Yan-Yuan Lei,Xiang-Shu Cui

1School of Nursing,Yanbian University,Yanji,Jilin,China

Abstract Attribution Retraining is a hot research topic in the field of psychology and pedagogy,and has been paid more and more attention in the field of nursing education in recent years.This study comprehensively retrieved attribution retraining related literature from Chinese and English databases and used literature analysis method to summarize the theoretical basis, assessment tools and application of attribution retraining in nursing education in China.The aim of this review is to promote the wider application of attribution retraining in the field of nursing education and provide reference for cultivating more excellent nursing talents.

Keywords:Attribution retraining;Nursing education;Review

Introduction

Attribution is how people explain the success or failure of important events in their lives.Attribution Retraining is an intervention in cognitive behavior that tries to make an individual or group acquire some attribution skill, develop an objective and positive attribution style,and change their cognition,mood,and behavior through the associated attribution retraining procedures.It is a very hot topic in the field of psychology and education in recent years [1-2].It induces the formation of positive emotion and expectation through the change of positive attribution style, and provides a new approach and method for enhancing achievement motivation, correcting inferiority complex, and improving physical and mental health[3].In recent years,this method has been gradually applied in the field of nursing education and has a positive influence on the career of nursing students.Through literature retrieval and research,it is found that attribution retraining can guide nursing students to form positive attribution style, stabilize nursing professional thought, play a positive effect in improving practical operation skills and theoretical learning performance, and contribute to enhance the achievement motivation of nursing students and stimulate their learning enthusiasm, which is an effective method[4,5].Based on the existing literature,this paper reviewed the theoretical basis, assessment tools and application of attribution retraining in nursing education in China, aiming to provide reference for the promotion and application of attribution retraining in nursing education in China.

Theoretical Basis

Attribution theory is the theoretical basis of attribution retraining and has a research history of more than 60 years.According to existing studies, there are similarities and differences in many attribution theories,and the influential attribution theories mainly include Weiner achievement attribution theory [6] and Seligman learned helplessness attribution theory [7].Attribution theory is rooted in social psychology and is based on social cognition.Meanwhile, theories of developmental psychology and clinical psychology are later integrated into the research category of attribution theory.To sum up, the theoretical basis of attribution retraining involves many fields.Through the literature retrieval,it is found that the attribution theory research in the field of psychology and sociology in recent years.For instance, research has confirmed a positive right interpersonal attribution way help to improve students' mental health level [8], Song GD et al.[9]study to explore the essence of the process of social compliance and attribution has important theoretical and application value.To sum up, attribution theory is of great significance to the research and application of a certain field.As Han RS, a psychologist, said:the theory of attribution is of great significance for the guidance of educational practice, and plays a very necessary role in cultivating students' personal qualities and helping them grow up healthfully and correctly.Therefore, the application of attribution retraining in the field of nursing education urgently needs more researchers' attention and attention, so as to contribute to the cultivation of more nurses with core competence.

Assessment tools

By searching relevant literatures at home and abroad,it is found that there are two widely used assessment tools:the Attribution Style Questionnaire (ASQ) and the Multidimensional-Multiattributional Causality Scale (MMCS).The questionnaire was compiled and developed by a research team of foreign scholars, and has been widely used in China after years of development and localization.

Attributional style questionnaire,ASQ

This scale is a self-rating scale, which is composed of 12 events of different hypothetical situations [10],including 6 positive events and 6 negative events.It has three attributional dimensions of internality,stability and wholeness.Its Cronbach's α is 0.843, and its content validity is 0.852.Likert 7-point scoring method was used.In the positive events, 1 was the lowest score and 7 was the highest score.For negative events,1 is the highest score and 7 is the lowest score.Positive and negative events were scored independently because of the reverse order of rating.

Multi dimension-multi attributional causality scale(MMCS)

The Multi dimension-multi attributional causality scale was developed by Lefcourt in 1979, used to measure the achievement and control the source of several dimensions.The scale has a total of 48 items [11],including four attribution dimensions:ability, effort,environment and luck.The first two of which belong to internal control and the last two belong to external control.Likert 5-point scoring method was used.Total score = external control score - internal control score,Total score > 0 indicates that the attribution style inclined to external control, the higher the score, the stronger the external control; The total score < 0 indicates that the attribution style tends to internal control, and the lower the score, the stronger the internal control.The total score = 0 indicates that the attribution is neutral, and the Cronbach's α of the total table is 0.84,showing good reliability and validity.

The implementation of attribution retraining in nursing education in China

Through reviewing relevant literature, it is found that the application of attribution retraining in the field of nursing education and targeted intervention for nursing students or clinical nurses are helpful to achieve the established goals.In the early stage, researchers are required to participate in the attribution retraining process, and the research team should have professionals who have received systematic attribution retraining and obtained corresponding qualifications.In addition,the overall training cycle is long, so many studies adopt 8 intervention retraining sessions, each 60～120min,in the form of group discussion,to guide the subjects to gradually make attribution in a positive direction.Most researchers carry out attribution retraining on the basis of attribution theory and practice combined with teaching practice.In view of this, the author summarized the following four commonly used intervention methods from the perspective of achievement motivation attribution,including theoretical teaching, situational simulation,organized discussion and model demonstration.

Theoretical teaching

The purpose of this method is to give priority to preconceived ideas, so that the research subjects can first understand some basic knowledge such as what is attribution and what is the process of attribution retraining.Collective training was conducted for the included research objects, and attribution retraining professionals taught the basic knowledge of attribution theory.Meanwhile, nursing students or nurses who raised questions were given answers, which helped to lay a theoretical foundation for the smooth development of subsequent attribution training activities.Group learning and individual instruction are the first steps adopted in most interventional studies[12].

Situational simulation

The researcher sets up an appropriate environment according to the actual situation of the research object to simulate a learning experience or working experience, so that the research object can gradually form reasonable attribution based on the theoretical knowledge learned by experiencing the feeling of success or failure.Xie XX et al.[13] used the model person to set different scenarios for nursing students to experience the success or failure of puncture.They praised the successful puncture students and attributed the success to their personal efforts, and helped the unsuccessful puncture students to build up their self-confidence and ascribe it to internal factors.Wu MC et al.[14] conducted a simulated job fair and asked each nursing student to make a brief self-introduction,with the purpose of allowing them to objectively evaluate themselves.Then, other nursing students made mutual evaluation and supplement to help them fully understand themselves and provide environmental support for subsequent rational attribution.

Organized discussion

During attribution retraining, the research subjects should be encouraged to record and analyze the success and failure cases they have experienced without affecting their normal work and learning.Then,the researchers regularly organize discussions and summarization to encourage each research object to communicate their own feelings, and attribution retraining experts give positive praise and encouragement to their speeches and expressions, and strengthen correction of inappropriate understandings and opinions [15].This process of discussion and communication is designed to lead subjects to make general attributions, such as attributing success to internal causes such as ability and effort.

Model Demonstration

Through the demonstration and guidance function of the model,the research object can be helped to make a positive and reasonable attribution, which will have a positive influence on its future work and study.Through literature review, it is found that the intervention method of model demonstration has obvious effect on the enhancement of attribution of the research subjects, which is helpful for the research subjects to carry the changes in attribution retraining into their future work, study and life, and produce positive attribution style.Interventions include watching inspirational movies, learning from top caregivers and recommending high-quality literature.This is helpful to guide the research subjects to set up the role model image in their hearts and make objective and positive attribution of success and failure[16].

Application effect of attribution retraining in nursing education

With the development of multidisciplinary comprehensive application, attribution retraining has been gradually applied in nursing education, and its application effect has become an urgent concern of nursing researchers.In China, the intervention for nursing students or clinical nurses mainly starts with teaching methods, teaching models and management models.However, there is little intervention from the aspect of psychological application.Therefore,Chinese researchers need to further strengthen the exploration in this aspect.At present,through literature review and summary,attribution retraining can be used as a cognitive behavior intervention method.Its application effect in the field of nursing education mainly includes the following three aspects.

Attribution retraining is helpful to form positive attribution tendency and improve self-confidence

Song XH et al.[5] studied the influence of attribution retraining on college students' English learning strategies and academic achievement.It is found that if students attribute success or failure to internal control attribution, that is, strong ability and hard work, they will take the initiative to find suitable learning strategies for themselves, learn and use language more efficiently,and enhance self-confidence in learning, so as to achieve academic success.If the failure is attributed to external and uncontrollable factors such as luck, task difficulty and environment, which will produce negative emotional experience.It is easy to ignore the role of effort in success, and ultimately affect the persistence of learning action, leading to future academic failure.Sun JF et al.[17] applied personalized attribution retraining method in nursing work to prevent unplanned extubation of severe neurosurgery patients.The results showed that patients'recognition of the disease and their indwelling tube behavior were improved by optimizing the attribution style and attribution ability, and patients' bad disease thought centered on self-misfortune was changed, and patients' positive psychological cognition of the disease was promoted, and their confidence in overcoming the disease was improved.Therefore,positive attribution retraining can form positive attribution tendency and improve the research objects’self-confidence in study and work.

Attribution retraining is helpful to cultivate the comprehensive ability and improve the overall quality of nursing students

Nursing education in China should cultivate senior nursing professionals who can adapt to the development of The Times, not only with solid professional skills,but also with comprehensive quality.Attribution retraining embodies this educational idea.Xie XX et al.[13] applied attribution retraining in teaching, and implemented the clinical teaching mode of "combination of teaching and doing" with quality cultivation and technical training.The results showed that the assessment scores and patient satisfaction of nursing students in the intervention group were significantly higher than those in the control group,indicating that the application of attribution retraining in clinical teaching can not only improve the professional quality and ability of nursing students,but also provide a new method for clinical skill practice teaching.According to the research of Yu Q et al.[18],attribution retraining can maximize the general sense of self-efficacy of nursing students, stimulate their enthusiasm for learning and mobilize their initiative in learning, laying a foundation for cultivating nursing talents with high clinical comprehensive ability.In conclusion,the results of the study suggest that nursing educators can guide the adaptive attribution style of nursing workers and students in their future teaching activities, help them to establish correct values,cultivate positive and stable professional ability, and promote the development of nursing discipline.

Attribution retraining is helpful to improve the core competence of clinical nurses

Chai YX et al.[4] conducted attribution retraining on the core competence of nurses with low seniority in the emergency department, and the research results showed that there were statistically significant differences in the scores of clinical nurses' core competence and various dimensions before and after attribution retraining.This proves that the attribution retraining program can effectively improve the professional competence of nurses with junior experience in the emergency department.Tai H et al.[19] conducted attribution retraining for 187 nursing college students in Taiwan, China, to improve writing ability and perceptual ability.By measuring the results before and after intervention, they showed that the writing performance and perceptual ability of nursing students were significantly improved, which was similar to the research results of Sukariyah MB [20].To sum up, clinical specialized nurses have different requirements for post competence,which suggests that hospital managers can strengthen the training of specialized nurses' core competence by formulating and referring to reasonable attribution retraining programs, so as to add backbone strength to clinical nursing work.

Summary and prospect

To sum up, attribution retraining has been initially carried out in the field of nursing education, and has played a positive impact on the career development of nursing students or clinical nurses.It was found that attribution retraining can be combined with other psychotherapy and had a wide positive impact on the career development of college students [21].Besides,some studies showed that attribution retraining can effectively relieve depression [22], reduce learning burnout [23] and improve nursing students’ cognition[24].In view of this, whether attribution retraining can be more widely used in nursing students in the future.It can be used to improve negative emotions and reduce job burnout, which is also a topic that needs to be further explored.It is hoped that nursing educators can apply attribution retraining combined with other teaching methods to nursing teaching, so as to guide nursing students to the correct career direction and contribute to the cultivation of more outstanding nursing talents in the field of nursing education in future.