Nursing Student Perceptions of Academic and Clinical Integrity.

AIM: This study aimed to explore how nursing students define and describe academic and clinical integrity and to identify social and psychological influences on student decisions to act with integrity. BACKGROUD: Nursing students are exhibiting a decline in academic and clinical integrity. Academic dishonesty often correlates to clinical dishonesty, subsequently impacting patient care quality and safety. Student perceptions and understanding of integrity are unknown. METHOD: A qualitative descriptive approach guided this study. A purposive sample of 19 traditional baccalaureate nursing students was recruited to participate in one-hour face-to-face interviews. RESULTS: All participants defined academic and clinical integrity as honest, ethical, and accountable behavior. Additional subthemes of characteristics, facilitators and barriers, and outcomes of acting with integrity emerged. CONCLUSION: Students recognize the positive characteristics of integrity and their effects on personal growth and optimal patient outcomes. These findings can inform faculty in developing and supporting a culture of integrity.

Supporting Faculty During Pedagogical Change Through Reflective Teaching Practice: An Innovative Approach.

Given the recent calls for transformation of nursing education, it is critical that faculty be reflective educators. Reflective teaching practice is a process of self-examination and self-evaluation to gain insight into teaching to improve the teaching-learning experience. Limited attention has been given to this notion in the nursing education literature. An innovative reflective teaching practice approach for nursing education is proposed, consisting of question cues, journaling, and a process of facilitated meetings. The authors describe their perceptions of using this approach with faculty during the implementation of a new pedagogy and suggest areas for further research.

Best practices for creating social presence and caring behaviors online.

AIM: To identify best practices and evidence-based strategies for creating an online learning environment that encompasses caring behaviors and promotes social presence. BACKGROUND: Faculty who teach online classes are challenged to create a sense of social presence and caring behaviors in a virtual world in which students feel connected and part of the learning environment. METHOD: To extrapolate evidence to support best practices, a review of literature was conducted focused on social presence and caring online. RESULTS: Faculty messages that are respectful, positive, encouraging, timely, and frequent foster social presence and caring behaviors while also allowing for caring interactions, mutual respect, and finding meaning in relationships. CONCLUSION: A variety of measures to emulate caring online intertwine with social presence to promote a sense of caring and belonging. More research is needed to support the evidence for these strategies.

Exploring reflection as a process embedded in experienced nurses' practice: a qualitative study.

AIM: This article is a report of a study aimed at obtaining an in-depth description of how experienced acute care staff nurses perceive and use reflection in clinical practice. BACKGROUND: Reflection is viewed as a critical component of professional practice. The basic assumption is that reflection involves a deliberate process of thinking about a clinical situation which leads to insight and a subsequent change in practice. Several prescriptive models for reflection exist to provide a guide for reflection, however, few are grounded from an empirical examination of reflection in practice. There is a dearth of empirical data on what is actually happening in practice. DESIGN: Descriptive, qualitative. METHODS: In-depth interviews with 12 experienced acute care staff nurses in a community hospital in Northeastern USA was used to address the study aims. Data were collected between November 2009-May 2010. RESULTS/FINDINGS: Examples of reflection were embedded in patient situations needing immediate nursing intervention. Reflection was a process involving four phases: Framing of the Situation, Pausing, Engaging in Reflection, and Emerging Intentions. CONCLUSION: Experienced nurses used a process of reflection-on-action in practice. They gained insight and formulated intentions for change in nursing practice. Structured facilitated reflection might assist nurses in achieving a depth of reflection necessary to move from their intentions to changes in practice.

Stress among caregivers of chronically ill older adults: implications for nursing practice.

Caregiving is a dynamic process involving a series of decisions at different stages of a person's chronic illness trajectory. Research suggests the burdens of caregiving can lead to caregiver stress, the actual or perceived physical or emotional strain experienced by the caregiver. Nurses have a pivotal role in assessing for caregiver stress and providing interventions to assist caregivers. This article defines caregiver stress, discusses the impact that caregiving has on a caregiver, provides assessment principles to identify caregiver stress, and includes evidence-based interventions that can be tailored to individual caregivers to encourage health-promoting behaviors.

Research priorities for nursing professional development: a modified e-Delphi study.

In 2010, the National Nursing Staff Development Organization Research Committee identified the need to delineate research priorities for nursing professional development (NPD). A Delphi study with 13 experts in NPD resulted in the identification of 24 priorities for the next 5 years. These priorities provide the future direction for NPD research and funding.

Use of Exam Wrapper Metacognitive Strategy to Promote Student Self-assessment of Learning: An Integrative Review.

BACKGROUND: Metacognitive knowledge and regulation are critical to nursing students who must apply knowledge to rapidly changing and complex conditions. Exam wrappers assist learners to consider past study habits with the goal of improving future exam preparation. However, little is known about use of exam wrappers in nursing education. PURPOSE: The purpose of this integrative review was to describe the disciplines, populations, courses, specific strategies, and outcomes of the exam wrapper strategy. METHODS: A systematic literature search of peer-reviewed publications was completed in any discipline using exam wrappers. RESULTS: Ten academic disciplines of primarily introductory students completed exam wrappers with positive effects on course and exam grades, as well as metacognition, and noted changes in future study habits. CONCLUSIONS: The exam wrapper strategy has been successfully implemented with improvements in course and exam grades, levels of metacognition, and changes in future study habits.

Exploring the Charge Nurse Role Transition: A Qualitative Study of the Novice's Perspective.

The novice charge nurse role transition is not well understood. This article reports on a qualitative descriptive study of the novice charge nurse role transition. Rubin and Rubin's responsive interviewing was used. Fourteen novice charge nurses participated in Zoom interviews. Thematic analysis revealed three phases: taxiing to the runway , takeoff , and reaching cruising altitude , each with distinct themes. Nursing professional development practitioners can use these findings to better understand and support new charge nurses through this transition.

Using reflection strategies to link course knowledge to clinical practice: the RN-to-BSN student experience.

Reflection is viewed as an essential element of professional practice. However, there is limited research exploring practice changes as a result of reflection within the context of new knowledge. In addition, literature suggests that nursing students may have difficulty linking course knowledge to their practice; reflection may facilitate this process. Colaizzi's phenomenology was used to describe the experience of 10 RN-to-BSN students using reflection strategies to facilitate a change in thinking or practice actions within the context of course knowledge. Seven themes emerged: facing emotional barriers, weighing the choices for reflection, making sense, percolating insights, letting go, blending insights into practice, and looking back and acknowledging growth. Structured reflection facilitated changed perspectives and practice actions. Students were able to transcend emotions to begin reflection. Faculty assumed the role of reflective guide. A consistent reflective structure across courses may facilitate learning and use of reflection.

Reflective narrative: a tool for learning through practice.

Reflection has recently gained increased recognition for its potential to facilitate learning. New insights gained through reflection enable the nurse to respond to clinical situations from a changed perspective. Skill, however, is required in learning to reflect. In this article, the author provides a systematic approach for staff development specialists to use to assist staff in reflecting on practice through a written reflective narrative.

Description and comparison of exam wrapper learning strategy use in baccalaureate and associate degree nursing students: A descriptive study.

BACKGROUND: Exam wrapper, a structured self-regulated learning strategy, assists students to review study habits and performance on an exam with the goal of improving future study habits. Little is known about the use of this strategy in nursing students, particularly associate degree students. OBJECTIVES: To describe and compare demographic characteristics, study habits, reasons for getting content wrong on an exam and future study plans between associate degree and baccalaureate nursing students. DESIGN: A cross sectional, descriptive comparative study of exam wrapper use in associate degree and baccalaureate nursing students. SETTINGS: A medium-sized public university and small private college in the northeastern United States. PARTICIPANTS: A convenience sample 102 prelicensure baccalaureate (n = 63) and associate degree (n = 39) nursing students. Mean age of 21.9 ± 5.6, GPA of 3.46 ± 0.38, 7% male, 57% commuter students, 75% employed an average of 14 ± 11.4 h per week. METHODS: Data were collected by course faculty during an in-class exam review following a multiple-choice examination. Students completed a demographic form and exam wrapper that assessed pre-exam study habits, reasons for getting items wrong on an exam and future study habits. RESULTS: Associate degree students had lower GPAs (3.19 vs 3.57, p = .000), were older (27 vs 19.2, p = .000), more often commuted (100% vs 31%, p = .000), were employed (95% vs 65%, p < .001), were more likely to study at home (39.5% vs 13.1%, p = .000) and spent significantly longer on each study activity (p = .000) than baccalaureate students. When comparing reasons for getting a question wrong and intended study habits, baccalaureate and associate degree students did not differ. CONCLUSIONS: Use of the exam wrapper strategy allows nursing students at all levels of prelicensure education to actively reflect upon their learning with the goal of improving future learning.

Returning for a baccalaureate: a descriptive exploratory study of nurses' perceptions.

This qualitative study examines the experience of the RN who pursues a bachelor of science to determine the meaning found by pursuit of a baccalaureate, the extent to which the pursuit of the degree influences one's perception of oneself as a professional, and the impact of the degree on one's practice. The participants found personal satisfaction in pursuing their degrees and developed a broader approach to nursing practice. Implications for staff development specialists are discussed.

Effects of Guided Reflection on Diabetes Self-Care: A Randomized Controlled Trial.

The purpose of this study was to evaluate the effects of guided reflection on self-care behaviors, confidence scores, and diabetes knowledge among adults with diabetes. A randomized controlled trial with a pre/posttest design was used to generate data from a convenience sample of 62 adults with diabetes recruited from a single site. After viewing a 30-minute video on how to manage diabetes, participants were randomized to a control group (CG) (usual care) or an intervention group (IG). The IG further engaged in a reflection educational session. For 8 weeks, the IG isolated diabetes-related events weekly, critically analyzed them using Gibbs's reflective questions, and recorded their analysis in a journal. They also shared their perspective relative to using the journal in an audiotaped interview. Main measures included baseline and 8-week clinical outcomes (self-care maintenance, monitoring, management, and confidence scores and diabetes knowledge scores) and intervention acceptability. Compared to the CG, the IG had no statistically significant difference in self-care measures over time, although scores trended in the anticipated direction. Importantly, both groups had statistically significant improvement in self-care scores. Furthermore, there was statistically significant improvement in diabetes knowledge among IG participants. Informatively, IG critically analyzed 147 diabetes-related events concentrating on blood glucose, diet, exercise, monitoring, medication, sleep pattern, and health care visits. Participants found the guided reflection activity highly acceptable. Combined educational and reflection interventions are effective approaches for improving self-care outcomes and diabetes knowledge among adults with diabetes. Research concentrating on purposeful patient reflection is warranted in a larger sample paying careful attention to study limitations.

The effect of guided reflection on heart failure self-care maintenance and management: A mixed methods study.

OBJECTIVE: Evaluate the effect of structured, guided reflection on patient descriptions of self-care maintenance and management. BACKGROUND: Inadequate HF self-care behaviors are linked to hospitalizations. Symptom monitoring and recognition are precursors to adequate HF self-care. Reflection on actions taken during HF exacerbations may lead to insights and future changes in HF self-care maintenance and management. METHODS: One-group mixed method pre-test/post-test design. Following cognitive screening, self-care maintenance and management was measured prior to the intervention at a home visit one-week after hospital discharge, and one-month post intervention. Qualitative data consisted of audiotaped individual interviews with participants, field notes and reflective diaries kept by patients. RESULTS: The results (N = 10) demonstrate large effect sizes and increases in self-care maintenance (69.9 vs 79.6, d = 1.04) and management (47.2 vs 63.9, d = 2.53) scores after intervention. Eight themes emerged from the data that reflected the HF participant's experience of self-care. Reflection evoked emotions around concerns for family and mortality. Participants linked symptoms experienced with contextual factors which facilitated discussion about changing future actions. CONCLUSIONS: Purposeful reflection may be necessary for the development of self-care. Guided reflection on previous actions that includes contextual considerations may also play a role in enhancing self-care management by allowing the person to more fully understand the illness experience.

Exploring outcomes and evaluation in narrative pedagogy: An integrative review.

OBJECTIVES: To identify narrative pedagogy learning outcomes and evaluation methods used for pre-licensure nursing students. Recommend areas for expanding narrative pedagogy research. DESIGN: An integrative review using a modified version of Cooper's 1998 framework, as described by Whittemore and Knafl (2005). DATA SOURCES: A computer-assisted search of the literature from 1995 to 2015 was performed using the search terms narrative pedagogy and nursing. Databases included the Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, Educational Resources Information Center, Educational Research Complete, Medline, PsychArticles, PsychINFO, and the Teacher Reference Center. Ancestry searches led to the inclusion of additional articles. REVIEW METHODS: Twenty-six texts met the criteria for full review and were evaluated for methodological rigor and relevance to the review aims. Nine articles achieved an acceptable quality score and were used for thematic analysis. RESULTS: Learning outcomes associated with narrative pedagogy were grouped into five themes: thinking, empowerment, interconnectedness, learning as a process of making meaning, and ethical/moral judgment. Multiple methods of evaluation are necessary to evaluate these learning outcomes. CONCLUSIONS: Narrative pedagogy may be a beneficial philosophical approach to teaching. However, at this time, there is insufficient evidence to recommend its universal adoption. It is too broad in its approach to reliably measure its effectiveness. Future research should examine the effectiveness of specific teaching strategies to promote desired learning outcomes.

Content Validation and Utility of a Critical Reflective Inquiry Assessment Tool.

A Critical Reflective Inquiry (CRI) Assessment Tool was developed based on the CRI Model to assess reflection in nursing practice. Experienced clinicians evaluated the CRI Assessment for clarity and relevance to the CRI Model and nursing practice utility. Content validity index was calculated for each item in the scale and then averaged across all items. The tool has potential in education and orientation for assessing the depth and focus of reflection and what is learned.

Accelerated Master's Programs in Nursing for Non-Nurses: An Integrative Review of Students' and Faculty's Perceptions.

Accelerated master's programs in nursing for non-nurses (AMPNNNs) are rapidly increasing in number. They offer accelerated entry into nursing practice for individuals with a baccalaureate degree or higher. An integrative review, based on Whittemore and Knafl (2005) was conducted to identify the characteristics of the students and the perceptions of students, graduates, and faculty who participate in these programs. A search of published literature yielded 15 sources with relevant data for this integrative review. Student characteristics indicate predominantly Caucasian females who are older, mature, and academically accomplished. There is a dearth of literature related to the perceptions of students and faculty as they experience the program. Student experienced role changes, and the demands of nursing education were notable. Faculty identified the need to develop innovative teaching strategies for adult learners. The gaps in the evidence base of AMPNNNs are highlighted, and areas for future research are recommended.

Exploring problems encountered among experienced nurses using critical reflective inquiry: implications for nursing professional development.

This study explored problems encountered by nurses using critical reflective inquiry to examine clinical situations and the impact of group discussion on the reflective process. Secondary qualitative analysis of 19 reflective situations, rom a reflection continuing education program, revealed that nurses had problematic pauses in reflection and were stuck in cyclical self-questioning. Peer group discussion prompted deeper reflection. Experienced nurses may need assistance to enhance the comprehensiveness, depth, and scope of reflection on practice situations.

The Lasater Clinical Judgment Rubric as a Framework to Enhance Clinical Judgment in Novice and Experienced Nurses.

Clinical judgment has been identified as a critical component of professional nursing practice and enables nurses to deliver safe patient care with optimal outcomes. Nurses, particularly those transitioning into clinical practice, may require assistance to enhance their clinical judgment skills. This article presents the Lasater Clinical Judgment Rubric, which has primarily been used in the academic setting, as a framework for nursing professional development specialists to enhance the clinical judgment skills of novice and experienced nurses.