The review was conducted in three major stages and eight steps using thematic synthesis. The researchers searched relevant Health and Medicine databases for primary studies published in any language with an English abstract and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Studies focusing on nurse educator challenges and nursing student attrition were critically appraised with the Mixed Methods Appraisal Tool. Thematic content analysis combined deductive and inductive reasoning; where included studies presented both nurse educators and students, the analysis used only data from educators. Of 1,330 initially identified studies, 37 met the inclusion criteria.

The abstract identifies persistent challenges in nursing education environments and highlights the importance of effective clinical and educational learning environments. Proposed responses include enhancing the nursing profession’s image, revising curricula and implementing student-focused teaching methods. It also calls for support for students during clinical placements, learning environments with adequate infrastructure, fair workload distribution and competitive remuneration to support educator motivation and retention. The authors additionally suggest that revised policies could improve continuous professional development and mentorship for new nurse educators. These are presented in the abstract as possible solutions rather than outcomes evaluated by the review.

South Africa provided the motivating context for the research. The abstract reports that problems in nursing training have contributed to a shortage of newly qualified nurses, while nursing education institutions accredited by the South African Nursing Council can register only limited numbers of students. Despite assistance from nurse educators, some students still fail to complete their training, and the authors suggest that educators may face challenges in addressing factors related to attrition. The findings are described as globally relevant, but the available evidence is limited to the abstract. It does not provide the geographic distribution, detailed characteristics or study-level quality findings for the 37 included studies, so the scope and limitations of the underlying evidence cannot be assessed further from the supplied material. The article is an early-access version in BMC Nursing and remains subject to further editorial changes.

Subject of Research: Nurse educator challenges associated with nursing student attrition in South African and global nursing education

Article Title: Challenges experienced by nurse educators to minimise the attrition of nursing students: a systematic review

Article References: Kent, A., Scholtz, S., Lubbe, W., & Rabie, T. (2026). Challenges experienced by nurse educators to minimise the attrition of nursing students: a systematic review. BMC Nursing. https://doi.org/10.1186/s12912-026-05455-5

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05455-5

Keywords: nursing student attrition, nurse educators, systematic review, mixed-studies review, thematic synthesis, nursing education, clinical placements, South Africa, Challenges, experienced, nurse, educators

The team followed the widely used scoping review framework of Arksey and O’Malley, which structures the work into five stages: clarifying the purpose and research question, identifying relevant literature, selecting studies, extracting data, and then collating, summarizing and reporting the results. The search surfaced 412 publications, of which 23 met the inclusion criteria. That funnel from hundreds of candidates to a couple of dozen included studies is typical of scoping reviews, but the small final corpus also reflects how specialized the literature on any single assessment instrument tends to be. What the 23 studies revealed, however, was strikingly consistent.

The core finding is that the AssCE tool serves as a systematic and structured vehicle for feedback, mediating both formative and summative assessment of students. In practical terms, the tool is not a single end-of-placement exam but a scaffold stretched across the whole clinical period. The review documents its use for planning the placement in advance, for student self-assessment, for daily follow-up of progress, and for formal assessment discussions with preceptors and the academic lecturer at the midpoint and the end of the clinical period. This rhythm of repeated, structured checkpoints is precisely what assessment researchers have long argued distinguishes learning-oriented evaluation from a one-off grade.

The experiences reported across the included studies were mainly positive, and notably so across all three groups involved in clinical education. Students and preceptors appreciated the tool as a structure for the content of the clinical period, giving shape to what can otherwise be an amorphous apprenticeship. Lecturers, whose perspective is often underreported in placement research, reported that while using the tool was time-consuming, well-prepared preceptors and students enabled deeper-level discussions about the student’s knowledge and performance. In other words, the instrument’s value scaled with the preparation of the people using it, a finding with clear implications for how universities introduce assessment tools at placement sites.

One of the more forward-looking results concerns digitalization. The lecturers in the reviewed studies supported developing the AssCE tool toward digital formats, a sentiment that mirrors the broader shift in health professional education toward electronic assessment platforms that can log progress in real time rather than relying on paper forms completed at intervals. The authors also report that comparisons indicated benefits of the AssCE compared with other equivalent locally developed tools for clinical education, suggesting that a nationally grounded, theoretically derived instrument may outperform the ad hoc checklists that individual institutions tend to produce.

Perhaps the most intriguing strand of the review concerns uses of the tool beyond its original purpose. Alongside clinical education, the research studies showed that the AssCE tool was useful in other areas as well, for example when nurses estimated their own competence. That extension from student assessment to professional self-assessment is significant, because competence estimation among practicing nurses is a persistent challenge for workforce planning and continuing education. A tool designed to make a student’s developing abilities visible apparently also helps seasoned clinicians map their own.

The authors attribute the tool’s durability to its design pedigree. It was created based on experiences of opportunities for dialogue and verification of students’ level of knowledge, which means its architecture was built around conversation and evidence rather than around box-ticking. That lineage helps explain why students and preceptors alike described it as a structure for the placement: the instrument encodes an expectation that assessment is something done with the student, not to the student. In an era when clinical placements are under pressure from staffing shortages and compressed curricula, tools that make dialogue efficient may matter more than ever.

The review is not uncritical. The conclusion notes that the tool has been used in new areas, and that this spread indicates a need for further development and psychometric testing. Psychometric evaluation, the statistical assessment of an instrument’s reliability and validity, is the gold standard for proving that a measurement tool measures what it claims to measure consistently. A tool that has migrated from assessing nursing students in clinical placements to gauging practicing nurses’ self-estimated competence is operating in contexts its original validation may not fully cover, and the authors are transparent that this expansion outpaces the testing.

The stakes of this line of research are easy to underestimate. Clinical practice is perceived as important for students’ learning and professional development, and one prerequisite for optimal learning is having assessment tools that support continuous development and assessment of students’ different abilities. When assessment is vague or inconsistent, students can pass placements without demonstrable competence, or competent students can be failed on the basis of a preceptor’s impression. Structured instruments like AssCE aim to close that gap by anchoring judgments in defined criteria and repeated dialogue, and the review suggests that after two decades the approach has earned its keep.

Published as open access in BMC Nursing on 17 September 2026, the review arrives at a moment when nursing education worldwide is scrutinizing how clinical competence is certified. Its message is twofold: a well-designed assessment tool can structure the entire arc of a clinical placement and foster the deeper discussions that turn supervision into learning, but tools that travel into new territory must be re-validated there. For the universities, hospitals and preceptors who depend on instruments like AssCE, the next chapter will likely be digital, and the evidence base will need to keep pace with the tool’s expanding reach.

Subject of Research: Use and experiences of the Assessment of Clinical Education (AssCE) tool in nursing education

Article Title: Assessment of clinical education (ASSCE): a scoping review of use and experiences of the tool

Article References: Löfmark, A., Engström, M., & Mårtensson, G. (2026). Assessment of clinical education (ASSCE): a scoping review of use and experiences of the tool. BMC Nursing, 25(1), Article 862. https://doi.org/10.1186/s12912-026-05379-0

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05379-0

Keywords: AssCE tool, nursing education, clinical education, assessment tools, scoping review, formative assessment, summative assessment, preceptors, self-assessment, psychometric testing, clinical placements, digitalization

The research, published in BMC Nursing, was led by Xiaoyan Zeng and Enru Lin, co-first authors from the School of Nursing at Fujian Medical University, together with colleagues including Rong Hu and Ying Wang. The team adopted a descriptive qualitative design, the methodological approach of choice when researchers want to capture participants’ experiences in their own terms while still producing a structured, analysable account. Rather than testing hypotheses or measuring variables, descriptive qualitative work asks open questions and lets patterns emerge from what participants say, making it particularly well suited to a concept like dignity, whose meaning varies between individuals and contexts.

Recruitment was deliberately broad. Using purposive sampling, the researchers enrolled 29 full-time undergraduate nursing students drawn from 15 universities across mainland China. Purposive sampling means participants were selected for their relevance to the research question rather than at random, ensuring the sample included students with varied educational and clinical experiences. Between September and December 2025, each student took part in an individual semi-structured online interview. Semi-structured interviews follow a flexible guide of open-ended questions, allowing participants to raise unexpected themes while ensuring every interview covers the core topic. Conducting the interviews online widened the geographic reach of the study and allowed students to speak from familiar surroundings, which can encourage candour on sensitive subjects such as perceived social status.

The interview data were analysed using Braun and Clarke’s thematic analysis, a widely used six-phase framework in which researchers immerse themselves in transcripts, code meaningful segments, and iteratively group codes into themes that capture something important about the dataset as a whole. The rigour of this approach depends on systematic coding and repeated comparison across the entire corpus, and it produces themes that are analytic summaries rather than simple topic labels. In this study, the process distilled hundreds of student statements into three overarching themes: external social valuation of nursing, appraisal of nursing’s professional value, and evolving professional dignity.

The first theme, external social valuation of nursing, describes how students’ sense of dignity was continuously calibrated against how society evaluates the profession. Students described encountering social attitudes that could either diminish or enhance their dignity. Where nursing was dismissed as subordinate work, an extension of medicine, or a fallback choice for those who could not enter other programmes, students reported feeling their chosen profession devalued, and with it their own sense of worth. Conversely, where nursing was recognised as skilled, caring, and indispensable, particularly in the wake of public health events that put nurses in the public eye, students described a corresponding lift in pride and confidence. The finding underscores that dignity is not generated solely inside the individual; it is partly on loan from the surrounding culture, and students are acutely sensitive to the exchange rate.

The second theme, appraisal of nursing’s professional value, shifts the focus from society’s gaze to the students’ own assessment of what nursing contributes. Students came to understand dignity through the meaningful nature of nursing work, the tangible difference nurses make to patients’ lives, and the professional respect that accrues with demonstrated clinical competence. In other words, dignity was not merely conferred from outside; it could be earned and internalised as students developed skills, witnessed recovery in patients they had cared for, and recognised the irreplaceable role of nursing within the health system. This internal appraisal acted as a counterweight to negative social attitudes, suggesting that professional value and social valuation operate through partly independent psychological pathways.

The third theme, evolving professional dignity, captures the developmental character of the phenomenon. Students’ perceptions were not fixed; they were continually reconsidered through nursing education and clinical exposure. Early in training, many students held impressions formed largely by media portrayals and family expectations. As they progressed through coursework and entered clinical placements, direct contact with real patients, practising nurses, and the realities of hospital work forced a renegotiation of what dignity in nursing meant to them personally. Some experiences consolidated their commitment; others exposed gaps between the profession’s ideals and its everyday conditions. The authors characterise students as occupying a vulnerable yet formative position, in which dignity and professional identity are actively taking shape and remain open to both damage and deliberate cultivation.

Why does this matter beyond the interview room? The research team argues that the development of professional dignity reflects a complex interplay of individual and contextual factors, with social recognition playing a central role. Dignity is linked in the wider nursing literature to professional identity, retention, and quality of care, and a workforce that enters practice with a diminished sense of professional worth may be more susceptible to burnout and attrition. For a profession already facing global shortages, understanding how the next generation constructs, or fails to construct, a durable sense of dignity is a workforce question as much as an educational one. The Chinese context adds particular interest, since nursing’s social standing varies considerably across countries and health systems, and the study provides a grounded account from one of the world’s largest nursing education systems.

The practical implications point squarely at nurse educators and clinical mentors. The authors conclude that these figures should recognise dignity formation as a developmental process and provide deliberate support to foster stronger professional dignity among students. In practice, that could mean explicitly addressing social stereotypes about nursing in the curriculum, creating structured opportunities for students to reflect on meaningful patient encounters, ensuring clinical mentors model respectful interprofessional behaviour, and designing placements where students can experience competence and its recognition firsthand. Because the study is qualitative, it does not quantify how common each experience is or test which interventions work; its contribution is a detailed, evidence-based map of the terrain that future quantitative and interventional research can now navigate.

The study was approved by the Biomedical Ethics Committee of Fujian Medical University, with approval dated January 17, 2024, and all participants provided written informed consent, with participation voluntary and withdrawal permitted at any time. It was funded by the Teaching Research Program for Undergraduate Education at Fujian Medical University and the Minjiang Education Leading Talents Program, with the funders having no role in the design, analysis, or publication decisions. Published open access on September 16, 2026, the research offers a timely reminder that professional dignity is not a fixed attribute that nursing students either possess or lack, but a living construct assembled from social signals, professional values, and lived experience, and one that educators can actively help to build.

Subject of Research: Undergraduate nursing students' perceptions of professional dignity

Article Title: Full-time undergraduate nursing students’ perceptions of professional dignity: a descriptive qualitative study of social attitudes, professional values, and self-identity

Article References: Zeng, X., Lin, E., Li, R., Hu, R., & Wang, Y. (2026). Full-time undergraduate nursing students’ perceptions of professional dignity: a descriptive qualitative study of social attitudes, professional values, and self-identity. BMC Nursing. https://doi.org/10.1186/s12912-026-05387-0

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05387-0

Keywords: nursing students, professional dignity, nursing education, qualitative research, professional identity, thematic analysis, social attitudes, clinical placements, nurse workforce, China, BMC Nursing, nursing ethics

The research, published in Frontiers in Health Services, examined Te Kotahi Oranga, a student-assisted health clinic established in 2022 at Waikato Institute of Technology in Hamilton. Students from nursing, occupational therapy, social work, clinical exercise physiology and other disciplines undertook placements at the clinic, delivering health screening, falls prevention, pre-diabetes management and other community-based interventions targeting type 2 diabetes, COPD, adult asthma and fall risk. Crucially, while students participated in client assessment, care planning and interprofessional case discussions, clinical governance remained with qualified health professionals, making it a student-assisted rather than fully student-run model.

What set the clinic apart was its explicit Theory of Change, which identified subjective wellbeing as an ultimate outcome for participating students. The framework posited that wellbeing would be fostered through intermediate outcomes including leadership development, community connection, cultural understanding, clinical capability and sense of purpose. The clinic was designed in close collaboration with local Māori and Pacific health providers, delivering culturally responsive care embedded within Te Tiriti o Waitangi principles, and received significant philanthropic funding including a $1.5 million multi-year Community Impact Grant from Trust Waikato.

To test whether this developmental ambition was realised, researchers conducted a prospective longitudinal evaluation. Students were surveyed at three time points: at baseline within the first two weeks of placement, at completion of the placement, and six months afterwards. A total of 124 surveys were completed by 73 students between October 2022 and November 2024. The 57-item instrument included the validated Satisfaction with Life Scale (SWLS), a widely used five-item measure of global life satisfaction, alongside programme-specific items developed collaboratively with academic staff, clinic representatives and the impact evaluation consultancy Huber Social to capture outcomes such as leadership, cultural understanding and interprofessional collaboration.

The statistical analysis was appropriately cautious given the modest sample. Paired baseline-to-post-placement comparisons used 32 matched cases, providing an estimated post-hoc power of 0.782, while attrition at the six-month follow-up reduced the longitudinal sample to just 16 respondents, dropping power to 0.353 for paired analysis and 0.424 for group-level independent analysis. Where normality assumptions were violated, as assessed by the Shapiro-Wilk test, non-parametric alternatives such as the Wilcoxon signed-rank and Mann-Whitney U tests were used instead of paired-samples t-tests. No adjustment for multiple comparisons was applied, and the authors emphasised that individual p-values should be interpreted cautiously as exploratory findings.

Against this backdrop, the results were striking. Global life satisfaction, measured by the SWLS, remained essentially stable across the placement period, rising about 4 percent between baseline and post-placement before returning close to baseline at six months, with none of these differences reaching statistical significance. The authors argue that even this stability is notable, given substantial evidence that clinical training placements are typically associated with declining wellbeing, elevated stress and increased burnout risk among health professional students.

Meanwhile, the intermediate outcomes theorised to support wellbeing improved significantly. In paired analysis of 32 matched cases, students reported large increases in opportunities to lead client care, with baseline scores of 4.0 on a seven-point scale rising to 6.19 after placement, an effect size of d = -1.14. Statistically significant gains were also observed for sense of connection with the community, comfort leading a team of peers, ability to advocate for oneself and one’s client within the clinical team, confidence in clinical decision-making, access to community care learning opportunities, and communication with clients and their whānau, the Māori term for extended family in a broad sense. In the exploratory six-month group-level analysis, significant increases persisted for leadership opportunities, community connection and culturally attuned interactions with clients, while improvements in communication and sense of purpose approached but did not meet conventional significance thresholds.

Perhaps the most sobering findings came from the correlation analysis, which identified factors associated with students’ life satisfaction that lay well outside the clinic’s remit. The strongest association was having sufficient income to cover everyday needs, with a Pearson correlation of r = 0.612, p < 0.001. Moderate positive associations were observed for sleep sufficiency (r = 0.55), access to appropriate career development opportunities (r = 0.543), a strong support network of family and friends (r = 0.522) and motivation to pursue a career with underserved communities (r = 0.493). The authors note that income security reinforces a growing literature highlighting the limits of educational interventions in addressing wellbeing without parallel attention to structural and material conditions, and they call for students to be financially supported while engaged on required learning placements. Intriguingly, income sufficiency was also associated with motivation to work with underserved communities (r = 0.307, p = 0.014), a relationship whose direction cannot be determined from the present data but which may warrant further investigation regarding whether financial factors shape students’ career intentions and workforce aspirations.

The study has clear limitations. It relied on self-reported survey data, employed a single-site design within one New Zealand clinic, and suffered substantial attrition at the six-month follow-up, which reduced statistical power and increased the risk of non-response bias. The participant sample was also overwhelmingly drawn from nursing and occupational therapy, with 95 percent coming from these disciplines, limiting generalisability across the wider health professions. The observational design further limits causal inference, meaning associations cannot be interpreted as evidence that clinic participation directly caused the observed improvements.

Nevertheless, the authors argue that this is the first study to consider the impact of student-led clinic involvement on student subjective wellbeing as a core element of evaluation, and the findings suggest that such clinics function as developmental learning environments whose value extends beyond clinical skill acquisition. The improvements in leadership, communication, community connection, self-advocacy and culturally attuned practice align with capabilities increasingly recognised as critical to modern healthcare, supporting patient-centred care, interprofessional collaboration and responsiveness to diverse communities. Recognising wellbeing as both an outcome and an enabling condition, the authors conclude, aligns evaluation with contemporary views of educational quality and social impact, and strengthens the case for student-led clinics as environments that may support the formation of capable, resilient and thriving future health professionals.

Subject of Research: Health Services Research

Article Title: Student outcomes in a student-led clinic: beyond clinical learning

Article References: Broman, P., Vaughan, S., Andersen, P., Cannings, M. J., Haggie, M. B. P., O’Connor, K., Kovanur Sampath, K., Tan, S., Webster, O., Yap, J. R., & Brownie, S. (2026). Student outcomes in a student-led clinic: beyond clinical learning. Frontiers in Health Services, 6, Article 1884776. https://doi.org/10.3389/frhs.2026.1884776

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1884776

Keywords: student-led clinics, health professional education, student wellbeing, Satisfaction with Life Scale, clinical placements, New Zealand, interprofessional education, Frontiers in Health Services, Student, outcomes, student-led, clinic

Occupational therapy occupies a distinctive position among the health professions. Practitioners help patients regain the ability to carry out the everyday activities that give life meaning, from dressing and cooking to returning to work after injury. Doing this well demands more than memorised facts. Students must weave together theoretical knowledge, clinical reasoning and practical technique in real time, often with patients whose presentations resist neat textbook categories. The authors of the new study argue that conventional lecture-based learning frequently falls short of preparing interns for this integration, leaving a gap between what students know and what they can actually do at the bedside.

The BOPPPS model, an acronym for Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment and Summary, offers a scaffold for structuring any teaching session. It opens by capturing attention and connecting new material to prior experience, states clear learning objectives, gauges what students already know, then devotes the core of the session to active participation rather than passive listening. Learning is checked afterwards, and the session closes with a synthesis of key points. Case-based learning, meanwhile, anchors instruction in real clinical scenarios, asking students to analyse, discuss and solve problems the way they eventually will in practice. Combining the two produces a programme in which structured pedagogy and authentic clinical content reinforce one another across pre-class, in-class and after-class phases.

Despite encouraging reports from other health disciplines, the combination had never been formally evaluated in occupational therapy internships. To fill that gap, a team at the Department of Rehabilitation Medicine of Suzhou Municipal Hospital, affiliated with Nanjing Medical University, ran a single-centre randomised controlled trial between November 2025 and March 2026. Sixty undergraduate occupational therapy interns were enrolled and randomly assigned in equal numbers to an experimental group receiving the BOPPPS-CBL programme or a control group receiving traditional lecture-based learning.

The researchers measured outcomes with some care. Theoretical knowledge was scored on a 100-point scale, as were clinical skills, the latter assessed through an Objective Structured Clinical Examination, a widely used method in which students rotate through stations and are observed performing standardised clinical tasks. Teaching satisfaction, a secondary outcome, was measured on a 20-item questionnaire adapted from the SETQ framework, an instrument with a reported internal consistency of Cronbach’s alpha of 0.87. Statistical analysis used analysis of covariance with pre-test scores as covariates, and Bonferroni correction was applied across the five satisfaction subdomains to guard against false positives. Notably, when a significant interaction between group allocation and pre-test scores emerged for clinical skills, the team switched to change-score analysis as the primary approach and confirmed the result with a Bootstrap sensitivity analysis, a level of statistical caution not always seen in education research.

The findings were striking. The experimental group scored significantly higher than the control group on both post-test theoretical knowledge and clinical skills, with p values below 0.001 and effect sizes that are unusually large for educational interventions: partial eta-squared values of 0.91 for knowledge and 0.895 for skills. In practical terms, the structured case-driven programme accounted for the overwhelming majority of the variance in post-test performance between the groups. Satisfaction followed the same pattern. Students taught with BOPPPS-CBL reported significantly higher total teaching satisfaction, and all five subdomains, including Teaching Enthusiasm, remained significant after Bonferroni correction. The study also explored the relationship between satisfaction and knowledge, finding a strong partial correlation of 0.860 after controlling for group allocation and pre-test scores, though the authors flag this association as exploratory rather than confirmatory.

Why might the combined approach work so well? The BOPPPS structure imposes a rhythm that keeps learners engaged at every stage, while the cases give abstract theory a concrete face. A student who has debated how to adapt a bathroom routine for a patient with hemiplegia is far more likely to recall the relevant principles, and to apply them flexibly, than one who has only heard them described in a slide deck. The pre-class and after-class components extend learning beyond contact hours, turning the placement into a continuous cycle of preparation, practice and reflection rather than a series of isolated encounters. The high satisfaction scores suggest that this intensity was experienced not as a burden but as a more meaningful way to learn.

The authors are admirably candid about the limits of their evidence. Instructor identity was completely confounded with group allocation, meaning the same teachers delivered the experimental programme and different teachers delivered the lectures, so any observed difference could partly reflect who was teaching rather than what was taught. The educational dosage was also unequal between the arms, and the trial was registered retrospectively, on September 9, 2026, after enrolment had begun in November 2025, owing to administrative delays. Because of these constraints, the team interprets the results as preliminary, exploratory support for the entire educational package rather than proof that the BOPPPS-CBL model itself is the active ingredient.

That caution matters for anyone hoping to translate the findings into policy. Educational interventions are notoriously difficult to evaluate cleanly, and single-centre trials with large effect sizes sometimes shrink when replicated more rigorously. The authors call for prospectively registered, multi-centre trials with validated outcome measures, longer-term follow-up and factorial or multi-arm designs capable of isolating which components of the package actually drive the benefit while controlling for instructor effects. Until such trials exist, widespread implementation cannot be recommended, even though the signal from Suzhou is strong enough to justify the effort.

Nevertheless, the study adds to a growing body of evidence that clinical education across the health professions is being transformed by active, case-centred pedagogy. For occupational therapy, a field whose entire ethos centres on meaningful, real-world function, teaching methods that mirror the complexity of practice seem a natural fit. The trial was approved by the Ethics Committee of Suzhou Municipal Hospital, all participants gave written informed consent, and the work was funded by the hospital’s 2024 Educational Research Project. If larger, better-controlled studies confirm what this one suggests, the way rehabilitation students learn during placements could shift decisively away from the lecture hall and toward the structured, case-driven classrooms where theory and practice finally meet.

Subject of Research: A randomised controlled trial of BOPPPS combined with case-based learning in occupational therapy clinical education

Article Title: BOPPPS combined with case-based learning for occupational therapy clinical placements: a single-centre randomised controlled trial

Article References: Dai, Y., Ju, X., Xu, Y., Jia, G., & Wang, X. (2026). BOPPPS combined with case-based learning for occupational therapy clinical placements: a single-centre randomised controlled trial. BMC Medical Education. https://doi.org/10.1186/s12909-026-10559-2

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10559-2

Keywords: BOPPPS model, case-based learning, occupational therapy, clinical education, randomised controlled trial, medical education, clinical skills, teaching satisfaction, Objective Structured Clinical Examination, lecture-based learning, clinical placements, rehabilitation

The research, led by Doreen Mukona of the University of Massachusetts Dartmouth together with colleagues at Ajman University, the University of Zimbabwe, and the University of Global Health Equity in Kigali, took place at a tertiary health sciences college in the United Arab Emirates. The team designed a concurrent, equal-status mixed-methods study, meaning that quantitative survey data and qualitative free-text responses were collected at the same time and given equal analytical weight. A total of 133 nursing students in academic years two through four participated. The quantitative arm used an adapted 31-item Pressure Injury Prevention Knowledge questionnaire, derived from the internationally recognized Pressure Ulcer Knowledge Assessment Tool, while two open-ended questions invited students to describe the barriers they perceived and the improvements they would suggest.

The headline finding is sobering. On average, students scored 19.9 out of 31 points, equivalent to 64.1 percent, with a standard deviation of 16.6 percent. Only 20.3 percent of participants reached the pre-specified threshold for good knowledge of 80 percent or higher. A further 42.1 percent fell into the moderate band of 60 to 79 percent, while 37.6 percent scored below 60 percent, classed as poor. In other words, nearly four in ten future nurses at this institution had knowledge levels that fell short of what most educators would consider safe for independent clinical practice. The participants, who had a mean age of 21.9 years and were almost entirely Emirati nationals at 99.2 percent, represent the demographic that will staff the country’s expanding hospital network in the coming years.

One of the most technically revealing results concerns how students performed on different types of test items. The questionnaire included both true-keyed items, where the correct answer affirms a correct practice, and false-keyed items, where the correct answer requires students to reject a plausible but wrong statement. Students scored a striking 79.7 percent correct on true-keyed items but only 40.5 percent on false-keyed ones, a difference that was highly statistically significant with a paired t-value of 18.96 and p less than 0.001, corresponding to a very large effect size with Cohen’s d of 1.65. This pattern suggests that students can recognize correct prevention practices when they see them but struggle to identify incorrect ones, a cognitive profile consistent with surface learning rather than the deep conceptual understanding needed to make sound clinical judgments in ambiguous real-world situations.

The researchers also explored whether knowledge grew with experience. Knowledge was weakly but significantly associated with year of study, with Spearman correlation coefficients between 0.23 and 0.25 and p values below 0.01, and with the number of clinical placements completed, at rho equal to 0.22 and p equal to 0.01. However, when the team built an adjusted multivariable linear regression model, no individual predictor remained statistically significant, and the model explained only seven percent of the variance in knowledge scores, with p equal to 0.09. This weak explanatory power is itself informative: it implies that academic seniority alone does not reliably produce pressure injury expertise, and that other factors, such as teaching quality, curriculum emphasis, and individual study habits, likely play larger roles than the researchers could capture with the variables available.

The qualitative arm of the study painted a vivid picture of why knowledge fails to translate into action. Using qualitative content analysis, the researchers identified six categories of barriers. The most frequently cited was a poor training-practice linkage, reported by 54 percent of students, meaning that what they learned in lectures did not match what they encountered or were allowed to do during clinical placements. Lack of time followed closely at 51 percent, reflecting the relentless pace of hospital wards where prevention tasks such as repositioning patients every two hours compete with medications, documentation, and emergencies. Workforce-capacity constraints were cited by 43 percent of respondents, pointing to understaffing that leaves too few hands to turn and reposition immobile patients as often as guidelines demand.

The remaining barriers, though less frequently mentioned, are no less important. Lack of equipment was reported by 26 percent of students, a reminder that even well-trained nurses cannot deliver prevention without pressure-redistributing mattresses, cushions, and adequate dressing supplies. Communication or documentation breakdowns accounted for 13 percent of responses, highlighting how prevention depends on seamless handovers and accurate skin assessments recorded across shifts. Finally, patient-related complexity, cited by 12 percent, acknowledged that some patients present challenges, such as restlessness, obesity, or medical instability, that make standard prevention protocols difficult to follow. Together, these six categories describe a system problem rather than an individual failing: students may know exactly what to do, yet find themselves embedded in clinical environments that do not support doing it.

When asked how nursing education could be improved, the students were remarkably consistent. Regular training was the most popular suggestion at 58.9 percent, followed by simulation-based learning at 35.7 percent and updated guidelines at 22.3 percent. Simulation deserves particular attention from educators and policymakers alike. High-fidelity manikins and scenario-based exercises allow students to practice skin assessments, risk scoring with tools such as the Braden Scale, and repositioning techniques in a safe environment where mistakes carry no human cost. The strong student demand for simulation echoes a broader international movement in nursing education toward experiential learning, and the findings suggest that in the UAE context this shift has not yet gone far enough to close the theory-practice gap that students themselves identified as the leading barrier.

The study’s methodology merits confidence as well as scrutiny. The authors followed the STROBE reporting guidelines for observational studies and the SRQR standards for qualitative research, and they used Kuder-Richardson Formula 20 to assess the internal consistency of the adapted questionnaire. Ethical approval was granted by the Fatima College of Health Sciences Research Ethics Committee, and the study was conducted in accordance with the Declaration of Helsinki, with electronic informed consent and voluntary participation. The authors transparently disclose that the first author held a teaching role at the participating institution, a potential influence on both student disclosures and data interpretation, and they describe coding safeguards used to mitigate this. The study was not prospectively registered and received no external funding, details that readers should weigh when interpreting the results.

What, then, should change? The findings point to a coordinated agenda. Nursing curricula in the UAE and similar settings should place greater emphasis on false-keyed reasoning, teaching students not just what correct prevention looks like but how to spot and correct unsafe practice. Clinical placements need structured, supervised opportunities to perform actual prevention tasks rather than merely observe them. Hospitals and colleges should jointly invest in simulation laboratories, ensure equipment availability, and address the workforce and time constraints that students identified so clearly. Pressure injuries cost health systems enormously in prolonged stays, infections, and litigation, and they inflict real suffering on vulnerable patients. If nearly 80 percent of graduating nurses fall short of good knowledge, and if even knowledgeable students are blocked by systemic barriers, then the solution must span the classroom, the simulation suite, and the ward floor simultaneously. This study provides the regional evidence base to start that conversation.

Subject of Research: Nursing students' knowledge of pressure injury prevention and barriers to applying it in the United Arab Emirates

Article Title: Knowledge of pressure injury prevention and perceived barriers to applying it among nursing students at a tertiary institution in the United Arab Emirates: a mixed-methods study

Article References: Mukona, D., Mukona, R. F., Zvinavashe, M., & Ndaimani, A. (2026). Knowledge of pressure injury prevention and perceived barriers to applying it among nursing students at a tertiary institution in the United Arab Emirates: a mixed-methods study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10537-8

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10537-8

Keywords: pressure injuries, pressure ulcers, nursing education, nursing students, knowledge assessment, mixed methods, theory-practice gap, simulation training, clinical placements, United Arab Emirates, wound care, patient safety