Simulated Wound Care as a Competence Assessment Method for Student and Registered Nurses.

OBJECTIVE: To describe the development and use of a wound care simulation assessing RNs' and graduating student nurses' practical wound care competence and to describe observations of participants' wound care competence. METHODS: A descriptive, qualitative design was used. Data were collected in 2019 from 50 healthcare professionals and students using a simulated wound care situation and an imaginary patient case. The simulation was based on a previously developed and tested wound care competence assessment instrument, which included a 14-item checklist that assesses practical wound care competence of chronic wounds. The data were analyzed and described based on the 14 competence areas or as other competencies. RESULTS: Participants showed competence in identification of wound infection, debridement, dressing selection, tissue type identification, and consultation. Participants' shortcomings were related to pain assessment and management, asepsis, offloading, and documentation. Simulation was shown to be a promising tool to assess healthcare professionals' and students' practical wound care competence in a safe and standardized situation. CONCLUSIONS: This study provided new information about simulation as a method to assess student nurses' and RNs' wound care competence. The results could be used in wound care education planning and development in both undergraduate nursing education and continuing education for nursing professionals.

Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology.

BACKGROUND: People with disabilities (PWDs) experience significant health disparities. The complex experience of disability requires that nurses are adequately and deliberately prepared to care for PWDs. However, there are no recognized nursing competencies to direct education and care. PURPOSE: The purpose of this study was to develop a set of nursing competencies to better prepare prelincensure nursing students to provide competent care to PWDs. METHODS: A 2-round Delphi survey was administered to experts in the field of disabilities (n = 47, n = 35). Quantitative and qualitative methods were used to analyze data. RESULTS: Three major themes emerged: unique knowledge, volume and repetition, and distinct disability culture. Competencies were reduced with a focus on 4 dimensions: environment and care, communication, culture, and referral. CONCLUSIONS: The 12 new competencies can serve as the foundation for the inclusion of disability content in nursing curricula.

Despite Challenges: Nursing Student Persistence.

BACKGROUND: Seeking to improve nursing student retention in their small university, faculty conducted a literature review on attrition in nursing education and discovered it to be a significant global problem with nearly one third of qualified students discontinuing. Improved nursing student persistence could stem the growing worldwide nursing shortage. The existing research on retention indicates multi-faceted challenges and impacts but offers scant solutions or insight into student perspectives. METHOD: The nursing faculty piloted a bridge course for the freshman cohort to develop intrinsic strengths for student persistence and begin soliciting student feedback using a mixed-methods phenomenological approach. RESULTS: Faculty describe the bridge course framework and activities and present initial student responses. CONCLUSION: The pilot bridge course serves as one step toward identifying challenges and interventions from students' perspectives to support persistence as a means of meeting nursing shortage demands. [J Nurs Educ. 2019;58(7):427-430.].

A process evaluation of a mobile cooperation intervention: A mixed methods study.

BACKGROUND: A mobile cooperation intervention was developed to facilitate the cooperation of nursing students with nurse teacher and to improve the students' clinical learning outcomes. The intervention consisted of training in a mobile application's functionality and its use during clinical practicum cooperation procedures. OBJECTIVES: To describe the development of a mobile application for student-teacher cooperation and to examine the acceptability of the mobile cooperation intervention for advancing intervention development. DESIGN: A user-centred design and a mobile application development lifecycle model were applied to develop a mobile application. A process evaluation that used mixed methods design was conducted within the intervention group after a randomized controlled trial of a complex mobile cooperation intervention. SETTING: The clinical practicum wards of seven hospitals in a hospital district in Finland. PARTICIPANTS: Second-year pre-registration nursing students (N = 52) from one nursing school. METHODS: Process evaluation questionnaires were completed upon completion of the five week intervention and essays were written by the students eleven weeks after the intervention ended. RESULTS: A system usability scale (SUS) assessed the overall usability of the mobile application as rather good (a mean SUS score of 69.86 out of 100). Positive feedback about the mobile application's usability and utility was reported and recommendations for further development were highlighted. The intervention demonstrated high acceptability. In general, the students actively used the mobile application for intervention procedures at home and in the clinical practicum ward. CONCLUSIONS: The findings support the high acceptability of mobile cooperation intervention and its potential while also providing evidence for the development team's future development of the mobile application. Additionally, this study provides an example of mobile application development and process evaluation in nursing education research.

Exploring health economics course competencies' value for nurse administrators.

BACKGROUND: A survey of nursing administrators in the United States was conducted to solicit opinions about health economics (HE) course competencies for baccalaureate nursing programs. PURPOSE: To provide rationale for intensifying educational efforts to increase nurses' awareness about the value of HE skills in their everyday work. METHODS: Participants were asked to rate six HE competencies using a Likert scale. Paired-samples t tests, bivariate correlations, and standard multiple linear regressions were used to analyze survey results. DISCUSSION: A strong direct relationship exists between the amount of prior knowledge nursing administrators have about HE and the perceived level of usefulness of HE skills. CONCLUSION: Nurses' contributions to creating value in healthcare must be encouraged. Increasing the share and accessibility of the HE content in continuing education offerings could be one way to expand HE knowledge among practicing nurses and promote cost-effective delivery of healthcare in the United States.

Assessment of Prelicensure Undergraduate Baccalaureate Nursing Students: Ostomy Knowledge, Skill Experiences, and Confidence in Care.

Care of the patient with an ostomy is included in the curriculum of prelicensure nursing programs, but no studies examining student nurses' knowledge about stoma care have been published. The purpose of this project was to examine the ostomy knowledge, experiences, and confidence of nursing students in order to assess and improve the curriculum. At the end of the fall 2016 semester, students enrolled in 3 separate nursing courses in an undergraduate program were asked to participate in a project to examine students' ostomy knowledge, their experiences, and their confidence in providing care. This project was undertaken to explore the college's ostomy curriculum. Participation was voluntary, and no student who was willing to participate was excluded. Students completed a 50-question knowledge test, answered questions about the frequency of performing ostomy-related skills, and rated their confidence in providing ostomy care. Responses were examined with descriptive and inferential statistics. Of 189 possible participants, 138 completed the questionnaires and included mostly women (113, 81.9%); participant mean age was 27.26 ± 6.22 years. The mean number of correct knowledge responses was 35.66 (71.32%); 66 participants (47.8%) reported no experience caring for a patient with an ostomy. The most common skills performed in clinical rotations were emptying (49) and changing (24) the pouch. A scale of 1 to 5 was used to evaluate 6 confidence items, with students having a mean confidence score of 19.54 ± 5.20. They had the most confidence in their ability to empty a pouch and to size and fit the pouching and the least confidence in teaching and community resources. Confidence was related to the number of skills performed in the lab (r = .32; P <.001), the number of skills performed in clinical practice (r = .38; P <.001), and ostomy knowledge scores (r = .23; P <.007). Total correct knowledge scores did not differ significantly by year in the educational program. Based on the results of this survey, it was concluded that students had a beginning knowledge about ostomy care and very limited clinical experience, yet confidence in providing ostomy care was high. Curriculum adjustments were implemented, including strategies for increasing ostomy knowledge, opportunities to provide care, and confidence; these need further investigation in prelicensure undergraduate nursing programs. The effect of curriculum adjustments remains to be evaluated.

Moving Closer to the 2020 BSN-Prepared Workforce Goal.

: One of the recommendations of the landmark Future of Nursing: Leading Change, Advancing Health report was to increase the proportion of nurses with a bachelor of science in nursing or higher degree to 80% by 2020. In 2012, the American Organization of Nurse Executives was selected by the Robert Wood Johnson Foundation as the National Program Office for a new initiative-the Academic Progression in Nursing (APIN) program-with the goal of identifying and developing the most promising strategies for creating a more highly educated nursing workforce. This article discusses the findings of APIN's four-year project.

Attrition of undergraduate nursing students at selected South African universities.

BACKGROUND: The nursing profession forms the backbone of many healthcare systems. It therefore needs a consistent supply of registered nurses to deliver continuous and safe quality healthcare, and to replace the nurses leaving or retiring from the profession. Attrition actively occurs among nursing students in South Africa and threatens the future supply of registered nurses. AIM: The aim of the study was to describe the attrition rate at selected South African universities and the factors influencing undergraduate nursing students to discontinue their nursing studies at these universities. METHOD: A quantitative descriptive design was followed. Heads of the nursing departments at the selected universities captured data with a specifically designed questionnaire. Thereafter their former nursing students provided information via a structured telephonic interview on the reasons why they discontinued the nursing programme. RESULTS: The study revealed that attrition of undergraduate nursing students for three intake years (2007, 2008 and 2009) at the participating universities was between 39.3% and 58.7%. Academic and financial reasons as well as poor wellness and health were the main causes for attrition. Another factor was failure to cope with the demands of the clinical environment. CONCLUSION: Attrition might not occur immediately when a nursing student is challenged, as the student might exploit the various types of support offered. Although some nursing students do benefit from the offered support, a large number of nursing students still discontinue the undergraduate nursing programme.

Working towards widening participation in nurse education.

The widening participation agenda has particular significance for worldwide nursing since it is a profession which is under increasing scrutiny in its recruitment and retention practices. Debate about this agenda within nurse education is strengthened by careful scrutiny of the research within the wider context of higher education, some of which challenges commonly held assumptions. This paper examines four areas of relevance to the UK widening participation agenda: disability, ethnicity, socioeconomic status and family responsibilities. Taken together, they indicate that nurse education operates within a particularly complex context with some important implications for the future design of pre-registration programmes. These complexities should be debated in depth by educational commissioners and providers, in tandem with regulatory bodies.

The Culturally Diverse Nursing Student: A Review of the Literature.

PURPOSE: The purpose of this article is to discuss the facilitators and barriers to the retention and graduation of the culturally diverse nursing student using the social ecological model (SEM). DESIGN: Literature review. METHOD: A review of the literature was conducted and the SEM was used to evaluate the facilitators and barriers to the success of culturally diverse nursing students. FINDINGS: The SEM is an appropriate means to evaluate the facilitators and barriers to the retention and success of the culturally diverse nursing student. Researchers link health disparities in marginalized populations with diversity of the health care workforce. Consequently, the SEM provides a multidimensional view of the problem of focus, while providing a guide for the development for sustainable solutions to address the issues. Additional research is necessary using a social determinant of health model such as the SEM to facilitate dialogue and change in current retention strategies.

Do Associate Degree Registered Nurses Fare Differently in the Nurse Labor Market Compared to Baccalaureate-Prepared RNs?

Roughly 40% of the nearly 3 million registered nurses (RNs) in the United States have an associate's degree (ADN) as their highest level of nursing education. Yet even before the recent Institute of Medicine report on The Future of Nursing, employers of RNs have increasingly preferred baccalaureate-prepared RNs (BSNs), at least anecdotally. Data from the American Community Survey (2003-2013) were analyzed with respect to employment setting, earnings, and employment outcomes of ADN and BSN-prepared RNs. The data reveal a divergence in employment setting: the percentage of ADN-prepared RNs employed in hospitals dropped from 65% to 60% while the percentage of BSN-prepared RNs employed in hospitals grew from 67% to 72% over this period. Many ADNs who would have otherwise been employed in hospitals seem to have shifted to long-term care settings.

The influence of teaching method on performance of suicide assessment in baccalaureate nursing students.

BACKGROUND: Student nurses identify many barriers to assessing patients' risk for suicide. OBJECTIVE: This pilot study developed and tested an innovative active learning strategy using simulated standardized patients to determine its effectiveness in teaching suicide assessment skills to a sample of 34 junior and senior baccalaureate nursing students. DESIGN: This study employed an experimental, two-group posttest design and three National League for Nursing/Laerdal Simulation Evaluation instruments. After reading about suicide assessment, the experimental group was exposed to a simulated standardized patient portraying a suicidal patient. The control group received a recorded lecture on suicide assessment. RESULTS: The experimental group demonstrated a significant difference in student scores of self-confidence, satisfaction, and student perceptions of the educational practices (active learning, collaboration, and appeal to diverse learning styles) when compared to the lecture format. CONCLUSION: Suicide assessment is a critical assessment skill set that can be effectively taught to nursing students using standardized patients.

Economic evaluation of the 80% baccalaureate nurse workforce recommendation: a patient-level analysis.

BACKGROUND: Higher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute of Medicine report calls for increasing the proportion of BSN-educated nurses to 80% by 2020. Patient-level evidence of cost and quality implications of the 80% BSN threshold is needed for a business case to support these efforts. OBJECTIVES: To conduct the economic analysis of meeting the 80% BSN threshold on patient outcomes and costs, using linked patient-nurse data. RESEARCH DESIGN: Retrospective observational patient-level analysis of electronic data. Linear and logistic regression modeling with patient controls and diagnosis and unit fixed effects. SUBJECTS: A total of 8526 adult medical-surgical patients matched with 1477 direct care nurses from an Eastern US academic medical center, during June 1, 2011-December 31, 2011. MEASURES: Outcomes include hospital mortality, all-cause same-facility 30-day readmission, length-of-stay, and total hospitalization cost. BSN proportion is a continuous measure for the proportion of nurse assessment inputs into the patient's electronic medical record made by BSN-educated nurses; a dichotomous indicator for BSN proportion is 0.8-1.0. RESULTS: Continuous BSN proportion was associated with lower mortality (OR=0.891, P<0.01). Compared with patients with <80% BSN care, patients receiving ≥ 80% of care from BSN nurses had lower odds of readmission (OR=0.813, P=0.04) and 1.9% shorter length-of-stay (P=0.03). Economic simulations support a strong business case for increasing the proportion of BSN-educated nurses to 80%. CONCLUSIONS: A combined approach of increasing the hospital-level BSN proportion to 80% and assuring a high BSN dose through individual patient-level staffing assignments is needed to achieve projected quality and costs benefits.

Perceived facilitators and barriers to baccalaureate degree completion among registered nurses with an associate's degree.

BACKGROUND: A strong movement is underway in the United States to increase the percentage of baccalaureate-prepared registered nurses (RNs). However, the percentage of associate's-prepared RNs who go on to pursue baccalaureate education remains low. The authors sought to determine facilitators and barriers that associate's-prepared RNs experience in progressing toward baccalaureate nursing education. METHOD: A convenience sample (n = 81) of associate's-prepared RNs was used to collect data on perceived facilitators and barriers to progression toward baccalaureate nursing education. RESULTS: Facilitators included a desire for personal growth, professional and career enhancement, programmatic and articulation friendliness, and encouragement by others. Barriers included family and job constraints, financial concerns, and lack of differential treatment between associate's-prepared RNs and baccalaureate-prepared RNs. CONCLUSION: Although at first glance the identification of four facilitators and three barriers may appear to indicate an advance toward progression to baccalaureate education, the magnitude of the barriers may outweigh that of the facilitators. Therefore, the magnitude of both facilitators and barriers is worthy of future study.

Demographic and academic-related differences between standard-entry and graduate-entry nursing students: a prospective correlational survey.

BACKGROUND: Students who enroll in graduate-entry nursing programs are described as more highly motivated, scoring higher in most learning strategies, and achieving greater academic success than standard-entry nursing students. DESIGN: A prospective correlational design was used to compare the demographic and academic-related characteristics of standard-entry and graduate-entry nursing students in their first year of study. METHODS: Between 2007 and 2011, students enrolled in the Bachelor of Nursing, Standard Entry and the Bachelor Nursing, Graduate Entry at a large Australian university were surveyed in the first year of their program. Data included English-language usage and time spent in paid work, as well as four dimensions of Pintrich's Motivated Strategies for Learning Questionnaire. Survey data was linked to students' academic grades at the end of the semester. RESULTS: A total of 730 students completed the survey and consented to collection of their academic grades. Graduate-entry students were more likely to be older (28.6 vs. 24.3 years, P < 0.001), and there was a higher percentage of males (25.2% vs. 15.9%, P = 0.003). Although no difference was identified between groups for use of Extrinsic Goal Orientation as a learning strategy, the graduate-entry students were more likely to identify Peer Learning, Help Seeking and Critical Thinking as strategies for learning than the standard-entry students (P < 0.001). Further, while this group of students achieved a higher mean GPA (4.8 vs. 4.0, P < 0.001) compared to the standard-entry students, regression analyses revealed that in both groups, lower levels of English-language proficiency and increased time spent in paid work were predictors of poorer academic performance. CONCLUSIONS: Similar to US-based studies, demographic and academic-related differences were identified between standard-entry and graduate-entry nursing students. However, the study also highlights lower levels of English-language proficiency and increased time spent in paid work negatively impacted academic performance in both groups of nursing students.

Nursing students' perceptions toward the nursing profession from clinical practicum in a baccalaureate nursing program-a qualitative study.

The purpose of this study was to explore senior nursing students' perceptions toward the nursing profession and their experiences in clinical practicum in Taiwan. This study used semistructured interview guides and unstructured face-to-face dialogue with the participants based on a qualitative method. A purposive sample with a snowball method from a baccalaureate nursing program in Southern Taiwan was used to recruit participants. A total of 30 senior nursing students participated in this study. Data were collected from February to May 2011. The interviews were transcribed verbatim, and data were analyzed based on the phenomenological approach of qualitative methodology. Data were categorized into three major themes: in-depth recognition of nursing, recognition of the meaning and value of life, and decision conflicts for being a nurse. The findings of the study not only help nursing educators further understand the educational effects of clinical practicum, but also provide information for managers of medical organizations to recruit and train newly graduated nurses.

An assessment of students' confidence in performing psychiatric mental health nursing skills: the impact of the clinical practicum experience.

BACKGROUND: In 2008, the American Psychiatric Nurses Association and the International Society for Psychiatric Nursing jointed developed Psychiatric Mental Health Nursing competencies for BSN students. In the newly created accelerated track of the BSN program, students spend less time than traditional students in psychiatric mental health (PMH) clinical practica. OBJECTIVES: The primary objective was to discover how the PMH practicum experience influences BSN students' perceptions of their confidence in performing PMH clinical skills. DESIGN: An evaluation design was used in this study. RESULTS: There was significant improvement in students' confidence performing PMH clinical competencies after completing the PMH nursing practicum. The current structure of clinical provides students with experiences that promote their confidence. CONCLUSIONS: Students self-assessment about learning needs and skill level should be assessed preclinically to allow for practice to gain confidence.

Health, sustainability and student travel.

A survey of 246 pre-registration nursing students in a University in the South West of England was carried out to explore the impact of course related travel on the student experience. Results from the survey indicated that students' main mode of transport to practice placements was by car which reflects the rural nature of the South West and the relative paucity of public transport. Long distances that many students travel to their study centre and to placements, and the concurrent financial strain that this creates, impacted negatively on the student experience. Students recognised the need to travel to a place of study and clinical placements and suggestions of minimising the negative impact of travel were offered. These included the increased use of electronic delivery of lectures, attendance at local university premises, the provision of shared transport to placements and placements closer to the student's home. Few students, however, considered the environmental impact of travel. Higher Education Institutions need to address issues of sustainability through promoting student wellbeing and taking steps to reduce greenhouse gas emissions. It is therefore important that student awareness of sustainability related issues is increased as well as focusing on reducing the environmental impact through organisational change.