A Qualitative Exploration of Barriers and Enablers to Health Equity Competencies in Clinical Practice: Application of the Health Equity Implementation Framework

Effects of cooperative learning and situational simulation on nursing competence in clinical practice among nursing students: A quasi-experimental study

Increasingly more resources are being used internationally in training and educating qualified healthcare personnel due to high personnel flow and rapid development within technology, care and treatment. Consequently, transferring learning from simulation-based training to competency in clinical practice is an essential question for healthcare faculty and management. Nevertheless, there is no established method for assessing if transfer occurs. This article aims to demonstrate how a hybrid method can explore transfer of learning from a simulation-based course to competency in clinical practice.

University of Virginia School of Medicine

To develop a substantive theoretical explanation of how mentors make sense of their experiences where nursing students are on the borderline of achievement of competence in clinical practice. The reluctance of Registered Nurse mentors to fail nursing students in clinical practice despite concerns about competence remains a contemporary issue in international healthcare education. Mentors' assessment decisions have considerable impact for a variety of key stakeholders, not least for students in these circumstances. Grounded theory qualitative study. Phase one involved 20 individual semi-structured interviews with nurse mentors in one United Kingdom National Health Service Health Board (July-October 2009). Phase two included eight individual semi-structured interviews and seven focus groups with mentors and practice educators (n=38) in four further Health Boards (June 2011-February 2012). Data were analysed using open, axial and selective coding consistent with grounded theory method. Three categories 'the conundrum of practice competence,' 'the intensity of nurturing hopefulness,' and 'managing assessment impasse,' led to the study's substantive theoretical explanation - 'Seeking authorization: Establishing collective accountability for mentorship.' This demonstrates how mentors are dependent on key sources of support and feedback to validate their assessment decision-making, notwithstanding substantial personal, professional and organizational pressures. We conclude that management of borderline assessment situations is considerably developed by recognition of the authorizing effects of a wider community of assessors. Consequently, we identify the personal, professional and organizational implications involved in the preparation, support and regulation of mentors specifically during borderline assessment circumstances.

Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education. To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students' moral competence in clinical practice. A qualitative hermeneutic approach was employed to interpret the teachers' experiences. Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted. Ethical approval was granted and all participants signed their informed consent. Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources. Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting. There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients' rights and safety.

Assessment of nursing students' competence in clinical practice: A systematic review of reviews

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Background: Clinical practice competence is affected by different factors in a clinical setting like the skill of the educator, staff–student interaction, and a clear assessment guideline. Effective mentoring and constructive feedback will also influence learning. Poor performance is caused by low competence and improving competency should improve performance. The purpose of this meta-analysis is to assess factors affecting the clinical practice competency of medical and health science students in Ethiopia. Methods: We conducted a related literature search (February up to March 2023) of PubMed and Web of Science databases for studies describing the factors associated with clinical practice competency among medical and health science students in Ethiopia. The quality of studies was independently assessed by the Newcastle–Ottawa quality scale (NOS), which was guided by the PRISMA checklist. The Q test and I2 statistics were used to evaluate the heterogeneity among selected studies. If the heterogeneity was obvious (I2>50%), the random effects model (REM) was used. If the heterogeneity was low (I2≤50%), the fixed effects model (FEM) was used. Results: There were 1613 participants in four (4) investigations. The pooled effect size of clinical practice competency among students in the form of odds ratio (OR) with the presence of a checklist was 3.40 (95% CI 2.50–4.62), p<0.01, I2=0%), with the orientation of objective was 3.84 (95% CI 2.29–6.43), p<0.00001, I2=57%), having confidence during performing the procedure was 2.16 (95% CI 1.17–3.99), p=0.01, I2=53%). The final pooled effect size after trim and fill analysis in the random effect model was found to be 1.27 (95%CI: -0.19, -2.73) for the association between staff encouragement to do practice and clinical practice competency. This indicated that absence of a significant association between staff encouragement to do practice and clinical practice competency among medical and health science students in Ethiopia. Conclusions: The presence of a checklist, the orientation of objective, and students having confidence while performing a procedure are factors associated with clinical practice competency among nursing and health science students in Ethiopia.

Objective To explore the effects of the flipped classroom based on micro-lecture in the standardized training for new nurses. Methods A total of 65 new nurses in Shenzhen Hospital, Beijing University of Traditional Chinese Medicine who were recruited from July 2015 to July 2016 were selected and divided into observation group (n=32) and control group (n=33) by random number table method. The control group received the routine standard training, while the observation group received the flipped classroom based on micro-lecture in addition to the routine standard training. After training, the nurses' theoretical and clinical practise competence were analyzed and compared based on their performance in the Self-initiated Learning Ability Scale, Registered Nurses' Core Competence Assessment Scale and Satisfaction Questionnaire. Results After training, the nurses in the observation group achieved higher score in theory (82.68±8.85) , clinical practice (83.64±5.93) , self-initiated learning (112.32±8.62) , and nurses' core competence (162.23±17.96) than the control group with statistical significance (t=3.258, 6.679, 6.085, 3.808; P<0.01) . The satisfaction rate was 87.9% in the observation group and 65.6% in the control group with statistical significance (χ2=4.532, P=0.033) . Conclusions The application of the flipped classroom based on micro-lecture in the standardized training of new nurses can better improve the training efficacy, young nurses' comprehensive and core ability and their autonomous learning ability . Key words: Nurses; Standardized training; New nurses; Micro-lecture; Flipped classroom

Over the past two decades, the teaching of anatomy to medical students has undergone major transformative changes. The purpose of this study was to better understand current perceptions of anatomical competence of residents. We examined residents’ perceptions of their own anatomical competence in clinical practice as well as program directors’ perceptions of their residents’ anatomical competence in clinical practice. A mixed methods survey was sent to both residents and program directors of 15 residency programs at Indiana University School of Medicine. The survey response rates for residents and program directors were 46% (n = 385) and 71% (n = 61), respectively. Results indicate that residents believed their gross anatomy education better prepared them to be anatomically competent, in contrast to their program directors perception (P = &lt;0.0001). However, program directors believed that their residents were developing anatomical competence at an appropriate rate, in contrast to the residents who were less satisfied with their rate of progress (P = &lt;0.0001). Finally, both residents and program directors agreed that there is a need for more formal anatomy educational opportunities during residency. Exploring these results within the context of a changing anatomy curriculum brings to the forefront important perspectives on anatomical competence.

Objective: The study aimed to examine the relationship between empathic tendency and violence management competence in clinical practice among nursing students. Materials and Method: This correlational study was conducted among nursing students enrolled in the spring semester of the 2024-2025 academic year at a university in the eastern region of Türkiye between March 2024 and June 2024. The study population consisted of nursing students (N=812) enrolled in the spring semester in academic year. The sample size was determined to be 287 students using OpenEpi version 3 "Sample Size Calculation for a Known Population" with an effect size of 80% and a confidence interval of 95%. Data were collected using a personal information form, the Empathic Tendency Scale and the Violence Management Competence Scale for Nursing Students in Clinical Practice. Results: The study found that the mean score of nursing students on the Clinical Violence Management Skills Scale was 93.72 ± 27.03 (28, 140), while the mean score on the Empathic Tendency Scale was 65.12 ± 8.52 (41, 91). A weak but statistically significant positive correlation was observed between the mean score on the Empathic Tendency Scale and both the overall mean score and the sub-dimensions of the Violence Management Competence Scale (P&amp;lt;0.001, P&amp;lt;0.05). Conclusion: The study concluded that nursing students have above-average levels of empathic tendency and violence management competence in clinical practice. It was observed that as students' empathic tendencies increased, their competence in managing violence in clinical settings also improved.

BackgroundGood communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students’ experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students’ ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency.MethodsThematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity.ResultsReflection on real difficult clinical communication situations appears to increase medical students’ ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer.ConclusionsReflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students’ overall communicative competency.

Using a phenomenological approach, this study explores the different dimensions of student nurse assessment in clinical practice from the perspective of 10 experienced practitioners. Phenomenology, one of the various types of qualitative research methods, is used to discover and understand the meaning of human life experiences through an analysis of the subjects' descriptions of situations. It is therefore of particular value when addressing the questions posed in the present study: (a) what attributes characterize competence and non-competence in learner nurses, (b) how they recognize these attributes in practice, and (c) how they measure competence at different levels of preparation. Rather than provide answers, the phenomenologist explores the meaning of the language used in determining competence in practice. Through this contribution to the understanding of the notion of competence and its measurement by these experienced practitioners, it may be possible in some way to unravel the confusion that surrounds the meaning of competence represented in the literature. It is hoped that, through the discovery of the lived world of these clinicians, others may be better facilitated for and within their role as assessors in the future.

In the past few decades, cultural awareness and cultural competence in clinical practice have become an important point of focus among helping professionals. Moreover, helping professionals have raised concerns regarding the gaps in current professional ethical codes regarding multicultural competence in clinical practice. That is, professional ethical codes may not adequately provide guidelines and considerations that are culturally informed in providing care for diverse clients, especially when facing ethical dilemmas. An issue that may arise is that helping professionals opt to follow Eurocentric ethical frameworks over culturally informed ethical decision-making when faced with an ethical dilemma, potentially to the detriment of the client. This chapter provides an overview of the professional ethical codes and criticisms of these in relation to multicultural ethics and multicultural competence. Next, the concept of multicultural ethical competence is discussed in conjunction with ethical decision-making models. This chapter also brings focus to two examples of the intersections between ethics and legal issues impacting culturally diverse clients. At the end of the chapter, two case examples are provided along with ethical considerations. Finally, a resource table is provided listing various ethical and practice guidelines for practitioners and students to utilize when working with culturally diverse clients.

Assessing student competency in clinical practice poses a significant challenge for nursing educators. Rubrics are assessment tools to mitigate subjective biases and lay out set standards and criteria to assess performance, assignment or behavior. The rising enrollment of nursing students at the University of Medicine and Pharmacy, Hue University indicates a shift in healthcare education, but the health system’s slow adaptation presents challenges. Current assessment methods lack a unified standard, leading to inconsistencies in measuring nursing competencies. A standardized assessment framework is urgently needed to improve education quality and prepare students for national certification exams, yet evaluations of effectiveness in Vietnam remain unexamined. This quasi-experimental study aimed to compare the effectiveness of rubrics and traditional methods in assessing student competency in clinical practice on self-confidence, satisfaction with clinical teaching, and academic results among nursing students studying a module on women’s health, mothers, families, and nursing care. Purposive sampling was employed to select 186 nursing students at the University of Medicine and Pharmacy, Hue University, with 89 students in the rubric group and 97 students in the traditional group. Data collection tools included the Demographic Characteristics, Self-perceived Confidence, Undergraduate Nursing Student Academic Satisfaction Scale, and Rubric and Traditional Assessment. The results of the study demonstrated that students in the rubric group exhibited significantly higher mean scores across several important dimensions, including overall confidence, satisfaction with clinical teaching, and learning performance when compared to their counterparts in the traditional group. However, the rubric group did not report a statistically significant increase in perceptions regarding instructors being “approachable and comfortable about asking questions,” nor in demonstrating a “high level of knowledge and clinical expertise.” We concluded that the implementation of a rubric-based assessment approach positively influences students’ perceptions of their abilities and contributes to a more effective learning environment than the traditional method. Therefore, we consider that the rubric method should be used to evaluate the quality of nursing practice training with further testing widely in other groups of students, nursing courses, and other settings.