Pub Date : 2025-11-13DOI: 10.1016/j.nedt.2025.106915
Cailiang Qiu , Xiaoyan Ni , Yan Wang , Miao Cao , Xue Li , Zhifang Huang , Qiongni Chen , Caili Ma , Yubiao He
Objective
To explore effects of credit bank on clinical communication skills, critical thinking skills, self-directed learning ability, professional identity and public stigma associated with hepatitis B patients of nursing interns in the infectious diseases department.
Methods
Employing a table of random numbers method, 140 nursing interns from the infectious diseases department of a grade-A tertiary hospital in Hunan Province were selected at random between an intervention group and a control group. The control group received routine clinical teaching in the infectious diseases department, while the intervention group implemented the credit bank practice plan in addition to the routine teaching practice. After 4 weeks of training, the disparities in clinical communication skills, critical thinking skills, professional identity, self-directed learning ability, and reduction of public stigma towards hepatitis B patients were examined between the two groups of nursing interns.
Results
Statistics revealed that after 4 weeks of intervention, the scores of clinical communication skills, critical thinking skills, professional identity, and self-directed learning ability of the intervention group were significantly higher in the intervention group than in the control group, while the scores of public stigma against hepatitis B patients were significantly lower in the intervention group compared to the control group, and the differences were statistically significant (P < 0.05).
Conclusion
The results of this study show that credit bank teaching practice can reduce the public stigma of hepatitis B patients among nursing interns in the infectious diseases department and improve their clinical communication skills, critical thinking skills, professional identity and self-directed learning ability.
{"title":"Effects of a “credit bank” intervention on the professional identity and public stigma among nursing students: A randomized controlled trial","authors":"Cailiang Qiu , Xiaoyan Ni , Yan Wang , Miao Cao , Xue Li , Zhifang Huang , Qiongni Chen , Caili Ma , Yubiao He","doi":"10.1016/j.nedt.2025.106915","DOIUrl":"10.1016/j.nedt.2025.106915","url":null,"abstract":"<div><h3>Objective</h3><div>To explore effects of credit bank on clinical communication skills, critical thinking skills, self-directed learning ability, professional identity and public stigma associated with hepatitis B patients of nursing interns in the infectious diseases department.</div></div><div><h3>Methods</h3><div>Employing a table of random numbers method, 140 nursing interns from the infectious diseases department of a grade-A tertiary hospital in Hunan Province were selected at random between an intervention group and a control group. The control group received routine clinical teaching in the infectious diseases department, while the intervention group implemented the credit bank practice plan in addition to the routine teaching practice. After 4 weeks of training, the disparities in clinical communication skills, critical thinking skills, professional identity, self-directed learning ability, and reduction of public stigma towards hepatitis B patients were examined between the two groups of nursing interns.</div></div><div><h3>Results</h3><div>Statistics revealed that after 4 weeks of intervention, the scores of clinical communication skills, critical thinking skills, professional identity, and self-directed learning ability of the intervention group were significantly higher in the intervention group than in the control group, while the scores of public stigma against hepatitis B patients were significantly lower in the intervention group compared to the control group, and the differences were statistically significant (<em>P</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>The results of this study show that credit bank teaching practice can reduce the public stigma of hepatitis B patients among nursing interns in the infectious diseases department and improve their clinical communication skills, critical thinking skills, professional identity and self-directed learning ability.</div></div>","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"158 ","pages":"Article 106915"},"PeriodicalIF":4.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.nedt.2025.106923
Zhengjun Zhu , Meicao Wang , Zixuan Li , Yuhan Li , Kexin Xue , Yanping Sun , Yanli Zeng
Background
Moral distress arises when nursing students recognize the ethically appropriate action but are constrained from acting due to institutional or interpersonal barriers. During clinical placements, they frequently encounter unethical practices, hierarchical dynamics, and value dissonance that evoke emotional strain and ethical disillusionment. Such experiences can undermine moral competence and hinder professional identity formation. Although moral distress among students has gained increasing scholarly attention, prior reviews often lacked conceptual coherence, cultural inclusiveness, and methodological rigor.
Objectives
To systematically synthesize and interpret qualitative evidence on nursing students' experiences of moral distress during clinical practice.
Methods
A qualitative systematic review and meta-synthesis was conducted following Joanna Briggs Institute methodology and reported in accordance with PRISMA and ENTREQ guidelines. Ten databases—PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Cochrane Library, CNKI, CBM, and WanFang—plus Google Scholar were searched from inception to November 2024 (updated October 3, 2025). Studies were appraised using the JBI Critical Appraisal Checklist, and data were analyzed thematically using NVivo 14. Confidence in the synthesized findings was assessed via the JBI ConQual process.
Results
Nine studies from eight countries were included. Six overarching themes and 17 subthemes were identified, highlighting moral distress triggered by unethical conduct, limited autonomy, and inadequate supervision. Students often responded with silence or avoidance, whereas access to peer or faculty support promoted moral resilience. ConQual assessment rated two themes as high confidence, one as moderate, and three as low.
Conclusions
Moral distress among nursing students is a culturally embedded, multifactorial experience shaped by systemic, relational, and personal influences. Integrating reflective mentorship and ethics-focused education may transform moral adversity into resilience and support the ethical development of future nurses.
背景：当护理学生认识到道德上适当的行为，但由于制度或人际障碍而无法采取行动时，就会出现道德困境。在临床实习期间，他们经常遇到不道德的做法，等级动态和价值失调，引起情绪紧张和道德幻灭。这样的经历会削弱道德能力，阻碍职业身份的形成。尽管学生的道德困扰已经引起了越来越多的学术关注，但之前的评论往往缺乏概念上的一致性、文化包容性和方法上的严谨性。目的：系统地综合和解释护生临床实践中道德困扰经历的定性证据。方法：采用Joanna Briggs研究所的方法进行定性系统评价和meta综合，并按照PRISMA和ENTREQ指南进行报告。检索了pubmed、Embase、CINAHL、PsycINFO、Scopus、Web of Science、Cochrane Library、CNKI、CBM、万方等10个数据库，检索时间从成立到2024年11月（更新时间为2025年10月3日）。使用JBI关键评估清单对研究进行评估，并使用NVivo 14对数据进行主题分析。通过JBI征服过程评估综合结果的置信度。结果：纳入了来自8个国家的9项研究。确定了6个总体主题和17个副主题，突出了由不道德行为、有限的自主权和监督不足引发的道德困境。学生们通常以沉默或回避作为回应，而获得同伴或教师的支持则促进了道德韧性。conquest评估将两个主题评为高可信度，一个为中等可信度，三个为低可信度。结论：护生的道德困扰是一种文化嵌入的、受系统、关系和个人影响的多因素体验。整合反思指导和以伦理为重点的教育可以将道德逆境转化为弹性，并支持未来护士的道德发展。
{"title":"Moral distress among nursing students during clinical practice: A qualitative systematic review and meta-synthesis","authors":"Zhengjun Zhu , Meicao Wang , Zixuan Li , Yuhan Li , Kexin Xue , Yanping Sun , Yanli Zeng","doi":"10.1016/j.nedt.2025.106923","DOIUrl":"10.1016/j.nedt.2025.106923","url":null,"abstract":"<div><h3>Background</h3><div>Moral distress arises when nursing students recognize the ethically appropriate action but are constrained from acting due to institutional or interpersonal barriers. During clinical placements, they frequently encounter unethical practices, hierarchical dynamics, and value dissonance that evoke emotional strain and ethical disillusionment. Such experiences can undermine moral competence and hinder professional identity formation. Although moral distress among students has gained increasing scholarly attention, prior reviews often lacked conceptual coherence, cultural inclusiveness, and methodological rigor.</div></div><div><h3>Objectives</h3><div>To systematically synthesize and interpret qualitative evidence on nursing students' experiences of moral distress during clinical practice.</div></div><div><h3>Methods</h3><div>A qualitative systematic review and meta-synthesis was conducted following Joanna Briggs Institute methodology and reported in accordance with PRISMA and ENTREQ guidelines. Ten databases—PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Cochrane Library, CNKI, CBM, and WanFang—plus Google Scholar were searched from inception to November 2024 (updated October 3, 2025). Studies were appraised using the JBI Critical Appraisal Checklist, and data were analyzed thematically using NVivo 14. Confidence in the synthesized findings was assessed via the JBI ConQual process.</div></div><div><h3>Results</h3><div>Nine studies from eight countries were included. Six overarching themes and 17 subthemes were identified, highlighting moral distress triggered by unethical conduct, limited autonomy, and inadequate supervision. Students often responded with silence or avoidance, whereas access to peer or faculty support promoted moral resilience. ConQual assessment rated two themes as high confidence, one as moderate, and three as low.</div></div><div><h3>Conclusions</h3><div>Moral distress among nursing students is a culturally embedded, multifactorial experience shaped by systemic, relational, and personal influences. Integrating reflective mentorship and ethics-focused education may transform moral adversity into resilience and support the ethical development of future nurses.</div></div>","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"157 ","pages":"Article 106923"},"PeriodicalIF":4.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Corrigendum to “The mediating effect of advanced health assessment on the relationship between self-directed learning and clinical thinking among master of nursing specialist postgraduate students: A structural equation model” [Nurse Educ. Today, 144 (2025)106480]","authors":"Lulu Wang , Yuqing Zhang , Chunjing Zhang , Biaoxin Zhang","doi":"10.1016/j.nedt.2025.106904","DOIUrl":"10.1016/j.nedt.2025.106904","url":null,"abstract":"","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"157 ","pages":"Article 106904"},"PeriodicalIF":4.2,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-06DOI: 10.1016/j.nedt.2025.106913
Yuan Li , Biru Luo , Jing Shi , Miao Chen , Mei Rosemary Fu , Shujuan Liao
Background
Internet addiction and depressive symptoms co-occur frequently among nursing students, threatening their well-being and academic success in a demanding educational environment. The underlying symptom dynamics, however, remain unclear. Network analysis can identify key symptom interactions, providing an empirical basis for targeted interventions and support strategies within nursing education.
Objectives
This study aimed to (1) identify central symptoms within the Internet addiction-depressive symptom network, (2) detect bridge symptoms connecting distinct symptom clusters, and (3) examine gender-specific network patterns among nursing students.
Design
A multicenter cross-sectional study.
Setting
Fourteen universities across seven major geographical regions of China.
Participants
6019 nursing students recruited through two-stage sampling.
Methods
Data were collected between April and July 2024 using the 6-item Internet Addiction Test and the 9-item Patient Health Questionnaire. Network analysis was performed to estimate symptom networks, identify central and bridge symptoms, and examine gender-specific patterns.
Results
Analysis of 5984 valid responses revealed a stable network comprising 15 nodes with 80 non-zero edges. Fatigue/low energy (Expected Influence [EI] = 1.497) and Internet preoccupation (EI = 1.211) emerged as the most central symptoms in the network, while offline emotional dysregulation (bridge EI = 0.234) served as the primary bridge symptom. Gender comparisons revealed significant structural differences (P = 0.049); regarding local connectivity patterns, males showed stronger connections in behavioral control failure and physiological-emotional instability, and females exhibited elevated connectivity in academic impairment and self-concept preservation.
Conclusions
Fatigue/low energy and Internet preoccupation emerged as central symptoms, with offline emotional dysregulation as the primary bridge. Gender-specific network patterns demonstrated distinct symptom interactions, suggesting that targeted interventions should be designed respectively for males and females. These findings advance understanding of symptom-level dynamics and provide evidence-based implications for developing targeted psychological and behavioral interventions within nursing education to enhance students' mental health, academic success, and professional development.
{"title":"Internet addiction and depressive symptoms among nursing students: A network analysis with implications for nursing education","authors":"Yuan Li , Biru Luo , Jing Shi , Miao Chen , Mei Rosemary Fu , Shujuan Liao","doi":"10.1016/j.nedt.2025.106913","DOIUrl":"10.1016/j.nedt.2025.106913","url":null,"abstract":"<div><h3>Background</h3><div>Internet addiction and depressive symptoms co-occur frequently among nursing students, threatening their well-being and academic success in a demanding educational environment. The underlying symptom dynamics, however, remain unclear. Network analysis can identify key symptom interactions, providing an empirical basis for targeted interventions and support strategies within nursing education.</div></div><div><h3>Objectives</h3><div>This study aimed to (1) identify central symptoms within the Internet addiction-depressive symptom network, (2) detect bridge symptoms connecting distinct symptom clusters, and (3) examine gender-specific network patterns among nursing students.</div></div><div><h3>Design</h3><div>A multicenter cross-sectional study.</div></div><div><h3>Setting</h3><div>Fourteen universities across seven major geographical regions of China.</div></div><div><h3>Participants</h3><div>6019 nursing students recruited through two-stage sampling.</div></div><div><h3>Methods</h3><div>Data were collected between April and July 2024 using the 6-item Internet Addiction Test and the 9-item Patient Health Questionnaire. Network analysis was performed to estimate symptom networks, identify central and bridge symptoms, and examine gender-specific patterns.</div></div><div><h3>Results</h3><div>Analysis of 5984 valid responses revealed a stable network comprising 15 nodes with 80 non-zero edges. Fatigue/low energy (Expected Influence [EI] = 1.497) and Internet preoccupation (EI = 1.211) emerged as the most central symptoms in the network, while offline emotional dysregulation (bridge EI = 0.234) served as the primary bridge symptom. Gender comparisons revealed significant structural differences (<em>P</em> = 0.049); regarding local connectivity patterns, males showed stronger connections in behavioral control failure and physiological-emotional instability, and females exhibited elevated connectivity in academic impairment and self-concept preservation.</div></div><div><h3>Conclusions</h3><div>Fatigue/low energy and Internet preoccupation emerged as central symptoms, with offline emotional dysregulation as the primary bridge. Gender-specific network patterns demonstrated distinct symptom interactions, suggesting that targeted interventions should be designed respectively for males and females. These findings advance understanding of symptom-level dynamics and provide evidence-based implications for developing targeted psychological and behavioral interventions within nursing education to enhance students' mental health, academic success, and professional development.</div></div>","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"157 ","pages":"Article 106913"},"PeriodicalIF":4.2,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.nedt.2025.106911
Rachael Crocker , Lindsay Gillman , Ann Ooms , Jacqui Williams
Background
Practice assessment documentation is a critical component of midwifery education globally, to ensure students meet regulatory standards for clinical proficiency. However, variations in documentation, grading criteria, and assessor interpretation have led to inconsistencies in student assessment. This scoping review maps existing literature evaluating midwifery practice assessment documentation, synthesises the evidence, and identifies gaps.
Methods
A scoping review was conducted following the JBI methodology, including searches in CINAHL, MEDLINE, Embase, MIDIRS, Web of Science, Scopus, APA PsycInfo, and Education Research Complete. Gray literature sources, reference lists, and systematic review databases were also screened. Studies evaluating midwifery practice assessment documentation in clinical education across Australia, New Zealand, Canada, the UK, and EU member states were included. Data extraction followed a narrative synthesis approach.
Results
Nine articles met the inclusion criteria, including seven primary research articles, one national report, and one conference presentation. Key themes identified included validity and reliability of documentation and assessment tools, training, time, language and consistency. Several articles highlighted the need for nationalised assessment tools, with some evidence suggesting that standardisation can improve reliability and feedback quality.
Conclusion
The review highlights ongoing challenges in midwifery assessment, emphasising the need for standardised, user-friendly documentation that ensures consistency and reliability. Ensuring that midwifery assessment effectively captures both clinical competencies and professional attitudes is essential to fostering well-rounded, competent practitioners ready to meet the demands of contemporary midwifery practice. While nationalised tools show promise, further research is required to assess their impact on student learning and assessor’ confidence.
实践评估文件是全球助产教育的重要组成部分，以确保学生达到临床熟练程度的监管标准。然而，在文件、评分标准和评估员解释方面的差异导致了学生评估的不一致。这一范围审查绘制现有文献评估助产实践评估文件，综合证据，并确定差距。方法按照JBI方法进行范围综述，包括在CINAHL、MEDLINE、Embase、MIDIRS、Web of Science、Scopus、APA PsycInfo和Education Research Complete中进行检索。灰色文献来源、参考文献列表和系统评价数据库也被筛选。研究评估了澳大利亚、新西兰、加拿大、英国和欧盟成员国临床教育中的助产实践评估文件。数据提取遵循叙事综合方法。结果9篇文章符合纳入标准，其中主要研究论文7篇，国家报告1篇，会议报告1篇。确定的关键主题包括文件和评估工具的有效性和可靠性、培训、时间、语言和一致性。几篇文章强调了国有化评估工具的必要性，一些证据表明，标准化可以提高可靠性和反馈质量。结论该综述强调了助产评估中存在的挑战，强调需要标准化、用户友好的文件，以确保一致性和可靠性。确保助产评估有效地捕捉临床能力和专业态度是必不可少的培养全面的，有能力的从业者准备满足当代助产实践的需求。虽然国有化的工具显示出希望，但需要进一步的研究来评估它们对学生学习和评估员信心的影响。
{"title":"Practice assessment documentation for midwifery programmes: A scoping review","authors":"Rachael Crocker , Lindsay Gillman , Ann Ooms , Jacqui Williams","doi":"10.1016/j.nedt.2025.106911","DOIUrl":"10.1016/j.nedt.2025.106911","url":null,"abstract":"<div><h3>Background</h3><div>Practice assessment documentation is a critical component of midwifery education globally, to ensure students meet regulatory standards for clinical proficiency. However, variations in documentation, grading criteria, and assessor interpretation have led to inconsistencies in student assessment. This scoping review maps existing literature evaluating midwifery practice assessment documentation, synthesises the evidence, and identifies gaps.</div></div><div><h3>Methods</h3><div>A scoping review was conducted following the JBI methodology, including searches in CINAHL, MEDLINE, Embase, MIDIRS, Web of Science, Scopus, APA PsycInfo, and Education Research Complete. Gray literature sources, reference lists, and systematic review databases were also screened. Studies evaluating midwifery practice assessment documentation in clinical education across Australia, New Zealand, Canada, the UK, and EU member states were included. Data extraction followed a narrative synthesis approach.</div></div><div><h3>Results</h3><div>Nine articles met the inclusion criteria, including seven primary research articles, one national report, and one conference presentation. Key themes identified included validity and reliability of documentation and assessment tools, training, time, language and consistency. Several articles highlighted the need for nationalised assessment tools, with some evidence suggesting that standardisation can improve reliability and feedback quality.</div></div><div><h3>Conclusion</h3><div>The review highlights ongoing challenges in midwifery assessment, emphasising the need for standardised, user-friendly documentation that ensures consistency and reliability. Ensuring that midwifery assessment effectively captures both clinical competencies and professional attitudes is essential to fostering well-rounded, competent practitioners ready to meet the demands of contemporary midwifery practice. While nationalised tools show promise, further research is required to assess their impact on student learning and assessor’ confidence.</div></div>","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"157 ","pages":"Article 106911"},"PeriodicalIF":4.2,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.nedt.2025.106901
Jingbang Liu , Ting Chen , Shan Li , Yeru Xia , Hong Zhu , Ruijuan Wu , Qinli Cao , Xiaoyan Gong , Lili Wu
Background
Intensive Care Unit (ICU) nursing is demanding, requiring advanced clinical decision-making and emergency management skills. Simulation-based instruction is central to ICU nursing education but remains constrained by the cost and time required for scenario authoring, limited faculty capacity for feedback, and slow content updates. Large language models (LLMs)-based pedagogical agents may augment instructor training by supporting rapid scenario generation, formative guidance, and on-demand assistance. However, evidence from real-world ICU instructor training is limited, and the balance between perceived benefits, usability, and objective educational outcomes is unclear.
Objective
To evaluate the feasibility and learner-perceived impact of integrating an LLM-based pedagogical agent into ICU simulation instructor training.
Methods
An exploratory quasi-experimental study was conducted with 40 ICU nurses from a tertiary hospital in February 2025. Participants were randomly assigned to an experimental group (n = 20) using the LLM-based AI teaching agent for simulation training, and a comparison group (n = 20) using traditional blended learning. The training effectiveness was assessed using the Chinese version of the Jeffries Simulation Design Scale (SDS), the System Usability Scale (SUS), the Adult Online Learning Self-Efficacy Scale, and a teaching satisfaction questionnaire. Data were analyzed using Wilcoxon rank-sum tests and t-tests.
Results
The experimental group outperformed the comparison group in multiple areas. Specifically, in the SDS, the experimental group scored higher in case authenticity (5.00 vs. 4.00, p < 0.001), scenario complexity (5.00 vs. 4.00, p < 0.001), feedback mechanisms (5.00 vs. 4.00, p < 0.001), interactivity (5.00 vs. 4.00, p < 0.001), and teaching objectives (5.00 vs. 4.25, p < 0.001). The experimental group also showed higher self-efficacy in learning ability (16.0 vs. 13.0, p < 0.001) and learning technology (18.0 vs. 16.0, p = 0.045). Satisfaction was high in both groups and demonstrated a pronounced ceiling effect.
Conclusion
Embedding an LLM-based pedagogical agent into ICU simulation instructor training was feasible and associated with more favorable learner-perceived simulation design quality and online learning self-efficacy, while usability did not differ from traditional blended learning. Findings are preliminary and hypothesis-generating; future multi-centre, adequately powered randomized controlled trials are warranted to determine efficacy and isolate the LLM component's independent contribution.
背景：重症监护病房（ICU）的护理要求很高，需要先进的临床决策和应急管理技能。基于模拟的教学是ICU护理教育的核心，但仍然受到场景创作所需的成本和时间、有限的教师反馈能力和缓慢的内容更新的限制。基于大型语言模型（llm）的教学代理可以通过支持快速场景生成、形成性指导和随需应变的帮助来增加教师培训。然而，来自现实世界ICU教员培训的证据是有限的，并且感知收益、可用性和客观教育结果之间的平衡尚不清楚。目的：评估将法学硕士教学代理整合到ICU模拟讲师培训中的可行性和学习者感知的影响。方法：于2025年2月对某三级医院ICU护士40名进行探索性准实验研究。参与者被随机分配到使用基于llm的AI教学代理进行模拟训练的实验组（n = 20）和使用传统混合学习的对照组（n = 20）。采用中文版Jeffries模拟设计量表（SDS）、系统可用性量表（SUS）、成人在线学习自我效能量表和教学满意度问卷对培训效果进行评估。数据分析采用Wilcoxon秩和检验和t检验。结果：实验组在多个方面优于对照组。具体而言，在SDS中，实验组在案例真实性方面得分更高（5.00 vs. 4.00, p）。结论：在ICU模拟讲师培训中嵌入基于法学硕士的教学代理是可行的，并且与更有利的学习者感知的模拟设计质量和在线学习自我效能相关，而可用性与传统的混合学习没有差异。研究结果是初步的，并产生假设；未来有必要进行多中心、充分有力的随机对照试验，以确定疗效并分离LLM成分的独立贡献。
{"title":"LLM-based pedagogical agent for ICU simulation instructor training: A quasi-experimental study","authors":"Jingbang Liu , Ting Chen , Shan Li , Yeru Xia , Hong Zhu , Ruijuan Wu , Qinli Cao , Xiaoyan Gong , Lili Wu","doi":"10.1016/j.nedt.2025.106901","DOIUrl":"10.1016/j.nedt.2025.106901","url":null,"abstract":"<div><h3>Background</h3><div>Intensive Care Unit (ICU) nursing is demanding, requiring advanced clinical decision-making and emergency management skills. Simulation-based instruction is central to ICU nursing education but remains constrained by the cost and time required for scenario authoring, limited faculty capacity for feedback, and slow content updates. Large language models (LLMs)-based pedagogical agents may augment instructor training by supporting rapid scenario generation, formative guidance, and on-demand assistance. However, evidence from real-world ICU instructor training is limited, and the balance between perceived benefits, usability, and objective educational outcomes is unclear.</div></div><div><h3>Objective</h3><div>To evaluate the feasibility and learner-perceived impact of integrating an LLM-based pedagogical agent into ICU simulation instructor training.</div></div><div><h3>Methods</h3><div>An exploratory quasi-experimental study was conducted with 40 ICU nurses from a tertiary hospital in February 2025. Participants were randomly assigned to an experimental group (n = 20) using the LLM-based AI teaching agent for simulation training, and a comparison group (n = 20) using traditional blended learning. The training effectiveness was assessed using the Chinese version of the Jeffries Simulation Design Scale (SDS), the System Usability Scale (SUS), the Adult Online Learning Self-Efficacy Scale, and a teaching satisfaction questionnaire. Data were analyzed using Wilcoxon rank-sum tests and <em>t</em>-tests.</div></div><div><h3>Results</h3><div>The experimental group outperformed the comparison group in multiple areas. Specifically, in the SDS, the experimental group scored higher in case authenticity (5.00 vs. 4.00, <em>p</em> < 0.001), scenario complexity (5.00 vs. 4.00, <em>p</em> < 0.001), feedback mechanisms (5.00 vs. 4.00, <em>p</em> < 0.001), interactivity (5.00 vs. 4.00, <em>p</em> < 0.001), and teaching objectives (5.00 vs. 4.25, <em>p</em> < 0.001). The experimental group also showed higher self-efficacy in learning ability (16.0 vs. 13.0, <em>p</em> < 0.001) and learning technology (18.0 vs. 16.0, <em>p</em> = 0.045). Satisfaction was high in both groups and demonstrated a pronounced ceiling effect.</div></div><div><h3>Conclusion</h3><div>Embedding an LLM-based pedagogical agent into ICU simulation instructor training was feasible and associated with more favorable learner-perceived simulation design quality and online learning self-efficacy, while usability did not differ from traditional blended learning. Findings are preliminary and hypothesis-generating; future multi-centre, adequately powered randomized controlled trials are warranted to determine efficacy and isolate the LLM component's independent contribution.</div></div>","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"157 ","pages":"Article 106901"},"PeriodicalIF":4.2,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-02DOI: 10.1016/j.nedt.2025.106903
Huali Shi , Yanyan Zhang , Yanxiang Zhao , Meng Meng , Chen Zhi , Hui Ma
Background
Biosafety events pose a global threat. Nurses in tertiary general hospitals are among the first responders. They must have comprehensive competencies to respond appropriately to individuals exposed to biosafety risks while ensuring their safety.
Objectives
This study designed a training program to enhance nurses' biosafety emergency response competence in tertiary general hospitals in Beijing. It examined the effectiveness of improving their knowledge, skills, and response competence.
Design
A quasi-experiment study was developed.
Methods
This study was conducted from 24 May 2024 to 31 July 2024. Convenience sampling was used to select 100 nursing staff from Beijing who participated in this study. Participants were assigned to the experimental and control groups in the recruitment order. The general characteristics were analyzed using descriptive statistics. The Shapiro-Wilk test was employed to assess the normality of the study variables. A paired sample t-test or Wilcoxon signed rank test was conducted to compare the group before and after the intervention.
Results
A significant difference was observed between the pre-training and post-training regarding knowledge, skills, and response competence. The comparative analyses across multiple time points showed no significant differences between pre-training and one month later measurements for most variables. A noticeable decline in knowledge, skills, and response competencies was noted three months later. Nurses expressed high satisfaction with the overall training, and training manuals received the highest score.
Conclusions
The emergency response training program for biosafety events effectively increased nurses' knowledge, skills, and emergency response competence in tertiary general hospitals. Regular training for nurses should be implemented to consolidate the effectiveness of such training. A policy support system with standardized resource allocation and an online training platform should be developed. This system is designed to address institutional disparities while maintaining the adaptability of programs across different hospital levels.
{"title":"The effectiveness of the emergency response training program for biosafety events of nurses' competence in the tertiary general hospital: A quasi-experiment study","authors":"Huali Shi , Yanyan Zhang , Yanxiang Zhao , Meng Meng , Chen Zhi , Hui Ma","doi":"10.1016/j.nedt.2025.106903","DOIUrl":"10.1016/j.nedt.2025.106903","url":null,"abstract":"<div><h3>Background</h3><div>Biosafety events pose a global threat. Nurses in tertiary general hospitals are among the first responders. They must have comprehensive competencies to respond appropriately to individuals exposed to biosafety risks while ensuring their safety.</div></div><div><h3>Objectives</h3><div>This study designed a training program to enhance nurses' biosafety emergency response competence in tertiary general hospitals in Beijing. It examined the effectiveness of improving their knowledge, skills, and response competence.</div></div><div><h3>Design</h3><div>A quasi-experiment study was developed.</div></div><div><h3>Methods</h3><div>This study was conducted from 24 May 2024 to 31 July 2024. Convenience sampling was used to select 100 nursing staff from Beijing who participated in this study. Participants were assigned to the experimental and control groups in the recruitment order. The general characteristics were analyzed using descriptive statistics. The Shapiro-Wilk test was employed to assess the normality of the study variables. A paired sample <em>t</em>-test or Wilcoxon signed rank test was conducted to compare the group before and after the intervention.</div></div><div><h3>Results</h3><div>A significant difference was observed between the pre-training and post-training regarding knowledge, skills, and response competence. The comparative analyses across multiple time points showed no significant differences between pre-training and one month later measurements for most variables. A noticeable decline in knowledge, skills, and response competencies was noted three months later. Nurses expressed high satisfaction with the overall training, and training manuals received the highest score.</div></div><div><h3>Conclusions</h3><div>The emergency response training program for biosafety events effectively increased nurses' knowledge, skills, and emergency response competence in tertiary general hospitals. Regular training for nurses should be implemented to consolidate the effectiveness of such training. A policy support system with standardized resource allocation and an online training platform should be developed. This system is designed to address institutional disparities while maintaining the adaptability of programs across different hospital levels.</div></div>","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"158 ","pages":"Article 106903"},"PeriodicalIF":4.2,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-07-29DOI: 10.1016/j.nedt.2025.106838
Kristina Mikkonen, Sok Ying Liaw, Lina Spirgienė, Andrėjus Subočius, Povilas Ignatavičius, Tomas Blažauskas, Olga Riklikienė
The growing complexity of healthcare systems and the imperative for collaborative practice underscore the pressing need to innovate interprofessional education. This paper presents a multidimensional pedagogical framework that integrates blended classroom-based learning, high-fidelity simulation (HFS), and AI-enhanced extended reality (XR) technologies to develop interprofessional competences and improve preparedness for emergency care. Grounded in socio-constructivist and student-centred educational theories, the approach combines theoretical knowledge acquisition with immersive and experiential learning environments that reflect the realities of clinical practice. HFS provides a controlled setting to cultivate critical thinking, decision-making, and collaborative skills. In parallel, AI-enhanced XR introduces adaptive, gamified scenarios that foster digital competence, emotional resilience, and situated cognition. Together, these elements form a cohesive educational strategy that prepares nursing, midwifery, and medical students for high-stakes clinical situations such as anaphylaxis and trauma care. The framework contributes to enhanced patient safety, learner engagement, and the cultivation of future-ready professionals. It also responds to international calls for digital transformation and innovation in healthcare education. By harmonising traditional teaching methods with emerging technologies, this framework offers a globally relevant, scalable solution for advancing interprofessional learning across diverse healthcare contexts.
{"title":"Multidimensional pedagogical framework for interprofessional education: Blending classroom, high fidelity and extended reality simulation.","authors":"Kristina Mikkonen, Sok Ying Liaw, Lina Spirgienė, Andrėjus Subočius, Povilas Ignatavičius, Tomas Blažauskas, Olga Riklikienė","doi":"10.1016/j.nedt.2025.106838","DOIUrl":"10.1016/j.nedt.2025.106838","url":null,"abstract":"<p><p>The growing complexity of healthcare systems and the imperative for collaborative practice underscore the pressing need to innovate interprofessional education. This paper presents a multidimensional pedagogical framework that integrates blended classroom-based learning, high-fidelity simulation (HFS), and AI-enhanced extended reality (XR) technologies to develop interprofessional competences and improve preparedness for emergency care. Grounded in socio-constructivist and student-centred educational theories, the approach combines theoretical knowledge acquisition with immersive and experiential learning environments that reflect the realities of clinical practice. HFS provides a controlled setting to cultivate critical thinking, decision-making, and collaborative skills. In parallel, AI-enhanced XR introduces adaptive, gamified scenarios that foster digital competence, emotional resilience, and situated cognition. Together, these elements form a cohesive educational strategy that prepares nursing, midwifery, and medical students for high-stakes clinical situations such as anaphylaxis and trauma care. The framework contributes to enhanced patient safety, learner engagement, and the cultivation of future-ready professionals. It also responds to international calls for digital transformation and innovation in healthcare education. By harmonising traditional teaching methods with emerging technologies, this framework offers a globally relevant, scalable solution for advancing interprofessional learning across diverse healthcare contexts.</p>","PeriodicalId":54704,"journal":{"name":"Nurse Education Today","volume":"154 ","pages":"106838"},"PeriodicalIF":4.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号