Critical thinking, communication, decision-making confidence, and practicum stress among nursing students in maternal nursing practicum: A structural equation model

Background: A nursing practicum course plays a vital role in enhancing the clinical competence of nursing students. Core competencies such as critical thinking, communication, and clinical decision-making are essential for professional nursing practice. Maternal nursing practicums possess unique characteristics that can contribute to increased practicum-related stress. However, there is limited evidence-based research examining the relationships between practicum stress and key aspects of nursing competence, including critical thinking, communication skills, and confidence in clinical decision-making among nursing students. Aim: This study aimed to investigate the interrelationships among critical thinking, communication, and clinical decision-making confidence and examined the impact of practicum stress on these competencies among undergraduate nursing students. Design: A cross-sectional correlational design. Settings: Participants were recruited from four universities in Taiwan. Participants: A convenience sample of 219 undergraduate nursing students who had completed a maternal nursing practicum was recruited from October 2021 to April 2022. Methods: Students were surveyed using validated scales to measure their practicum stress, critical thinking, communication, and clinical decision-making confidence during maternal nursing practicum. Covariance-based structural equation modeling (CB-SEM) was used to analyze data and examine the interrelationships among these variables. All statistical analyses were conducted using SPSS and AMOS. Results: The participants included undergraduate nursing students (mean age: 21.4 years, 84 % female). Practicum stress had significant negative direct effects on critical thinking and communication. Critical thinking influenced communication. Additionally, communication mediated the effects of stress and critical thinking on decision-making confidence. The model fit indices for an emerging were strong: χ2/df = 1.71, SRMR = 0.05, RMSEA = 0.06, GFI = 0.91, TLI = 0.96, CFI = 0.97. Conclusions: Practicum stress reduces critical thinking and communication abilities, influencing decision-making confidence in nursing students during maternal practicums. Strategies to reduce stress and strengthen critical thinking and communication skills are essential to support nursing students' clinical decision-making competency.