The purpose of this study was to investigate the effectiveness of using an activity package for enhancing midwifery clinical leadership among nursing students. The author designed activities for enhancing midwifery clinical leadership among nursing students composed of the following five activities: 1) a management game for developing “self-management”; 2) a management game for “developing cognitive processes”; 3) a management game for “developing leader-follower skills”; 4) a teamwork game for “team quality”; 5) reflective thinking, “think reflectively and change your perspectives”. based on leadership skill approach theory8 and the concept of teamwork as the guideline for developing the training activities11, as the guidelines for developing the training activities and active learning. 12 A variety of models and techniques were used, namely team-based learning, game-based learning, simulation-based learning and reflection, which corresponded with 21st Century Skills to promote and support learners in learning from real practice with instructors as leaders to advise and help with the design of learning activities, so learners can benefit from hands-on learning. This finding corresponds with the findings of a study by Zenobia C.Y. Chan, who stated that nursing education should design course curriculum with enthusiastic education management, promotion of students in creative thinking and real, hands-on practice.13 Enthusiastic learning is the development of cognitive processes, which will cause learners to succeed academically and professionally.14,15 In this organization of activities to supplement course curriculum, procedures were followed by holding training activities on a continual basis, beginning with self-management activities for the participants to receive training and develop skills in goal-setting, time management, planning and problem-solving. Next were the activities for developing cognitive processes, helping develop listening, cognitive and communication skills. When the participants joined in the training and had practiced self-management and cognitive thinking, they began to practice teamwork activities in order to develop leader-follower skills and followed the simulated situation, “Nursing for Women with Prolapsed Cord”, so the training participants could learn about teamwork, management and problem-solving together in addition to summarizing with a reflective thinking activity. These activities resulted in the learners learning together, solving problems together and even contributed to enhanced leadership. Furthermore, having the nursing students work together as a team resulted in learning exchanges among the students.16 This finding corresponds with the findings of a study by Worangkhana Khumsuk (2021), who investigated simulation-based learning in preparing nursing students for practice in the subject of nursing practice for mothers, infants and midwifery. According to the findings, the nursing students gained more knowledge and self-efficacy before engaging in clinical practice.17 This finding corresponded with the findings of a study by Phunthip Chubkhuntod, Prangthip Thasanoh Elter, Nuchamart Gaewgoontol, Rutchanee Potchana (2019), who studied the effects of a simulation-based learning model on knowledge, self-efficacy and abilities in applying nursing process skills during the intrapartum care of nursing students. According to the findings, simulation-based learning helped increase self-efficacy and ability in the use of nursing processes among the nursing students.18 Therefore, if nursing students have self-efficacy in clinical nursing practice, they will dare to think, dare to decide, efficiently communicate with health care teams and enhance leadership for nursing students.19
Concerning the effectiveness of the activity package for enhancing midwifery clinical leadership among nursing students, the students were found to have better posttest midwifery clinical leadership than pretest with statistical significance at .05. It can be said, therefore, that midwifery clinical leadership among nursing students gained added development due to the effectiveness of the activity package to enhance midwifery clinical leadership. Active learning was used, which supports the research hypothesis. Due to the fact that, before engaging in practice, the nursing students enhanced leadership through various activities such as a management game for developing self-management; a management game for developing cognitive processes; a game for developing leader-follower skills; development of leader-follower skills; teamwork activities and reflective thinking activities, resulted in the nursing students becoming familiar with themselves, learning how to work as a team and gaining self-efficacy in expressing increased leadership. This finding corresponded with the findings of a study by Towle A. (2015), who organized active learning to enhance leadership among nursing students. According to the findings, the active learning exercises were able to enhance leadership for the nursing students.20 The above findings also correspond with the findings of a study by Marath U. & Ramachandra R. (2015), who enhanced the leadership of nursing students by using activities to supplement course curriculum. According to the findings, the activities were also able to enhance the leadership of the nursing students.21 Obviously, therefore, the effectiveness of the activity package to enhance midwifery clinical leadership for nursing students before they engage in clinical practice can enhance the leadership of nursing students.22 After the training, the nursing students engaged in clinical practice in antenatal departments, labor/delivery rooms, and postpartum units where they took on the role of head nurse. Thus, the nursing students were able to fully act out the role based on their duties, while they worked as a team and solved problems together in acting out their roles in leading self and others, which corresponds with the leadership competencies of professional nurses at the ANA Leadership Institute in leading self and others. In other words, nursing students need to have self-awareness, self-motivation, self-management, flexibility, adaptability, good relationships, efficient communication, conflict management, empowerment and the ability to build good relationships among colleagues on multidisciplinary teams.23 Similarly, a study by Akbar MA, Juniarti N, Yamin A.(2021), who investigated the roles of community nurse practitioners in management to prevent Covid-19 outbreaks in communities and found that collaborating was the heart of Covid-19 prevention and management.24 Collaboration is a leadership skill. Based on the findings of this study, community nurse practitioners with good leadership can efficiently manage the prevention of Covid-19 outbreaks.
This study discovered that most nursing students are unaware of how important leadership is to the nursing profession. If nursing students possess knowledge about leadership and awareness of its importance, they will improve their leadership skills, which is similar to a leadership development program for nursing students in Western Australia that enhanced knowledge about leadership, leadership skills and practices involved wit leadership. The findings of the study revealed that the nursing students had increased leadership.25 Nevertheless, the management of graduate nursing courses at every educational institution should promote and support every nursing student in receiving leadership practice and development for professional development and future advancement.