nurse manager problem solving skills

What is Problem-Solving in Nursing? (With Examples, Importance, & Tips to Improve)

Whether you have been a nurse for many years or you are just beginning your nursing career, chances are, you know that problem-solving skills are essential to your success. With all the skills you are expected to develop and hone as a nurse, you may wonder, “Exactly what is problem solving in nursing?” or “Why is it so important?” In this article, I will share some insight into problem-solving in nursing from my experience as a nurse. I will also tell you why I believe problem-solving skills are important and share some tips on how to improve your problem-solving skills.

What Exactly Is Problem-Solving In Nursing?

5 reasons why problem-solving is important in nursing, reason #1: good problem-solving skills reflect effective clinical judgement and critical thinking skills, reason #2: improved patient outcomes, reason #3: problem-solving skills are essential for interdisciplinary collaboration, reason #4: problem-solving skills help promote preventative care measures, reason #5: fosters opportunities for improvement, 5 steps to effective problem-solving in nursing, step #1: gather information (assessment), step #2: identify the problem (diagnosis), step #3: collaborate with your team (planning), step #4: putting your plan into action (implementation), step #5: decide if your plan was effective (evaluation), what are the most common examples of problem-solving in nursing, example #1: what to do when a medication error occurs, how to solve:, example #2: delegating tasks when shifts are short-staffed, example #3: resolving conflicts between team members, example #4: dealing with communication barriers/lack of communication, example #5: lack of essential supplies, example #6: prioritizing care to facilitate time management, example #7: preventing ethical dilemmas from hindering patient care, example #8: finding ways to reduce risks to patient safety, bonus 7 tips to improve your problem-solving skills in nursing, tip #1: enhance your clinical knowledge by becoming a lifelong learner, tip #2: practice effective communication, tip #3: encourage creative thinking and team participation, tip #4: be open-minded, tip #5: utilize your critical thinking skills, tip #6: use evidence-based practices to guide decision-making, tip #7: set a good example for other nurses to follow, my final thoughts, list of sources used for this article.

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Home » Degrees » RN to MSN » Registered Nurse to Master of Science in Nursing in Administrative Leadership in Nursing » How Leaders Approach Problem-Solving

How Leaders Approach Problem-Solving

Published On: July 12, 2022

No environment is free from problems. But, some require more creative solutions than others.

Healthcare, in particular, presents almost unlimited opportunities for things to go wrong — both in terms of patient care and inter-staff/intra-staff relationships. The problems present within healthcare settings are often a matter of life and death.

It takes effective leadership to keep all issues to a minimum and patient safety remains a priority.

What Makes a Great Leader?

If we think about the great leaders throughout time, they share a few common characteristics. Specific to nurse leaders, Indeed.com lists the following as core qualities for leaders:

compassion/empathy
critical thinking
dedication to excellence
communication
collaboration/team building
open-mindedness
forward-thinking
accessibility

Another valuable quality in leadership is being proactive in problem-solving. Good leaders handle issues as they arrive. They are capable of “putting out fires,” and that’s important. Yet, great leaders anticipate problems before they come to a head.

Core Skills Nurse Leaders Need to Possess

While some of the above resonates as more intuitive, emotional intelligence — as opposed to procedural — can be learned. Of course, there are practical skills nurse leaders need to develop as well.

Examples of these skills are healthcare finance and economics. Mastering budgets and efficiently allocating resources is important for nurse leaders. Nurses also need to know how to communicate financial demands to upper administration.

The online Registered Nurse (RN) to Master of Science in Nursing (MSN) in Administrative Leadership program from Northeastern State University (NSU) dedicates a course to heightening nurses’ skills and knowledge surrounding this responsibility.

NSU’s program also includes a course titled Organizational and Systems Management in Nursing. The course description states that nurses will learn about “contemporary influences, theories, principles, and functional strategies related to management/administration and organizational systems at the micro, meso, and macrosystem levels.”

Leadership’s Role in Addressing Lateral and Horizontal Violence (LHV)

While nurse leaders don’t necessarily need to be experts in human resources, it’s a substantial knowledge base. Human resources knowledge is especially relevant given the persistence of lateral and horizontal violence (LHV) within the nursing profession. The World Health Organization (WHO), International Council of Nurses and Public Services International have recognized this issue as a significant global public health priority.

Just how dangerous is LHV to nursing? A study published by Nurse Management describes LHV as: “all acts of meanness, hostility, disruption, discourtesy, backbiting, divisiveness, criticism, lack of unison, verbal or mental abuse, and scapegoating. [These] behaviors taint healthcare organizations; cause irreparable harm to workplace culture; breakdown team communication; and severely impact the quality of the care provided, thereby jeopardizing patient safety.”

With a solid leadership foundation, nurses can handle toxic behaviors that damage the work environment. In doing so, they change the workplace culture and guiding others to follow in their footsteps.

Empowerment Sets Everyone Up for Success

Perhaps the greatest responsibility of a nurse leader is to empower those in their charge. John Quincy Adams said, “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”

Northeastern State University recognizes empowerment as an essential skill. In the Leadership Development for the Advanced Nursing Professional course, students learn to “effectively manage change, empower others, and influence political processes.”

What Type of Leader Do You Aspire to Be?

It takes much more than “putting in your time” to become an effective leader. Nurses might rise through the ranks based on experience, but are they actually effecting change in the nursing profession? Unless they possess a robust leadership skill set, the answer is likely no. So, what kind of leader do you want to be?

Learn more about Northeastern State University’s online RN to MSN in Administrative Leadership program .

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Six Tips for Success as a Nurse Manager

May 22, 2020

View all blog posts under Articles | View all blog posts under Doctor of Nursing Practice

Nurses transitioning to management roles can expect new responsibilities.

Taking on a leadership role as a nurse manager requires more than clinical skills, critical thinking, and strong communication. Nurses who have earned a doctor of nursing practice (DNP) degree and are stepping into management take on new responsibilities that include planning, budgeting, time management, quality improvement, and staff relations.

In a new leadership role, DNP-prepared nurses are expected to direct employee performance to align with an organization’s objectives and goals. The job can be challenging for nurse managers who are redefining their roles in healthcare and with their peers and coworkers.

“Strong nursing leadership is needed to create practice environments and work climates that are healthier and safer for both nurses and patients,” Janet Henriksen said in Nursing Management . “Nurse managers are recognized as leaders who have the ability to create practice environments that influence the quality of patient care, nurse job satisfaction levels, and the achievement of performance goals.”

In deciding to make the transition to management, registered nurses (RNs) who are considering a DNP degree should understand the nurse manager’s role in healthcare. The leading DNP programs, including the online DNP program at Duquesne University , provide learning opportunities for RNs to make smooth transitions to management.

Nursing and management experts say there are practical tips for becoming an effective DNP-educated nurse manager:

1. Keep communication open and honest

Poor communication has been linked to preventable medical errors, nurse turnover, and low morale. In turn, low morale leads to high levels of stress, low job satisfaction, and reduced quality of life, Kathleen A. Vertino said in the Online Journal of Issues in Nursing .

New managers should understand what is essential to the staff and provide feedback. Managers should also seek input from superiors and staff nurses for a greater understanding of organizational needs. Key components of communication include:

Using active listening skills
Practicing positive body language
Paraphrasing comments for clarity
Avoiding negative messages

“The manager can no longer give orders and respond in an authoritative manner and get results,” Charlotte Eliopoulos, executive director of the American Association for Long Term Care Nursing, said. ‘In addition to assuring work gets completed, the manager must nurture a satisfied workforce.”

2. Expand critical thinking skills

Nurse managers are expected to make decisions and solve problems as part of the job. Critical thinking — analysis, evaluation, inference, problem-solving, and deductive reasoning — play an important role in making decisions and solving problems.

Indeed, nurses utilize critical thinking skills in their daily practice. One study showed strong critical thinking skills could also impact a unit as a whole. A study in the Journal of Nursing Scholarship found nurse managers who have robust critical thinking skills help create positive work environments. As a result, staff nurses deliver better care.

3. Be a visionary

Don’t be afraid to take measured chances, Janet Henriksen said in a Nursing Management article. Nurse managers should be able to express their vision to guide change and outline a plan to achieve action.

Self-awareness, the ability to understand one’s personal strengths and weaknesses, and emotional intelligence, or being able to read and understand others’ emotions, is essential to becoming a successful visionary. Nurses who possess both skills are committed to an overall vision rather than self-interests, Henriksen said in an article titled “An alternative approach to nurse manager leadership.”

“They challenge the status quo, listen and encourage others, and engage in a shared vision,” she said of visionary nurse managers.

4. Serve as a mentor and seek a mentor

Mentors provide important guidance for both new nurses and managers. Serving as a mentor allows nurse managers to impart their personal experiences to new staff nurses. Working with a mentor provides nurse managers with guidance on the transition from nurse to nurse manager, Dr. Lisa M. Aldisert said in Becker’s Hospital Review.

5. Set the tone

In 2017, research from the independent patient satisfaction firm Press Ganey found nurse leaders influence work environments, safety, quality, and patient outcomes. In its nursing special report, the company found that effective leadership helps organizations make improvements in all areas.

Researchers also found effective nurse leaders provide transformational leadership, which encourages greater nurse autonomy and professional development opportunities. When nurse leaders use appropriate staffing and teamwork, patient outcomes are positively affected.

6. Embrace education

A DNP education prepares RNs for the rigors of working as a nurse manager. The leading programs help nurse leaders tackle all of the challenges that come with management, including understanding the role of business and finance and assisting in creating healthcare policy.

Even after graduation, nurse leaders are encouraged to seek continuing education opportunities for future growth. The most successful nurse managers continually explore their roles in healthcare and work to better themselves.

Additional Tips for Nurse Manager Success

RNs who have transitioned to leadership roles say some of the best advice is also the most practical:

Learn time management: The nurse manager’s position includes added responsibilities and demands. Time management is essential to getting the job done.
Recognize potential problems: Conflict is an inevitable part of life, but so is resolution. Determine the causes of conflict and address them quickly.
Take ownership for mistakes: Every new leader makes mistakes, but blaming others and denying wrongdoing only fosters alienation.
Learn from mistakes: Advancing to a leadership position means you have the skill to succeed. Ask the right questions and seek answers.

The skill to succeed comes as a result of earning a degree through the leading online DNP program at Duquesne University. Through the university’s DNP program, students have an opportunity to earn an advanced doctoral degree in one of three specialized areas of study: Transcultural Nursing, Forensic Nursing, or Nursing Education.

About Duquesne University’s Online DNP Program

Duquesne University’s online Online Doctor of Nursing Practice program prepares RNs for leadership roles in hospitals, medical centers, and other healthcare facilities. With a DNP degree, nurses can lead teams to make positive changes in healthcare. Duquesne University’s online DNP program provides one-on-one faculty mentorships and a 100 percent online curriculum. For more information, contact Duquesne University now.

Additional Reading:

Duquesne University Blog, “Why You Should Earn Your Doctor Of Nursing Practice (DNP) Online” Duquesne University Blog, “Doctor Nurse Practitioners Influencing Health Care Policy ”

Nursing Management, “An alternative approach to nurse manager leadership” Huron, “If I Knew Then What I Know Now: Advice For Nurse Leaders From A Former CNO” The Online Journal of Issues in Nursing, “Effective Interpersonal Communication: A Practical Guide to Improve Your Life” Nursing Management, “Tips for the novice manager” American Association for Long Term Care Nursing, “Coaching and Communication with a Diverse Workforce” Journal of Nursing Scholarship, “Critical thinking of nurse managers related to staff RNs’ perceptions of the practice environment” Becker’s Hospital Review, “3 Ways to help nurse managers transition into leadership” Industry Edge, “2017 Nursing Special Report: The Pivotal Role of Nurse Managers” American Organization of Nurse Executives, Key competencies

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Problem Solving in Nursing Management

Dive deep into the multifaceted world of nursing management with a special focus on problem-solving. This comprehensive guide presents a detailed look at the process, importance, and challenges of problem-solving in nursing management. By highlighting essential skills, neurologically based frameworks, and the relationship with decision-making, it offers both theoretical understanding and practical solutions. Explore real-life case studies, leadership's role, and the link with critical thinking. This is an enriching journey towards developing strategic competencies and achieving effective problem-solving in a vital healthcare sector.

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Understanding Problem Solving in Nursing Management

Problem solving in nursing management is a crucial process that you need to grasp as a prospective or current nurse. This involves using a logical, systematic approach to resolving issues encountered in a nursing environment, focusing on maintaining quality patient care .

Problem Solving: This is identifying and overcoming obstacles to achieving a goal. In nursing, this generally revolves around improving patient health outcomes and ensuring efficient healthcare facility operations.

Importance of Problem Solving in Nursing Management

Nursing professionals are constantly faced with intricate issues that require decisive and effective solutions. The ability to implement problem-solving is crucial in maintaining optimal patient care , operational efficiency , and fostering team collaboration.

For instance, suppose a sudden shortage of resources like catheters or syringes is experienced in a healthcare facility. In such a case, the nursing manager will need to swiftly solve the problem either by reallocating resources, timely ordering supplies, or finding a temporary alternative, ensuring the patients' needs are continually met.

Key Skills Required for Problem Solving in Nursing Management

Effective problem-solving in nursing management is anchored on a set of key skills. These abilities equip you to navigate complex situations and formulate impactful solutions. They include:

Critical Thinking: This is your ability to analyse situations in detail and understand their implications.
Decisiveness: The readiness to make important decisions swiftly and confidently.
Communication: Sharing and receiving information clearly and effectively.
Collaboration: Working effectively as part of a team.

These skills are interconnected. For example, your ability to think critically informs your decisiveness. Your decisions are then made clear to your team through effective communication, and together, through collaboration, the problem is solved.

Common Challenges in Problem Solving in Nursing Management

In your nursing management journey, you will come across multiple challenges when attempting to solve problems. These obstacles might occur due to several factors, such as resource limitations, personnel issues, and complex patient needs .


Resource Constraints	Shortage of essential medical supplies or understaffing.
Personnel Issues	Conflicts among team members or unforeseen absence of staff.
Complex	Patients with rare medical conditions that require specialized care.

While these challenges can be daunting, equipping yourself with robust problem-solving skills will help you navigate these complications and maintain high standards of patient care.

Scrutinising the Problem Solving Process in Nursing Management

Delving deeper into the problem-solving process in nursing management, you get to navigate its intricacies and mechanisms. This exploration can bolster your abilities to resolve complex situations in your nursing career.

Steps involved in the Problem Solving Process

Problem-solving in nursing management is a multifaceted task that often involves several steps. To understand how to tackle issues expertly, you will need a clear understanding of each stage.

Problem-Solving Process: A systematic approach used to address complications and make decisions. In nursing, it’s composed of several steps, each essential to the resolution of issues.

Here are the key steps:

Identification: In this stage, you recognise the existence of a problem. It is essential to understand the barriers to your goals and spotlight areas that require improvement.
Definition: You clearly articulate the problem. By understanding its nuances, magnitude, and implications, you can efficiently tailor a solution.
Analysis: This involves examining the problem closely from different perspectives, which includes understanding the cause and effect, stakeholders involved, and potential impacts.
Development of Solutions: Here you brainstorm possible solutions. It's essential to contemplate multiple alternatives to ensure the most effective resolution is chosen.
Decision Making: In this step, you select the best solution based on the gathered information and analysis. Considerations may include effectiveness, resources needed, and potential side effects.
Implementation: You put the chosen solution into action, carefully monitoring its effectiveness and making necessary adjustments.
Evaluation: Finally, you assess the outcome. This helps to determine the effectiveness of your solution and informs future problem-solving efforts.

Neurological Framework for Problem Solving in Nursing Management

Many problem-solving methods exist, but one valuable perspective is through understanding the neurological framework in nursing management. This biological approach delves into how your brain processes information and develops solutions.

Neurological Framework: A biological perspective that explains how a nurse's brain processes, analyses, and responds to problems encountered in the nursing environment.

This framework refers to cognitive processes which involve:

Critical thinking: This involves actively and skillfully conceptualising, applying, analysing, and evaluating information gathered from observation, experience, reflection, or communication.
Decision making: This is the cognitive process of selecting a course of action from multiple possibilities. It's based on both intuition and logical reasoning.
Problem-solving: This involves overcoming hurdles and finding a conclusion, and it usually includes decision-making. It involves creativity and critical thinking to arrive at effective solutions.

Role of Creativity in the Problem Solving Process

Nursing management often involves complex and unique problems. To effectively tackle these challenges, it's crucial to breed creativity in the problem-solving process.

Imagine there's a sudden surge in patient intake due to a local health crisis, resulting in a bed shortage. A creative solution might be to convert other non-critical spaces such as conference rooms temporarily into patient monitoring units, thereby managing the surge effectively.

Importance of Team Collaboration in the Problem Solving Process

In a nursing environment, you are not working in isolation. Collaboration is a critical aspect of problem-solving in nursing management, as diverse insights can lead to innovative and effective solutions.

Consider a scenario where there's a need to implement a new system for managing patient records. To effectively solve potential issues in system implementation, you might need input from various team members including nursing staff, IT specialists, and data management experts. Each member's contribution, based on their expertise and perspective, is crucial in charting a comprehensive problem-solving strategy, ensuring the successful implementation and integration of the new system.

Decision Making and Problem Solving in Nursing Management

Decision making and problem-solving are two interconnected aspects in the realm of nursing management. Understanding their correlation and distinctiveness is key to effectively managing issues and improving patient outcomes in a healthcare setting.

The Interplay between Decision Making and Problem Solving

The connection between decision making and problem solving in nursing management is truly significant. In almost every situation where a problem arises, decision making is an inseparable component of the problem-solving process.

Decision Making in Nursing: This involves selecting a course of action from different alternatives. It is the bridge connecting problem analysis with implementing solutions, and it requires evaluation of information, predicaments, and possible outcomes.

Once you have identified and defined a problem, analysed it, and developed potential solutions, the next step involves decision making. This is where you select the most suitable solution among the alternatives.

For instance, if you are dealing with a bed shortage problem in your healthcare facility, some possible solutions could be outsourcing to other healthcare facilities, using other spaces such as conference rooms as makeshift wards, or deploying portable hospital beds.

Each of these solutions has its pros and cons, and it's here that decision-making skills come into play. You'll need to compare and contrast each option, considering factors like cost, time, resources available, and the overall impact on patient care. The chosen solution is then implemented, and the effects are evaluated for future reference.

Distinguishing Decision Making from Problem Solving in Nursing Management

Though inherently connected, problem solving and decision making are distinct processes within nursing management. Where problem-solving is a comprehensive process that entails identifying, analysing, and solving issues, decision making is a component nested within this process, acting as the transition point from analysis to action.

Problem Solving in Nursing: This is a broader process involving the identification of an issue or obstacle, systematic analysis to understand it, devising potential solutions, choosing the most suitable through decision making, implementing it, and finally reviewing the effectiveness of the implemented solution.

Consider a real-life scenario such as medication errors. If these errors are occurring frequently in your healthcare setup, the problem-solving process will involve identifying the issue (increased medication errors), defining and analysing it (finding the root causes, such as miscommunication or system glitches). This would then lead to brainstorming potential solutions, like improved communication systems or enhanced employee training. The decision-making process would then come into play when choosing the best solution to implement.

Techniques for Effective Decision Making in Problem Solving Scenarios

Effective decision making underpins successful problem solving in nursing management. Implementing the right techniques can enhance your decision-making process, thus leading to more effective problem resolution.

Some proven techniques include:

Pros and Cons Analysis: List the advantages and disadvantages of each solution to help you visualise the impacts of each decision.
Decision Matrix: Establish criteria and rate potential solutions. The choice with the highest score is then considered the best decision.
Cost-Benefit Analysis: Determine the financial implication of each decision and compare it to the benefits. Solutions with a high benefit-cost ratio are preferred.

Working collaboratively to brainstorm and analyse solutions promotes critical thinking and creativity, ensuring that the chosen solution maximises the use of resources and improves patient outcomes .

In unavoidable circumstances where decisions have to be made rapidly and with limited information, using intuition, a nurse's experience, and insights combined with analytical thinking can be beneficial. This is where the balanced blend of clinical expertise and effective risk-taking come into play.

Decision making is never static in nursing management. The cyclic nature of the decision-making process, where outcomes of decisions are continually assessed and feedback is used to improve future decision making, showcases its dynamic and iterative nature. This reinforces the vital role decision making plays in the problem-solving process.

Unpacking Examples of Problem Solving in Nursing Management

By exploring various examples and case studies, you gain a practical view of problem-solving in nursing management. These insights can better equip you to tackle real-life challenges in a healthcare setting.

Case Study Analysis of Problem Solving Scenarios

Case studies provide a thorough view of how problem-solving strategies are applied in various nursing management scenarios. Analysing such cases exposes you to diverse methods and solutions and encourages you to think critically and innovatively.

Case Study Analysis: A detailed examination of a particular instance or event to draw conclusions, develop solutions, or learn from the situation.

Let's investigate a case concerning patient waiting times. In a healthcare facility, it is observed that patients often have to wait for prolonged periods to receive care, leading to dissatisfaction and affecting the overall quality of service. The problem-solving steps might look like this:

Identification and Definition: The problem is identified as long patient waiting times. It is defined as patients waiting more than 45 minutes to receive care.
Analysis: The cause of the problem is found to be a shortage of nursing staff during peak hours.
Development of Solutions: Several possible solutions emerge, such as recruiting additional staff, offering overtime to existing staff, or streamlining operational processes to reduce inefficiencies.
Decision Making: After careful analysis, it is decided to hire additional part-time staff to handle peak hours.
Implementation: The recruitment process is initiated and new members integrated into the team.
Evaluation: After a few months, waiting times are reassessed. A significant reduction is observed, confirming the effectiveness of the solution.

Case study analysis provides a rich source of knowledge and transferable insights that can be helpful in similar or entirely different scenarios. Drawing parallels from varying contexts and understanding how solutions are adapted to unique situations helps bolster your problem-solving skills and adaptability in nursing management.

Varied Approaches to Problem Solving in Different Nursing Scenarios

Different nursing scenarios call for diverse problem-solving strategies. Understanding the varying approaches, from algorithm-based to intuition-driven, equips you to manage multidimensional and intricate issues effectively.

Algorithm-based Approach: This involves following a clearly defined set of rules or procedures to solve a problem. It can be applicable in situations with defined parameters and scope, such as diagnosing a health condition based on a specific set of symptoms.

Intuition-driven Approach: This combines a nurse's experience, knowledge, and instinct to solve a problem. It applies to ambiguous scenarios where conventional rules may not be applicable, such as managing a patient's fear or anxiety.

Problem-solving in nursing management is all about adapting to the environment and the situation. The right approach may vary, calling for flexibility, creativity, critical thinking, and a deep understanding of the issue for successful resolution.

Real Life Applications of Problem Solving Strategies in Nursing Management

The real world of nursing is complex and dynamic, and various problem-solving strategies can apply on any given day. To navigate smoothly, you need to understand how the various approaches can be adapted to specific situations.

Consider solving a recurrent communication issue within your nursing team. The algorithmic approach might involve establishing clear communication protocols or using digital tools to streamline interaction. However, the intuition-driven approach might involve informal team-building meetings to foster better personal connections. In this situation, the best solution might be a blend of the two approaches to ensure both procedural clarity and improved team relationships.

The key takeaway here is that there is no "one-size-fits-all" solution in nursing management. Problem-solving requires flexibility, openness, and the ability to judge which strategy will perform best in a particular scenario.

Exploring Nursing Management Problem-Solving Strategies

Problem-solving strategies in nursing management form the backbone of effective healthcare services. By ensuring that nursing personnel can tackle issues with aplomb and proficiency, these strategies contribute significantly to patient satisfaction and positive outcomes.

Development of Strategic Problem-Solving Competencies

The first step towards demystifying problem-solving processes in nursing management is the development of strategic problem-solving competencies. The journey from novice to expert involves honing these skills and integrating them into your practical work.

Strategic Problem-Solving Competencies: These are a set of core skills that facilitate effective problem-solving in nursing management, including critical thinking, innovative thinking, collaboration, adaptability, leadership, and decision-making.

Acquiring these skills involves both academic learning and practical experiences. Gaining theoretical knowledge lays the foundation, while integrating this knowledge within a clinical context enriches and refines these competencies.

Critical Thinking: This involves analysing situations from multiple perspectives, evaluating different solutions, and making informed decisions.
Innovative Thinking: Innovative thinking pertains to thinking outside the box, especially when conventional solutions are inadequate.
Collaboration: In nursing, effective problem-solving often requires collaborative efforts, valuing diverse ideas and working towards common goals.
Adaptability: Healthcare settings are continually changing, and the ability to swiftly adapt to new situations is crucial.
Leadership: Good leadership skills facilitate effective management of teams and ensuring that everyone is following the established problem-solving process.
Decision Making: Ability to implement effective decisions is vital for successful problem solving.

Role of Leadership in Implementing Problem Solving Strategies

The role of leadership in implementing problem-solving strategies must not be understated. Effective leadership not only guides teams through problem-solving processes but also fosters a supportive environment where team members feel safe to contribute ideas and question assumptions.

Leadership in Nursing: This involves guiding, motivating, and supporting nursing staff to deliver quality healthcare services. Also, it encompasses enhancing team cooperation, improving communication, and fostering a culture of continuous learning.

Leadership employs a variety of approaches in implementing problem-solving strategies. Different leadership styles can be applied based on the nature of the problem and the team dynamics. Transformational leadership, for instance, inspires others to exceed their personal goals and work for a collective purpose. On the other hand, participative leadership encourages open discussions and collective decision-making, promoting a more inclusive and democratic problem-solving process.

Leadership is also instrumental in creating an environment that encourages the sharing of problems openly, without fear of judgment, hence facilitating early identification and efficient resolution of issues. By also ensuring that learning opportunities are provided to enhance team problem-solving capabilities, leadership positively influences problem-solving outcomes.

Use of Resources in Problem Solving Strategies

Effective resource utilization is a critical component of successful problem-solving strategies in nursing management. The term 'resources' in this context includes human resources such as nursing staff and doctors, as well as material resources like medical supplies, equipment, and facilities.

Resource Utilisation: This refers to the efficient and effective use of available resources to achieve desired outcomes. In nursing, it involves ensuring that staff, equipment, and supplies are optimally used to deliver quality healthcare services and solve arising problems.

Problem-solving often necessitates the optimal use of available resources. For example, if there is an issue of high patient-to-nurse ratio, one of the possible solutions could be redistributing nursing staff according to workload and patient needs, or hiring additional staff if finances permit.

Every solution should be weighed based on its resource implications. The best solution is often the one that optimally utilises available resources to provide the maximum benefit. For example, while hiring additional staff might solve the problem, it might not be the best solution if the budget is very limited. In such a case, reallocation of existing staff may be a more practical solution.

Similarly, if there is a shortage of a particular supply, then alternatives may need to be sought, or rationing implemented. A critical analysis of such situations is necessary to ensure that the solutions proposed and implemented do not create other problems related to resource allocation and use.

It's also important to remember to continuously evaluate the impact of your solutions on resource utilisation. This will not only help you ensure sustainable use of resources but also contribute to continuous improvement in problem-solving strategies.

Understanding the stages of problem-solving in nursing practice is fundamental to addressing various challenges that arise in the healthcare sector. These problem-solving stages enable you to identify issues, create and implement solutions, and review the outcomes for improvement purposes.

Initial Assessment and Identification: The First Stage of Problem Solving

The initial phase of problem-solving in nursing management involves the assessment and identification of the issue at hand. This stage is critical as the correct identification of the problem lays the foundation for effective solution design and implementation.

Initial Assessment: This is the preliminary evaluation of the situation, leading to the recognition of existing problems. This stage involves observation, questioning, and data gathering to understand the issue better.

This initial step requires keen observation skills and critical thinking. While observation helps in gathering relevant details, critical thinking enables you to scrutinize this information and identify potential problems. You could also use feedback from your team and other relevant stakeholders to gain a comprehensive understanding of the issue.

For instance, suppose you discover unusually high levels of patient discomfort during specific hours. The initial assessment might involve examining patient records during these hours, observing nursing practices in these time frames, and seeking feedback from both patients and nursing staff. This comprehensive approach could potentially reveal the issue, like a shortage of staff during peak hours, leading to delayed or inefficient care.

Formulating Actionable Solutions: The Mid Stages of the Problem-solving Process

Once the problem is identified, the next phase is generating actionable solutions. The validity and effectiveness of these solutions significantly influence the problem-solving process's success, thus necessitating careful deliberation and thorough evaluation.

Actionable Solution: A practical, feasible strategy that can be implemented to resolve the problem. It's typically developed through brainstorming, analysis, and evaluation of various alternatives.

The process of formulating actionable solutions involves brainstorming potential remedies, evaluating these against a set criteria, and choosing the most viable option. Ideally, this should be a collaborative effort involving all relevant stakeholders. Collaborative problem-solving encourages diversity in ideas and promotes inclusivity.

Careful Analysis	Evaluation Against Set Criteria	Choosing Viable Option
Gather as many potential solutions as possible through brainstorming sessions	Evaluate potential solutions based on criteria such as feasibility, efficiency, and impact	The most suitable solution is chosen after careful evaluation

Innovation is a key driver in formulating actionable solutions. Traditional problem-solving methods might fail in the face of complex or unique problems, necessitating innovative ideas. Remember, the most effective solutions often result from 'thinking outside the box'.

Evaluation and Reflection: The Final Stage of Problem Solving

The final stage of problem-solving is evaluation and reflection. After implementing the chosen solution, it is essential to assess its effectiveness in solving the identified problem. This stage offers an opportunity to learn from the implemented action and make necessary adjustments for future improvement.

Evaluation and Reflection: This stage involves reviewing the implemented solution to assess its effectiveness. Reflection involves learning from the process and experiences to ensure continuous improvement.

To achieve meaningful evaluation and reflection, a systematic approach must be adopted. Begin with the assessment of the effect of the solution on the original problem. Have the waiting times reduced following the staff adjustments? Is there an improved level of patient comfort? These are the kind of questions you need to address.

Following the evaluation, it's crucial to reflect on the entire process. Consider what worked well and what didn't. Reflecting on these experiences offers valuable insights that can be used to improve future problem-solving processes.

Take the earlier example of high levels of patient discomfort due to staff shortage during peak hours. Suppose, after implementing the solution of adjusting staff schedules, you find that there's a significant improvement in patient comfort levels. This shows that your solution worked. However, during reflection, you realise that the process took more time than necessary due to delayed decision-making. For future improvement, you could consider setting specific timelines for each stage of the problem-solving process.

In conclusion, problem-solving is a cyclical process. It doesn't end with implementing a solution; instead, it opens doors for continuous learning and improvement. Adapting to this cycle is key to honing your problem-solving proficiency in nursing management.

Critical Thinking and Problem Solving in Nursing

Problem solving in nursing management is underpinned by the practice of critical thinking. An understanding of the delicate interplay between these two capabilities is central to the enhancement of nursing management and the ultimate delivery of efficient patient care.

The Connection Between Critical Thinking and Problem Solving in Nursing

There is a strong relationship between critical thinking and problem solving in nursing, evidenced by the significant role each plays in the healthcare sector. Critical thinking provides the foundation upon which problem-solving strategies are built.

Critical Thinking: This is the disciplined process of analysing, interpreting, evaluating, and drawing conclusions from varying levels of data, information or experiences. It involves a deeper level of thinking to understand, evaluate and resolve complex issues or situations.

The process of problem-solving often begins with an evaluation of the situation, gathering data, appraising the data, and coming with strategic solutions. By applying critical thinking, you can get a clear understanding of the problem, which helps devise more effective solutions.

For example, in implementing new protocols in a nursing unit, critical thinking may involve evaluating the necessity of the change, the potential effect on the nursing staff’s workflow, and patient care. The ability to think critically facilitates well-informed decisions, thereby enhancing the problem-solving process.

Beyond problem identification and solution generation, critical thinking is also instrumental in the review phase of the problem-solving process. It allows you to reflect on the effectiveness of implemented solutions, the overall process, and areas that could be improved. Therefore, the integration of critical thinking not only enriches problem-solving but also contributes to continuous learning and improvement in nursing management.

Enhancing Critical Thinking for Effective Problem Solving in Nursing Management

Enhancing critical thinking skills in the nursing workforce enriches problem-solving efforts and ultimately results in improved patient outcomes and service delivery. This strengthening could be achieved through several strategies.

Enhancing Critical Thinking: The process of improving critical thinking skills to enhance one's ability to evaluate complex situations effectively and make informed decisions.

Firstly, continuous learning and professional development activities such as workshops, seminars, and online courses can provide essential tools for sharpening critical thinking skills.

Secondly, fostering a culture of open communication and collaborative problem-solving offers great benefits. These platforms facilitate the sharing of diverse perspectives, promoting deep analyses, and enriching the problem-solving process.

Lastly, reflective practice can also positively impact critical thinking abilities. Regular reflection on your practice, experiences, and learnings enables you to identify gaps in your thinking and areas of improvement. It encourages a deeper level of thinking that enriches the problem-solving process.

Continuous learning and participation in professional development activities.
Fostering a culture of open communication and collaborative problem-solving.
Engaging in reflective practice regularly.

Examples of Critical Thinking Leading to Effective Problem Solving

The application of critical thinking skills often results in improved problem-solving outcomes in nursing management. Several instances illustrate this relationship.

For instance, consider a situation where a nursing unit has seen a significant increase in medication errors. The nursing manager applies critical thinking to evaluate the situation, identify potential causes, and devise solutions. Through an in-depth review of pharmaceutical administration procedures, team collaboration, discussion, and data evaluation, the nursing manager identifies the root cause - an overly complicated method of logging medication.

Armed with this information, they innovate a simpler, more effective system. By cutting down on needless complexity, the nursing unit sees a drastic decrease in medication errors. This example shows how the application of critical thinking streamlined a complex process, providing an effective solution to the problem at hand.

Another instance could be changing patient demographics, with more elderly patients requiring care. A nursing manager applies critical thinking to understand the unique needs of these patients and the potential challenges that might arise in catering to these needs. As a result, they develop tailored care plans and training programmes for the nursing staff to better care for elderly patients, resulting in improved patient satisfaction.

These examples highlight how critical thinking can lead to effective problem solving in nursing management, ultimately resulting in better service delivery and patient care. Therefore, enhancing critical thinking should be seen as a vital strategy for improving problem-solving proficiency in nursing management.

Problem Solving in Nursing Management - Key takeaways

Problem Solving in Nursing Management: It is a thorough process involving the identification, analysis, and (de)cision-making to solve issues in nursing management. It also includes implementation and review of the effectiveness of the solutions.
Decision Making Techniques: Different techniques such as Pros and Cons Analysis, Decision Matrix, and Cost-Benefit Analysis can enhance the decision-making process in problem-solving scenarios.
Case Study Analysis: It involves the detailed examination of various scenarios to inform problem-solving strategies and practice.
Approaches to Problem-Solving: Different approaches may apply in different nursing scenarios, such as the algorithm-based approach for well-defined scenarios and the intuition-driven approach for ambiguous situations.
Strategic Problem-Solving Competencies: These are essential skills including critical thinking, innovative thinking, collaboration, adaptability, leadership, and decision-making, crucial in effective problem-solving.
Leadership in Nursing: Leadership plays a key role in guiding, motivating, and supporting nursing staff. It influences the successful implementation of problem-solving strategies.
Resource Utilisation: Efficient and effective use of available resources, such as nursing staff, equipment, and supplies, is vital in problem-solving in nursing management.
Stages of Problem Solving in Nursing Practice: The stages include the identification, analysis, and resolution of problems, which are crucial in responding to challenges in the healthcare sector.

Flashcards in Problem Solving in Nursing Management 14

What is the significance of problem-solving in nursing management?

Problem-solving in nursing management is crucial in maintaining optimal patient care, operational efficiency, and fostering team collaboration by resolving intricate issues with decisive and effective solutions.

What are the key skills required for effective problem-solving in nursing management?

The key skills required are critical thinking, decisiveness, communication, and collaboration. Each skill is interconnected and helps in formulating impactful solutions.

What are the key steps involved in the problem-solving process in nursing management?

The key steps are identification, definition, analysis, development of solutions, decision making, implementation, and evaluation.

What does the neurological framework in nursing management involve?

This framework involves cognitive processes such as critical thinking, decision making, and problem-solving.

What is decision making in nursing management?

This involves selecting a course of action from different alternatives. It acts as a bridge, connecting problem analysis with implementing solutions and requires evaluation of information, predicaments, and possible outcomes.

What is problem solving in nursing management and how is it different from decision making?

Problem solving is a broader process involving the identification of an issue, systematic analysis to understand it, devising potential solutions, choosing the most suitable through decision making, implementing it, and finally reviewing the effectiveness of the implemented solution. Decision making, on the other hand, is a component nested within this process.

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The perceived problem-solving ability of nurse managers

Affiliation.

1 Hacettepe University, School of Nursing, Ankara, Turkey. [email protected]
PMID: 16787468
DOI: 10.1111/j.1365-2934.2006.00551.x
J Nurs Manag. 2006 Oct;14(7):571

Study rationale: The development of a problem-solving approach to nursing has been one of the more important changes in nursing during the last decade. Nurse Managers need to have effective problem-solving and management skills to be able to decrease the cost of the health care and to increase the quality of care.

Study aim: This descriptive study was conducted to determine the perceived problem-solving ability of nurse managers.

Method: From a population of 87 nurse managers, 71 were selected using the stratified random sampling method, 62 nurse managers agreed to participate. Data were collected through a questionnaire including demographic information and a problem-solving inventory. The problem-solving inventory was developed by Heppner and Petersen in 1982, and validity and readability studies were done. It was adapted to Turkish by Sahin et al (1993). The acquired data have been evaluated on the software spss 10.0 programme, using percentages, mean values, one-way anova and t-test (independent samples t-test).

Results: Most of the nurses had 11 or more years of working experience (71%) and work as charge nurses in the clinics. It was determined that 69.4% of the nurse managers did not have any educational training in administration. The most encountered problems stated were issues related to managerial (30.6%) and professional staff (25.8%). It was identified that nurse managers who had received education about management, following scientific publication and scientific meeting and had followed management models, perceived their problem-resolving skills as more adequate than the others (P>0.05).

Conclusion: In this study, it was determined that nurses do not perceive that they have problem-solving skills at a desired level. In this context, it is extremely important that this subject be given an important place in both nursing education curriculum and continuing education programmes.

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Relationship Between the Problem-Solving Skills and Empathy Skills of Operating Room Nurses

AY, Fatma 1* ; POLAT, Şehrinaz; KASHIMI, Tennur

1 PhD, RN, Assistant Professor, Faculty of Health Sciences, Department of Midwifery, Istanbul University-Cerrahpaşa, Turkey

2 PhD, RN, Directorate of Nursing Services, Hospital of Faculty of Medicine, Istanbul University, Turkey

3 MS, RN, Director, Operating Room, Hospital of Faculty of Medicine, Istanbul University, Turkey.

Accepted for publication: January 21, 2019

*Address correspondence to: Fatma AY, No.25, Dr. Tevfik Saglam Street, Dr. Zuhuratbaba District, Bakirkoy, Istanbul 34147, Turkey. Tel: +90 212 4141500 ext. 40140; Fax: +90 212 4141515; E-mail: [email protected]

The authors declare no conflicts of interest.

Cite this article as: Ay, F., Polat, Ş., & Kashimi, T. (2019). Relationship between the problem-solving skills and empathy skills of operating room nurses. The Journal of Nursing Research , 28 (2), e75. https://doi.org/10.1097/jnr.0000000000000357

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background

The use of empathy in problem solving and communication is a focus of nursing practice and is of great significance in raising the quality of patient care.

Purpose

The purposes of this study are to investigate the relationship between problem solving and empathy among operating room nurses and to explore the factors that relate to these two competencies.

Methods

This is a cross-sectional, descriptive study. Study data were gathered using a personal information form, the Interpersonal Problem Solving Inventory, and the Basic Empathy Scale ( N = 80). Descriptive and comparative statistics were employed to evaluate the study data.

Results

Age, marital status, and career length were not found to affect the subscale scores of cognitive empathy ( p > .05). A negative correlation was found between the subscale scores for “diffidence” and “cognitive empathy.” Moreover, the emotional empathy scores of the graduate nurses were higher than those of the master's/doctorate degree nurses to a degree that approached significance ( p = .078). Furthermore, emotional empathy levels were found to decrease as the scores for insistent/persistent approach, lack of self-confidence, and educational level increased ( p < .05). The descriptive characteristics of the participating nurses were found not to affect their problem-solving skills.

Conclusions/Implications for Practice

Problem solving is a focus of nursing practice and of great importance for raising the quality of patient care. Constructive problem-solving skills affect cognitive empathy skills. Educational level and career length were found to relate negatively and level of self-confidence was found to relate positively with level of cognitive empathy. Finally, lower empathy scores were associated with difficult working conditions in operating rooms, intense stress, and high levels of potential stress-driven conflicts between workers in work settings.

Introduction

Healthcare institutions are where individuals seek remedies to their health problems. These institutions face problems, which relate to both employees and care recipients. These problems may occur spontaneously and require immediate solution. Moreover, these problems require that the preferred remedies be adapted to address the unique nature of both organizational circumstances and individual requirements. Therefore, it is important that nurses, who are a major component of the healthcare system, have problem-solving skills.

Operating rooms are complex, high-risk environments with intense levels of stress that require rapid judgment making and fast implementation of appropriate decisions to increase patients' chances of survival ( Kanan, 2011 ; Jeon, Lakanmaa, Meretoja, & Leino-Kilpi, 2017 ). Furthermore, aseptic principles may never be compromised, and a high level of coordination and cooperation among team members should be maintained in these areas ( Kanan, 2011 ; Sandelin & Gustafsson, 2015 ). The members of a surgical team may vary in the operating room ( Sandelin & Gustafsson, 2015 ; Sonoda, Onozuka, & Hagihara, 2018 ). Under these difficult conditions, time management and workload are important stress factors for nurses ( Happell et al., 2013 ; Suresh, Matthews, & Coyne, 2013 ). At the same time, operating room nurses are legally responsible for the nature and quality of the healthcare service received by patients before, during, and after their surgical intervention ( Kanan, 2011 ). The American Nurses Association defines a nurse as “the healthcare professional establishing, coordinating and administering the care while applying the nursing process in an aim to meet the identified physiological, psychological, sociocultural and spiritual needs of patients who are potentially at the risk of jeopardized protective reflexes or self-care ability because of surgery or invasive intervention” ( Association of periOperative Registered Nurses, 2015 ).

Problem solving is the most critical aspect of the nursing practice. The fact that nursing requires mental and abstract skills, such as identifying individual needs and finding appropriate remedies, was first stated in 1960s. In 1960s, the nursing theorists Abdellah, Orem, and Levin emphasized the mental aspect of nursing. They argued that the most critical requirement of nurses in the clinical field is the ability to decide on and plan the right action and that nursing care should be founded on a sound knowledge base ( Taşci, 2005 ).

The World Health Organization has stated that “taking measures and applying a problem-solving approach to provide appropriate care is one of the compulsory competencies of nurses” ( Taşci, 2005 ). Thus, enhancing the problem-solving skills of nurses is of great importance in raising the quality of patient care ( Taylor, 2000 ; Yu & Kirk, 2008 ). On the other hand, Bagnal (1981) argued that people with problem-solving skills need to be equipped with personal traits including innovation, clear manifestation of preferences and decisions, having a sense of responsibility, flexible thinking, courage and adventurousness, ability to show distinct ideas, self-confidence, a broad area of interest, acting rationally and objectively, creativity, productivity, and critical perspective (as cited in Çam & Tümkaya, 2008 ).

To provide the best surgical care to a patient, team members must work together effectively ( Sonoda et al., 2018 ). One of the most important factors affecting the quality of healthcare service delivery is effective communication between healthcare professionals and healthcare recipients, with empathy forming the basis for effective communication.

Because of the intrinsic nature of the nursing profession, nurses should have empathy skills. Thus, empathy is the essence of the nursing profession ( Fields et al., 2004 ; Vioulac, Aubree, Massy, & Untas, 2016 ). A review of resources in the literature on problem solving reveals that gathering problem-related data is the first major step toward determining the root causes of a problem. In this respect, empathy is an important skill that helps properly identify a problem. On the basis of the definition of empathy, sensing another person's feelings and thoughts and placing oneself in his or her position or feeling from within his or her frame of reference should work to improve one's problem-solving skills, particularly those skills related to social problem solving ( Taşci, 2005 ; Topçu, Baker, & Aydin, 2010 ; Vioulac et al., 2016 ). It is possible to explain empathic content emotionally as well as cognitively. Emotional empathy (EE) means feeling the emotions of another person and providing the most appropriate response based on his or her emotional state. This is very important in patient–nurse communications. Cognitive empathy (CE) is the ability to recognize the feelings of another without experiencing those feelings yourself ( de Kemp, Overbeek, de Wied, Engels, & Scholte, 2007 ).

Gender, age, level of education, marital status, years of work, duration working at current institution, and problem-solving situations have been shown in the literature not to affect the problem-solving or empathy skills of nurses ( Abaan & Altintoprak, 2005 ; Kelleci & Gölbaşi, 2004 ; Yu & Kirk, 2008 ). Empathy is especially critical to the quality of nursing care and is an essential component of any form of caring relationship. The findings in the literature regarding empathy among nurses are inconsistent ( Yu & Kirk, 2008 ), and no findings in the literature address the relationship between problem-solving skills and empathy skills in operating room nurses.

Today, the healthcare system demands that nurses use their professional knowledge to handle patient problems and needs in flexible and creative ways. Problem solving is a primary focus of the nursing practice and is of great importance to raising the quality of patient care ( Kelleci & Gölbaşi, 2004 ; Yu & Kirk, 2008 ). Enhancing the problem-solving and empathy skills of nurses may be expected to facilitate their identification of the sources of problems encountered during the delivery of healthcare services and their resolution of these problems.

The purposes of this study are to investigate the relationship between problem solving and empathy in operating room nurses and to explore the factors related to these two competencies.

Study Model and Hypotheses

This study is a cross-sectional and descriptive study. The three hypotheses regarding the relationships between the independent variables are as follows:

H1: Sociodemographic characteristics affect problem-solving skills.
H2: Sociodemographic characteristics affect level of empathy.
H3: Problem-solving skills are positively and significantly correlated with empathy.

Study Population and Sample

The study was conducted during the period of May–June 2015 at three hospitals affiliated with Istanbul University. The study population consisted of 121 nurses who were currently working in the operating rooms of these hospitals. The study sample consisted of the 80 nurses who volunteered to participate and answered all of the questions on the inventory.

Data Collection Tool

Study data were gathered using a personal information form, the Interpersonal Problem Solving Inventory (IPSI), and the Basic Empathy Scale.

Personal information form

This questionnaire, created by the researchers, is composed of 10 questions on the age, gender, educational background, organization and department, position, and organizational and professional functions of the respondent.

Interpersonal problem solving inventory

The IPSI, developed and validated by Çam and Tümkaya (2008) , was used in this study. The Cronbach's α internal consistency coefficients of the IPSI subscales were previously evaluated at between .67 and .91. The IPSI includes 50 items, all of which are scored on a 5-point Likert scale, with 1 = strictly inappropriate and 5 = fully appropriate . The lack of self-confidence (LSC) subscale assesses lack of confidence in problem solving. The constructive problem solving (CPS) subscale assesses emotions, thoughts, and behaviors that contribute to the effective and constructive solution of interpersonal problems. The negative approach to the problem subscale assesses intensely the negative emotions and thoughts such as helplessness, pessimism, and disappointment that are experienced when an interpersonal problem is encountered. The abstaining from responsibility subscale assesses failure to take responsibility for solving the problem. The persistent approach (PA) subscale assesses self-assertive/persistent thoughts and behaviors in solving problems encountered in interpersonal relationships. A high score on a subscale indicates a high interpersonal-problem-solving capability for that subscale category ( Çam & Tümkaya, 2008 ). A high score on the negative approach to the problem subscale indicates a higher likelihood of experiencing intense negative feelings and thoughts such as helplessness, pessimism, and sadness when encountering a problem. A high score on CPS indicates that the respondent will show more of the emotions, thoughts, and behaviors that contribute to the problem in an effective and constructive way. A low level of self-confidence indicates that the respondent will exhibit low self-confidence toward effectively resolving a problem. A high score on the abstaining from responsibility subscale indicates a high inclination to assume responsibility to resolve a problem ( Table 1 ). The high level of insistent approach indicates that the participant is more willing to solve problems ( Çam & Tümkaya, 2008 ). In this study, the Cronbach's α reliability coefficients were .901, .899, .763, .679, and .810, respectively.

Basic empathy skill scale

The Basic Empathy Skill Scale was developed by Jolliffe and Farrington (2006) and validated by Topçu et al. (2010) in Turkish. It is a 5-Likert scale (1 = s trictly disagree and 5 = strictly agree ) consisting of 20 items, of which nine measure CE and 11 measure EE. The Cronbach's α coefficients that were calculated for the reliability study range between .76 and .80. The lowest possible scores are 9 and 45 and the highest possible scores are 11 and 55 for the CE and EE subscales, respectively. A high score on the CE subscale indicates that the CE level is high, and a high score on the EE subscale indicates that the EE level is high ( Topçu et al., 2010 ). The two subscales of the Basic Empathy Skill Scale have been found to be highly reliable. The Cronbach's α reliability coefficients in this study were .782 for the CE subscale and .649 for the EE subscale.

Data Collection

The study was conducted between May and June 2015 at three hospitals affiliated with Istanbul University. The researcher explained the study to those nurses who agreed to participate. The questionnaire form was distributed to the participants, the purpose of the investigation was clarified, and permission to use participant data was obtained. The participants completed the questionnaire on their own, and the completed questionnaires were collected afterward. The time required to complete the questionnaire was 15–20 minutes in total.

Evaluation of Data

Number Cruncher Statistical System 2007 (Kaysville, UT, USA) software was used to perform statistical analysis. To compare the quantitative data, in addition to using descriptive statistical methods (mean, standard deviation, median, frequency, ratio, minimum, maximum), the Student t test was used to compare the parameters with the regular distribution in the two groups and the Mann–Whitney U test was used to compare the parameters without normal distribution in the two groups. In addition, a one-way analysis of variance test was used to compare three or more groups with normal distribution, and a Kruskal–Wallis test was used to compare three or more groups without normal distribution. Pearson's correlation analysis and Spearman's correlation analysis were used to evaluate the relationships among the parameters. Finally, linear regression analysis was employed to evaluate multivariate data. Significance was determined by a p value of < .05.

Ethical Considerations

Ethical conformity approval was obtained from the Non-Interventional Clinical Research Ethics Board at Istanbul Medipol University (108400987-165, issued on March 30, 2015). Written consent was obtained from the administrations of the participating hospitals. Furthermore, the informed consent of nurses who volunteered to participate was obtained. Permission to use the abovementioned scales that were used in this study as data collection tools was obtained via e-mail from their original authors.

Eighty nurses (97.5% female, n = 78; 2.5% male, n = 2) were enrolled as participants. The age of participants ranged between 24 and 64 (mean = 37.56 ± 8.12) years, mean years of professional nursing experience was 15.84 ± 8.30, and mean years working in the current hospital was 13.19 ± 8.23. Other descriptive characteristics for the participants are provided in Table 2 .

A comparison of scale subdimension scores revealed a negative and statistically significant correlation at a level of 22.3%. Statistical significance was reached only between the LSC subscale and the CE subscale ( r = −.223, p = .047; Table 3 ). Thus, a higher LSC score was associated with a lower CE score.

Comparisons between participants' descriptive characteristics and subdimension scores on the problem-solving skill scale revealed no significant differences. Thus, demographic characteristics such as age, educational background, and career length were found to have no influence on problem-solving skills ( p > .05; Table 4 ).

Age, marital status, and professional career length were not found to affect the CE and EE subscale scores, with no statistically significant correlations found between the two subscales ( p > .05; Table 4 ). However, the EE scores of undergraduate nurses were found to be higher than those of postgraduate nurses, at a level that approached statistical significance ( p = .078). In addition, the average CE scores of nurses who had worked for 1–10 and 11–20 years were higher than those of nurses who had worked for 21 years or more, at a level that approached statistical significance ( p = .066).

A statistically significant difference was found between mean years working in the current hospital and educational background, respectively, and CE scores ( p = .027 and p = .013; Table 4 ). On the basis of paired comparison analysis, the CE scores of participants with 1–10 years of working experience at their current hospital were higher than those with ≥ 21 years of working experience at their current hospital ( p = .027). Also on the basis of paired comparison analysis, the CE score of participants educated to the undergraduate level was found to be higher at a statistically significant level than those educated to the master's/doctorate degree level ( p = .013).

The comparison of problem-solving skill scores by descriptive characteristics revealed no statistically significant difference between subscale scores and the variables of age, marital status, length of professional and organizational career, or educational background ( p > .05). Thus, the descriptive characteristics of the participants did not affect their problem-solving skills.

Regression Analysis of Risk Factors Affecting Cognitive and Empathy Skills

Variables found after univariate analysis to have significance levels of p < .01 were subsequently modeled and evaluated. A regression analysis was conducted to determine the effect on CE skills of educational level, duration of institutional work, CPS level, and self-insecurity level. The explanatory power of this model was 29.9% ( R 2 = .299), and the model was significant ( p < .001). As a result of the analysis, CPS ( p = .006), educational status of graduate ( p < .001), and working for the current hospital for a period of more than 20 years ( p = .004) were found to have a significant and positive influence on the CE score.

A 1-unit increase in the CPS score was found to increase CE skills by 0.139 points (β = 0.139, 95% CI [0.041, 0.237], p < .01). For education, graduate education was found to decrease the CE score by 4.520 points (β = −4.520, 95% CI [−6.986, −2.054], p < .001). For duration working for the current hospital, working for the same institution for a period exceeding 20 years was found to decrease the CE score by 3.429 points (β = −3.429, 95% CI [−5.756, −1.102], p < .05). In addition, a 1-unit increase in the LSC score was found to decrease the CE score by 0.114 points, which did not achieve statistical significance (β = 0.114, 95% CI [−0.325, 0.096], p > .05).

Regression analysis was used to evaluate the effects of education, PA, and LSC on the risk factors affecting EE. As a result of this evaluation, the explanatory power of the model was determined as 15.3% ( R 2 = .153), which was significant despite the low level ( F = 3.388, p = .001). The effects of PA ( p = .021) and educational status ( p = .015) on the EE score were shown through analysis to be statistically significant ( Table 5 ). A 1-unit increase in PA score was found to increase the EE score by 0.323 points (β = 0.323, 95% CI [0.049, 0.596], p < .05). For education, having a graduate education was found to decrease the EE score by 3.989 points (β = −3.989, 95% CI [−7.193, −0.786], p < .05). Moreover, the LSC score was found to be 0.119 points lower than the EE score. However, this result was not statistically significant (β = −0.193, 95% CI [−0.467, 0.080], p > .05). Dummy variables were used in the regression analysis of sociodemographic characteristics (educational status and years working for the current hospital).

This study found that age, marital status, educational background, years of professional working experience, and years working for the current hospital did not affect the problem-solving skills of the participants. In the literature, the findings of several studies indicate that characteristics such as age, educational background, department of service, and career length do not affect the problem-solving skills of nurses ( Abaan & Altintoprak, 2005 ; Kelleci & Gölbaşi, 2004 ; Yu & Kirk, 2008 ), whereas other studies indicate that these variables do affect these skills ( Ançel, 2006 ; Watt-Watson, Garfinkel, Gallop, Stevens, & Streiner, 2000 ; Yu & Kirk, 2008 ). However, beyond these characteristics, some studies have reported a positive correlation between the problem-solving skills of nurses and their educational level, with this correlation mediated by the physical conditions of the workplace, good relationships with colleagues, and educational background ( Yildiz & Güven, 2009 ). These findings suggest that factors affecting the empathy and problem-solving skills of nurses working in operating rooms differ from known and expected factors.

Operating room nurses deliver dynamic nursing care that requires attention and close observation because of the fast turnover of patients. In addition to the problem-solving skills that they use during the patient care process, these nurses must use or operate a myriad of lifesaving technological devices and equipment ( AbuAlRub, 2004 ; Özgür, Yildirim, & Aktaş, 2008 ). The circumstances in which nurses employ their problem-solving skills are generally near-death critical conditions and emergencies. Furthermore, operating rooms are more isolated than other areas of the hospital, which affects nurses who work in operating rooms and intensive care units ( AbuAlRub, 2004 ; Özgür et al., 2008 ).

Communication is a critical factor that affects the delivery of healthcare services. Communication does not only take place between a service recipient and a provider. To establish a teamwork philosophy between employees, it is essential to build effective communication ( Sandelin & Gustafsson, 2015 ). Empathic communication helps enhance the problem-solving skills of nurses as they work to learn about individual experiences ( Kumcağiz, Yilmaz, Çelik, & Avci, 2011 ). Studies in the literature have found that nurses who are satisfied with their relationships with colleagues, physicians, and supervisors have a high level of problem-solving skills ( Abaan & Altintoprak, 2005 ; Kumcağiz et al., 2011 ) and that higher problem-solving skills are associated with a higher level of individual achievement ( Abaan & Altintoprak, 2005 ; Chan, 2001 ). Another finding of this study is that CPS increases the cognitive emphatic level. This may be attributed to constructive problem-solving skills increasing CE, as these skills are associated with feelings, thoughts, and behaviors that contribute to problem resolution.

A review of the literature on empathy and communication skills revealed, as expected, that these skills increased with level of education ( Kumcağiz et al., 2011 ; Vioulac et al., 2016 ). However, a number of studies have reported no significant correlation between age, marital status, and professional working experience and empathy skills or communication abilities in nurses ( Kumcağiz et al., 2011 ; Yu & Kirk, 2008 ).

EE is assumed to be a more intuitive reaction to emotions. Factors that affect EE are nurses working with small patient groups, frequent contact with patient groups, and long periods spent accompanying or being in close contact with patient groups ( Vioulac et al., 2016 ). Studies in the literature have reported no correlation between the empathy skills of nurses and demographic characteristics ( Vioulac et al., 2016 ). This study supports this finding, with the empathy skills of operating room nurses found to be close to the peak value of the scale.

Studies in the literature reveal a positive correlation between empathy and career length ( Watt-Watson et al., 2000 ; Yu & Kirk, 2008 ) as well as a correlation between increased professional experience and lower empathy ( Yu & Kirk, 2008 ). This study found an association between longer periods working for the same hospital and higher levels of education with lower empathy scores. This may be attributed to the difficult working conditions in operating rooms, intense stress, and high level of potential stress-driven conflicts between employees in work settings.

Stress is a major factor that affects the empathy skills and relationship-building abilities of nurses ( Vioulac et al., 2016 ). Nurses are exposed to a wide variety of stressors such as quality of the service, duration of shifts, workload, time pressures, and limited decision-making authority ( Patrick & Lavery, 2007 ; Shimizutani et al., 2008 ; Vioulac et al., 2016 ). In particular, environments evoking a sense of death (e.g., operating rooms) is another factor known to elevate perceived stress ( Ashker, Penprase, & Salman, 2012 ). High stress may lead to negative consequences such as reduced problem-solving abilities ( Zhao, Lei, He, Gu, & Li, 2015 ). Both having a long nursing career and working in stressful environments such as operating rooms may negatively affect empathy and problem-solving skills. However, this study revealed that working for a long period at the current hospital had no influence on problem-solving skills. The low reliability of the scales means that the variance may be high in other samples that are drawn from the same main sample, with the resultant data thus not reflecting the truth.

Low reliability coefficients reduce the significance and value of the results obtained by increasing the standard error of the data ( Şencan, 2005 ). The Cronbach's α of the EE scale used in the study was between .60 and .80 and is highly trustworthy. However, the Cronbach's α value is close to .60 (i.e., .649). This result may elicit suspicion in regression analysis estimates that are done to determine the variables that affect EE. In the correlation analysis, a statistically significant weak correlation was found only between the LSC subdimension and CE. However, the fact that the subscales of empathy and problem-solving skills are significantly related to the regression models may also be related to the reliability levels of the scales.

According to the results of the regression analysis, all of the variables remaining in Model A affected level of low for the CE ( R 2 = .299). Having constructive problem-solving skills ( p = .006), having a high level of education ( p < .001), and working for the current hospital for over 20 years ( p = .004) were found to be significantly related to CE.

Other variables were found to have no significant effect. According to the results of the regression analysis, all of the remaining variables in Model B accounted for a relatively low portion of the EE ( R 2 = .153). When the t test results for the significance of the regression coefficients were examined, it was determined that PA ( p = .021) and educational status ( p = .015) were significant predictors of EE. Other variables had no significant effect ( Table 5 ). The increase in the level of education of nurses may have increased their cognitive and emotional development. Thus, working in the same hospital for over 20 years was found to increase the levels of CE and EE. This result may be because of greater professional experience and regular experience handling numerous, different problems. In addition, the low explanatory power of the models may also be because of the fact that many other arguments that may affect empathy were not modeled. When constant values are fixed and the value of the independent variables entering the regression formula is zero, constant value is the estimated value of the dependent variable. According to findings of this study, sociodemographic characteristics and problem-solving abilities did not affect empathy level, although the CE value was 31.707 and the EE value was 37.024. Repeating this research in larger and different nurse groups may be useful to verify these research results.

Conclusions

The following results were derived from this study: First, constructive problem-solving skills affect CE skills. EE is adversely affected by the PA and LSC. Second, no correlation was found between the demographic characteristics of nurses and their problem-solving skills. Third, as level of education increases, cognitive and emotional levels of empathy decrease.

Duration of time spent working at one's current healthcare institution and educational level were both found to correlate negatively with the CE score. The higher the educational level and PA and the lower the self-confidence of the participants, the lower their EE levels. Finally, higher constructive problem-solving scores were associated with higher CE skills.

Limitations

The major limitation of the study is that it was conducted in the affiliated hospitals of one healthcare organization. The study data were obtained from operating room nurses who currently worked in these hospitals and who volunteered to participate. The conditions of nurses who did not participate in the study cannot be ascertained. A second important limitation is that the data reflect the subjective perceptions and statements of the participants. A third important limitation is that participant characteristics such as trust in management, trust in the institution, burnout, and communication skills were not assessed. For this reason, the effects of these variables on problem-solving and empathy skills remain unknown.

Author Contributions

Study conception and design: SP

Data collection: TK

Data analysis and interpretation: FA, SP

Drafting of the article: FA

Critical revision of the article: FA

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operating room; critical thinking; surgery; cognitive; emotional

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Factors Influencing Problem-Solving Competence of Nursing Students: A Cross-Sectional Study

Eunhee choi.

1 Department of Nursing, Korean Bible University, 32 Dongil-ro(st) 214-gil, Nowon-gu, Seoul 01757, Korea; moc.revan@1029iohci

Jaehee Jeon

2 Department of Nursing, Gangneung-Wonju National University, Gangneung-si 26403, Korea

Associated Data

Not applicable.

Problem-solving ability is an important competency for nursing students to enable them to solve various problems that occur in dynamic clinical settings. The purpose of this cross-sectional study was to identify the factors that affect the problem-solving ability of nursing students. The subjects of this study were 192 nursing college students in their second year or beyond. The research tool consisted of an online questionnaire, with a total of 91 items regarding general characteristics, metacognition, and communication competence. Data collection was conducted from 10 to 30 March 2022. An online survey link was uploaded to the student group of a social network service from two nursing colleges that permitted data collection. Subjects who agreed to participate directly accessed and responded to the online survey. The collected data were analyzed using descriptive statistics, and the factors associated with the problem-solving ability of nursing students were examined using hierarchical multiple regression analysis. The subjects’ mean problem-solving ability score was 3.63 out of 5. Factors affecting problem-solving ability were age, communication competence, and metacognition, among which metacognition had the greatest influence. These variables explained 51.2% of the problem-solving ability of nursing students. Thus, it is necessary to provide guidance to improve metacognition and to develop educational methods to improve communication competence in curricular and non-curricular courses to improve the problem-solving ability of nursing students.

1. Introduction

Nurses must have the ability to develop individual problem-solving methods to satisfy their patients’ diverse and high-level health needs [ 1 ]. However, the medical field is characterized by uncertainty, instability, and unpredictability; thus, it is not easy for nurses to apply or utilize the knowledge learned within controlled situations in schools, and therefore, it is often difficult for nurses to address the health needs of patients [ 2 ]. The problem-solving ability required in such situations is an essential skill that college students majoring in nursing must have in order to effectively perform their assigned nursing tasks after graduation, while successfully adapting in order to practice in a rapidly changing medical field [ 3 ]. Therefore, strategies to improve the problem-solving ability of nursing students should be applied in their education.

This study aimed to examine the relationship between metacognition, communication competency, and the problem-solving ability of nursing students, and to identify factors that affect nursing students’ problem-solving ability. The results represent basic data that could help inform the development of educational strategies to improve the communication skills of nursing students.

Problem solving involves recognizing the difference between the problem solver’s current state and the goal state to be reached, and resolving the obstacles that prevent them from achieving the goal [ 4 ]. Acquiring problem-solving ability based on judgment and critical thinking is an important element of nursing education [ 5 ]. Furthermore, the use of effective problem-solving strategies based on professional knowledge is a competency that a professional nurse should possess [ 3 ].

Recently, metacognition has been recognized in psychology and pedagogy as a central element of the understanding, self-learning, communication, and problem-solving processes. Metacognition is the ability to think about one’s own thinking [ 6 ], as expressed by the individual knowing and controlling their thought processes and applying previously acquired knowledge, skills, and experiences using appropriate strategies [ 7 ]. In particular, metacognition is an important variable for learning and problem-solving. It is the knowledge related to the selection of an appropriate strategy for the task; the establishment, selection, and application of problem-solving measures; evaluation of the effectiveness of the applied measures; and checking and adjusting the performance process [ 6 , 7 ]. Accordingly, interest in metacognition is increasing in the field of nursing, with emphasis on the problem-solving ability of nursing students [ 8 ].

Metacognition affects problem solving by cultivating the learner’s active attitude, linking existing knowledge with new knowledge, and fostering the development of practical cognitive strategies that can be used for problem solving [ 7 ]. Previous studies on learners’ metacognition have observed that a higher level of metacognition leads to an improvement in the problem-solving process, as metacognition has a significant effect on goal setting and problem-solving performance [ 9 ]. Thus, metacognition and problem-solving ability are closely related; furthermore, metacognition is a key strategic aspect in the problem-solving process [ 10 ]. Although metacognition is a powerful predictor of learning outcomes and problem-solving success, it is not clear how metacognition works regarding cognitive strategies and learning outcomes [ 11 ]. A study of adolescent metacognition-related cognition (learning strategies and problem-solving strategies) and how metacognition affects various types of learning performance confirmed that problem solving is the only mediator between general metacognition and learning performance [ 11 ]. Metacognition plays a major role in improving learning and work ability, and the appropriate use of metacognition when performing nursing tasks can improve the personal lives of nurses [ 12 ]. Therefore, it is necessary to assess the influence of metacognition and problem-solving ability on nursing education.

Communication competence is a major factor that affects problem-solving ability [ 13 ]. It is essential for smoothly maintaining professional relationships with medical personnel, patients, and guardians in diverse and complex medical environments [ 14 ]. Since communication competence is an important aspect of problem solving, it can affect the quality of nursing and the satisfaction of the patient [ 15 ]. There is an urgent need to improve communication competence, as various issues that arise during the clinical process can be solved through communication between medical staff and patients, and nurses are responsible for much of the continuous communication with patients and their guardians [ 16 ]. However, a lack of communication competence among nurses may lead to miscommunication, and thereby, poor outcomes, even if nurses possess good problem-solving methods [ 13 ].

While previous studies have revealed the relationship between communication competence and the problem-solving ability of nursing students [ 13 , 17 ], there is a lack of research regarding the relationship between metacognition, communication competence, and problem-solving ability. Through this research, we confirmed the relationship between the metacognition and problem-solving ability of nursing college students, the relationship between communication ability and problem-solving ability, and finally, examined the factors that affect variables associated with problem-solving ability, including metacognition.

2. Materials and Methods

2.1. design.

This study used quantitative methods to investigate the relationship between the metacognition, communication ability, and problem-solving ability of nursing students and to identify factors that affect problem-solving ability.

2.2. Participants and Procedures

The subjects of this study were nursing students enrolled in two nursing colleges in the same city and region. Since data collection was conducted in March, second-year, third-year, and fourth-year students, with college life experience, were targeted. The required number of study subjects was calculated using the G-Power 3.1.9.7 program, which determined a significance level of 0.05, an effect size of 0.15, a power of 0.90, and 11 predictors, for multiple regression analysis. The minimum sample size was 152. In consideration of the dropout rate, 170 was set as the target number of subjects.

Data collection was conducted from 10 to 30 March 2022. The survey was conducted online. Consent for participation in the study was obtained by the individual reading the explanation of the purpose of the study and checking a consent box, which was displayed on the first screen of the online survey. The study subjects were redirected to the questionnaire completion page after providing their consent. It required approximately 10 min to complete the questionnaire. A total of 200 participants accessed and completed the questionnaire; 192 questionnaires were used for analysis after excluding 8 questionnaires that were determined to have been completedinccurately.

2.3. Instruments

The tools of this study consisted of a total of 91 items, including 9 items regarding general characteristics, 20 metacognition items, 15 items dealing with communication competencies, and 45 regarding problem-solving skills.

The items regarding the general characteristics of the subjects included age, sex, academic level, interpersonal relationships, satisfaction with major, problem based learning (PBL) experience, number of related experiences, clinical practice experience (yes or no), and number of weeks of clinical practice experience.

Metacognition was assessed using the state metacognitive inventory developed by O’Neil Jr et al. [ 18 ], as modified and supplemented by Joo [ 19 ]. It consists of a total of 20 items that assess the four sub-factors of metacognition: cognition, cognitive strategy, plan, and monitoring, using a 5-point Likert scale ranging from 1 point, for ‘not at all’, to 5 points, for ‘strongly agree’. The Cronbach’s α measure of the reliability of the tool was 0.86 at the time of development and 0.89 in the study of Joo [ 19 ]. The value in the current study was 0.91.

Communication competence was measured using a comprehensive interpersonal communication competence scale developed by Rubin [ 20 ], as modified and supplemented by Hur [ 21 ] to fit Korean culture. This tool consists of 15 items related to communication, such as self-exposure, cross-exposure, social tension relief, assertiveness, and concentration. Each item is assessed on a 5-point Likert scale ranging from 1 point, for ‘not at all’, to 5 points, for ‘strongly agree’. The Cronbach’ α reliability measure at the time of development was 0.72, and the value in this study was 0.84.

Problem-solving ability was assessed via a life-skills measurement tool developed by the Korea Educational Development Institute [ 22 ]. This tool considers 5 problem factors (clarification, cause analysis, alternative development, plan and implementation, and performance evaluation) and 9 sub-factors (problem recognition, information collection, analysis ability, divergent thinking, decision making, planning ability, execution and risk taking, evaluation, and feedback), and thus consists of 45 items in total. Each item is assessed on a 5-point Likert scale ranging from 1 point, for ‘very rarely’, to 5 points, for ‘very often’, with higher scores indicating better problem-solving skills. The reliability at the time of tool development was indicated by a Cronbach’s α value of 0.95, whereas in this study, the Cronbach’s α value was 0.90.

2.4. Statistical Analysis

Statistical analyses were performed using SPSS (ver. 25) statistical software (IBM). The subjects’ general characteristics, metacognition, communication competence, and problem-solving ability were analyzed by number and percentage, as well as mean and standard deviation. To test the normality of all variables, skewness and kurtosis were assessed. In general, when the absolute value of skewness is less than 2 or the absolute value of kurtosis is less than 7, there are no problems associated with deviations in the variable distributions from normality [ 23 ]. In this study, skewness ranged between −0.002 and 0.435, with absolute values less than 2, and kurtosis ranged between −0.204 to 1.580, with absolute values less than 7, thus indicating that the variables satisfied the assumption of univariate normality. Differences in metacognition, communication competence, and problem-solving ability according to the general characteristics of the subjects were analyzed by mean, standard deviation, independent t-test, and one-way ANOVA, followed by Scheffé’s post hoc analysis. The correlation between metacognition, communication competence, and problem-solving ability of the participants was analyzed using Pearson’s correlation coefficient. Factors affecting the subject’s problem-solving ability were analyzed using hierarchical multiple regression.

2.5. Ethical Considerations

Before the study was conducted, the research proposal and questionnaire were approved by the Institutional Review Board of Gangneung–Wonju National University (No: GWNUIRB-2022-1). The tools used in the study were used after obtaining the consent of the original author. When explaining the purpose of the study, it was emphasized that the participants had the right to withdraw from the study at any time, that the anonymity and confidentiality of the survey results were guaranteed, and that the study results would not be used for other purposes. Participants were provided with a small gift to motivate participation.

3.1. General Characteristics

Table 1 illustrates that the participants’ mean age was 21.56 ± 1.99. Most participants were women (81.3%).

General Characteristics of Participants (N = 192).

Variable	Categories	N	%
Sex	Male	36	18.7
Sex	Female	156	81.3
Age (years)	<21	62	32.3
	21~<23	84	43.8
	≥23	46	24.0
	Mean ± SD	21.56 ± 1.99
Academic level	Sophomore	63	32.8
	Junior	64	33.3
	Senior	65	33.9
Interpersonal relationships	Very good	29	15.1
	Good	118	61.5
	Moderate	45	23.4
Satisfaction with major	Very satisfied	30	15.6
	Satisfied	100	52.1
	Moderately satisfied	47	24.5
	Dissatisfied	15	7.8
PBL experience	Yes	130	68.2
PBL experience	No	62	31.8
Number of PBL experiences	0	62	32.3
	1~2	29	15.1
	3~6	55	28.6
	≥7	46	24.0
Clinical practice experience	Yes	104	50.2
Clinical practice experience	No	88	46.8
Weeks of clinical practice experience	0	88	45.9
	1~6	54	28.1
	≥7	50	26.0

† SD, standard deviation; ‡ PBL, problem-based learning.

3.2. Scores for Metacognition, Communication Competence, and Problem-Solving Ability

Table 2 illustrates that the average score of the subjects’ metacognition was 3.86 ± 0.47 (out of 5). Among the sub-domains, cognitive strategy showed the highest score of 4.03 ± 0.45, followed by monitoring, with 3.90 ± 0.59. The average for communication competence was 3.92 ± 0.42 points (out of 5 points). The average for problem-solving ability was 3.63 ± 0.35 (out of 5), and among the sub-domains, problem clarification was the highest at 3.83 ± 0.52, and cause analysis was the lowest at 3.28 ± 0.36.

Scores for metacognition, communication competence, and problem-solving ability. (N = 192).

Categories	M ± SD	Range	Min	Max	Skewness	Kurtosis
Cognition	3.87 ± 0.54	1–5	2.00	5.00	−0.405	0.616
Cognitive strategy	4.03 ± 0.45	1–5	2.80	5.00	−0.002	−0.204
Planning	3.66 ± 0.59	1–5	2.00	5.00	−0.234	0.449
Monitoring	3.90 ± 0.59	1–5	2.20	5.00	−0.366	0.364
	3.86 ± 0.47	1–5	2.35	5.00	−0.214	0.607
	3.92 ± 0.42	1–5	2.60	4.93	0.025	0.582
Problem clarification	3.83 ± 0.52	1–5	1.80	5.00	−0.508	1.288
Cause analysis	3.28 ± 0.36	1–5	2.50	5.00	0.435	1.171
Alternative development	3.64 ± 0.47	1–5	2.20	5.00	0.285	0.989
Planning/implementation	3.63 ± 0.51	1–5	1.50	5.00	−0.203	1.580
Performance evaluation	3.65 ± 0.39	1–5	2.60	5.00	0.351	1.205
	3.63 ± 0.35	1–5	2.53	4.64	0.243	1.253

3.3. Differences in Problem-Solving Ability According to General Characteristics

The problem-solving ability according to the general characteristics of the subjects was as follows ( Table 3 ): age (F = 4.32, p = 0.015), academic level (F = 10.17, p < 0.001), interpersonal relationships (F = 9.47, p < 0.001), satisfaction with major (F = 3.73, p = 0.012), PBL experience (F = 3.73, p = 0.012), number of PBL experiences (F = 3.20, p = 0.025), and practical experience (F = 2.74, p = 0.007). There was a significant difference in problem-solving ability accorfing to the number of training weeks (F = 4.46, p = 0.013). Scheffé’s post hoc analysis indicated that participants older than 23 years old and younger than 20 years old, as well as fourth-year students, were more dissatisfied than were second-year students. In other cases, interpersonal relationships were very good. Additionally, satisfaction with the major was more than satisfactory. Problem-solving ability was statistically significantly higher for those with more than 7 weeks of practice, and there was no case of not having more than 7 weeks of practice.

Differences in metacognition, communication competence, and problem-solving ability according to nursing students’ general characteristics (N = 192).


		M ± SD	t/F( )	M ± SD	t/F( )	M ± SD	t/F( )
Age (years)	<21	3.75 ± 0.48	2.83 (0.061)	3.87 ± 0.38	0.84 (0.433)	3.54 ± 0.32	4.32 (0.015) a < c
	21–<23	3.92 ± 0.47		3.95 ± 0.42		3.64 ± 0.37
	≥23	3.92 ± 0.44		3.96 ± 0.47		3.73 ± 0.31
Sex	Male	3.92 ± 0.42	0.68 (0.409)	3.95 ± 0.41	0.30 (0.584)	3.70 ± 0.35	1.81 (0.181)
Sex	Female	3.85 ± 0.49	0.68 (0.409)	3.92 ± 0.42	0.30 (0.584)	3.61 ± 0.34	1.81 (0.181)
Academic level	Sophomore	3.72 ± 0.59	5.59 (0.004) a < c	3.80 ± 0.43	4.58 (0.011) a < c	3.51 ± 0.29	10.17 (<0.001) a < c
	Junior	3.89 ± 0.47		3.96 ± 0.35		3.60 ± 0.32
	Senior	3.99 ± 0.45		4.01 ± 0.44		3.77 ± 0.37
Interpersonal relationships	Very good	4.07 ± 0.54	5.79 (0.004) a > c	4.38 ± 0.40	40.71 (<0.001) c < b < a	3.78 ± 0.48	9.47 (<0.001) b, c < a
	Good	3.88 ± 0.44		3.92 ± 0.32		3.66 ± 0.29
	Moderate	3.70 ± 0.48		3.63 ± 0.39		3.46 ± 0.33
Satisfaction with major	Very satisfied	4.09 ± 0.43	7.21 (<0.001) d < b, c < a	4.19 ± 0.48	7.70 (<0.001) c, d < a	3.76 ± 0.38	3.73 (0.012) d < a, b
	Satisfied	3.92 ± 0.45		3.94 ± 0.38		3.66 ± 0.33
	Moderately satisfied	3.71 ± 0.50		3.77 ± 0.40		3.53 ± 0.35
	Dissatisfied	3.55 ± 0.37		3.77 ± 0.31		3.52 ± 0.23
PBL experience	Yes	3.93 ± 0.47	2.92 (0.004)	3.98 ± 0.40	2.74 (0.007)	3.68 ± 0.36	3.06 (0.003)
PBL experience	No	3.72 ± 0.47	2.92 (0.004)	3.81 ± 0.43	2.74 (0.007)	3.52 ± 0.28	3.06 (0.003)
Number of PBL experiences	0	3.72 ± 0.47	2.87 (0.038)	3.81 ± 0.43	2.47 (0.063)	3.52 ± 0.28	3.20 (0.025)
	1~2	3.92 ± 0.51		3.97 ± 0.47		3.66 ± 0.42
	3~6	3.95 ± 0.47		3.98 ± 0.38		3.70 ± 0.36
	≥7	3.91 ± 0.44		3.98 ± 0.38		3.68 ± 0.32
Clinical practice experience	Yes	3.93 ± 0.42	2.40 (0.019)	3.97 ± 0.38	1.58 (0.115)	3.69 ± 0.32	2.74 (0.007)
Clinical practice experience	No	3.78 ± 0.52	2.40 (0.019)	3.91 ± 0.44	1.58 (0.115)	3.56 ± 0.36	2.74 (0.007)
Weeks of clinical practice experience	0	3.78 ± 0.52	3.02 (0.051)	3.87 ± 0.46	1.58 (0.208)	3.56 ± 0.36	4.46 (0.013) a < c
	1~6	3.96 ± 0.40		3.93 ± 0.35		3.66 ± 0.29
	≥7	3.91 ± 0.44		4.00 ± 0.41		3.73 ± 0.35

† Scheffé test; ‡ PBL, problem based learning.

3.4. Relationship beetween Metacognition, Communication Competence, and Problem-Solving Ability

There was a strong, significantly positive correlation between metacognition and problem-solving ability (r = 0.672, p < 0.001), and communication competence and problem-solving ability (r = 0.542, p < 0.001). There was also a strong, significantly positive correlation between metacognition and communication competence (r = 0.557, p < 0.001; Table 4 ).

Relationships between metacognition, communication competence, and problem-solving ability (N = 192).

Variables	Metacognition	Communication Competence	Problem-Solving Ability
Variables	r ( )	r ( )	r ( )
Metacognition	1
Communication competence	0.557 (<0.001)	1
Problem-solving ability	0.672 (<0.001)	0.542 (<0.001)	1

3.5. Factors Influencing Problem-Solving Ability

Among general characteristics, variables were converted into dummy variables as needed to confirm their effect on the problem-solving ability of nursing students (e.g., age, 23 years or older = 1; academic level, third year = 1; interpersonal relationships, very good = 1; satisfaction with major, more than satisfied = 1; the number of PBL experiences, 3–6 times = 1; and the number of training weeks, 7 weeks or more = 1). A hierarchical stepwise multiple regression analysis was then performed, inputting communication ability followed by metacognition, which were significantly correlated.

The Durbin–Watson value was 1.96 (close to 2), which confirmed that there was no autocorrelation between the independent variables. The variance inflation factor was 1.013 to 4.999; as all value were less than 10, there were no problems with multicollinearity between independent variables.

General characteristics that showed a significant difference with problem-solving ability in univariate analyses were first input to Model 1, namely age, academic level, interpersonal relationships, and satisfaction with major. This model explained 8.1% of the variance in problem-solving ability. When PBL experience and frequency, clinical practice, and number of weeks were added to Model 1 (Model 2), the variance explained was 12.5%, namely an increased of 4.4% compared to Model 1. When communication competence and metacognition were additionally added to Model 2 (Model 3), the variance explained was 51.2%, which is an increase of 38.7% compared to Model 2. Finally, age (β = 0.11, p = 0.048), communication competence (β = 0.24, p = 0.001), and metacognition (β = 0.52, p = 0.023) were significantly related to problem-solving ability. These variables exhibited an explanatory power of 51.2% (F = 21.01, p < 0.001) regarding job satisfaction; the most influential variable was metacognition ( Table 5 ).

Factors influencing problem-solving ability (N = 192).

Variables	Model 1			Model 2			Model 3
Variables	B	β	t	B	β	t	B	β	t
Age (R = ≥23)	0.13	0.16	2.29 *	0.10	0.13	1.77	0.09	0.11	1.99 *
Academic level (R = Junior)	−0.06	−0.09	−1.22	−0.23	−0.31	−2.71 *	−0.12	−0.17	1.91
Interpersonal relationships (R = Very good)	0.16	0.17	2.41 *	0.14	0.15	2.11 *	−0.19	−0.02	−0.33
Satisfaction with major (R = Satisfied)	0.13	0.17	2.40 *	0.11	0.15	2.10 *	−0.01	−0.02	−0.35
PBL experience				−0.25	−0.34	−2.25 *	−0.09	−0.11	−1.01
Number of PBL experiences (R = 3–6)				0.14	0.19	1.66	0.14	0.18	2.13 *
Clinical practice experience				0.11	0.16	1.16	0.11	0.16	1.16
Weeks of clinical practice experience (R = ≥7)				−0.00	−0.004	−0.03	0.09	0.12	−0.03
Communication competence							0.19	0.24	3.42 *
Metacognition							0.38	0.52	8.22 *
	Adj R = 0.081, F = 5.20, = 0.001			Adj R = 0.125, F = 4.42, < 0.001			Adj R = 0.512, F = 21.01, < 0.001

† Dummy variables; ‡ Reference; ¶ PBL, problem-based learning; * p < 0.05.

4. Discussion

In this study, the mean problem-solving ability score of nursing students was 3.63 out of 5, which is similar to the 3.56 points reported in a study targeting third- and fourth- year students in the department of nursing [ 24 ]. However, the current value is higher than the 3.44 points reported in a study targeting first- and second-year students [ 13 ]. Participants in these studies were nursing students in the second, third, and fourth years of study in this paper, in the third and fourth years in the study done by Kim et al. [ 24 ]; and in the first and second grades in the study by Ji et al. [ 13 ]. Problem-solving ability can be developed under the influence of various factors; those identified in previous studies include communication ability [ 13 ], critical thinking ability [ 12 , 25 ], metacognition [ 11 ], and self-directed learning [ 2 ]. These factors are continuously improved through various interpersonal relationships formed while learning and studying liberal arts and other major subjects, rather than existing as innate abilities [ 26 ]. Therefore, the degree of problem-solving ability was rather high in the study targeting the upper grades. Problem-solving ability in various unexpected situations is essential for working as a nurse [ 27 ]. In the current study, the problem-solving ability score of nursing students approximated the 72.6 percentile of the full 100-point scale. Although this score is relatively high, it is nevertheless necessary to improve problem-solving ability; given the nature of the nurse’s job, this ability represents a very important competency. Therefore, it is necessary to improve the problem-solving ability level of nursing students in Korea. The results of this study showed that factors affecting nursing students’ problem-solving ability were metacognition, communication competence, and age. It is necessary to establish a strategy that considers these factors to improve the problem-solving ability of nursing students.

The participants’ average metacognitive score was 3.86 out of 5, which was slightly higher than the 3.61 observed in a study conducted using the same tools for second-year nursing students [ 12 ]. While direct comparison using other tools is difficult, the metacognitive level of 72.3 obtained by Kim [ 28 ] for all grades in the nursing department was lower than the 77.2 points (out of 100 points) obtained in this study. According to Sternberg and Sternberg [ 29 ], the problem-solving phase includes problem identification, problem expression, strategy formulation, information construction, resource allocation, supervision, and evaluation. For health science students, metacognitive instruction has been shown to have a positive effect on students’ problem-solving ability and in improving academic achievement [ 30 ]. That is, metacognition is a key factor in predicting learning outcomes in the problem-solving domain [ 31 ]. These results were replicated in this study, which showed that a higher metacognitive level of nursing students indicated a significantly higher problem-solving ability. The subjects of this study were second-, third-, and fourth-year nursing students, and it is thought that their metacognitive level was improved compared to students in earlier phases of education, as a result of the curriculum of the nursing department. Educational programs and strategies to improve metacognition will be needed to improve the problem-solving ability of nursing students. The components of metacognition are thinking deeply in the planning stage, establishing possible strategies, undertaking regulating and monitoring activities to carry out the strategy, and revising and regulating to ensure that the solution is progressing in an appropriate direction to achieve the goal [ 32 ]. Therefore, a professor who instructs and checks nursing students is necessary to enable them to set their own goals in the curricular and non-curricular programs as they advance through the course, plan and implement strategies to achieve their goals through deep thinking, and conduct their own monitoring and control processes.

The average communication competence score of the subjects was 3.92 out of 5. Previous studies targeting students in various years of the course at the department of nursing found that the communication competence of nursing students also improved as they progressed through the course, with values reported of 3.58 points [ 33 ] and 3.56 points [ 34 ].

In previous studies, communication competence was a factor affecting nursing students’ problem-solving ability [ 13 ]. However, the current study is valuable because it additionally revealed that the level of problem-solving ability significantly increased according to the level of communication competence. Case-based education is suggested as a strategy to simultaneously improve communication competence and problem-solving skills in nursing student education [ 17 ]. This is because it is difficult to solve problems through integrative thinking and effective communication in a clinical environment, such as a hospital, with only theoretical knowledge of nursing subjects. Thus, the PBL method is applied to theoretical education in nursing colleges [ 35 , 36 ]. The results of this study showed that the presence or absence of PBL education had a significant effect on the problem-solving ability of nursing students; this ability improved when the PBL factor was added to Model 2. Therefore, it is necessary for nursing professors to practice and improve the communication competence of their students through case-based education in various subjects beginning in the first year to improve the problem-solving abilities of the students.

Additionally, the age of the subjects was also a factor influencing the problem-solving ability. Stewart, Cooper, and Moulding [ 37 ] reported that metacognitive levels increase with age. The study revealed that the communication competence of nursing students improved through various experiences [ 38 ]. Age may have had a similar influence.

Previous studies identified critical thinking disposition, empathy, nursing professional intuition, self-leadership [ 24 ], learning motivation [ 17 ], and communication competence [ 13 ] as examples of factors that affect nursing students’ problem-solving ability. However, this study demonstrated that metacognition also significantly affects the problem-solving ability of nursing students. In particular, metacognition and communication competence are considered key concepts, as they explained 51.2% of nursing students’ problem-solving ability. Therefore, it is necessary to consider and continuously apply educational strategies to improve metacognition and communication competence in the education of nursing students in the future.

This study is limited by the small number of nursing colleges that were included in the sampling, as this hinders the generalizability of the results.

5. Conclusions

This was a descriptive research study that identified the degree of and correlations between metacognition, communication competence, and problem-solving ability of nursing students, and identified factors that affect problem-solving ability. The results demonstrated that age, communication competence, and metacognition were the factors that most significantly affected the problem-solving ability of nursing students. Among these factors, metacognition had the greatest influence. Therefore, to improve the problem-solving ability of nursing students, an educational strategy is needed to improve communication competence through case-based learning in the curriculum, and development and application of activities such as PBL. In addition, the guidance of professors is needed to enable nursing students to improve their metacognition.

Since this study revealed that metacognition is a factor that influences the problem-solving ability of nursing students, we recommend conducting a study to check whether it affects actual problem-solving by developing and applying a metacognitive improvement curriculum in the future.

Acknowledgments

We would like to thank the nursing students who participated in the study.

Funding Statement

This study was supported by the research fund of Korean Bible University in 2021.

Author Contributions

Conceptualization, E.C. and J.J.; methodology, E.C. and J.J.; validation, E.C.; formal analysis, E.C.; investigation, E.C. and J.J.; resources, E.C. and J.J.; data curation, E.C.; writing—original draft preparation, E.C.; writing—review and editing, J.J.; supervision, E.C.; project administration, E.C. and J.J.; funding acquisition, E.C. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Gangneung–Wonju National University (No. GWNUIRB-2022-1).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Stumped five ways to hone your problem-solving skills.

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Respect the worth of other people's insights

Problems continuously arise in organizational life, making problem-solving an essential skill for leaders. Leaders who are good at tackling conundrums are likely to be more effective at overcoming obstacles and guiding their teams to achieve their goals. So, what’s the secret to better problem-solving skills?

1. Understand the root cause of the problem

“Too often, people fail because they haven’t correctly defined what the problem is,” says David Ross, an international strategist, founder of consultancy Phoenix Strategic Management and author of Confronting the Storm: Regenerating Leadership and Hope in the Age of Uncertainty .

Ross explains that as teams grapple with “wicked” problems – those where there can be several root causes for why a problem exists – there can often be disagreement on the initial assumptions made. As a result, their chances of successfully solving the problem are low.

“Before commencing the process of solving the problem, it is worthwhile identifying who your key stakeholders are and talking to them about the issue,” Ross recommends. “Who could be affected by the issue? What is the problem – and why? How are people affected?”

He argues that if leaders treat people with dignity, respecting the worth of their insights, they are more likely to successfully solve problems.

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Best 5% interest savings accounts of 2024, 2. unfocus the mind.

“To solve problems, we need to commit to making time to face a problem in its full complexity, which also requires that we take back control of our thinking,” says Chris Griffiths, an expert on creativity and innovative thinking skills, founder and CEO of software provider OpenGenius, and co-author of The Focus Fix: Finding Clarity, Creativity and Resilience in an Overwhelming World .

To do this, it’s necessary to harness the power of the unfocused mind, according to Griffiths. “It might sound oxymoronic, but just like our devices, our brain needs time to recharge,” he says. “ A plethora of research has shown that daydreaming allows us to make creative connections and see abstract solutions that are not obvious when we’re engaged in direct work.”

To make use of the unfocused mind in problem solving, you must begin by getting to know the problem from all angles. “At this stage, don’t worry about actually solving the problem,” says Griffiths. “You’re simply giving your subconscious mind the information it needs to get creative with when you zone out. From here, pick a monotonous or rhythmic activity that will help you to activate the daydreaming state – that might be a walk, some doodling, or even some chores.”

Do this regularly, argues Griffiths, and you’ll soon find that flashes of inspiration and novel solutions naturally present themselves while you’re ostensibly thinking of other things. He says: “By allowing you to access the fullest creative potential of your own brain, daydreaming acts as a skeleton key for a wide range of problems.”

3. Be comfortable making judgment calls

“Admitting to not knowing the future takes courage,” says Professor Stephen Wyatt, founder and lead consultant at consultancy Corporate Rebirth and author of Antidote to the Crisis of Leadership: Opportunity in Complexity . “Leaders are worried our teams won’t respect us and our boards will lose faith in us, but what doesn’t work is drawing up plans and forecasts and holding yourself or others rigidly to them.”

Wyatt advises leaders to heighten their situational awareness – to look broadly, integrate more perspectives and be able to connect the dots. “We need to be comfortable in making judgment calls as the future is unknown,” he says. “There is no data on it. But equally, very few initiatives cannot be adjusted, refined or reviewed while in motion.”

Leaders need to stay vigilant, according to Wyatt, create the capacity of the enterprise to adapt and maintain the support of stakeholders. “The concept of the infallible leader needs to be updated,” he concludes.

4. Be prepared to fail and learn

“Organisations, and arguably society more widely, are obsessed with problems and the notion of problems,” says Steve Hearsum, founder of organizational change consultancy Edge + Stretch and author of No Silver Bullet: Bursting the Bubble of the Organisational Quick Fix .

Hearsum argues that this tendency is complicated by the myth of fixability, namely the idea that all problems, however complex, have a solution. “Our need for certainty, to minimize and dampen the anxiety of ‘not knowing,’ leads us to oversimplify and ignore or filter out anything that challenges the idea that there is a solution,” he says.

Leaders need to shift their mindset to cultivate their comfort with not knowing and couple that with being OK with being wrong, sometimes, notes Hearsum. He adds: “That means developing reflexivity to understand your own beliefs and judgments, and what influences these, asking questions and experimenting.”

5. Unleash the power of empathy

Leaders must be able to communicate problems in order to find solutions to them. But they should avoid bombarding their teams with complex, technical details since these can overwhelm their people’s cognitive load, says Dr Jessica Barker MBE , author of Hacked: The Secrets Behind Cyber Attacks .

Instead, she recommends that leaders frame their messages in ways that cut through jargon and ensure that their advice is relevant, accessible and actionable. “An essential leadership skill for this is empathy,” Barker explains. “When you’re trying to build a positive culture, it is crucial to understand why people are not practicing the behaviors you want rather than trying to force that behavioral change with fear, uncertainty and doubt.”

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Leadership in Nursing: Qualities & Why It Matters

4 min read • May, 19 2023

Strong leaders in nursing are vital to help navigate the constant evolution of health care. Nurse leaders do more than balance costs, monitor productivity, and maintain patient and staff satisfaction. They serve as role models and influence health care organizations at all levels. A strong nurse leader motivates their colleagues, setting the tone for a safe, civil workplace with a culture of high morale and job retention.

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A nurse leader is defined by their actions, and not always by a position of authority. Leaders in nursing inspire and influence others to achieve their maximum potential. They use applied leadership in nursing by drawing upon critical thinking skills to manage a team.

Nurse leaders take a broad view of how daily tasks impact the overall goals of the health care organization. They communicate expectations to their team and motivate them to achieve predetermined goals. Nurses can lead from various organizational areas if they project the necessary leadership qualities to influence others.

Leadership Qualities in Nursing

A nurse leader role combines essential nursing, business, and leadership skills developed through ongoing learning . They must be flexible enough to adapt to technological changes, fluctuating payment methods, new treatment modalities, and regulatory and legislative environments. Critical skills for effective nursing leadership include:

Communication and Collaboration : These skills can reduce miscommunication, encourage shared decision making, and provide a sense of working together toward common goals.
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The Transformational nurse leader works to inspire nurses to achieve a greater vision by helping with strength development. This nursing leadership style works well with mentoring.
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The Servant nurse leadership style focuses on employee development and individual needs. This method works well with goal-driven environments or as a nurse educator.
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The Transactional nurse leader does well with short-term goals by focusing on efficiency and performance. This task-oriented style reduces errors and works well with tight deadlines.

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Projecting leadership skills in nursing that influences others can allow a nurse to lead without being assigned a specific leadership position. The aspiring nurse leader might:

Seek out a mentor or become one
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Nurse leaders make a difference in workplace culture and drive positive changes in health care legislation. When a team admires the qualities of their leader, it boosts morale and promotes a psychologically safe workplace, which leads to higher job satisfaction and retention rates. Influential leaders in nursing ensure that the organization's vision is communicated to the nursing staff while mentoring the nursing leadership of tomorrow .

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Published: 28 June 2024

Perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education: a mixed methods study

Basma Mohammed Al Yazeedi ORCID: orcid.org/0000-0003-2327-6918 1 ,
Lina Mohamed Wali Shakman 1 ,
Sheeba Elizabeth John Sunderraj ORCID: orcid.org/0000-0002-9171-7239 1 ,
Harshita Prabhakaran ORCID: orcid.org/0000-0002-5470-7066 1 ,
Judie Arulappan 1 ,
Erna Judith Roach ORCID: orcid.org/0000-0002-5817-8886 1 ,
Aysha Al Hashmi 1 , 2 &
Zeinab Al Azri ORCID: orcid.org/0000-0002-3376-9380 1

BMC Nursing volume 23 , Article number: 441 ( 2024 ) Cite this article

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Metrics details

Case analysis is a dynamic and interactive teaching and learning strategy that improves critical thinking and problem-solving skills. However, there is limited evidence about its efficacy as an assessment strategy in nursing education.

This study aimed to explore nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education.

This study used a mixed methods design. Students filled out a 13-item study-advised questionnaire, and qualitative data from the four focus groups was collected. The setting of the study was the College of Nursing at Sultan Qaboos University, Oman. Descriptive and independent t-test analysis was used for the quantitative data, and the framework analysis method was used for the qualitative data.

The descriptive analysis of 67 participants showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred with the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58), and 80.3% assented its association with clinical competencies as reflected by knowledge and cognitive skills (m = 3.21, SD = 0.60). No significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p > 0.05) was identified Three qualitative findings were discerned: case analysis is a preferred assessment method for students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills.

Conclusions

This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

Peer Review reports

Introduction

Nurses play a critical role in preserving human health by upholding core competencies [ 1 ]. Clinical competence in nursing involves a constant process of acquiring knowledge, values, attitudes, and abilities to deliver safe and high-quality care [ 2 , 3 ]. Nurses possessing such competencies can analyze and judge complicated problems, including those involving crucial patient care, ethical decision-making, and nurse-patient disputes, meeting the constantly altering health needs [ 4 , 5 ]. To optimize the readiness of the new graduates for the challenging clinical work environment needs, nurse leaders call for integrating clinical competencies into the nursing curriculum [ 6 , 7 ] In 2021, the American Association of Colleges of Nursing (AACN) released updated core competencies for professional nursing education [ 8 ]. These competencies were classified into ten fundamental essentials, including knowledge of nursing practice and person-centered care (e.g. integrate assessment skills in practice, diagnose actual or potential health problems and needs, develop a plan of care), representing clinical core competencies.

Nursing programs emphasize clinical competencies through innovative and effective teaching strategies, including case-based teaching (CBT) [ 9 ]. CBT is a dynamic teaching method that enhances the focus on learning goals and increases the chances of the instructor and students actively participating in teaching and learning [ 10 , 11 ]. Additionally, it improves the students’ critical thinking and problem-solving skills and enriches their capacity for independent study, cooperation capacity, and communication skills [ 12 , 13 , 14 , 15 ]. It also broadens students’ perspectives and helps develop greater creativity in fusing theory and practice [ 16 , 17 , 18 , 19 , 20 ]. As the learning environment significantly impacts the students’ satisfaction, case analysis fosters a supportive learning atmosphere and encourages active participation in learning, ultimately improving their satisfaction [ 21 , 22 ].

In addition to proper teaching strategies for clinical competencies, programs are anticipated to evaluate the students’ attainment of such competencies through effective evaluation strategies [ 23 ]. However, deploying objective assessment methods for the competencies remains challenging for most educators [ 24 ]. The standard assessment methods used in clinical nursing courses, for instance, include clinical evaluations (direct observation), skills checklists, Objective Structured Clinical Examination (OSCE), and multiple-choice questions (MCQs) written exams [ 25 ]. MCQs tend to test the recall of factual information rather than the application of knowledge and cognitive skills, potentially leading to assessment inaccuracies [ 26 ].

Given the aforementioned outcomes of CBT, the deployment of case analysis as a clinical written exam is more closely aligned with the course’s expected competencies. A mixed methods study was conducted among forty nursing students at the University of Southern Taiwan study concluded that the unfolding case studies create a safe setting where nursing students can learn and apply their knowledge to safe patient care [ 6 ]. In a case analysis, the patient’s sickness emerges in stages including the signs and symptoms of the disease, urgent care to stabilize the patient, and bedside care to enhance recovery. Thus, unfolding the case with several scenarios helps educators track students’ attained competencies [ 27 ]. However, case analysis as an assessment method is sparsely researched [ 28 ]. A literature review over the past five years yielded no studies investigating case analysis as an assessment method, necessitating new evidence. There remains uncertainty regarding its efficacy as an assessment method, particularly from the students’ perspectives [ 29 ]. In this study, we explored the undergraduate nursing students’ perceived efficacy of case analysis as an assessment method for clinical competencies. Results from this study will elucidate the position of case analysis as an assessment method in nursing education. The potential benefits are improved standardization of clinical assessment and the ability to efficiently evaluate a broad range of competencies.

Research design

Mixed-method research with a convergent parallel design was adopted in the study. This approach intends to converge two data types (quantitative and qualitative) at the interpretation stage to ensure an inclusive research problem analysis [ 30 ]. The quantitative aspect of the study was implemented through a cross-sectional survey. The survey captured the perceived efficacy of using case analysis as an assessment method in clinical nursing education. The qualitative part of the study was carried out through a descriptive qualitative method using focus groups to provide an in-depth understanding of the perceived strengths experienced by the students.

Study setting

Data were collected in the College of Nursing at Sultan Qaboos University (SQU), Oman, during the Spring and Fall semesters of 2023. At the end of each clinical course, the students have a clinical written exam and a clinical practical exam, which constitute their final exam. Most clinical courses use multiple-choice questions (MCQs) in their written exam. However, the child health clinical course team initiated the case analysis as an assessment method in the clinical written exam, replacing the MCQs format.

Participants

For this study, the investigators invited undergraduate students enrolled in the child health nursing clinical course in the Spring and Fall semesters of 2023. Currently, the only course that uses case analysis is child health. Other courses use MCQs. A total enumeration sampling technique was adopted. All the students enrolled in child health nursing clinical courses in the Spring and Fall 2023 semesters were invited to participate in the study. In the Spring, 36 students registered for the course, while 55 students were enrolled in the Fall. We included students who completed the case analysis as a final clinical written exam on the scheduled exam time. Students who did not show up for the exam during the scheduled time and students not enrolled in the course during the Spring and Fall of 2023 were excluded. Although different cases were used each semester, both had the same structure and level of complexity. Further, both cases were peer-reviewed.

Case analysis format

The format presents open-ended questions related to a clinical case scenario. It comprises three main sections: Knowledge, Emergency Room, and Ward. The questions in the sections varied in difficulty based on Bloom’s cognitive taxonomy levels, as presented in Table 1 . An answer key was generated to ensure consistency among course team members when correcting the exam. Three experts in child health nursing peer-reviewed both the case analysis exam paper and the answer key paper. The students were allocated two hours to complete the exam.

Study instruments

Quantitative stage.

The researchers developed a study questionnaire to meet the study objectives. It included two parts. The first was about the demographic data, including age, gender, type of residence, year in the program, and cumulative grade point average (GPA). The second part comprised a 13-item questionnaire assessing the perceived efficacy of case analysis as an assessment method. The perceived efficacy was represented by the acceptability of case analysis as an assessment method (Items 1–5 and 13) and the association with clinical competencies (Items 6 to 12). Acceptability involved format organization and clarity, time adequacy, alignment with course objectives, appropriateness to students’ level, and recommendation for implementation in other clinical nursing courses. Clinical competencies-related items were relevant to knowledge (motivation to prepare well for the exam, active learning, interest in topics, collaboration while studying) and cognitive skills (critical thinking, decision-making, and problem-solving skills) (The questionnaire is attached as a supplementary document).

The questionnaire is answered on a 4-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree. Higher scores indicated better perceived efficacy and vice versa. The tool underwent content validity testing with five experts in nursing clinical education, resulting in an item-content validity index ranging from 0.7 to 1. The Cronbach alpha was 0.83 for acceptability and 0.90 for clinical competencies.

Qualitative stage

For the focus group interviews, the investigators created a semi-structured interview guide to obtain an in-depth understanding of the students’ perceived strengths of case analysis as an assessment method. See Table 2 .

Data collection

Data was collected from the students after they gave their written informed consent. Students were invited to fill out the study questionnaire after they completed the case analysis as a clinical written exam.

All students in the child health course were invited to participate in focus group discussions. Students who approached the PI to participate in the focus group discussion were offered to participate in four different time slots. So, the students chose their time preferences. Four focus groups were conducted in private rooms at the College of Nursing. Two trained and bilingual interviewers attended the focus groups, one as a moderator while the other took notes on the group dynamics and non-verbal communication. The discussion duration ranged between 30 and 60 min. After each discussion, the moderator transcribed the audio recording. The transcriptions were rechecked against the audio recording for accuracy. Later, the transcriptions were translated into English by bilingual researchers fluent in Arabic and English for the analysis.

Rigor and trustworthiness

The rigor and trustworthiness of the qualitative method were enhanced using multiple techniques. Firstly, quantitative data, literature reviews, and focus groups were triangulated. Participants validated the summary after each discussion using member checking to ensure the moderator’s understanding was accurate. Third, the principal investigator (PI) reflected on her assumptions, experiences, expectations, and feelings weekly. In addition, the PI maintained a detailed audit trail of study details and progress. The nursing faculty conducted the study with experience in qualitative research and nursing education. This report was prepared following the Standard for Reporting Qualitative Research (SRQR) protocol [ 31 ].

Data analysis

Quantitative data were entered in SPSS version 24 and analyzed using simple descriptive analysis using means, standard deviations, and percentages. After computing the means of each questionnaire item, an average of the means was calculated to identify the perceived efficacy rate. A similar technique was used to calculate the rate of acceptability and clinical competencies. The percentage was calculated based on the mean: gained score/total score* 100. In addition, the investigators carried out an independent t-test to determine the relationship between the perceived efficacy and students’ GPA.

The qualitative data were analyzed using the framework analysis method. In our analysis, we followed the seven interconnected stages of framework analysis: (1) transcription, (2) familiarization with the interview, (3) coding, (4) developing a working analytical framework, (5) applying the analytical framework, (6) charting data into framework matrix and (7) interpreting the data [ 32 ]. Two members of the team separately analyzed the transcriptions. Then, they discussed the coding, and discrepancies were solved with discussion.

Mixed method integration

In our study, the quantitative and qualitative data were analyzed separately, and integration occurred at the interpretation level by merging the data [ 33 ]. As a measure of integration between qualitative and quantitative data, findings were assessed through confirmation, expansion, and discordance. If both data sets confirmed each other’s findings, it was considered confirmation, and if they expanded each other’s insight, it was considered expansion. Discordance was determined if the findings were contradictory.

Ethical considerations

Ethical approval was obtained from the Research and Ethics Committee of the College of Nursing, SQU (CON/NF/2023/18). Informed consent was collected, and no identifiable information was reported. For the focus group interviews, students were reassured that their grades were finalized, and their participation would not affect their grades. Also, the interviewers were instructed to maintain a non-judgmental and non-biased position during the interview. Data were saved in a locked cabinet inside a locked office room. The electronic data were saved in a password-protected computer.

The results section will present findings from the study’s quantitative and qualitative components. The integration of the two data types is described after each qualitative finding.

Quantitative findings

We analyzed the data of 67 participants, representing a 73.6% response rate. The mean age was 21.0 years old (SD 0.73) and 36.4% were male students. See Table 3 for more details.

The descriptive analysis showed that the mean value of the perceived efficacy of case analysis as an assessment method was 3.20 (SD = 0.53), demonstrating an 80% agreement rate. Further analysis indicated that 78.5% of the students concurred the acceptability of case analysis as an assessment method (mean = 3.14, SD = 0.58) and 80.3% (m = 3.21, SD = 0.60) assented the clinical competencies associated with it.

For the items representing acceptability, 81.8% of the students agreed that the case analysis was written clearly, and 80.3% reported that it was well organized. As per the questions, 81% described they were appropriate to their level, and 79.8% agreed upon their alignment with the course objectives. Moreover, the time allocated was adequate for 74.5% of the students, and 73.5% recommend using case analysis as an evaluation strategy for other clinical written examinations.

Regarding the clinical competencies, 77.3% of students agreed that the case analysis motivated them to prepare well for the exam, 81.3% reported that it encouraged them to be active in learning, and 81.0% indicated that it stimulated their interest in the topics discussed in the course. Additionally, 76.5% of the students agreed that the case analysis encouraged them to collaborate with other students when studying for the exam. Among the students, 82.5% reported that the case analysis as an assessment method enhanced their critical thinking skills, 81.0% agreed that it helped them practice decision-making skills, and 81.8% indicated that it improved their problem-solving abilities. See Table 4 .

The independent t-test analysis revealed no significant difference in the perceived efficacy between students with lower and higher GPAs (t [61] = 0.05, p > 0.05). Further analysis showed that the means of acceptability and clinical competencies were not significantly different between the lower GPA group and higher GPA group, t [62] = 0.72, p > 0.05 and t [63] = -0.83, p > 0.05, respectively (Table 5 ).

Qualitative findings

A total of 22 had participated in four focus groups, each group had 5–6 students. The qualitative framework analysis revealed three main findings; case analysis is a preferred assessment method to students when compared to MCQs, case analysis assesses students’ knowledge, and case analysis assesses students’ cognitive skills.

Qualitative Finding 1: case analysis is a preferred assessment method to students when compared to MCQs

Most of the students’ statements about the case analysis as an assessment method were positive. One student stated, “Previously, we have MCQs in clinical exams, but they look as if they are theory exams. This exam makes me deal with cases like a patient, which is good for clinical courses.” . At the same time, many students conveyed optimism about obtaining better grades with this exam format. A student stated, “Our grades, with case analysis format, will be better, … may be because we can write more in open-ended questions, so we can get some marks, in contrast to MCQs where we may get it right or wrong” . On the other hand, a few students suggested adding multiple-choice questions, deleting the emergency department section, and lessening the number of care plans in the ward section to secure better grades.

Although the case analysis was generally acceptable to students, they have repeatedly expressed a need to allocate more time for this type of exam. A student stated, “The limited time with the type of questions was a problem, …” . When further discussion was prompted to understand this challenge, we figured that students are not used to handwriting, which has caused them to be exhausted during the exam. An example is “writing is time-consuming and energy consuming in contrast to MCQs …” . These statements elucidate that the students don’t necessarily mind writing but recommend more practice as one student stated, “More experience of this type of examination is required, more examples during clinical practice are needed.” Some even recommended adopting this format with other clinical course exams by saying “It’s better to start this method from the first year for the new cohort and to apply it in all other courses.”

Mixed Methods Inference 1: Confirmation and Expansion

The abovementioned qualitative impression supports the high acceptability rate in quantitative analysis. In fact, there is a general agreement that the case analysis format surpasses the MCQs when it comes to the proper evaluation strategies for clinical courses. Expressions in the qualitative data revealed more details, such as the limited opportunities to practice handwriting, which negatively impacted the perceived adequacy of exam time.

Qualitative Finding 2: case analysis assesses students’ knowledge

Students conferred that they were reading more about the disease pathophysiology, lab values, and nursing care plans, which they did not usually do with traditional means of examination. Examples of statements include “… before we were not paying attention to the normal lab results but …in this exam, we went back and studied them which was good for our knowledge” and “we cared about the care plan. In previous exams, we were not bothered by these care plans”. Regarding the burden that could be perceived with this type of preparation, the students expressed that this has helped them prepare for the theory course exam; as one student said, “We also focus on theory lectures to prepare for this exam …. this was very helpful to prepare us for the theory final exam as well.” However, others have highlighted the risks of limiting the exam’s content to one case analysis. The argument was that some students may have not studied the case completely or been adequately exposed to the case in the clinical setting. To solve this risk, the students themselves advocated for frequent case group discussions in the clinical setting as stated by one student: “There could be some differences in the cases that we see during our clinical posting, for that I recommend that instructors allocate some time to gather all the students and discuss different cases.” Also, the participants advocated for more paper-based case analysis exercises as it is helpful to prepare them for the exams and enhance their knowledge and skills.

Mixed Methods Inferences 2: Confirmation and Expansion

The qualitative finding supports the quantitative data relevant to items 6, 7, and 8. Students’ expressions revealed more insights, including the acquisition of deeper knowledge, practicing concept mapping, and readiness for other course-related exams. At the same time, students recommended that faculty ensure all students’ exposure to common cases in the clinical setting for fair exam preparation.

Qualitative Finding 3. case analysis assesses students’ cognitive skills

Several statements conveyed how the case analysis format helped the students use their critical thinking and analysis skills. One student stated, “It, the case analysis format, enhanced our critical thinking skills as there is a case with given data and we analyze the case….” . Therefore, the case analysis format as an exam is potentially a valid means to assess the student’s critical thinking skills. Students also conveyed that the case analysis format helped them link theory to practice and provided them with the platform to think like real nurses and be professional. Examples of statements are: “…we connect our knowledge gained from theory with the clinical experience to get the answers…” and “The questions were about managing a case, which is what actual nurses are doing daily.” Another interesting cognitive benefit to case analysis described by the students was holistic thinking. For example, one student said, “Case analysis format helped us to see the case as a whole and not only from one perspective.”

Mixed Methods Inferences 3: Confirmation

The quantitative data indicated mutual agreement among the students that the case analysis enhanced their critical thinking, decision-making, and problem-solving skills. The students’ statements from the interviews, including critical thinking, linking theory to practice, and holistic thinking, further supported these presumptions.

This research presents the findings from a mixed methods study that explored undergraduate nursing students’ perceived efficacy of using case analysis as an assessment method. The perceived efficacy was reflected through acceptability and association with two core competencies: knowledge and cognitive skills. The study findings showed a high rate of perceived efficacy of case analysis as an assessment method among nursing students. Additionally, three findings were extracted from the qualitative data that further confirmed the perceived efficacy: (1) case analysis is a preferred assessment method to students compared to MCQs, (2) case analysis assesses students’ knowledge, and (3) case analysis assesses students’ cognitive skills. Moreover, the qualitative findings revealed details that expanded the understanding of the perceived efficacy among nursing students.

Previous literature reported students’ preference for case analysis as a teaching method. A randomized controlled study investigated student’s satisfaction levels with case-based teaching, in addition to comparing certain outcomes between a traditional teaching group and a case-based teaching group. They reported that most students favored the use of case-based teaching, whom at the same time had significantly better OSCE scores compared to the other group [ 34 ]. As noted, this favorable teaching method ultimately resulted in better learning outcomes and academic performance. Although it may be challenging since no answer options are provided, students appreciate the use of case analysis format in their exams because it aligns better with the course objectives and expected clinical competencies. The reason behind students’ preference for case analysis is that it allows them to interact with the teaching content and visualize the problem, leading to a better understanding. When case analysis is used as an assessment method, students can connect the case scenario presented in the exam to their clinical training, making it more relevant.

In this study, students recognized the incorporation of nursing knowledge in the case analysis exam. They also acknowledged improved knowledge and learning abilities similar to those observed in case-based teaching. Boney et al. (2015) reported that students perceived increased learning gains and a better ability to identify links between different concepts and other aspects of life through case-based teaching [ 35 ]. Additionally, case analysis as an exam promotes students’ in-depth acquirement of knowledge through the type of preparation it entails. Literature suggested that case-based teaching promotes self-directed learning with high autonomous learning ability [ 34 , 36 ]. Thus, better achievement in the case analysis exam could be linked with a higher level of knowledge, making it a suitable assessment method for knowledge integration in nursing care.

The findings of this study suggest that case analysis can be a useful tool for evaluating students’ cognitive skills, such as critical thinking, decision-making, and problem-solving. A randomized controlled study implied better problem-solving abilities among the students in the case-based learning group compared to those in the traditional teaching methods group [ 12 ]. Moreover, students in our study conveyed that case analysis as an exam was an opportunity for them to think like real nurses. Similar to our findings, a qualitative study on undergraduate nutrition students found that case-based learning helped students develop professional competencies for their future practice, in addition to higher-level cognitive skills [ 37 ]. Therefore, testing students through case analysis allows educators to assess the student’s readiness for entry-level professional competencies, including the thinking process. Also, to evaluate students’ high-level cognitive skills according to Bloom’s taxonomy (analysis, synthesis, and evaluation), which educators often find challenging.

Case analysis as an assessment method for clinical courses is partially integrated in case presentation or OSCE evaluation methods. However, the written format is considered to be more beneficial for both assessment and learning processes. A qualitative study was conducted to examine the impact of paper-based case learning versus video-based case learning on clinical decision-making skills among midwifery students. The study revealed that students paid more attention and were able to focus better on the details when the case was presented in a paper format [ 38 ]. Concurrently, the students in our study recommended more paper-based exercises, which they believed would improve their academic performance.

This study has possible limitations. The sample size was small due to the limited experience of case analysis as a clinical written exam in the program. Future studies with larger sample sizes and diverse nursing courses are needed for better generalizability.

Implications

Little evidence relates to the efficacy of case analysis as an evaluation method, suggesting the novelty of this study. Despite the scarcity of case-based assessment studies, a reader can speculate from this study’s findings that there is a potential efficacy of case analysis as an assessment method in nursing education. Future research is warranted to validate the effectiveness of case-analysis assessment methods and investigate the effects of case-analysis exams on academic and clinical performance.

Overall, our findings are in accordance with the evidence suggesting students’ perceived efficacy of case analysis as a teaching method. This study adds a potential for the case analysis to be acceptable and relevant to the clinical competencies when used as an assessment method. Future research is needed to validate the effectiveness of case analysis exams in other nursing clinical courses and examine their effects on academic and clinical performance.

Data availability

The datasets used and/or analyzed during the current study are available fromthe Principal Investigator (BAY) upon reasonable request.

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Acknowledgements

The authors wish to thank the nursing students at SQU who voluntarily participated in this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Basma Mohammed Al Yazeedi, Lina Mohamed Wali Shakman, Sheeba Elizabeth John Sunderraj, Harshita Prabhakaran, Judie Arulappan, Erna Judith Roach, Aysha Al Hashmi & Zeinab Al Azri

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Contributions

Dr. Basma Mohammed Al Yazeedi contributed to conceptualization, methods, data collection, data analysis, writing the draft, and reviewing the final draft. Ms. Lina Mohamed Wali Shakman contributed to conceptualization, data collection, data analysis, writing the draft, and reviewing the final draft. Ms. Sheeba Elizabeth John Sunderraj contributed to conceptualization, methods, data collection, writing the draft, and reviewing the final draft.Ms. Harshita Prabhakaran contributed to conceptualization, data collection, writing the draft, and reviewing the final draft.Dr. Judie Arulappan contributed to conceptualization and reviewing the final draft.Dr. Erna Roach contributed to conceptualization writing the draft and reviewing the final draft.Ms. Aysha Al Hashmi contributed to the conceptualization and reviewing the final draft. Dr. Zeinab Al Azri contributed to data collection, data analysis, writing the draft, and reviewing the final draft.All auhors reviewed and approved the final version of the manuscirpt.

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The study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Research and Ethics Committee of the College of Nursing, Sultan Qaboos University SQU (CON/NF/2023/18). All data was held and stored following the SQU data policy retention. Informed consent to participate was obtained from all of the participants in the study.

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Supplementary Material 1:

The questionnaire used in this study is attached as a supplementary document.

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Yazeedi, B.M.A., Shakman, L.M.W., Sunderraj, S.E.J. et al. Perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education: a mixed methods study. BMC Nurs 23 , 441 (2024). https://doi.org/10.1186/s12912-024-02102-9

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Nurse leaders as problem-solvers: Addressing lateral and hor
Nurse leaders perceive their role as a problem-solver, which is a necessary step in advocacy. 27 Problem-solving is a process that contains the elements of decision-making and critical thinking. 28. The theory that emerged from the core categories explicitly focused on the central phenomenon of LHV in the nursing work environment.
Developing Strategy: A Guide For Nurse Managers to Manage Nursing Staff
Nurse managers are tasked with the near-impossible to ensure the care provided in the unit is of high quality, keep patients and families satisfied with the care, as well as achieve productivity goals, all while addressing the needs of the staff. ... Thus, nurses working in managerial positions must develop their problem-solving skills. Current ...
PDF Nurse Manager Competencies
2 AONE NURSE MANAGER COMPETENCIES ©2015 The American Organization of Nurse Executives Suggested APA Citation: American Organization of Nurse Executives. (2015). ... » Assist others in developing problem solving skills » Foster a healthy work environment 5. Promote professional development » Promote stress management
Nursing Leadership: Your Journey as a Nurse Manager |ANA
Effective communication and problem-solving skills are essential for setting a positive tone within the team. Professional Development Opportunities. Continuous learning is vital for Nurse Managers. Organizations like the American Nurses Association (ANA) offer various professional development resources to help Nurse Managers stay updated and ...
PDF Problem Solving Training for First Line Nurse Managers
Objective: This paper evaluates the effects of an interactive problem solving training program on first-line nurse managers' self-reported problem solving skills. Methodology: The data for this evaluation study was collected between December 2011 and May 2012.Data were collected on three occasions using the Problem Solving Inventory.
How to Be a Good Nurse Manager
Manage priorities. A good nurse manager has plenty of tasks but often needs more time. Strong organizational and time management skills — and the ability to streamline processes and delegate appropriate tasks — help to improve efficiency and empower your staff. Embrace change. Health care is constantly changing.
Problem-Solving for Nurse Leaders
mentorship. delegation. open-mindedness. forward-thinking. accessibility. Another valuable quality in leadership is being proactive in problem-solving. Good leaders handle issues as they arrive. They are capable of "putting out fires," and that's important. Yet, great leaders anticipate problems before they come to a head.
Problem Solving in Nursing: Strategies for Your Staff
Problem solving for nurses is essential to quality patient care. Explore problem-solving examples in nursing and devise effective strategies.
Impact of Nurse Leaders Behaviors on Nursing Staff Performance: A
Analyze the impact of work environment, nurses' performance, behavior, problem-solving skills, and transformational role on sustainable nursing leadership: Quantitative: N = 205 (118 nurse managers, 54 nurses, 12 director nurses, 21 methodologist nurses); 196 F, 9 M; 90% >30 years: Knowledge and awareness
6 Tips for Being a Successful Nurse Manager
Expand critical thinking skills. Nurse managers are expected to make decisions and solve problems as part of the job. Critical thinking — analysis, evaluation, inference, problem-solving, and deductive reasoning — play an important role in making decisions and solving problems.
PDF Critical thinking in Nursing: Decision-making and Problem-solving
A free flow of ideas is essential to problem-solving and decision-making because it helps prevent preconceived ideas from controlling the process. Many decisions in healthcare are arrived at by group or teams rather than by the individual, and this type of decision-making requires special skills. General steps to all decision making include:
Problem Solving in Nursing Management
Dive deep into the multifaceted world of nursing management with a special focus on problem-solving. This comprehensive guide presents a detailed look at the process, importance, and challenges of problem-solving in nursing management. By highlighting essential skills, neurologically based frameworks, and the relationship with decision-making, it offers both theoretical understanding and ...
Critical thinking in nurse managers
Critical thinking can have a powerful influence on the decision making and problem solving that nurse managers are faced with on a daily basis. The skills that typify critical thinking include analysis, evaluation, inference, and deductive and inductive reasoning. It is intuitive that nurse managers require both the skills and the dispositions ...
The perceived problem-solving ability of nurse managers
It was identified that nurse managers who had received education about management, following scientific publication and scientific meeting and had followed management models, perceived their problem-resolving skills as more adequate than the others (P>0.05). Conclusion: In this study, it was determined that nurses do not perceive that they have ...
Critical Thinking in Nursing: Developing Effective Skills
Practicing your problem-solving skills can improve your critical-thinking skills. Analyze the problem, consider alternate solutions, and implement the most appropriate one. Besides assessing patient conditions, you can apply these skills to other challenges, such as staffing issues. How to Develop and Apply Critical-Thinking Skills in Nursing ...
The perceived problem-solving ability of nurse managers.
Study rationale: The development of a problem-solving approach to nursing has been one of the more important changes in nursing during the last decade. Nurse Managers need to have effective problem-solving and management skills to be able to decrease the cost of the health care and to increase the quality of care. Study aim: This descriptive study was conducted to determine the perceived ...
Strategies for Problem Solving
Step 2: Analyze the Problem. Break down the problem to get an understanding of the problem. Determine how the problem developed. Determine the impact of the problem. Step 3: Develop Solutions. Brainstorm and list all possible solutions that focus on resolving the identified problem. Do not eliminate any possible solutions at this stage.
Relationship Between the Problem-Solving Skills and Empathy ...
room nurses and to explore the factors that relate to these two competencies. Methods This is a cross-sectional, descriptive study. Study data were gathered using a personal information form, the Interpersonal Problem Solving Inventory, and the Basic Empathy Scale (N = 80). Descriptive and comparative statistics were employed to evaluate the study data. Results Age, marital status, and career ...
Factors Influencing Problem-Solving Competence of Nursing Students: A
The subjects' mean problem-solving ability score was 3.63 out of 5. Factors affecting problem-solving ability were age, communication competence, and metacognition, among which metacognition had the greatest influence. These variables explained 51.2% of the problem-solving ability of nursing students. Thus, it is necessary to provide guidance ...
Stumped? Five Ways To Hone Your Problem-Solving Skills
Respect the worth of other people's insights. getty. Problems continuously arise in organizational life, making problem-solving an essential skill for leaders.
Developing Strategy: A Guide For Nurse Managers to Manage Nursing Staff
Nurse managers are tasked with the near-impossible to ensure the care provided in the unit is of high quality, keep patients and families satisfied with the care, as well as achieve productivity goals, all while addressing the needs of the staff. ... Thus, nurses working in managerial positions must develop their problem-solving skills. Current ...
Collaborative project-based learning in global health: Enhancing
Specifically, the study aims were: (1) to quantitatively evaluate the change in global health competency, communication skills, problem-solving skills, and self-directed learning skills before and after the implementation of the course; and (2) to qualitatively investigate the undergraduate nursing students' overall experiences with the course.
Healthcare
The nursing education program in this study provides comprehensive experiential learning through advanced virtual simulation, significantly enhancing nursing students' performance confidence, critical-thinking abilities, and problem-solving skills across a wide range of clinical scenarios. By repeatedly engaging with diverse learning topics ...
Leadership in Nursing: Qualities & Why It Matters
Professionalism and Leadership: Leaders in nursing build vital relationships and collaborate with various health care teams on sensitive topics. Using critical thinking skills allows those in nursing leadership roles to analyze decisions impacting the organization. They then clearly explain the rationale in a manner that encourages staff support.
Perceived efficacy of case analysis as an assessment method for
Case analysis is a dynamic and interactive teaching and learning strategy that improves critical thinking and problem-solving skills. However, there is limited evidence about its efficacy as an assessment strategy in nursing education. This study aimed to explore nursing students' perceived efficacy of case analysis as an assessment method for clinical competencies in nursing education.
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What is Problem-Solving in Nursing? (With Examples, Importance, & Tips to Improve)

What Exactly Is Problem-Solving In Nursing?

How Leaders Approach Problem-Solving

What Makes a Great Leader?

Core Skills Nurse Leaders Need to Possess

Leadership’s Role in Addressing Lateral and Horizontal Violence (LHV)

Empowerment Sets Everyone Up for Success

What Type of Leader Do You Aspire to Be?

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Role of Creativity in the Problem Solving Process

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Decision Making and Problem Solving in Nursing Management

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Techniques for Effective Decision Making in Problem Solving Scenarios

Unpacking Examples of Problem Solving in Nursing Management

Case Study Analysis of Problem Solving Scenarios

Varied Approaches to Problem Solving in Different Nursing Scenarios

Real Life Applications of Problem Solving Strategies in Nursing Management

Exploring Nursing Management Problem-Solving Strategies

Development of Strategic Problem-Solving Competencies

Role of Leadership in Implementing Problem Solving Strategies

Use of Resources in Problem Solving Strategies

Initial Assessment and Identification: The First Stage of Problem Solving

Formulating Actionable Solutions: The Mid Stages of the Problem-solving Process

Evaluation and Reflection: The Final Stage of Problem Solving

Critical Thinking and Problem Solving in Nursing

The Connection Between Critical Thinking and Problem Solving in Nursing

Enhancing Critical Thinking for Effective Problem Solving in Nursing Management

Examples of Critical Thinking Leading to Effective Problem Solving

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Relationship Between the Problem-Solving Skills and Empathy Skills of Operating Room Nurses

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