title: Determinants of nursing competence of nursing students in Taiwan: the role of self-reflection and insight.
abstract: BACKGROUND
  A nursing practicum course is critical to strengthening the nursing competence of nursing students. Research has found that practice stress and coping behaviors can have either a negative or positive influence on the learning and practice performance of nursing students. Nevertheless, there are few evidence-based studies related to the relationship between self-reflection and insight and nursing competence in Taiwanese nursing students.
  
  
  OBJECTIVE
  To test the determinants and the effect of self-reflection and insight on nursing competence in nursing students during the first 2 months of their practice experience.
  
  
  METHODS
  Cross-sectional and correlational research designs were employed.
  
  
  METHODS
  From September to November 2013, a total of 312 nursing students at a junior college in southern Taiwan served as participants in this study. Four questionnaires were used to collect data: Self-reflection and Insight Scale (SRIS), Perceived Stress Scale (PSS), Coping Behavior Inventory (CBI), and Holistic Nursing Competence Scale (HNCS). The research model was evaluated through structural equation modeling (SEM), with the use of the partial least squares (PLS) method.
  
  
  RESULTS
  Results indicated that self-reflection and insight, practice stress, and practice coping behavior were statistically significantly associated with nursing competence. In addition, self-reflection and insight were significantly and positively associated with practice coping behavior and negatively associated with practice stress. Students' coping behavior partially mediates the effect of self-reflection and stress on nursing competence. Overall, these variables explained 39.4% of the variance in these students' nursing competence.
  
  
  CONCLUSIONS
  Self-reflection and insight affected nursing competence during the practice period. These variables have not only had a direct influence on nursing competence but also an indirect effect through the mediating effect of coping behavior and stress.
authors.affiliation: Department of Child-Educare, Min-Hwei Junior College of Health Care Management, No. 1116, Sec. 2, Jhongshan E. Rd., Liouying Dist., Tainan City 73658, Taiwan, ROC. Electronic address: chengjoo2000@yahoo.com.tw.
authors.forename: Cheng-Joo
authors.initials: CJ
authors.lastname: Eng
authors.affiliation: Department of Nursing, Min-Hwei Junior College of Health Care Management, No. 1116, Sec. 2, Jhongshan E. Rd., Liouying Dist., Tainan City 73658, Taiwan, ROC. Electronic address: pai55215@ms41.hinet.net.
authors.forename: Hsiang-Chu
authors.initials: HC
authors.lastname: Pai
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D011594:Psychometrics; D012649:Self Concept; D013315:Stress, Psychological; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires; D013624:Taiwan; D055815:Young Adult
keywords: Adaptive behavior; Clinical competence; Coping behavior; Holistic nursing competence; Insight; Psychological; Self-reflection; Stress