Balancing the seen and unseen: Nurse educator as role model for critical thinking.

Critical thinking is an important indicator of student learning and is an essential outcome of baccalaureate nursing education. The role of nurse educators in the development of students' critical thinking has been overlooked despite the importance of their actions to facilitate critical thinking in nursing education. We used a constructivist grounded theory approach within a larger mixed methods triangulation study to explore how nurse educators revealed their critical thinking in practice. From the grounded theory approach, a model emerged from our research, outlining the important aspects of nurse educators' critical thinking and how it is revealed in the clinical setting. The important categories of this model include: a) fostering the student-educator relationship; b) role modeling critical thinking; c) mobilizing and operationalizing resources; as well as d) balancing factors that impact nurse educators' critical thinking. Our findings inform what is known about nurse educators' critical thinking and how it can be implemented in nurse educators' teaching practice. Given our findings, we offer recommendations for future nursing education practice and research, including the need to apply our findings in additional settings and further develop nurse educators' awareness of their own critical thinking.

Nurse educators' critical thinking: A mixed methods exploration.

Nurse educator's critical thinking remains unexamined as a key factor in the development of students' critical thinking. OBJECTIVES: The objective of this study is to understand how nurse educators reveal their critical thinking in the clinical setting while supervising students. DESIGN: This study uses a single-phase triangulation mixed methods design with multiple data gathering techniques. PARTICIPANTS/SETTINGS: Participants for this study are clinical nurse educators from a large Western Canadian baccalaureate nursing program who teach 2nd or 3rd year students in medical-surgical settings. METHODS: Participants for this study completed a demographic survey, the California Critical Thinking Skills Test (CCTST), the California Critical Thinking Disposition Inventory (CCTDI), participant observation in a clinical practice setting, and semi-structured interviews. RESULTS: The results from the California Critical Thinking assessments (CCTST and CCTDI) show that participants are positively inclined and have a moderate to strong ability to think critically, similar to other studies. Participants find it difficult to describe how they reveal their critical thinking in the clinical setting, yet all participants use role modeling and questioning to share their critical thinking with students. When the quantitative and qualitative results are compared, it is apparent that the confidence in reasoning subscale of the California Critical Thinking Skills Test is higher in those educators who more frequently demonstrate and voice engagement in reflective activities. Dispositions associated with critical thinking, as measured by the California Critical Thinking Disposition Inventory, are more easily observed compared to critical thinking skills. CONCLUSIONS: This study is a beginning exploration of nurse educators' critical thinking-in-action. Our mixed methods approach uncovers a valuable approach to understanding the complexity of nurse educators' critical thinking. Further study is needed to uncover how nurse educators' can specifically enact their thinking abilities to support student learning in the clinical setting.

Process Matters: Successes and Challenges of Recruiting and Retaining Participants for Nursing Education Research.

Researchers who study nursing education encounter difficulty when trying to recruit and retain nurse educator participants. Researchers would benefit from knowing more about effective and ineffective sampling strategies and methods to increase the efficiency of the research process. This article outlines the struggles and successes encountered with a mixed methods study that examined nurse educators' critical thinking. Specific examples are interwoven with current literature to uncover some important insights and future recommendations for researchers in nursing education.

An Integrative Review of the Concealed Connection: Nurse Educators' Critical Thinking.

BACKGROUND: The role of nurse educators in the development of students' critical thinking has been overlooked despite the emphasized need for effective teaching methods. METHOD: An integrative review was performed to examine both quantitative and qualitative research published from 2000 to 2015 related to nurse educators' critical thinking. RESULTS: Many barriers and facilitators existing on individual, interpersonal, and contextual levels affected nurse educators' critical thinking. Various tools have been used to measure nurse educators' critical thinking. This review also highlighted the continued lack of a consensus definition of critical thinking and the limited presence of conceptual models to guide the use of critical thinking in nursing education. CONCLUSION: Continued examination of nurse educators' critical thinking is needed, given the limited number of studies that have been completed. Much needs to be explored further, including conceptualizations of critical thinking and confirmation of emerging themes identified in this review. [J Nurs Educ. 2017;56(11):648-654.].

Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review.

BACKGROUND: Implementing research findings into practice is a complex process that is not well understood. Facilitation has been described as a key component of getting research findings into practice. The literature on facilitation as a practice innovation is growing. This review aimed to identify facilitator roles and to describe characteristics of facilitation that may be associated with successful research use by healthcare professionals. METHODS: We searched 10 electronic databases up to December 2016 and used predefined criteria to select articles. We included conceptual papers and empirical studies that described facilitator roles, facilitation processes or interventions, and that focused on healthcare professionals and research use. We used content and thematic analysis to summarise data. Rogers' five main attributes of an innovation guided our synthesis of facilitation characteristics. RESULTS: Of the 38 488 articles identified from our online and manual search, we included 195 predominantly research studies. We identified nine facilitator roles: opinion leaders, coaches, champions, research facilitators, clinical/practice facilitators, outreach facilitators, linking agents, knowledge brokers and external-internal facilitators. Fifteen facilitation characteristics were associated with research use, which we grouped into five categories using Rogers' innovation attributes: relative advantage, compatibility, complexity, trialability and observability. CONCLUSIONS: We found a diverse and broad literature on the concept of facilitation that can expand our current thinking about facilitation as an innovation and its potential to support an integrated, collaborative approach to improving healthcare delivery.

Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis.

BACKGROUND: Risk factors for psychiatric comorbidity in multiple sclerosis (MS) are poorly understood. OBJECTIVE: We evaluated the association between physical comorbidity and incident depression, anxiety disorder, and bipolar disorder in a MS population relative to a matched general population cohort. METHODS: Using population-based administrative data from Alberta, Canada we identified 9624 persons with MS, and 41,194 matches. Using validated case definitions, we estimated the incidence of depression, anxiety disorder, and bipolar disorder, and their association with physical comorbidities using Cox regression, adjusting for age, sex, socioeconomic status, and index year. RESULTS: In both populations, men had a lower risk of depression and anxiety disorders than women, as did individuals who were ≥45 years versus <45 years at the index date. The risk of bipolar disorder declined with increasing age. The risks of incident depression (HR 1.92; 1.82-2.04), anxiety disorders (HR 1.52; 1.42-1.63), and bipolar disorder (HR 2.67; 2.29-3.11) were higher in the MS population than the matched population. These associations persisted essentially unchanged after adjustment for covariates including physical comorbidities. Multiple physical comorbidities were associated with psychiatric disorders in both populations. CONCLUSION: Persons with MS are at increased risk of psychiatric comorbidity generally, and some physical comorbidities are associated with additional risk.

Chronic lung disease and multiple sclerosis: Incidence, prevalence, and temporal trends.

OBJECTIVES: We aimed to estimate the incidence and prevalence of chronic lung disease (CLD), including asthma and chronic obstructive pulmonary disease, in the MS population versus a matched cohort from the general population. METHODS: We used population-based administrative data from four Canadian provinces to identify 44,452 persons with MS and 220,849 age-, sex- and geographically-matched controls aged 20 years and older. We employed a validated case definition to estimate the incidence and prevalence of CLD over the period 1995-2005, and used Poisson regression to assess temporal trends. RESULTS: In 2005, the crude incidence of CLD per 100,000 persons was 806 (95%CI: 701-911) in the MS population, and 757 in the matched population (95%CI: 712-803). In 2005, the crude prevalence of CLD was 13.5% (95%CI: 13.1-14.0%) in the MS population, and 12.4% (95%CI: 12.3-12.6%) in the matched population. Among persons aged 20-44 years, the average annual incidence of CLD was higher in the MS population than in the matched population (RR 1.15; 95%CI: 1.02-1.30), but did not differ between populations for those aged ≥45 years. The incidence of CLD was stable, but the prevalence of CLD increased 60% over the study period. CONCLUSION: CLD is relatively common in the MS population. The incidence of CLD has been stable over time, but the prevalence of CLD has increased. Among persons aged 20-44 years, CLD is more common in the MS population than in a matched population. Given the prevalence of CLD in the MS population, further attention to the effects of CLD on outcomes in MS and approaches to mitigating those effects are warranted.

High incidence and increasing prevalence of multiple sclerosis in British Columbia, Canada: findings from over two decades (1991-2010).

Province-wide population-based administrative health data from British Columbia (BC), Canada (population: approximately 4.5 million) were used to estimate the incidence and prevalence of multiple sclerosis (MS) and examine potential trends over time. All BC residents meeting validated health administrative case definitions for MS were identified using hospital, physician, death, and health registration files. Estimates of annual prevalence (1991-2008), and incidence (1996-2008; allowing a 5-year disease-free run-in period) were age and sex standardized to the 2001 Canadian population. Changes over time in incidence, prevalence and sex ratios were examined using Poisson and log-binomial regression. The incidence rate was stable [average: 7.8/100,000 (95 % CI 7.6, 8.1)], while the female: male ratio decreased (p = 0.045) but remained at or above 2 for all years (average 2.8:1). From 1991-2008, MS prevalence increased by 4.7 % on average per year (p < 0.001) from 78.8/100,000 (95 % CI 75.7, 82.0) to 179.9/100,000 (95 % CI 176.0, 183.8), the sex prevalence ratio increased from 2.27 to 2.78 (p < 0.001) and the peak prevalence age range increased from 45-49 to 55-59 years. MS incidence and prevalence in BC are among the highest in the world. Neither the incidence nor the incidence sex ratio increased over time. However, the prevalence and prevalence sex ratio increased significantly during the 18-year period, which may be explained by the increased peak prevalence age of MS, longer survival with MS and the greater life expectancy of women compared to men.

Interventions that promote retention of experienced registered nurses in health care settings: a systematic review.

AIM: The aim of this review was to report the effectiveness of strategies for retaining experienced Registered Nurses. BACKGROUND: Nursing researchers have noted that the projected nursing shortage, if not rectified, is expected to affect healthcare cost, job satisfaction and quality patient care. Retaining experienced nurses would help to mitigate the shortage, facilitate the transfer of knowledge and provision of quality care to patients. EVALUATION: A systematic review of studies on interventions that promote the retention of experienced Registered Nurses in health care settings. KEY ISSUES: Twelve studies were included in the final analysis. Most studies reported improved retention as a result of the intervention. Team work and individually targeted strategies including mentoring, leadership interest and in-depth orientation increased job satisfaction and produced higher retention results. CONCLUSIONS: Few published studies have examined interventions that promote the retention of experienced Registered Nurses in healthcare. Retention was highest when multiple interventions were used. Further research is needed to inform nurse leaders of ways to retain nurses and to maintain quality care in health care settings. IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP: Programmes targeting the retention of experienced nurses need to be considered when implementing measures to decrease the nursing shortage and its effects on quality care.

Skills and attributes required by clinical nurse specialists to promote evidence-based practice.

PURPOSE/OBJECTIVES: The purposes of this article were to describe the challenges that clinical nurse specialists (CNS) face in their role and to examine how CNSs describe the skills and attributes that are needed to promote the use of evidence-based practice (EBP) in their workplaces. This article is based on findings from a dissertation regarding how CNSs promote EBP in a western Canadian province. DESIGN: A sequential explanatory participant selection mixed-methods design was used for this study. SETTING: The study took place in a western Canadian province that has a population of 1 million people, with 42.7% of the population residing in the 2 largest cities. SAMPLE: The sample was drawn from a provincial registered nurse database. The sample for the survey was 23, and for the interviews, there were 11 participants. METHODS: The telephone survey contained 113 questions grouped into several subcategories. SPSS 18 was used to analyze the survey data. The semistructured interviews were conducted face to face, transcribed, and reviewed for recurrent themes. Interpretive description was used to analyze the themes. FINDINGS: The major challenges faced by CNSs are role strain, lack of support and resources, and role ambiguity. The skills and attributes required to be a CNS are graduate preparation, clinical expertise, and people/communication skills. CONCLUSIONS: Clinical nurse specialists can improve patient outcomes by promoting EBP; to do so, they need to work in supportive contexts that give those in the CNS role a set of clear role expectations. IMPLICATIONS: There are challenges faced by CNSs in Canada, and there is a need to strengthen the CNS's role by standardizing the regulatory requirements at a national level.

Implementing the supportive supervision intervention for registered nurses in a long-term care home: a feasibility study.

BACKGROUND: This pilot study was conducted in response to the call in 2009 by the International Association of Gerontology and Geriatrics to focus on effective leadership structures in nursing homes and to develop leadership capacity. Few researchers have evaluated interventions aimed at enhancing the leadership ability of registered nurses in long-term care. AIM: The aim of the pilot study was to test the feasibility of a three-part supportive supervisory intervention to improve supervisory skills of registered nurses in long-term care. METHODS: A repeated measures group design was used. Quantitative data were collected from healthcare aides, licensed practical nurses (i.e., supervised staff), and registered nurses (i.e., supervisors). Focus groups with care managers and supervisors examined perceptions of the intervention. RESULTS: There were nonsignificant changes in both the registered nurse supervisors' job satisfaction and the supervised staff's perception of their supervisors' support. Supervised staff scores indicated an increase in the use of research utilization but did not reflect an increase in job satisfaction. Focus group discussions revealed that the supervisors and care managers perceived the workshop to be valuable; however, the weekly self-reflection, coaching, and mentoring components of the intervention were rare and inconsistent. CONCLUSIONS: While the primary outcomes were not influenced by the Supportive Supervision Intervention, further effort is required to understand how best to enhance the supportive supervisory skills of RNs. Examples of how to improve the possibility of a successful intervention are advanced. IMPLICATIONS: Effective supervisory skills among registered nurses are crucial for improving the quality of care in long-term care homes. Registered nurses are receptive to interventions that will enhance their roles as supervisors.

Can one learn to think critically? - a philosophical exploration.

Within nursing, critical thinking is a required skill that educators strive to foster in their students' development for use in complex healthcare settings. Hence the numerous studies published measuring critical thinking as a terminal outcome of education. However, an important comparison between different philosophical underpinnings such as person, truth and the nature of nursing, and how one defines and utilizes critical thinking in practice, has been absent from discussions about critical thinking and learning. When one views critical thinking with varying philosophical lenses, important questions are raised and discussion is expanded. These questions illuminate different perspectives of critical thinking and attempt to explore whether critical thinking can be learned in nursing. The implications of taking a single philosophical viewpoint and a pluralistic approach to understanding critical thinking and learning are explored.

Leadership practices and staff nurses' intent to stay: a systematic review.

AIM: The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers' leadership practices and staff nurses' intent to stay in their current position. BACKGROUND: The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses' intent to stay is fundamental to retaining nurses in the workforce. METHODS: Published English language articles on leadership practices and staff nurses' intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. RESULTS: Relational leadership practices influence staff nurses' intentions to remain in their current position. CONCLUSION: This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses' intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. IMPLICATIONS FOR NURSE MANAGERS: Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge.

Towards better measures of research utilization: a collaborative study in Canada and Sweden.

AIMS: This paper is a report of a study examining research utilization in nursing. The specific aims were to (1) clarify the construct of research utilization, and (2) identify observable indicators of research utilization. BACKGROUND: Robust measures of research utilization do not exist despite steadily increasing numbers of studies in the field. One reason for this is theoretical confusion surrounding the central concepts in the field. METHOD: A qualitative (focus group) design was used to explore the construct of research utilization in two countries: Canada and Sweden. A systematic and sequential (three phases) approach to expert sampling framed the study. Phase 1 consisted of initial construct clarification by the research team (2005). In Phase 2, a face-to-face meeting with a panel of international research utilization nursing experts was held (2005). Phase 3 consisted of a series of focus groups with nursing care (direct and non-direct) providers (2005-2007). Data were analysed using content analysis. FINDINGS: The nursing care providers did not commonly use the term 'research utilization'. Several examples of research utilization were provided; a majority of these examples related to instrumental research utilization and became increasingly concrete as one moved from non-direct to direct care participants. Participants identified several indicators of research utilization (instrumental and conceptual). From these indicators, a measurement schematic was derived. CONCLUSIONS: The construct of research utilization is multi-faceted. Several indicators of research utilization were identified, which can be used to augment existing or develop a new and improved measure that taps both instrumental and conceptual use.

Mapping the knowledge utilization field in nursing from 1945 to 2004: a bibliometric analysis.

BACKGROUND: The field of knowledge utilization has been hampered by several issues including: the synonymous use of multiple terms with little attempt at definition precision; an overexamination of knowledge utilization as product, rather than a process; and a lack of progress to cross disciplinary boundaries to advance knowledge development. In order to address the challenges and current knowledge gaps in the knowledge utilization field in nursing, a comprehensive picture of the current state of the field is required. METHODS: Bibliometric analyses were used to map knowledge utilization literature in nursing as an international field of study, and to identify the structure of its scientific community. FINDINGS: Analyses of bibliographic data for 433 articles from the period 1945-2004 demonstrated three trends: (1) there has been significant recent growth and interest in this field, (2) the structure of the scientific knowledge utilization community is evolving, and (3) the Web of Science does not index the majority of journals where this literature is published. CONCLUSIONS: In order to enhance the accessibility and profile of this literature, and nursing's scientific literature at large, we encourage the International Academy of Nursing Editors to work collaboratively to increase the number of journals indexed in the Web of Science.

Defining the fundamentals of care.

A three-stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a-narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self-care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.

Novice nurses' first death in critical care.

BACKGROUND: The curative focus of critical care and the advanced technology may overshadow the fact that critically ill patients die. Research investigating critical care nurses involvement with death has predominately focused on experienced nurses, but these findings may not be applicable to novice nurses. Increasingly, novice nurses are beginning their careers in critical care and there is minimal research describing their experiences with death. PURPOSE: To explore the experiences of novice nurses with their first patient death in critical care. METHOD: Approval was received by the University of Alberta Health Research Ethics Board and the health region's Nursing Division Administration to conduct a qualitative research study. Five nurses, employed in a medical-surgical intensive care unit, participated in the study. Data collection involved an unstructured interview with each participant. FINDINGS: Analysis of the data revealed five themes: anticipating death, transition from life to death, the moment of death, being with the family, and carrying on. These findings are discussed with implications for academic and clinical settings and suggestions for future nursing research.

Clinical nurse specialists' approaches in selecting and using evidence to improve practice.

UNLABELLED: ABSTRACT Background: Evidence-based practice (EBP) has become the desired standard within all health disciplines because the integration of the best evidence into clinical practice is fundamental to optimizing patient outcomes. The valuing of research and research-based knowledge as the basis for decision making is explicit in current discourse in the health sciences. Despite the desires of proponents of EBP for use of evidence derived through research, nurses prefer to use knowledge derived from experience and social interactions. The clinical nurse specialist (CNS) is in the ideal position to act as a link between evidence and practice; however, a paucity of knowledge exists on how CNSs select and use evidence in their daily practice. PURPOSE: The purpose of this descriptive, cross-sectional study was to examine the approaches used by CNSs to select and use evidence in their daily practice. METHOD: A telephone survey, developed for this study from a pilot study conducted by the principal investigator (PI), was used to elicit responses from a purposive sample of CNSs living in a western Canadian province who were willing to be contacted for research, and who had practiced clinically as CNSs within the past year. A response rate of 75% (n = 94) was achieved. Descriptive statistics were used to describe and compare the variables of interest. RESULTS: Literature tailored to particular specialties and personal experiences were reported as the most frequently accessed sources of evidence. This evidence was most often used to facilitate improvements in patient care, and least often used to develop further research proposals. CONCLUSION: This study indicates that although CNSs select and use evidence from a wide variety of sources, further development of their capacity to retrieve and transfer knowledge may increase the uptake of research findings in nursing practice.