Design
Our study used a cross-sectional, descriptive, correlational design.
Participants
Nursing students enrolled in a capstone course in developing healthcare-related products participated in this study; all students were from one university of technology in northern Taiwan. The first author described the study design and purpose to all students, and invited them to participate the last week of the course. Packets containing a description n of the study design and purpose, survey questionnaires and a consent form were distributed to all enrolled students (n = 120). The first author explained that students who wanted to be participants would need to sign the consent form enclosed in the packet, fill out the questionnaires, and return the packets. In order to maintain the anonymity of the participants, a coding number was assigned to each packet. A total of 98 packets were returned after the conclusion of the course, for a response rate of 81.6%. All 98 packets contained signed consent forms The average age of the participants was 21.3 years (standard deviation (SD) =.47; almost all (98%) were female. G*Power 3.1.9.2 software [42] was used to determine sample size required for observing the same effect of the instruments over time with an alpha-type error < .05 and power beta of 85%. The minimum sample size was determined to be 95.
Capstone Course
The capstone course was designed to help nursing students develop patentable healthcare-related products that can be applied to clinical care. The format of the 18-week course included lectures from seven nursing faculty and small group discussions with teams of 7-8 students. Material covered included patent searching, healthcare product development and needs assessment. Students also received instruction in the use of creative thinking tools, such as brain storming to stimulate divergent and convergent thinking skills. Students were required to develop an innovative product, give a mid-term presentation, and present the final product at the end of the semester to the seven nursing faculty and their student-team.
Measurements
Creativity
The Torrance Tests of Creative Thinking (TTCT) [18] determined nursing students’ levels of creativity. The TTCT measures two areas of creativity: verbal (TTCT-V) and figural (TTCT-F. We used a Chinese version of the TTCT to evaluate creativity [32]. The TTCT-V contains six activities; each activity begins with a picture and the student responds with a written description of the picture. Three subscales are used for scoring: fluency, which is the number of ideas related to the picture, originality, which is the uniqueness of the response, and flexibility, which is the variety of different ideas [21]. The range for the subscales scores of fluency, flexibility, and originality are 0-50, 0-26, and 0-100, respectively; total score ranges from 0-176.
The TTCT-F is comprised of three activities: picture construction, picture completion, and repeated figures of lines and circles. Four subscales score each activity on the TTCT-F: fluency, originality, and flexibility, as describe for the TTCT-V, and elaboration, which involves rich imagery and abstraction [21]. The range for the subscale scores of fluency, flexibility, originality, and elaboration are 0-57, 0-35, 0-114, and 0-171, respectively; total score ranges from 0-377.
In this study, the Cronbach’s alpha coefficients for the subscales of the TTCT-F were between 0.79 and 0.98. In addition, we also measured total scores for TTCT-F and TTCT-V, as suggested by Okuda, Runco, and Berger [43]. In this study, the Cronbach’s alpha coefficients for total scores for the TTCT-F and TTCT-V and were 0.83 and 0.90, respectively.
Creative personality traits
The Affective Components of Creativity Scale (ACCS) assessed components of participants’ personalities considered to be associated with creativity [29]. The ACCS is a self-assessment instrument derived from the New Creative Affective Scale developed by Xia [31]; the scale measures personality traits of affective creativity: imagination, curiosity, adventure, and challenge. Statements are rated on a 4-point Likert scale; 1 = completely disagree to 4 = completely agree. Some questions are reverse scored. Higher scores indicate higher perceived levels of creativity. The reliability estimate for the ACCS is .92, and satisfactory validity was confirmed through factor analyses. In this study, Cronbach’s alpha coefficient was .78 for the total score and ranged from .70 to .85 for all subscales, indicating satisfactory reliability. Table 1 shows examples of statements for each subscale of the ACCS.
Innovation
Innovation was determined by the mean final grade for the 98 students at the end of the capstone course. The seven faculty who taught the capstone graded the students on attendance and participation (30 points), a mid-term report (30 points), a team evaluation (10 points). Students also received a score for their final project, which included a presentation of their project to faculty and team members (10 points) and a project creativity score (20 points), which is described below. Therefore, the maximum score for innovation was 100 points; 20% was their product creativity score.
Product creativity was determined using the Consensual Assessment Technique, which assumes the combined assessment from a diverse panel of experts is the best way to determine the creativity of a product [41]. In this study, the panel was comprised of four judges: a dean of nursing, a practicing RN, an expert in industrial design, and an expert in patent design. The judges scored each product independently for novelty and usefulness. Novelty was determined by originality and uniqueness of the product, as compared to other similar products on the market. Usefulness was determined by appropriateness, which was a measure of how likely the product would be used, and esthetics, which measured visual appeal. Each of the four items was scored low (1 point) to high (5 points); range = 4-20 points; consistency, as measured by Cronbach’s alpha coefficient, was .72 and .85 for novelty and usefulness, respectively. Inter-rater reliability was acceptable (ICCnovelty = .91, ICCusefulness = .87). Scores from the four judges were averaged to determine the project creativity score for each developed product.
Data collection and analysis
Data were collected after nursing students completed the 18-week capstone course, in the fall of the 2016. Anonymous survey data were collected from paper-and-pencil questionnaires, which included information regarding the students’ age, gender, and their final grade in the capstone course. Data from the questionnaires were analyzed using SPSS version 20.0. Descriptive statistics, such as the mean (M) and standard deviation (SD) were used to describe participants’ characteristics, and scores for innovation, creativity, and creative personality traits. Analysis using Pearson’s correlation coefficient was used to identify correlations between innovation, creativity, and creative personality traits. To reduce the likelihood of bias in testing 12 variables, we applied a Bonferroni correction (a = .05/12), resulting in a required significance p .004.
Ethical Considerations
Approval was obtained from Institutional Review Board of the hospital ethics committees prior to data collection. When the coded packets were returned, the director of the healthcare program checked for the presence of a signed consent form and removed it from the packet to ensure confidentiality of the students’ information. The consent form explained the purpose of the study, assurance that confidentiality and anonymity of the student would be maintained, and that failure to participate would not affect their status as a nursing student.