Using Invitational Theory to Examine Nursing Students' Experiences of Their Learning Environment.

AIM: The aim of this study was to test Purkey's invitational theory to evaluate unique aspects of the learning environment in nursing education. BACKGROUND: Faculty evaluate student learning but rarely students' unique experiences within learning environments. METHOD: This interpretive phenomenological analysis explored students' perceptions of their prelicensure learning environments. Twelve participants from two private bachelor of science in nursing programs were interviewed about their experiences. RESULTS: Students' perceptions of what helped (invited) their learning and hindered (disinvited) their learning included thematic aspects of learning environments based on Purkey's theory: people, places, processes, policies, and programs. Findings illustrate facets of the learning environment often not considered by educators in planning learning environments most conducive to student learning. CONCLUSION: Purkey's theory is a plausible framework for nurse educators to evaluate learning environments from students' perspectives and may provide valuable data about the unique milieu that promotes or hinders successful learning.

Preparing new nurses with complexity science and problem-based learning.

Successful nurses function effectively with adaptability, improvability, and interconnectedness, and can see emerging and unpredictable complex problems. Preparing new nurses for complexity requires a significant change in prevalent but dated nursing education models for rising graduates. The science of complexity coupled with problem-based learning and peer review contributes a feasible framework for a constructivist learning environment to examine real-time systems data; explore uncertainty, inherent patterns, and ambiguity; and develop skills for unstructured problem solving. This article describes a pilot study of a problem-based learning strategy guided by principles of complexity science in a community clinical nursing course. Thirty-five senior nursing students participated during a 3-year period. Assessments included peer review, a final project paper, reflection, and a satisfaction survey. Results were higher than expected levels of student satisfaction, increased breadth and analysis of complex data, acknowledgment of community as complex adaptive systems, and overall higher level thinking skills than in previous years.

Career persistence in baccalaureate-prepared acute care nurses.

PURPOSE: To explain how baccalaureate-prepared acute care nurses understand, adapt to, and negotiate challenge and change in acute care settings in the context of social and structural features and consequently develop career persistence there. DESIGN: Grounded theory method based on the research of Strauss and Corbin. METHODS: A research team conducted open-ended interviews with a theoretic sample of 19 new and experienced baccalaureate-prepared (BSN) nurses in the southeast United States during 2007 and 2008 until saturation was achieved. Interviews were audiotaped and transcribed verbatim. Constant comparative method was used to analyze data to three increasingly abstract levels culminating in theory emergence. A diagram was developed to better understand relationships and processes. FINDINGS: A central category, building professional resilience, emerged as the central social process with three core processes of verifying fit, stage setting, and optimizing the environment contributing to career persistence in acute care. Core processes include skills and practices nurses have learned to negotiate changing acute care environments while sustaining patient advocacy. Definitions, properties, and dimensions of each were established. CONCLUSIONS: The study offers a systematic framework for understanding and promoting career persistence for acute care nurses. Findings broaden theories of resilience to the unique settings of acute care nursing and further extend theoretical understanding of the nursing shortage and market issues of supply and demand. CLINICAL RELEVANCE: A middle range theory of professional resilience and career persistence makes visible skills and practices acute-care nurses use to weather continuous change and challenge in health care. Teachable practices can be integrated into nursing education and staff development to improve professional career longevity of experienced nurses at the bedside.

A mixed-methods study of coping and depression in adolescent girls with polycystic ovary syndrome.

BACKGROUND AND PURPOSE: Polycystic ovary syndrome (PCOS) is a complex metabolic disorder associated with clinical manifestations that could be psychologically distressing to adolescent girls considering the concern of body image during the developmental stage of adolescence. Poor psychological functioning is related to increased mortality, higher health care costs, and negative health outcomes. Coping has been identified as impacting health and adaptation to illness; therefore, the purpose was to examine coping and depression in adolescent girls with PCOS. METHODS: Adolescent girls, aged 13-18 years and diagnosed with PCOS completed questionnaires regarding coping and depression and participated in interviews. A convergent, parallel, mixed-method design was used. CONCLUSIONS: Girls perceived very little control over the aspects of PCOS, with menstrual irregularities and the threat of infertility reported as the most stressful and least controllable aspects of PCOS. Lower control was a predictor of greater depression among the participants. IMPLICATIONS FOR PRACTICE: Providers should strive to establish rapport with adolescent girls and ask specifically about their concerns surrounding PCOS to provide meaningful health education. Providers should also be aware of the risk for depression among this population and should routinely screen patients and keep channels of communication open regarding the symptoms of depression.

Professional resilience in baccalaureate-prepared acute care nurses: first steps.

New nurses typically begin their practice in acute care settings in hospitals, where their work is characterized by time constraints, high safety risks for patients, and layers of complexity and difficult problems. Retention of experienced nurses is an issue central to patient safety. The purpose of this qualitative study was to explore the nature of professional resilience in new baccalaureate-prepared nurses in acute care settings and to extrapolate pedagogical strategies that can be developed to support resilience and career longevity. Findings revealed a common process of evolving resilience among participants. New nurses spend a significant amount of time learning their place in the social structure. With positive experiences, they begin to feel more competent with skills and relationships and become increasingly aware of discrepancies between their ideas of professional nursing and their actual experiences in the work setting. The risk of new nurses leaving their practice is constantly present during these struggles. Acceptable compromises yield a reconciliation of the current crisis, typically occurring long after formal precepting has ended. Personal growth is evident by the evolving clarity of professional identity, an edifying sense of purpose, and energy resources to move forward. For new nurses, professional resilience yields the capacity for self-protection, risk taking, and moving forward with reflective knowledge of self.

Professional resilience, practice longevity, and Parse's theory for baccalaureate education.

New nurses seem unable to find a means of flourishing professionally in acute care practice and, consequently, exit far earlier than expected. Worldviews of baccalaureate students have changed from previous generations; yet, the approaches to nursing education remain essentially the same. Just as clinical settings benefit from nursing theory as the basis for nursing practice and scientific inquiry, the science of nursing education would benefit from nursing theory as a basis for guiding educational practice. Parse's human science theory, the Human Becoming School of Thought, is a fitting theoretical framework for a model of teaching-learning for undergraduate baccalaureate nursing education. In addition, as a theory of dynamic relational synchrony, Parse's work provides an appropriate framework with which to promote professional resilience and career longevity by purposefully engaging students within student-faculty dyads to explore personal meanings and philosophies of caring, and to create strong professional identities.

Interprofessional problem-based learning project outcomes between prelicensure baccalaureate of science in nursing and doctor of pharmacy programs.

BACKGROUND: Persistently high medical error rates, caregiver dissatisfaction, and compromised patient safety often result from poorly coordinated, increasingly complex health care. Barriers to interprofessional health professions education persist despite the urgent calls for improved quality and safety. Investigators explored the effects of a problem-based learning (PBL) strategy between prelicensure doctorate of pharmacy (PharmD) and baccalaureate nursing (BSN) students. METHOD: A descriptive design was used to compare the learning gains and satisfaction with a PBL hybrid approach for BSN and PharmD prelicensure student groups over three academic terms. RESULTS: Consistent with earlier works, content-based learning gains and student satisfaction were not significantly different between groups. Narrative data provide insight into perceived benefits, barriers, and perspectives of participating students and facilitators. CONCLUSION: Attributes of this pedagogical approach provide opportunity for prelicensure students to explore professional interdependence while adequately mastering fact-based content.