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  • 1.
    Engström, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden; Nursing Department, Medicine and Health College, Lishui University, China .
    Löfmark, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Faculty of Health Education, Stord/Haugesund University College, Norway.
    Ugland Vae, Karen Johanne
    Faculty of Health Education, Stord/Haugesund University College, Norway.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Nursing students' perceptions of using the Clinical Education Assessment tool AssCE and their overall perceptions of the clinical learning environment: a cross-sectional correlational study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 51, p. 63-67Article in journal (Refereed)
    Abstract [en]

    Background

    Clinical education is a vital part of nursing students' learning; the importance of assessment tools and feedback in stimulating student learning has been stressed, but this needs to be studied in more detail.

    Objectives

    To examine relationships between nursing students' perceptions of using an Assessment tool in Clinical Education (AssCE) during their mid-course discussion and final assessment, the content discussed during these meetings between the student, preceptor and nurse teacher and the students' overall perception of the clinical learning environment.

    Design

    A cross-sectional, correlational design was used.

    Setting and Participants

    A convenience sample of 110 nursing students from one Norwegian university college with two campuses.

    Methods

    Data were collected with self-developed questionnaires and analysed using logistic regression with SPSS and the PROCESS macro for mediation analysis.

    Results

    There was a positive relationship between nursing students' perceptions of using the assessment tool AssCE and their overall perception of the clinical learning environment. This relationship was, in turn, mediated by the content discussed during the formative mid-course discussion and summative final assessment.

    Conclusions

    Our conclusion is that the assessment tool AssCE supported students' clinical learning and that this relationship, in turn, was mediated by the degree to which the conversation during the assessment meeting focused on the student's knowledge, skills and professional judgement.

  • 2.
    Eriksson, Elisabet
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.
    Högstedt, Denice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Lishui University, China.
    Jansson, I.
    Göteborgs universitet.
    Preceptors' experiences of supervising internationally educated nurses attending a bridging program: An interview study2023In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 131, article id 105975Article in journal (Refereed)
    Abstract [en]

    Background

    Internationally educated nurses attending a bridging program must demonstrate clinical competence and meet requirements to apply for a nursing license in Sweden.

    Objectives

    To describe preceptors' experiences of supervising internationally educated nurses undergoing clinical practice education during a bridging program.DesignA qualitative descriptive study.

    Settings

    Two universities offering the 1-year bridging program for nurses with a nursing degree from outside European Union/European Economic Area and Switzerland.

    Participants

    Fifteen preceptors, all registered nurses, who supervised internationally educated nurses were included.

    Methods

    Semi-structured interviews were performed, and data were analyzed using qualitative content analysis.ResultsSupervising internationally educated nurses was not the same as supervising nursing students and raised feelings of both joy and frustration. Preceptors had to adapt supervision to the student's nursing knowledge and skills. They had to help students communicate in Swedish and form good relationships with other students, patients, and other professionals. Most preceptors requested more information about the student's nurse education, country of education/cultural background, and previous work experiences. Mixed experiences of support from the university, first-line managers, and colleagues were reported.ConclusionsBeing a preceptor for internationally educated nurses is a challenge, and supervision training is important for managing preceptorship. To supervise students based on their level of knowledge and skills, more information must be shared with the preceptor. Encounters with others are of importance in the training, where teamwork and person-centered care must be in focus, both in prior theoretical education and in clinical practice education.

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  • 3.
    Gardulf, Ann
    et al.
    Karolinska Institutet, Stockholm, Sweden; The Japanese Red Cross Institute for Humanitarian Studies, Tokyo, Japan.
    Nilsson, Jan
    The Japanese Red Cross Institute for Humanitarian Studies, Tokyo, Japan; Karlstad University, Karlstad, Sweden.
    Florin, Jan
    Dalarna University, Falun, Sweden.
    Leksell, Janeth
    Dalarna University, Falun, Sweden; Uppsala University, Uppsala, Sweden.
    Lepp, Margret
    University of Gothenburg, Gothenburg, Sweden; Østfold University College, Halden, Norway.
    Lindholm, Christina
    Sophiahemmet University, Stockholm, Sweden.
    Nordström, Gun
    Karlstad University, Karlstad, Sweden; Hedmark University College, Hedmark, Norway.
    Theander, Kersti
    Karlstad University, Karlstad, Sweden; County Council of Värmland, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Karlstad University, Karlstad, Sweden; Hedmark University College, Hedmark, Norway.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Uppsala University, Uppsala, Sweden.
    Johansson, Eva
    Karolinska Institutet, Stockholm, Sweden.
    The Nurse Professional Competence (NPC) Scale: Self-reported competence among nursing students on the point of graduation2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 36, p. 165-171Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients.

    OBJECTIVES: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors.

    METHODS AND PARTICIPANTS: The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1 [20-56]years, 87.3% women) from 11 universities/university colleges participated.

    RESULTS: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (93.2% vs 87.5% of NSPGs).

    SUMMARY AND CONCLUSION: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.

  • 4.
    Hellström-Hyson, Eva
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    To take responsibility or to be an onlooker: Nursing students' experiences of two models of supervision2012In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 32, no 1, p. 105-110Article in journal (Refereed)
    Abstract [en]

    AIM: The present study aimed at describing how nursing students engaged in their clinical practice experienced two models of supervision: supervision on student wards and traditional supervision. BACKGROUND: Supervision for nursing students in clinical practice can be organized in different ways. In the present study, parts of nursing students' clinical practice were carried out on student wards in existing hospital departments. The purpose was to give students the opportunity to assume greater responsibility for their clinical education and to apply the nursing process more independently through peer learning. METHOD: A descriptive design with a qualitative approach was used. Interviews were carried out with eight nursing students in their final semester of a 3-year degree program in nursing. The data were analyzed using content analysis. FINDINGS: Two themes were revealed in the data analysis: When supervised on the student wards, nursing students experienced assuming responsibility and finding one's professional role, while during traditional supervision, they experienced being an onlooker and having difficulties assuming responsibility. CONCLUSIONS: Supervision on a student ward was found to give nursing students a feeling of acknowledgment and more opportunities to develop independence, continuity, cooperation and confidence.

  • 5.
    Hofsten, Anna
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Medical science.
    Gustafsson, Christina
    University of Gävle, Faculty of Education and Business Studies, Department of Culture Studies, Religious Studies and Educational Sciences, Curriculum studies.
    Häggström, Elisabeth
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Case seminars open doors to deeper understanding: Nursing students’ experiences of learning2010In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 30, no 6, p. 533-538Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The Case Method is a teaching method in which cases from real life inspire students to actively seek knowledge that they discuss in structured seminars. Case seminars in health education have been evaluated, compared and discussed, but descriptions that can help us understand how students learn in the seminars have not previously been published. In a Swedish nursing programme, where case seminars have been used for several years, students were asked to write about their experiences of learning in the seminars. The aim of the present study was to describe this learning process from the students' point of view.

    METHOD:

    Written data were analysed using content analysis.

    FINDINGS:

    A theme concerning how the Case Method opens doors to deeper understanding was identified as a thread running through different codes and categories. Students described the importance of new perspectives and their wish to participate in discussions with other students. The students indicated that the structure, which involved pre-prepared cases and writing on the white board, positioned their own knowledge in a wider context and that the learning atmosphere enabled everyone to participate.

    CONCLUSIONS:

    The Case Method seems to involve students in a way that deepens their understanding and critical thinking.

  • 6.
    Holmström, Inger K.
    et al.
    School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Kaminsky, Elenor
    School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Höglund, Anna T.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Nursing students' awareness of inequity in healthcare - An intersectional perspective.2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 48, p. 134-139Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The overall aim of the present study was to explore awareness of inequity in healthcare and the intersection between different structures of power among nursing students. Another aim was to delineate the knowledge and use of Swedish Healthcare Direct in this group.

    DESIGN: The study had a descriptive design with a quantitative approach.

    PARTICIPANTS: The sample consisted of 157 nursing students from three universities in central Sweden.

    METHODS: The students filled out a study specific questionnaire in class. The questionnaire consisted of short descriptions of twelve fictive persons who differed in gender, age, and ethnicity, with questions about their life situation. The mean was calculated for each assessed fictive person for every item. In the next step, the assessments were ranked from the lowest probability to the highest probability. A 'Good life-index' consisting of quality of life, power over own life, and experience of discrimination, was also calculated. Free text comments were analysed qualitatively.

    RESULTS: People with Swedish names were assessed to have the highest probability of having a good life. Among those with Swedish names, the oldest woman was assessed as having the lowest probability of a good life. All students had knowledge about Swedish Healthcare Direct, but more female students had used the service compared to male students.

    CONCLUSIONS: The results indicate that the nursing students had awareness of how power and gender, ethnicity and age, are related. Based on the free text comments, the questions and the intersectional perspective seemed to evoke some irritation which points to their sensitive nature. Therefore, the questionnaire could be used as a tool to start a discussion of equity in healthcare and in interventions where the aim is to raise awareness of inequality and intersectionality.

  • 7.
    Häggström, Elisabeth
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Bruhn, Åsa
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Caregivers' attitude to education and supervision in work with the older people in a nursing home2009In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 29, no 8, p. 850-854Article in journal (Refereed)
    Abstract [en]

    Community-based care in Sweden has problems recruiting and keeping staff with formal competence and education. Both the caregiver’s well-being and the receiver’s care improve when the personnel receive support in the form of continuing supervision and education. Yet the caregivers in this study did not participate in a training and supervision programme during working hours. The aim of this study was to describe the attitudes towards education, support and supervision in the care of older people in municipal care in Sweden. The study used a qualitative approach with a descriptive design. Twelve caregivers, nine enrolled nurses and three nurses’ aides from four wards in a nursing home were interviewed. The interviews were analysed with qualitative content analysis. The main findings showed that all of the caregivers were positive towards the idea of participating in training and asked for education and supervision but felt that the management did not create conditions that made it possible to participate during working hours. According to the findings there is a need for developing new forms and methods for learning that can be integrated into working life.

  • 8.
    Högstedt, Denice
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet; Lishui universitet.
    Jansson, Inger
    Göteborgs universitet.
    Eriksson, Elisabet
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.
    Attending a bridging program to obtain a Swedish nursing license: An interview study with internationally educated nurses2021In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 99, article id 104744Article in journal (Refereed)
    Abstract [en]

    Background: Bridging programs have been created to facilitate internationally educated nurses’ integration process. Thus far, studies on bridging programs have been few and have only been conducted in English-speaking countries. Due to language barriers, it may be a greater challenge to attend a bridging program in a non-English-speaking country. 

    Objectives: The aim was to examine internationally educated nurses’ experience of attending a one-year bridging program to obtain a Swedish nursing license. 

    Design: A qualitative study with a descriptive design was applied. 

    Settings: The study setting was the five universities offering the one-year, full-time Swedish bridging program.  

    Participants: Purposive sampling was used. Eighteen nurses participated in the study at the end of the program. 

    Methods: Semi-structured interviews were conducted and analyzed using qualitative content analysis. 

    Results: Studying in a new environment and language was challenging and intensive, as were adapting to a new healthcare system and relearning some nursing practices. However, attending the bridging program was also rewarding and gave feelings of happiness and pride; the nurses developed their nursing skills as well as their language and academic skills. Moreover, they became familiar with Sweden’s nursing practices, healthcare system, and culture. Good support was important, but not always enough. 

    Conclusions: By attending a bridging program, nurses can become familiar with the country’s healthcare system and nursing practices. Moreover, develop their language skills and attain skills important to lifelong learning. Although the program may not eliminate all difficulties nurses often experience in a new country, it can offer the support nurses need to handle the challenges. However, for some nurses, due to different backgrounds and prerequisites, the support offered may need to be more individualized.

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  • 9.
    Högstedt, Denice
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Jansson, I.
    Göteborgs universitet.
    Eriksson, Elisabet
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Three paths to a Swedish nursing license: Two for internationally educated nurses and one for regular nursing students – A cross-sectional study of self-rated professional competence, self-efficacy, and thriving2022In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 119, article id 105595Article in journal (Refereed)
    Abstract [en]

    Background

    Bridging programs are offered to support migrated nurses, but in some countries, nurses can also choose to validate their nursing competence. Thus far, little is known about how migrated nurses estimate their competence when they are about to enter working life in a new country and how this differs from regular nursing students.

    Objective

    To compare two groups of internationally educated nurses' – those from bridging programs and those who chose validation – and one group of regular nursing students' self-rated professional competence when they are about to start working as registered nurses. The hypotheses were: 1) internationally educated nurses rate their competence higher than regular nursing students and 2) those from bridging programs rate their competence higher than those who chose validation. In addition, the aim was to compare the groups' self-efficacy and thriving.

    Design

    A cross-sectional, comparative design.

    Settings

    Five universities in Sweden.

    Participants

    Nurses educated in non-European countries from a bridging program (n = 128, response rate 79.0 %) or validation process (n = 61, response rate 59.2 %) and students graduating from the regular nursing program (n = 213, response rate 68.3 %).

    Methods

    Data were collected with coded questionnaires (paper or online) between 2019 and 2021 and analyzed using non-parametric tests, e.g., Kruskal-Wallis.

    Results

    Both groups of internationally educated nurses had higher median scores on total nursing competence (both groups p < 0.001), general self-efficacy (bridging programs p < 0.001, validation p = 0.020), and total thriving (bridging programs p < 0.001, validation p = 0.012) than regular nursing students did. However, comparing the groups of internationally educated nurses showed no significant differences.

    Conclusion

    Internationally educated nurses rated their competence high but with differences within the groups for different competence areas. More research is needed to investigate whether the different paths are important for nurses' competence later in working life, and some of the competence areas might need extra attention when nurses start working.

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  • 10.
    Johansson, Linda
    et al.
    Jönköping University, School of Health and Welfare, Institute of Gerontology, Aging Research Network-Jönköping, Jönköping, Sweden.
    Silén, Marit
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Research methods in nursing students' Bachelor's theses in Sweden: a descriptive study2018In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 66, p. 187-193Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the nursing programme in Sweden, students complete an independent project that allows them to receive both a professional qualification as a nurse and a Bachelor's degree. This project gives students the opportunity to develop and apply skills such as critical thinking, problem-solving and decision-making, thus preparing them for their future work. However, only a few, small-scale studies have analysed the independent project to gain more insight into how nursing students carry out this task.

    OBJECTIVES: The aim of the present study was to describe the methods, including ethical considerations and assessment of data quality, applied in nursing students' independent Bachelor's degree projects in a Swedish context.

    DESIGN: A descriptive study with a quantitative approach.

    METHODS: A total of 490 independent projects were analysed using descriptive statistics.

    RESULTS: Literature reviews were the predominant project form. References were often used to support the analysis method. They were not, however, always relevant to the method. This was also true of ethical considerations. When a qualitative approach was used, and data collected through interviews, the participants were typically professionals. In qualitative projects involving analysis of biographies/autobiographies or blogs participants were either persons with a disease or next of kin of a person with a disease.

    CONCLUSIONS: Although most of the projects were literature reviews, it seemed unclear to the nursing students how the data should be analysed as well as what ethical issues should be raised in relation to the method. Consequently, further research and guidance are needed. In Sweden, independent projects are not considered research and are therefore not required to undergo ethics vetting. However, it is important that they be designed so as to avoid possible research ethics problems. Asking persons about their health, which occurred in some of the empirical projects, may therefore be considered questionable.

  • 11.
    Johnsson, Christina
    et al.
    Karolinska Institutet, Department of Nursing, Huddinge, Sweden.
    Kjellberg, Anders
    University of Gävle, Department of Technology and Built Environment, Ämnesavdelningen för inomhusmiljö.
    Lagerström, Monika
    Karolinska Institutet, Department of Nursing, Huddinge, Sweden.
    Evaluation of nursing students' work technique after proficiency training in patient transfer methods during undergraduate education2006In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 26, no 4, p. 322-331Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if nursing students improved their work technique when assisting a simulated patient from bed to wheelchair after proficiency training, and to investigate whether there was a correlation between the nursing students' work technique and the simulated patients' perceptions of the transfer. METHOD: 71 students participated in the study, 35 in the intervention group and 36 in the comparison group. The students assisted a simulated patient to move from a bed to a wheelchair. In the intervention group the students made one transfer before and one after training, and in the comparison group they made two transfers before training. Six variables were evaluated: work technique score; nursing students' ratings of comfort, work technique and exertion, and the simulated patients' perceptions of comfort and safety during the transfer. The result showed that nursing students improved their work technique, and that there was a correlation between the work technique and the simulated patients' subjective ratings of the transfer. In conclusion, nursing students improved their work technique after training in patient transfer methods, and the work technique affected the simulated patients' perceptions of the transfer.

  • 12.
    Kristofferzon, Marja-Leena
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Löfmark, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Stord/Haugesund University College, Department of Health Sciences, Haugesund, Norway.
    Nursing students' perceptions of clinical supervision: The contributions of preceptors, head preceptors and clinical lecturers2013In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 33, no 10, p. 1252-1257Article in journal (Refereed)
    Abstract [en]

    Aim: The aims of the study were 1) to investigate to what extent nursing students were satisfied with the supervision provided by facilitators (preceptor, head preceptor, and clinical lecturer), 2) to compare nursing students' ratings of facilitators' contribution to supervision as supportive and challenging, and 3) to examine relationships between facilitators' supportive and challenging behavior in supervision and nursing students' perception of fulfillment of expected learning outcomes in clinical education.

    Background: Although there are many studies on support of students in clinical education, few have addressed this from the students' point of view or made comparisons between different facilitators.

    Methods: A cross-sectional survey study was conducted during April to November 2010, where 107 nursing students, from a university in central Sweden, answered a questionnaire about supervision immediately after their period of clinical education.

    Result: Supportive behavior in supervision was rated higher by students for all facilitator groups as compared with challenging behavior. The students rated preceptors and clinical lecturers as more supportive than head preceptors and clinical lecturers as providing more challenges than the two other facilitator groups. Supportive and challenging behavior in supervision explained 39% of the variance in students' overall learning outcomes. However, the regression coefficient was only significant for students' ratings of supportive behavior for the preceptor.

    Conclusions: Nursing students were satisfied with facilitators' supervision and by their contribution to fulfillment of overall learning outcomes. Comparisons showed that preceptors in a higher degree were perceived as supportive while clinical lecturers were perceived as more important as challengers for critical thinking, reflection and exchange of experiences between students. The model of supervision seems to be promising, but the roles across facilitators need to be made clearer, especially the head preceptor's role, which seemed to be the most unclear role in this model.

  • 13.
    Lindberg, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for research and Development, Uppsala University, Gävle. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala; Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Nursing student's expectations for their future profession and motivating factors - a longitudinal descriptive study from Sweden2020In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 84, article id 104218Article in journal (Refereed)
    Abstract [en]

    Background

    The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored.

    Objective

    To describe students' motives to become registered nurses and their expectations regarding their future profession.

    Design

    A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.

    Participants and setting

    A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden.

    Methods

    A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis.

    Results

    An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.

    Conclusion

    The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

  • 14.
    Löfmark, Anna
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Stord/Haugesund University College, Department of Health Sciences, Haugesund, Norway.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Validation of the tool Assessment of Clinical Education (AssCE): a study using Delphi method and clinical experts2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 50, p. 82-86Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to establish the validity of the tool Assessment of Clinical Education (AssCE). The tool is widely used in Sweden and some Nordic countries for assessing nursing students' performance in clinical education. It is important that the tools in use be subjected to regular audit and critical reviews. The validation process, performed in two stages, was concluded with a high level of congruence. In the first stage, Delphi technique was used to elaborate the AssCE tool using a group of 35 clinical nurse lecturers. After three rounds, we reached consensus. In the second stage, a group of 46 clinical nurse lecturers representing 12 universities in Sweden and Norway audited the revised version of the AssCE in relation to learning outcomes from the last clinical course at their respective institutions. Validation of the revised AssCE was established with high congruence between the factors in the AssCE and examined learning outcomes. The revised AssCE tool seems to meet its objective to be a validated assessment tool for use in clinical nursing education.

  • 15.
    Mårtensson, Gunilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    What are the structural conditions of importance to preceptors' performance?2013In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 33, no 5, p. 444-449Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Preceptors play a critical role in the process of developing nursing students' knowledge, skills and ability to make independent and critical judgments, however relatively little is known about what aspects are associated with nurses' performance as preceptors.

    OBJECTIVES:

    To investigate structural conditions and professional aspects of potential importance to nurses' perceptions of their performance as preceptors, and to evaluate the validity and reliability of a questionnaire measuring nurses' perceptions of being a preceptor.

    METHODS:

    The study had a correlational design. Total population sampling (N=1720) in a county council district in central Sweden was used to screen for nurses with recent preceptor experience, 933 nurses responded (response rate 54%), of those 323 nurses fulfilled the inclusion criteria. The present findings are based on data from 243 of these subjects. Data were collected with a questionnaire and analyzed using multiple regressions analyses, exploratory factor analyses and reliability coefficients.

    RESULTS:

    The results show that aspects such as receiving feedback on the function as a preceptor, being able to plan and prepare the clinical education period, receiving support from unit managers and having specific supervision education explain 31% of nurses' overall view of their performance as preceptors. However, structural conditions and professional experiences could not explain preceptors' use of reflection and critical thinking when acting as preceptors. These findings are discussed within the framework of Kanter's structural theory of power in organizations. Further, the psychometric evaluation showed that the questionnaire is a valid and reliable instrument for measuring nurses' structural conditions for and perceptions of their performance as preceptors.

    CONCLUSIONS:

    Structural conditions such as feedback and support seemed to strengthen nurses' general view of their performance as preceptors but did not seem to facilitate nurses' work toward the aim of higher education and helping nursing students develop critical thinking.

  • 16.
    Mårtensson, Gunilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Löfmark, Anna
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Stord Haugesund University College, Haugesund, Norway.
    Implementation and student evaluation of clinical final examination in nursing education2013In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 33, no 12, p. 1563-1568Article in journal (Refereed)
    Abstract [en]

    Background

    Clinical examinations have a distinct focus, the overall aim being to demonstrate through action whether nursing students have acquired the knowledge and skills necessary to be safe and accountable practitioners. This complexity of knowledge cannot be assessed using single examinations, thus there is a need to develop multiple assessment approaches.

    Objectives

    To describe the process of developing valid clinical examinations for nursing students at the end of the final semester and to evaluate students' perceptions of these examination formats.

    Outline of the developmental process

    Based on earlier research, overall goals for the degree of Bachelor of Science in Nursing and guided by both task-related and relational aspects of nursing, two clinical final examinations were developed and tested. One was a standardized test of performance in vitro using Objective Structured Clinical Examination (OSCE) based on five specific areas in which newly graduated nurses had shown deficiencies. The other was a test of performance in real conditions, in vivo, using Bedside Observation Examination (BOE) assessing nurse–patient relation, entirely based on patients' needs.

    Nursing Students' Evaluation

    Three classes of students (n = 203) were asked to participate and answer a study-specific questionnaire. The students highly valued the two examinations and perceived that the knowledge and skills tested were relevant to nurses' work. They found the examinations stressful, but at the same time meaningful, and felt they could do themselves full justice through this form of examination.

    Recommendations

    The assessment test should be chosen depending on the preferred outcome. The OSCE, with its high degree of standardization, is appropriate to use to assess task-related aspects of nursing (show how), while the BOE, with its low degree of standardization, is suitable in real settings and has the potential to capture the relational aspects of nursing (does).

  • 17.
    Nilsson, Jan
    et al.
    Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden; Department of Health Promotion Sciences, Sophiahemmet University, Stockholm, Sweden; Japanese Red Cross Institute for Humanitarian Studies, Tokyo, Japan.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Gardulf, Ann
    Japanese Red Cross Institute for Humanitarian Studies, Tokyo, Japan; Unit of Clinical Nursing Research, Immunotherapy and Immunology, Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    A short version of the nurse professional competence scale for measuring nurses' self-reported competence2018In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 71, p. 233-239, article id S0260-6917(18)30695-6Article in journal (Refereed)
    Abstract [en]

    Background: The Nurse Professional Competence (NPC) Scale with 88-items has been used to measure self-reported competence among nursing students and registered nurses in many national and international nursing research projects. However, a shorter version of the scale with maintained quality has been requested to further enhance its usability.

    Objectives: To develop and evaluate the construct validity and internal consistency of a shorter version of the NPC Scale. Design: A developmental and methodological design. Participants and Settings: The study was based on a sample of 1810 nursing students at the point of graduation from 12 universities in Sweden.

    Methods: The number of items in the original NPC Scale was reduced using several established research steps and then evaluated for data quality and construct validity using principal component analysis and confirmatory factor analysis. Reliability was measured as internal consistency using Cronbach's alpha.

    Results: The extensive process of reducing the number of items resulted in a version with 35 items. Principal component analysis resulted in six factors explaining 53.6% of the variance: “Nursing Care” “Value-based Nursing Care” “Medical and Technical Care” “Care Pedagogics” “Documentation and Administration of Nursing Care” and “Development, Leadership, and Organization of Nursing Care”. All factors showed Cronbach's alpha values of >0.70. The confirmative factor analysis goodness-of-fit indexes were for root mean square error of approximation 0.05 and for comparative fit index 0.89.

    Conclusions: The NPC Scale Short Form (NPC Scale-SF) 35-items revealed promising results with a six-factor structure explaining 53.6% of the total variance. This 35-item scale can be an asset when used alone and together with other instruments it can provide the possibility of more complex analyses of self-reported competence among nursing students and registered nurses. 

  • 18.
    Nilsson, Jan
    et al.
    Karlstad University, Karlstad, Sweden.
    Johansson, Eva
    Karolinska Institutet, Huddinge, Sweden.
    Egmar, Ann-Charlotte
    The Red Cross University College, Stockholm, Sweden.
    Florin, Jan
    Dalarna University, Falun, Sweden.
    Leksell, Janeth
    Dalarna University, Falun, Sweden.
    Lepp, Margret
    University of Gothenburg, Gothenburg, Sweden.
    Lindholm, Christina
    Sophiahemmet University College, Stockholm, Sweden.
    Nordström, Gun
    Karlstad University, Karlstad, Sweden, and Hedmark University College, Hedmark, Norway.
    Theander, Kersti
    Karlstad University, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Karlstad University, Karlstad, Sweden, and Hedmark University College, Hedmark, Norway.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University.
    Gardulf, Ann
    Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Development and validation of a new tool measuring nurses self-reported professional competence: the nurse professional competence (NPC) scale2014In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 34, no 4, p. 574-580Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To develop and validate a new tool intended for measuring self-reported professional competence among both nurse students prior to graduation and among practicing nurses. The new tool is based on formal competence requirements from the Swedish Board of Health and Welfare, which in turn are based on WHO guidelines.

    DESIGN: A methodological study including construction of a new scale and evaluation of its psychometric properties.

    PARTICIPANTS AND SETTINGS: 1086 newly graduated nurse students from 11 universities/university colleges.

    RESULTS: The analyses resulted in a scale named the NPC (Nurse Professional Competence) Scale, consisting of 88 items and covering eight factors: "Nursing care", "Value-based nursing care", "Medical/technical care", "Teaching/learning and support", "Documentation and information technology", "Legislation in nursing and safety planning", "Leadership in and development of nursing care" and "Education and supervision of staff/students". All factors achieved Cronbach's alpha values greater than 0.70. A second-order exploratory analysis resulted in two main themes: "Patient-related nursing" and "Nursing care organisation and development". In addition, evidence of known-group validity for the NPC Scale was obtained.

    CONCLUSIONS: The NPC Scale, which is based on national and international professional competence requirements for nurses, was comprehensively tested and showed satisfactory psychometrical properties. It can e.g. be used to evaluate the outcomes of nursing education programmes, to assess nurses' professional competences in relation to the needs in healthcare organisations, and to tailor introduction programmes for newly employed nurses.

  • 19.
    Pålsson, Ylva
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mårtensson, Gunilla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Leo Svenne, Christine
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ädel, Eva
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, China .
    A peer learning intervention for nursing students in clinical practice education: a quasi-experimental study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 51, p. 81-87Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies of peer learning indicate that the model enables students to practice skills useful in their future profession, such as communication, cooperation, reflection and independence. However, so far most studies have used a qualitative approach and none have used a quasi-experimental design to study effects of nursing students' peer learning in clinical practice.

    OBJECTIVES: To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance.

    DESIGN: Quasi-experimental.

    SETTING: The study was conducted during nursing students' clinical practice.

    PARTICIPANTS: All undergraduate nursing students (n=87) attending their first clinical practice were approached. Seventy students out of 87 answered the questionnaires at both baseline and follow-up (42 of 46 in the intervention group and 28 of 39 in the comparison group).

    METHODS: During the first two weeks of the clinical practice period, all students were supervised traditionally. Thereafter, the intervention group received peer learning the last two weeks, and the comparison group received traditional supervision. Questionnaire data were collected on nursing students' self-rated performance during the second (baseline) and last (follow-up) week of their clinical practice.

    RESULTS: Self-efficacy was improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. For the other self-rated variables/tests, there were no differences in changes over time between the groups. Studying each group separately, the intervention group significantly improved on thirteen of the twenty variables/tests over time and the comparison group improved on four.

    CONCLUSIONS: The results indicate that peer learning is a useful method which improves nursing students' self-efficacy to a greater degree than traditional supervision does. Regarding the other self-rated performance variables, no interaction effects were found.

  • 20.
    Silén, Marit
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, Institute of Gerontology/Department of Nursing, Jönköping, Sweden .
    Aims and theoretical frameworks in nursing students' Bachelor's theses in Sweden: a descriptive study2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 37, p. 91-96Article in journal (Refereed)
    Abstract [en]

    Background: Nursing students' independent projects in Sweden not only provide an opportunity to receive a professional qualification as a nurse but also gain a Bachelor's degree in nursing. The aim of these projects is to demonstrate knowledge and understanding within the major field of the education. Objectives: This study aimed to describe and analyze the topics as well as theoretical frameworks and concepts in nursing students' independent projects, which lead to a Bachelor's degree, in a Swedish context. Design: A total of 491 independent projects, written by nursing students in Sweden, were included in the study. Methods: Topics together with theoretical frameworks and concepts in the projects were identified. Similar topics and theoretical frameworks and concepts, respectively, were grouped into subcategories, and similar subcategories were then merged into a main category. The number of entries in each category was counted for descriptive statistics in order to allow for the demonstration of magnitude. Results: The most common topics concerned experiences and managing when having an illness, experiences of care and of being a caregiver, and healthcare staff's care and knowledge. The nursing theories/models that were most often used were Eriksson's Theory of Caritative Caring, Travelbee's Human-to-Human Relationship Model, and Orem's Self-care Theory. Among the non-nursing theories/models, perspectives and concepts lifeworld, ethical values and principles, existential concepts and quality of life/health-related quality of life, were most often used by these students. Conclusion: There may be some difficulty in finding a topic for the project that is relevant for both a professional qualification as a nurse, as well as for achieving the requirements of a Bachelor's degree in nursing. The study indicates that there is a need to widen the student's understanding of different nursing theories/perspectives/models/concepts during nursing education so that students are familiar with a broad range of these when conducting their independent project.

  • 21.
    Theander, Kersti
    et al.
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; Faculty of Public Health, Department of Nursing and Mental Health, Hedmark University College, Hedmark, Norway.
    Carlsson, Marianne
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Florin, Jan
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Gardulf, Ann
    Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden; The Japan Red Cross Institute for Humanitarian Studies, Tokyo, Japan .
    Johansson, Eva
    Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden; The Japan Red Cross Institute for Humanitarian Studies, Tokyo, Japan .
    Lindholm, Christina
    Sophiahemmet University, Stockholm, Sweden.
    Nordström, Gun
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; Faculty of Public Health, Department of Nursing and Mental Health, Hedmark University College, Hedmark, Norway.
    Nilsson, Jan
    Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden; The Japan Red Cross Institute for Humanitarian Studies, Tokyo, Japan.
    Adjusting to future demands in healthcare: curriculum changes and nursing students' self-reported professional competence2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 37, p. 178-183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nursing competence is of significant importance for patient care. Newly graduated nursing students rate their competence as high. However, the impact of different designs of nursing curricula on nursing students' self-reported nursing competence areas is seldom reported.

    OBJECTIVES: To compare newly graduated nursing students' self-reported professional competence before and after the implementation of a new nursing curriculum. The study had a descriptive comparative design. Nursing students, who graduated in 2011, having studied according to an older curriculum, were compared with those who graduated in 2014, after a new nursing curriculum with more focus on person-centered nursing had been implemented.

    SETTING: A higher education nursing program at a Swedish university.

    PARTICIPANTS: In total, 119 (2011 n=69, 2014 n=50) nursing students responded.

    METHODS: Nursing students' self-reported professional competencies were assessed with the Nurse Professional Competence (NPC) scale.

    RESULTS: There were no significant differences between the two groups of nursing students, who graduated in 2011 and 2014, respectively, with regard to age, sex, education, or work experience. Both groups rated their competencies as very high. Competence in value-based nursing was perceived to be significantly higher after the change in curriculum. The lowest competence, both in 2011 and 2014, was reported in education and supervision of staff and students.

    CONCLUSIONS: Our findings indicate that newly graduated nursing students - both those following the old curriculum and the first batch of students following the new one - perceive that their professional competence is high. Competence in value-based nursing, measured with the NPC scale, was reported higher after the implementation of a new curriculum, reflecting curriculum changes with more focus on person-centered nursing.

  • 22.
    Zhu, Li
    et al.
    Lishui University China.
    Lian, Zhengmei
    Lishui University China.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Lishui University, Uppsala university.
    Use of a flipped classroom in ophthalmology courses for nursing, dental and medical students: A quasi-experimental study using a mixed-methods approach.2020In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 85, article id 104262Article in journal (Refereed)
    Abstract [en]

    Background

    Traditional teaching is associated with dilemmas, such as low motivation to learn and passive learning. In contrast, use of a flipped classroom with the proper learning design has the potential to promote accelerated learning, bolster transmission of competencies (i.e., critical thinking, communication and problem-solving skills) and improve teamwork capacity, all of which are of great significance in professional healthcare practice, including nursing, dentistry and medicine.

    Objective

    The aim of the study was to examine the effects of using a flipped classroom in ophthalmology courses for undergraduate nursing students, dental students and higher vocational medical students.

    Design

    A quasi-experimental design was used with an intervention (n = 100) and a comparison group (n = 100), pre-/post-testing measures and a mixed-methods approach.

    Setting

    A university in China.

    Participants

    A total of 200 students were included.

    Methods

    Students' self-rated learning ability was measured before and after the courses, and skill exams were performed after the courses. In addition, interviews were conducted with the clinical medical students concerning their experiences of the flipped classroom.

    Results

    Students' self-rated learning ability improved significantly more in the intervention than in the comparison group, for the total scale and the three factors ‘learning goals’, ‘self-efficacy and social learning’ and ‘problem-solving’. Skill exam scores were statistically significantly better in the intervention than in the comparison group. On the whole, the clinical medicine students felt the flipped classroom had a positive impact and improved their learning ability as well as knowledge in ophthalmology.

    Conclusions

    Use of a flipped classroom for nursing, dental and clinical medical students in ophthalmology courses shows promising results in the form of students' skill exam scores and self-rated learning ability.

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