Angelo Dante

Factors associated with nursing students' academic success or failure: A retrospective Italian multicenter study

With the increasing standardization of nursing education in Europe under the Bologna Process Declaration (1999), there is a growing interest in defining a common concept of academic success and/or failure, measuring associated factors and comparing differences and similarities between different countries. While there is literature available on these issues from other countries, the phenomenon has not been studied in Italy. The aim of this study was to define the factors associated with academic success or failure in an Italian cohort of nursing students on a bachelors degree course. A retrospective multicenter study design was adopted. All students enrolling in the academic year 2004-05 on two different bachelors courses in the north of Italy were interviewed. Only 81 of the 117 students considered (69.2%) concluded their course in three years. Multivariate analysis identified two factors determining academic success/failure: good results in the entry examination for the bachelors degree in nursing sciences were associated with academic success (OR 4.217, IC(95%) 1.501-11.84), while family commitments, e.g. caring for children or elderly people were associated with academic failure (OR 0.120, IC(95%) 0.03-0.471). Academic failure has a strong impact on students, their families, the teaching faculties and the community, and its prevention is a challenge in the countries with a shortage of nurses.

Self-directed learning competence assessment within different healthcare professionals and amongst students in Italy

In the last few years the significance of life-long learning skills has been greatly realised with regard to adult learning, which is based on self-motivation, engagement in learning and making full use of a persons resources. In this context, it is paramount that healthcare professionals take responsibility for their profession by being innovative, creative and flexible to change in order to facilitate the adaptation process and encourage responsiveness to change. The main principles can be summarized as lifelong learning, which are strictly linked to self-directed learning. The aims of this study were to describe (a) the self-directed learning competence of nurses (registered nurse, RN) and radiologist technicians (RT); (b) the self-directed learning competence of RN and RT students before their graduation. A comparative cross-sectional study approach was adopted; a consecutive sample of RNs and RTs attending continuing education seminars, workshops and other initiatives from 2009 to 2010 were considered for this study. Moreover, all nursing and radiology technicians students about to graduate in the same course and studying in the same region were included. The self-rating scale of self-directed learning (SRSSDL) was used to collect data for the purpose of the study. Eight hundred and forty-seven participants were involved (453 RNs, 141 RTs, 182 RN students and 68 RT students) who obtained an average SRSSDL score of 224.7 (±25.0). RNs and RTs got on average a medium-high score (229.1 ± 22.9 and 219.6 ± 29.2, respectively) and the majority of them (63.8-51.1%) reached a high level of self-directed learning. In order to promote tailored continuing education programs and interprofessional continuing education strategies, and identify the support to offer to healthcare workers according to their needs, educators should be aware of their self-directed learning skills. Therefore, individuals with high competence should adopt different strategies from those who have limited skills. Reflecting on self-directed learning competence of students before their graduation incorporates self-directed learning into the professional continuum and clarifies the Universitys contribution in developing this important skill.

Publication efficiency among the higher impact factor nursing journals in 2009: A retrospective analysis

BACKGROUND Knowledge translation is attracting different professional, educational and institutional strategies mainly focused on how new knowledge should be tailored and transferred at bedside. Less attention is dedicated to the antecedent of knowledge translation, which is the availability of the knowledge itself. Knowledge diffusion is a process by which an innovation is communicated through certain channels among members of a social system over time. Publishing in peer review journals is recognised as the main method for knowledge diffusion: nevertheless publication efficiency has received little attention to date. OBJECTIVES Describing publication efficiency via nursing journals as the time occurring between data collection and manuscript publication was the main aim of the study. The secondary aim was to discover the differences, if any, in publication efficiency within manuscripts reporting results from different study designs. DESIGN A retrospective study design was adopted in 2010. METHODS The 2009 Impact Factor List of Nursing Journals published by the ISI web of Knowledge in 2010 was obtained. The first top ten IF Nursing Journals available as a full text and for which the overall ISI 5-Year Impact Factor was also available, was eligible. The articles published on paper by the selected journals, from 1st January to 31st December 2009, were then included. Commentaries, editorials and book reviews were excluded. For each article included, the following were evaluated: (a) the time occurring between each step of publication, from data collection to article submission, acceptance and publication online and on paper; and (b) the differences in the publication efficiency within articles reporting different study designs. RESULTS 1152 articles were included. From the end of data collection to manuscript publication online/on paper it takes an average of 981 days [CI95% 929-1032] (2.5-3 years). Meta-analysis and systematic reviews have demonstrated the fastest process, requiring an average 1.3 years and 1.9 years respectively. Case-control, cohort and quasi-experimental studies have required more time to enjoy publication in nursing journals, 4 years, 3.5 years and 3.2 years respectively. CONCLUSIONS The production time of an article from its data collection involves significant processes and skills. However, the time may also be lengthened by factors not related to the processes of research, such as the time available to researchers. The scientific world needs to reflect on publication efficiency because lateness can potentially have a negative impact on patients and on further research. In the future, the same emphasis given to the evaluation of knowledge translation effectiveness should be given also to the complex process of knowledge diffusion, discovering facilitators and barriers.

The cost of the objective structured clinical examination on an Italian nursing bachelor's degree course

The OSCE (Objective Structured Clinical Examination) is considered the most valid and reliable method for assessing the clinical skills of students training for health professions, but its use is limited by the related high costs. We analyzed the cost retrospectively of using an OSCE designed for second-year students (2009) in our degree course, adopting the Reznick et al. guidelines (1993), which recommend assessing both high-end costs and low-end costs. The high-end costs adopting the OSCE amounted to € 145.23 per student, while the low-end costs were € 31.51 per student. Considering the economic crisis and the cost-containment measures applied also in nursing education, strategies for further reducing costs are discussed.

Knowledge and competence with patient safety as perceived by nursing students: The findings of a cross-sectional study

BACKGROUND Ensuring safety in health-care settings is provoking improvements both in education and clinical practice. However, the studies available have not offered to date information regarding knowledge and competence on patient safety (PS) developed by nursing students over their academic career. There is no documentation of the amount of close calls and/or adverse events that students may have witnessed and the degree of safety perceived in the attended clinical settings. OBJECTIVES To describe the perception of nursing students regarding their own knowledge and competence on PS and describe differences, if any, among students attending the first, second and third academic year. DESIGN A cross-sectional study design was undertaken in 2013. PARTICIPANTS AND SETTING A convenience sample of 621 nursing students of two bachelors nursing degrees located in two Italian universities, was the population target of the study. Students attending the first, second and third academic year, obtaining admission to the annual clinical competence examination, were eligible. METHODS The Italian version of the Health Professional Education in Patient Safety Survey (H-PEPSSIta) and open-ended questions was administered to the students after having obtained their informed written consent. RESULTS A total of 573 students (response rate 92.4%) participated. Around a quarter (28.8%) of students reported having experienced an adverse event or close call during their clinical experience. The settings where they learn were perceived as unsafe by 46.9% of students. PS knowledge and competence as perceived by students, was high (Median=4) in all factors and dimensions of the H-PEPSSIta tool. High PS knowledge and competence was reported by first-year students, moderate by second-year students and higher at the end of the third-year. CONCLUSIONS Faculties and health-care institutions offering clinical placements have to share the responsibility of well-prepared future nurses, working together to improve PS through dialogue when issues are identified by students.

Factors influencing the choice of a nursing or a non-nursing degree: A multicenter, cross-sectional study

Current literature has paid increasing attention to the factors influencing career decisions; nevertheless, few studies have compared candidates that have chosen a nursing versus a non-nursing degree. A multicenter, cross-sectional study design was performed to explore whether or not certain individual variables and having inaccurate data about nursing as a profession influenced the choice of a non-nursing degree. Six non-nursing and three nursing degree programs offered by two public Italian universities were involved. A total of 507 students who had just enrolled in non-nursing degree programs and 202 in nursing degree programs were invited to complete a questionnaire comprising 12 closed items. Overall, from 40.0% to 57.1% of the variation in choosing a degree other than nursing was explained by variables such as age, and having inaccurate data on the nursing profession. For each year over 19 years of age, the likelihood that the student would decide to enroll in a nursing degree program increases. For each wrong answer reported on the questionnaire evaluating knowledge on nursing profession, there was a reduction of approximately six times in the likelihood that the student would enroll in a nursing degree program. Information regarding the nursing profession should be offered in early stages of life; in addition, offering accurate data on the profession is a key factor in evaluating the congruence of the career with the individuals personal motivations, aspirations, and talents.

Enhancing self-directed learning among Italian nursing students: A pre- and post-intervention study

BACKGROUND In accordance with Knowless theory, self-directed learning (SDL) may be improved with tutorial strategies focused on guided reflection and critical analysis of the learning process. No evidence on effects on SDL abilities of different tutorial strategies offered to nursing students during the 1st clinical experience is available. OBJECTIVES To evaluate the effect of different tutorial strategies offered to nursing students on their SDL abilities. DESIGN A pre-post intervention non-equivalent control group design was adopted in 2013. For the treatment group, structured and intensive tutorial interventions including different strategies such as briefing, debriefing, peer support, Socratic questioning, performed by university tutors were offered during the 1st clinical experience; for the control group, unstructured and non-intensive tutorial strategies were instead offered. SETTING Two Bachelor of Nursing Degree. PARTICIPANTS Students awaiting their clinical experience (n=238) were the target sample. Those students who have completed the pre- and the post-intervention evaluation (201; 84.4%) were included in the analysis. METHODS SDL abilities were measured with the SRSSDL_ITA (Self Rating Scale of Self Directed Learning-Italian Version). A multiple linear regression analysis was developed to explore the predictive effect of individual, contextual and intervention variables. RESULTS Three main factors explained the 36.8% of the adjusted variance in SDL scores have emerged: a) having received a lower clinical nurse-to-student supervision (B 9.086, β 2.874), b) having received higher level and structured tutorial intervention by university tutors (B 8.011, β 2.741), and c) having reported higher SDL scores at the baseline (B .550, β .556). CONCLUSIONS A lower clinical nurse-to-student ratio (1:4), accompanied by unstructured and non-intensive tutorial intervention adopted by university tutors, seemed to be equivalent to an intensive clinical supervision (1:1) accompanied by higher level and structured tutorial strategies activated by the university tutors.

Predictive power of individual factors and clinical learning experience on academic success: findings from a longitudinal study.

Academic failure is the inability of a nursing student to graduate or to complete the nursing degree on time. This longitudinal cohort study, involving 2 Italian universities, documents the effects of selected individual variables and the quality of the clinical learning experience as perceived by students on academic success. Factors related to the clinical learning experience were the quality of the supervisory relationship, pedagogical atmosphere, and commitment of the ward related to the level of personalized nursing care delivered and clarity of nursing documentation.

The effects of mandatory preclinical education on exposure to injuries as reported by Italian nursing students: a 15‐year case–control, multicentre study

Of all the health workers, nurses show the highest risk of occupational exposure to percutaneous injuries, which constitutes the greatest risk of infection from blood-borne transmissible agents (e.g. hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV)) (Pr€ uss-Ust€ un et al. 2005). Nursing students are at greater risk of percutaneous injuries than staff nurses due to a lack of knowledge and clinical experience and as a result of the high levels of perceived stress during clinical training (Talas 2009). In addition, students believe that patients are not a source of infection (Yang et al. 2007). Educational programmes aimed to produce positive changes in knowledge of and attitudes towards safety are recommended; however, little evidence on education effects is available in the current literature (Yang et al. 2007, Petrucci et al. 2009).

Measuring patient safety knowledge and competences as perceived by nursing students: An Italian validation study.

The study sought to validate the Italian version of the Health Professional Education in Patient Safety Survey (H-PEPSS), an instrument used to assess the perceptions of health professionals regarding patient safety competence. The H-PEPSS was administered to a sample of 574 bachelor degree nursing students in two north-eastern Italian universities. Its factor structure, validity and reliability were examined using explorative factor analysis. The internal consistency of the Italian version of H-PEPSS (H-PEPSSIta) measured with Cronbachs alpha (α) was higher for both classroom (.938) and clinical training (.942) dimensions. The six factors that emerged from the analysis were composed of three to five items loading ≥.55 and explaining 69.344% of the classroom total variance and 70.425% of the clinical training total variance of the H-PEPSSIta. The H-PEPSSIta is a valid tool capable of evaluating the self-perception of nursing students regarding patient safety knowledge and competence. Therefore, the instrument could be adopted in educational settings as a periodic nursing student report. This may help students reflect on PS related-issues, and evaluate gaps in knowledge and competences; furthermore, data emerging from periodic self-reports may offer the opportunity to tailor educational strategies to fill the gaps in PS knowledge and competences that emerge.