RESUMEN
BACKGROUND: Publication of the research work done during the master's program is highly desirable. However, there is a paucity of data on the number of publications, especially from low-income countries. The objective was to find out the status of the publication of the theses of post-graduate students in Nursing from the Institute of Medicine, Tribhuvan University, Nepal from 2015-2019. METHODS: Cross-sectional analytical design with a structured interview via telephone was done for data collection. Independent variables were age, marital status, current work status, current working organization, type of research, year of graduation, and facilitators and barriers to publication, whereas dependent was the publication status of the thesis. RESULTS: Two hundred five (76.2%) out of 269 participated in the study. The age group ranged from 27 to 50 years (mean ± SD = 36.6±4.8). The majority 89.3% were married. Currently working in academic institutions was 51.7%. One hundred ninety-eight (96.6%) respondents performed a cross-sectional descriptive study. Only 2.9% of studies were cross-sectional analytical and 0.5% were qualitative. Seventy-five (36.6%) respondents published their theses. Twenty-seven (36.0%) were published in PubMed-indexed journals. The most common facilitator for publication was academic satisfaction [59 out of 75(78.7%)] followed by encouragement from supervisors 52.0% and peers 40.0%, whereas the commonest barrier to publication was lack of interest [80 out of 124 (64.5%)] followed by lack of confidence 51.6%. CONCLUSIONS: Based on the results, more than one-third of the participants published their theses in national and international journals including those indexed in PubMed. Provision of university research grants, development of publication culture among post-graduate students, and making a provision of academic publication before degree awards should be encouraged for more academic publication.
Asunto(s)
Estudiantes de Enfermería , Humanos , Estudios Transversales , Nepal , Adulto , Masculino , Femenino , Estudiantes de Enfermería/estadística & datos numéricos , Persona de Mediana Edad , Tesis Académicas como Asunto , Educación de Postgrado en Enfermería/estadística & datos numéricos , Edición/estadística & datos numéricosRESUMEN
BACKGROUND: Doctorate of Nursing Practice preparation is recommended for entry to nurse practitioner (NP) practice but there are few comparative studies, and their designs conflate educational pathways. PURPOSE: To investigate time use, functional autonomy, and job outcomes among NPs without a doctorate, NPs whose initial NP preparation and doctorate were separated by 2 or more years, and NPs whose NP preparation and doctorate were concurrent. METHOD: We selected all NPs from the 2018 National Sample Survey of Registered Nurses, except those whose doctorates focused on research. We controlled for confounding and applied sample weights to produce nationally representative results. DISCUSSION: NPs' educational pathways are associated with distinct practice roles and, moving forward, policy should be informed by evidence that accounts for their differences. CONCLUSION: Concurrent NPs had higher levels of functional autonomy compared with NPs without a doctorate, but patterns of time use were essentially the same. Separate doctoral education was associated with teaching and administration.
Asunto(s)
Educación de Postgrado en Enfermería , Enfermeras Practicantes , Autonomía Profesional , Humanos , Enfermeras Practicantes/estadística & datos numéricos , Enfermeras Practicantes/educación , Femenino , Masculino , Adulto , Persona de Mediana Edad , Educación de Postgrado en Enfermería/estadística & datos numéricos , Encuestas y Cuestionarios , Estados Unidos , Satisfacción en el TrabajoRESUMEN
BACKGROUND: The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood. AIMS: This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects. METHODS: Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus. RESULTS: Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0-5). LINKING EVIDENCE TO ACTION: Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.
Asunto(s)
Educación de Postgrado en Enfermería , Estudiantes de Enfermería , Humanos , Educación de Postgrado en Enfermería/métodos , Educación de Postgrado en Enfermería/normas , Educación de Postgrado en Enfermería/estadística & datos numéricos , Estudiantes de Enfermería/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Postgraduate orthopaedic programs for physician assistants (PAs) and nurse practitioners (NPs) number 14 as of 2020. To better understand the characteristics of these programs a census was undertaken. The result is that most programs are 1 year in duration and in 2019 produced 40 graduates. The role of the orthopaedic PA and NP fellow is to gain an understanding of a wide range of musculoskeletal disorders, develop procedural skills, first assist in the operating room, and facilitate management of patients and discharge throughput. PA and NP fellows work alongside categorical orthopaedic physician residents. The number of graduates from PA orthopaedic training programs is estimated at 200, spanning 20 years. The other 11,145 + PAs (99%) are trained on-the-job. For hospital systems, the employment of orthopaedic postgraduate PA and NP fellows provides value through cost management and billable services.
Asunto(s)
Enfermeras Practicantes/educación , Ortopedia/educación , Asistentes Médicos/educación , Educación de Postgrado en Enfermería/métodos , Educación de Postgrado en Enfermería/estadística & datos numéricos , Humanos , Enfermeras Practicantes/tendencias , Ortopedia/tendencias , Asistentes Médicos/tendencias , Rol Profesional , Facultades de Medicina/organización & administración , Facultades de Medicina/estadística & datos numéricos , Facultades de Enfermería/organización & administración , Facultades de Enfermería/estadística & datos numéricosRESUMEN
PURPOSE: To examine completion and attrition of students in nursing PhD programs. METHODS: Total 5,391 students who matriculated into nursing PhD programs in 2001 to 2010 were selected from the AACN database. FINDINGS: The completion rate of the students was 74.2% and the attrition rate was 22.7%. On average, it took 5.7 years for the students to graduate and 3.7 years for the students who left without graduating to drop out. The mean age at matriculation and graduation was 42.4 and 47.5, respectively. Male students, part-time students, students of post-baccalaureate programs, students who were not faculty or held a part-time faculty position, students of the 2001 to 2010 matriculation cohorts, and students in PhD programs with 25% or more of the courses taught online were more likely to experience attrition. CONCLUSION: The study findings provide useful information for the nursing education community to better address the issue of nursing PhD shortage.
Asunto(s)
Educación de Postgrado en Enfermería/estadística & datos numéricos , Investigación en Enfermería/estadística & datos numéricos , Abandono Escolar/estadística & datos numéricos , Estudiantes de Enfermería/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Adulto JovenRESUMEN
Statistics knowledge is essential for nursing faculty in both teaching and research roles. In the teaching role when discussing nursing research, nursing faculty are confronted with statistical concepts and statistical methods applications. Knowledge of fundamental statistical concepts is needed so that nursing faculty can understand and critically evaluate the literature. The purpose of this study was to assess nursing faculty knowledge of fundamental statistical concepts. A probability sample with a 7.7% response rate yielded participation from 164 nursing faculty from 26 accredited schools. Results showed that most faculty members (91.5%) read peer-reviewed health-related scientific journal articles. On average, nursing faculty answered 5.1 (SD = 1.6) out of 8 statistical knowledge questions correctly. Problematic concepts included randomization (43.3% correct), and interpreting a confidence interval (42.7%) and odds ratio (33.5%). The results of this study may be used to improve statistics education and training for future nursing faculty and strengthen scholarship for nursing faculty conducting research.
Asunto(s)
Educación de Postgrado en Enfermería/normas , Docentes de Enfermería/normas , Competencia Profesional/normas , Estadística como Asunto/normas , Estudios Transversales , Educación de Postgrado en Enfermería/estadística & datos numéricos , Docentes de Enfermería/estadística & datos numéricos , Humanos , Competencia Profesional/estadística & datos numéricos , Instituciones Académicas/organización & administración , Instituciones Académicas/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: The aging and retirement of the current nursing professoriate and the increasing numbers of nurses pursuing practice doctorates has precipitated decreasing numbers of nurses, specifically diverse nurses pursuing a research doctorate, thus limiting the development of nursing science. PURPOSE: To describe factors influencing decisions about entering a PhD program from the perspectives of early-entry PhD nursing students. METHOD: A qualitative descriptive design using semistructured interviews to explore the perceptions of making the decision to pursue a PhD in nursing of the students who participated in two early-entry mentoring programs. FINDINGS: A model, entitled "Seizing Opportunity" was developed from the findings about the process of students deciding to pursue a PhD. DISCUSSION: Motivators and detractors that can help nursing educators understand how to successfully recruit diverse PhD students were uncovered. Providing knowledge and mentoring for early entry students can increase the numbers of diverse students pursuing a PhD in nursing.
Asunto(s)
Selección de Profesión , Bachillerato en Enfermería/estadística & datos numéricos , Educación de Postgrado en Enfermería/estadística & datos numéricos , Estudiantes de Enfermería/psicología , Estudiantes de Enfermería/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación en Enfermería/estadística & datos numéricos , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: This article evaluates a single-institution educational innovation using course-specific open educational resources (OER). METHOD: This educational innovation uses a course-specific library resource guide of OERs and evaluates students' perspectives on the quality, integration, and experience with the resources. At the completion of a nursing graduate course, the OER Satisfaction Scale was administered to the course participants. The course-specific OERs were assessed compared to students' experiences with traditional course materials. RESULTS: The overall score on the OER Satisfaction Scale was 4.01 on a 5-point Likert Scale. Students appreciated that the resources were free and found that the information was manageable and easy to navigate. However, they were challenged with shutting out other distractions and taking useful notes. CONCLUSION: Using OERs enhanced student engagement with the course content by requiring learners to assume a more active role as course participants. Further work is needed to understand the effectiveness of OERs, particularly in graduate nursing education. [J Nurs Educ. 2020;59(10):577-580.].
Asunto(s)
Educación de Postgrado en Enfermería , Recursos en Salud , Educación de Postgrado en Enfermería/métodos , Educación de Postgrado en Enfermería/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Humanos , Estudiantes de EnfermeríaRESUMEN
Recent reports from the Institute of Medicine document the increase in the number of nurses enrolled in doctoral education preparing for nurse scientist and leadership roles in the transformation of health care. This means that many doctoral students will acquire a knowledge of the research process, learn how to review and critique relevant literature, select appropriate research designs, and with the guidance of their dissertation chair and committee, design and conduct high quality, scholarly research studies that culminate in successfully defended doctoral dissertations. The health care profession expects that these dissertations, which include quantitative, qualitative, or mixed methods, will contribute to the knowledge base of the nursing profession and advance improvement in clinical and public health outcomes in the populations served by the nursing profession. This article reviews the concept of rigor in research, the rationale for rigor, various approaches that increase rigor, and the associated concepts that strengthen a research study.
Asunto(s)
Tesis Académicas como Asunto/normas , Educación de Postgrado en Enfermería/métodos , Estudiantes de Enfermería/estadística & datos numéricos , Educación de Postgrado en Enfermería/normas , Educación de Postgrado en Enfermería/estadística & datos numéricos , HumanosRESUMEN
BACKGROUND AND PURPOSE: Accelerated bachelor's and master's nursing students supported through the New Careers in Nursing program were surveyed (n = 3,506) using subscales from Arthur's Professional Self-Concept in Nursing Instrument (PSCNI). Reliability and validity of the instrument was assessed. METHODS: Factor analysis using a random split-half design were conducted and differences investigated based on characteristics. RESULTS: Four factors were revealed: leadership (α = .85), skill (α = .89), career positivity (α = .72), and career negativity (α = .72), with acceptable confirmatory fit. Gender and race/ethnicity differences were found in self-perceived leadership and skill and in career positivity by race/ethnicity. Accelerated bachelor's and master's students were different on skill and career positivity. CONCLUSIONS: Self-perceived leadership, skill, career positivity, and career negativity are distinct PSCNI concepts.
Asunto(s)
Bachillerato en Enfermería/estadística & datos numéricos , Educación de Postgrado en Enfermería/estadística & datos numéricos , Autoimagen , Estudiantes de Enfermería/psicología , Estudiantes de Enfermería/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Adulto , Análisis Factorial , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
OBJECTIVE: to discuss the paths taken by Brazilian Nursing in the development of terminological subsets of the International Classification for Nursing Practice. METHOD: documentary research, carried out in master's dissertations and doctoral theses, which developed terminological subsets, available at the Bank of Doctoral Theses and Master's Dissertations of the Under-graduation Personnel Improvement Coordination. The variables were analyzed were institution, year; academic level, type of health service, methodological approach, clientele, theoretical reference, validation of terms, cross mapping, modeling of new concepts, validation of statements, method used for elaboration, term collection, finalization and dissemination. RESULTS: 124 doctoral theses and master's dissertations were found, 91 were excluded and 33 were included, 23 (69.70%) of which were master's dissertations, with the highest production in 2014 (n=10; 30.30%), with emphasis on the Northeast (36.36%); the 'Primary Care' scenario, with six studies (18.18%); and the predominant clientele was cancer patients. As for the methodological characteristics, in 96% of the studies, the quantitative approach was used; in 2%, a qualitative approach; and 2% associated the quantitative and qualitative approaches. As for the type of study, 60% were methodological and 24% descriptive-exploratory, with the Horta model being the most used (36%). CONCLUSION: the paths are successful, yet still permeated by weaknesses in the validations and potentialities to standardize the language.
Asunto(s)
Tesis Académicas como Asunto , Bibliometría , Terminología Normalizada de Enfermería , Vocabulario Controlado , Brasil , Bases de Datos Bibliográficas/estadística & datos numéricos , Educación de Postgrado en Enfermería/estadística & datos numéricos , Humanos , Lenguaje , Investigación en Enfermería/estadística & datos numéricosRESUMEN
BACKGROUND: Specialist graduate emergency nursing education programs are essential to the delivery of high quality and safe healthcare to patients with complex needs in emergency care. Little is known about tertiary emergency nursing programs in Australia. This study aimed to determine the academic and professional characteristics of Australian emergency programs. METHOD: This embedded mixed-method study examined the academic and professional characteristics of Australian emergency programs in two interdependent phases: (1) document and content analysis of Australian graduate emergency nursing program websites; and (2) semi-structured interviews with the associated convenors. The data underwent framework analysis using eight pre-identified categories of (i) course entry, (ii) fee arrangement, (iii) mode of delivery, (iv) volume of learning, (v) clinical assessment, (vi) employment requirements, (vii) graduate expectations, and (viii) influence of healthcare employers and professional engagement. RESULTS: Prior clinical experience and the requirement for concurrent practising in an emergency care environment influenced were common, however fee arrangements were not clearly articulated. The College of Emergency Nursing Australasia Practice Standards for the Emergency Nursing Specialist featured in part within 12 programs, principally to guide development of clinical assessments. CONCLUSION: Establishment of emergency nursing graduate practice standards could better inform the design and delivery of emergency nurse programs, and yield benefits in terms of graduate expectations and satisfaction and improved patient care.
Asunto(s)
Éxito Académico , Educación de Postgrado en Enfermería/clasificación , Educación de Postgrado en Enfermería/normas , Australia , Educación de Postgrado en Enfermería/estadística & datos numéricos , Humanos , Profesionalismo , Facultades de Enfermería/organización & administración , Facultades de Enfermería/normas , Facultades de Enfermería/estadística & datos numéricosAsunto(s)
Educación de Postgrado en Enfermería/métodos , Enfermería Basada en la Evidencia/educación , Estudiantes de Enfermería/estadística & datos numéricos , Curriculum/tendencias , Educación de Postgrado en Enfermería/estadística & datos numéricos , Enfermería Basada en la Evidencia/estadística & datos numéricos , Humanos , Encuestas y CuestionariosRESUMEN
Master's level education can play important function in developing the knowledge and skills for nurses and allied professionals working in advanced roles in dementia care. However, little is known about the challenges experienced by professionals when making the transition to post-graduate study. This was a qualitative study comprising individual interviews with 15 graduates, nine of whom were nurses, who had experience of attending a part-time Master's in Dementia Care in the Northwest of England. Four sequential themes emerged from the data: 'Deciding what to do', 'Taking it on', 'Keeping going' and 'Endings and New beginnings'. Findings confirmed that Master's education for nurses and other professionals is significant in developing knowledge and instilling confidence in changing practice. Nevertheless, professionals experienced challenges in juggling the competing demands of education, family and work and were seen to navigate and negotiate their student journey by drawing on internal resources and external supports. The study adds to evidence that Master's level study is likely to benefit practice in dementia care; however, employers and Higher Education Institutions need to develop effective and flexible supports to enable nurses and allied professionals to engage effectively in part-time taught post graduate education.
Asunto(s)
Demencia/enfermería , Educación de Postgrado en Enfermería/normas , Adulto , Actitud del Personal de Salud , Demencia/fisiopatología , Educación de Postgrado en Enfermería/métodos , Educación de Postgrado en Enfermería/estadística & datos numéricos , Inglaterra , Femenino , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Investigación CualitativaRESUMEN
Appropriate clinical practice sites with skilled preceptors are the backbone of family nurse practitioner (FNP) students' education. Faculty are also in need of practice sites to stay abreast of current clinical practice and maintain clinical hours for certification. The purpose of this article is to relate the process of developing a practice model to meet the needs of the FNP student and faculty. Academia and student life professionals collaborated to use an existing student health center on campus as an education site with an FNP nursing faculty member as a preceptor. This qualitative descriptive study presents reflections of the experience from the student perspective. Three main themes were identified: independence, confidence, and trust. Lessons learned from the faculty perspective are also reviewed. Benefits of the project ultimately outweighed barriers. The interdepartmental precepted practice experience completed its fourth successful year and maintains support through the university's student life division. The model may provide strategies, particularly for FNP programs and faculty in smaller universities, to increase and diversify clinical experiences and provide a faculty practice site.
Asunto(s)
Docentes de Enfermería/psicología , Enfermeras de Familia/educación , Evaluación de Necesidades , Estudiantes de Enfermería/psicología , Educación de Postgrado en Enfermería/métodos , Educación de Postgrado en Enfermería/normas , Educación de Postgrado en Enfermería/estadística & datos numéricos , Docentes de Enfermería/estadística & datos numéricos , Enfermeras de Familia/psicología , Enfermeras de Familia/estadística & datos numéricos , Humanos , Entrevistas como Asunto/métodos , Pennsylvania , Investigación Cualitativa , Estudiantes de Enfermería/estadística & datos numéricosRESUMEN
Preceptors are essential to nurse practitioner (NP) students' transition from being a student to competent entry-level NP graduate. The literature is replete with data pertaining to the benefits of and barriers to preceptors engaging in the clinical education of NP students, and little has changed in the last two decades in this regard. Therefore, faculty solicited preceptor input to enhance curriculum revision and clinical training preparation. This qualitative inquiry project derived data from interviews with 13 preceptors in a variety of clinical settings. Interviews were audio-recorded, transcribed verbatim, and analyzed using a content analysis method. Recruiting, training, and retaining qualified, willing preceptors are of paramount importance to NP programs. This article describes preceptor expectations of NP students' knowledge, skills, and attitudes for optimal clinical rotation experiences. The results have important implications for innovative NP educational models, developing trust in NP education programs and promoting competency development of the NP student using entrustable professional activities.
Asunto(s)
Educación de Postgrado en Enfermería/normas , Mentores/psicología , Preceptoría/normas , Actitud del Personal de Salud , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Educación de Postgrado en Enfermería/métodos , Educación de Postgrado en Enfermería/estadística & datos numéricos , Humanos , Entrevistas como Asunto/métodos , Mentores/estadística & datos numéricos , Preceptoría/métodos , Preceptoría/estadística & datos numéricos , Investigación Cualitativa , Mejoramiento de la CalidadRESUMEN
BACKGROUND: Current doctoral degree options may not meet needs of nurses desiring educator roles in academic or health care settings. PURPOSE: The purpose of the study was to assess preferences for existing terminal degree options for nurse educators and determine the need for a new doctoral degree in nursing education. METHOD: Nurses in practice, academia, and leadership nationwide (n = 826) answered a 19-item needs assessment survey regarding adequacy of and interest in terminal degree options. RESULTS: More than 60% reported current doctoral degrees available to nurse educators lack content in curriculum development and teaching-learning best practices in nursing. Most data supported a new terminal degree. CONCLUSION: A primary factor in nurses choosing not to enroll in a terminal degree program may be limited availability of education aligned with career goals. The doctor of nursing education, a practice degree parallel to the DNP, could prepare nurses for academic and practice educator roles.
Asunto(s)
Selección de Profesión , Educación de Postgrado en Enfermería/estadística & datos numéricos , Educación de Postgrado en Enfermería/normas , Docentes de Enfermería/psicología , Personal de Enfermería/psicología , Aprendizaje Basado en Problemas/estadística & datos numéricos , Aprendizaje Basado en Problemas/normas , Adulto , Anciano , Anciano de 80 o más Años , Docentes de Enfermería/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación en Educación de Enfermería , Personal de Enfermería/estadística & datos numéricos , Estados Unidos , Adulto JovenRESUMEN
ABSTRACT: Current trends dictate that advanced practice registered nurses (APRNs) must be competent to address quality/safety issues specific to older adults. A gap analysis and review of key competencies in an adult-gerontology APRN-Doctorate of Nursing Practice (DNP) curriculum prompted the design and evaluation of an innovative online course, Quality and Safety for the Aging Adult. Course objectives align with key competencies, including graduate-level Quality and Safety Education for Nurses (QSEN) and the DNP Essentials. The course purpose was to prepare adult-gerontology APRN-DNP students as leaders to promote quality/safety outcomes for aging adults. The six-step Knowledge-to-Action Framework guided course development and evaluation. Select graduate-level QSEN competencies were used to construct a 20-item Quality and Safety Survey (4-point Likert scale) (Cronbach's alpha, 0.916). This survey was used during week 1 (pre) and week 15 (post) of the semester to evaluate students' preparation and confidence to perform key QSEN competencies. Significant improvements (p < .000) between pre/post scores on the Quality and Safety Survey were found across five classes. Students felt more prepared and confident to apply selected QSEN competencies on course completion. Moreover, nearly 60% (primary care) and nearly 35% (acute care) adult-gerontology APRN students selected the older adult population for their DNP projects. The Quality and Safety for the Aging Adult course positively influenced five classes of adult-gerontology APRN-DNP students. Integrating QSEN competencies with gerontology and quality/safety content is an effective strategy to prepare APRNs to lead quality/safety initiatives in aging adults. This innovative online course offers a successful model for innovative DNP education of adult-gerontology APRNs.