The Impact of Nursing Students' Metacognition, Clinical Judgment, and Program Outcome on Self-confidence with Clinical Decision Making

이승희 단국대학교 글로벌벤처전략연구소 2026 Entrepreneurship&ESG연구 Vol.6 No.1

This study is a descriptive survey research aimed at identifying the relationship between nursing students' metacognition, clinical judgment, program outcome, and self-confidence in clinical decision making, along with the factors influencing self-confidence in clinical decision making. The target population for this study consists of third-year nursing students enrolled in domestic nursing programs. The convenience sample is comprised of third-year students from university's nursing department located in Chungnam, recruited through convenience sampling. Data collection involved a total of 110 participants. The regression model results were significant (F=50.47, p<.001), and the adjusted coefficient of determination (Adjusted R²) indicating the model's explanatory power was .605. The variables influencing self-confidence in clinical decision making were, in order of significance: metacognition (β=.439, p<.001), clinical judgment (β=.391, p<.001), and program outcome (β=.137, p=.046). Metacognition emerged as the factor exerting the greatest influence. This study is significant in that it identified key factors influencing nursing students' self-confidence in clinical decision making and provided basic data for developing teaching and learning strategies. In conclusion, self-confidence in clinical decision making is a complex process involving the interaction of various factors. Therefore, an integrated approach encompassing research, education, and practice is necessary to achieve optimal outcome.

간호학 실습교과목 학습성과에 따른 효과적인 실습방법

윤지아,강경림,김명희 안암교육학회 2019 한국교육학연구 Vol.25 No.4

This study is a descriptive research study performed to present basic data for efficient practical training by investigating clinical nursing practice education experience by learning outcomes of graduates and expected graduates who completed clinical practice, Highfidelity Patient Simulator Simulation practice (HPS practice) and Standard Patient Simulation practice (SP practice). Subjects are 110 people in total including 59 expected graduates and 51 graduates, whose clinical nursing career have less than one year. Research tools are consist of 2 forms of questions which are selected questions and open questions. Selected questions ask effective way of clinical practice by learning outcomes of clinical practice. Open questions ask about clinical practice experiences. Result of study shows that questions which were answered as effective clinical practice by both expected graduates and graduates are 4 out of 7 clinical course learning outcomes. Those 4 questions of affirmative answers were ‘Practical application of theoretical knowledge’ (p<.001), ‘Communication between patient, caregiver and medical staff’ (p<.001, p=.036, respectively), ‘Understanding Legal and Ethical standard of nursing specialty intuition and nursing practice’ (p<.001) and ‘Establishing and Application of nursing course through critical thinking’ (p<.001). One question that HPS practice was answered effective by both expected graduates and graduates is ‘Selection and Nursing of core basic nursing skills’ (p<.001, p=.003, respectively). Another question that SP practice was answered effective by only expected graduates is ‘Enhancement of Nursing Leadership competence’ (p=.002) and one question that HPS practice was answered effective by only expected graduates is ‘Understanding and Confirming action plan of Nursing needs situation’ (p=.021). No significant practice method was found for graduates. Interview results of clinical practice shows that clinical practice was limited to observation centered which was unable to perform direct nursing and though direct nursing was possible at simulation practice, acting environment was limited as well. In conclusion, we expect efficient clinical education will be performed by enhancing effective practical method by learning outcomes of clinical education and by driving active participation of learner and by developing excellent scenario of simulation practice which could provide enough precedent learning. 본 연구는 임상실습과 고충실도 모형을 활용한 시뮬레이션 실습(HPS 실습) 및 표준화 환자를 활용한 시뮬레이션 실습(SP 실습)을 모두 이수한 졸업예정자와 졸업자의 학습성과 별 실습교육 경험을 조사하여 효율적인 실습교육을 위한 기초자료를 제시하고자 수행되었다. 연구 대상자는 간호학과 졸업예정자 59명과 졸업 후 1년 미만의 신규간호사 51명을 포함한 총 110명이 었다. 연구도구는 실습교과목의 학습성과 관련 효과적인 실습방법을 선택하는 문항과 실습경험에 대한 개방형 질문으로 구성되었다. 실습교과목 학습성과 7개 항목 중 졸업예정자와 졸업자 모두 임상실습이 효과적이라고 응답한 항목은 ‘이론적 지식의 실무 적용’(p<.001), ‘환자, 보호자, 의료진과 의사소통’(각각p<.001, p=.036), ‘간호 전문직관과 간호 실무의 법적, 윤리적 기준의 이해’(p<.001), ‘비판적 사고를 통한 간호과정의 수립 및 적용’(p<.001)으로 총 4개 항목이었다. 졸업예정자와 졸업자 모두 HPS 실습이 효과적이라고 응답한 항목은 ‘핵심기본간호술의 선택 및 수행’(각각 p<.001, p=.003)으로 1개 항목이었다. 졸업예정자에서만 ‘간호 리더십 역량의 제고’ 항목은 SP 실습이(p=.002), ‘간호 요구상황의 이해 및 대처방법 확인’ 항목은 HPS 실습이(p=.021) 효과적이라고 응답한 반면, 졸업자는 통계적으로 유의한 실습방법이 나타나지 않았다. 실습경험에 대한 면담결과 임상실습은 관찰위주의 실습으로 직접 간호 수행이 제한적이었고, 시뮬 레이션 실습은 직접 간호 수행은 가능하지만 실습상황이 제한적이었다. 본 연구결과를 바탕으로 실습교육 학습성과 항목에 따라 효과적인 실습방법을 강화하되 임상실습 시 학습자의 능동적인 참여와 시뮬레이션 실습 시 우수한 시나리오의 개발 및 충분한 선행학습을 유도함으로써 효율적인 실습교육이 이루어지기를 기대한다.

Impacts of Rapid Recanalization and Collateral Circulation on Clinical Outcome after Intraarterial Thrombolysis

정혜선,Hyon-Jo Kwon,송희정,고현송,Yong Soo Kim,Ju Hun Lee,Jee Eun Shin,Suk Hoon Lee,김제 대한뇌졸중학회 2015 Journal of stroke Vol.17 No.1

Background and Purpose Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT. Methods We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time. Results In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT. Conclusions The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.

진료역량 중심의 기본의학교육 학습성과

이강욱,Lee, Kang Wook 연세대학교 의과대학 2016 의학교육논단 Vol.18 No.3

Outcome-based learning is a global trend in medical education. The Korean Association of Medical Colleges (KAMC) has been developing learning objectives for basic medical education (BME) in Korea. In 2012, KAMC published the 1st edition of "Learning outcomes of basic medical education: Clinical competency-centered" in order to promote outcome-based medical education. KAMC has recently revised and updated the learning outcomes of basic medical education in the clinical competency-centered 2nd edition to reflect the suggestions of all medical schools in Korea and improve application of the published learning outcomes for BME in the field of medical education. KAMC has been making efforts to integrate clinical competency-centered learning outcomes with scientific concepts and principle-centered learning outcomes in addition to basic clinical skills and performance in BME.

Is There a "Trial Effect" on Outcome of Patients with Metastatic Renal Cell Carcinoma Treated with Sunitinib?

Daniel Keizman,Keren Rouvinov,Avishay Sella,Maya Gottfried,Natalie Maimon,Jenny J. Kim,Mario A. Eisenberger,Victoria Sinibaldi,Avivit Peer,Michael A. Carducci,Wilmosh Mermershtain,Raya Leibowitz-amit 대한암학회 2016 Cancer Research and Treatment Vol.48 No.1

Purpose Studies suggested the existence of a ‘trial effect,’ in which for a given treatment, participa- tion in a clinical trial is associated with a better outcome. Sunitinib is a standard treatment for metastatic renal cell carcinoma (mRCC). We aimed to study the effect of clinical trial participation on the outcome of mRCC patients treated with sunitinib, which at present, is poorly defined. Materials and Methods The records of mRCC patients treated with sunitinib between 2004-2013 in 7 centers across 2 countries were reviewed. We compared the response rate (RR), progression free survival (PFS), and overall survival (OS), between clinical trial participants (n=49) and a matched cohort of non-participants (n=49) who received standard therapy. Each clinical trial participant was individually matched with a non-participant by clinicopathologic factors. PFS and OS were determined by Cox regression. Results The groups were matched by age (median, 64), sex (male, 67%), Heng risk (favorable, 25%; intermediate, 59%; poor, 16%), prior nephrectomy (92%), RCC histology (clear cell 86%), pre-treatment neutrophil to lymphocyte ratio (> 3 in 55%, n=27), sunitinib induced hyper- tension (45%), and sunitinib dose reduction/treatment interruption (41%). In clinical trial participants versus non-participants, RR was partial response/stable disease 80% (n=39) versus 74% (n=36), and progressive disease 20% (n=10) versus 26% (n=13) (p=0.63; odds ratio, 1.2). The median PFS was 10 versus 11 months (hazard ratio [HR], 0.96; p=0.84), and the median OS 23 versus 24 months (HR, 0.97; p=0.89). Conclusion In mRCC patients treated with sunitinib, the outcome of clinical trial participants was similar to that of non-participants who received standard therapy.

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Mehmet Zileli,Shradha Maheshwari,Shashank Sharad Kale,Kanwaljeet Garg,Sajesh K. Menon,Jutty Parthiban 대한척추신경외과학회 2019 Neurospine Vol.16 No.3

This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick’s grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski’s sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.

진료역량 중심의 기본의학교육 학습성과

이강욱 연세대학교 의과대학 2016 의학교육논단 Vol.19 No.3

Outcome-based learning is a global trend in medical education. The Korean Association of Medical Colleges (KAMC) has been developing learning objectives for basic medical education (BME) in Korea. In 2012, KAMC published the 1st edition of “Learning outcomes of basic medical education: Clinical competency-centered” in order to promote outcome-based medical education. KAMC has recently revised and updated the learning outcomes of basic medical education in the clinical competency-centered 2nd edition to reflect the suggestions of all medical schools in Korea and improve application of the published learning outcomes for BME in the field of medical education. KAMC has been making efforts to integrate clinical competency-centered learning outcomes with scientific concepts and principle-centered learning outcomes in addition to basic clinical skills and performance in BME.

Factors Affecting Clinical Outcome of 1107 Phaco-surgeries: Postoperative One Day, One Week and Two Months

Joo Youn Oh, Jin Hak Lee 대한검안학회 2008 검안 및 콘택트렌즈 학회지 Vol.7 No.1

Purpose: To determine which factors might affect the outcome of cataract surgery with respect to time after surgery. Methods: Clinical records of 1,107 eyes who underwent phacoemulsification and posterior chamber intraocular lens implantation by one surgeon were reviewed. Patient characteristics, intraoperative problems, and postoperative complications were evaluated as potential factors affecting the outcome. Visual outcome was determined by best-corrected Snellen visual acuity one day, one week, and two months after surgery. Results: Macular degeneration was independently associated with visual outcome thoroughout the two-month follow-up period. Old age, uveitis, prior vitrectomy, diabetes mellitus, and posterior capsule rupture were significantly associated with poorer outcome at one day or one week after surgery, but not related to the outcome at two months. Conclusions: Macular degeneration was identified as an only predictor of visual outcome after cataract surgery. Factors other than macular degeneration did not affect the outcome two months after surgery.

요추 유합술 후 발생한 인접 분절 퇴행성 변화와 임상 결과와의 상관관계

양준영,이준규,송호섭,김태훈,연규웅 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.1

Study Design: Retrospective study Objectives: To determine the relationship between clinical outcome and adjacent segment degeneration (ASD) after lumbar fusion. Summary of Literature Review: Few studies have analyzed the correlation between clinical outcomes and ASD. Materials and Methods: Between January 2000 and December 2004, 217 patients who underwent lumbar spinal fusion ( 2 years of follow-up) were evaluated. The patients were divided into 2 groups: one-segment (A) and two-segment (B). The UCLA grading scale was used to evaluate the prevalence of ASD on radiography. The association between clinical outcome and ASD was evaluated by Spearman’s correlation. Results: ASD occurred in 11.6% (13/112) of patients in group A and 15.2% (16/105) of patients in group B. The number of cases which progressed to more than 2 levels of the degenerative grade were 0 cases in group A and 13 cases (81.3%) in group B. In A, 5 out of 13 ASD cases downgraded one level in their clinical outcomes. In B, all 16 ASD cases downgraded more than one level in their clinical outcomes. Worsening in degenerative grade, was correlated with worse clinical outcome (Spearman’s rho = 0.829, P 0.05). Conclusions: The association of clinical outcomes with ASD after fusion showed a significant correlation, especially association with ASD after multiple segment fusion.

Correlations between Microbiological Outcomes and Clinical Responses in Patients with Severe Pneumonia

김성민,Jerome J. Schentag 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.3

Background: In treatment of pneumonia, microorganisms sometimes persist, appear or reappear despite good clinical responses. On the other hand, recent increasing antibiotic resistance emphases the goal of rapid eradication of pathogen in severe infection. This study was planned to evaluate the correlations between microbiological outcomes and clinical responses in severe pneumonia. Materials and Methods: Data was gathered from 3 clinical trials regarding severe pneumonia. Microbiological outcomes, determined by serial culture of respiratory tract samples,were compared with clinical outcomes. Results: In total, 146 bacterial strains from 76 patients were analyzed. While clinical success was generally related to total or partial eradication of isolated organisms, Acinetobacter , Enterobacter , Pseudomonas aeruginosa , and Stenotrophomonas maltophilia were often not eradicated and yet were observed in 56% of cases considered clinically successful at the end of antibiotic treatment. Most of the non-eradicated strains (71%) already had or developed resistance against the antibiotics used for treatment. Ten patients relapsed during the follow-up period; 7 of these relapses were associated with 10 non-eradicated organisms. Conclusions: These data raise concern about the pathogenicity of bacteria that persist in the respiratory tract even though good clinical outcomes of pneumonia are achieved, especially when Acinetobacter, Enterobacter , P. aeruginosa , or S. maltophilia were involved. Thus, clinical relapse and development of drug resistance by non-eradicated organisms may be raised.