Application of Case Review Based on Training Transfer Theory in the Training of New Nurses：a randomized controlled trial

Application of Case Review Based on Training Transfer Theory in the Training of New Nurses：a randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of Case Review Based on Training Transfer Theory in the Training of New Nurses：a randomized controlled trial Lian Hong Wu, Ling Xia Liu, Yan Mao, Bing Hu, Xiao Ling Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6337034/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background and Purpose New nurses often encounter demanding work environments that hinder their professional growth and transition into proficient practitioners. Current training programs for novice nurses typically fall short in content, methodology, and outcomes, with insufficient focus on the transfer of knowledge and skills. This study aims to assess the effectiveness of case reviews, grounded in training transfer theory, in facilitating the transfer and application of knowledge and skills among new nurses. Methods A randomized controlled trial was conducted to evaluate the impact of an intervention incorporating case reviews based on training transfer theory. Sixty new nurses from Longgang District Maternal and Child Health Hospital in Shenzhen were enrolled through convenience sampling and randomly assigned into two groups via block randomization. The control group underwent standard general training, while the observation group received the same curriculum, augmented with case reviews grounded in training transfer theory. Both groups participated in a 12-month training program. One month post-training, comparisons were made between the groups across multiple outcomes, including training satisfaction, self-directed learning ability, nursing case report quality, OSCE assessment scores, new nurses' core competencies, patient satisfaction, and transition shock. Results Post-training, the observation group exhibited significantly higher scores in training satisfaction, self-directed learning ability, core competencies, nursing case report quality, OSCE results, and patient satisfaction compared to the control group (P < 0.05). Moreover, the observation group demonstrated significantly lower transition shock scores than the control group (P < 0.05). Conclusion Case review-based training, underpinned by training transfer theory, effectively enhances new nurses' core competencies and self-directed learning abilities, fosters motivation for knowledge transfer, and supports a smoother transition to competent professional practice. Trial registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR) on April 3, 2025.identifier (The clinical trial registration process is ongoing). Training Transfer Case Review in Nursing New Nurses Figures Figure 1 Figure 2 1. Introduction New nurses or newly graduated nurses in this study are defined as registered nurses with less than one year of clinical experience. The training of new nurses plays a pivotal role in the development of nursing talent, influencing both their career advancement and the quality of patient care. The World Health Organization predicts a shortage of 4.5 million nursing professionals by 2030 [ 1 ] , signaling the need for a large influx of new nurses into the workforce. However, new nurses are among the most vulnerable to nursing-related adverse events [ 2 ] . Research emphasizes that strengthening the core competencies of new nurses and supporting their transition into professional roles is essential for improving care outcomes [ 3 , 4 ] . In the UK, new nurses undergo a minimum of four months of training [ 5 ] . In Australia, a year-long general medical training program has been introduced for new nurses [ 6 ] . In China, the training of new nurses is still developing. In February 2016, the National Health and Family Planning Commission issued the "Standardized Training Outline for Newly Recruited Nurses (Trial)" [ 7 ] , which mandates two years of standardized clinical training following employment. Despite the adoption of the "Outline" by various domestic medical institutions, a unified, nationwide standardized training system remains lacking, and approaches to management and training vary across hospitals [ 8 ] . Current training predominantly focuses on theoretical knowledge and technical skills, with a teaching model led by instructors. This passive learning approach results in low participation and acceptance, limiting training effectiveness and failing to engage nurses' curiosity and enthusiasm for learning, thereby impeding the development of their clinical thinking and problem-solving skills [ 9 , 10 ] . Research also indicates that training outcomes for new nurses in China's tertiary hospitals are suboptimal, with actual compliance rates falling far short of guideline expectations, particularly for process assessments, which show a compliance rate of only 21.43% [ 11 ] . Therefore, there is an urgent need to explore and design more effective training programs for new nurses that enhance the transfer of knowledge into clinical practice. For those engaged in continuing medical education after graduation, learning transitions from passive information absorption to self-directed learning, which becomes a critical method for professional growth [ 12 ] . Self-directed learning has been shown to foster the professional development of nurses, enabling them to continually expand their knowledge and improve the quality of clinical care, a process that is particularly crucial for new nurses [ 13 ] . The education of new nurses covers a broad spectrum of knowledge, with a primary focus on integrating theory with practice [ 10 ] . New nurses possess varied needs regarding both the content and format of training, which extend beyond traditional theoretical lectures. They seek to incorporate clinical examples and gain a deeper understanding of nursing advancements and contemporary issues [ 14 , 15 ] . Learning through real-life cases is closely aligned with clinical practice and serves as a problem-oriented teaching method that encourages nurses to approach challenges from multiple perspectives. This method effectively stimulates engagement and initiative, cultivates clinical thinking, bridges the gap between theoretical knowledge and clinical practice, and enhances problem-solving skills, critical thinking, and motivation to learn [ 16 – 18 ] . Many new nurses experience significant challenges during the transition from students to healthcare professionals, a phenomenon known as transition shock. Transition shock encompasses a range of negative responses, such as anxiety, doubt, and confusion, arising from discrepancies between theoretical knowledge and clinical environments, limited practical experience, complex clinical settings, and unfamiliar interpersonal dynamics [ 19 ] . Early experiences of transition shock can hinder a new nurse's ability to adapt to the clinical environment, contribute to work-related stress [ 4 ] , and even lead to severe burnout [ 20 ] , all of which can result in transition failure. Failure to navigate this critical period is a primary contributor to the high turnover rates among new nurses in their first year [ 21 ] . Previous research has highlighted the persistently high attrition rate among newly graduated nurses, an ongoing challenge in the healthcare sector [ 22 ] . In the United States, the turnover rate for newly graduated nurses within their first year is 23.8% [ 23 ] , while in China, it ranges from 35–60% [ 24 ] . New nurses often cite their limited professional knowledge as the greatest source of transition shock, leading to stress and fear due to insufficient expertise and nursing skills [ 4 , 25 ] . Research has shown that enhancing the core competencies of new nurses is key to a successful transition into professional nursing roles [ 26 , 27 ] . Therefore, improving the core competencies of new nurses to facilitate a smooth transition is a critical challenge that requires urgent attention. The success of a training program is largely determined by the extent of learning transfer [ 28 ] . Training transfer, or training outcome transfer, refers to the degree to which trainees are able to consistently and effectively apply the knowledge, skills, and attitudes gained during training to their work practices [ 29 ] . Currently, five primary training transfer theory models exist, with the Kirkpatrick Four-Level Evaluation Model, introduced in 1959, being the most widely recognized for evaluating training effectiveness [ 30 ] . It has been applied across various sectors, including healthcare, corporate management, and education [ 30 ] . Training transfer theory is grounded in needs analysis, with problem-solving at its core, emphasizing the transformation of training outcomes. It views training as a dynamic process that transitions from learning to practical application [ 31 ] . The "transfer problem" has gained increasing attention in organizational training, where training often fails to translate into improved performance [ 32 ] . Training transfer is a multifaceted process influenced not only by work-related factors but also by the characteristics of the trainees and the design of the training program. Among these, the design of the training is considered a critical factor [ 31 , 33 – 34 ] . Training transfer theory has been successfully applied in nursing-related fields [ 35 ] . Designing training programs based on this theory can facilitate the transformation of training outcomes and enhance overall training effectiveness [ 32 ] . Different training designs can yield varying degrees of training transfer. Thus, this study aims to evaluate the effectiveness of case review, grounded in training transfer theory, in the training of new nurses through a randomized controlled trial. The objective is to strengthen the core competencies of new nurses, facilitate the transfer of their knowledge and skills, and improve the overall training transfer process. 2. Participants and Methods 2.1. Research Design This study was a randomized controlled trial with two parallel groups, designed to explore the effectiveness of case review based on training transfer theory in the training of new nurses. 2.2. Participants Selection 2.2.1. Inclusion criteria Inclusion criteria were as follows: (1) A bachelor's degree or higher in nursing; (2) No participation in other relevant training during the study period. 2.2.2.Exclusion criteria Exclusion criteria were as follows: (1) Completion of standardized training at another hospital; (2) Absence from more than two training sessions; (3) Withdrawal from the study due to reasons such as resignation, sick leave, or maternity leave. 2.2.3. Participants recruited New nurses from Longgang District Maternal and Child Health Hospital in Shenzhen were selected as participants for this study. Convenience sampling was employed as the sampling method. 2.2.4. Sample size estimation Sample size calculation was performed using the formula n1 = n2 = 2σ 2 (tα + tβ) 2 /δ 2 [36] , with α = 0.05 and β = 0.1. Based on relevant literature [37] , the mean difference between the two groups (δ) was set at 29.62, and the standard deviation (σ) was 31.19. Accounting for a 20% attrition rate, the minimum sample size for each group was calculated to be 30. A total of 60 new nurses were included in this study. 2.3.Randomization and allocation concealment Using a computer-generated random number sequence, eligible participants were randomly assigned to either the intervention group or the control group in a 1:1 ratio. An independent researcher (Y.M), who had no involvement in participant enrollment or intervention delivery, generated the concealed allocation list prior to trial initiation using validated randomization software. Opaque sequentially numbered envelopes containing group assignments were prepared and securely stored. These envelopes were opened sequentially only after obtaining written informed consent, ensuring strict allocation concealment. This robust methodology effectively minimized selection bias by preventing investigators from predicting or influencing group assignments based on baseline characteristics. The randomization procedures strictly adhered to CONSORT 2010 guidelines for clinical trial reporting. 2.4. Training design The training period for both groups was from February 2024 to February 2025, lasting 12 months. 2.4.1. Control group The control group received conventional general training, which included the following components: monthly hospital-level professional learning sessions, monthly departmental professional learning sessions, monthly reflective journal writing, bi-monthly Objective Structured Clinical Examination (OSCE) assessments, quarterly departmental nursing ward rounds, quarterly departmental nursing teaching rounds, quarterly departmental emergency drills, and submission of one nursing case report per quarter, archived in the hospital's self-developed "New Nurse Target Training Manual." Additionally, there was an annual evidence-based data sharing session. 2.4.2. Observation group The observation group was developed based on the control group, incorporating an Artificial Intelligence-Assisted case review system guided by training transfer theory. The implementation of this system followed the specific steps outlined below: (1) Establishment of the Teaching Group A teaching group consisting of 10 members was formed under the leadership of the nursing department. The group included the director and deputy director of the nursing department, six head nurses (two from the gynecology department, two from the obstetrics department, one from the pediatrics department, and one from the neonatology department), and two nursing department staff members. The director of the nursing department served as the group leader, overseeing teaching activities, evaluating teaching quality, and coordinating related tasks. The deputy director acted as the deputy leader, responsible for drafting case review standards, review processes, case quality evaluation standards, and teaching activity plans, in addition to organizing the teaching process. The two nursing department staff members functioned as teaching secretaries—one handled the collection of case reports, recording review suggestions, and providing written feedback, while the other managed the distribution and collection of evaluation standards, prepared review meetings, and provided logistical support. (2) Revision of the Case Report Quality Evaluation Standards The case report quality evaluation standards were revised using the "Case Report Paper Quality Evaluation Tool" from the Joanna Briggs Institute (2016). The revised standards for the maternal and child health hospital included 10 key dimensions: case selection and abstract, medical record introduction, advanced health assessment and nursing diagnosis, nursing goals and plans, treatment/nursing interventions, patient outcomes and nursing efficacy, discharge follow-up, discussion and reflection, artificial intelligence assistance and evidence-based references, and case report writing quality. (3) Implementation of the Training Program The deputy leader of the teaching group organized and explained the implementation plan for the training program. (4) Case Collection and Pre-Review Preparation New nurses were required to submit one nursing case report by the 10th of every alternate month, totaling seven reports. These case reports were expected to reflect specialty characteristics and include the application of nursing processes, nursing progress, and nursing challenges, with at least five references from the past five years. Reports were submitted in both Word and PowerPoint formats. Prior to the review meetings, the teaching secretary shared the submitted case reports in a WeChat group. Nurses in the observation group were instructed to familiarize themselves with the case reports of other nurses, including the results from artificial intelligence assistance and evidence-based references, in preparation for the review. The teaching secretary coded the 30 submitted case reports and used a WeChat mini-program to randomly assign one case to each nurse for cross-review. The assigned nurse, known as the primary reviewer, conducted a comprehensive, in-depth review, while other nurses provided supplementary reviews. (5) Centralized Cross-Review of Nursing Cases Review meetings were held between the 15th and 20th of each month, for a total of six sessions. During these sessions, new nurses first presented their individually written nursing case reports using PowerPoint, with a time limit of 5–8 minutes. The primary reviewer then conducted the case review using PowerPoint, following the 10 dimensions of the case quality standards. The review focused on strengths, weaknesses, and evidence-based suggestions or recommendations, with a time limit of 3–5 minutes. The teaching group leader chaired the review session and, based on the characteristics of the case and professional requirements, randomly selected 5–8 nurses from other specialties to participate in supplementary reviews. Each supplementary review was limited to 2–3 minutes, focusing on evaluating nursing assessments and interventions. The head nurse from the newly recruited nurse's department also participated in the case review. (6) Review Records and Summary The session moderator summarized the case review meeting, highlighting strengths and weaknesses to continuously improve the quality of nursing case reports and review sessions. The teaching secretary recorded the comments and suggestions from the case review and compiled a summary, which was shared in the WeChat group and sent to the head nurse of the newly recruited nurse's department. (7) Clinical Application and Case Report Formation The head nurse guided the new nurses in applying the suggestions and recommendations from the review meeting in clinical practice. They tracked the outcomes of these applications and assisted in the writing of the case reports. (8) Post-Clinical Transformation Case Review After the clinical application, new nurses presented their revised cases. The teaching group conducted reviews based on the established case quality standards. The secretary recorded the review comments and provided feedback. (9) Training on Weak Knowledge Points Each month, the teaching group evaluated the implementation of the training program, identified the training needs of new nurses, and developed targeted training plans based on common issues identified during reviews and case report writing. These plans were then implemented. The specific training model is illustrated in Figure 1. 2.5. Evaluation Indicators and Data Collection The effectiveness of the teaching activities was evaluated using the Kirkpatrick model, which assesses four levels: reaction, learning, behavior, and results. The reaction and learning levels reflect the learning outcomes of the training, while the behavior and results levels assess the training transfer process and its outcomes [30] . 2.5.1. Reaction Level (1) Training Satisfaction : The "New Nurse Training Satisfaction Questionnaire," a self-developed instrument, was used to assess training satisfaction across five aspects: training format, content, schedule, practicality, and effectiveness (Supplementary File 1) . The questionnaire contained 10 items,the total score ranges from 10 to 100, with higher scores indicating greater satisfaction. The questionnaire was distributed one month after the training. (2) Self-Directed Learning Ability : The Self-Directed Learning Ability Scale, a Chinese assessment tool created by Lin [39] , was used to evaluate the self-directed learning ability of new nurses. The scale consists of 28 items across three dimensions, scored on a 5-point Likert scale (1 = completely disagree; 5 = completely agree), with an overall Cronbach's α of 0.86. Surveys were administered at two time points: one month before and one month after the training. 2.5.2. Learning Level (1) Nursing Case Report Quality Score(Supplementary File 2) : One month before and one month after the training, each group of new nurses submitted a nursing case report. These reports were evaluated blindly by the teaching group according to the maternal and child health hospital's nursing case report quality evaluation standards. The average score for each group was calculated, with a maximum score of 100. Higher scores indicated better case quality. (2) OSCE Assessment Scores: The OSCE assessment was designed according to the OSCE standards [39] , consisting of five stations: nursing assessment, skill operation, clinical thinking, health education, and humanistic care(Supplementary File 3) . Each station had a maximum score of 100. The scoring standards were developed by the research team and modified through Delphi expert consultation. Two examiners, who were senior instructors or head nurses, evaluated each station. 2.5.3. Behavior Level Core Competency of New Nurses: The core competency of new nurses was evaluated both one month prior to and one month following the training, using the Competency Inventory for Registered Nurses developed by Liu [40] . This Chinese self-assessment tool measures core competencies based on the ICN's Core Competency Framework for Nurses and is widely used among registered nurses in China. The instrument covers seven dimensions: critical thinking and research ability, clinical nursing ability, leadership, interpersonal relationships, legal and ethical practice, professional development, and education and consultation. It consists of 55 items rated on a 5-point Likert scale (0 = no ability; 4 = highly capable), with higher scores reflecting stronger core competency. The total score ranges from 0 to 220, with scores below 110 indicating low competency, scores between 110 and 164 indicating moderate competency, and scores of 165 or higher indicating high competency. The scale's overall Cronbach's α coefficient was 0.798, with coefficients for individual dimensions ranging from 0.706 to 0.775. 2.5.4. Results Level: (1) Patient Satisfaction: Patient satisfaction with new nurses was assessed both one month before and one month after the training using a self-developed "Patient Satisfaction with Bedside Nurse Work Survey," created by the nursing department(Supplementary File 4). Informed consent was obtained from patients prior to survey participation. Five patients, each cared for by a different new nurse, were randomly selected to complete the questionnaire. (2) Transition Shock Level: The transition shock level of new nurses was assessed using the New Nurse Transition Shock Evaluation Scale developed by Xue [41] , based on transition shock theory. This scale evaluates four dimensions: physical, psychological, knowledge and skills, and socio-cultural development, consisting of 27 items rated on a 5-point Likert scale (1-5 points). The total score ranges from 27 to 135, with higher scores indicating greater transition shock severity. The scale demonstrated strong reliability, with Cronbach's α coefficients ranging from 0.840 to 0.918. 2.6. Data Analysis Data were analyzed using SPSS 26.0. Normality was assessed using the Kolmogorov–Smirnov test. For normally distributed data, mean ± SD (x̄ ± s) values were reported and analyzed using independent t-tests. Non-normally distributed data were expressed as medians (Q1, Q3) and analyzed with Wilcoxon rank-sum tests. Categorical variables were summarized as frequencies (%) and compared using chi-square (χ 2 ) tests, with statistical significance set at P < 0.05. 2.7. Ethical Consideration This study was conducted in accordance with ethical guidelines to ensure participant safety. Approval was obtained from the ethics committee of Longgang District Maternal and Child Health Hospital in Shenzhen (LGFYKYXMLL-2025-9).Informed consent was obtained from all participants following full disclosure of the research purposes, voluntary engagement protocols, and stringent measures to ensure participant anonymity and data confidentiality. 3. Results 3.1. Demographic result A total of 115 students were initially assessed for eligibility. However, 55 were excluded due to not meeting the inclusion criteria (e.g., absence from training, failure to fulfill the academic criteria) or declining to participate (Fig. 2 ).A total of 60 new nurses were enrolled in the trial, with 30 in the control group and 30 in the observation group. The mean age was 22.58 ± 0.99 years, with 6 males and 54 females. Of the participants, 53 held bachelor's degrees, and 7 held master's degrees. No statistically significant differences were observed in the general characteristics between the two groups (all P > 0.05), confirming their comparability. Details are presented in Table 1 . During the training, three nurses in the control group withdrew due to resignation. Table 1 Comparison of General Characteristics Between the Two Groups of New Nurses( x̄ ± s ) Group Number of Participants Age (years, x̄ ± s) Gender n (%) Education level n (%) Male Female Undergraduate Master Observation Group 30 22.67 ± 0.71 4 26 27 3 Control Group 30 22.50 ± 1.22 2 28 26 4 t/χ2 0.645 0.851 0.396 P 0.522 0.398 0.694 3.2. Comparison of Training Satisfaction Between the Two Groups of New Nurses The observation group exhibited significantly higher overall satisfaction compared to the control group (P < 0.05; Table 2 ). Table 2 Comparison of Training Satisfaction Between the Two Groups of New Nurses ( x̄ ± s ) Group Number of Participants Overall Satisfaction Observation Group 30 96.17 ± 2.71 Control Group 27 89.00 ± 3.91 χ2 8.111 P < 0.001 3.3. Comparison of Self-Directed Learning Ability Between the Two Groups of New Nurses Prior to the training, no significant intergroup difference was observed in self-directed learning ability (P > 0.05). Following the intervention, the observation group exhibited significantly higher scores than the control group (P < 0.05; Table 3 ). Table 3 Comparison of Self-Directed Learning Ability Scores Between the Two Groups of New Nurses ( x̄ ± s ) Group Before Training After Training Observation Group 88.80 ± 4.82 (n = 30) 112.43 ± 8.99 (n = 30) Control Group 89.23 ± 4.64 (n = 30) 96.44 ± 5.69 (n = 27) χ2 -0.354 7.922 P 0.724 < 0.001 3.4. Comparison of Nursing Case Report Quality Scores Between the Two Groups of New Nurses Prior to the training, no significant difference in nursing case report quality scores was observed between the groups (P > 0.05). After the intervention, the observation group achieved significantly higher scores than the control group (P < 0.05; Table 4 ). Table 4 Comparison of Nursing Case Report Quality Scores Between the Two Groups of New Nurses ( x̄ ± s ) Group Before Training After Training Observation Group 69.73 ± 5.43 (n = 30) 85.77 ± 5.35 (n = 30) Control Group 68.83 ± 7.07 (n = 30) 73.15 ± 6.24 (n = 27) χ2 0.553 8.213 P 0.582 < 0.001 3.5. Comparison of OSCE Assessment Results Between the Two Groups of New Nurses One month prior to training, no significant differences were found in OSCE assessment results between the groups (P > 0.05). One month after training, the observation group demonstrated significantly higher total OSCE scores than the control group (P < 0.05; Table 5 ). Table 5 Comparison of OSCE Assessment Scores Between the Two Groups of New Nurses ( x̄ ± s ) Group Before Training After Training Observation Group 67.53 ± 6.78 (n = 30) 86.70 ± 4.10 (n = 30) Control Group 70.13 ± 5.43 (n = 30) 73.78 ± 6.01 (n = 27) χ2 -1.639 9.570 P 0.107 < 0.001 3.6. Comparison of Core Competencies Between the Two Groups of New Nurses Prior to training, no significant intergroup differences were observed in total core competency scores or in any individual dimensions (P > 0.05). Following the training, the observation group demonstrated significantly higher total core competency scores, as well as superior scores in critical thinking and research ability, clinical nursing ability, leadership, interpersonal relationships, professional development, and education and consultation, compared to the control group, with all differences being statistically significant (all P 0.05). Detailed results are presented in Tables 6 and 7. Table 6 Comparison of Core Competency Scores Between the Two Groups of New Nurses Before Training ( x̄ ± s ) Group Number of Participants Critical thinking and research ability Clinical nursing ability Leadership ability Interpersonal relationships Legal and ethical practice Professional development Education and consultation Total Score Observation Group 30 21.00 ± 2.61 30.13 ± 3.57 24.83 ± 3.64 23.13 ± 3.13 19.17 ± 2.41 15.77 ± 3.16 18.53 ± 2.86 152.57 ± 10.39 Control Group 30 20.90 ± 2.51 31.37 ± 2.80 24.73 ± 2.68 23.93 ± 2.03 18.70 ± 2.04 14.83 ± 1.66 18.47 ± 1.63 152.93 ± 9.67 χ2 0.151 -1.490 0.121 -1.175 0.810 1.432 0.111 -1.420 P 0.880 0.142 0.904 0.245 0.421 0.159 0.912 0.888 Group Number of Participants Critical thinking and research ability Clinical nursing ability Leadership ability Interpersonal relationships Legal and ethical practice Professional development Education and consultation Total Score Observation Group 30 27.37 ± 2.76 36.73 ± 1.57 30.80 ± 2.51 26.23 ± 2.21 19.17 ± 2.53 19.40 ± 1.56 20.23 ± 1.50 179.93 ± 4.72 Control Group 27 23.96 ± 2.58 33.22 ± 2.10 26.96 ± 1.97 24.59 ± 1.95 19.07 ± 1.57 16.81 ± 1.69 19.15 ± 1.66 163.78 ± 3.31 χ2 4.812 7.080 6.450 2.982 0.164 6.851 2.594 14.806 P < 0.001 < 0.001 < 0.001 0.004 0.871 < 0.001 0.012 < 0.001 Table 7 Comparison of Core Competency Scores Between the Two Groups of New Nurses After Training ( x̄ ± s ) 3.7. Comparison of Patient Satisfaction Between the Two Groups of New Nurses Prior to training, no significant intergroup difference was observed in patient satisfaction scores (P > 0.05). After training, the observation group attained significantly higher scores than the control group (P < 0.05; Table 8 ). Table 8 Comparison of Patient Satisfaction Between the Two Groups of New Nurses ( x̄ ± s ) Group Before Training After Training Observation Group 84.55 ± 3.03 (n = 150) 95.96 ± 2.49 (n = 150) Control Group 84.77 ± 3.29 (n = 150) 88.48 ± 3.78 (n = 135) χ2 -6.02 19.92 P 0.547 0.05). After training, the observation group exhibited significantly lower scores than the control group (P < 0.05; Tables 9 – 10 ). Table 9 Comparison of Transition Shock Scores Between the Two Groups of New Nurses Before Training ( x̄ ± s ) Group Number of Participants Physical Psychological Knowledge and Skills Social Development Total Score Observation Group 30 22.07 ± 2.38 23.23 ± 4.47 18.80 ± 2.51 22.53 ± 2.79 86.63 ± 7.34 Control Group 30 22.57 ± 2.86 23.07 ± 3.28 18.13 ± 2.60 22.73 ± 2.79 86.50 ± 7.04 χ2 -0.736 0.165 1.011 -0.278 0.070 P 0.465 0.870 0.316 0.782 0.945 Table 10 Comparison of Transition Shock Scores Between the Two Groups of New Nurses After Training ( x̄ ± s ) Group Number of Participants Physical Psychological Knowledge and Skills Social Development Total Score Observation Group 30 19.37 ± 2.66 20.17 ± 2.64 15.70 ± 2.37 20.53 ± 2.32 75.77 ± 5.61 Control Group 27 21.89 ± 1.93 22.59 ± 3.99 17.56 ± 1.78 22.63 ± 2.72 84.67 ± 6.21 χ2 -4.060 -2.674 -3.364 -3.143 -5.685 P < 0.001 0.01 0.001 0.003 < 0.001 4. Discussion 4.1. Case review based on training transfer theory can stimulate the training transfer motivation of new nurses. Training transfer hinges on the stimulation of both learning and transfer motivation. Transfer motivation pertains to the trainees' subjective effort to optimize the application of knowledge and skills acquired during training in their actual work environment. It forms the core of higher-order cognitive processes such as problem-solving and creative thinking, serving as a critical determinant for the occurrence of training transfer [35,42] . This study, centered on "nursing cases," designed a teaching process tailored to the needs of new nurses. The process, informed by the training transfer concept, includes evidence-based case review and evaluation, clinical practice and transformation, and subsequent effectiveness assessment. Results indicated that the observation group exceeded the control group in terms of satisfaction and self-directed learning capabilities. The study required new nurses to analyze real nursing case challenges, establishing a foundation and context for learning transfer. By actively linking training knowledge to clinical issues, they gained a deeper understanding and developed the flexibility to apply this knowledge in novel contexts, which in turn reinforced their self-directed learning capacity. Furthermore, guided by insights from centralized case reviews, the application and transformation of these insights into clinical practice, followed by further evaluation, initiated a problem-solving process rooted in behavioral reflection. This combination of reflection and experience empowered new nurses to quickly analyze, correct errors, and validate their actions, thus enhancing their sustained motivation to internalize and transfer the skills and knowledge acquired during training. 4.2. Case review based on training transfer theory can enhance the training transfer ability of new nurses. The core competency of new nurses serves as a critical indicator of both their training transfer ability and the effectiveness of training transfer. This study demonstrates that case review, grounded in training transfer theory, can significantly enhance the core competencies of new nurses. Notably, the clinical nursing ability of new nurses in the observation group increased from 30.13 ± 3.57 before training to 36.73 ± 1.57 after training, representing the greatest improvement among the core competencies. The OSCE assessment, an objective measure of nurses' clinical practice abilities [38] , revealed that the experimental group outperformed the control group. The development of clinical nursing ability is paramount for new nurses, as it constitutes the foundation of clinical practice and marks the starting point for building a nursing career [43] . Previous studies have indicated that nurses often face difficulties in transferring theoretical knowledge into clinical practice [44] . However, in this study, new nurses enhanced their understanding of clinical nursing processes, refined their clinical reasoning, and bolstered their ability to assess patient needs, create nursing plans, and resolve nursing issues through a closed-loop training model comprising "nursing patients - writing case reports - evidence-based review - clinical application and transformation - reinforcement of weak areas." This approach notably improved their clinical nursing competencies. Willman et al. [45] identified critical thinking as a core competency for newly graduated nurses, although it received the lowest self-assessment scores. In contrast, this study found significant improvement in critical thinking and research skills, with the magnitude of improvement second only to clinical nursing competence. Prior to the review, new nurses were tasked with analyzing the feasibility, innovation, and effectiveness of nursing interventions in case reports using evidence-based methods, thereby identifying issues and challenges that fostered their critical thinking and evidence-based abilities. During the centralized review, new nurses from diverse specialties analyzed and evaluated nursing cases from various perspectives, expanding their knowledge base, facilitating interdisciplinary integration, and advancing professional development [46] . Additionally, during case reviews and presentations, new nurses were required to articulate their viewpoints and engage in discussions, thereby improving their language proficiency and academic presentation skills. These findings align with those reported by Ma et al. [47] . The study also revealed that education and consultation, along with legal and ethical practice, were the weakest dimensions of core competencies, both before and after training. This highlights the need for hospitals to design targeted training components to improve education and consultation skills, as well as ethical and legal practice capabilities, to enhance overall competencies, in accordance with Zhao et al.'s findings [48] . 4.3. Case review based on training transfer theory can facilitate the successful transition of new nurses into professional nurses. Transition shock is widely recognized as a key factor contributing to higher turnover rates among new nurses. A study conducted in South Korea revealed that the turnover rate for newly graduated nurses (29.0%) was 2.1 times higher than that for experienced nurses (13.9%), with transition shock potentially playing a significant role [49] . Furthermore, transition shock and nurses' clinical performance are mutually causal. Wallin et al. [50] conducted a longitudinal study over five years, which found that transition shock delayed the professional skill development of new nurses by more than two years, resulting in poor evidence-based practice in clinical settings. This delay in practical competence is, in turn, linked to heightened transition shock [19] . The present study identified that the most significant change in transition shock scores occurred in the dimension of knowledge and skills. New nurses may experience transition shock during their initial period because their existing knowledge and skills are insufficient to meet the demands of their new job responsibilities. This finding aligns with Hu et al.'s report [51] . Moreover, following the training, the observation group exhibited a significantly lower total transition shock score compared to the control group, with a marked reduction in the psychological dimension as well. This decrease may be attributed to the case review approach based on training transfer theory, which stimulated their transfer motivation and enhanced their transfer capabilities. Previous studies have also highlighted that self-efficacy, job satisfaction, peer support, and a positive work environment are critical factors for facilitating the successful transition of new nurses into their professional roles [52] . 5. Limitations The implementation and evaluation of the training in this study were limited to a one-year period, which may not fully capture the long-term effects of case review on training transfer outcomes. Future research should consider extending the observation period to more accurately assess the enduring transfer effects, leading to more comprehensive and reliable conclusions. Additionally, the study sample was drawn from a single medical institution, and the relatively small and specific sample may not fully represent the diversity of healthcare organizational environments, which could limit the external validity of the findings. Therefore, future research should leverage municipal-level nursing quality control and education centers to expand the scope of this training model across different nursing environments, conducting multicenter, large-sample randomized controlled trials to more precisely evaluate the implementation effects of case review in training new nurses. 6. Conclusion In conclusion, case review based on training transfer theory, with its focus on training effectiveness and the practical application of outcomes, proves to be an effective strategy for enhancing the clinical core competencies and self-directed learning abilities of new nurses. It stimulates their motivation for training transfer, improves their transfer capabilities, and facilitates their successful transition into competent professional nurses. By centering on clinical nursing cases and integrating centralized review with clinical application transformation, this approach overcomes the monotony and inefficiencies of traditional training models. It has garnered high praise from new nurses, achieving the dual objectives of training and fostering the high-quality development of nursing. This method holds significant potential for widespread application in clinical nursing education. Abbreviations OSCE assessment Objective Structured Clinical Examination assessment ICN International Council of Nurses Declarations Ethics declarations This study was conducted in accordance with ethical guidelines to ensure participant safety. Approval was obtained from the ethics committee of Longgang District Maternal and Child Health Hospital in Shenzhen (LGFYKYXMLL-2025-9).Informed consent was obtained from all participants following full disclosure of the research purposes, voluntary engagement protocols, and stringent measures to ensure participant anonymity and data confidentiality. Consent for publication Not applicable. Data Availability The data presented in this study is available for further access upon request. Competing Interests The authors declare no competing interests. Funding This study was conducted without external financial support or institutional funding. Author information Authors and Affiliations Department of Nursing,Longgang District Maternity & Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College ) LianHong Wu,Yan Mao1,Bing Hu,XiaoLing Li Department of Gynecology,Longgang District Maternity & Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College ) LingXia Liu Contributions Study design: LHW,XLL,BH; acquisition of data: LHW, LXL,YM; analysis: XLL,LXL,YM; drafting of the article: LHW,XLL; critical review and revision of the manuscript: LHW,XLL,BH. Corresponding authors Correspondence to XiaoLing Li Acknowledgements The authors gratefully acknowledge the review panel for their guidance and support in this study. References Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and 'universal' health coverage? BMJ Glob Health. 2022;7(6):e009316. Saintsing D, Gibson LM, Pennington AW. The novice nurse and clinical decision-making: how to avoid errors. J Nurs Manag. 2011;19(3):354–9. Missen K, McKenna L, Beauchamp A. Registered nurses' perceptions of new nursing graduates' clinical competence: A systematic integrative review. Nurs Health Sci. 2016;18(2):143–53. Woo MWJ, Newman SA. The experience of transition from nursing students to newly graduated registered nurses in Singapore. Int J Nurs Sci. 2019;7(1):81–90. Whitehead B, Owen P, Holmes D, Beddingham E, Simmons M, Henshaw L, et al. Supporting newly qualified nurses in the UK: a systematic literature review. Nurse Educ Today. 2013;33(4):370–7. Aggar C, Bloomfield J, Thomas TH, Gordon CJ. Australia's first transition to professional practice in primary care program for graduate registered nurses: a pilot study. BMC Nurs. 2017;16:14. Li XY, Li XF, Tang XH,Chen YY. Practice and evaluation of the General Guideline for Training of New Graduate Nurses. J Nurs Sci 2017,32(6):61–6398. Wang Y, Chen Y, Wang L, Wang W, Kong X, Li X. Assessment of the effectiveness of the BOPPPS model combined with case-based learning on nursing residency education for newly recruited nurses in China: a mixed methods study. BMC Med Educ. 2024;24(1):215. Shang X, Lin Z, Xie X, Fang S, Chen L, Gu Z, et al. Establishment of standardized training system for new nurses based on post competency. Chin Nurs Res. 2019;33:1334–7. Sun B, Fu L, Yan C, Wang Y, Fan L. Quality of work life and work engagement among nurses with standardised training: The mediating role of burnout and career identity. Nurse Educ Pract. 2022;58:103276. Li MM. Luo J.Literatures analysis on standardized training in new recruited nurses. Chin J Mod Nurs. 2017;23(7):1016–20. Yu L. Situation and practice of cultivation of autonomous learning ability in clinical teaching of standardized training for residents. Chin Med Herald. 2020;17(4):63–6569. Visiers-Jiménez L, Palese A, Brugnolli A, Cadorin L, Salminen L, Leino-Kilpi H, et al. Nursing students' self-directed learning abilities and related factors at graduation: A multi-country cross-sectional study. Nurs Open. 2022;9(3):1688–99. Zhang T, Gong FH,Shi ZY,Xiao N, Zeng YY, Liao JX, et al. Application of MOOC teaching in new entry nurses standardized training of respiratory medicine. Chin J Mod Nurs. 2018;24(9):1009–11. Li XY, Zhu XP,Yin XB,Liu F, Xie CY, Wu YH. Qualitative study on newly recruited nurses' experience of standardized training. Chin J Mod Nurs. 2019;25(3):270–3. Cen XY, Hua Y, Niu S, Yu T. Application of case-based learning in medical student education: a meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(8):3173–81. Hasamnis AA, Arya A, Patil SS. Case-based Learning: Our Experience in Clinical Pharmacology Teaching. J Pharm Bioallied Sci. 2019;11(2):187–9. McLean SF. Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev. 2016;3:JMECD.S20377. Lee T, Kim E, Ji Y. The mediating effect of transition shock on the relationship between readiness for practice and turnover intention of new graduate nurses in South Korea: A longitudinal study. Nurse Educ Today. 2024;143:106394. AbuAlRub RF. Abu Alhaija'a MG. Perceived benefits and barriers of implementing nursing residency programs in Jordan. Int Nurs Rev. 2019;66(1):43–51. Kim EY, Yeo JH. Transition shock and job satisfaction changes among newly graduated nurses in their first year of work: A prospective longitudinal study. J Nurs Manag. 2021;29(3):451–8. Labrague LJ, De Los Santos JAA, Falguera CC, Nwafor CE, Galabay JR, Rosales RA, et al. Predictors of nurses' turnover intention at one and five years' time. Int Nurs Rev. 2020;67(2):191–8. 2024 NSI National Health Care Retention & RN Staffing Report. NSI Nursing Solutions Inc. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report . pdf.Accessed December 13, 2024. Clipper B, Cherry B. From Transition Shock to Competent Practice: Developing Preceptors to Support New Nurse Transition. J Contin Educ Nurs. 2015;46(10):448–54. Liang HF, Lin CC, Wu KM. Breaking through the dilemma of whether to continue nursing: Newly graduated nurses' experiences of work challenges. Nurse Educ Today. 2018;67:72–6. Doughty L, McKillop A, Dixon R, Sinnema C. Educating new graduate nurses in their first year of practice: The perspective and experiences of the new graduate nurses and the director of nursing. Nurse Educ Pract. 2018;30:101–5. Ashton KS. The orientation period: essential for new registered nurses' adaptation. Nurs Sci Q. 2015;28(2):142–50. Schettino G, Capone V. From Online Learning to Clinical Practice: An Investigation on the Factors Influencing Training Transfer Among Physicians. Healthc (Basel). 2025;13(2):133. Hanum AL, Hu Q, Wei W, Ma F. A longitudinal assessment of factors affecting training transfer among new clinical nurse specialists. Int J Nurs Sci. 2024;11(3):308–14. Anderson LN, Merkebu J. The Kirkpatrick Model: A Tool for Evaluating Educational Research. Fam Med. 2024;56(6):403. Saks AM, Burke-Smalley LA. Is transfer of training related to firm performance? Int J Train Dev. 2014;18(2):104–15. Ma F, Bai Y, Bai Y, Ma W, Yang X, Li J. Factors influencing training transfer in nursing profession: a qualitative study. BMC Med Educ. 2018;18(1):44. Ben Mansour J, Naji A, Leclerc A. The Relationship between Training Satisfaction and the Readiness to Transfer Learning: The Mediating Role of Normative Commitment. Sustainability. 2017;9(5):834. Pham TT, Lingard H, Zhang RP. Factors Influencing Construction Workers’ Intention to Transfer Occupational Health and Safety Training. Saf Sci. 2023;167:106288. Zhang Y, Lv FF,Chen Q, Shi Y, Zhang HM, Tian YT. Research advances in training transfer and implications for specialist nurse training. Chin J Nurs. 2022;57(11):1391–5. Bolarinwa OA. Sample size estimation for health and social science researchers: The principles and considerations for different study designs. Niger Postgrad Med J. 2020;27(2):67–75. Chen KH, Ning L, Liu ZY,Zeng N. Construction and application of pre-job training program for new nurses based on transformative learning. Chin J Med Educ Res. 2023;22(8):1257–62. Lin Y, Jang AL. Developing a Measure Scale of Autonomous Learning Competencies of Nursing Undergraduates. J Nurs PLA. 2004;21(6):1–4. Onwudiegwu U, OSCE:. DESIGN, DEVELOPMENT AND DEPLOYMENT. J West Afr Coll Surg. 2018 Jan-Mar;8(1):1–22. Liu M, Yin L, Ma MY,Luo SX. Confirmatory factor analysis of Competeney Inventory for Registered Nurse. Chin J Nurs. 2008;43(3):204–6. XueYR, Lin P, Gao XQ,Zhao ZJ,Li L, Liu GJ, et al. Development and the reliability and validity test of the Transition Shock of Newly Graduated Nurses Scale. Chin J Nurs. 2015;50(6):674–8. Miles DA. Simulation Learning and Transfer in Undergraduate Nursing Education: A Grounded Theory Study. J Nurs Educ. 2018;57(6):347–53. Xie CY, Zhang J, Yin XB, et al. Methods for measurement of new graduate nurses' clinical competence: a literature review. J Nurs Sci. 2019;34(2):98–101. Kuraoka Y. Effects of a learning programme for nurse managers to connect their experience: A quasi-experimental study. J Nurs Manag. 2022;30(5):1188–95. Willman A, Bjuresäter K, Nilsson J. Newly graduated nurses' clinical competencies and need for further training in acute care hospitals. J Clin Nurs. 2020;29(13–14):2209–20. Zhou YH. Qu B,Ding L.Organization and practice in the discussion of difficult nursing cases. Chin J Mod Nurs. 2014;20(12):1438–40. Ma J, Song XA,Ren H, Zhang CY, Gao J, Chen XM. Application of case report model in standardized training of newly recruited nurses. Chin J Mod Nurs. 2020;26(32):4547–51. Zhao XH, Zhao GX, Shi BY,Jin G. Application of the combination teaching modal of observation-teaching-discussion (OTD) and case instruction in nutritional nurse training. Chin J Mod Nurs. 2019;25(12):1565–8. Kim EY, Yeo JH. Effects of pre-graduation characteristics and working environments on transition shock of newly graduated nurses: A longitudinal study. Nurse Educ Today. 2019;78:32–6. Wallin L, Gustavsson P, Ehrenberg A, Rudman A. A modest start, but a steady rise in research use: a longitudinal study of nurses during the first five years in professional life. Implement Sci. 2012;7:19. Hu XY, Sun AL,Peng SH. Relationship of transition shock and job satisfaction for newly graduated registered nurses. J Nurs Sci. 2016;31(15):54–5567. Yao L, Chen J, Zhao Q, Bai D, Li Y, Xiao M, Du Y, Liu L. Level and influencing factors of transition shock among new nurses in China: A multicenter cross-sectional study. Health Sci Rep. 2023;6(12):e1758. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 24 Jun, 2025 Editor invited by journal 29 May, 2025 Editor assigned by journal 24 Apr, 2025 Submission checks completed at journal 19 Apr, 2025 First submitted to journal 19 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6337034","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476875565,"identity":"46ae6209-3c9e-4d32-bada-851c4520f90f","order_by":0,"name":"Lian Hong Wu","email":"","orcid":"","institution":"Longgang District Maternity \u0026Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Lian","middleName":"Hong","lastName":"Wu","suffix":""},{"id":476875566,"identity":"e5554a47-b453-4463-8434-ea07346d4930","order_by":1,"name":"Ling Xia Liu","email":"","orcid":"","institution":"Longgang District Maternity \u0026Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Ling","middleName":"Xia","lastName":"Liu","suffix":""},{"id":476875567,"identity":"57ebb2b3-daab-44c9-9e9f-ad736d3db038","order_by":2,"name":"Yan Mao","email":"","orcid":"","institution":"Longgang District Maternity \u0026Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Mao","suffix":""},{"id":476875568,"identity":"4d665b23-0b2c-4266-8832-284216b9af1b","order_by":3,"name":"Bing Hu","email":"","orcid":"","institution":"Longgang District Maternity \u0026Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Hu","suffix":""},{"id":476875569,"identity":"56665374-1aee-4f55-99bc-c0f27d657d40","order_by":4,"name":"Xiao Ling Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAApElEQVRIiWNgGAWjYBACPgbmxgcfftiQoIWNgbHZcGZPGmla2qQ52A6TokUisUGagee8bN8B5oePbhClhedgg3GBxW3jmQfYjI1ziNLC3tiQPIPnduKGAzxs0sRpYWZsOMzDdo4ULeyNjc08bAdI0cJzsJlxZk+y8czDxPqFXyL5+I8PP+xk+443P3xMlBYYAPqIFOUQLQdI1TIKRsEoGAUjBgAAV3Yx3+rRvjYAAAAASUVORK5CYII=","orcid":"","institution":"Longgang District Maternity \u0026Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College)","correspondingAuthor":true,"prefix":"","firstName":"Xiao","middleName":"Ling","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-03-30 06:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6337034/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6337034/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85647860,"identity":"8d4b79d5-f89b-422a-b343-8f4b9e919434","added_by":"auto","created_at":"2025-06-30 08:51:08","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":151956,"visible":true,"origin":"","legend":"\u003cp\u003eTraining Model Diagram\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6337034/v1/ad0667a718115c71aae60894.jpeg"},{"id":85647875,"identity":"2dde8687-3ecc-43b6-af04-dd334bef05cd","added_by":"auto","created_at":"2025-06-30 08:51:10","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41866,"visible":true,"origin":"","legend":"\u003cp\u003eConsort flow diagram of the study\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6337034/v1/4085e16fb4a9a26c4432d29a.jpeg"},{"id":85649536,"identity":"5933975c-835f-4f6f-8b7e-22487f055339","added_by":"auto","created_at":"2025-06-30 08:59:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2315768,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6337034/v1/db532ca0-affc-4b5b-9e4a-738fa410d12e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of Case Review Based on Training Transfer Theory in the Training of New Nurses：a randomized controlled trial","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eNew nurses or newly graduated nurses in this study are defined as registered nurses with less than one year of clinical experience. The training of new nurses plays a pivotal role in the development of nursing talent, influencing both their career advancement and the quality of patient care. The World Health Organization predicts a shortage of 4.5\u0026nbsp;million nursing professionals by 2030\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, signaling the need for a large influx of new nurses into the workforce. However, new nurses are among the most vulnerable to nursing-related adverse events\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Research emphasizes that strengthening the core competencies of new nurses and supporting their transition into professional roles is essential for improving care outcomes\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. In the UK, new nurses undergo a minimum of four months of training\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In Australia, a year-long general medical training program has been introduced for new nurses\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. In China, the training of new nurses is still developing. In February 2016, the National Health and Family Planning Commission issued the \"Standardized Training Outline for Newly Recruited Nurses (Trial)\" \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, which mandates two years of standardized clinical training following employment. Despite the adoption of the \"Outline\" by various domestic medical institutions, a unified, nationwide standardized training system remains lacking, and approaches to management and training vary across hospitals \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Current training predominantly focuses on theoretical knowledge and technical skills, with a teaching model led by instructors. This passive learning approach results in low participation and acceptance, limiting training effectiveness and failing to engage nurses' curiosity and enthusiasm for learning, thereby impeding the development of their clinical thinking and problem-solving skills\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Research also indicates that training outcomes for new nurses in China's tertiary hospitals are suboptimal, with actual compliance rates falling far short of guideline expectations, particularly for process assessments, which show a compliance rate of only 21.43% \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Therefore, there is an urgent need to explore and design more effective training programs for new nurses that enhance the transfer of knowledge into clinical practice.\u003c/p\u003e \u003cp\u003eFor those engaged in continuing medical education after graduation, learning transitions from passive information absorption to self-directed learning, which becomes a critical method for professional growth\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Self-directed learning has been shown to foster the professional development of nurses, enabling them to continually expand their knowledge and improve the quality of clinical care, a process that is particularly crucial for new nurses\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe education of new nurses covers a broad spectrum of knowledge, with a primary focus on integrating theory with practice\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. New nurses possess varied needs regarding both the content and format of training, which extend beyond traditional theoretical lectures. They seek to incorporate clinical examples and gain a deeper understanding of nursing advancements and contemporary issues\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLearning through real-life cases is closely aligned with clinical practice and serves as a problem-oriented teaching method that encourages nurses to approach challenges from multiple perspectives. This method effectively stimulates engagement and initiative, cultivates clinical thinking, bridges the gap between theoretical knowledge and clinical practice, and enhances problem-solving skills, critical thinking, and motivation to learn\u003csup\u003e[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMany new nurses experience significant challenges during the transition from students to healthcare professionals, a phenomenon known as transition shock. Transition shock encompasses a range of negative responses, such as anxiety, doubt, and confusion, arising from discrepancies between theoretical knowledge and clinical environments, limited practical experience, complex clinical settings, and unfamiliar interpersonal dynamics\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Early experiences of transition shock can hinder a new nurse's ability to adapt to the clinical environment, contribute to work-related stress\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, and even lead to severe burnout\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, all of which can result in transition failure. Failure to navigate this critical period is a primary contributor to the high turnover rates among new nurses in their first year\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Previous research has highlighted the persistently high attrition rate among newly graduated nurses, an ongoing challenge in the healthcare sector \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In the United States, the turnover rate for newly graduated nurses within their first year is 23.8% \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, while in China, it ranges from 35\u0026ndash;60% \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. New nurses often cite their limited professional knowledge as the greatest source of transition shock, leading to stress and fear due to insufficient expertise and nursing skills\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Research has shown that enhancing the core competencies of new nurses is key to a successful transition into professional nursing roles\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Therefore, improving the core competencies of new nurses to facilitate a smooth transition is a critical challenge that requires urgent attention.\u003c/p\u003e \u003cp\u003eThe success of a training program is largely determined by the extent of learning transfer\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Training transfer, or training outcome transfer, refers to the degree to which trainees are able to consistently and effectively apply the knowledge, skills, and attitudes gained during training to their work practices\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCurrently, five primary training transfer theory models exist, with the Kirkpatrick Four-Level Evaluation Model, introduced in 1959, being the most widely recognized for evaluating training effectiveness\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. It has been applied across various sectors, including healthcare, corporate management, and education\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Training transfer theory is grounded in needs analysis, with problem-solving at its core, emphasizing the transformation of training outcomes. It views training as a dynamic process that transitions from learning to practical application\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe \"transfer problem\" has gained increasing attention in organizational training, where training often fails to translate into improved performance\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Training transfer is a multifaceted process influenced not only by work-related factors but also by the characteristics of the trainees and the design of the training program. Among these, the design of the training is considered a critical factor\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTraining transfer theory has been successfully applied in nursing-related fields\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Designing training programs based on this theory can facilitate the transformation of training outcomes and enhance overall training effectiveness\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Different training designs can yield varying degrees of training transfer.\u003c/p\u003e \u003cp\u003eThus, this study aims to evaluate the effectiveness of case review, grounded in training transfer theory, in the training of new nurses through a randomized controlled trial. The objective is to strengthen the core competencies of new nurses, facilitate the transfer of their knowledge and skills, and improve the overall training transfer process.\u003c/p\u003e"},{"header":"2. Participants and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Research Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was a randomized controlled trial with two parallel groups, designed to explore the effectiveness of case review based on training transfer theory in the training of new nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Participants Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1. Inclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria were as follows: (1) A bachelor\u0026apos;s degree or higher in nursing; (2) No participation in other relevant training during the study period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.2.Exclusion criteria\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExclusion criteria were as follows: (1) Completion of standardized training at another hospital; (2) Absence from more than two training sessions; (3) Withdrawal from the study due to reasons such as resignation, sick leave, or maternity leave.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.3. Participants recruited\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNew nurses from Longgang District Maternal and Child Health Hospital in Shenzhen were selected as participants for this study. Convenience sampling was employed as the sampling method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.4. Sample size estimation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size calculation was performed using the formula n1 = n2 = 2\u0026sigma;\u003csup\u003e2\u003c/sup\u003e(t\u0026alpha; + t\u0026beta;)\u003csup\u003e2\u003c/sup\u003e/\u0026delta;\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e[36]\u003c/sup\u003e, with \u0026alpha; = 0.05 and \u0026beta; = 0.1. Based on relevant literature \u003csup\u003e[37]\u003c/sup\u003e, the mean difference between the two groups (\u0026delta;) was set at 29.62, and the standard deviation (\u0026sigma;) was 31.19. Accounting for a 20% attrition rate, the minimum sample size for each group was calculated to be 30. A total of 60 new nurses were included in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.Randomization and allocation concealment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing a computer-generated random number sequence, eligible participants were randomly assigned to either the intervention group or the control group in a 1:1 ratio. An independent researcher (Y.M), who had no involvement in participant enrollment or intervention delivery, generated the concealed allocation list prior to trial initiation using validated randomization software. Opaque sequentially numbered envelopes containing group assignments were prepared and securely stored. These envelopes were opened sequentially only after obtaining written informed consent, ensuring strict allocation concealment. This robust methodology effectively minimized selection bias by preventing investigators from predicting or influencing group assignments based on baseline characteristics. The randomization procedures strictly adhered to CONSORT 2010 guidelines for clinical trial reporting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Training design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe training period for both groups was from February 2024 to February 2025, lasting 12 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.1. Control group\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe control group received conventional general training, which included the following components: monthly hospital-level professional learning sessions, monthly departmental professional learning sessions, monthly reflective journal writing, bi-monthly Objective Structured Clinical Examination (OSCE) assessments, quarterly departmental nursing ward rounds, quarterly departmental nursing teaching rounds, quarterly departmental emergency drills, and submission of one nursing case report per quarter, archived in the hospital\u0026apos;s self-developed \u0026quot;New Nurse Target Training Manual.\u0026quot; Additionally, there was an annual evidence-based data sharing session.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.2. Observation group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe observation group was developed based on the control group, incorporating an Artificial Intelligence-Assisted case review system guided by training transfer theory. The implementation of this system followed the specific steps outlined below:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(1) Establishment of the Teaching Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA teaching group consisting of 10 members was formed under the leadership of the nursing department. The group included the director and deputy director of the nursing department, six head nurses (two from the gynecology department, two from the obstetrics department, one from the pediatrics department, and one from the neonatology department), and two nursing department staff members. The director of the nursing department served as the group leader, overseeing teaching activities, evaluating teaching quality, and coordinating related tasks. The deputy director acted as the deputy leader, responsible for drafting case review standards, review processes, case quality evaluation standards, and teaching activity plans, in addition to organizing the teaching process. The two nursing department staff members functioned as teaching secretaries\u0026mdash;one handled the collection of case reports, recording review suggestions, and providing written feedback, while the other managed the distribution and collection of evaluation standards, prepared review meetings, and provided logistical support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(2) Revision of the Case Report Quality Evaluation Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case report quality evaluation standards were revised using the \u0026quot;Case Report Paper Quality Evaluation Tool\u0026quot; from the Joanna Briggs Institute (2016). The revised standards for the maternal and child health hospital included 10 key dimensions: case selection and abstract, medical record introduction, advanced health assessment and nursing diagnosis, nursing goals and plans, treatment/nursing interventions, patient outcomes and nursing efficacy, discharge follow-up, discussion and reflection, artificial intelligence assistance and evidence-based references, and case report writing quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(3)\u003c/strong\u003e \u003cstrong\u003eImplementation of the Training Program\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThe deputy leader of the teaching group organized and explained the implementation plan for the training program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(4)\u003c/strong\u003e \u003cstrong\u003eCase Collection and Pre-Review Preparation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNew nurses were required to submit one nursing case report by the 10th of every alternate month, totaling seven reports. These case reports were expected to reflect specialty characteristics and include the application of nursing processes, nursing progress, and nursing challenges, with at least five references from the past five years. Reports were submitted in both Word and PowerPoint formats. Prior to the review meetings, the teaching secretary shared the submitted case reports in a WeChat group. Nurses in the observation group were instructed to familiarize themselves with the case reports of other nurses, including the results from artificial intelligence assistance and evidence-based references, in preparation for the review. The teaching secretary coded the 30 submitted case reports and used a WeChat mini-program to randomly assign one case to each nurse for cross-review. The assigned nurse, known as the primary reviewer, conducted a comprehensive, in-depth review, while other nurses provided supplementary reviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(5) Centralized Cross-Review of Nursing Cases\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Review meetings were held between the 15th and 20th of each month, for a total of six sessions. During these sessions, new nurses first presented their individually written nursing case reports using PowerPoint, with a time limit of 5\u0026ndash;8 minutes. The primary reviewer then conducted the case review using PowerPoint, following the 10 dimensions of the case quality standards. The review focused on strengths, weaknesses, and evidence-based suggestions or recommendations, with a time limit of 3\u0026ndash;5 minutes. The teaching group leader chaired the review session and, based on the characteristics of the case and professional requirements, randomly selected 5\u0026ndash;8 nurses from other specialties to participate in supplementary reviews. Each supplementary review was limited to 2\u0026ndash;3 minutes, focusing on evaluating nursing assessments and interventions. The head nurse from the newly recruited nurse\u0026apos;s department also participated in the case review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(6) Review Records and Summary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe session moderator summarized the case review meeting, highlighting strengths and weaknesses to continuously improve the quality of nursing case reports and review sessions. The teaching secretary recorded the comments and suggestions from the case review and compiled a summary, which was shared in the WeChat group and sent to the head nurse of the newly recruited nurse\u0026apos;s department.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(7) Clinical Application and Case Report Formation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe head nurse guided the new nurses in applying the suggestions and recommendations from the review meeting in clinical practice. They tracked the outcomes of these applications and assisted in the writing of the case reports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(8) Post-Clinical Transformation Case Review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the clinical application, new nurses presented their revised cases. The teaching group conducted reviews based on the established case quality standards. The secretary recorded the review comments and provided feedback.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(9) Training on Weak Knowledge Points\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach month, the teaching group evaluated the implementation of the training program, identified the training needs of new nurses, and developed targeted training plans based on common issues identified during reviews and case report writing. These plans were then implemented. The specific training model is illustrated in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Evaluation Indicators and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe effectiveness of the teaching activities was evaluated using the Kirkpatrick model, which assesses four levels: reaction, learning, behavior, and results. The reaction and learning levels reflect the learning outcomes of the training, while the behavior and results levels assess the training transfer process and its outcomes \u003csup\u003e[30]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.1. Reaction Level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(1) Training Satisfaction\u003c/strong\u003e: The \u0026quot;New Nurse Training Satisfaction Questionnaire,\u0026quot; a self-developed instrument, was used to assess training satisfaction across five aspects: training format, content, schedule, practicality, and effectiveness (Supplementary File 1) . The questionnaire contained 10 items,the total score ranges from 10 to 100, with higher scores indicating greater satisfaction. The questionnaire was distributed one month after the training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(2) Self-Directed Learning Ability\u003c/strong\u003e: The Self-Directed Learning Ability Scale, a Chinese assessment tool created by Lin\u003csup\u003e[39]\u003c/sup\u003e, was used to evaluate the self-directed learning ability of new nurses. The scale consists of 28 items across three dimensions, scored on a 5-point Likert scale (1 = completely disagree; 5 = completely agree), with an overall Cronbach\u0026apos;s \u0026alpha; of 0.86. Surveys were administered at two time points: one month before and one month after the training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.2. Learning Level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(1) Nursing Case Report Quality Score(Supplementary File 2) :\u003c/strong\u003e One month before and one month after the training, each group of new nurses submitted a nursing case report. These reports were evaluated blindly by the teaching group according to the maternal and child health hospital\u0026apos;s nursing case report quality evaluation standards. The average score for each group was calculated, with a maximum score of 100. Higher scores indicated better case quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(2) OSCE Assessment Scores:\u003c/strong\u003e The OSCE assessment was designed according to the OSCE standards\u003csup\u003e[39]\u003c/sup\u003e, consisting of five stations: nursing assessment, skill operation, clinical thinking, health education, and humanistic care(Supplementary File 3) . Each station had a maximum score of 100. The scoring standards were developed by the research team and modified through Delphi expert consultation. Two examiners, who were senior instructors or head nurses, evaluated each station.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.3. Behavior Level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCore Competency of New Nurses:\u003c/strong\u003e The core competency of new nurses was evaluated both one month prior to and one month following the training, using the Competency Inventory for Registered Nurses developed by Liu\u003csup\u003e[40]\u003c/sup\u003e. This Chinese self-assessment tool measures core competencies based on the ICN\u0026apos;s Core Competency Framework for Nurses and is widely used among registered nurses in China. The instrument covers seven dimensions: critical thinking and research ability, clinical nursing ability, leadership, interpersonal relationships, legal and ethical practice, professional development, and education and consultation. It consists of 55 items rated on a 5-point Likert scale (0 = no ability; 4 = highly capable), with higher scores reflecting stronger core competency. The total score ranges from 0 to 220, with scores below 110 indicating low competency, scores between 110 and 164 indicating moderate competency, and scores of 165 or higher indicating high competency. The scale\u0026apos;s overall Cronbach\u0026apos;s \u0026alpha; coefficient was 0.798, with coefficients for individual dimensions ranging from 0.706 to 0.775.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.4. Results Level:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) \u003cstrong\u003ePatient Satisfaction:\u003c/strong\u003e Patient satisfaction with new nurses was assessed both one month before and one month after the training using a self-developed \u0026quot;Patient Satisfaction with Bedside Nurse Work Survey,\u0026quot; created by the nursing department(Supplementary File 4). Informed consent was obtained from patients prior to survey participation. Five patients, each cared for by a different new nurse, were randomly selected to complete the questionnaire.\u003c/p\u003e\n\u003cp\u003e(2) \u003cstrong\u003eTransition Shock Level:\u003c/strong\u003e The transition shock level of new nurses was assessed using the New Nurse Transition Shock Evaluation Scale developed by Xue\u003csup\u003e[41]\u003c/sup\u003e, based on transition shock theory. This scale evaluates four dimensions: physical, psychological, knowledge and skills, and socio-cultural development, consisting of 27 items rated on a 5-point Likert scale (1-5 points). The total score ranges from 27 to 135, with higher scores indicating greater transition shock severity. The scale demonstrated strong reliability, with Cronbach\u0026apos;s \u0026alpha; coefficients ranging from 0.840 to 0.918.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6. Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Data were analyzed using SPSS 26.0. Normality was assessed using the Kolmogorov\u0026ndash;Smirnov test. For normally distributed data, mean \u0026plusmn; SD (x̄ \u0026plusmn; s) values were reported and analyzed using independent t-tests. Non-normally distributed data were expressed as medians (Q1, Q3) and analyzed with Wilcoxon rank-sum tests. Categorical variables were summarized as frequencies (%) and compared using chi-square (\u0026chi;\u003csup\u003e2\u003c/sup\u003e) tests, with statistical significance set at P \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.7. Ethical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with ethical guidelines to ensure participant safety. Approval was obtained from the ethics committee of Longgang District Maternal and Child Health Hospital in Shenzhen (LGFYKYXMLL-2025-9).Informed consent was obtained from all participants following full disclosure of the research purposes, voluntary engagement protocols, and stringent measures to ensure participant anonymity and data confidentiality.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic result\u003c/h2\u003e \u003cp\u003eA total of 115 students were initially assessed for eligibility. However, 55 were excluded due to not meeting the inclusion criteria (e.g., absence from training, failure to fulfill the academic criteria) or declining to participate (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).A total of 60 new nurses were enrolled in the trial, with 30 in the control group and 30 in the observation group. The mean age was 22.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99 years, with 6 males and 54 females. Of the participants, 53 held bachelor's degrees, and 7 held master's degrees. No statistically significant differences were observed in the general characteristics between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), confirming their comparability. Details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. During the training, three nurses in the control group withdrew due to resignation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of General Characteristics Between the Two Groups of New Nurses(\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(years, x̄ \u0026plusmn; s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGender n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEducation level n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale Female\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUndergraduate Master\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et/χ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Comparison of Training Satisfaction Between the Two Groups of New Nurses\u003c/h2\u003e \u003cp\u003eThe observation group exhibited significantly higher overall satisfaction compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of Training Satisfaction Between the Two Groups of New Nurses (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverall Satisfaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Comparison of Self-Directed Learning Ability Between the Two Groups of New Nurses\u003c/h2\u003e \u003cp\u003ePrior to the training, no significant intergroup difference was observed in self-directed learning ability (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Following the intervention, the observation group exhibited significantly higher scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of Self-Directed Learning Ability Scores Between the Two Groups of New Nurses (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore Training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter Training\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.99 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.69 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Comparison of Nursing Case Report Quality Scores Between the Two Groups of New Nurses\u003c/h2\u003e \u003cp\u003ePrior to the training, no significant difference in nursing case report quality scores was observed between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After the intervention, the observation group achieved significantly higher scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of Nursing Case Report Quality Scores Between the Two Groups of New Nurses (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore Training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter Training\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.15\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Comparison of OSCE Assessment Results Between the Two Groups of New Nurses\u003c/h2\u003e \u003cp\u003eOne month prior to training, no significant differences were found in OSCE assessment results between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). One month after training, the observation group demonstrated significantly higher total OSCE scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of OSCE Assessment Scores Between the Two Groups of New Nurses (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore Training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter Training\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.53\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.70\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43 (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01 (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e3.6. Comparison of Core Competencies Between the Two Groups of New Nurses\u003c/h2\u003e \u003cp\u003ePrior to training, no significant intergroup differences were observed in total core competency scores or in any individual dimensions (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Following the training, the observation group demonstrated significantly higher total core competency scores, as well as superior scores in critical thinking and research ability, clinical nursing ability, leadership, interpersonal relationships, professional development, and education and consultation, compared to the control group, with all differences being statistically significant (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no significant difference was observed in the scores for legal and ethical practice between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Detailed results are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and 7.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of Core Competency Scores Between the Two Groups of New Nurses Before Training (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"20\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eCritical thinking and research ability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eClinical nursing ability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eLeadership ability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eInterpersonal relationships\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003eLegal and ethical practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003eProfessional development\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003eEducation and consultation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e21.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e30.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e24.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e23.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e19.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e15.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e18.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e152.57\u0026thinsp;\u0026plusmn;\u0026thinsp;10.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e20.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e31.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e24.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e23.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e18.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e14.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e18.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e152.93\u0026thinsp;\u0026plusmn;\u0026thinsp;9.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e-1.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e-1.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e1.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e-1.420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCritical thinking and research ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eClinical nursing ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eLeadership ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eInterpersonal relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eLegal and ethical practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eProfessional development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003eEducation and consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e27.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e36.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e30.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e26.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e19.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e19.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e20.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003e179.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e23.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e33.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e26.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e24.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e19.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e16.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e19.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003e163.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e6.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e2.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e6.851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e2.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003e14.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;7 Comparison of Core Competency Scores Between the Two Groups of New Nurses\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAfter Training (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e3.7. Comparison of Patient Satisfaction Between the Two Groups of New Nurses\u003c/h2\u003e \u003cp\u003ePrior to training, no significant intergroup difference was observed in patient satisfaction scores (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After training, the observation group attained significantly higher scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of Patient Satisfaction Between the Two Groups of New Nurses (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore Training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfter Training\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03 (n\u0026thinsp;=\u0026thinsp;150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49 (n\u0026thinsp;=\u0026thinsp;150)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29 (n\u0026thinsp;=\u0026thinsp;150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78 (n\u0026thinsp;=\u0026thinsp;135)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-6.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e3.8. Comparison of Transition Shock Between the Two Groups of New Nurses\u003c/h2\u003e \u003cp\u003ePrior to training, no significant intergroup difference was observed in transition shock scores (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After training, the observation group exhibited significantly lower scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Tables\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of Transition Shock Scores Between the Two Groups of New Nurses Before Training (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychological\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003cp\u003eand Skills\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSocial Development\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86.63\u0026thinsp;\u0026plusmn;\u0026thinsp;7.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of Transition Shock Scores Between the Two Groups of New Nurses After Training (\u003c/b\u003ex̄ \u0026plusmn; s\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychological\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003cp\u003eand Skills\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSocial Development\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservation Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e75.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.59\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e84.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-5.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003cstrong\u003e4.1. Case review based on training transfer theory can stimulate the training transfer motivation of new nurses.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTraining transfer hinges on the stimulation of both learning and transfer motivation. Transfer motivation pertains to the trainees' subjective effort to optimize the application of knowledge and skills acquired during training in their actual work environment. It forms the core of higher-order cognitive processes such as problem-solving and creative thinking, serving as a critical determinant for the occurrence of training transfer\u0026nbsp;\u003csup\u003e[35,42]\u003c/sup\u003e. This study, centered on \"nursing cases,\" designed a teaching process tailored to the needs of new nurses. The process, informed by the training transfer concept, includes evidence-based case review and evaluation, clinical practice and transformation, and subsequent effectiveness assessment. Results indicated that the observation group exceeded the control group in terms of satisfaction and self-directed learning capabilities. The study required new nurses to analyze real nursing case challenges, establishing a foundation and context for learning transfer. By actively linking training knowledge to clinical issues, they gained a deeper understanding and developed the flexibility to apply this knowledge in novel contexts, which in turn reinforced their self-directed learning capacity. Furthermore, guided by insights from centralized case reviews, the application and transformation of these insights into clinical practice, followed by further evaluation, initiated a problem-solving process rooted in behavioral reflection. This combination of reflection and experience empowered new nurses to quickly analyze, correct errors, and validate their actions, thus enhancing their sustained motivation to internalize and transfer the skills and knowledge acquired during training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Case review based on training transfer theory can enhance the training transfer ability of new nurses.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe core competency of new nurses serves as a critical indicator of both their training transfer ability and the effectiveness of training transfer. This study demonstrates that case review, grounded in training transfer theory, can significantly enhance the core competencies of new nurses. Notably, the clinical nursing ability of new nurses in the observation group increased from 30.13 ± 3.57 before training to 36.73 ± 1.57 after training, representing the greatest improvement among the core competencies. The OSCE assessment, an objective measure of nurses' clinical practice abilities\u0026nbsp;\u003csup\u003e[38]\u003c/sup\u003e, revealed that the experimental group outperformed the control group.\u003c/p\u003e\n\u003cp\u003eThe development of clinical nursing ability is paramount for new nurses, as it constitutes the foundation of clinical practice and marks the starting point for building a nursing career\u0026nbsp;\u003csup\u003e[43]\u003c/sup\u003e. Previous studies have indicated that nurses often face difficulties in transferring theoretical knowledge into clinical practice\u0026nbsp;\u003csup\u003e[44]\u003c/sup\u003e. However, in this study, new nurses enhanced their understanding of clinical nursing processes, refined their clinical reasoning, and bolstered their ability to assess patient needs, create nursing plans, and resolve nursing issues through a closed-loop training model comprising \"nursing patients - writing case reports - evidence-based review - clinical application and transformation - reinforcement of weak areas.\" This approach notably improved their clinical nursing competencies. Willman et al.\u0026nbsp;\u003csup\u003e[45]\u003c/sup\u003e identified critical thinking as a core competency for newly graduated nurses, although it received the lowest self-assessment scores. In contrast, this study found significant improvement in critical thinking and research skills, with the magnitude of improvement second only to clinical nursing competence. Prior to the review, new nurses were tasked with analyzing the feasibility, innovation, and effectiveness of nursing interventions in case reports using evidence-based methods, thereby identifying issues and challenges that fostered their critical thinking and evidence-based abilities. During the centralized review, new nurses from diverse specialties analyzed and evaluated nursing cases from various perspectives, expanding their knowledge base, facilitating interdisciplinary integration, and advancing professional development\u0026nbsp;\u003csup\u003e[46]\u003c/sup\u003e. Additionally, during case reviews and presentations, new nurses were required to articulate their viewpoints and engage in discussions, thereby improving their language proficiency and academic presentation skills. These findings align with those reported by Ma et al.\u0026nbsp;\u003csup\u003e[47]\u003c/sup\u003e. The study also revealed that education and consultation, along with legal and ethical practice, were the weakest dimensions of core competencies, both before and after training. This highlights the need for hospitals to design targeted training components to improve education and consultation skills, as well as ethical and legal practice capabilities, to enhance overall competencies, in accordance with Zhao et al.'s findings\u0026nbsp;\u003csup\u003e[48]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3. Case review based on training transfer theory can facilitate the successful transition of new nurses into professional nurses.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransition shock is widely recognized as a key factor contributing to higher turnover rates among new nurses. A study conducted in South Korea revealed that the turnover rate for newly graduated nurses (29.0%) was 2.1 times higher than that for experienced nurses (13.9%), with transition shock potentially playing a significant role\u0026nbsp;\u003csup\u003e[49]\u003c/sup\u003e. Furthermore, transition shock and nurses' clinical performance are mutually causal. Wallin et al.\u0026nbsp;\u003csup\u003e[50]\u003c/sup\u003e conducted a longitudinal study over five years, which found that transition shock delayed the professional skill development of new nurses by more than two years, resulting in poor evidence-based practice in clinical settings. This delay in practical competence is, in turn, linked to heightened transition shock\u003csup\u003e\u0026nbsp;[19]\u003c/sup\u003e. The present study identified that the most significant change in transition shock scores occurred in the dimension of knowledge and skills. New nurses may experience transition shock during their initial period because their existing knowledge and skills are insufficient to meet the demands of their new job responsibilities. This finding aligns with Hu et al.'s report\u0026nbsp;\u003csup\u003e[51]\u003c/sup\u003e. Moreover, following the training, the observation group exhibited a significantly lower total transition shock score compared to the control group, with a marked reduction in the psychological dimension as well. This decrease may be attributed to the case review approach based on training transfer theory, which stimulated their transfer motivation and enhanced their transfer capabilities. Previous studies have also highlighted that self-efficacy, job satisfaction, peer support, and a positive work environment are critical factors for facilitating the successful transition of new nurses into their professional roles\u0026nbsp;\u003csup\u003e[52]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eThe implementation and evaluation of the training in this study were limited to a one-year period, which may not fully capture the long-term effects of case review on training transfer outcomes. Future research should consider extending the observation period to more accurately assess the enduring transfer effects, leading to more comprehensive and reliable conclusions. Additionally, the study sample was drawn from a single medical institution, and the relatively small and specific sample may not fully represent the diversity of healthcare organizational environments, which could limit the external validity of the findings. Therefore, future research should leverage municipal-level nursing quality control and education centers to expand the scope of this training model across different nursing environments, conducting multicenter, large-sample randomized controlled trials to more precisely evaluate the implementation effects of case review in training new nurses.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eIn conclusion, case review based on training transfer theory, with its focus on training effectiveness and the practical application of outcomes, proves to be an effective strategy for enhancing the clinical core competencies and self-directed learning abilities of new nurses. It stimulates their motivation for training transfer, improves their transfer capabilities, and facilitates their successful transition into competent professional nurses. By centering on clinical nursing cases and integrating centralized review with clinical application transformation, this approach overcomes the monotony and inefficiencies of traditional training models. It has garnered high praise from new nurses, achieving the dual objectives of training and fostering the high-quality development of nursing. This method holds significant potential for widespread application in clinical nursing education.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eOSCE assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObjective Structured Clinical Examination assessment\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICN\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInternational Council of Nurses\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with ethical guidelines to ensure participant safety. Approval was obtained from the ethics committee of Longgang District Maternal and Child Health Hospital in Shenzhen (LGFYKYXMLL-2025-9).Informed consent was obtained from all participants following full disclosure of the research purposes, voluntary engagement protocols, and stringent measures to ensure participant anonymity and data confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in this study is available for further access upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted without external financial support or institutional funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Nursing,Longgang District Maternity \u0026amp; Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College )\u003c/p\u003e\n\u003cp\u003eLianHong Wu,Yan Mao1,Bing Hu,XiaoLing Li\u003c/p\u003e\n\u003cp\u003eDepartment of Gynecology,Longgang District Maternity \u0026amp; Child Healthcare Hospital of Shenzhen City ( Affiliated Shenzhen Women and Children'sHospital (Longgang)of Shantou University Medical College )\u003c/p\u003e\n\u003cp\u003eLingXia Liu\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: LHW,XLL,BH; acquisition of data: LHW, LXL,YM; analysis: XLL,LXL,YM; drafting of the article: LHW,XLL; critical review and revision of the manuscript: LHW,XLL,BH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to XiaoLing Li\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the review panel for their guidance and support in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and 'universal' health coverage? BMJ Glob Health. 2022;7(6):e009316.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaintsing D, Gibson LM, Pennington AW. The novice nurse and clinical decision-making: how to avoid errors. J Nurs Manag. 2011;19(3):354\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMissen K, McKenna L, Beauchamp A. Registered nurses' perceptions of new nursing graduates' clinical competence: A systematic integrative review. Nurs Health Sci. 2016;18(2):143\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoo MWJ, Newman SA. The experience of transition from nursing students to newly graduated registered nurses in Singapore. Int J Nurs Sci. 2019;7(1):81\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitehead B, Owen P, Holmes D, Beddingham E, Simmons M, Henshaw L, et al. Supporting newly qualified nurses in the UK: a systematic literature review. Nurse Educ Today. 2013;33(4):370\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAggar C, Bloomfield J, Thomas TH, Gordon CJ. Australia's first transition to professional practice in primary care program for graduate registered nurses: a pilot study. BMC Nurs. 2017;16:14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi XY, Li XF, Tang XH,Chen YY. Practice and evaluation of the General Guideline for Training of New Graduate Nurses. J Nurs Sci 2017,32(6):61\u0026ndash;6398.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Chen Y, Wang L, Wang W, Kong X, Li X. Assessment of the effectiveness of the BOPPPS model combined with case-based learning on nursing residency education for newly recruited nurses in China: a mixed methods study. BMC Med Educ. 2024;24(1):215.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShang X, Lin Z, Xie X, Fang S, Chen L, Gu Z, et al. Establishment of standardized training system for new nurses based on post competency. Chin Nurs Res. 2019;33:1334\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun B, Fu L, Yan C, Wang Y, Fan L. Quality of work life and work engagement among nurses with standardised training: The mediating role of burnout and career identity. Nurse Educ Pract. 2022;58:103276.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi MM. Luo J.Literatures analysis on standardized training in new recruited nurses. Chin J Mod Nurs. 2017;23(7):1016\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu L. Situation and practice of cultivation of autonomous learning ability in clinical teaching of standardized training for residents. Chin Med Herald. 2020;17(4):63\u0026ndash;6569.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVisiers-Jim\u0026eacute;nez L, Palese A, Brugnolli A, Cadorin L, Salminen L, Leino-Kilpi H, et al. Nursing students' self-directed learning abilities and related factors at graduation: A multi-country cross-sectional study. Nurs Open. 2022;9(3):1688\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang T, Gong FH,Shi ZY,Xiao N, Zeng YY, Liao JX, et al. Application of MOOC teaching in new entry nurses standardized training of respiratory medicine. Chin J Mod Nurs. 2018;24(9):1009\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi XY, Zhu XP,Yin XB,Liu F, Xie CY, Wu YH. Qualitative study on newly recruited nurses' experience of standardized training. Chin J Mod Nurs. 2019;25(3):270\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCen XY, Hua Y, Niu S, Yu T. Application of case-based learning in medical student education: a meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(8):3173\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasamnis AA, Arya A, Patil SS. Case-based Learning: Our Experience in Clinical Pharmacology Teaching. J Pharm Bioallied Sci. 2019;11(2):187\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLean SF. Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev. 2016;3:JMECD.S20377.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee T, Kim E, Ji Y. The mediating effect of transition shock on the relationship between readiness for practice and turnover intention of new graduate nurses in South Korea: A longitudinal study. Nurse Educ Today. 2024;143:106394.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbuAlRub RF. Abu Alhaija'a MG. Perceived benefits and barriers of implementing nursing residency programs in Jordan. Int Nurs Rev. 2019;66(1):43\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim EY, Yeo JH. Transition shock and job satisfaction changes among newly graduated nurses in their first year of work: A prospective longitudinal study. J Nurs Manag. 2021;29(3):451\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabrague LJ, De Los Santos JAA, Falguera CC, Nwafor CE, Galabay JR, Rosales RA, et al. Predictors of nurses' turnover intention at one and five years' time. Int Nurs Rev. 2020;67(2):191\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2024 NSI National Health Care Retention \u0026amp; RN Staffing Report. NSI Nursing Solutions Inc. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report\u003c/span\u003e\u003cspan address=\"https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. pdf.Accessed December 13, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClipper B, Cherry B. From Transition Shock to Competent Practice: Developing Preceptors to Support New Nurse Transition. J Contin Educ Nurs. 2015;46(10):448\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang HF, Lin CC, Wu KM. Breaking through the dilemma of whether to continue nursing: Newly graduated nurses' experiences of work challenges. Nurse Educ Today. 2018;67:72\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoughty L, McKillop A, Dixon R, Sinnema C. Educating new graduate nurses in their first year of practice: The perspective and experiences of the new graduate nurses and the director of nursing. Nurse Educ Pract. 2018;30:101\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshton KS. The orientation period: essential for new registered nurses' adaptation. Nurs Sci Q. 2015;28(2):142\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchettino G, Capone V. From Online Learning to Clinical Practice: An Investigation on the Factors Influencing Training Transfer Among Physicians. Healthc (Basel). 2025;13(2):133.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanum AL, Hu Q, Wei W, Ma F. A longitudinal assessment of factors affecting training transfer among new clinical nurse specialists. Int J Nurs Sci. 2024;11(3):308\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson LN, Merkebu J. The Kirkpatrick Model: A Tool for Evaluating Educational Research. Fam Med. 2024;56(6):403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaks AM, Burke-Smalley LA. Is transfer of training related to firm performance? Int J Train Dev. 2014;18(2):104\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa F, Bai Y, Bai Y, Ma W, Yang X, Li J. Factors influencing training transfer in nursing profession: a qualitative study. BMC Med Educ. 2018;18(1):44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBen Mansour J, Naji A, Leclerc A. The Relationship between Training Satisfaction and the Readiness to Transfer Learning: The Mediating Role of Normative Commitment. Sustainability. 2017;9(5):834.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePham TT, Lingard H, Zhang RP. Factors Influencing Construction Workers\u0026rsquo; Intention to Transfer Occupational Health and Safety Training. Saf Sci. 2023;167:106288.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Lv FF,Chen Q, Shi Y, Zhang HM, Tian YT. Research advances in training transfer and implications for specialist nurse training. Chin J Nurs. 2022;57(11):1391\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolarinwa OA. Sample size estimation for health and social science researchers: The principles and considerations for different study designs. Niger Postgrad Med J. 2020;27(2):67\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen KH, Ning L, Liu ZY,Zeng N. Construction and application of pre-job training program for new nurses based on transformative learning. Chin J Med Educ Res. 2023;22(8):1257\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin Y, Jang AL. Developing a Measure Scale of Autonomous Learning Competencies of Nursing Undergraduates. J Nurs PLA. 2004;21(6):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnwudiegwu U, OSCE:. DESIGN, DEVELOPMENT AND DEPLOYMENT. J West Afr Coll Surg. 2018 Jan-Mar;8(1):1\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu M, Yin L, Ma MY,Luo SX. Confirmatory factor analysis of Competeney Inventory for Registered Nurse. Chin J Nurs. 2008;43(3):204\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXueYR, Lin P, Gao XQ,Zhao ZJ,Li L, Liu GJ, et al. Development and the reliability and validity test of the Transition Shock of Newly Graduated Nurses Scale. Chin J Nurs. 2015;50(6):674\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiles DA. Simulation Learning and Transfer in Undergraduate Nursing Education: A Grounded Theory Study. J Nurs Educ. 2018;57(6):347\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie CY, Zhang J, Yin XB, et al. Methods for measurement of new graduate nurses' clinical competence: a literature review. J Nurs Sci. 2019;34(2):98\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuraoka Y. Effects of a learning programme for nurse managers to connect their experience: A quasi-experimental study. J Nurs Manag. 2022;30(5):1188\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWillman A, Bjures\u0026auml;ter K, Nilsson J. Newly graduated nurses' clinical competencies and need for further training in acute care hospitals. J Clin Nurs. 2020;29(13\u0026ndash;14):2209\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou YH. Qu B,Ding L.Organization and practice in the discussion of difficult nursing cases. Chin J Mod Nurs. 2014;20(12):1438\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa J, Song XA,Ren H, Zhang CY, Gao J, Chen XM. Application of case report model in standardized training of newly recruited nurses. Chin J Mod Nurs. 2020;26(32):4547\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao XH, Zhao GX, Shi BY,Jin G. Application of the combination teaching modal of observation-teaching-discussion (OTD) and case instruction in nutritional nurse training. Chin J Mod Nurs. 2019;25(12):1565\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim EY, Yeo JH. Effects of pre-graduation characteristics and working environments on transition shock of newly graduated nurses: A longitudinal study. Nurse Educ Today. 2019;78:32\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallin L, Gustavsson P, Ehrenberg A, Rudman A. A modest start, but a steady rise in research use: a longitudinal study of nurses during the first five years in professional life. Implement Sci. 2012;7:19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu XY, Sun AL,Peng SH. Relationship of transition shock and job satisfaction for newly graduated registered nurses. J Nurs Sci. 2016;31(15):54\u0026ndash;5567.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYao L, Chen J, Zhao Q, Bai D, Li Y, Xiao M, Du Y, Liu L. Level and influencing factors of transition shock among new nurses in China: A multicenter cross-sectional study. Health Sci Rep. 2023;6(12):e1758.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Training Transfer, Case Review in Nursing, New Nurses","lastPublishedDoi":"10.21203/rs.3.rs-6337034/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6337034/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground and Purpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNew nurses often encounter demanding work environments that hinder their professional growth and transition into proficient practitioners. Current training programs for novice nurses typically fall short in content, methodology, and outcomes, with insufficient focus on the transfer of knowledge and skills. This study aims to assess the effectiveness of case reviews, grounded in training transfer theory, in facilitating the transfer and application of knowledge and skills among new nurses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA randomized controlled trial was conducted to evaluate the impact of an intervention incorporating case reviews based on training transfer theory. Sixty new nurses from Longgang District Maternal and Child Health Hospital in Shenzhen were enrolled through convenience sampling and randomly assigned into two groups \u003cem\u003evia\u003c/em\u003e block randomization. The control group underwent standard general training, while the observation group received the same curriculum, augmented with case reviews grounded in training transfer theory. Both groups participated in a 12-month training program. One month post-training, comparisons were made between the groups across multiple outcomes, including training satisfaction, self-directed learning ability, nursing case report quality, OSCE assessment scores, new nurses' core competencies, patient satisfaction, and transition shock.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePost-training, the observation group exhibited significantly higher scores in training satisfaction, self-directed learning ability, core competencies, nursing case report quality, OSCE results, and patient satisfaction compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, the observation group demonstrated significantly lower transition shock scores than the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCase review-based training, underpinned by training transfer theory, effectively enhances new nurses' core competencies and self-directed learning abilities, fosters motivation for knowledge transfer, and supports a smoother transition to competent professional practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial registration\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study was registered at the Chinese Clinical Trial Registry (ChiCTR) on April 3, 2025.identifier (The clinical trial registration process is ongoing).\u003c/p\u003e","manuscriptTitle":"Application of Case Review Based on Training Transfer Theory in the Training of New Nurses：a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-30 08:50:54","doi":"10.21203/rs.3.rs-6337034/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-06-24T12:19:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-29T08:40:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-24T09:15:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-19T12:14:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-04-19T12:13:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1eb6d87e-57df-4f84-b65b-67eef4ee9951","owner":[],"postedDate":"June 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-30T08:50:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-30 08:50:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6337034","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6337034","identity":"rs-6337034","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}