INTRODUCTION:Career intentions of newly qualified nurses (NQN) during their transition period have not been explored in our setting. The study explored career intentions of NQN during their transition to clinical practice in Uganda. METHODS:We conducted a qualitative descriptive study. We conducted 14 in-depth interviews among NQN. We explored their career plans, intentions to stay or leave clinical nursing, and the reasons for wanting to stay or leave nursing. Thematic analysis was used to analyse the data. FINDINGS:Three themes were identified: 1) intentions to leave clinical practice, 2) brain drain intentions, and 3) factors shaping career intentions. NQN intended to leave clinical practice. Instead of clinical nursing roles, NQN wanted to work in academia, research, and non-governmental settings which did not directly involve patient care. Graduates intended to pursue master's programs that could take them out of clinical nursing roles. Some desired to work as nurse educators which motivated them to remain in nursing, while some intended to even pursue clinical nursing master's program so they can join academia. Limited employment opportunities were perceived as a major influence for young nurses' desires to leave clinical practice and for their brain drain intentions. The low recognition of the nursing degree program in private clinical settings was seen to foster intentions to leave clinical practice. While some expressed interest to leave clinical practice, some wanted to remain in nursing. This was related to intrinsic motivation for the profession and patient care, and the more employment opportunities available for nursing graduates. CONCLUSION:NQN intended to leave clinical practice and to work in outside countries mainly because of the limited employment opportunities in clinical settings. Addressing limited employment opportunities and the poor work conditions that may force young nursing graduates out of clinical practice is critical in reducing nursing attrition rates, and brain drain to outside countries.
BACKGROUND:Leadership is increasingly recognized as a core competency in nursing practice and education. However, leadership education is often introduced in the later stages of undergraduate nursing programs, leaving students uncertain about how leadership applies to clinical practice. Innovative pedagogical approaches are therefore needed to support early leadership development. Storytelling may provide opportunities for students to engage with authentic professional experiences, reflect on leadership behaviours, and connect leadership concepts with future nursing practice. OBJECTIVES:This study aimed to explore first-year nursing students' learning experiences following participation in a theory-informed storytelling-based leadership education session, with particular attention to how they understood nursing leadership and reflected on leadership in their future professional roles. METHOD:A qualitative descriptive design was used to evaluate a storytelling-based leadership learning activity implemented in an undergraduate nursing program. The intervention consisted of a two-hour face-to-face educational session in which two nurse academics shared their professional leadership experiences through structured storytelling and discussion. Storytelling was used as the pedagogical strategy, with experiential learning theory informing the reflective learning process and social learning theory informing the role-modelling component of the session. Data were collected from 58 first-year nursing students through a written questionnaire consisting of nine open-ended questions and analysed using thematic analysis. RESULTS:Four main themes emerged from the analysis: (1) reframing leadership perceptions through leadership stories, (2) leadership as a learnable and developable competency, (3) leadership readiness for future professional roles, (4) translating leadership learning into nursing practice. Students described leadership as extending beyond formal managerial roles and recognized its relevance to clinical practice, teamwork, and patient care. Students also identified leadership as a competency that can be developed through experience and professional learning. CONCLUSION:Storytelling-based educational interventions may support nursing students' understanding of leadership by connecting leadership concepts with authentic professional experiences. Such approaches may foster early leadership awareness and help students consider how leadership relates to their future professional nursing roles.
Professional regulation aims to assure the public that nurses are educated to minimum standards of competency and safety. Yet, assurance is not reducible to the existence of written standards alone. It also depends on the quality of the relationship between regulators and educators through which standards are developed and enacted. Imbalance in this relationship is evident within international debates around issues such as clinical practice hours, simulation pedagogy, board governance, graduate mobility, and the perceived extension of regulatory authority into curriculum design. This asymmetrical relationship may encourage defensive compliance, risk aversion and self-limiting behaviours among educators that potentially constrains pedagogical innovation and the development of person-centred and place-sensitive curricula that are responsive to local population need and uncertain future practice contexts. In this paper, we argue that the perceived inequality in the regulator-educator relationship is neither inherent nor inevitable. Drawing on Foucault's concept of governmentality, we suggest that through challenging perceptions of regulator dominance, educators have more influence on curriculum design than perceived. This point is developed using Lefebvre's rhythmanalysis to characterise the current regulator-educator relationship as arrhythmic, marked by often unspoken discomfort and disagreement. Recognising that conflict-free alignment between regulator and educator (eurythmia) is an unattainable and unwanted end, we argue instead for a polyrhythmic relationship sustained through what we call 'critical polyvocality'. Cultivating critical polyvocality requires opening positively disruptive dialogical spaces characterised by constructive tensions, mutual respect and shared responsibilities between people. Far from weakening public assurance, we conclude that this constructive disagreement and debate can enable co-production of future-focused, living statements of shared professional expectations that enhance public protection through genuine regulator-educator partnership.
BACKGROUND:Global nursing shortages require educational models that strengthen workforce capacity while advancing professional competence. Conventional postgraduate pathways often require extended leave from employment, which can intensify staffing pressures, increase financial burden for students, and perpetuate the theory-practice gap. Work-study programmes (WSPs) which integrate protected study time with ongoing clinical practice, offer a potential solution but remain under-defined in postgraduate nursing education, particularly in Asian health-system contexts. AIM:To explore multi-stakeholder perspectives on postgraduate WSPs and develop a framework for integrating learning, practice, and workforce sustainability. METHODS:A qualitative descriptive study was conducted using semi-structured focus groups and interviews with 20 stakeholders: five postgraduate WSP students, five clinical nurse facilitators, five academic faculty members, and five adjunct lecturers. Data were analysed inductively using thematic analysis and subsequently interpreted through Donabedian's Structure-Process-Outcome model and Kolb's Experiential Learning Theory, which were selected a priori as sensitising frameworks to support interpretation and framework development. RESULTS:Findings were organised across three domains. WSP structure included definitions of WSPs, distinctive programme features, stakeholder roles and collaboration, and policy and guideline development. Effective implementation processes comprised learning and teaching strategies, constructive assessment approaches, and implementation facilitators and barriers. Programme evaluation and outcomes included evaluation approaches and perceived impacts of successful WSP implementation. These elements were synthesised into a multi-stakeholder framework that explicates how WSPs integrate learning and practice while supporting workforce sustainability. CONCLUSION AND IMPLICATION:WSPs represent a promising education model for aligning postgraduate nursing education with workforce needs. The proposed multi-stakeholder postgraduate WSP framework advances conceptual understanding by linking structural enablers, educational processes, and multi-level outcomes to support learning-practice integration and workforce sustainability. The framework provides practical guidance for programme design, implementation, and evaluation.
BACKGROUND:Research competence is crucial for evidence-based practice; however, the complex interplay between research competence and its multidimensional correlates remains insufficiently understood among nursing undergraduates. AIM:To investigate the network structure of research competence and its associations with critical thinking, research attitude, self-directed learning, and information literacy among nursing undergraduates. METHODS:A cross-sectional study was conducted with 2537 nursing undergraduates using a cluster sampling from two medical universities in Southwest China. Research competence and its multidimensional correlates were measured. An EBICglasso network based on Spearman correlations identified central and bridge nodes, with accuracy and stability evaluated by bootstrapping. Networks stratified by research participation were examined using mixed graphical modeling and compared with the permutation-based Network Comparison Test. RESULTS:The estimated network contained 190 non-zero edges. Literature Retrieval Ability (Strength = 2.42) and Research Design Ability (Strength = 2.32) emerged as the most central nodes. Literature Retrieval Ability (Bridge Strength = 1.46) and Research Design Ability (Bridge Strength = 1.36) were identified as the strongest bridge nodes connecting information literacy and critical thinking to research competence. Research experience was associated with significant differences in network structure and global strength (diff = 3.75, p < 0.001). Students with research experience exhibited a denser and more cohesive network. CONCLUSION:Literature Retrieval Ability and Research Design Ability appeared to be the most structurally important dimensions in the research competence network of nursing undergraduates. These findings may help inform the design of undergraduate research training by highlighting competencies that appear to be structurally important within the network. In addition, research experience was associated with a more integrated and cohesive competence structure, suggesting that structured opportunities for undergraduate research engagement may warrant further attention in educational practice and future research.
INTRODUCTION:Competency-based assessment (CBA) is central to competency-based education (CBE) in nursing, yet the evidence about its effectiveness is fragmented across methods, settings, and outcomes. AIM:To synthesize the strengths and limitations of CBA approaches in nursing education and to map them onto established educational frameworks. METHODS:An umbrella review of reviews was conducted, including systematic, scoping, integrative, and theoretical reviews of CBA in pre-registration and early-career nursing. Searches of PubMed, CINAHL, Scopus, Web of Science, and ERIC (from inception to November 2025) were conducted in accordance with Joanna Briggs Institute and PRISMA guidance, with eligibility defined using the Population, Concept, and Context (PCC) framework, and data were integrated through narrative synthesis. RESULTS:Twenty reviews, encompassing more than 700 primary studies, identified six CBA domains: simulation-based and Objective Structured Clinical Examination (OSCE) assessments, workplace-based assessments (WBAs), technology-enhanced assessments, learning-based and reflective assessments, research competency assessments, and program-level CBE evaluations. Across domains, CBAs predominantly targeted higher-order cognitive and performance outcomes aligned with the upper levels of Bloom's taxonomy and Miller's pyramid. Simulations and OSCEs showed strong validity and acceptability but were resource-intensive and often anxiety-provoking. Workplace-based tools captured authentic performance but were constrained by assessor variability and limited psychometric properties. Technology-enhanced and reflective approaches fostered engagement and self-regulation yet frequently relied on heterogeneous, weakly validated measures. Evidence for research competencies and program-level CBE remained limited and methodologically modest. CONCLUSION:CBAs in nursing provide rich information on complex competencies but are unevenly developed. Integrated, theory-informed, and programmatic assessment systems are required to optimise their contribution to practice-ready graduates.
Aims The study aimed primarily to evaluate the effects and experiences of virtual reality (VR) simulations on culturally and linguistically diverse (CALD) nursing students' clinical reasoning, confidence, satisfaction, and stress-related neurophysiological reactions. The two VR scenarios were used to provide clinically relevant learning contexts for students at different stages of nursing education. Design Within-subjects mixed-methods design with multimodal data collection. Methods VR technology was developed using Unreal Engine 5 and MetaHuman and included post-surgical discharge and anaphylaxis cases. CALD first- and second-year nursing students (n = 29) in English-language degree programmes participated, and 16 were interviewed. Clinical reasoning was evaluated using the Nurses' Clinical Reasoning Scale. Self-confidence, satisfaction, and perceived simulation design were evaluated using the Student Satisfaction and Self-Confidence in Learning Scale and Simulation Design Scale. Stress-related neurophysiological responses were collected using heart rate (HR) and electrodermal activity (EDA). Quantitative data were analysed using within-subject statistical tests and descriptive analyses. Students' experiences were explored through interviews and inductive content analysis. Results Clinical reasoning improved significantly in the total sample after VR simulation. Students reported high self-confidence and satisfaction, and simulation design was evaluated positively across most domains. HR and EDA fluctuated across measurement points, but stress-related neurophysiological responses did not increase significantly in the total sample. Scenario-specific findings were reported descriptively as contextual information, not as evidence of differences in scenario effectiveness. Participants described how VR learning enhanced professional competence and preparation for practice, alongside both positive and challenging effects on confidence and motivation. Conclusion VR simulation appears to be a promising, safe, and student-centred educational method for supporting CALD nursing students' clinical reasoning, nursing skills, and communication skills. Findings highlight the importance of structured support, feedback, and guided reflection for learners developing clinical and language skills simultaneously.
Aim This systematic review aimed to evaluate the overall effectiveness of extended reality technologies as a unified educational approach in supporting the development of clinical competency in nursing education. Design A systematic review and meta-analysis. Methods This review focused exclusively on randomized controlled trials to ensure methodological consistency and a high level of evidence. Articles were retrieved from seven major databases: PubMed, Cochrane Library, OVID, Scopus, Web of Science, CINAHL, and ScienceDirect. Searches were conducted using keywords related to extended reality technologies and nursing education, and the review was reported in accordance with the PRISMA 2020 checklist. Results The systematic review included 22 studies; 12 were included in the meta-analysis. The meta-analysis showed that extended reality technologies significantly improved exam performance and learning satisfaction compared with traditional educational methods. However, no significant effects were observed for communication skills, knowledge acquisition, self-confidence, simulation performance, or stress. High heterogeneity was identified for several outcomes, reflecting variability in intervention designs and participant characteristics. Conclusion The findings suggest that extended reality technologies may support selected aspects of nursing education, particularly exam performance and learning satisfaction. However, the evidence does not consistently demonstrate significant effects across all domains of clinical competency, including communication skills, knowledge acquisition, self-confidence, simulation performance, and stress. Future studies using standardized protocols, validated measurement tools, and competency-driven outcome measures are needed to fully integrate extended reality technologies into evidence-based nursing education and practice.
Background Artificial intelligence (AI) is rapidly entering academic nursing education, yet its integration remains uneven and often lacks pedagogical guidance. Understanding how nursing educators perceive AI's role is critical to ensuring its appropriate and effective use. Aim This rapid review aimed to synthesize current evidence on nursing educators' perceptions of AI in academic nursing education, with a focus on identifying which educational tasks can be enhanced, replaced, or are not amenable to AI. Methods A rapid review was conducted using a multimethod search strategy that combined AI-assisted semantic searching, structured database searches, targeted journal and reference list searching, and manual verification. Eligible studies reporting nursing educators' perspectives on AI in academic settings were synthesized using descriptive and directed content analyses informed by predefined domains, while remaining open to emergent themes. Results A total of 55 studies were included in this review. Educators consistently view AI as augmenting rather than replacing faculty roles. AI is perceived as most effective in simulation-based learning and personalized tutoring, followed by feedback and assessment, curriculum design and administrative work, and academic writing and research support. Bounded tasks, including administrative drafting, grading and the summarizing of narrative data, may be partially substituted, though faculty oversight remains necessary. In contrast, relational, ethical and judgment-based domains, including empathy, moral reasoning, complex clinical judgment, hands-on clinical practice and faculty mentorship, are not considered substitutable. Workload effects are directionally mixed: AI reduces time spent on bounded tasks, but verifying its outputs generates new demands. Perceptions vary with prior exposure, which correlated with trust in AI, and with age, gender, academic rank and nationality. Key barriers include limited training, ethical concerns and infrastructure gaps. Conclusion AI's educational impact depends less on technological capability than on pedagogical design, faculty preparedness, and governance. Evidence from resource-constrained settings indicates that these preconditions are themselves unevenly distributed, highlighting the need for structured implementation strategies that address infrastructure and verification burden alongside pedagogy.
Background Ethical awareness among nursing students is associated with attitudes toward medical errors in clinical practice. With the rapid advancement of artificial intelligence (AI) technologies, there is a growing need to develop and evaluate innovative research ethics education programs that integrate advanced technologies to foster appropriate ethical awareness. Aim This study aimed to examine the effects of AI-based research ethics education on nursing students' academic ethics awareness, attitudes toward plagiarism, and knowledge of research ethics. Design A quasi-experimental study using a non-equivalent control group pretest–posttest design was conducted. Participants A total of 77 participants were recruited and assigned to either the experimental group (n = 41) or the control group (n = 36). Methods The experimental group participated in an AI-based intervention program for 2 h per week over 5 weeks. Participants in the experimental group were divided into five teams, with 7–9 students per team. The control group received conventional nursing research classes. Both groups completed questionnaires measuring academic ethics awareness, attitudes toward plagiarism, and knowledge of research ethics before and after the intervention. Results The intervention did not produce a statistically significant between-group difference in academic ethics awareness (AEA) (t = −0.711, p = .479). Regarding attitudes toward plagiarism, significant between-group differences were found in negative attitudes (t = 2.897, p = .005) and subjective norms (t = −2.991, p = .004). In addition, knowledge of research ethics showed a significant between-group difference (t = 3.927, p < .001). Conclusion The findings demonstrate that AI-based research ethics education is an effective educational approach for improving nursing students' attitudes toward plagiarism and knowledge of research ethics. These results highlight the potential of AI-based education as an innovative ethics education strategy and provide empirical evidence to support the selection of teaching methods aimed at strengthening ethical competencies in nursing education.
AIMS:To synthesize instrument-specific levels of psychological capital (PsyCap) among undergraduate nursing students and examine its correlates and preliminary evidence concerning potential mediating pathways. DESIGN:A systematic review and meta-analysis. DATA SOURCES:CINAHL, Embase, MEDLINE, PubMed, ScienceDirect, Web of Science, CNKI, and WanFang Data were searched for studies published from January 2000 to June 2026. METHODS:Random-effects meta-analyses were used to estimate instrument-specific pooled PsyCap scores and correlation coefficients. Subgroup analyses and exploratory univariable meta-regression were conducted to examine between-study heterogeneity. An exploratory two-stage meta-analytic structural equation modeling (MASEM) analysis was conducted when sufficiently comparable correlation data were available. RESULTS:Thirty-four studies involving 15,705 nursing students were included. The pooled item-level mean was 4.235 for the Psychological Capital Questionnaire (PCQ; k = 13; 95% CI: 4.080-4.390; I2 = 98.80%) and 4.459 for the Positive Psychological Capital Questionnaire (PPQ; k = 13; 95% CI: 4.252-4.667; I2 = 99.42%). PsyCap was positively associated with professional identity, academic engagement, and self-directed learning, and negatively associated with stress-related and maladaptive outcomes. Exploratory meta-regression identified study-level female composition as a potential source of heterogeneity, although substantial residual heterogeneity remained. MASEM based on two cross-sectional studies suggested an indirect association between perceived stress and self-directed learning through PsyCap; temporal ordering and causal mediation cannot be established. CONCLUSIONS:PsyCap was consistently associated with psychological and academic outcomes among undergraduate nursing students, although pooled levels varied substantially across studies and measurement instruments. Evidence concerning potential mediating pathways remains preliminary. Greater measurement consistency and longitudinal or intervention research are needed to clarify the role of PsyCap in nursing education.
BACKGROUND:Palliative care and end-of-life care training are increasingly recognized as essential components of nursing education worldwide. Comprehensive training in general palliative care can prepare nurses for handling complex challenges. Simulation-based training offers an innovative approach to prepare nurses and nursing students for the demands of palliative and end-of-life care. OBJECTIVES:To examine the effect of simulation-based training in improving nursing students' and nurses' knowledge, attitudes, skills, and confidence in palliative care compared to conventional education or no intervention. DATA SOURCES:Five databases, including PubMed, MEDLINE, EMBASE, CINAHL PLUS, and Cochrane CENTRAL, were searched from inception to May 8, 2025. METHODS:Randomized controlled trials and quasi-experimental studies involving nurses and nursing students were included. The outcomes assessed were knowledge, attitudes, skills, and confidence related to palliative care. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tools. A narrative synthesis was conducted, and meta-analysis was performed by using a random-effects model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using I2 statistics and Cochran's Q test. RESULT:Eleven studies (3 randomized controlled trials and 8 quasi-experimental studies) involving 909 participants (588 nurses [64.7%] and 321 nursing students [35.3%]) were included, with 9 studies contributing to the meta-analysis. Simulation-based training showed statistically significant improvements in knowledge (SMD = 1.49; 95% CI: 1.12 to 1.86, Z = 7.91, p < 0.00001) and skill performance (SMD = 1.29; 95% CI: 0.79 to 1.78, Z = 5.08, p < 0.00001) for both nurses and nursing students. Subgroup analysis revealed that nursing students experienced significant gains in confidence (SMD = 1.39; 95% CI: 0.51 to 2.28, Z = 3.10, p = 0.002) compared to non-simulation settings. However, the effect of simulation-based training on improving nurses' and nursing students' attitudes remains inconclusive. CONCLUSION AND IMPLICATIONS:Simulation-based training significantly enhances nursing students' confidence, as well as nurses' and nursing students' knowledge and skill performance in palliative and end-of-life care. However, its effect on attitudes remains uncertain, and high-quality randomized controlled trials are needed. Future research should focus on robust trials to assess the long-term effects, address cultural and psychological factors, accommodate the diverse needs of nurses and students, and incorporate patient outcome assessments.
