Indiana University-Purdue University Indianapolis (IUPUI) / Objective: To explore and compare the use of metacognitive, cognitive, and environmental resource management self regulatory learning (SRL) strategies used by a national sample of students enrolled in traditional and accelerated baccalaureate nursing programs. Background: Learner focused reforms in nursing education require students to assume more responsibility for learning. Nursing student responsibility for learning is reflected in their use of metacognitive, cognitive, and environmental resource SRL strategies. Learning strategy use promotes the development of clinical reasoning and lifelong learning skills requisite to meet the needs of complex patients in a dynamic healthcare environment. Method: Using Bandura’s social cognitive theory as a framework, the learning subscales of the Motivated Strategies for Learning Questionnaire were used to survey a national sample of 514 baccalaureate nursing students enrolled in their final semester of a traditional baccalaureate nursing program or a 12-month accelerated baccalaureate program. Delineation of student use of metacognitive, cognitive (rehearsal, organization, and elaboration), and environmental resource management (help seeking, peer learning, effort regulation, and time and study environment) SRL strategies was examined by program and in light of age, grade point average (GPA), weekly hours spent studying independently, and weekly hours spent in employment. Results: Differences in SRL strategy use were found between the program groups and between program groups divided by sample age. Older students in both the accelerated and traditional programs used more metacognition and elaboration SRL strategies than their younger traditional counterparts. Older traditional students used significantly more effort regulation SRL strategies than both groups of younger students. Both older groups of students studied significantly more, used significantly more time and study environment SRL strategies, and had significantly higher GPAs than the younger groups of students from both programs. Conclusions: This study provides a framework for learner focused nursing education by explicitly defining differences in SRL strategy use of students enrolled in traditional and accelerated baccalaureate nursing programs.

Indiana University-Purdue University Indianapolis (IUPUI) / Increasing the success of diverse undergraduate students is central to the mission of many nursing programs. Numerous programs administer learning style inventories in order to obtain baseline information about students’ learning needs. However, little is understood about students’ intent to use the learning style preference information. The purpose of this study was to examine variables associated with intent to use learning style preference information by undergraduate nursing students. Variables included demographic, academic, and learning style preference variables as well as students’ ability to explain learning style preference information, obtained from a commercial learning style inventory. A purposive convenience sample (N = 219) was obtained from six baccalaureate nursing programs in different geographical areas to achieve adequate learner diversity for the variables to be studied. A researcher-developed survey entitled Intent to Use Learning Style Preference Information was used to collect study data. Students responded to questions regarding demographic, academic, and learning style preference information. Pearson correlation, independent samples t test, analysis of variance, and multiple linear regression methods were used for statistical analyses. The significant variables of type of BSN program, years of education, person who shared results, perception of usefulness of learning style assessment, and ability to explain learning style preference information, when entered into the regression model, accounted for 32.5% of the variance in the intent to use learning style preference information, F(5, 198) = 19.07, p < .001. Intent to use learning style preference information was greater for BSN students in four-year programs as opposed to accelerated programs, those with fewer overall years of education, whose results were shared by an academic advisor rather than faculty, who perceived their learning style assessment as useful, and who had high ability to explain their learning style preference information. Evaluation of fiscal resources required for administration of learning style inventories and perceived usefulness of the information by students is critical. Implications from this study include ensuring students’ ability to understand and explain their learning style preference information, as well as providing strategies that students can utilize throughout their curriculum. Further research is recommended to determine the impact of implementation strategies.

Indiana University-Purdue University Indianapolis (IUPUI) / For nursing students to be successful in current and future practice they must be proficient critical thinkers and be able to use reflective judgment skills to manage the daily dilemmas of healthcare practice. Critical thinking and reflective judgment are not elements of nursing curricula unless faculty explicitly design learning activities to develop these skills. This study examined the relationship between reflective judgment and critical thinking by comparing a measure of reflective judgment, the Reasoning about Current Issues (RCI) test, with a measure of critical thinking in nursing (the HESI Exit Exam) in a sample population of senior associate degree nursing (ADN) students (N = 108). The descriptive variables of individual ADN student’s age, grade point average (GPA) in nursing courses and the number of completed college/university credit hours were also examined. A modest correlation (r = .370, p < .01) was found between critical thinking and reflective judgment indicating a positive relationship between these two variables. However, the results supported the hypothesis that these are separate concepts; while the students achieved an acceptable level on the measure of critical thinking, they did not exhibit the skill level of an effective reflective thinker. Positive correlations were found between reflective judgment and individual student age and nursing program GPA (p < .01). Critical thinking was also positively correlated with age (r = .351) and GPA (r = .426). There were no statistically significant correlations noted between the number of credits or previously earned baccalaureate degrees with either reflective judgment or critical thinking. An appreciation of the unique commonalities and differences between reflective judgment and critical thinking is essential for the development of innovative strategies and pedagogies meant to advance teaching/learning within schools of nursing with an explicit focus on both concepts and an ultimate goal of improving competence in newly graduated nurses. The implication for nurse educators is in changes and innovations that can lead to more effective thinkers. Careful pedagogical planning and a mindful inclusion of learning activities to develop both reflective judgment and critical thinking skills may lead to increased competence as nursing students and as new graduate nurses.

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.

published_or_final_version / Education / Master / Master of Education

The 2008 World Health Report emphasises that we need “primary health care (PHC) now more than ever”. Competent primary health care providers who “put people first” are required in the front line in order to make a difference. The need for widely accessible, competent and caring professional nurses thus places expectations on training programmes and health services. In South Africa, a number of studies have been conducted on primary health care and methods of teaching clinical competence to nursing students (Truscott 2010; Magobe et al. 2010; Naledi et al. 2010) but not on the experiences of nursing students during PHC practice. The researcher observed that the emphasis on the positive, supportive and helpful experiences of nursing students in coping with challenges during their clinical practice was distinctly lacking. The objective of the study was to explore and describe the experiences of nursing students during the clinical practice in PHC settings. It was expected that this information will enable the researcher to formulate recommendations to support nursing students to cope with challenges during clinical practice in a PHC setting. A qualitative descriptive inquiry, with an appreciative approach was used. Five semi-structured focus group interviews were conducted to obtain data. The population comprised of 4th year nursing students who were selected using purposive sampling with the assistance of a mediator, namely the Head of the Department for PHC at a Nursing College. The sample size was determined by data saturation. Data analysis was carried out simultaneously with the collection of data. Fifteen main themes were identified during a consensus discussion between the researcher and the co-coder. The main findings related to the meaning students attached to being placed in a PHC clinic; positive, supportive and helpful experiences; how they can be supported and what help them cope irrespective of challenges they experienced. Conclusions were drawn which pertained to: placement in a PHC setting for clinical practice; positive, supportive and helpful experiences; support when placed at a PHC setting for clinical practice and coping measures when placed at a PHC setting for clinical practice; and recommendations were formulated for nursing education, nursing research and nursing practice that focused on supporting and empowering nursing students to cope with challenges experienced at a PHC setting. / MCur, North-West University, Potchefstroom Campus, 2015

The 2008 World Health Report emphasises that we need “primary health care (PHC) now more than ever”. Competent primary health care providers who “put people first” are required in the front line in order to make a difference. The need for widely accessible, competent and caring professional nurses thus places expectations on training programmes and health services. In South Africa, a number of studies have been conducted on primary health care and methods of teaching clinical competence to nursing students (Truscott 2010; Magobe et al. 2010; Naledi et al. 2010) but not on the experiences of nursing students during PHC practice. The researcher observed that the emphasis on the positive, supportive and helpful experiences of nursing students in coping with challenges during their clinical practice was distinctly lacking. The objective of the study was to explore and describe the experiences of nursing students during the clinical practice in PHC settings. It was expected that this information will enable the researcher to formulate recommendations to support nursing students to cope with challenges during clinical practice in a PHC setting. A qualitative descriptive inquiry, with an appreciative approach was used. Five semi-structured focus group interviews were conducted to obtain data. The population comprised of 4th year nursing students who were selected using purposive sampling with the assistance of a mediator, namely the Head of the Department for PHC at a Nursing College. The sample size was determined by data saturation. Data analysis was carried out simultaneously with the collection of data. Fifteen main themes were identified during a consensus discussion between the researcher and the co-coder. The main findings related to the meaning students attached to being placed in a PHC clinic; positive, supportive and helpful experiences; how they can be supported and what help them cope irrespective of challenges they experienced. Conclusions were drawn which pertained to: placement in a PHC setting for clinical practice; positive, supportive and helpful experiences; support when placed at a PHC setting for clinical practice and coping measures when placed at a PHC setting for clinical practice; and recommendations were formulated for nursing education, nursing research and nursing practice that focused on supporting and empowering nursing students to cope with challenges experienced at a PHC setting. / MCur, North-West University, Potchefstroom Campus, 2015

The overall aim was to investigate bachelor nursing students’ experiences with simulation as a learning approach conducted under various conditions. Additionally, the aim was to translate and validate questionnaires for the evaluation of simulation in a Norwegian context. Methods: Quantitative and qualitative methods were used. Nursing students responded to three questionnaires after attending either low- or high-fidelity simulation. Data were analyzed with statistics (I). Two evaluation questionnaires were subjected to a principal components analysis (II, III). Data were obtained from nursing students through focus group interviews, and analyzed with a qualitative content analysis (IV). Main findings: Independent of the fidelity level in the simulation and educational level, the students reported satisfaction and that the emphasized features in learning were present. Those who had used a paper/pencil case study were the most satisfied (I). Debriefing was reported to be crucial for learning, but in particular by attending the large groups, also as a stressful and intrusive situation (IV).The Norwegian version of the questionnaire, the Student Satisfaction and Self-Confidence Scale, revealed no stable factor solution (II). The translated version of the Debriefing Experience Scale was shown to hold a good potential for evaluating debriefing, but benefited from reducing the subscales (III). To ensure safety and security were reported to be a prerequisite for learning, with the students requesting a more frequent use of simulation and a higher degree of familiarity with active learning in their program in general (IV). Conclusions: Simulation at all fidelity levels should be used in nursing education. To exploit the potential, the learning approaches should be integrated into the program in general through a systematic and structured building of a learning community. A further validation and testing of the questionnaires in different programs and contexts is needed.

Submitted in fulfillment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, 2014. / Background The Council for Higher Education and the South African Nursing Council accredit institutions with learning and assessment practices which aim to develop and prepare graduates to be critical thinkers. The undergraduate nursing programme at the Durban University of Technology introduced the writing of reflective journals by their students in 2011. Students submitted journals of poor quality which lacked reflection. Aim of the study The purpose of this study was to evaluate the use of guided reflective journals by assessing the levels of reflection of the undergraduate nursing students during clinical learning and practice. Methodology An exploratory sequential mixed methods design, using quantitative and qualitative paradigm, was used for this study. A purposive sample of 40 participants was used to collect data. A perceptions questionnaire was administered to the 40 participants to determine their perceptions on how they experienced writing of the reflective journals. Content analysis was used to analyse the written content of the reflective journals. Descriptive statistics such a Chi-square goodness of fit and Wilcoxon Signed Ranks test were used determine levels of reflections and the differences in the first and second journals. Lincoln and Guba’s 1985 criteria for trustworthiness were applied to the study. Results Analysis of the journals revealed lower levels of reflection in the first reflective journal compared to improved levels in the second journal. Furthermore, the participants generally expressed writing of reflective journals as a valuable tool in professional, personal development as well as clinical learning. Levels of reflection and development of reflective practice will be greatly enhanced if all involved in nurse education will actively participate in encouraging writing of reflective journals by student nurses.

Interest in developing critical thinking skills in nursing students has grown in proportion to the demand for thoughtful, capable nursing professionals in healthcare. The National League for Nursing has required schools of nursing to combine teaching styles and course content to develop critical thinking, decision making, and independent judgement. Limited research has been done regarding the relationship of critical thinking ability to clinical decision-making. The purpose of this study was to determine the relationship between these two variables, using a sample of senior baccalaureate students in four schools of nursing.Two research questions were addressed: What is the relationship between critical thinking and clinical decision-making of senior baccalaureate nursing students? and, what is the relationship between selected demographic variables and critical thinking and clinical decision-making in senior baccalaureate nursing students?McPeck's (1981, 1990) critical thinking theory, which guided the study, emphasizes consideration of multiple factors in reaching a decision, toleration of differing conclusions, and the importance of teaching and evaluating critical thinking within the context of a discipline. Critical thinking was measured by the California Critical Thinking Skills Test (CCTST, Facione, 1993), a standardized, 34-item, multiple choice test which targets critical thinking skills. Test items are designed to be discipline-neutral and jargon-free, and have a Kuder-Richardson internal reliability coefficient of .70. Judgement in making clinical decisions was measured by the Nursing Performance Simulation Instrument (NPSI, Gover, 1970), which is composed of four simulations that depict typical nursing situations and test problem-solving proficiency. Six-month test-retest reliability of the NPSI was found to be r=.63. Demographic information on age, gender, GPA, number of completed college credit hours, healthcare work experience, healthcare licensure was collected from subjects.The sample included senior baccalaureate nursing students from four universities (N=88). Nursing faculty at each site was contacted before testing for approval to administer the exam to students. Informed consent was obtained from each subject, and students were able to withdraw from the study at any time. Verbal instructions were given to subjects, and confidentiality was insured by the use of a number identifier on each test. The instruments were administered by, and remained in, the possession of the researcher. Results obtained were reported to test sites as group data only. No risks or benefits were identified in participation in the study.Data analysis was done by a combination of methods, using Pearson product-moment analysis, t-test procedures, and canonical correlation. Results indicated that no relationship existed between critical thinking and clinical decision-making, as measured by the CCTST and the NPSI. The only statistically significant relationship was a weak positive correlation between age and performance on the NPSI. Canonical correlation analysis indicated the older subjects, with a lower GPA and, to a lesser extent, fewer credit hours tended to score higher on the NPSI and lower on the CCTST.The study was significant, in that the results will broaden the knowledge of the relationship between critical thinking and clinical decision-making in nursing. / School of Nursing