Identification Of Problems Research Articles

Analysis of Effectiveness of Discovery Learning Model in Science Learning Activities for Basic Students

Unlike other learning models, the Discovery Learning model emphasizes theoretical and practical in-depth material exploration, ensuring no learning objectives are overlooked. This differs from other student-centred learning (SCL) models, which grant full autonomy to students. The Discovery Learning model incorporates the role of lecturers as assistants, allowing students to build a strong foundational understanding of knowledge. This study investigates the effectiveness of the Discovery Learning model in science learning for students of the Madrasah Ibtidaiyah Teacher Education program at IAIN Sultan Amai Gorontalo. The research was conducted through four cycles, each consisting of the learning steps of stimulation, problem identification, data collection, data processing, verification, generalization, and reflection. The success of the learning activities was measured by improvements in learning outcomes, reflected in the scores of pre-tests conducted before implementing the learning model and post-tests conducted afterwards. The hypothesis was tested using the paired-sample test to determine the significance between pre-test and post-test scores in each cycle, followed by an effectiveness test using the N-gain test. The findings confirmed the hypothesis, as all cycles showed a t-value greater than the critical t-table value, indicating increased learning outcomes through the Discovery Learning model. This was also evident in the consistent improvement in the average scores between pre-tests and post-tests in each cycle. However, based on the N-gain test, the effectiveness of the learning model was found to be only 53.35%, which falls into the category of low effectiveness. This suggests a need for additional scientific literature and laboratory equipment within the scope of IAIN Sultan Amai Gorontalo.

Emissivity and Reflectivity Measurements for Passive Radiative Cooling Technologies

Due to their optical properties, passive radiative cooling (PRC) materials can effectively reflect solar radiation while simultaneously dissipating heat through the infrared transparency windows using outer space as a cold and renewable heat sink. This makes it possible to achieve sub-ambient temperatures even in direct sunlight without using any electricity for cooling or air-conditioning. However, the accurate determination of these peculiar optical properties is challenging and subject to high uncertainty levels when using commercial instruments available to industrial end users and research laboratories. Within the EU project PaRaMetriC, aiming at establishing a metrological framework for the comparable performance evaluation of PRC technologies, the Physikalisch-Technische Bundesanstalt is leading a work package dedicated to the development of accurate and traceable methods to determine the infrared optical and thermophysical properties of PRC materials. These include reflectivity and emissivity in the broad spectral range from 250 nm to 50 µm, encompassing both, the solar spectrum (250 nm–2500 nm) and the infrared transparency window of the atmosphere (7.1 μm–13 μm) with a target absolute uncertainty of less than 0.03. For this purpose, several candidate benchmark passive cooling materials have been characterized by PTB in the wavelength range between 1.4 µm and 50 µm. The range 250 nm to 1.4 µm will be covered in an upcoming paper. Characterizations of, and comparisons between, reference and end-user measurement techniques applied for the measurements of selected PRC materials will not only allow accurate determination of the thermophysical properties, but also identification of measurement problems and suitable approaches in this rapidly expanding field.

Development of an Energy-Efficient Electrical Load Model for Optimizing Electricity Consumption in the Headquarters Building of PT Semen Padang Using the PDCA Approach

The increasing electricity consumption in the public building sector has a significant impact on greenhouse gas (CO2) emissions, which is proportional to the volume of energy used. This study aims to develop an energy-efficient electrical load model to optimize electricity consumption in the headquarters building of PT Semen Padang using the Plan-Do-Check-Action (PDCA) approach. In the Plan stage, problem identification was conducted through a Pareto diagram and root cause analysis using a fishbone diagram. The dominant issue identified was energy waste in the lighting system. The solution implemented included the installation of motion sensor-based switch control devices to regulate lighting use automatically. In the Do phase, the devices were installed and tested, while in the Check phase, the evaluation showed a reduction in electricity consumption from over 85,000 kWh per month to below 80,000 kWh per month, resulting in an electricity cost savings of IDR 31 million per month. The Action phase established standards for inputs, processes, and outputs to ensure the sustainability of the improvements made. This study not only provides financial benefits but also supports the company's Energy Management System policy. With the PDCA approach, improvement processes can be carried out systematically and continuously, making a tangible contribution to energy efficiency in the public building sector.

Penerapan Artificial Neural Network untuk Memprediksi Persediaan Obat Esensial

The availability of essential medicines is a fundamental factor in ensuring high-quality healthcare services, especially in primary healthcare facilities such as Puskesmas. Inefficient drug inventory management can lead to various issues, including drug shortages that disrupt medical services and overstocking that may result in waste due to expiration. An accurate prediction system is essential to support more effective and efficient drug inventory planning. This study aims to analyze historical drug usage patterns to generate more accurate predictions. The research methodology includes problem identification, data collection, preprocessing, ANN architecture design, implementation, and system evaluation. Historical drug usage data from previous years is used for training and testing, with a division of 70% for training and 30% for testing. The backpropagation algorithm is applied to optimize the model by adjusting parameters such as the number of neurons in the hidden layer, learning rate, and activation function. The study results show that the ANN model with a 12-12-1 architecture achieves a high prediction accuracy, with a Mean Absolute Percentage Error (MAPE) of 2.13% for paracetamol stock. The developed MATLAB application provides an interactive platform for users to input historical data and obtain dynamic stock predictions. This system implementation is expected to help Puskesmas manage drug inventory more effectively, reduce the risks of shortages and overstocking, and improve efficiency in essential drug distribution. This study contributes to the field of health informatics by demonstrating the effectiveness of ANN in drug inventory prediction. Future research may explore hybrid machine learning models or integrate external factors, such as seasonal disease patterns and community demand levels, to enhance predictive accuracy and adaptability.

Challenging Isomorphic Mimicry With Human‐Centred Design to Build Capacity in Three African Higher Education Institutions

ABSTRACTThe Innovation Scholars Program (ISP) in sub‐Saharan Africa (SSA) targets the issue of organizational capacity development in higher education institutions (HEIs). HEI's are susceptible to patterns of isomorphic mimicry, manifested where institutions often replicate behaviors perceived to be ideal without developing internal capacities for maintaining or adjusting. ISP addresses these patterns through individual and organizational capacity development leading to a focus on institutional function. Isomorphic mimicry is characterized by a focus on form over function (e.g., a new classroom building with no classes scheduled vs. building capacity of instructors to deliver relevant learning outcomes for their society); and incentives for leaders to use new resources to maintain the status quo (agenda conformity). Isomorphic mimicry is driven by global pressures but felt in part by HEI leaders and faculty. To address these issues, the ISP employs human‐centered design (HCD) as a cornerstone of its approach. HCD is a user‐focused problem‐solving methodology that involves understanding the needs of the end‐users whom we include as faculty, administrative leaders, and community‐based stakeholders. Participants in ISP design and create prototypes and refine solutions through iterative, interdisciplinary, cross‐hierarchical, feedback loops. Within the ISP, HCD was operationalized through workshops matched to design phases which led participants to deploy a working prototype. We measured individual and organizational learning, including participants' outcomes and collective patterns of organizational responsiveness, observed in part through a cross‐case comparative analysis. As participant observers, we noted individual and organizational outcomes and conducted interviews, document analysis, and field observations to identify and understand new patterns. In each of the three ISP programs, individuals developed capacity, faculty and administrators learned to use HCD together (organizational capacity) as a problem‐solving approach. Participants built trust in the process of local problem identification. Specifically, we observed where HCD ideas and principles appeared in locally identified use cases. The HCD approach fostered a shared language for making change, built trust among participants, and led to changes that outlasted project funding. By integrating individual learning and organizational change through HCD principles, HEIs established a new pattern of work, and focused on function, moved away from intensification (more of the same spending) toward repeatable processes and the needs of end‐users. Integrating individual and collective learning with function in mind was key to interrupting components of isomorphic mimicry. The ISP helped ensure that organizational novelty was aimed at functional outcomes rather than status quo actions. Several of the initiatives begun in ISP continue to resonate and evolve post‐project funding and have become self‐sustaining in the local HEI ecosystem.

Detection and Severity Classification of Sleep Apnea Using Continuous Wearable SpO2 Signals: A Multi-Scale Feature Approach

The use of wearable devices for sleep apnea detection is growing, but their limited signal resolution poses challenges for accurate diagnosis. This study explores the feasibility of using SpO2 signals from wearable sensors for detecting sleep apnea and classifying its severity. We propose a novel multi-scale feature engineering approach, which extracts features from coarsely grained SpO2 signals across timescales ranging from 1 s to 600 s. Our results show that traditional SpO2 markers, such as the oxygen desaturation index (ODI) and Lempel–Zip complexity, lose their relevance with the Apnea–Hypopnea Index (AHI) at longer timescales. In contrast, non-linear features like complex entropy, sample entropy, and fuzzy entropy maintain strong correlations with AHI, even at the coarsest timescales (up to 600 s), making them well suited for low-resolution data. Multi-scale feature extraction improves model performance across various machine learning algorithms by alleviating model bias, particularly with the Bayes and CatBoost models. These findings highlight the potential of multi-scale feature engineering for wearable device applications where only low-resolution data are commonly available. This could improve accessibility to low-cost, at-home sleep apnea screening, reducing reliance on expensive and labor-intensive polysomnography. Moreover, it would allow even healthy individuals to proactively monitor their sleep health at home, facilitating the early identification of potential sleep problems.

Action Research on Combining the Teach-back Method to Optimize the Perioperative Clinical Care Pathway for Hair Transplant Patients.

This study aimed to optimize the perioperative clinical care pathway for hair transplantation patients by integrating action research and the teach-back method, and to validate its clinical application. A total of 116 hair transplantation patients were divided into control and experimental groups based on time periods.The control group followed the conventional care, while the experimental group utilized action research combined with the teach-back method for training and assessment.. After two iterative cycles of problem identification, planning, action, reflection, and implementation, the care pathway was refined. Outcomes measured included hair follicle survival rate, complication incidence, secondary transplantation rates within 12 months, postoperative self-management, and satisfaction. The experimental group showed higher follicle survival rates (Z=8.788, P=0.001), lower complication incidence (χ²=3.940, P=0.047), improved postoperative self-management (Z=3.426, P=0.001), and greater satisfaction (χ²=4.245, P=0.039).There was no significant difference between the two groups in the occurrence of secondary hair transplantation within 12 months post-operation (P=0.618). By combining action research with the teach-back method, we significantly optimized perioperative care, achieving notable improvements in the survival rate of hair follicle units post-operation, a reduction in the incidence of complications, and enhancements in both postoperative self-management capabilities and patient satisfaction.

Performance Evaluation of Iran University of Medical Sciences Hospitals Based on the PABON LASSO Model and its Comparison with National Standards

Background: Evaluation of hospital performance plays an important role in improving the quality and quantity of services provided. The purpose of this study is to evaluate the performance of Iran University of Medical Sciences hospitals using the PABON LASSO model in 2022. Methods: This descriptive and cross-sectional study was conducted in 2022. Thirteen hospitals affiliated to Iran University of Medical Sciences formed the study population. Data were analyzed by SPSS22 software using PABON LASSO model. A one-sample t-test was used for comparison. Results: Out of 13 hospitals, 38.46% were in the first region, 23.07% were in the third region, and finally 30.76% were in the fourth region of the matrix. Based on the results, in the studied hospitals, the average length of stay (ALS) was 4 days, the bed occupancy rate (BOR) was 72.89%, and the bed turnover rate (BTR) was determined 72.14 times a year. Conclusion: The BOR index in the studied hospitals had a higher level of desirability compared to the national standard. Using one of the active methods of problem identification in hospitals and by understanding the relationship between performance indicators, it is possible to provide a platform for policy-making and revision of current policies in order to use the maximum performance capacity.

Polish librarians towards meeting the information needs of the LGBTQ+ community

This article discusses the results of research on how the information needs of LGBTQ+ community can be satisfied by the librarians in Poland. The inspiration for conducting these observations was the research conducted in the United States by John Siegel, Martin Morris and Gregg A. Stevens back in January 2020 that was published in the “College & Research Libraries”. It is important to highlight that, until today, no one in Poland has engaged themselves in this subject. The main aim of the study was to check how librarians approach meeting selected needs of people from the LGBTQ+ community and what knowledge they have in this area. The research using a survey questionnaire allowed for the identification of problems that librarians working in different types of libraries encounter on a daily basis. It allowed to identify problems that librarians working in different types of libraries face every day. 716 participants took part in the research. Factor analysis was performed for selected questions. It was also checked whether there is a relationship between the respondents' comfort level with meeting information needs, gender and place of residence. During the study, 716 responses were received from librarians working in various types of libraries in Poland, of which the largest number of questionnaires were completed by employees of public libraries (560; 78.2%). Factor analysis conducted in relation to the most important terms related to the LGBTQ+ community confirmed knowledge of only selected concepts. In-depth studies were also conducted in relation to questions in which librarians were to assess their level of comfort in meeting selected information needs. The results showed that employees of larger libraries cope better in this area and have greater openness.

Pengembangan Modul Ajar Matematika Berbasis Nilai-Nilai Budaya Bugis Terintegrasi Dimensi Profil Pelajar Pancasila

The very urgent problems facing the world of education are (a) the availability of teaching modules that maintain a balance between intellectual intelligence and character, (b) the fragmentation of local cultural values ​​with foreign culture which has the impact of eliminating the culture of good manners or etiquette, and (c) The results of the education report evaluation show that national education goals have not been achieved. This research approach uses Development Research (R&D) with research implementation stages following the Four D Model (4D) which consists of four development stages, namely: Define, Design, Develop, and Disseminate. The Define stage includes literature study activities and field surveys for the purposes of problem identification and need analysis, the Design stage includes initial product design activities, the Develop stage includes expert validation activities, product revisions, one-on-one and small group trials, and the Disseminate stage includes socialization activities fieldwork and final product revisions. The novelty offered in this research is a teaching module that integrates the cultural values ​​of the Bugis tribe (Sipakatau, Sipakalebbi, and Sipakainge) with the goals of national education or the dimensions of the Pancasila student profile.

Undergraduate Research in the Andes: Overcoming Barriers to Developing-Country Farm-Household Focused Analysis

This paper provides a qualitative description of a long-term engagement of undergraduate students in an immersive research experience in Ecuador. We describe and analyze factors related to operation under common challenges to field research in developing countries. We address issues of incentives and barriers to faculty and students interested in pursuing international undergraduate research. Our program has engaged students at Virginia Tech eight times since 2007, including a total of 50 U.S. undergraduates, and was designed to attract students of all socioeconomic strata. It begins with a Spring semester three-credit class on research methods, household survey administration, and data analysis and inference. During this time, partners in Ecuador are introduced through remote meetings and joint work on the survey. In mid-May, we fly to Quito, where students take language and culture lessons, finalize the survey, and gain exposure to the various institutions involved in the research. After two weeks, the group travels to the remote survey location, currently near Riobamba in Chimborazo Province. Four weeks of data collection paired with local students follow. Finally, data are analyzed, and a report is prepared and presented to an advisory group in the subsequent Fall semester. The programmatic goals were to (1) provide undergraduates with a substantive research experience in a developing country; and (2) provide useful data for the project as to the attitudes of Ecuadorian farmers toward adoption of environmentally friendly agricultural practices. The program is built around several principles: (i) end-to-end student engagement from problem identification through presentation of findings to stakeholders; (ii) financial accessibility—all participation costs are covered; (iii) primary data collection from farm-households in the study area; (iv) full partnership with host-country researchers and students; and (v) supportive and complementary past and ongoing agronomic research in the study area. Lessons include challenges related to program structure; administration—the Institutional Review Board (IRB) clearance, travel approvals, and financial matters; technical challenges—questionnaire design, CAPI surveying, teaching, and programming data analysis; and field supervision, language, and cultural awareness. Linkages to high-quality ongoing agronomic research allow the socioeconomic research to focus on technology adoption and technology-relevant factors such as profitability, risk, and access to inputs. These themes are well-addressed through socioeconomic research.

Empowerment of Youth Cadres in HIV/AIDS Prevention Efforts at Youth Health Post of Nurul Anwar Boarding School, Komba, Sentani

ABSTRACT The many reproductive health problems of adolescents, then the provision of information, services and education on reproductive health of adolescents becomes very important. Adolescent problems that are closely related to reproductive health are often rooted in the lack of information and understanding and awareness to achieve reproductive health. Adolescent access to these service places is very low. To overcome health problems that occur in adolescents, comprehensive efforts are needed, namely by forming a youth health post. Youth cadres have an important role in providing information to the community, especially about adolescent health. The important role of peers is as a source of knowledge other than that obtained within the family. Peers are a form of a teenager's external environment. If adolescents have peers who have good behavior and knowledge about HIV/AIDS, it will contribute greatly to preventing adolescents from contracting HIV/AIDS, so it is necessary to provide assistance and information to youth cadres so that they can help disseminate the information provided. The method used is through an analytical approach, problem identification, intervention planning and implementation, namely empowering youth cadres in preventing HIV/AIDS by providing information and teaching cadres to conduct basic health checks, namely general condition checks. Providing education about HIV/AIDS, risk behavior for HIV/AIDS transmission (free sex, drugs and alcohol) found that youth cadres were very enthusiastic and interested in learning the guidance provided so that youth cadres would be more confident in carrying out their duties as youth cadres at the Youth Health Post. Keywords: Youth Cadres, Education, HIV/AIDS, HIV/AIDS transmission risk behavior and HIV/AIDS prevention.

IMPLEMENTASI METODE FUZZY TIME SERIES UNTUK PERAMALAN PENJUALAN PADA RESTORAN COCO BISTRO TANJUNG

As competition in the culinary industry becomes increasingly intense, restaurant companies are required to focus more on product management and inventory control to maintain customer satisfaction and ensure smooth operations. Coco Bistro Tanjung, part of the Tropical Group, still relies on historical sales data without using scientific methods to forecast sales, which often leads to difficulties in determining the optimal amount of raw material inventory. This study aims to forecast sales for the upcoming period using the Fuzzy Time Series method, which is considered effective in addressing sales fluctuations. The research process begins with problem identification, a literature review, and the selection of the method, followed by the collection of sales data from Coco Bistro Tanjung. Forecasting is performed manually using the Fuzzy Time Series method, and the accuracy of the forecasts is evaluated using MAPE, MSE, and MAE. The results show that the Fuzzy Time Series method can provide accurate predictions for six main food categories, with the Balinese Main Course category achieving the best accuracy (MAPE 8.72%), classified as "Very Good," while the Pizza category showed the lowest accuracy with a MAPE of 38.75%, classified as "Fair." This research proves that the Fuzzy Time Series method is effective in forecasting sales trends for most food categories, which can help the company optimize inventory management and improve operational efficiency.

Vocal Fatigue and RecoveryPatterns AmongCall CenterOperators: A Workday Progression Study.

Vocal Fatigue and RecoveryPatterns AmongCall CenterOperators: A Workday Progression Study.

Advocating for Our Children: An Initiative Utilizing Verbal and Video Education to Increase Adverse Childhood Experiences Questionnaire Form Response Rate.

Negative experiences in childhood, Adverse Childhood Experiences, significantly increase the risk of adverse health outcomes in adulthood. Obtaining a better understanding of the experiences a child has been through during development allows providers to connect them with resources to improve health outcomes. We performed problem identification via PubMed and the Florida Department of Health web page. We used the plan-do-study-act (PDSA) quality improvement method. Intervention one involved teaching clinic staff about distributing the Adverse Childhood Experiences Questionnaire (ACE-Q) form during well-check visits. Intervention two involved a video education tool to explain the purpose and importance of the ACE-Q to caretakers. We conducted a retrospective chart review at the 17 Davis and HealthPark clinics 3 months preceding each PDSA cycle. We analyzed the data to assess the response rate to the ACE-Q before and after each cycle. The educational initiatives increased the response rate to the ACE-Q form in both PDSA cycles. The ACE-Q was significantly more likely to be filled out after the first (19.2% in pre versus 24.8% in post, P < 0.001) and second PDSA cycles (15% in pre versus 45.2% in post, P < 0.001). Verbal and video education models can increase the response rate to the ACE-Q. Response collection is valuable for identifying and supporting patients at the highest risk for poor health outcomes. Future studies would benefit from addressing low view counts on video interventions, standardizing ACE-Q score assessment, and implementing sustainable measures.

Impact of community health nursing in the health status of the residents of Barangay Calantipay

The undergraduate nursing students of SMCB in their second and third year are trained and motivated to respond with competence and compassion to the health needs of residents in underserved communities. By conducting health education, environmental cleanliness campaign, supervised immunization, deworming, rehabilitation and the like, they can elevate the health status of the communities for the better. Community Health Nursing provides learning in the form of tasks that involve the assessment of community health needs, identification of health problems, planning of activities and evaluating the effectiveness of the plans formulated in response to the identified problems. They also implement solutions and monitor the progress of their health plans. Community nursing exposure within the supervision of competent clinical instructors facilitates an increasingly important experience for undergraduate nursing students. Therefore, nursing education providers and health services must ensure that student nurses are exposed to high quality community that provide suitable learning experiences for them to acquire the skills, knowledge and attitudes required for optimum health services in the future

Structural and Psychological Empowerment in R&D Teams

OVERVIEW: Innovation success requires structural and psychological empowerment. This article reports the results of a study examining factors associated with empowerment among R&D teams. The study findings revealed the benefits of structural (granted) empowerment and determined that the motivational aspects of psychological (perceived) empowerment are critical to helping R&D teams make influential contributions in their organizations. Leadership policies that help teams set their work goals, develop processes for achieving those goals, and articulate clear objectives and institute norms for progressing work are significant. Team members perceive they are empowered under three conditions: (1) when they feel free to set goals, choose processes, and use flexible approaches to project management; (2) when project team leaders are part of the problem identification process for scoping the project; and (3) when the team is free to access expertise from across the organization as needed. Although study participants identified team leaders’ leadership style as the most important enabler of empowerment, companies rarely invest in leadership development for project leaders. Not all team members are interested in being empowered, which has implications for selection and hiring of R&D personnel.

ANALYSIS OF PASSENGER TERMINAL SERVICE QUALITY LEVEL AT BANYUWANGI AIRPORT

Banyuwangi Airport has become an important air transportation facility in East Java, playing a strategic role as a gateway to leading tourist areas. This study aims to identify the current level of service quality of the passenger terminal at the airport, understand the factors that influence its performance, and develop evidence-based recommendations to improve service quality. A systematic research design was implemented, encompassing stages from problem identification to data analysis and report preparation. The primary objective was to identify aspects of terminal services needing improvement to enhance user satisfaction, guided by initial observations and literature reviews. The analysis of hierarchical processes (AHP) method was employed for data analysis, focusing on assessing criteria weights through pairwise comparisons to generate improvement recommendations. The results indicate that passenger satisfaction varies significantly across different types of facilities. Several concrete steps and strategic recommendations are proposed to enhance service quality and address the identified gaps.

Project Centric Learning: A Business Plan on Interior Upliftment Solutions – Ambilift Pvt. Ltd

This paper reports on a comprehensive business plan for Ambilift Pvt. Ltd.—a startup company that provides innovative interior upliftment solutions. Based on the project-based learning method, this research presents typical design issues in commercial and domestic settings. With virtual consultations, data-driven design, and green design, Ambilift is positioned to offer quality interior designing to the masses. This paper is organized in some chapters, ranging from the vision, mission, scope, service portfolio, geographic reach, technology integration, and target market. Later chapters address problem identification, solution alignment (with a Business Model Canvas and value proposition), team strategy, marketing strategies, and financial planning. The final section synthesizes insights and suggests next steps towards sustainable growth.

Navigating Disparities: An In-depth Analysis of Perceived Competency Importance and Training Discrepancies in Clinical Placements among Students and Clinical Nurses.

This study investigated the perceived importance and training of competencies during nursing clinical placements by examining the perspectives of nursing students and clinical nurses. We conducted a cross-sectional study using an online survey of 351 nursing students and 247 clinical nurses. We utilized the Borich needs assessment model to identify the perceived importance and training of competencies during clinical placement. Students and nurses rated their perceived importance and training levels on 32 competency items regarding direct nursing care, indirect nursing care, decision-making and problem-solving, attitude, and nursing professionalism. Students and clinical nurses identified nursing handovers, nursing records, crisis coping abilities, clinical problem identification, clinical decision making, and priority setting in nursing as competencies of greater importance and with more significant discrepancies from training during clinical placements (Quadrant I in the locus for focus model). Clinical nurses reported examination, skin integrity management, and communication with medical staff as having higher importance and greater discrepancies from training (Quadrant I). In contrast, students recognized them as having lower importance and higher discrepancies (Quadrant II). For students, the perceived importance of all competence domains was significantly associated with the corresponding training (Spearman's rho = .30-.56, p < .01). For clinical nurses, only the perceived importance of nursing professionalism was associated with all training domains (Spearman's rho = approximately .14-.20, p < .05). The disparities between students' and nurses' perceptions of the importance and training of competencies during clinical placements highlight the need to modify the clinical nursing education system.