Asynchronous e-learning has become the mainstream choice since the transformation of learning formats by the coronavirus disease-19 pandemic. This scoping review aimed to examine the technologies ...used in asynchronous e-learning for the continuing education of clinical nurses and their modes of delivery and effectiveness.
This scoping review covered the period between 2011 and 2023. Six databases were searched for relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol.
Sixty articles met the inclusion criteria. There was a noticeable trend toward using diverse technology-enabled and enhanced training (TEET) options after 2017. The enabling technological approaches, such as interactive online modules (25 articles) and video modules (25 articles), are described in the articles. The most commonly used enhancing technologies were scenario-based learning (nine articles), resource access (eight articles), computer simulation or virtual reality (three articles), and gamification (three articles). Among the outcomes, knowledge acquisition was the most commonly examined outcome (41 articles).
Notably, many interactive TEET modules were used in asynchronous e-learning. There were few studies on gamification, computer simulation or virtual reality, and scenario-based learning (techniques to enhance intrinsic motivation further). However, the adoption of asynchronous e-learning with advanced TEET options is anticipated to increase in the future. Therefore, objective outcome measures are required to determine the effects of such learning methods on knowledge acquisition and behavioral changes.
Abstract
Background
Nurses are one of the most critical members of advance care planning (ACP) discussion. The evaluation of ACP self-efficacy is of great significance for developing targeted ACP ...interventions among clinical nurses and update their professional roles. However, there are few instruments to evaluate their ACP self-efficacy in mainland China. The purpose of this study was to translate the ACP self-efficacy scale into Chinese and evaluate its psychometric properties among clinical nurses.
Methods
A methodological study of the translation and validation of the ACP self-efficacy scale was conducted from January to March 2022. It involved three phases: (1) the translation and revision of the scale; (2) the exploration and evaluation of the item (
n
= 436); (3) the psychometric evaluation of the scale (
n
= 674).
Results
After a rigorous translation and revision, the ACP self-efficacy scale with three dimensions and 16 items was finally formed. In this study, the critical ratios of the item ranged from 8.226 to 17.499, and the item-total correlation coefficients ranged from 0.437 to 0.732, and the factor loadings of the item ranged from 0.638 to 0.882. The content validity index of the scale was 0.946. Supported by the eigenvalues, the three-factor structure explained the cumulative 61.131% of the overall variance. As the results of confirmatory factor analysis, all the recommended fitting indexes were appropriate. The average variance extracted values ranged from 0.570 to 0.756, and the composite reliability values ranged from 0.858 to 0.925. The total Cronbach's α coefficient, split-half reliability coefficient and test–retest reliability coefficient of the scale were 0.896, 0.767 and 0.939, respectively.
Conclusion
The Chinese version of ACP self-efficacy scale was successfully introduced into China, showing good psychometric properties among clinical nurses, and can effectively assess the ACP self-efficacy. Also, the scale can provide nursing educators with a significant strategy to develop ACP educational procedure and post-intervention measures for clinical nurses to improve nurse-led ACP practice.
Background: Nursing competence is an essential element in ensuring high-quality nursing care and positive patient outcomes. Valid and reliable assessment tools for assessing nurse competence are ...needed to help nurse supervisors measure whether nurses are performing their job well and to provide a baseline for improving the competences of nurses. Purpose: This study was designed to develop and psychometrically validate the Competence Scale for Clinical Nurses (CSCN). Methods: The CSCN was developed in three steps: (a) generalize assessment items from nursing competence-related scales and a review of the relevant literature, (b) determine the content validity of the developed scale, and (c) psychometrically test the developed scale. Five hundred nurses were recruited from a medical center in southern Taiwan. Exploratory and confirmatory factor analyses were executed to analyze construct validity and internal consistency reliability. Results: The scale-content validity index was .87, as determined by five experts. Two thirds (63.29%) of the variance was explained by three factors: basic care skills (nine items), being dedicated to work (five items), and patient-centered and ethical considerations (four items). A second-order confirmatory factor analysis indicated that the data fit the model well. The Cronbach's alpha coefficients for each of the three factors and the total scale were .84-.91. Conclusions/Implications for Practice: The 18-item CSCN is a feasible and time-efficient tool for assessing competence in clinical nurses. Nursing supervisors may use this tool to explore nurses' competency and routinely track the effect of continuing education on competence. Continuous evaluation of nurses' clinical-based competence using the CSCN is recommended.
Clinical nurses are susceptible to compassion fatigue when exposed to various types of traumatic events in patients for extended periods of time. However, the developmental process, staging, and ...psychological responses distinct to each stage of compassion fatigue in nurses are not fully clarified. This study aimed to explore the processes of compassion fatigue and the psychological experiences specific to each phase of compassion fatigue among clinical nurses.
Charmaz's Constructivist Grounded Theory methodology was used in this qualitative research. Semi-structured interviews were conducted with 13 clinical nurses with varying degrees of compassion fatigue from December 2020 to January 2021. Interview data were analyzed using grounded theory processes.
The data were categorized into five separate categories and 22 sub-categories. This study found that the process of compassion fatigue is dynamic and cumulative, which was classified into five phases: compassion experience period, compassion decrement period, compassion discomfort period, compassion distress period, and compassion fatigue period.
Clinical nurses who experience compassion fatigue may go through five stages that are stage-specific and predictable. The findings can shed light on local and global applications to better understand the problem of nurses' compassion fatigue. The interventions for addressing compassion fatigue in clinical nurses should be stage-specific, targeted, and individualized.
Enhancement of reflective ability leads to improved nursing practice and individual growth. This study aimed to develop a reliable, validated scale that can effectively assess the reflective ability ...of clinical nurses.
Study participants were 1,872 nurses. We developed an anonymous self-administered questionnaire consisting of 33 original scale items and used it to conduct a survey. The scale was developed based on a construct validity study using item analysis, exploratory factor analysis, and confirmatory factor analysis. Reliability was estimated with Cronbach's α values. Criterion-related validity was assessed using Pearson's correlation analysis.
There were 1,292 responses (response rate, 69.0%). Responses from 1,262 subjects with no missing data were analyzed (valid response rate, 97.7%). Based on the item analysis and exploratory factor analysis, we developed a trial scale model with 3 factors and 25 items. We named the first factor (Factor 1) "Recall Their Own Nursing Practice," the second factor (Factor 2) "Reflect on Their Own Nursing Practice" and the third factor (Factor 3) "Expand Their Own Nursing Practice". This model was modified based on modification indices from the confirmatory factor analysis. A model with 3 factors and 19 items was developed. It had acceptable fit indices (goodness of fit index = 0.914; adjusted goodness of fit index = 0.890; comparative fit index = 0.949; root mean square error of approximation = 0.070). Cronbach's α coefficients were 0.962 for all scale items, 0.922 for Factor 1, 0.918 for Factor 2, and 0.885 for Factor 3. The correlation coefficient between the model and the Professional Identity Scale of Nurses was 0.506 (
< 0.01).
We developed a reflective ability scale consisting of 3 factors and 19 items. We demonstrated its construct validity, reliability, and criterion-related validity. This scale can effectively assess the reflective ability of nurses.
Purpose: To investigate the difficulty faced by clinical nurses working in acute hospitals in support with returning to work for middle-aged patients after coronary artery bypass grafting (CABG). ...Method: Semi-structured interviews were conducted with 10 senior clinical nurses working in acute hospitals and analyzed with content analysis (Krippendorff). Results: The nurses experienced the following themes: A feeling of resistance to the burden of nursing services and duties, Hesitation due to lack of expertise, Mismatch between expectation and achievement, Issues with the reinstatement support system, and Need for the system to prioritize other duties. Conclusion: The nurses experienced both self and external support-based difficulties in terms of how to balance reinstatement with a patient and other types of jobs, risk aversion with regard to patients, and institutional evaluation. There is a need to recognize and prioritize the necessity and expertise of reinstatement support and the value of the return to work support of nurses.
Objective: To find out the facilitators and barriers to the use of evidence-based practice (EBP) in nursing professionals working in the clinical area. Method: Qualitative descriptive exploratory ...study, with discourse analysis, 6 focus groups were carried out with 3 to 7 participants for a total of 32, a purposive sampling was used; an average of 60 to 90 minutes were recorded per focus group. For the analysis we used the fragmentation, coding and categorisation of the interviews obtaining thematic categories, subcategories and codes from the use of Atlas Ti version 8. Results: 69 % of the interviewees responded that the undergraduate or postgraduate had received some kind of training in EBP, the main source of information when they have any doubt in clinical practice are the institutional protocols or colleagues with more experience. Facilitators identified in this study were: time to investigate, training in EBP, initiative, research groups and peers; barriers were: lack of institutional support, little training in EBP, lack of time, language, professional demotivation and rejection in the face of change. Conclusions: The facilitators and barriers presented by nursing professionals working in the clinical area are described. Facilitators such as: time for research, training in EBP, initiative, consolidating research groups and colleagues as facilitators; barriers such as: little training in EBP, lack of time, language, lack of motivation and interest in acquiring new learning and rejection of change
Objetivo: Descobrir os facilitadores e as barreiras ao uso da prática baseada em evidências (PBE) em profissionais de enfermagem que atuam na área clínica. Método: Estudo exploratório descritivo qualitativo, com análise de discurso; foram realizados 6 grupos focais com 3 a 7 par-ticipantes, totalizando 32; foi usada uma amostragem intencional; foi registrada uma média de 60 a 90 minutos por grupo focal. Para a análise utilizouse a fragmentação, codificação e catego-rização das entrevistas obtendose categorias temáticas, subcategorias e códigos a partir da utilização do Atlas Ti versão 8. Resultados: 69% dos entrevistados responderam que a graduação ou pósgraduação havia recebido algum tipo de treinamento em PBE, a principal fonte de infor-mação quando têm alguma dúvida na prática clínica são os protocolos institucionais ou colegas com mais experiência. Os facilitadores identificados neste estudo foram: tempo para investigar, treinamento em PBE, iniciativa, grupos de pesquisa e colegas; as barreiras foram: falta de apoio institucional, pouco treinamento em PBE, falta de tempo, idioma, desmotivação profissional e rejeição diante de mudanças. Conclusões: São descritos os facilitadores e as barreiras apresentados pelos profissionais de enfermagem que trabalham na área clínica. Facilitadores como: tempo para pesquisa, treinamento em PBE, iniciativa, consolidação de grupos de pesquisa e colegas como facilitadores; barreiras como: pouco treinamento em PBE, falta de tempo, idioma, falta de motivação e interesse em adquirir novos aprendizados e rejeição a mudanças.
Objetivo: Conocer los facilitadores y barreras para el uso de la práctica basada en evidencia (PBE) en profesionales de enfermería que laboran en el área clínica. Método: Estudio cualitativo de tipo exploratorio descriptivo, con análisis de discurso, se realizaron 6 grupos focales conformados por 3 a 7 participantes para un total de 32 personas, se utilizó un muestreo intencional; en promedio fueron grabados entre 60 a 90 minutos por grupo focal. Para el análisis se empleó la fragmentación, codificación y categorización de las entrevistas obteniendo categorías temáticas, subcategorías y códigos a partir del uso del programa Atlas Ti versión 8. Resultados: El 69 % de los entrevistados respondió que el pregrado o posgrado habían recibido algún tipo de formación en PBE, la principal fuente de información cuando tienen alguna duda en la práctica clínica son los protocolos institucionales o los compañeros con más experiencia. Los facilitadores identificados en este estudio fueron: tiempo para investigar, formación en PBE, iniciativa, grupos de investigación y compañeros; las barreras fueron: falta de apoyo institucional, poca formación en PBE, falta de tiempo, idioma, desmotivación profesional y el rechazo frente al cambio. Conclusiones: Se describen los facilitadores y barreras que presentan los profesionales de enfermería que laboran en el área clínica. Facilitadores como: tiempo para investigar, formación en PBE, iniciativa, consolidar grupos de investigación y compañeros como facilitadores; barreras como: poca formación en PBE, falta de tiempo, idioma, desmotivación y desinterés por adquirir nuevos aprendizajes y rechazo ante el cambio.
Background:
Ethical competence in nursing practice helps clinical nurses to think critically, analyse issues, make ethical decisions, solve ethical problems and behave ethically in their daily work. ...Thus, ethical competence contributes to the promotion of high-quality care. However, studies on ethical competence in Malawi are scanty.
Objectives:
The aim of this study was to explore ethical competence among clinical nurses in selected hospitals in Malawi.
Methodology:
A cross-sectional survey was conducted in four selected hospitals in Malawi with a sample of 271 clinical nurses. Data were collected using self-administered questionnaires, which included a Moral Competence Scale for Home Care Nurses. Descriptive statistics and logistic regression were computed for the dataset using STATA version 12.0.
Ethical consideration:
The study protocol complied with all ethical requirements and was approved by the College of Medicine Research Ethics Committee under the University of Malawi.
Results:
The clinical nurses in Malawi are ethically competent. However, there is a significantly high number (p < 0.05) of nurses 57% (n = 135) with low ethical competence. There was no significant association between respondents’ demographic variables and level of ethical competence (p > 0.05). Three determinants of high ethical competence level (strong will, judgement skills and recognition of discrepancy of intention) were identified through a reduced model after stepwise logistic regression analysis. Furthermore, results show that indicators of ethical competence include caring, confidentiality and observance of nurses dressing code. The study has also confirmed that the Moral Competence Scale for Home Care Nurses is a reliable tool to assess ethical competence in low-resource settings.
Conclusion:
The majority of nurses who completed the survey had low ethical competence. However, clinical nurses with high ethical competence level are required to competently manage complex ethical challenges in health facilities. Strategies for enhancing ethical competence such as continuing ethics education, establishment of ethics committees and provision of supportive supervision are recommended to enable nurses in Malawi attain a high level of ethical competence.
Objetivo: Determinar la utilización de evidencia científica disponible por el profesional de enfermería para planificar los cuidados otorgados. Metodología: Búsqueda en bases de datos: Proquest, ...Pubmed, Science Direct, Medline. Se seleccionó nueve artículos para análisis, publicados entre los años 2011 y 2021 en idiomas inglés y español, ajustados a requerimientos PRISMA. Resultados: Se obtuvieron 356 investigaciones, de las cuales 9 cumplieron con criterios de selección. Los artículos incluidos no miden el nivel de utilización de la Enfermería Basada en Evidencia (EBE) para la planificación de los cuidados, sin embargo, se describen factores facilitadores y barreras para su implementáción. Conclusión: La evidencia disponible no es suficiente para determinar la utilización de la evidencia en los cuidados otorgados por parte del profesional de enfermería. Se describen barreras de tipo personales y organizacionales para su utilización. Para lograr una adecuada implementáción de la EBE es necesario contar con estrategias efectivas en los entornos clínicos y esfuerzos multidisciplinarios para su utilización. Es necesario la realización de estudios de mayor calidad, para generar datos confiables que evidencien cómo impacta el conocimiento, el nivel de formación en investigación y el apoyo institucional en la utilización de la EBE en la práctica clínica.
The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work ...performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions.
This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed.
Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy.
Our study provides a nuanced understanding of the multifaceted factors influencing nurses' mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings.
The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676 .
This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).
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