AIM:To systematically identify instruments assessing clinical nurse preceptor competence, evaluate their methodological quality and measurement properties and provide recommendations for instrument selection in clinical and research practice. BACKGROUND:Clinical nurse preceptors are experienced nurses who guide and support nursing students and nurses undertaking clinical training at different career stages. They play a vital role in clinical education and professional development. Numerous instruments have been developed to assess clinical nurse preceptor competence; however, a comprehensive systematic evaluation based on the COSMIN guideline is still lacking. DESIGN:A systematic review was conducted in accordance with the COSMIN guideline. METHODS:Six English databases and two Chinese databases were searched to identify studies involving instruments used to assess clinical nurse preceptor competence. Two reviewers independently conducted study selection, data extraction and literature appraisal. Methodological quality was evaluated using the COSMIN Risk of Bias checklist and measurement properties were synthesized according to COSMIN criteria. RESULTS:18 studies involving 16 instruments were included. Three instruments received Category C, while the others were classified as Category B. CONCLUSIONS:Among Category B instruments, the revised Nursing Student Mentors' Competence Instrument (MCI), the core competence tool for clinical nursing teachers and the Core Competence Scale for Nursing Preceptors of Undergraduate Students showed high-quality evidence for sufficient structural validity and internal consistency and were provisionally recommended for use. Future studies should further refine and evaluate these instruments, emphasizing cross-cultural validity, measurement error and responsiveness in line with COSMIN guidelines.
AIM:To examine the current evidence regarding the combined use of virtual simulation and standardized patients in nursing education and to identify implementation patterns, educational outcomes and research gaps. BACKGROUND:Virtual simulation and standardized patients are widely used in simulation-based nursing education, yet each approach has limitations when used alone. Their combined use may integrate the advantages of repeatable digital practice and authentic interpersonal interaction. DESIGN:Scoping review. METHODS:The review followed the Arksey and O'Malley framework and Joanna Briggs Institute guidance. PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, CNKI, Wanfang and CBM were searched from inception to 6 May 2026. Two reviewers independently screened studies and charted data. Findings were synthesised descriptively. RESULTS:Eight studies published between 2017 and 2025 were included. The studies focused mainly on paediatric nursing, health assessment, end-of-life communication, basic nursing skills and telehealth. Three integration patterns were identified: virtual pre-training followed by standardized-patient scenarios; high-fidelity or electronic simulation combined with standardized patients and immersive virtual reality followed by face-to-face standardized-patient simulation. At the study level, positive changes were reported for knowledge and/or skills in several studies, although the magnitude and statistical significance varied by study design and outcome measure. For example, Yang et al. (2025) reported improvements in selected learning outcomes, whereas the between-group difference in theory scores was not statistically significant. These findings should therefore be interpreted in relation to the methodological heterogeneity of the included studies. CONCLUSIONS:Combining virtual simulation with standardized patients shows promise for strengthening clinical competence in nursing education. Future research should prioritise standardised intervention frameworks, core outcome sets, multicentre trials, longitudinal follow-up and economic evaluation.
AIM:To compare the effectiveness of scenario-based simulation versus case-based teaching in improving geriatric nurses' multiple competencies for Advance Care Planning (ACP). BACKGROUND:Geriatric nurses are pivotal in ACP but often lack adequate preparedness, necessitating training that addresses both knowledge and behavioral-attitudinal components. Simulation-based education offers a safe environment to develop such complex clinical skills. DESIGN:A quasi-experimental, non-equivalent control group pretest-posttest design. METHOD:Within a provincial geriatric nursing training program in China, 196 nurses were allocated by cohort: 80 to simulation teaching and 116 to case-based teaching. Outcomes were measured at baseline and post-intervention using validated instruments assessing ACP knowledge, communication skills, self-efficacy and practice preference. Analysis included 183 participants after attrition. RESULTS:Groups were comparable at baseline. Both groups improved in ACP knowledge, with no significant between-group differences. However, the simulation group showed significantly greater gains in communication skills, self-efficacy and practice preference (all p < 0.05). Participants also rated the simulation experience highly (Simulation Effectiveness Tool Modified scores: 45.98/57). CONCLUSION:Scenario-based simulation teaching is more effective than case-based teaching in enhancing communication skills, self-efficacy and practice preference for ACP in geriatric nursing, while being equally effective in improving ACP knowledge. Integrating simulation into ACP education is recommended. Future research should employ randomized designs and assess long-term outcomes.
AIM:To identify predictors of critical thinking among Chinese undergraduate midwifery students and examine the extent to which the clinical learning environment mediates the association between preceptorship and students' critical thinking. BACKGROUND:Critical thinking is a core competency for safe, woman-centred midwifery practice and a key global educational goal. However, little is known about links between preceptorship, the clinical learning environment and critical thinking especially in non-Western contexts. DESIGN:This multi-centre cross-sectional study recruited 654 undergraduate midwifery students from 10 universities in mainland China. METHODS:The online self-report survey included translated versions of the Midwifery Student Evaluation of Practice (MidSTEP) and student version of the Carter Assessment of Critical Thinking in Midwifery (CACTiM). Statistical analyses included bivariate tests, stepwise linear regression and mediation analysis using SPSS PROCESS (Model 4). RESULTS:Five significant predictors of critical thinking were identified: passion for the midwifery profession, opting for a midwifery major, facilitating > 5 births, smaller clinical group size and no exposure to disrespectful maternity care. Critical thinking was positively correlated with both the clinical learning environment and preceptorship, with the clinical learning environment fully mediating the association between preceptorship and critical thinking. CONCLUSIONS:Our findings extend an existing conceptual model of midwifery critical thinking by establishing the effect of the clinical learning environment. This finding supports the development of quantifiable clinical placement benchmarks and provides an evidence base for targeted educational reform in undergraduate midwifery programs to foster critical thinking competencies for safe, woman-centred maternity care.
AIM:To develop the Professional Competency Scale (PCS) with validation evidence to assess professional competency in newly graduated nurses. BACKGROUND:Newly graduated nurses' competency affects retention. However, there is a dearth of reliable and valid measures assessing professional competency. DESIGN:A methodological study to develop and validate a scale. METHODS:The PCS was developed following the nine procedural steps proposed by DeVellis and Thorpe. A total of 650 newly graduated nurses were recruited from hospitals of different levels across Taiwan. Structural validity was tested using exploratory and confirmatory factor analysis and criterion-related validity was also evaluated. Internal consistency reliability was assessed with Cronbach's α and McDonald's ω. RESULTS:An initial 51-item questionnaire was developed. Exploratory factor analysis indicated the removal of 11 items, leaving 40 items across three factors of professional competency for newly graduated nurses: clinical care, soft skills and education and management (44% of variance explained). Confirmatory factor analysis results supported the three-factor structure with 40 items. Criterion-related validity was supported by positive relationships with work adaptation (r = 0.59-0.76; p < .001). The PCS demonstrated high internal consistency (α = 0.96; ω = 0.96). CONCLUSION:A 40-item PCS for newly graduated nurses in Taiwan was developed and demonstrated good psychometric characteristics.
AIM:To systematically synthesize evidence on AI literacy educational interventions among nursing students. BACKGROUND:Artificial Intelligence (AI) literacy is increasingly recognized as an important educational priority for nursing students. However, evidence regarding educational interventions designed to enhance AI literacy remains limited and fragmented. DESIGN:A systematic review. METHODS:Seven databases were searched from inception to March 24, 2026. Studies were included if they: (1) enrolled nursing students as participants; (2) evaluated AI literacy educational interventions; (3) measured AI literacy as an outcome; and (4) employed quasi-experimental or randomized controlled trial designs. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies and findings were synthesized narratively. RESULTS:Three quasi-experimental studies involving 443 nursing students were included. Two studies included comparison groups, whereas one used a single-group pre-test/post-test design. All three studies reported statistically significant improvements in AI literacy following the interventions. One study reported significant improvements in higher-order thinking skills, another reported a significant reduction in AI anxiety and the third demonstrated enhanced performance in academic writing. Methodological quality was rated as high in two studies and moderate in one study. Heterogeneity in study designs and measurement instruments precluded meta-analysis. CONCLUSIONS:Preliminary evidence suggests that AI literacy educational interventions may improve nursing students' AI literacy. However, the current evidence base remains limited, with only three quasi-experimental studies identified and no randomized controlled trials available. Future research should prioritize well-designed randomized controlled trials, the development of nursing-specific AI literacy assessment instruments and investigations of long-term outcomes to inform educational practices.
AIM:To evaluate the psychometric properties and responsiveness of the Resuscitation Self-Efficacy Scale (RSES) among ward nurses before and after simulation-based advanced life support (ALS) training. BACKGROUND:Although the RSES was developed to measure nurses' perceived capability in resuscitation, evidence regarding its psychometric evaluation among ward nurses participating in ALS training remains limited. DESIGN:Secondary psychometric analysis of data obtained from a simulation-based ALS training study. METHODS:Ward nurses (N = 191) from general hospitals completed the RSES before and immediately after participation in a simulation-based ALS training program. Psychometric evaluation included item analysis, internal consistency reliability, evidence based on internal structure, construct validity through convergent and discriminant validity, relations with an external performance measure and responsiveness. RESULTS:The RSES demonstrated good internal consistency, with a Cronbach's α of.80 for the total scale and.88-.91 across the four factors. Factor analysis supported the original four-factor structure, with satisfactory model fit (CFI =.958, TLI =.949, RMSEA =.052 and SRMR =.072). Evidence of convergent and discriminant validity met recommended criteria. Individual resuscitation self-efficacy showed modest positive associations with team-level ALS performance and the RSES demonstrated moderate responsiveness to change (standardized response mean =.77). CONCLUSIONS:The findings provide psychometric evidence supporting the use of the RSES for assessing resuscitation self-efficacy among ward nurses participating in simulation-based ALS training. The RSES may be useful for evaluating educational outcomes and monitoring changes in learners' self-efficacy following educational interventions.
Aim To examine the effects of Extended Reality (XR) case-based learning in interprofessional education on pre-licensure health profession students’ learning outcomes and explore students’ experiences with the technology. Background Interprofessional education is essential for preparing a collaborative practice-ready health workforce. Although virtual simulation is increasingly used to support interprofessional learning, most evidence relates to screen-based environments with limited immersion. XR technologies, including virtual reality, augmented reality and mixed reality, offer immersive learning environments that may enhance interprofessional collaboration. Design Mixed methods systematic review following PRISMA 2020 guidelines. Methods MEDLINE (PubMed), Scopus, CINAHL, Web of Science and ProQuest were searched for studies published between 2015 and 2025. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Quantitative data were analysed using effect size calculations where possible and narrative synthesis. Qualitative data were analysed using content analysis. Quantitative and qualitative evidence were integrated using a convergent segregated approach. Results Nine studies were included. Most studies used virtual reality in single- or multi-user emergency care scenarios. Quantitative findings demonstrated statistically significant improvements in teamwork, interprofessional communication and performance indicators. Qualitative analysis identified perceived learning benefits, realism and immersion, cognitive and affective responses, pedagogical reflections and the central role of debriefing. Conclusions XR shows promise for enhancing teamwork and communication in interprofessional education. However, the evidence base remains limited by methodological heterogeneity and a focus on feasibility rather than educational effectiveness. Future research should adopt rigorous, theory-driven designs with standardised interprofessional outcome measures and examine the pedagogical role of emerging technologies. Registration PROSPERO CRD420261324031. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420261324031.
AIM:To develop and validate the Learning Flow Scale for Thai nursing students. BACKGROUND:Learning flow is a key psychological state that promotes deep engagement, skill development and optimal learning outcomes in nursing education. However, standardized instruments specifically designed to assess learning flow among Thai nursing students remain limited. DESIGN:A descriptive cross-sectional design was employed. METHODS:A total of 471 undergraduate nursing students across multiple public nursing colleges in Thailand participated in the scale development and validation process. Scale items were generated using both inductive and deductive approaches based on literature review, qualitative insights and theoretical frameworks of flow in learning contexts. The underlying factor structure was explored using exploratory factor analysis (EFA) and subsequently confirmed through confirmatory factor analysis (CFA). RESULTS:A 23-item Learning Flow Scale with a four-factor structure was identified. The four dimensions were labeled 'Goal-Activity Alignment', 'Real-Time Reflective Clarity', 'Autonomous Learning Experience' and 'Deep Concentration and Immersion'. The overall scale demonstrated excellent internal consistency (Cronbach's α = 0.958), with subscale reliability coefficients ranging from 0.802 to 0.926. Model fit indices from CFA supported the adequacy of the proposed measurement model. CONCLUSION:The Learning Flow Scale for Thai nursing students demonstrates strong psychometric properties and provides a valid and reliable tool for assessing learning flow in nursing education. The scale may support educators in identifying students' engagement patterns and designing pedagogical strategies that enhance meaningful and effective learning experiences.
AIM:This study developed the Nursing Student Resilience Scale-Social and Emotional Learning (NSRS-SEL) and evaluated its psychometric properties. BACKGROUND:Existing resilience instruments primarily assess general psychological resilience and may not fully capture the social and emotional competencies relevant to nursing students' adaptation in academic and clinical contexts. DESIGN:A mixed-methods design. METHODS:Phase 1 involved a literature review and qualitative interviews with 20 nursing students to inform item development. Phase 2 examined the psychometric properties of the NSRS-SEL among 350 nursing students in southern Taiwan. Independent subsamples were used for exploratory factor analysis (EFA; n = 150) and confirmatory factor analysis (CFA; n = 159). Content validity, reliability and construct validity were assessed. A total of 41 participants were excluded due to incomplete or invalid responses during data screening. RESULTS:Content validity indices ranged from 0.89 to 1.00 at the item level, with a scale-level content validity index (S-CVI/Ave) of 0.92. EFA yielded a 22-item, three-factor structure: Inner Strength and Life Meaning, Active Coping and Problem Solving and Adaptive Beliefs and Social Support. CFA supported the three-factor model (χ²/df = 2.06, GFI = 0.80, CFI = 0.90, RMSEA = 0.08). Cronbach's α ranged from 0.85 to 0.89, composite reliability from 0.82 to 0.89 and average variance extracted from 0.43 to 0.55. CONCLUSION:The NSRS-SEL demonstrates preliminary evidence of an acceptable factor structure, reliability and validity. Further studies are needed to confirm its psychometric properties and to examine its applicability across different educational and cultural contexts.
AIM:To present the Human-AI Partnership Model, a conceptual framework for integrating artificial intelligence into faculty mentorship to enhance reflective learning, feedback continuity and institutional insight in nursing and health professions education. BACKGROUND:Faculty mentorship is central to academic development but remains fragmented, informal and difficult to scale. Inconsistent access, variable feedback quality and limited evaluability constrain its effectiveness, particularly in complex academic and clinical roles. DESIGN:Conceptual discussion paper. METHODS:The HAPM was developed through integration of Systems Theory, Cognitive Apprenticeship and Adult Learning Theory. The model conceptualizes mentorship as a multi-level system linking individual reflection, relational mentoring processes and organizational learning and is operationalized through a structured AI-supported workflow. RESULTS:The HAPM outlines a cyclical process incorporating reflective inputs, AI-assisted synthesis, mentor interpretation and longitudinal feedback. The model demonstrates how AI can support reflective depth, improve feedback consistency, reduce administrative burden and generate aggregated insights to inform faculty development. Ethical governance, human oversight and equity considerations are embedded throughout the framework.
AIM:To map and synthesize the existing evidence on technology acceptance and emotional experience associated with the use of immersive virtual reality (VR) in nursing training, including theoretical models, assessment methods, reported outcomes and the interplay between both constructs. BACKGROUND:Immersive VR has emerged as an innovative educational tool in healthcare, enabling experiential learning in safe environments. While previous research has reported positive usability, perceived usefulness and satisfaction, less attention has been given to the interplay between technology acceptance and emotional experience, particularly among nurses. DESIGN:A scoping review. METHODS:A systematic search was conducted across PubMed, CINAHL, PsycINFO, ERIC and Web of Science for studies published between 2016 and 2026. Studies were included if they examined immersive VR in nursing training and reported outcomes related to technology acceptance and/or emotional experience. Data were extracted and synthesized using a descriptive analytical approach. RESULTS:43 studies were included. Technology acceptance was generally positive, with perceived usefulness, perceived ease of use and intention to use emerging as the most frequently reported constructs. However, theoretical acceptance models were used infrequently and inconsistently across studies. Emotional experience was characterized by high satisfaction, engagement and presence, alongside anxiety and cybersickness. Only 7 studies provided evidence on the relationship between emotional experience and technology acceptance, with findings suggesting a broadly positive but predominantly indirect association. CONCLUSIONS:Technology acceptance in immersive VR nursing training cannot be fully explained by cognitive models alone. More integrative approaches incorporating emotional and contextual dimensions are needed.
AIM:To investigate the effectiveness of integrating evidence-based teaching (EBT) with the Conceive-Design-Implement-Operate (CDIO) model in urology nursing clinical practice. BACKGROUND:Technological advances in urology have raised higher requirements for nursing interns regarding clinical proficiency and critical thinking. Traditional pedagogical approaches are inadequate for contemporary nursing training. EBT fosters learners' competence in evidence-based practice (EBP), whereas the CDIO framework integrates theoretical knowledge with clinical practice. Nevertheless, relevant empirical research on its combined application remains insufficient. DESIGN:Historical controlled study. METHODS:The control group (n = 184) received traditional teaching between September 2024 and March 2025, whereas the observation group (n = 152) adopted the EBT-CDIO model from September 2025 to March 2026. Assessments included theoretical and practical skill scores, along with comprehensive capabilities in EBP, self-directed learning and critical thinking. RESULTS:The observation group achieved significantly higher scores than the control group (P < 0.001) in theoretical evaluation, operational performance, EBP, self-directed learning and critical thinking. CONCLUSIONS:Integrated EBT-CDIO teaching was associated with higher theoretical and operational scores among nursing interns and correlated with better development of core competencies including evidence-based practice, self-directed learning and critical thinking.
