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Objectives: To examine and consolidate literature regarding the advantages and disadvantages of utilizing ChatGPT in healthcare education and research., Design/methods: We searched seven electronic databases (PubMed/Medline, CINAHL, Embase, PsycINFO, Scopus, ProQuest Dissertations and Theses Global, and Web of Science) from November 2022 until September 2023. This scoping review adhered to Arksey and O'Malley's framework and followed reporting guidelines outlined in the PRISMA-ScR checklist. For analysis, we employed Thomas and Harden's thematic synthesis framework., Results: A total of 100 studies were included. An overarching theme, "Forging the Future: Bridging Theory and Integration of ChatGPT" emerged, accompanied by two main themes (1) Enhancing Healthcare Education, Research, and Writing with ChatGPT, (2) Controversies and Concerns about ChatGPT in Healthcare Education Research and Writing, and seven subthemes., Conclusions: Our review underscores the importance of acknowledging legitimate concerns related to the potential misuse of ChatGPT such as 'ChatGPT hallucinations', its limited understanding of specialized healthcare knowledge, its impact on teaching methods and assessments, confidentiality and security risks, and the controversial practice of crediting it as a co-author on scientific papers, among other considerations. Furthermore, our review also recognizes the urgency of establishing timely guidelines and regulations, along with the active engagement of relevant stakeholders, to ensure the responsible and safe implementation of ChatGPT's capabilities. We advocate for the use of cross-verification techniques to enhance the precision and reliability of generated content, the adaptation of higher education curricula to incorporate ChatGPT's potential, educators' need to familiarize themselves with the technology to improve their literacy and teaching approaches, and the development of innovative methods to detect ChatGPT usage. Furthermore, data protection measures should be prioritized when employing ChatGPT, and transparent reporting becomes crucial when integrating ChatGPT into academic writing., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the author(s)., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Social media usage has been ubiquitous and extensively integrated into the daily lives of student nurses. However, there exists a paucity of understanding regarding the influence of social media on student nurses' personal and professional development., Objective: To examine the influence of social media on student nurses' personal and professional values., Design: A systematic mixed-studies review., Methods: English language published studies were sourced from hand searches and seven electronic databases (PubMed, CINAHL, Embase, PsycINFO, ProQuest Dissertation and Theses Global, Scopus, and Web of Science) from the inception of each database to January 2023., Results: Twenty-six studies were included. Two main themes and eight subthemes were derived through thematic synthesis. The first main theme, Shaping Student Nurses into Nurses, included four subthemes: 1.1) Personal Development, 1.2) Professional Development, 1.3) Advocacy, and 1.4) Networking. The second main theme, Repercussions of Social Media Usage, included four subthemes: 2.1) Frustrations, 2.2) Discriminative Feelings, 2.3) Compulsive feelings, and 2.4) Consequences of Inappropriate Usage., Conclusion: The ubiquitous utilization of social media among the current generation of student nurses, for personal, educational, and professional purposes, has precipitated transformative effects conducive to their holistic development. Notwithstanding the potential perils associated with privacy violation and inappropriate usage, educational institutions can develop pedagogical strategies and guidelines in collaboration with healthcare institutions and professionals, aimed at the incorporation of social media within the educational curricula and the prospective workplace environments of student nurses., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: The review aims to synthesize and consolidate the factors and situations in which student nurses experience moral distress during their clinical practice and its potential implications for patient care and outcomes., Design: A qualitative systematic review., Data Sources: The articles were sourced from PubMed, Embase, CINAHL, Scopus, PsycInfo, Web of Science, ERIC (ProQuest), and ProQuest Dissertations and Theses Global Database between their inception dates to December 2022. Reference lists of included studies were also screened for additional studies., Review Methods: Published and unpublished primary studies of any qualitative research methods focused on student nurses' experiences of moral distress regardless of their education level were included in this review. Two reviewers independently screened titles and abstracts, assessed full-text articles for eligibility, extracted data, and appraised the quality of included studies. Sandelowski and Barroso's (2007) two-step meta-synthesis approach and Braun and Clarke's (2006) thematic analysis framework were used to analyze and interpret findings from included studies., Results: Seven studies met the inclusion criteria and were included in the review. The meta-synthesis revealed an overarching theme, "Moral Distress and its Intertwined Roots". This was supported by the four main themes: 1) Inadequacy and lack of autonomy, 2) Unprofessionalism of healthcare professionals, 3) Differing cultural views and values of patients and their relatives, and 4) Healthcare needs versus resource constraints., Conclusion: This review highlights the experiences of student nurses in situations of moral distress, including feelings of inadequacy and powerlessness when faced with ethical challenges, and the negative impact of resource constraints, unprofessional behavior, and cultural differences. Collaborative efforts between healthcare professionals and student nurses are needed to promote shared decision-making, prioritize ethical training, and provide culturally sensitive care to address these challenges and ultimately improve patient care., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the author(s)., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The transition experience of newly graduated registered nurses is highly stressful and associated with high attrition rates., Objectives and Design: This qualitative systematic review aims to consolidate the available evidence on the experiences of newly graduated registered nurses' role transition from nursing students to registered nurses., Data Sources: English language research published between 2010 and 2022 was searched using PubMed, CINAHL, Scopus, Embase, PsycInfo and ProQuest Dissertations and Thesis databases., Review Methods: Data were extracted using a data extraction form and appraised using the Critical Appraisal Skills Programme (CASP) tool for published studies or the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for unpublished studies or grey literature, respectively., Results: The review included 25 studies and the meta-synthesis identified four themes: (a) Knowledge deficit, (b) Overwhelming clinical practise, (c) Importance of workplace support, and (d) Meaning of "being a nurse"., Conclusions: Newly graduated registered nurses experienced facing knowledge deficits in the clinical setting and felt overwhelmed with work, especially for newly graduated registered nurses during the Covid-19 pandemic. Support from colleagues was invaluable, and they wished for better support through standardised transition programs. Despite nursing being mentally and physically exhausting, many newly graduated registered nurses regarded their profession satisfying and meaningful, however some eventually resigned. Understanding the transition experiences of newly graduated registered nurses can provide valuable insights on how to facilitate their transition and in turn decrease attrition rates, and ensure safe care for the patients and that public healthcare needs are met., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: The use of Standardized Patients (SPs) as a supplement to traditional clinical experience is of interest in the advanced practice nursing curriculum. Yet, evidence exploring this area is limited. This systematic review aims to consolidate and synthesize findings on the available evidence of using standardized patients (SPs) on advanced practice nurse (APN) students' learning and assessment experiences., Design: Mixed-studies systematic review., Data Sources: PubMed, EMBASE, Cochrane Library, CINAHL, Scopus, PsycINFO, and ProQuest Dissertations and Theses from the inception of each database to May 2022., Review Methods: Quantitative, qualitative, and mixed-method studies involving the use of SPs for education and assessments among APN students were included in this review., Results: Twenty studies were included. Three themes were identified through thematic synthesis: (1) Benefits associated with standardized patients, (2) Uniqueness of standardized patient experience, and (3) Preference and way forward. Overall, these students benefited from refining knowledge, clinical skills, and communication skills, and perceived a boost in confidence in their nursing competencies through SP simulations. More studies with rigorous methodology are needed to ascertain the causal relationships between SP simulations and APN students. Future studies should evaluate the cost-effectiveness of SP, especially in low-income countries. Inter-professional SP simulations and hybrid simulations should be explored further. Considerations for improvements include allocating more sessions for multisource feedback, offering dyadic or group support, and providing assessments that are more formative during simulations., Conclusions: SP simulation can complement traditional clinical experience in providing APN students with the knowledge, clinical skills, and communication skills in the real-world context., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Entrustable professional activity (EPA) framework has gained popularity within competency-based healthcare education programmes across disciplines, professions, and countries. As opposed to traditional time-based approach, EPAs bridge the gaps between competency framework and clinical practice, however, limited information on nursing EPAs highlights a need to develop EPAs specific to graduate nursing education to promote patient safety and quality patient care., Objectives: This paper described comprehensively the four-stage approach used to develop and pilot test a set of core EPAs for advanced practice nurse (APN) education., Method: The four-stage approach used to develop and pilot the EPAs included: 1) team formation, 2) development of conceptual framework, 3) identifying and reviewing core EPAs, and 4) pilot testing the EPAs. Post pilot test and surveys were conducted for the EPA developers, APN preceptors and interns to explore their perceptions and experiences using the EPAs., Results: A framework of nine core EPAs was developed for APN education, including: 1) perform an initial assessment and formulate management plans, 2) manage follow-up care for a clinical encounter, 3) plan, perform and evaluate care procedures, 4) recognise and manage patients requiring urgent care, 5) manage care transitions within and between health care organisations, 6) recognise and manage pharmacological needs of patients, 7) collaborate with patients, families, and community to improve health through disease prevention and health promotion, 8) participate in health quality improvement initiative, and 9) develop self and others for professional practice., Conclusion: Despite the stakeholders having generally positive attitudes towards the use of EPAs, it has its drawbacks. More research is needed to examine the psychometric properties of the EPA assessment tools and evaluate the effectiveness of EPAs in graduate nursing education. Additionally, the described set of core APN EPAs needs more refinement and rigorous testing before it can be implemented on a larger scale., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Peer feedback is an effective learning tool for students, improving academic performance and learning satisfaction. In nursing education, it has been widely used in the assimilation of clinical skills. However, the effectiveness of peer feedback as an educational intervention needs to be evaluated holistically beyond intervention research, considering students' perception to garner valuable insights to guide the successful implementation of peer feedback., Objective: This review aimed to consolidate the qualitative evidence exploring perceptions and experiences of nursing students who have used peer feedback as a learning tool., Design: Qualitative systematic review., Data Sources: Nine databases were searched from their respective inception dates until December 2021., Review Methods: Data were extracted using a modified Joanna Brigg's qualitative data extraction tool, and the Critical Appraisal Skills Programme (CASP) tool was used to appraise the quality of included studies. Meta-synthesis was done using Sandelowski and Barroso's two-step approach., Results: The review included 14 studies and the synthesis identified an overarching theme: 'feeling lost to finding ways' and four themes: (1) An uncomfortable learning experience; (2) confronting disagreements; (3) greater engagement with learning; and (4) value added beyond learning., Conclusion: The present review summed up the wide range of nursing students' experiences, from feeling inadequate and having little confidence in the usefulness of peer feedback to reaping valuable benefits in terms of teamwork and leadership skills. The nursing curriculum could include peer feedback; however peer students adequate training and support. Future research could focus on developing and evaluating preparatory programs to improve the learning experiences of nursing students using peer feedback., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: End-of-Life care and experiencing death of infants, children, and teenagers remain one of the most difficult and traumatic events for nurses and nursing students, potentially leading to personal and professional distress. Although efforts have been made to alleviate stressors in these settings, improvements remain slow. Understanding nurses and nursing students' experiences of pediatric End-of-Life care and death in multiple care settings may direct interventions to better support quality of care and healthcare professionals in these areas., Objective: This review aimed to qualitatively synthesize existing literature to examine the nurses and nursing students' experiences of providing End-of-Life care to children and the death of pediatric patients., Design: The qualitative systematic review was conducted using Sandelowski and Barroso's guidelines. The included studies were appraised using the Critical Appraisal Skill Program., Data Sources: This qualitative systematic review was registered with the International Prospective Register of Systematic Reviews. Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from the database inception date through May 2021., Results: Thirty articles were included to form three key themes: (1) Emotional impact of pediatric End-of-Life care and death, (2) Perspective of delivering optimal care: What works and what does not, and (3) The complex role of nurses in pediatric End-of-Life care. Overall, the findings suggested that in an emotionally taxing environment, clinical and emotional support were paramount. Furthermore, there is a need to examine nurses' role in End-of-Life decision making and provide more discussion on professional boundaries., Conclusion: This review offered nurses' and nursing students' perceptions of pediatric End-of Life care and death in the nursing profession. Findings can provide useful insights towards the planning of educational programs and institutional changes that supports nurses and nursing students in these settings., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach., Objectives: To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic., Design: A descriptive qualitative design using Photovoice was adopted., Setting: The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong)., Participants: Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic., Methods: Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards., Results: Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not., Conclusion: Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected., Design: The descriptive cross-sectional quantitative design was used., Settings: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021., Participants: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study., Methods: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic., Results: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels., Conclusions: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: To consolidate the available evidence regarding healthcare students' experiences of coaching interventions' effect on their mental well-being in tertiary educational institutions., Design: A mixed studies review., Data Sources: Seven electronic databases were searched for relevant studies from their inception dates until July 2021: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations and Theses Global., Review Methods: This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies reviews was adopted to analyze all findings and thematic analysis was conducted according to Braun and Clarke's (2006) framework., Results: Three themes and seven subthemes are generated from the 12 included studies. The main themes are: 1) Receiving much-needed help, 2) Unlocking the secrets of success, and 3) Way forward for coaching in healthcare education., Conclusions: Many students benefited from the coaching interventions in terms of academic, emotional and psychological support and received guidance in professional development. However, careful preparation of both coaches and students is needed to improve the success of coaching interventions. Future coaching interventions could incorporate both group and individual sessions, assign students to coaches based on their clinical interests and consider conducting online coaching sessions using video calls. Improvement of study rigor would be required to achieve more accurate results. Lastly, future studies should be conducted on healthcare students of more diverse disciplines and cultures to increase results' generalizability., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To examine the effectiveness of simulation-based interventions in improving empathy among healthcare students., Design: A systematic review and meta-analysis of randomized controlled trials and clinical controlled trials., Data Sources: Studies in English language were sourced from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations & Theses Global) from their respective inception dates until October 2020., Review Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I 2 statistics and Cochran's Q chi-squared test. Quality appraisal was conducted using the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plots., Results: Sixteen studies were included in this review. Meta-analysis reported statistically significant small, medium and very large effect sizes for empathy reported by healthcare students (SMD = 0.46, 95% CI: 0.25 to 0.66), simulated patients (SMD = 0.65, 95% CI: 0.41 to 0.89) and other personnel (independent observers, faculty members and examiners) (SMD = 1.27, 95% CI: 0.64 to 1.90) respectively, showing the effectiveness of simulation-based interventions in improving empathy among healthcare students. Subgroup analyses found that role-play was more effective than simulated patient and disease-state simulations. Multi-sessional interventions conducted for up to seven months and group-based simulation delivery were found to be more effective., Conclusion: Educational institutions should conduct regular simulation-based interventions to continuously develop healthcare students' empathy during their academic journey. Future trials should involve students from more diverse healthcare disciplines. Empathy should be measured in a standardized manner and rely less on self-reported measures. Role-play segments and group-based simulations could be added to increase interventions' effectiveness. Studies should conduct longer follow-up assessments to determine the sustainability of students' empathy following intervention. Future research is needed to corroborate the current findings., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: To examine the effectiveness of end-of-life educational interventions in improving nurses and nursing students' attitude toward death and care of dying patients., Design: A systematic review and meta-analysis of randomized controlled trials and controlled clinical trials., Data Sources: English language studies were sourced from five electronic databases (PubMed, Embase, CINAHL, PsycINFO and ProQuest Dissertations & Theses Global) to November 2020., Review Methods: A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I 2 statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level., Results: Nine studies were included. Meta-analyses showed that end-of-life educational interventions were effective in improving attitude toward death and care of dying patients among nurses and nursing students at post-intervention. The sustainability of improvement of both attitudes could not be determined due to the lack of follow-up assessments by the included studies. Subgroup analyses revealed that both nurses and nursing students showed similar attitude improvement, online educational courses were feasible and attitude toward death may require longer interventions (more than 2 months) to show improvement., Conclusions: Future trials could be improved by organizing both group-based segments and combined sessions for nurses and nursing students. Online components could be incorporated for convenience. Topics related to spirituality and grief management should be included. Future research is needed to examine the sustainability of nurses and nursing students' improvement in attitude toward death and care of dying patients, as well as how the change in their attitude affects their clinical practices., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Due to technological advancements and the current generation being more tech-savvy, the use of virtual worlds in nursing education and clinical practice is increasingly popular. We performed a systematic review on randomised controlled trials and quasi-experimental studies to examine the current evidence on the use of virtual worlds as a teaching tool and to ascertain the outcomes measured., Design: Systematic review of randomised controlled trials and quasi-experimental studies., Data Sources: Six electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, Web of Science, and ProQuest) were searched by title and abstract from each database's date of inception to December 2019., Review Methods: The Joanna Briggs Institute's Critical Appraisal Tool was used to conduct critical appraisal of the selected articles., Results: Eighteen studies were included in the narrative summary. Studies were mostly conducted in developed countries and focused on nursing students. Advantages of virtual worlds include higher time-cost-effectiveness as compared to mannequin-based simulations and face-to-face lectures. Two major disadvantages were technological issues and the lack of realism., Conclusions: Among the three learning outcomes (skills-based, cognitive, and affective), virtual worlds are the most effective in improving cognitive outcomes such as theoretical knowledge. This suggests that virtual worlds may be used as an alternative or complementary method to teach theoretical knowledge in nursing education., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Modern medical pedagogical strategies are shifting toward the use of virtual patient simulations., Objective: This study aims to examine students' users' attitudes and experiences and clinical facilitators' perspectives on student performances in the clinical setting post-virtual patient training., Design: A descriptive qualitative study design was used., Setting: Nursing faculty at a local university in Singapore., Participants: 24 nursing undergraduates and six clinical facilitators., Methods: This study is a follow-up of an experimental study on the Virtual Counseling Application Using Artificial Intelligence (VCAAI). The study took place from the academic year 2017/2018 ended in November 2019. Focus group discussions and individual interviews were conducted. All interviews and focus group discussions were audiotaped, transcribed verbatim, and analyzed using thematic analysis., Results: Two overarching themes (students' virtual patient user experience and clinical facilitators' evaluations of students' clinical communication skills) comprising six themes were generated. Themes under students' user experience included: 1) attitudes toward virtual patient training, 2) virtual patient's role in student development, and 3) enhanced features and implementation suggestions. Themes under clinical facilitators' evaluations included: 1) insights on students' communication skills and 2) approaches to improve communication skills. An overlapping theme titled 'value of technology in teaching communication' comprised of mutual feedback from both students and clinical facilitators. Early implementation, continued accessibility, enhancing realism and technological improvements to the VCAAI were listed as key areas for program improvement, while increased situational sensitivity and language training are recommended to further enhance students' communication skills., Conclusion: The mixed attitudes toward virtual patient interactions and recognitions of the benefits of virtual patient simulations suggest the potential effectiveness of the use of virtual patients in teaching effective nursing communication skills. However, the lack of authenticity and other limitations need to be addressed before official implementations of such trainings with virtual patients to undergraduate nursing curricula., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Nursing education adopts a time-based approach to assess the multifaceted competencies of student nurses. The competency-based approach is preferred historically as it is practical and ensures that individuals deliver effective healthcare practice. However, there remains a gap on how these competencies are actually applied in nursing practice. To facilitate the connection between competencies, competency-based education, and nursing practice, entrustable professional activities (EPAs) can be utilized to translate competencies into clinical practice. EPAs have shown promising results across multiple healthcare specialties and have become the current driving force to facilitate nursing care and practice. Given the limited information of EPAs in nursing education, it is an opportune time to develop EPAs specific to nursing care and practice., Objectives: To provide a detailed breakdown on the development of EPAs in nursing education to inform clinical care and practice., Methods: The development stages of EPAs included: i) the formation of a team, ii) the development of the conceptual framework, and iii) the pooling, reviewing, and revising of core EPAs., Results: A total of ten core EPAs were developed, with sub-EPAs nested within these core EPAs. The EPAs include: 1) patient engagement, 2) patient care and practice, 3) care management, 4) common procedures, 5) safety, 6) urgent care, 7) transition care, 8) patient education, 9) interprofessional collaboration, and 10) palliative care., Conclusion: The development of EPAs specific to nursing care and practice may offer nursing programs a guide to assist with curricula planning and a basis for developing entrustment assessment tools. The unfamiliarity of EPAs in nursing education may pose as implementation challenges to EPAs. Future research is warranted to evaluate and improve the developed EPAs., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Entrustable professional activities (EPA) are mainly used in graduate medical education and professional development and have not been widely implemented in nursing undergraduate settings. Nursing EPAs were therefore developed by the Alice Lee Centre of Nursing to translate theoretical nursing competencies into clinical practice and as forms of standardized clinical assessment tools. Feedback from various stakeholders is required to further refine the framework., Objectives: To explore the perceptions and experiences of using the new EPA framework in nursing students and hospital and university clinical instructors., Design: An exploratory qualitative study using focus group interviews., Participants: Seven year-one nursing undergraduates, 12 year-two undergraduates, seven university clinical instructors, and 18 hospital clinical instructors participated in this study., Methods: The students formed five groups, while the clinical instructors formed seven groups, each consisting of three to four participants. Semi-structured interviews were conducted to explore stakeholders' experiences and perceptions of the EPA assessment framework. Thematic analysis was used to analyze the data., Results: Despite initial mixed reactions of confusion and relief, many students and clinical instructors commended the comprehensive and structured EPA framework and its emphasis on holistic patient-centered care. EPAs also allow flexible assessment methods, encourage critical thinking among students, and promote team-based care and peer teaching. However, the assessment using a two-dimensional matrix with multiple competencies for the EPAs, subjective assessment criteria, the lack of standardization using checklists, subjective assessment criteria, and the lack of, manpower, and time may potentially affect the accuracy of the clinical assessments. The effectiveness of the EPA framework was also dependent on the quality of feedback, students' intrinsic motivations, and learning environments. The refinement of EPAs and entrustment levels, a physical checklist, and an incorporation of EPAs into school curricula were recommended to improve practitioners' learning experiences., Conclusions: The use of EPAs in nursing education continues to be a novel and evolving process. There remains a need for a further refinement of the EPA framework to tailor to instructors' expectations and students' capabilities., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The shortage of nurses has become a global phenomenon, and methods of decreasing the attrition rate of nurses have been explored. Resilience was one of the important factors that increased the retention rate of nurses who stayed in this highly stressful profession., Objectives: To understand how undergraduate nursing students perceive and experience their clinical placements and to identify the factors that helped them build resilience., Design: A qualitative design utilizing focus group interviews was adopted for this study., Participants: Nineteen third- and fourth-year undergraduate nursing students in a Bachelor of Nursing program participated in this study., Setting: This study was conducted at a local university in Singapore., Method: Four audio-taped focus group interviews were conducted., Results: Students reported that they were stressed while facing challenges head-on during their first clinical placements, mainly due to a lack of peer and clinical support. Gradually, students built resilience overtime and were able to adapt to the ward culture through peer support and reframing coping strategies., Conclusion: Nursing students gradually built resilience after accumulating experiences from their clinical placements. Although they eventually adapted well, peer, clinical, and informational support during clinical placements were lacking. Resilience programs that teach positive coping strategies and mindfulness training could be implemented in the undergraduate nursing curriculum., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Effective communication is important for nurse and patient outcomes. Nursing students often feel unprepared to communicate effectively with patients and other healthcare workers within the clinical environment. Blended learning pedagogy-based communication skills training can provide an alternative to traditional methods of teaching to enhance students' satisfaction and self-efficacy levels in communicating with others., Objectives: To examine the effectiveness of blended learning pedagogy in a redesigned communication module among nursing undergraduates in enhancing their satisfaction levels and attitudes towards learning communication module as well as self-efficacy in communication., Design: A single group pre-test and post-test quasi-experimental design was adopted., Settings and Participants: Data were collected from August 2016 to November 2016 from 124 nursing undergraduates from a leading nursing school., Methods: Blended learning pedagogy was adopted to redesign a communication module that offered a wide array of learning opportunities via face-to-face classroom and online sessions. Validated and reliable instruments were used to measure satisfaction levels with blended learning pedagogy, attitudes towards learning communication, and communication self-efficacy. Descriptive and inferential statistics were used to analyze the data., Results: Participants had enhanced satisfaction levels with blended learning pedagogy, better attitudes in learning communication skills, and improved communication self-efficacies at posttest (week 13 of the semester) when compared with their pre-test scores (week one of the semester). Participants scored higher in the Blended Learning Satisfaction Scale, the Communication Skills Attitude Scale, and the communication skills subscale of the Nursing Students Self-Efficacy Scale., Conclusions: Blended learning pedagogy can be effectively used in facilitating communication modules and enhancing student outcomes among nursing undergraduates. The long-term effectiveness of using blended learning pedagogy in facilitating communication modules should be evaluated from students' and patients' perspectives. Additionally, the technology should be constantly improved by incorporating more interactive functions and should be tested to accommodate the learners' needs., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Education is going through accelerated changes to accommodate the needs of contemporary students. However, there are ongoing concerns regarding the quality of education in communication skills for nurses and other healthcare professionals. Many studies have been conducted to evaluate the effectiveness of a blended learning pedagogical tool in enhancing the learning of nursing undergraduates. However, little is known about students' experiences of a blended learning model for teaching communication skills., Objective: To explore first year nursing students' experiences of the blended learning design adopted in a communication module., Design: A descriptive qualitative design was adopted., Settings and Participants: Data were collected in the form of written reflections from 74 first year nursing undergraduates who were enrolled in a university-affiliated nursing school., Methods: Students were asked to complete an online reflective exercise regarding an undergraduate communication module on their last day of class, and the submitted reflections were analyzed. A thematic analysis was conducted and ethics approval was obtained for this study., Results: Six overarching themes and fifteen subthemes were generated. The six overarching themes were: 1) Helpful and engaging classroom experience, 2) valuable online activities, 3) meaningful assessment, 4) appreciation for interprofessional education, 5) personal enrichment, and 6) overall feedback and recommendations., Conclusions: The students in this study felt that the blended pedagogy communication module enhanced their learning and boosted their confidence in facing similar situations. Interprofessional education was well-accepted among students as they attained a deeper understanding on the importance of interprofessional learning and an appreciation towards other professionals. Blended pedagogy can be used in teaching communication skills to nursing students to provide a holistic and up-to-date learning experience. Future studies should consider engaging students in face-to-face interviews to obtain a deeper understanding on their experiences of a blended pedagogy incorporated communication module., (Copyright © 2017 Elsevier Ltd. All rights reserved.)