Reflecting on diagnosis: The Metacognitive Diagnostic Reasoning Model©.

BACKGROUND: Diagnostic reasoning is a complex cognitive process that requires intuitive, heuristic processing from knowledge and experience, as well as deliberate and reflective thinking. Evidence on interventions to improve diagnostic reasoning is inconsistent, in part because different terms and models are used to guide research. PURPOSE: To present a model of the factors of diagnostic reasoning in Advanced Practice Registered Nurses (APRNs), based on a review of the literature supporting the Metacognitive Diagnostic Reasoning (MDR) Model©. METHODOLOGY: A review of the literature through systematic database search, historical articles, texts, and documents was conducted from inception through August 2023 (N = 41). RESULTS: The MDR model depicts the following concepts: (1) metacognition is viewed as the driving force of diagnostic reasoning; (2) dual cognitive processing and knowledge representations are used; (3) once a diagnosis, treatment plan, and evaluation are complete, APRNs use metacognition for the next patient encounter, using repetition for improvement of the process. CONCLUSIONS: The model combines key concepts of diagnostic reasoning, providing a framework for researchers to develop and test, and faculty to teach and evaluate this complex process in learners. IMPLICATIONS: The MDR model provides research opportunities to validate its usefulness and effectiveness and a framework to guide educational research, contributing to the body of evidence-based practice in nursing. In addition, it may foster ongoing education and training that could lead to more accurate diagnoses and treatment plans, ultimately improving patient care by reducing diagnostic errors.

The use of electronic health records in advanced practice nursing education: a scoping review.

Electronic health records are integral to the advanced practice registered nurse role, yet access and training during academic preparation are profoundly limited. Lack of exposure to electronic health records prevents students from becoming fully prepared for the responsibilities of clinical practice and potentially impacts quality of care, patient safety, and communication among patients and providers. This scoping review of 20 articles on electronic health record use in advanced practice registered nursing student education shows significant gaps in current research. Nine articles were classified as research. The remaining 11 were non-research reports of teaching innovations describing the use of simulated electronic health records in graduate nursing education or the use of an electronic health record in interprofessional education activities. Most of the limited research did not use valid and reliable instruments or robust designs, employed disparate approaches and tools to study the phenomenon, and measured low-level outcomes such as student navigation and confidence in using electronic health records. The non-research literature draws attention to the deficits in educational resources, including unaffordable electronic health records for academic use. Although rigorous evidence is lacking, a common theme throughout the reviewed literature was the benefit of simulation to develop electronic health record skills.

The Impact of a Perioperative Elective on Practice Workforce Development: Content Analysis.

PURPOSE: Developing strategies to educate, employ, and retain newly graduated nurses in perioperative (periop) settings is paramount to addressing a succession crisis with unprecedented vacancy rates. The purpose of this study was to explore the impact of a prelicensure periop elective on the decision of participants to seek and accept a periop position upon graduation and to describe their transition to practice experience. DESIGN: This study used qualitative descriptive methodology. METHODS: Virtual semistructured interviews were conducted in 2021 with 20 recent graduates of an accelerated prelicensure nursing program who completed a periop elective course. Questions focused on if they did or did not seek and accept a periop position upon graduation and, for those who accepted, explored their transition to practice experience. Data were coded using conventional and directed content analyses. FINDINGS: Three themes emerged via conventional content analysis: the impact of a prelicensure periop elective, the periop environment, and recommendations for faculty and hiring managers. Concerning directed content analyses, participants used the coping factors of situation, self, support, and strategies to navigate career transitions. CONCLUSIONS: A periop elective course delivered through academic-practice partnerships appears to be a successful strategy to address the succession crisis. Graduates were prepared to make informed decisions about entering the periop specialty.

An Examination of the Career Choices of Nursing Graduates After Completing a Perioperative Elective.

In light of the perioperative nursing shortage, academic leaders at a mid-Atlantic school of nursing and leaders of three health care systems implemented an academic-practice partnership with the goal of increasing interest in this specialty. Nursing researchers used a descriptive study design to collect data from nursing alumni who participated in the perioperative elective between 2017 and 2021. They found that 25 (38%) of 65 graduates who participated in the elective entered perioperative nursing and 38 (68%) of 56 graduates who answered a question on considering future employment as a perioperative nurse indicated they would do so regardless of their current employment status. Graduates who participated in the elective and experienced a perioperative capstone placement had low anticipated turnover scores and intended to remain in a perioperative position. Academic and health care leaders should consider academic-practice partnerships as a strategy to recruit and retain perioperative nurses.

Effectiveness of Screen-Based Simulation as a Strategy to Improve Nurse Practitioner Students' Access to Electronic Health Records in Clinical Education.

Learning to use electronic health records is essential for family nurse practitioner students to inform practice and clinical decision-making. Limited access to electronic health records during clinical training can lead to suboptimal use. Academic programs often rely on healthcare organizations to provide opportunities for students to learn electronic health record skills. However, clinical experiences are highly individualized, and students may not have access to electronic health records. Alternatives are needed to develop this critical competency. This study compared self-reported ratings regarding comfort and access to electronic health record documentation between students who participated in screen-based simulation and students who completed traditional clinical experiences with a preceptor during the last 70 hours of clinical training in one family nurse practitioner program. There was a significant difference in electronic health record access between students who participated in simulated versus traditional clinical experiences ( P = .002). There were no significant differences in ratings of comfort using electronic health records between groups. Both groups reported limited access to electronic health records in the first 500 hours of clinical experience. However, students who participated in screen-based simulation reported a quarter-fold increase in electronic health record access during their last 70 hours of clinical training.

The Inter Face of Social Media Recruitment and Nursing Education Research.

This study describes using social media in recruiting a large and hard-to-reach national sample of family nurse practitioner students in the United States enrolled in their final clinical course and the impact on survey response targets. Social media recruitment was initiated when sample targets were not met using traditional, direct email invitations. A cross-sectional, observational, complex-samples survey design was used to collect data from students enrolled in accredited programs. When inviting participants via emails to schools of nursing and program administrators was only moderately successful, direct recruitment via social media sites was used. Targeted study advertisements were shown 602 389 times to 77 410 unique Facebook users over 14 months. In the final sample of 3940 study participants, 46% (n = 1811) were recruited through social media. Survey responses for health education research are typically 50% or less of the target. Using Facebook was successful for recruiting a large, geographically disperse and representative student sample necessary to ensure findings were representative and generalizable. This recruitment strategy could be effectively used for a myriad of research in areas where social media use exists to gain access to participants who might otherwise not be accessible.

Learning Impact of Armed Forces Medical Background on Military Nursing Students in an Accelerated Bachelor of Science in Nursing Program.

ABSTRACT: The study examined differences between military students enrolled in an accelerated bachelor of science in nursing (BSN) program with and without medical experience and/or a previous bachelor's degree on graduation grade point average (GPA) and NCLEX®-RN first-time pass rates. Significant differences were found between groups with/without military medical experience on NCLEX-RN, but not graduation GPA. Significant differences were found between groups with/without prior degree on GPA, but not on NCLEX-RN. Having both medical experience and a prior degree did not make a difference on GPA or NCLEX-RN. Findings offer guidance on admission criteria to accelerated programs for this unique group of students.

Facilitators and challenges to military undergraduate nursing student success.

BACKGROUND: Understanding the broader community of educators and programs involved in the education of military nursing students (MNSs) is needed to develop best practices that support their academic success. PURPOSE: The purpose of this study was to 1) identify factors nursing faculty perceived would facilitate and/or challenge the success of MNSs when transitioning to and progressing through baccalaureate nursing programs, and 2) ascertain successful strategies used in teaching and working with these students. METHODS: A descriptive survey research design was used to collect data from faculty at 26 schools of nursing that received federal funding to support the transition of veterans to a career in nursing. Quantitative and qualitative data were collected, analyzed, and integrated via descriptive statistics and content analysis. RESULTS: The survey was completed by 88 faculty from 19 of the 26 schools. The top four categories for both the facilitators and challenges, based on Jeffreys' (2015) NURS Model, were student affective characteristics, student profile characteristics, professional integration factors, and environmental factors. Programmatic factors were the most commonly cited success strategies, including having culturally competent, knowledgeable, and designated faculty and staff for MNSs. CONCLUSION: Developing evidence-based strategies to use in teaching and advising MNSs ideally will ensure their academic success.

Lack of pediatric mental health clinical experiences among FNP students.

BACKGROUND: Mental health disorders accounted for approximately 5% of outpatient child and adolescent visits between 2008 and 2011, and 34.8% of these children were seen by a primary care provider. As primary care providers, family nurse practitioners (FNP) are positioned to address mental health issues across the lifespan; however, they require appropriate training and experience. AIM: The study examined pediatric mental health assessment clinical experiences in a national survey of FNP students. METHODS: A secondary analysis was performed on a data set of FNP students (N = 3940). Frequencies and chi-square analyses were performed to examine pediatric mental health assessment clinical experiences. RESULTS: Nearly 30% (n = 1118) of FNP students reported experiencing two or fewer pediatric mental health assessments during their clinical rotations. More than half (53%) of these students were required to set up their own preceptors and clinical sites. CONCLUSION: Despite the growing need for mental health care in the U.S, students reported lacking pediatric mental health assessment clinical opportunities. Moreover, students who set up their own clinical sites and preceptors were even less likely to assess pediatric patients' mental health. FNP educators and programs are encouraged to provide students with the support and opportunity for adequate pediatric practice, including mental health assessment.

An Innovative Distance-Based Mentorship Program for Nurse Practitioner Student-Alumni Pairs.

ABSTRACT: Little research exists on mentoring programs for nurse practitioner (NP) students. This pilot project aimed to develop, implement, and evaluate a distance program with NP alumni mentoring NP students across the United States. Mentor-mentee pairs (113) were hand-matched and surveyed at six months to collect program data. Most mentees wanted more job-hunting and resume-writing tips; mentors were interested in receiving strategies for mentoring and calendar reminders of important school events. Alumni were interested in helping prepare future NPs by serving as mentors but needed training. Distance mentorship programs may require additional structured guidelines and resources to facilitate success.

Traditional Clinical Outcomes in Prelicensure Nursing Education: An Empty Systematic Review.

BACKGROUND: Effectiveness of traditional apprenticeship models used in undergraduate nursing education has been questioned in the literature for over 50 years. This systematic review aimed to examine best evidence available upon which to base decisions regarding use of traditional clinical experience with prelicensure nursing students. METHOD: A systematic review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine electronic databases were searched. Full-text review was completed for 118 articles meeting inclusion criteria. RESULTS: No studies reported learning outcomes attributed to clinical education models, resulting in an empty review. Studies were commonly self-reports of perceptions and confidence, lacking quantitative outcomes. CONCLUSION: No sufficient evidence was found to support traditional clinical models. The scope of nursing practice and patient complexity requires higher order thinking skills, ability to prioritize, and leadership in interdisciplinary care environments. This review raises serious concerns about how nurse educators assess learning in traditional clinical environments. [J Nurs Educ. 2021;60(3):136-142.].

Faculty Perceptions in Facilitating Success for Accelerated BSN Student Veterans.

ABSTRACT: Student veterans enrolled in nursing programs often experience challenges transitioning to higher education environments. This study investigated faculty perspectives regarding the strengths and challenges of student veterans in an accelerated bachelor's of science in nursing program; faculty (N = 21) participated in focus groups. Four themes emerged: No Man Left Behind, Acclimating to the Higher Education Environment, Not Wanting to Be Different, and Professionalism/Maturity. Faculty perceived student veterans possess strengths and approaches to learning different from students without a military background. Integrating these strengths into the curriculum, with strategies such as team-based learning and group assignments, will leverage their skills and facilitate academic success.

Military nursing: A primer for new recruits.

This article offers an overview of military nursing and provides three examples that illustrate how nurses can advance their careers within each service.

Improving Pharmacology Standardized Test and Final Examination Scores Through Team-Based Learning.

BACKGROUND: Team-based learning (TBL) is a collaborative teaching and learning strategy emphasizing student engagement and application of knowledge. PURPOSE: The purpose of the study was to compare the differences in scores on pharmacology course final and standardized criterion-referenced examinations between students taught in a traditional lecture-based approach and those taught under the TBL approach. METHODS: Using a before-and-after design, 338 prelicensure students were taught pharmacology using either a traditional lecture-based approach or a TBL approach. RESULTS: Significant differences on course final and standardized examination scores were found between the groups, with students taught using TBL scoring higher than students in the traditional lecture-based group. CONCLUSIONS: Team-based learning had a positive impact on learning outcomes. Moreover, TBL may be a more efficient approach to teaching, as students in the TBL group had only 3 credit hours of content versus students in the traditional lecture-based group, who had 4 credit hours.

NLN Core Competencies for Nurse Educators: Are They Present in the Course Descriptions of Academic Nurse Educator Programs?

AIM: As an initial approach to determining representation of the NLN Core Competencies for Nurse Educators in Master's of Science in Nursing Education and Post-Master's Certificate programs, the study identified the presence of the competencies in course descriptions. BACKGROUND: The competencies are the gold standard to ensure academic nurse educators have the knowledge and skill to teach, assist learners, develop curricula, and implement effective evaluation methods. METHOD: A descriptive design that applied web scraping techniques was used to collect data from school web pages, including course descriptions, credit hours, practica information, distance accessibility, and Certified Nurse Educator exam preparation. RESULTS: Four competencies were well represented (≥85 percent), and four competencies were poorly represented (<50 percent) in a sample of 529 schools. CONCLUSION: Programs should review courses and course descriptions for inclusion of all competency areas that prepare nurse educators and make revisions to address poorly represented competencies.

A call to action: Building evidence for use of simulation in nurse practitioner education.

Leaders from national nursing organizations, nursing schools, and health care simulation vendors convened in early 2019 to discuss simulation in nurse practitioner (NP) education. Nurse practitioner clinical education needs a more standardized, efficient, and sustainable model to prepare NPs to provide quality care in complex health care systems. Currently, a major shortage of clinical sites and preceptors to educate students creates challenges for NP programs and nursing faculty. One strategy used by nursing programs to overcome this challenge is using simulation to provide clinical training for NP students in a safe, controlled environment. There remains, however, a lack of evidence linking these simulation experiences with clinical skills acquisition and program outcomes. Implementing competency-based education through standardized simulations has the potential to demonstrate quality, safety, and accountability across NP education programs. Ultimately, the expansion and acceptance of simulation hours in NP education is dependent on strong and favorable evidence from rigorous, high-quality studies.