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Few studies describe the nursing students' patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students' patient safety competencies.

BackgroundModern healthcare institutions are continuously changing, and Self-Directed Learning (SDL) abilities are considered a prerequisite for both nursing students and nurses in order to be proactive about these demanding challenges. To date, no systematic reviews of existing instruments aimed at detecting and critically evaluating SDL abilities have been published. Therefore, the aims of this review are: 1) identify the instruments for assessment of SDL abilities among nursing students and nurses; 2) critically evaluate the methodological studies quality; and 3) compare the psychometric properties of the available instruments.MethodsA psychometric-systematic-review was performed. CDSR, CINAHL, ERIC, MEDLINE, PROSPERO, SCOPUS databases were searched without restrictions in time and setting. All primary studies involving nursing students or nurses, written in English and aimed at validating SDL assessment tools, were included. Studies retrieved were evaluated according to the COnsensus-based-Standards for the selection of health Measurement-INstruments (COSMIN) panel. Study inclusion, data extraction and quality assessment were performed by researchers independently.ResultsEleven studies were included and four tools based on Knowles’s theory have emerged: 1) the Self-Directed Learning Readiness Scale; 2) the Self-Directed Learning Readiness Scale for Nursing Education; 3) the Self-Rating Scale of Self-Directed Learning, and 4) the Self-Directed Learning Instrument. A few psychometric properties have been considered in each study, from two to four out of the ten required. The quality of the methodologies used was in general, from fair to poor with the exception of one instrument (the Self-Directed-Learning-Instrument). The psychometric proprieties that emerged across the tools were good in general: the Cronbach α was from 0.73 to 0.91; structural validities have also reported good indexes both in the explorative and in the confirmative factor analyses.ConclusionsOn the basis of the findings, the Self-Directed-Learning-Instrument can be recommended for the assessment of SDL abilities among nursing students and nurses, given the excellent methodology quality adopted in estimating the psychometric properties. However, rigorous study designs aimed at estimating psychometric properties of tools in wide samples of nursing students and nurses across different stages of professional life, from undergraduate education to professional maturity, in different cultural, educational, and work settings, are strongly recommended.

BackgroundSelf-Directed Learning develops when students take the initiative for their learning, recognising needs, formulating goals, identifying resources, implementing appropriate strategies and evaluating learning outcomes. This should be seen as a collaborative process between the nurse educator and the learner. At the international level, various instruments have been used to measure Self-Directed Learning abilities (SDL), both in original and in culturally-adapted versions. However, few instruments have been subjected to full validation, and no gold standard reference has been established to date. In addition, few researchers have adopted the established tools to assess the concurrent validity of the emerging new tools. Therefore, the aim of this study was to measure the concurrent validity between the Self-Rating Scale of Self-Directed Learning (SRSSDL_Ita) – Italian version and the Self-Directed Learning Instruments (SDLI) in undergraduate nursing students.MethodsA concurrent validity study design was conducted in a Bachelor level nursing degree programme located in Italy. All nursing students attending the first, second or third year (n = 428) were the target sample. The SRSSDL_Ita, and the SDLI were used. The Pearson correlation was used to determine the concurrent validity between the instruments; the confidence of intervals (CI 95 %) bias-corrected and accelerated bootstrap (BCa), were also calculated.ResultsThe majority of participants were students attending their first year (47.9 %), and were predominately female (78.5 %). Their average age was 22.5 ± 4.1. The SDL abilities scores, as measured with the SRSSDL_Ita (min 40, max 200), were, on average, 160.79 (95 % CI 159.10–162.57; median 160); while with the SDLI (min 20, max 100), they were on average 82.57 (95 % CI 81.79–83.38; median 83). The Pearson correlation between the SRSSDL_Ita and SDLI instruments was 0.815 (CI BCa 95 % 0.774–0.848), (p = 0.000).ConclusionsThe findings confirm the concurrent validity of the SRSSDL_Ita with the SDLI. The SRSSDL_Ita instrument can be useful in the process of identifying Self-Directed Learning abilities, which are essential for students to achieve the expected learning goals and become lifelong learners.

Self-directed learning is considered a key feature in the learning process. Despite the emerging debate regarding continuing education strategies and the effectiveness and pertinence of the learning needs of adult learners, little evidence is available on the measurement of the self-directed learning competence of nurses. The main aim of the study was to evaluate the validity and reliability of the Self-rating Scale of Self-directed Learning (SRSSDL) in an Italian sample of nurses. The forward-backward translation process of the original SRSSDL was adopted. Forty-one nurses were involved in the test-retest reliability. Internal consistency was evaluated in a convenience sample of 334 nurses working in Northeast Italy. The Italian version of the SRSSDL has demonstrated good reliability (Pearson coefficient 0.73) and internal consistency (Cronbach's alpha coefficient 0.94). The SRSSDL was found to be a valid and reliable instrument in the Italian context. This study has implemented the external validity of the scale by its application to a different population and context in its first validation process.

Our data confirm that the combination of interferon alfa-2b and tribavirin is well tolerated and feasible in patients with HIV-HCV co-infection and it can be associated safely with highly active antiretroviral therapy. The sustained response achieved with the drug combination does not seem to be any better than that achieved with 12 months of monotherapy with interferon alfa-2b.

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