Resilience and GRIT among undergraduate nursing students during the COVID 19 pandemic.

OBJECTIVES: Grit and resilience are related but separate concepts. Grit is a long-term commitment toward goals, and it impacts student success and academic achievement. Resilience is the ability of students to recover from stress. Both are important factors in nursing students. METHODS: This descriptive study included surveys measuring demographics, grit, and resilience among two cohorts of senior nursing students in their last semester and explored challenges and difficulties experienced during the COVID-19 pandemic. RESULTS: The mean grit score for all students was 4.0 (0.52) and the mean resilience score was 3.63 (0.73). Directed content analysis of the ten open-ended survey questions revealed three themes: Impact on Education, Personal Impact, and Coping Mechanisms. CONCLUSIONS: Grit and resilience are important factors that can contribute to success in nursing programs and as graduate nurses in the healthcare settings.

Assessing the Impact of Unfolding Case Study Scenarios during High-Fidelity Pediatric Simulation among Undergraduate Nursing Students.

Simulation helps to prepare prelicensure nursing students for practice by providing opportunities to perform clinical skills and make decisions in a safe environment. The integration of nursing knowledge, skills, and decision-making abilities during simulated unfolding case-study scenarios may enhance student self-confidence and foster clinical judgement skills. The purpose of this study was to assess the impact of simulation using unfolding case-study scenarios on undergraduate nursing students' self-confidence in pediatric nursing knowledge, skills, and clinical judgment/decision-making abilities. This mixed methods study included a pre- and post-survey design to evaluate undergraduate nursing students' confidence in pediatric nursing knowledge, skills, and decision-making abilities after participation in both an instructor-led (guided) and a student-led (decision-making) simulation involving unfolding case-study scenarios. Friedman's ANOVA analyses revealed that all 16-items demonstrated statistically significant differences between the three measured responses (pre-simulation and both post-simulation surveys). Post-hoc Wilcoxon signed-rank tests revealed statistically significant differences in student ratings pre-simulation and post-instructor-led (guided) experience for all 16-scored items. The qualitative themes identified were perception of experience, pediatric nursing care, assimilation of knowledge, and critical thinking. Unfolding case-study simulation experiences positively impact the learning, self-confidence, and clinical judgement of undergraduate nursing students.

The impact of telehealth objective structured clinical evaluations in intraprofessional nursing education: A mixed methods study.

BACKGROUND: Telehealth is an expanding modality of providing care. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) released a white paper encouraging the inclusion of telehealth into nurse practitioner education. It is important for nursing students to gain experience with telehealth so that they are prepared to provide care via telehealth. OBJECTIVES: The purpose of this project was to evaluate the impact of incorporating telehealth simulation into objective structured clinical examinations (OSCEs) in the family nurse practitioner (FNP) and bachelor of science in nursing (BSN) programs. SETTING: This study was conducted at a public, liberal arts university in a rural area of the Southeast United States. PARTICIPANTS: The FNP and BSN students participated in this study. The FNP program is a hybrid master's degree program, which has a two-year plan of study. The BSN program is a traditional campus-based program, which includes two years of upper-division nursing courses. METHODS: This mixed-methods study included a pre- and post-survey design utilizing both quantitative and qualitative measures to evaluate undergraduate and graduate nursing students understanding of and comfort with telehealth and their perceptions of a simulated intradisciplinary telehealth OCSE experience. RESULTS: Students' telehealth knowledge, skills, and confidence were improved after the telehealth OSCE experience. Directed content analysis of the responses revealed three themes: increased knowledge of telehealth, technical difficulties, and teamwork/communication. CONCLUSIONS: It is beneficial for both undergraduate and family nurse practitioner students to have exposure to telehealth in their respective curriculums.

The Use of Debates in an Online Nursing Course.

BACKGROUND: It is important to foster active participation in online graduate nursing courses through creative teaching strategies, such as virtual synchronous debates. METHOD: A free videoconferencing system was used to complete the virtual synchronous debates. Demographic information and survey data were obtained to assess the impact of an online debate on critical thinking and presentation skills. RESULTS: Seven of the 10 scored survey items had statistically significant differences in preimplementation and postimplementation ranked scores. Five qualitative themes were revealed: predebate anxiety/nervousness, technical issues/online format, learning experience, improved presentation skills, and group work. CONCLUSION: Through virtual synchronous debates, graduate nursing students can gain a stronger appreciation for ethical issues in health care, learn to succinctly convey their views, and increase their confidence in presenting a professional argument.

Assessing the Impact of a Preclinical Immersion on Nurse Practitioner Student Confidence for the Initial Clinical Experience.

BACKGROUND: It is important for faculty to prepare nurse practitioner students for their first clinical experiences to ensure student success. PURPOSE: The purpose of this project was to implement a preclinical immersion and determine student perceptions about this experience. METHODS: A half-day preclinical immersion was instituted at the beginning of the family nurse practitioner students' first clinical course. Demographic information and survey data were obtained before the preclinical immersion experience, after completion of the immersion experience, and during the last 2 weeks of the first clinical course. RESULTS: Students' ratings of their clinical skills and knowledge improved during the duration of the semester for 5 of the 7 items. Directed content analysis revealed 3 themes: understanding of clinical expectations, face-to-face interactions with faculty, and cognitive/emotional clinical perceptions. CONCLUSION: The use of preclinical immersion experiences may both practically and emotionally prepare students for graduate nursing clinical experiences.

Assessing the Impact of Telehealth Objective Structured Clinical Examinations in Graduate Nursing Education.

BACKGROUND: The National Organization of Nurse Practitioner Faculties supports the incorporation of telehealth in nurse practitioner (NP) education. PURPOSE: The purpose of this article is to describe the implementation of a no-cost telehealth simulation and its impact on students in their first NP clinical course. METHODS: Twenty-eight NP students participated in the telehealth objective structured clinical examination (OSCE). Students completed an online survey about the impact of telehealth OSCE simulation both before and after the simulation. RESULTS: The students' general understanding of the field of telehealth was significantly greater after the telehealth OSCE experience. Directed content analysis revealed 3 themes: usefulness of telehealth, benefit in role preparation, and technology. CONCLUSION: The use of telehealth simulation can be an effective strategy to assess clinical competency, provide individualized feedback, and ensure students are using evidence-based practice.

The Impact of Collaborative Testing in Graduate Nursing Education.

BACKGROUND: Collaborative testing is an educational strategy that allows students to work in teams when completing an examination. METHOD: Twenty-eight family nurse practitioner students took four course examinations individually and collaboratively. Five comprehensive questions were included on the fourth examination. A survey was administered at the end of the course, with permission. RESULTS: All collaborative test scores were higher than the traditional test scores (traditional mean range = 80.78 [8.53] to 84.07 [7.41], collaborative mean range = 93.54 [3.77] to 94.07 [2.80], all p values < .001). Students did not demonstrate significant changes in mean scores for cumulative content on test four. Directed content analysis revealed four themes: Enhanced Understanding of Content, Collaboration With Classmates, Socialization, and Improved Grades. CONCLUSION: In graduate nursing education, collaborative testing may be an effective strategy to improve teamwork and communication skills, enrich relationships, and enhance critical thinking. [J Nurs Educ. 2019;58(6):357-359.].

Factors Influencing Southeastern U.S. Mothers' Participation in Baby-Friendly Practices: A Mixed-Methods Study.

BACKGROUND: Mothers in the southeastern United States, including rural-dwelling and African American mothers, have historically had low rates of breastfeeding; however, no studies have investigated these mothers' experiences of breastfeeding support processes associated with the Baby-Friendly Hospital Initiative. Research aim: This study aimed to determine factors influencing southeastern U.S. mothers' participation in Baby-Friendly practices and breastfeeding decisions. METHODS: Using a convergent parallel mixed-methods design, medical record review of mother-infant dyads ( n = 234) provided data to determine if those who participated in more than half of the Ten Steps to Successful Breastfeeding had improved breastfeeding outcomes. Logistic regression was conducted to determine whether maternal demographic/clinical characteristics were predictive of Baby-Friendly practice participation. Qualitative methods included in-depth interviews ( n = 16). Directed content analysis was conducted to identify themes. Results of the analysis of the two data sets were triangulated to enhance understanding of mothers' barriers to and facilitators of participation in Baby-Friendly practices. RESULTS: Rural-dwelling and African American mothers had greater odds of nonparticipation in Baby-Friendly practices relative to other groups (odds ratios = 5 and 10, respectively; p ≤ .01). Mothers who received lactation consultation and had moderate (15-44 min) or completed (≥ 45 min) skin-to-skin contact had greater odds of participation in Baby-Friendly practices (both odds ratios ≥ 17.5; p < .05). Directed content analysis revealed six themes: maternal desire to breastfeed, infant state, maternal state, milk supply concerns, provider support, and access to breastfeeding equipment and support services. CONCLUSION: Rural-dwelling African American mothers had limited knowledge of Baby-Friendly practices; however, culturally tailored services could improve Baby-Friendly practice participation and breastfeeding success.

The Impact in the United States of the Baby-Friendly Hospital Initiative on Early Infant Health and Breastfeeding Outcomes.

UNLABELLED: Studies were examined to evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breastfeeding and early infant health outcomes in U.S. POPULATIONS: Using the Social Ecological Model as a guiding theoretical framework, results were categorized into four interrelated multilevel factors: (1) maternal/infant dyad factors, (2) provider factors, (3) hospital organizational factors, and (4) policy/systems factors. Results from the review support the BFHI's success in facilitating successful breastfeeding initiation and exclusivity. Breastfeeding duration also appears to increase when mothers have increased exposure to Baby-Friendly practices, but deficiencies in breastfeeding tracking mechanisms have limited reliable breastfeeding duration data. Of the 10 steps of the BFHI, step 3, prenatal education and step 10, postnatal breastfeeding support are the most difficult steps to implement; however, those steps have the potential to significantly impact maternal breastfeeding decisions. The underlying mechanisms by which Baby-Friendly practices contribute to maternal breastfeeding decisions remain unclear; thus, studies are needed to examine mothers' experiences and perceptions of Baby-Friendly practices. Additionally, studies are needed to investigate the impact of the BFHI for women living in rural areas and in southeastern regions of the United States. Finally, studies are needed to examine early infant health outcomes related to the BFHI, especially for late premature infants (34-36 weeks) who are most vulnerable to poor outcomes and are in need of specialized breastfeeding support. Results from future qualitative and quantitative explorations could clarify how the delivery of Baby-Friendly practices leads to successful breastfeeding and infant health outcomes.