An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study
The use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, furth...
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| description | The use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, further study that tracks what influences students' clinical performance in actual clinical sites is vital.
The aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement.
This study used a correlational and longitudinal study design.
The 80 nursing students, who ranged in age from 19 to 21 (mean=20.38, SD=0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2months (Phase 2) and 4months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model.
The findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β=−0.14, p |
| doi_str_mv | 10.1016/j.nedt.2016.07.011 |
| format | Article |
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The aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement.
This study used a correlational and longitudinal study design.
The 80 nursing students, who ranged in age from 19 to 21 (mean=20.38, SD=0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2months (Phase 2) and 4months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model.
The findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β=−0.14, p<0.05) and on self-reflection with insight (SRI; β=−0.52, p<0.01). Self-reflection also had a significant positive effect on simulation learning effectiveness (β=0.37, p<0.01). Anxiety had a significant negative effect on students' nursing competence during the first 2months of practice in a clinical nursing site (β=−0.20, p<0.01). Simulation learning effectiveness and self-reflection and insight also had a significant positive effect on nursing competence during the first 2months of practice in a clinical site (β=0.13; β=0.16, p<0.05), respectively; and (2) when students practice in a clinical setting, their previous experience of nursing competence during the first 2months of clinical care and their self-reflection and insight have a significant positive effect on their 4-month nursing competence (β=0.58; β=0.27, p<0.01). Anxiety, however, had a negative effect on 4-month nursing competence but not significantly. Overall, 41% of the variance in clinical nursing performance was accounted for by the variables in the integrated model.
This study highlights that self-reflection with insight and clinical experience may help students to deflect anxiety that may influence the development of clinical competence. Of note is that real-life clinical experience has a stronger effect on enhancing clinical performance than does a simulation experience.
•Anxiety directly affects individual learning effectiveness and self-reflection with insight in a school simulation laboratory.•Self-reflection and learning effectiveness further influence the first 2 months of nursing competence in an actual clinical setting.•Following the first 2 months of clinical practice, nursing competence has the strongest direct effect at the 4-month mark of clinical nursing competence.•Although anxiety does not have a direct impact on clinical performance, during 4 months of clinical practice, it does have a direct impact on students’ self-reflection, which, in turn, affects students’ clinical nursing competence.]]></description><identifier>ISSN: 0260-6917</identifier><identifier>EISSN: 1532-2793</identifier><identifier>DOI: 10.1016/j.nedt.2016.07.011</identifier><identifier>PMID: 27518178</identifier><language>eng</language><publisher>Scotland: Elsevier Ltd</publisher><subject>Anxiety - psychology ; Clinical Competence ; Clinical experience ; Clinical medicine ; Clinical nursing ; Clinical placements ; Clinical skills ; College students ; Competence ; Educational Measurement ; Effects ; Experiential learning ; Female ; Holistic approach ; Holistic medicine ; Humans ; Insight ; Job performance ; Longitudinal Studies ; Male ; Nursing ; Nursing education ; Nursing Students ; Problem-Based Learning - methods ; Professional practice ; Questionnaires ; Reflection ; Reproducibility of Results ; Self Efficacy ; Self-reflection ; Selfreflection ; Simulation ; Simulation Training - methods ; Standardized patients ; Students, Nursing - psychology ; Taiwan ; Trait anxiety ; Young Adult</subject><ispartof>Nurse education today, 2016-10, Vol.45, p.156-162</ispartof><rights>2016 Elsevier Ltd</rights><rights>Copyright © 2016 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Oct 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c553t-e4defa5183e9364eacceeea92981210562728ca655da31a857238c32e9b2bd093</citedby><cites>FETCH-LOGICAL-c553t-e4defa5183e9364eacceeea92981210562728ca655da31a857238c32e9b2bd093</cites><orcidid>0000-0001-6557-5719</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.nedt.2016.07.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,31004,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27518178$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pai, Hsiang-Chu</creatorcontrib><title>An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study</title><title>Nurse education today</title><addtitle>Nurse Educ Today</addtitle><description><![CDATA[The use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, further study that tracks what influences students' clinical performance in actual clinical sites is vital.
The aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement.
This study used a correlational and longitudinal study design.
The 80 nursing students, who ranged in age from 19 to 21 (mean=20.38, SD=0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2months (Phase 2) and 4months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model.
The findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β=−0.14, p<0.05) and on self-reflection with insight (SRI; β=−0.52, p<0.01). Self-reflection also had a significant positive effect on simulation learning effectiveness (β=0.37, p<0.01). Anxiety had a significant negative effect on students' nursing competence during the first 2months of practice in a clinical nursing site (β=−0.20, p<0.01). Simulation learning effectiveness and self-reflection and insight also had a significant positive effect on nursing competence during the first 2months of practice in a clinical site (β=0.13; β=0.16, p<0.05), respectively; and (2) when students practice in a clinical setting, their previous experience of nursing competence during the first 2months of clinical care and their self-reflection and insight have a significant positive effect on their 4-month nursing competence (β=0.58; β=0.27, p<0.01). Anxiety, however, had a negative effect on 4-month nursing competence but not significantly. Overall, 41% of the variance in clinical nursing performance was accounted for by the variables in the integrated model.
This study highlights that self-reflection with insight and clinical experience may help students to deflect anxiety that may influence the development of clinical competence. Of note is that real-life clinical experience has a stronger effect on enhancing clinical performance than does a simulation experience.
•Anxiety directly affects individual learning effectiveness and self-reflection with insight in a school simulation laboratory.•Self-reflection and learning effectiveness further influence the first 2 months of nursing competence in an actual clinical setting.•Following the first 2 months of clinical practice, nursing competence has the strongest direct effect at the 4-month mark of clinical nursing competence.•Although anxiety does not have a direct impact on clinical performance, during 4 months of clinical practice, it does have a direct impact on students’ self-reflection, which, in turn, affects students’ clinical nursing competence.]]></description><subject>Anxiety - psychology</subject><subject>Clinical Competence</subject><subject>Clinical experience</subject><subject>Clinical medicine</subject><subject>Clinical nursing</subject><subject>Clinical placements</subject><subject>Clinical skills</subject><subject>College students</subject><subject>Competence</subject><subject>Educational Measurement</subject><subject>Effects</subject><subject>Experiential learning</subject><subject>Female</subject><subject>Holistic approach</subject><subject>Holistic medicine</subject><subject>Humans</subject><subject>Insight</subject><subject>Job performance</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Nursing</subject><subject>Nursing education</subject><subject>Nursing Students</subject><subject>Problem-Based Learning - methods</subject><subject>Professional practice</subject><subject>Questionnaires</subject><subject>Reflection</subject><subject>Reproducibility of Results</subject><subject>Self Efficacy</subject><subject>Self-reflection</subject><subject>Selfreflection</subject><subject>Simulation</subject><subject>Simulation Training - methods</subject><subject>Standardized patients</subject><subject>Students, Nursing - psychology</subject><subject>Taiwan</subject><subject>Trait anxiety</subject><subject>Young Adult</subject><issn>0260-6917</issn><issn>1532-2793</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkcuO1DAQRS0EYpqBH2CBLLFhk-BHJ3YQm9aIlzQSG1hbbrvSuOXYjZ0g5nv4USrqoRcsECu7yudeq-oS8pyzljPevz62CfzcCry3TLWM8wdkwzspGqEG-ZBsmOhZ0w9cXZEntR4ZY1oJ-ZhcCdVxzZXekF-7REOa4VDsDJ5O2UOkYy50_gYUxhHcXGkeaYU4NgXGiI2QE7XJUxdDCs5GCj9PUAKkOWARwZYU0oEidSHSUuraQw7NJ5sc4LeXdp0Xj_L6hu5ozOkQsA4JdevD3VPyaLSxwrP785p8ff_uy83H5vbzh083u9vGdZ2cG9h6GC0OJmGQ_RascwBgBzFoLjjreqGEdrbvOm8lt7rDXWgnBQx7sfdskNfk1dn3VPL3BepsplAdxGgT5KUadFY9U7rn_4EivGV6qxF9-Rd6zEvB4VZKdHzQikukxJlyJdeKizanEiZb7gxnZk3bHM2atlnTNkwZTBtFL-6tl_0E_iL5Ey8Cb88A4Np-BCimOszJgQ8FgzQ-h3_5_wZCB73m</recordid><startdate>201610</startdate><enddate>201610</enddate><creator>Pai, Hsiang-Chu</creator><general>Elsevier Ltd</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6557-5719</orcidid></search><sort><creationdate>201610</creationdate><title>An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study</title><author>Pai, Hsiang-Chu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c553t-e4defa5183e9364eacceeea92981210562728ca655da31a857238c32e9b2bd093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Anxiety - psychology</topic><topic>Clinical Competence</topic><topic>Clinical experience</topic><topic>Clinical medicine</topic><topic>Clinical nursing</topic><topic>Clinical placements</topic><topic>Clinical skills</topic><topic>College students</topic><topic>Competence</topic><topic>Educational Measurement</topic><topic>Effects</topic><topic>Experiential learning</topic><topic>Female</topic><topic>Holistic approach</topic><topic>Holistic medicine</topic><topic>Humans</topic><topic>Insight</topic><topic>Job performance</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Nursing</topic><topic>Nursing education</topic><topic>Nursing Students</topic><topic>Problem-Based Learning - methods</topic><topic>Professional practice</topic><topic>Questionnaires</topic><topic>Reflection</topic><topic>Reproducibility of Results</topic><topic>Self Efficacy</topic><topic>Self-reflection</topic><topic>Selfreflection</topic><topic>Simulation</topic><topic>Simulation Training - methods</topic><topic>Standardized patients</topic><topic>Students, Nursing - psychology</topic><topic>Taiwan</topic><topic>Trait anxiety</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pai, Hsiang-Chu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Nurse education today</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pai, Hsiang-Chu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study</atitle><jtitle>Nurse education today</jtitle><addtitle>Nurse Educ Today</addtitle><date>2016-10</date><risdate>2016</risdate><volume>45</volume><spage>156</spage><epage>162</epage><pages>156-162</pages><issn>0260-6917</issn><eissn>1532-2793</eissn><abstract><![CDATA[The use of clinical simulation in undergraduate nursing programs in Taiwan has gradually increased over the past 5years. Previous research has shown that students' experience of anxiety during simulated laboratory sessions influences their self-reflection and learning effectiveness. Thus, further study that tracks what influences students' clinical performance in actual clinical sites is vital.
The aim of the study is to develop an integrated model that considers the associations among anxiety, self-reflection, and learning effectiveness and to understand how this model applies to student nurses' clinical performance while on clinical placement.
This study used a correlational and longitudinal study design.
The 80 nursing students, who ranged in age from 19 to 21 (mean=20.38, SD=0.56), were recruited from a nursing school in southern Taiwan. Data were collected during three phases of implementation using four questionnaires. During the first phase, the State-Trait Anxiety Inventory (STAI), Simulation Learning Effectiveness Scale (SLES), and Self-Reflection and Insight Scale (SRIS) were used after students completed the simulation course in the school simulation laboratory. Nursing students also completed the Holistic Nursing Competence Scale at 2months (Phase 2) and 4months (Phase 3) after clinical practice experience. In Phase 3, students again completed the STAI and SRIS. Partial least squares (PLS), a structural equation modeling (SEM) procedure, was used to test the research model.
The findings showed that: (1) at the start of the simulation laboratory, anxiety had a significant negative effect on students' simulation learning effectiveness (SLE; β=−0.14, p<0.05) and on self-reflection with insight (SRI; β=−0.52, p<0.01). Self-reflection also had a significant positive effect on simulation learning effectiveness (β=0.37, p<0.01). Anxiety had a significant negative effect on students' nursing competence during the first 2months of practice in a clinical nursing site (β=−0.20, p<0.01). Simulation learning effectiveness and self-reflection and insight also had a significant positive effect on nursing competence during the first 2months of practice in a clinical site (β=0.13; β=0.16, p<0.05), respectively; and (2) when students practice in a clinical setting, their previous experience of nursing competence during the first 2months of clinical care and their self-reflection and insight have a significant positive effect on their 4-month nursing competence (β=0.58; β=0.27, p<0.01). Anxiety, however, had a negative effect on 4-month nursing competence but not significantly. Overall, 41% of the variance in clinical nursing performance was accounted for by the variables in the integrated model.
This study highlights that self-reflection with insight and clinical experience may help students to deflect anxiety that may influence the development of clinical competence. Of note is that real-life clinical experience has a stronger effect on enhancing clinical performance than does a simulation experience.
•Anxiety directly affects individual learning effectiveness and self-reflection with insight in a school simulation laboratory.•Self-reflection and learning effectiveness further influence the first 2 months of nursing competence in an actual clinical setting.•Following the first 2 months of clinical practice, nursing competence has the strongest direct effect at the 4-month mark of clinical nursing competence.•Although anxiety does not have a direct impact on clinical performance, during 4 months of clinical practice, it does have a direct impact on students’ self-reflection, which, in turn, affects students’ clinical nursing competence.]]></abstract><cop>Scotland</cop><pub>Elsevier Ltd</pub><pmid>27518178</pmid><doi>10.1016/j.nedt.2016.07.011</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-6557-5719</orcidid></addata></record> |
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| ispartof | Nurse education today, 2016-10, Vol.45, p.156-162 |
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| subjects | Anxiety - psychology Clinical Competence Clinical experience Clinical medicine Clinical nursing Clinical placements Clinical skills College students Competence Educational Measurement Effects Experiential learning Female Holistic approach Holistic medicine Humans Insight Job performance Longitudinal Studies Male Nursing Nursing education Nursing Students Problem-Based Learning - methods Professional practice Questionnaires Reflection Reproducibility of Results Self Efficacy Self-reflection Selfreflection Simulation Simulation Training - methods Standardized patients Students, Nursing - psychology Taiwan Trait anxiety Young Adult |
| title | An integrated model for the effects of self-reflection and clinical experiential learning on clinical nursing performance in nursing students: A longitudinal study |
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