The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses.

INTRODUCTION: Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses. METHODS: A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience. RESULTS: Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams. DISCUSSION: Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.

A closer look at first-time pass rates as the primary measure of program quality.

BACKGROUND: The NCLEX pass rate is considered the premier indicator of program quality. Nursing programs utilize first-time pass rates (F-TPR) as a basis for making program decisions - especially when confronted with a falling rate. PURPOSE: This survey was conducted to identify the array of strategies implemented to improve or maintain F-TPRs. Additionally, we sought to ascertain whether responding programs had experienced a problematic F-TPR and their experience in the aftermath. METHODS: This study utilized a descriptive survey of nursing programs. Data analysis included thematic analysis of an open-ended item and descriptive analysis of forced-choice items. RESULTS: Nursing programs report F-TPRs heavily influence decisions and policy making especially regarding admission/progression policies, use of standardized exams, and most consider it one of the most influential factors in program decision-making. CONCLUSION: A recommendation is made for changing the requirement to the percentage of students passing within two attempts.

Impact of Attendance on Academic Performance in Prenursing Students.

A descriptive-correlational design was used to explore the relationship between attendance and course grade in a prenursing course. Findings revealed that attendance was positively associated with final course grades (r443 = 0.54, P < .001). Traditional students attended a significantly higher percentage of classes than their nontraditional counterparts. These findings support the long-held belief by nursing faculty that attendance positively impacts course outcomes.

First-time NCLEX-RN pass rate: measure of program quality or something else?

The first-time NCLEX-RN(®) pass rate is considered by many to be the primary, if not sole, indicator of the quality of prelicensure nursing education programs. Used by state boards of nursing, educational program accreditors, and nursing faculty, the first-time NCLEX-RN pass rate influences important decisions about overall program quality, admission and progression policies, curricula, and teaching and learning practices. In this article, the authors call for a professional dialogue about the use of first-time pass rate (F-TPR) as an indicator of program quality, offer alternative methods for using the F-TPR as one measure of program quality, and suggest further research. One program's experience with low F-TPRs is offered as an exemplar of the unintended negative consequences that occur when the F-TPR is used as a sole criterion by a state board of nursing in judging a program's quality.

Moving toward greater diversity: a review of interventions to increase diversity in nursing education.

PURPOSE: To report the results of a comprehensive review of interventions used by nursing programs to increase the success of underrepresented minority nursing students graduating from prelicensure programs. DESIGN: This review used the five stages of review methodology described but Whittemore and Knafl to extract data, summarize, and synthesize findings of 11 studies included in this review. Intervention strategies were organized using concepts of Jeffreys's Nursing Undergraduate Retention and Success model. FINDINGS: Interventions were designed to improve recruitment, retention, and academic performance through a variety of innovative activities. CONCLUSIONS: This review highlighted the necessity for future researchers to report in-depth and detailed information about the implementation of interventions. Comprehensive information about the program, faculty, setting, interventions, and challenges faced during implementation were often missing from these reports, making replication difficult.

Measures of cultural competence in nurses: an integrative review.

BACKGROUND: There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals. DESIGN: An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure. METHOD: There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing. RESULTS: The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence. CONCLUSIONS: The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use.

The impact of employment on nursing students' academic performance.

As more nursing students are employed, it is essential that schools of nursing examine the relationship between student employment and academic performance. In this study, we found a statistically significant negative relationship between students who work at least 16 hours a week and academic performance, especially in high-attrition courses. Current practices in nursing education must be assessed to ensure that students who must work have every opportunity to succeed.

Perceived barriers to success for minority nursing students: an integrative review.

The objective of this paper was to identify barriers to successful program completion faced by underrepresented minority nursing students. This paper reveals that minority nursing student's face multiple barriers to success including lack of financial support, inadequate emotional and moral support, as well as insufficient academic advising, program mentoring, technical support, and professional socialization. An additional theme-a resolve to succeed in spite of the identified barriers-was identified. This body of literature focuses solely on successful minority students' experiences, revealing a significant gap in the research. The findings of this paper highlight the need to create and maintain nursing programs capable of aggressively supporting minority student needs. Recommendations for future research are included.