An outcome-based evaluation of nursing competency of baccalaureate senior nursing students in Taiwan

[[abstract]]Limited literature is available for demographic and learning factors related to performance of baccalaureate nursing students. The study aimed at examining mean differences in nursing competency between the first week and the sixth week of a nursing clinical practicum as well as evaluating mean differences in nursing competency by demographic and learning factors at the sixth week of a nursing clinical practicum controlling for baseline scores of nursing competency. A comparative study design was conducted using the competency inventory for baccalaureate senior nursing students based on learning outcomes. Participants were surveyed at the first week and the sixth week of a nursing practicum with 95% mean response rate. Paired t test was used to compare within-subjects differences in mean nursing competency. ANCOVA and Kruskal–Wallis test, and Mann–Whitney U test were conducted to compare between-subjects differences in mean nursing competency. There are significant mean differences in nursing competency in general clinical skills, lifelong learning, clinical biomedical science, caring, and critical thinking and reasoning between the 1st week and the 6th week of nursing practicum. Likewise, type of nursing program, prior schooling, type of nursing license, interest in nursing, and extracurricular activity experience were significantly related to mean total nursing competency. Similarly, demographic attributes (location of school, type of nursing program, prior schooling, type of nursing license, a family member working as a medical practitioner or a nurse, interest in nursing, attributes of preferred workplace after college) and learning factors (extracurricular activity experience, played an active role in classroom discussions and asked questions, academic class rank, and English grade, clinical biomedical science, nursing science, and nursing practicum) were significantly related to six-subscale scores of nursing competency. There are mean differences in nursing competency across several demographic and learning factors. These factors should be given greater emphasis by nurse educators in planning the academic and clinical phases of professional education

Factors affecting metacognition of undergraduate nursing students in a blended learning environment

[[abstract]]This paper is a report of a study to examine the influence of demographic, learning involvement and learning performance variables on metacognition of undergraduate nursing students in a blended learning environment. A cross-sectional, correlational survey design was adopted. Ninety-nine students invited to participate in the study were enrolled in a professional nursing ethics course at a public nursing college. The blended learning intervention is basically an assimilation of classroom learning and online learning. Simple linear regression showed significant associations between frequency of online dialogues, the Case Analysis Attitude Scale scores, the Case Analysis Self Evaluation Scale scores, the Blended Learning Satisfaction Scale scores, and Metacognition Scale scores. Multiple linear regression indicated that frequency of online dialogues, the Case Analysis Self Evaluation Scale and the Blended Learning Satisfaction Scale were significant independent predictors of metacognition. Overall, the model accounted for almost half of the variance in metacognition. The blended learning module developed in this study proved successful in the end as a catalyst for the exercising of metacognitive abilities by the sample of nursing students. Learners are able to develop metacognitive ability in comprehension, argumentation, reasoning and various forms of higher order thinking through the blended learning process

Development of a Scale of Nurses’ Competency in Anticipatory Grief Counseling for Caregivers of Patients with Terminal Cancer

Anticipatory grief leads to a highly stressful and conflicting experience among caregivers of patients with terminal cancer. Nurses lack the competency to assess and manage the caregivers’ psychological problems, which in turn affects the caregivers’ quality of life. A scale assessing the anticipatory grief counseling competency among nurses is unavailable. In this study, an Anticipatory Grief Counseling Competency Scale (AGCCS) was developed for nurses. The Scale (AGCCS) was translated into Chinese and then revised. Psychometric testing of the scale was conducted on 252 nurses who participated in the care of patients with terminal cancer at a regional teaching hospital in Southern Taiwan. The data were analyzed using descriptive statistics, reliability, and Pearson’s correlation, and principal component analysis and analysis of variance were performed. Item- and scale-content validity indexes were 0.99 and 0.93, respectively. The Cronbach α of internal consistency was 0.981. The final 53-item AGCCS had five factors, which accounted for 70.81% of the total variance. The Pearson correlation coefficients of these factors ranged between 0.406 and 0.880 (p < 0.001). The AGCCS can be used to evaluate the aforementioned competency for improving caregivers’ quality of care. It can also facilitate in-service education planning and evaluation

A Study of Medical Center Nurse's Self-assessment in Performance of Advanced Cardiac Life Support Skills

[[abstract]]護理人員在醫療團隊中常常是病人發生突發狀況，需要急救的目擊者或者為最先到達的專業人員。因此，護理人員是否有能力處理緊急狀況，往往關係著病人的預後。本研究目的在探討北部某醫學中心一年內曾接受高級心臟救命術課程之護理人員，自評執行急救能力之狀況，及不同基本屬性對其自評執行急救能力之影響。採橫斷性調查相關性研究，以Cronbach's α為.95的自擬「護理人員自我評估執行急救能力量表」進行資料收集，發出223份問卷，回收187份，有效問卷數為176份，有效問卷回收率達78.9%。護理人員自我評估執行急救能力整體平均得分為4.13分（SD=0.46），另利用探索式因素分析建構出六個因素命名為：呼吸道及循環之維持、急救評估及初步處置、團隊合作和異常處理、病患與家屬之溝通協調、護理急救角色功能之展現以及異常心律之判讀及處置，合計共解釋61.72%變異量。年齡愈大、護理進階層級較高、臨床工作年資愈久，急救能力得分顯著較高。建議醫院管理者針對年齡較小、初階護理層級、工作年資較短的新手醫療人員，規畫並安排其接受急救相關訓練課程，若能將護理進階訓練課程目標與本研究發現護理人員所應具備的急救能力結合，搭配相關認證制度，將有效提昇對病人之服務品質。 As nurses often discover patients who have a critical situation at first, they should be trained and be able to perform resuscitation skills adequately. This study aims to investigate medical center nurses who received advanced cardiac life support courses within a year and their self-assessment of the performance of ACLS skills, and to examine the association between demographic data and their self-evaluated ability of emergency.This descriptive and correlational study used a cross-sectional survey of clinical nurses from a medical center in northern Taiwan. We use ”nurse's self-assessment and performance of ACLS skills in medical center” scale as an instrument. Cronbach's α was .95. The study distributed 223 questionnaires of which 187 questionnaires were returned, giving an effective return rate of 94.1%. The mean self-rating score of ACLS competence was 4.13 (SD = 0.46) for all subjects. By using item analysis and explorations as well as exploratory factor analysis, they were extracted into six factors, named for: ”competence in proper care of respiratory and cardiovascular systems,” ”competence in pre-ACLS assessment and initial treatment of patients,” ”competence in teamwork and exception handling,” ”competence in communication with patients and their families,” ”competence in ACLS nursing,” and ”competence in nursing diagnosis and treatment of abnormal heart rhythm.” Six factors in total explained 61.72% of the variance. Subjects who were older, possessing higher level qualifications on the nursing clinical ladder, and who were more experienced in clinical nursing practice were found to achieve significantly higher mean scores in the self-assessment of ACLS competence.Hospital management should provide effective ACLS training for younger, elementary level qualifications on the nursing clinical ladder. In addition, advanced nursing training should include ACLS certification to enhance the overall quality of nursing care

Factors Associated With the Do-Not-Resuscitate Decision Among Surrogates of Elderly Residents at a Nursing Home in Taiwan

Background: Do-not-resuscitate (DNR) in nursing homes is an emerging advance directive in Taiwan, but little research has been conducted. The purpose was to determine the factors associated with signing a DNR directive in the largest hospital affiliated nursing home in Taiwan. Methods: A cross-sectional survey was conducted using a convenience sample from a nursing home in northern Taiwan between January 2011 and January 2012. The demographic characteristics of elderly residents were collected. 213 family surrogates of elderly residents were interviewed using a self-developed structured questionnaire related to DNR issues. The data were analyzed via descriptive statistics and logistic regression analysis. Results: Only 24/213 (11.3%) of elderly residents had the DNR directives. Of these, 20/24 (83%) were made by family surrogates. The factors significantly associated with the DNR decision included the elderly residents had severe brain injury (OR: 8.83, p = 0.023), pulmonary disease (OR: 7.24, p = 0.004), cancer (OR: 5.20, p = 0.045); the family surrogates believe in Buddhism (OR: 8.02, p = 0.030), and ever having discussed DNR with the resident (OR: 19.23, p < 0.001). This model explained 49.4% of the variance in whether or not a resident had a DNR directive. Conclusions: The findings indicated the DNR decision was associated with residents' conditions and surrogates' factors. These information are helpful to medical personnel in nursing homes to better understand and to assist the DNR decision-making process

A Study on the Efficacy of LOHAS / Low-Carbon Lifestyles

[[abstract]]目的：透過樂活減碳行動策略讓技術學院學生從真實情境，親自體驗樂活族的綠生活哲學，進而探討其學習成效。方法：本研究為單組前後測設計（One-group pretest-posttest design），以北部某技術學院73名學生為研究對象，參與樂活減碳行動策略之「綠生活資訊網絡」、「綠生活綠色植栽」及「綠生活作品記事」的體驗課程，並於行動策略介入前後接受前後測，比較學生節能減碳認知、節能減碳態度與個人減碳足跡狀況。結果：樂活減碳行動策略介入前後：（1）研究對象節能減碳認知前後測得分達顯著進步（p＜ .001），食（p＝ .038）與行（p＜ .001）二構面達顯著差異；（2）研究對象節能減碳態度未達顯著差異（p＝ .153），住、行與休閒則呈現退步情形；（3）研究對象個人減碳足跡達顯著進步（p＝ .002），衣（p＝ .001）與「住」（p＝ .003）二構面達顯著差異；（4）技術學院學生的節能減碳態度與學習滿意度呈顯著關係（p＝ .001）。結論：技職院校應開設或辦理節能減碳相關課程與活動，增加高等教育學生接觸節能減碳議題之機會，並於課程與研習中帶入體驗活動，更能引發學生對節能減碳相關議題的學習興趣、動機與成效，經由全面性、系統性、融貫性與長期的介入措施與自然薰陶，有助於技職院校學生提升節能減碳認知、態度與行動。 Objective: A low-carbon lifestyle program was administered to a group of vocational college students in Taiwan as a simulated green lifestyle philosophy experience. This study assessed the learning outcome of this group. Methods: A one-group pretest-posttest design was used on a study sample of 73 undergraduate students from a vocational college in northern Taiwan. A low-carbon life program was administered to the students by asking them to make use of a green lifestyle portal website, grow green plants, and chronicle their green lifestyle initiatives. Pretest and posttest questionnaires were administered before and after the program to assess participant knowledge and attitudes toward a low-carbon lifestyle and their attained carbon footprint reduction results. Results: A comparison of pretest and posttest results demonstrated that, after the program: (1) the sample achieved significantly higher test scores (p ＜ .001) in their knowledge of low-carbon life and achieved significantly different scores regarding their knowledge of low-carbon food (p = .038) and low-carbon transportation (p ＜ .001). (2) No significant difference was observed in scores related to participant attitudes toward low-carbon lifestyles (p = .153). Participants achieved significantly lower scores related to attitude toward lowcarbon housing, low-carbon transportation, and low-carbon recreation and leisure. (3) Participants achieved significantly higher carbon footprint reduction scores (p = .002) and significantly varying scores in terms of carbon footprint reduction scores related to clothing (p = .001) and housing (p = .003). (4) There was a significant correlation between participant attitudes toward a low-carbon lifestyle and overall satisfaction with the program (p ＜ .001). Conclusions: Courses and activities designed to promote a low-carbon lifestyle should be introduced into the vocational college curriculum to raise student awareness of low-carbon issues. Courses and activities should allow students to experience lowcarbon lifestyles to inspire greater learning motivation and enhance learning performance. A comprehensive, systematic, and long-term low-carbon lifestyle program that blends theory with practice should be effective in instilling awareness, attitude, and motivation necessary to encourage students to adopt behaviors appropriate to a low-carbon lifestyle

Self-Evaluation of Core Competencies and Related Factors among Baccalaureate Nursing Students

[[abstract]]背景 高等教育的評鑑開始注重以學習者為本位，重視學習成果與核心能力的評量，而台灣護理教育評鑑委員會亦訂定大學護理系特有的八大核心素養；然而，先前研究鮮少探討大學護理學生核心能力的影響因素。目的 本研究目的在於了解護理學生核心能力、探討個人背景與學習經驗對其護理核心能力之影響，以及分析護理學生核心能力之預測因子。方法 以橫斷性調查之描述性及相關性研究進行資料收集，以北部某私立科技大學二技護理系一年級學生為研究對象；以護理學生核心能力量表為研究工具，發出290份問卷，有效問卷279份，回收率96.2%。結果 護理學生自評核心能力之平均得分為5.23（SD=0.49），各向度得分由高至低依序為：倫理素養、克盡職責、關愛、溝通與合作、終身學習、一般護理臨床技能、批判性思考，以及基礎生物醫學科學。於差異性分析方面，對護理有興趣、有明確的生涯規劃、想繼續朝護理相關科系升學、畢業後最想至醫學中心服務、已決定畢業後最想服務的單位、曾參加校內活動、課堂討論及發言頻率較高、經常認真完成作業與準備考試、及在校成績較高的護理學生，其核心能力得分顯著較高。核心能力預測因子方面，畢業後的生涯規劃、畢業後最想服務的... Background: Evaluations of higher education programs are increasingly centered on the learner and designed to assess learning effectiveness and core competencies. Although the Taiwan Nursing Accreditation Council (TNAC) has established eight core competencies for college nursing departments, little research has been done to identify the most salient contributors to undergraduate nursing students' perceived competency levels.Purpose: This paper investigates the influence of student demographic factors and learning experience on students' development in terms of a selected sample of core nursing competencies and then identifies factors that significantly predicts such development.Methods: This is a cross-sectional descriptive correlational study. We collected data from a sample of freshmen students currently enrolled in a two-year nursing bachelor degree program at a private vocational university in Taipei, Taiwan. Participants self-assessed abilities in designated core nursing competencies using the Competency Inventory of Nursing Students (CINS). A total of 279 of 290 distributed que..

Factors Associated with Surgical Smoke Self-Protection Behavior of Operating Room Nurses

Surgical smoke has been proven to be harmful and carcinogenic to humans as well as increasing the risk of acquiring infectious diseases. The operating room nurses’ willingness to use protective equipment against surgical smoke was low. The factors associated with personal protective behavior in the operating room against surgical smoke were sparsely explored. The purpose of this study is to determine factors associated with surgical smoke self-protection behavior of the operating room nurses. This was a descriptive correlational study using a convenience sample from a medical center in northern Taiwan. The self-designed questionnaires included personal characteristics and perceived attributes. The data were analyzed by descriptive and linear regression. Attendance at in-service education with regard to surgical smoke, the attitude to surgical smoke, and surgical smoke self-protection barriers were significant factors found in multivariate linear regression after controlling the covariates. The overall model was significant and accounted for 14.2% of variances. In summary, attending in-service education, attitude and barriers in executing self-protective behaviors were significant factors. It is important to promote operating room nurses’ health through providing correct surgical smoke knowledge, self-protection strategies to improve attitudes toward surgical smoke, improving the hospital’s environment by adding surgical smoke evacuation equipment, and standardizing the operating procedures

A Needs Assessment of Nursing Staff AIDS Care Knowledge Needs

[[abstract]]背景　台灣愛滋病毒感染人數直線上升，截至2009年4月底，本國籍愛滋病毒感染人數為17,979人，近五年平均年增加率達18%，不管是全球或國內情況，除了醫療問題外，其他社會、心理問題也隨著愛滋病毒感染人數的增加而日趨複雜化。因此了解護理人員對愛滋病知識及臨床照護的教育需求，辦理相關的在職教育課程，以提升護理人員照顧愛滋病患的照護知識，促進護理人員的自我成長，可有助於專業發展與提升照護品質。目的　探討護理人員對愛滋病照護知識之需求，並探討不同個人背景變項之護理人員在愛滋病照護知識需求之差異性，以提供在職教育課程規劃之參考。方法　本研究為描述性及相關性研究設計(descriptive and correlational study design)，採橫斷式調查方法(cross-sectional survey)，以自擬結構式問卷進行資料收集。發出556份問卷，回收問卷546份，回收率98.2%。結果　護理人員愛滋病照護知識需求方面，依平均分數排序得分最高的前三項為：被害人性侵害後之後續處理、其次是預防傷害與後續處理及伺機性感染症之護理；得分需求最低的三項依序為HIV之流行病學、台灣愛滋病政策與法令及HIV傳染途徑；愛滋病照護知識需求之整體平均分數皆在4分以上。年齡越大對於愛滋病照護知識之需求越高；已婚對於知識之需求相較於未婚者為高，服務年資高者相較於服務年資低者，其知識需求較高。結論　研究結果可作為醫院在HIV/AIDS照護在職教育課程優先順序之安排；政策擬定之參考，例如：可將預防傷害及後續處理列為所有醫療人員必修之課程以及推廣安全針具之使用，以降低臨床工作人員針扎之風險。 Background: The number of HIV infections in Taiwan has been increasingly linear in recent years. At the close of April 2009, Taiwan registered 17, 979 AIDS infections. The average annual infection rate has grown an average 18% during the most recent five year period. Apart from medical problems, the social and psychological problems associated with AIDS are becoming increasingly complicated both in Taiwan and globally with the increasing number of HIV infections. Identifying the knowledge needs of nursing staff members for providing appropriate nursing care to HIV/AIDS patients is important to planning effective in-service nursing education programs. Quality of both patient care and professional development can be promoted.Purpose: This study investigated the HIV/AIDS educational needs of nursing staffs and variations in care knowledge needs by individual background. Results provide a reference for in-service education program planners.Methods: This was a descriptive and correlational study design that used self-structured questionnaires to conduct a cross-sectional survey. A total of 556 structural questionnaires were distributed and 546 completed questionnaires were returned (response rate=98.2%) and used in data analysis.Results: The average knowledge need score for nursing staffs with regard to HIV/AIDS patient care was ＞ 4 points. The highest three mean scores were (in rank order): follow-up treatment for victims after sexual assault, prevention of injury (e.g., sharp objects, exposure to infected body fluids) and subsequent management, and nursing care of opportunistic infection. The lowest three mean scores were (in rank order): HIV epidemiology, Taiwan HIV policies and regulations, and HIV transmission routes. Nurses who were older, married, or held senior nurse positions had more knowledge needs.Conclusion: This study can be a reference for prioritizing the arrangement of in-service HIV/AIDS care education and for formulating hospital policies related to HIV/AIDS patients. Prevention of injury and subsequent management of patients with opportunistic infections should be made mandatory in all health care provider courses. Also, enhancing promotion of safety needles can help reduce needle stick risks for clinical staff

The Effect of a Scenario-Based Communications Course on Self-Confidence in Novice Nurse Communications

[[abstract]]Background: Nurses are expected to have keen observation skills to monitor inpatient conditions and good communication skills to facilitate doctor-inpatient communications. Communication skills are thus a core attribute required of professional nurses.Purpose: This study explored the effectiveness of a scenario-based communication course on increasing the self-confidence of novice nurses in communicating with inpatients. Methods: This study used a quasi-experimental pre-test and post-test study design based on non-random cluster sampling and tests were administered on 118 novice nurses with less than one year of clinical experience at one of three training hospitals in Taipei City. The control group (nurses working at hospitals A and B) received a two-hour standard course in communications; The experimental group (nurses working at hospital C) received a three-hour scenario-based communications course. Data was provided by subjects via a self-rated scale that assessed respondent self-confidence in communicating with inpatients. Statistical analyses were performed using the SPSS statistical software package for Microsoft Windows (version 17.0).Results: Results of a dependent paired t-test show that average posttest scores for both groups were significantly higher (p＜.001) than average pretest scores. This demonstrated that both interventions were effective raising nurse confidence with inpatient communications. An ANCOVA showed no significant difference (p=.14) in average self-rated Confidence in Communication Scale scores between the two groups (experimental: 48.92, SD=5.04; control: 48.18, SD=5.14).Conclusions: Findings suggest the positive effect of both courses in increasing nurse confidence in communicating with inpatients. The scenario-based communications course was no more effective than the ordinary classroom communications course in making nurses more confident in communicating with inpatients