professional development of the NP. During this time of intense clinical instruction, students learn the process of applying the principles of diagnostic reasoning in a real world setting. Socialization into the role of the NP is an important component of the clinical education and may be impacted by the relationship established between the student and the preceptor. Multiple factors may have an impact on the resulting experience and relationship. Attitudes of both student and preceptor define and shape the relationship that develops throughout the clinical rotation. The student’s perception of the quality of the clinical experience may impact the outcome of the experience including the student’s sense of self-efficacy and confidence in practice skills and socialization into the role. This study focuses on the student’s perception of self-efficacy and confidence based on whether a mentoring relationship was established with at least one preceptor during the clinical experience. The study, a modified replication of Hayes’ 1997 study, demonstrated a strong sense of mentoring, self-efficacy and self-confidence in students enrolled in the final clinical course of a nurse practitioner program. The single most predictive factor for self-efficacy and self-confidence is length of time the student works with the preceptor as measured by months of clinical rotation. Other predictors of self-efficacy and self-confidence included the students’ perception of a mentor and how that mentorship was instrumental in the development of the skills and abilities necessary for transition into the role of the nurse practitioner. Self-efficacy was found to correlate highly with feelings of self-confidence in beginning skills such as physical assessment as well as higher level skills of diagnostic reasoning. As the students neared the end of clinical courses in the nurse practitioner program, most felt prepared to begin practice and cited traits similar to those attributed to preceptors as indicators of preparedness. / Department of Educational Studies

SAMMANFATTNING   Verksamhetsförlagd utbildning (VFU) har stor betydelse för studenternas lärande och kräver samordning mellan universitet och vårdenheter. Förklaringsgrunder och problematisering av praktiskt lärande är inte lika vanligt förekommande som att studera teoretisk förståelse . Det finns behov av pedagogisk utveckling av VFU. Syfte: Syftet med denna studie var att studera sjuksköterskestudenters uppfattning om måluppfyllelse gällande hälsofrämjande arbete, vid VFU i primärvården. Metod: En deskriptiv, kvalitativ design användes med fenomenografisk ansats. Tio sjuksköterskestudenter intervjuades. Resultat: Den fenomenografiska analysen resulterade i sju kvalitativt skilda beskrivningskategorier hierarkiskt ordnade underifrån;  universitetets betydelse och handledarens betydelse därefter komplex roll som student, otydligt mål för hälsofrämjande arbete och reflektion underlättade att förstå hälsofrämjande arbete. Två beskrivningskategorier låg högst upp bristande förutsättningar för aktivt deltagande och passivt deltagande gav helhet över exempel på hälsofrämjande arbete. Slutsats: Kunskap om sjuksköterskestudenters uppfattningar, i synnerhet gällande bristande förutsättningar för aktivt deltagande i hälsofrämjande arbete samt att passivt deltagande gav helhet över att kunna ge exempel på hälsofrämjande arbete, kan vägleda universitet och yrkeshandledare i utveckling av handledning vid VFU i primärvården. / ABSTRACT   Clinical education is important for student learning and requires coordination between universities and healthcare clinics. Fundamental explanations of clinical education are not as common as the study of theoretical understanding. There is a need for pedagogical development of clinical education. Aim: The aim of this study was to explore nursing students' perception of fulfillment of objective outcomes regarding health promotion, during clinical education in primary care. Method: A descriptive, qualitative design was used with phenomenographic approach. Ten nursing students were interviewed. Results: The phenomenographic analysis resulted in seven qualitatively different categories of description hierarchically ordered from below; importance of university and importance of the nursing supervisor then complex role as a student, unclear objectives for health promotion and reflection facilitated the understanding of health promotion. Two categories of description were on the top of the hierarchy lack of opportunities for active participation and passive participation gave wholeness of examples of health promotion. Conclusion: Knowledge of nursing students' perceptions, especially regarding lack of opportunities for active participation in health promotion and that passive participation gave wholeness of examples of  health promotion, can guide universities and nursing supervisors in their development of clinical education in primary care.

Bakgrund: Universitet och högskolor har utvecklat kliniska träningscentrum (KTC) där sjuksköterskestudenterna får integrera kliniska och teoretiska kunskaper. Scenarioträningar innebär att ett antal färdigheter läggs samman till ett autentiskt patientfall och färdighetsträning innebär att lära sig tekniken eller handling med upprepningsmöjligheter. Tekniken har utvecklats i takt med att sjukvården blivit allt mer komplex. Syftet: Syftet med denna studie var att jämföra två olika inlärningsmetoder i att koppla en infusion till en perifer venkateter bland sjuksköterskestudenter. Jämförelsen var mellan färdighetsträning och en kombination av färdighetsträning och scenarioträning. Metod: Fyrtio sjuksköterskestudenter rekryterades från termin 4 och indelades i en interventionsgrupp (19 studenter) och en jämförelsegrupp (21 studenter). Interventionsgruppen fick färdighet och scenarioträning och jämförelsegruppen fick färdighetsträning i att koppla en infusion till en perifer venkateter. Yrkeshandledare utvärderade studentens färdighet och förmåga att koppla en infusion under studenternas verksamhetsförlagda utbildning. Utvärderingen skedde med hjälp av ett frågeformulär baserat på OSCE protokoll och innehöll 5 domäner. Data analyserades med Chi-2 test och Mann-Whitney U test. Statistik programmet SPSS användes för att analysera utfallet. Resultat: Inga signifikanta skillnader sågs mellan grupperna beträffande bemötande, hygien, ergonomi, vårdteknik samt dokumentation. Båda grupperna uppnådde höga resultat inom alla domänerna förutom hygien och vårdteknik. Slutsats: Scenarioträning ökade inte studenternas färdighet och förmåga i att koppla en infusion till en perifer venkateter. Båda grupperna visade att det behövs mer träning på KTC i hygien och vårdteknik.

This ethnographic study explored the experiences of six Aboriginal nursing students in a nursing program with the hope of gaining understanding of such experiences. Four important themes emerged from the analysis of the interviews with the Aboriginal nursing students: (a) teaching about residential schools (the impact of colonization), (b) the push and pull of family and culture, (c) tensions with the nursing program, and (d) pressures to succeed. These themes revealed both the courage and tenacity of Aboriginal students to succeed against their fears of failure, rejection from their community, and rejection from the medical community. Nursing curricula need to be prepared to incorporate the concept of cultural safety and determine whether the dominant Euro-Canadian female nursing program requires that students give up their Aboriginal identity and assimilate, which can perpetuate colonialism.

Introduction The purpose of this study was to improve Indonesian nursing students' self-directed learning readiness. An educational intervention program (EIP) was developed, implemented and evaluated. Background to the study Many studies have documented the need for nursing students to be prepared for the rapidly changing and complex health care environment. Lifelong, self-directed learning (SDL) has been identified as an important ability for nursing graduates. However, no study has documented the needs of, or preparation required for, nursing students to function effectively in the rapidly changing health care system in Indonesia. The Indonesian diploma nursing schools still use a teacher-centred approach with little emphasis on a student-centred approach. Method The study used a mixed method involving both quantitative and qualitative design. Simple random sampling was used to select an intervention school and control school. The sample was 2nd year nursing students with 47 in the intervention group and 54 in the control group. A pre-post test questionnaire, using the Self-Directed Learning Readiness Scale (Guglielmino, 1978), was used to collect quantitative data and focus group discussions (FGD) were used to collect qualitative data regarding students' perceptions of SDL prior to and at the completion of study. The intervention group received an EIP. The Staged Self-Directed Learning Model (Grow, 1991) and the Teacher Student Control Continuum (D'A Slevin & Lavery, 1991) were used as the organising framework. A self-learning module and learning plans were used as learning strategies to operationalise SDL concepts alongside teacher-centred methods. The control group received the existing teacher-centred methods. At the completion of the intervention, clinical instructors from both the intervention and control groups participated in FGD to explore their perceptions of students' activities during the EIP. Results For the majority of students, readiness for SDL was 'below average'. The mean for the Indonesian nursing students was significantly lower than established norms (Guglielmino, 1978). The introduction of SDL concepts through an EIP improved the level of readiness for SDL in the intervention group from 'below average' to 'average' compared to the control group who remained in the 'below average' range. Higher SDL readiness was reported by female students and students who completed the educational intervention. The FGD before the intervention revealed that students perceived SDL as a 'self-activity'. Perceptions of students in the intervention group changed during the EIP compared to students in the control group. Students in the intervention group viewed SDL as a 'process of learning'. Increased self-confidence, incremental learning, and having direction in learning were identified as benefits of SDL. Knowledge and skills in SDL, learning materials and communication were identified as important issues that needed to be improved. Clinical Instructors' perceptions of students' clinical activities confirmed that students in the intervention group were 'more active' compared to the control group who were 'still inactive'. Conclusion The study confirmed the expected effect of the EIP on students' SDL readiness. The EIP improved nursing students' readiness for SDL and had a positive impact on students' perceptions of SDL. Introducing the concept of SDL through the EIP was found acceptable by the sample and was deemed feasible to implement within the Indonesian nursing education system. The study has potential to make a significant contribution to nursing education in Indonesia by promoting lifelong learning and SDL in nursing students and in curricula through the development of innovative curricula and teaching and learning practices. The study also has potential wider benefit to nursing practice and global health practice.

The aim of the research was to improve Taiwanese undergraduate nursing students' attitudes toward and knowledge about older people in order to encourage them to work with older people. People aged 65 and over currently make up 9.7% of the Taiwanese population (Department of Statistics 2006). With the increasing population of older people, health care professionals will have more experiences of caring for older people. However, an increasingly large body of literature suggests that most health care professionals have negative attitudes toward older people and little knowledge about older people. Studies from Western countries have indicated that attitudes toward and knowledge about older people can be improved through a variety of educational efforts. Two studies were conducted to examine these issues. Study 1 involved a cross sectional survey of 302 nursing students from four-year and two-year programs in a university in southern Taiwan. Overall, the results showed that nursing students held positive attitudes toward older people but had poor knowledge about older people. Moreover, the findings suggested that nursing students' intention to work with older people and gender were important factors influencing their attitudes toward older people. Age, nursing program, and living with older people were the variables which made independent contributions to knowledge about older people. Study 2 was a quasi-experimental design using pre-post tests with an intervention (experiental based learning) and control group (usual lecture based learning) (n = 60) to test the impact of a gerontological educational subject. Focus group data were also collected to examine students' reactions to the gerontological nursing subject and the experiential learning strategies used in an experiential-based learning group. The sample was students in the second semester of their second year from the same university used for Study 1. All 60 students were randomly assigned into either experiential-based learning or lecture-based learning groups for their gerontological nursing subject. The data were collected across three time points (pre-test, week 16 and week 20) using 2 validated instruments from Study 1. Qualitative data were also collected from the experimental group after students' clinical practice at week 20. In order to test for the effect of the intervention over time, repeated measures analysis of variance was used to determine the effectiveness of the experiential learning approach and clinical practice on each of the dependent variables of attitudes and knowledge. The results of Study 2 indicated that students' attitudes toward and knowledge about older people did not differ between the two groups In addition, there was no change in attitudes following the completion of the gerontological nursing subject. Students in both groups had improved their level of knowledge at the end of the gerontological subject. Therefore, the study hypotheses were not supported. Several factors such as lack of linkage between theoretical concepts and experience, the dominant 'exam culture', students' usual learning style and the structure of the program may explain the results. This was the first study which had introduced experiential learning into the selected university. It was necessary to conduct this initial study to understand the students' reaction to it. Therefore, based on the research findings from both the quantitative and qualitative results, the study indicates that additional studies are needed to continue exploring how experiential learning strategies may be used to improve students' attitudes toward and knowledge about older people.