Experiential Learning to Engage Millennial Learners in an Undergraduate Nursing Research Course.

Baccalaureate-prepared nurses are expected to participate in evidence-based practice by identifying clinical questions, critiquing evidence, and integrating theory into practice. This presents a challenge for faculty to facilitate a research course in a way that is valued by nursing students and will ultimately prepare them to successfully enter the workforce. This article describes an innovative strategy to engage millennial learners in an undergraduate research course by implementing a two-part evidence-based practice project. Student feedback has been positive with expressed interest in the project's application to practice.

Effects of Tactile Desensitization on Postoperative Pain After Amputation Surgery.

PURPOSE: Pain in the acute setting after amputation is complex with multiple types of pain experienced, including somatic and neuropathic. No studies have measured multiple pain control modalities while using self-management techniques for acute amputation pain. Desensitization could provide a means of pain control for somatic and neuropathic pain. The purpose of this study was to test the efficacious use and effects of tactile desensitization in managing acute postoperative pain after lower limb amputation. DESIGN: This was a pre-experimental repeated measure study. METHODS: Pain description, intensity, anxiety, depression, and medication usage were measured during repeated time periods. Pain intensity was measured before and after each intervention along with efficacy. FINDINGS: Of the times the intervention was self-administered (n = 50) there was a statistically significant reduction in the pain level (P < .001) with large effect sizes for all paired comparisons. Participants found the intervention efficacious and feasible to use. CONCLUSIONS: The findings support a reduction in pain intensity scores using pain medication coupled with tactile desensitization.

Moral Distress Among School Nurses.

School nurses are well positioned to provide care to a diverse population of school-age children, but their role and work environment can present a variety of moral dilemmas leading to moral distress. The purpose of this study is to identify the moral distress level that exists in school nurses and to describe its relationship to common moral dilemmas and school nurse characteristics. Data were collected through face-to-face attendance at school nurse meetings in North Carolina where 307 school nurses participated in the survey. Moral distress was measured using the moral distress thermometer, and common moral dilemmas were identified using a researcher developed questionnaire. Almost all of the school nurses (97.3%) experienced some degree of moral distress. Each of the common moral dilemmas was positively correlated with moral distress levels. The findings suggest that many of the common moral dilemmas experienced by school nurses are strongly related to moral distress.

Demonstrating the Relationship Between School Nurse Workload and Student Outcomes.

This article describes how one very large, diverse school district developed a Student Acuity Tool for School Nurse Assignment and used a logic model to successfully advocate for additional school nurse positions. The logic model included three student outcomes that were evaluated: provide medications and procedures safely and accurately, increase the number of students with a medical home, and increase the number of students with chronic illness that receive case management. Pairing a staffing formula with an evaluation plan that focuses on student outcomes and the priorities of the school district provides a strong case that school nurses are essential and that they contribute to student success.

Factors Related to School Nurse Workload.

Recognizing the need for a school nurse workload model based on more than the number of students in a caseload, the National Association of School Nurses issued recommendations related to measuring school nurse workload. Next, a workforce acuity task force (WATF) was charged with identifying the steps needed to further the recommendations. As a first step, the WATF focused on identifying existing literature and practices related to school nurse workload. The purpose of this article is to synthesize and categorize the factors that were identified, delineate sources for collecting and retrieving these factors, and make recommendations for clinicians and researchers interested in developing instruments to measure school nurse workload.

Seizing the Moment: Experiences of School Nurses Caring for Students With Overweight and Obesity.

School nurses are well positioned to assess, intervene, and evaluate efforts to positively impact students who are overweight or obese. The purpose of this qualitative, descriptive study was to explore the experiences of school nurses providing care to children living with overweight and obesity. Data were collected through face-to-face, tape-recorded, in-depth, open-ended interviews with 10 school nurses from rural areas of North Carolina working with minority and low-income children in the public school setting. The text of the interviews was transcribed and analyzed into codes, categories, and themes. Three themes and eight subthemes were identified. The three themes were identified as (1) "jumping hurdles," (2) "seize the moment," and (3) "moral distress." The findings of this study can be used to provide a better understanding of the experiences of school nurses caring for children with overweight and obesity that is necessary for planning successful school-based interventions.

School Nursing: Becoming Credible and Visible.

A group of school nurses attending the innovation relay event at the NASN 2017 Annual Conference were asked to tackle the problem expressed by many school nurses: How can we increase the visibility and credibility of school nurses? The innovation relay allowed school nurses to look at the problem differently so that they could identify innovative solutions. This article shares more detail on each of the team's solutions and illustrates how school nurses can look at problems in a new light.

Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and differences between US and Nicaraguan curricula and teaching modalities using the community engagement model.

BACKGROUND: Curricula evaluation is an essential phase of curriculum development. Study describes the implementation of a formative evaluation used by faculty members between Universidad Nacional Autonóma de Nicaragua (UNAN-Leon) Escuela de Enfermeriá, Nicaragua and East Carolina University College of Nursing (ECU CON) in North Carolina, US. OBJECTIVES: Program evaluation study to conduct an assessment, comparison of a medical-surgical adult curriculum and teaching modalities. Also, explore the Community Engagement (CE) Model to build a Central American-US faculty partnership. DESIGN: Methodological evaluation study utilizing a newly developed International Nursing Education Curriculum Evaluation Tool related to adult medical and surgical nursing standards. Also, the CE Model was tested as a facilitation tool in building partnerships between nurse educators. DATA: Nicaragua and US nursing faculty teams constructed the curriculum evaluation by utilizing the International Nursing Education Curriculum Evaluation Tool (INECET) by reviewing 57 elements covering 6 Domains related to adult medical and surgical nursing standards. METHODS: Developed, explored the utilization of the INECET based on a standard of practice framework. The Community Engagement Model, a fivephase cycle, Inform, Consult, Involve, Collaborate, and Empower was utilized to facilitate the collaborative process. RESULTS: Similarities between the US and Nicaraguan curricula and teaching modalities were reflective based on the 57 elements covering 6 Domain assessment tool. Case studies, lecture, and clinical hospital rotations were utilized as teaching modalities. Both schools lacked sufficient time for clinical practicum time. The differences, included UNAN-Leon had a lack of simulation skill lab, equipment, and space, whereas ECU CON had sufficient resources. The ECU school lacked applied case studies from a rural health medical-surgical adult nursing perspective and less time in rural health clinics. The UNAN-Leon nursing standards generalized based on the Ministry of Health (MINSA) and the US program was specific based on the American Nurses Association and various sub-specialties of nursing practice requirements. The CE Model was a useful framework to facilitate a collaborative partnership. CONCLUSION: Collaborative evaluation study using the International Nursing Education Curriculum Evaluation Tool can be an effective method to evaluate medical and surgical curricula similarities and differences within international nursing schools. The Community Engagement Model fostered a faculty partnership.

Health Literacy: Perceptions and Experiences of Pediatric Nephrology Interprofessional Team Members.

Health literacy is an important factor in health care quality. This study examined health literacy perception and health literacy experience of a convenience sample of pediatric nephrology interprofessional team members. Results indicated that the majority of pediatric nephrology interprofessional team members understand the need for health literacy and want to learn about health literacy, but have limited experience with health literacy. This study provides knowledge that can be used to develop, promote, and enhance best practices related to health literacy among pediatric nephrology interprofessional team members.

Process and outcomes of school nurse case management for students with asthma.

There have been many studies that have examined the impact of school-based asthma programs on students with asthma. However, most studies do not provide adequate elaboration on the components of the program. Therefore, replication of these programs is difficult. This study examines the process of school nurse case management, which includes the development of individualized goals and the provision of specific interventions. The process is then linked to several outcomes (parent perception, quality of life, and academic success). The study demonstrates the complexity of case management provided by school nurses and how goal attainment is related to the outcomes. The study supports policy recommendations that advocate for the importance of professional school nurses in improving the health and well-being of students with asthma.

Pilot testing the augmentech body position sensor on the morbidly obese patient.

The Augmentech Body Position Sensor (ABPS), a device for monitoring patient repositioning, was tested for use in morbidly obese patients. Specific aims were to: determine whether there was correspondence between data on patient turning and repositioning from the ABPS and data gathered through human observation; determine whether the ABPS is an acceptable instrument for measuring body movements in morbidly obese patients in terms of ease of use, comfort and ability to stay in place. A descriptive study was conducted. Data from the ABPS recording patients' body positions were compared with data from videotapes taken of the same patients during the same time period. The sleep center of a tertiary care facility in the southeastern United States was used. Ten participants with BMI ≥30 were selected from patients referred to the sleep center for polysomnography. Positioning the device on the patient's thigh, data were collected from midnight until discharge. Videotapes taken of the same patient during the same time period were examined for changes in body position over time. There was a strong correspondence between the videotaped data and the ABPS data. The device was comfortable and not irritating to the patient. The APBS can be a useful measure for determining changes in body position but further study should be undertaken to test other sites for placement.

School nurse evaluations: making the process meaningful and motivational.

The professional standards of school nursing practice provide a framework to help school nurses focus on their unique mission of promoting health and academic achievement for all students. Without the standards, the nurse's role can become task oriented and limited in scope. By using an evaluation tool that reflects the standards, nurses not only become aware and begin to understand the standards; they also become directly accountable for meeting them. In addition, developing an evaluation process based on the standards of school nurse practice increases the visibility of school nurses and helps school administrators understand the role of the school nurse. This article describes how one school district integrated the scope and standards of school nursing into the job description and performance evaluation of the nurse. The process which is used to complete the evaluation in a manner that is meaningful and motivational to the school nurse is described.

Disease-specific quality of life-patient acceptance: racial and gender differences in patients with implantable cardioverter defibrillators.

BACKGROUND: Despite its established effectiveness, living with an implantable cardioverter defibrillator (ICD) is associated with ongoing physical and psychosocial distress. Little is known about which factors impact the patients' adjustment to living with the device and whether there are racial or gender differences related to these factors. The purpose of this study was to investigate factors (demographic, clinical, psychosocial, and religiosity) related to patients' ICD acceptance and to examine racial and gender differences in ICD acceptance. METHODS: A total of 101 ICD patients (mean age, 65 ± 12.8 years, 34% female, 42% African American [AA]) seen in a cardiology clinic between January and August 2010 completed the Florida Patient Acceptance Survey (FPAS), Florida shock anxiety scale, ENRICHD social support instrument, hospital anxiety and depression scale, Hoge Religiosity Scale, and a demographic sheet during their clinic visit. RESULTS: All multiple-item scales demonstrated good internal consistency reliability, with Cronbach α values ranging from .77 to .89. Overall patient acceptance of the ICD was high, with an average FPAS acceptance score of 80.9 on the 0-to-100 point scale. The FPAS subscale scores indicated that the group was very positive about the benefits of having the device (mean, 90.3) and had few body image concerns (mean, 10.6), low device-related distress (mean, 15.6), and moderate return to function scores (mean, 63.0). White ICD participants were more accepting of their device than AA ICD patients were, scoring statistically significantly higher than AA patients on total patient acceptance and return to function and significantly lower than AA patients on device-related distress and shock anxiety. Controlling for ethnicity (ß = .10, P = .15), age (ß = .01, P = .90), and number of comorbidities (ß = .19, P = .003) in a hierarchical multiple regression, shock anxiety (ß = .31, P < .001), knowledge of the device (ß = .23, P = .001), social support (ß = .13, P = .08), Hospital Anxiety and Depression Scale anxiety (ß = .06, P = .51) and depression (ß = .25, P = .01), and importance of religion (ß = .17, P = .01) explained 46.8% of the variance in FPAS scores. CONCLUSIONS: Although overall patient acceptance was high, AAs in the study had statistically significant lower mean total Florida Patient Acceptance Scale scores and Return to Function scores than whites did and higher Device-Related Distress scores. The strongest predictors of patient acceptance for the total group were shock anxiety, depressive symptoms, and device knowledge. African Americans had significantly lower device knowledge scores and higher shock anxiety scores than whites did. These findings suggest that ICD patients, especially AA ICD patients, may require education and psychosocial measures to enhance acceptance of their device. This study supports a holistic and culturally sensitive approach to focused clinical and psychological assessment and interventions for those living with this life-saving technology.

Parent and teacher perceptions of the impact of school nurse interventions on children's self-management of diabetes.

Diabetes is a common chronic illness among school-age children. The school nurse collaborates with the student, parents, and teachers to help the child manage their diabetes effectively. Very little is known about the relationship between school nurse interventions and parent/teacher perceptions of the child's self-management. We examined this relationship in a sample of 69 school-age children who received case management from school nurses. Our findings suggest that teachers and parents do not always agree on how well a child manages their illness. When school nurses provide more education and counseling, parents are more likely to perceive an improvement in their child's self-management. Teachers are more likely to perceive an improvement when the nurse provides more classroom visits and includes the physical education teacher and guidance counselor. These findings suggest that the roles of educator, counselor, and collaborator are important for school nurses who provide care to school-age children with diabetes.

A School-Based Health Center-University Nursing Partnership: How We Filled in the GAPS.

Young adolescents, age 10-15 years, have increasing psychosocial and biomedical health care needs, yet are some of the lowest users of conventional health services. In eastern North Carolina, school-based health centers (SBHCs) provide primary health care to thousands of school-age children in the most rural, medically underserved areas. SBHCs receive reimbursement from local, state, and private funding sources and their viability depends on the demonstration of outcomes. Using the Guidelines for Adolescent Preventive Services (GAPS) assessment tool, an SBHC-university nursing partnership evaluated the use of preventive health services by fifth and sixth grade students (n = 690). Findings suggest that the vast majority of early adolescents needed a referral for a physical exam, nutrition, mental health, or health education services. This article describes key components for a successful SBHC-university nursing partnership that can evaluate and improve existing school health programs.

School nurses and children with diabetes: a descriptive study.

BACKGROUND: Managing diabetes in children is complex. The aims of this descriptive study were to describe the care provided to children with diabetes by school nurses using case management, to identify differences in care on the basis of the workload of the nurse and the age of the child, to explore the role of the nurse in responding to emergencies, and to describe the relationship between case management and quality of life. METHODS: School nurses completed an expanded health assessment. Individualized goals were established and interventions were provided on the basis of a protocol. Quantitative and qualitative data for children enrolled during the 2009-2010 academic year were analyzed. RESULTS: Eighty-six children were enrolled. The most common goals were related to establishing a safe school environment. Interventions varied depending on the workload of the nurse and the age of the child. Nurses assigned to 1-2 schools provided more intervention days (mean, 40.3 days) than did nurses assigned to 3-4 schools (mean, 24.4 days) (P < .05), particularly in the area of direct care. A total of 25 students experienced an emergency at school that initiated a cascade of events involving the parent (in 100% of cases), the teacher (in 96%), management of hyperglycemia (in 100%), and/or management of hypoglycemia (in 96%). For teens, case management improved quality of life, particularly the ability to communicate with health professionals. LIMITATIONS: The sample was small, and there was no comparison group. CONCLUSIONS: School nurses are effective in using case management to enhance the health and well-being of children with diabetes. This study should be replicated with a larger sample, a comparison group, and the inclusion of clinical outcomes.

The association of BMI and Braden total score on the occurrence of pressure ulcers.

PURPOSE: We compared pressure ulcer (PU) prevalence patients with a body mass index (BMI) of 40 or more, and Braden Scale scores of 16 or more to patients with lower BMI. METHODS: A cross-sectional study by using existing data was conducted combining patient skin status with BMI. Subjects underwent skin assessment for evidence of skin breakdown by nurses trained in PU assessment. Data from this assessment were combined with historic data gathered from review of medical records and BMI. SUBJECTS AND SETTING: The study was carried out in a tertiary medical center in Eastern North Carolina. Three hundred sixty-two patients were included in the prevalence study. RESULTS: Fourteen percent of all patients had at least 1 PU. The prevalence among patients with a BMI of less than 40 was 12.5% as compared to 26% in patients with a BMI of more than 40 (P 5 .01). When controlling for the effects of BMI, patients with a Braden Scale score of 16 or less were almost 6 times more likely to have a PU as compared to those with Braden Scale scores of more than 16 (P, .001). Body mass index had an independent association with the probability of PU occurrence. Patients with BMIs of more than 40 were almost 3 times more likely to have a PU compared to those with BMIs of 40 or less, after controlling for Braden risk (P 5 .01). CONCLUSION: A BMI of more than 40 and Braden Scale score of 16 or less were found to have an independent and statistically significant association with PU occurrence. Future studies should investigate the predictive validity of BMI along with individual Braden subscales.

Defining, delivering, and documenting the outcomes of case management by school nurses.

Case management is a component of school nurse practice that provides an opportunity to demonstrate the contribution that school nurses make to the health and academic success of children, particularly children with chronic health conditions. However, case management programs vary in their mission and scope, leading to confusion about what it means to be a case manager. Many programs acknowledge the difficulty in tracking outcomes and sustaining results. Using a capacity-building approach, the Case Management Project (CMP) developed a definition of case management and a set of baseline and outcome measures to assist school nurses to become effective case managers and track their outcomes.

Relationships of new nurses' perceptions and measured performance-based clinical competence.

BACKGROUND: This study examined the relationship between new nurses' performance-based measurements and perceptions of clinical competence. METHODS: Descriptive correlational designs were used to examine the relationships. Performance-based clinical competence was measured by the Performance Based Development System developed by Del Bueno (1990), and perceived competence was measured by specific items on the Casey-Fink Graduate Nurse Experience Survey (1999). RESULTS: Findings showed a significant difference in mean patient scores and professional role scores. Nurses who met the criteria for problem management had significantly higher scores on the patient care scale and the professional role scale than those who did not meet the criteria. Nurses with previous work experience (44%) were more likely to meet the criteria for problem management. Black participants scored lower on the patient care scale compared with others. CONCLUSION: This study provides a beginning understanding of the relationship between new nurses' perceptions and performance-based clinical competence.