High-Fidelity Simulation Versus Case Study: Which Is Best for Practical Nursing Students?

ABSTRACT: There is a gap in the literature regarding how simulation affects critical thinking skills for practical nursing students. A quasi-experimental two-group pretest-posttest study was conducted to determine the effects of high-fidelity simulation and interactive case studies on critical thinking scores of 29 practical nursing students. Both interventions had significant results (p = .001) between pretest and posttest; however, significance was not found regarding posttest scores between the high-fidelity simulation and interactive case study groups. Identifying pedagogical strategies that increase critical thinking skills for certificate-seeking practical nursing students is necessary to provide excellent nursing care and promote better patient outcomes.

Lessons From the Heart: A Kinesthetic Activity for Practical Nursing Students.

Current trends in health care delivery require nursing programs to change how education is presented to nursing students. Active learning strategies, such as discovery learning through kinesthetic activities, have been associated with increases in student engagement and satisfaction. A kinesthetic learning strategy was developed and implemented at a licensed practical nursing program to increase student engagement and provide knowledge of cardiovascular function and various etiologies associated with the heart. The goals of the activity were to provide deeper understanding and improve critical thinking and clinical application for the student.

The Similarities and Differences in Transition to Practice Experiences for New-Graduate RNs and Practical Nurses in Long-term Care.

OBJECTIVE: The aim of this study was to describe the transition-to-practice experience of new-graduate nurses (NGNs) in long-term-care (LTC) settings. BACKGROUND: Transitioning to professional practice is a challenging time for an NGN. This experience is scarcely described for RNs outside of acute care settings and not described for the LPN. METHODS: A qualitative case study was used to explore the described transition-to-practice experience of new-graduate RNs and LPNs in LTC. RESULTS: This study revealed that the transition-to-practice experience of new-graduate LPNs was similar to the experience described by RNs. Differences in experience were related to leadership roles in the setting. CONCLUSIONS: Findings contribute to new understanding of the experience of the NGN in LTC settings. This study reinforces the need for greater support for nursing graduates in this setting.

Process evaluation of a stepped-care program to prevent depression in primary care: patients' and practice nurses' experiences.

BACKGROUND: Depression is common in patients with diabetes type 2 (DM2) and/or coronary heart disease (CHD), with high personal and societal burden and may even be preventable. Recently, a cluster randomized trial of stepped care to prevent depression among patients with DM2 and/or CHD and subthreshold depression in Dutch primary care (Step-Dep) versus usual care showed no effectiveness. This paper presents its process evaluation, exploring in-depth experiences from a patient and practice nurse perspective to further understand the results. METHODS: A qualitative study was conducted. Using a purposive sampling strategy, data were collected through semi-structured interviews with 24 participants (15 patients and nine practice nurses). All interviews were audiotaped and transcribed verbatim. Atlas.ti 5.7.1 software was used for coding and structuring of themes. A thematic analysis of the data was performed. RESULTS: The process evaluation showed, even through a negative trial, that Step-Dep was perceived as valuable by both patients and practice nurses; perceived effectiveness on improving depressive symptoms varied greatly, but most felt that it had been beneficial for patients' well-being. Facilitators were: increased awareness of mental health problems in chronic disease management and improved accessibility and decreased experienced stigma of receiving mental health care. The Patient Health Questionnaire 9 (PHQ-9), used to determine depression severity, functioned as a useful starting point for the conversation on mental health and patients gained more insight into their mental health by regularly filling out the PHQ-9. However, patients and practice nurses did not widely support its use for monitoring depressive symptoms or making treatment decisions. Monitoring mental health was deemed important in chronically ill patients by both patients and practice nurses and was suggested to start at the time of diagnosis of a chronic disease. Appointed barriers were that patients were primarily motivated to participate in scientific research rather than their intrinsic need to improve depressive symptoms. Additionally, various practice nurses preferred offering individually based therapy over pre-determined interventions in a protocolled sequence and somatic practice nurses expressed a lack of competence to recognise and treat mental health problems. CONCLUSION: This study demonstrates both the benefits and unique demands of programs such as Step-Dep. The appointed facilitators and barriers could guide the development of future studies aiming to prevent depression in similar patient groups.

Valuing the EN workforce.

Some district health boards are embracing ENs in their skill mix but others remain resistant. Is the EN workforce at a tipping point and is the lack of workforce planning to blame?

Rejuvenating EN education.

The level 5 diploma is a huge milestone in enrolled nursing's journey. The future of enrolled nursing depends on the health sector committing to employing diploma graduates as ENs.

Enhancing Role Clarity for the Practical Nurse: A Leadership Imperative.

OBJECTIVE: The aim of this study was to determine factors contributing to practical nurse (PN) role confusion and the impact on nursing intraprofessional team collaboration. BACKGROUND: There is limited literature describing the intraprofessional relationship of the RN and PN in areas such as role conflict, scope of practice, and team collaboration. METHODS: A mixed-methods design was used targeting Ontario RNs and PNs, including an online survey and focus groups. RESULTS: Results (N = 1101) revealed varying levels of knowledge regarding the distinct and overlapping scope of practice for each role, with shared opinions regarding areas such as respect, teamwork, and the role of leadership. CONCLUSIONS: Nurses' roles will continue to evolve in response to changes in patient populations and healthcare systems. As such, role clarity is essential to support optimal use of nursing knowledge for safe patient care. Leadership is key to establishing parameters for professional practice and creating a culture of collaboration and respect.

Perspectives on Patient Safety Among Practical Nursing Students.

Background Practical nursing students are students enrolled in a two-year college practical nursing diploma program. They are responsible for providing safe patient care to the patients they care for. Assessing students' perceptions of their own patient safety competencies can help educators identify gaps in their knowledge and skills and identify, at a curricula level, the concepts and information required to improve the quality of their care. Purpose To explore practical nursing students' confidence in what they are learning about patient safety within their nursing education. Methods This cross-sectional descriptive study used a modified version of the Health Professional Education in Patient Safety Survey. Results Overall, students expressed the greatest confidence in their abilities to provide care in Clinical Safety topics. More than 75% of the students' feared punishment when making an error and 88% have difficulty questioning other healthcare providers. Less than 30% of students stated that a system-level focus on errors was taught to them in their education programs. Conclusions More investigation is needed to understand what practical nursing students' fear about the provision of safe care. Additional focus on systems aspects of hazard identification and the prevention of errors needs to be present in nursing education programs.

Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care.

AIM: To evaluate feasibility of a practical nurse-administered Drug-related Problem Risk Assessment Tool among home care clients ⩾65 years. METHODS: Altogether, 36 practical nurses participated in the study. They were trained about the purpose and use of the tool. The training consisted of a day long interactive workshop and involved reviewing four self-selected clients' medications using the tool (one as a pre-assignment before and three as post-assignments after the workshop). The data of this study were collected during the training. Triangulation, i.e. combination of methods and data, was used to evaluate the feasibility of the tool. Quantitative data were gathered from returned post-assignment tools and qualitative data from face-to-face discussions and open questions in feedback forms the practical nurses returned after the training. RESULTS: Practical nurses spent 10-45 minutes reviewing one client's medication using the tool (mean 20±8). They identified reliably 88% of the risk medicines used by the clients listed in the tool. Of the respondents (n=23) of the feedback forms, 43% reported that they felt it easy or quite easy to answer the questions of the tool. Generic names of medicines, time constraints, home-care workers'/client's lack of interest to client's pharmacotherapy and short client contacts were the most common barriers to use the tool. CONCLUSIONS: The Drug-Related Problem Risk Assessment Tool turned out to be feasible among practical nurses. The brief training on the content and use of the tool seems to be sufficient for ensuring reliable use of the tool.

Pain Assessment Strategies in Home Care and Nursing Homes in Mid-Norway: A Cross-sectional Survey.

The prevalence of pain ranges from 27.8% to 86.5% in nursing homes and 42% to 50% in home care. Pain assessment is the first step toward effective pain management. The aim of this study was to explore the use of pain assessment strategies (verbal, numeric, and observation rating scales and standardized questions) in home care and nursing homes. The study was a descriptive cross-sectional survey. Health care providers who were responsible for the patients' medications replied to a questionnaire. In-home care and nursing homes in 11 randomly selected municipalities in Mid-Norway were included. Three hundred ninety-two individuals were included in this study (70% response rate): 271 (69%) from nursing homes and 121 (31%) from home care. The respondents working in home care had a higher educational level than those in working in nursing homes. Pain assessment instruments were not used frequently in nursing homes and home care. Verbal and numeric rating scales were used significantly more frequently in home care than in nursing homes. Registered nurses (RNs) in nursing homes used standardized questions significantly more often than did RNs in home care. RNs and social educators in home care self-reported less competence in treating the patients' total pain experience than did those in nursing homes. Workplace (working in home care) and regular training in the use of pain assessment tools explained more than 20% of the variation in the use of pain assessment tools. Regular training in the use of pain assessment tools is needed for health care workers in home care and nursing homes.

Specific Physician Orders Improve Pain Detection and Pain Reports in Nursing Home Residents: Preliminary Data.

Despite evidence that many nursing home residents' pain is poorly managed, reasons for this poor management remain unanswered. The aim of this study was to determine if specific order sets related to pain assessment would improve pain management in nursing home (NH) residents. Outcomes included observed nurse pain assessment queries and resident reports of pain. The pretest/post-test study was performed in a 240-bed for-profit nursing home in the mid-southern region of the United States and participants were 43 nursing home residents capable of self-consent. Medical chart abstraction was performed during a 2-week (14-day) period before the implementation of specific order sets for pain assessment (intervention) and a 2-week (14-day) period after the intervention. Trained research assistants observed medication administration passes and performed participant interviews after each medication pass. One month after intervention implementation, 1 additional day of observations was conducted to determine data reliability. Nurses were observed to ask residents about pain more frequently, and nurses continued to ask about pain at higher rates 1 month after the intervention was discontinued. The proportion of residents who reported pain also significantly increased in response to increased nurse queries (e.g., "Do you have any pain right now?"), which underscores the importance of nurses directly asking residents about pain. Notably 70% of this long-stay NH population only told the nurses about their pain symptoms when asked directly. Findings uncover that using specific pain order sets seems to improve the detection of pain, which should be a routine part of nursing assessment.

Educational silos in nursing education: a critical review of practical nurse education in Canada.

Changes to practical nurse education (with expanded scopes of practice) align with the increasing need for nurses and assistive personnel in global acute care contexts. A case in point is this critical exploration of Canadian practical nursing literature, undertaken to reveal predominating discourses and relationships to nursing disciplinary knowledge. The objectives of this poststructural critical review were to identify dominant discourses in practical nurse education literature and to analyze these discourses to uncover underlying beliefs, constructed truths, assumptions, ambiguities and sources of knowledge within the discursive landscape. Predominant themes in the discourses surrounding practical nurse education included conversations about the nurse shortage, expanded roles, collaboration, evidence-based practice, role confusion, cost/efficiency, the history of practical nurse education and employer interests. The complex relationships between practical nursing and the disciplinary landscape of nursing are revealed in the analysis of discourses related to the purpose(s) of practical nurse education, curricula/educational programming, relationships between RN and PN education and the role of nursing knowledge. Power dynamics related to employer needs and interests, as well as educational silos and the nature of women's work, are also revealed within the intersection of various discourses.

Living longer at home: a qualitative study of older clients' and practical nurses' perceptions of home care.

AIMS AND OBJECTIVES: To identify descriptions of older (75+) home care clients and practical nurses regarding the current structure of home care available for older clients and the elements promoting the ability of clients to continue living at home. BACKGROUND: The ageing population is a major global challenge in social and health care. In many countries, the focus of care for older clients has shifted from institutional care towards a model of home care. Increasing attention has been paid to maximising the resources of older clients and aiming to support their living at home for as long as possible. DESIGN: A descriptive qualitative study METHODS: Data were collected from individual interviews by using videotaped home care visits as a tool for stimulated recall interviews. Two groups of participants were interviewed: 14 practical nurses and 23 older clients. Data were analysed by using the inductive content analysis. RESULTS: Both participant groups, practical nurses and older home care clients, described home care as organisationally driven, but highlighted the importance of individual encounters. In addition, both groups noted that clients' living at home can be supported by offering individually designed care. Individually designed care refers to showing respect to clients' opinions and promoting their individual resources. CONCLUSION: In order to be able to promote older home clients' living at home, the provided home care needs to be individually designed and must take into account clients' resources and their perspectives of meaningful and inspirational activities. RELEVANCE TO CLINICAL PRACTICE: The information produced by this study can be used to promote older clients' living at home for as long as possible. Therefore, practical nurses are required the ability to recognise older clients' individual resources and design individual care plans accordingly.

Bedside teaching and the acquisition of practical skills in mid-sixteenth-century Padua.

Very little is known to this point about the practical skills which sixteenth-century physicians needed and applied at the bedside and even less about how these skills were taught to students. Drawing on student notebooks and on printed collections of consilia by Padua professors, this paper outlines the different settings in which case-centered and, more specifically, bedside teaching was imparted in mid-sixteenth-century Padua. It describes the range of diagnostic and therapeutic skills that students acquired thanks to this hands-on training at the patient's bedside, from uroscopy and feeling the pulse to the manual exploration of the patient's abdomen, which, historians have wrongly believed, physicians performed very rarely or not at all, and surgical skills. Taking a closer look, more specifically, at the role of teaching in the Hospital of San Francesco in Padua, the paper provides evidence that not only Giovanna Battista da Monte but also at least one other mid-sixteenth-century professor, Antonio Fracanzani, made systematic use of the teaching opportunities which the hospital offered. Ultimately, the paper will argue that clinical teaching in the hospital did not differ fundamentally from forms of bedside teaching in the patients' homes, however. Both became increasingly popular in Padua and elsewhere at the time, reflecting a growing appreciation for the practical and sensory skills which future physicians needed in addition to theoretical learning if they hoped to be successful in the highly contested early modern medical marketplace.

Socialization of nontraditional nursing students.

Nurse educators are challenged to meet the needs of nontraditional students in mobility nursing programs. Increasing student diversity and a projected nursing shortage make retention, ensuring student success, and facilitating entrance into the profession the top priorities for educators. The role of peer support in the success of nontraditional students in a mobility program in the Midwest was explored through semistructured interviews with 10 graduates. Participants reported developing collegial relationships with other students; when friendships formed, caring connections, shared learning, and collaboration occurred. Nurse educators can encourage relationship building between students and facilitate shared learning among student groups.

Licensed practical nurse scope of practice and quality of nursing home care.

BACKGROUND: Although higher levels of registered nurse (RN) staffing in nursing homes are related to better care quality, licensed practical nurses (LPNs) provide most licensed-nursing care; prior research is mixed regarding how this influences quality. The nature of LPN practice, and RN direction of that practice, follows in part from state nurse practice acts (NPAs). OBJECTIVE: Among the 50 states and the District of Columbia, the aims of this study were to describe regulatory differences in how LPNs contribute to nursing assessment, care planning, delegation and supervision, and RN practice in these domains and to explore how these regulatory differences relate to quality of care in nursing homes. METHODS: The study design was a sequential explanatory mixed-methods design of NPAs and Centers for Medicare and Medicaid quality measures of long-stay nursing home residents. In the qualitative strand, 51 NPAs and related administrative code were analyzed to classify guidance on RN and LPN practice; then, the coded data were transformed to quantitative indicators of specificity regarding LPN and RN scope of practice. In the quantitative strand, state NPA data were linked to facility-level Centers for Medicare and Medicaid staffing and quality measures (N = 12,698 facilities) for cross-sectional, quantitative analyses. RESULTS: States varied considerably in how NPAs guided LPN and RN scope of practice. NPA differences were related to quality indicators of resident pain, catheter use, weight loss, and restraints, even when accounting for nursing home staff mix. DISCUSSION: Care quality was better in states where the NPA clearly described LPN scope, but only when there was also greater RN availability (p < .05). Classifying scope of nursing practice regulations moves beyond traditional staffing measures to inform understanding of the effects of the RN-to-LPN staffing ratio on quality of care in nursing homes.

Intraprofessional Practice Education using a community partnership model.

The Intraprofessional Practice Education (IPE) pilot project was designed to increase the number of high-quality practice education settings and to develop intraprofessional learning opportunities for nursing students from three different prelicensure programs. Students from the licensed practical nurse, registered nurse, and registered psychiatric nurse programs shared their practice education experience concurrently in a rural First Nations community. This project's framework, the Partnership Model for Community Health Nursing Education (PMCHNE), is described and includes an explanation of the planning and coordination that occurred prior to implementation of the pilot project. Various student practice education and cultural experiences are highlighted, and the results from the project's evaluation are discussed, including the utility of the PMCHNE and the benefits and challenges associated with implementing an IPE experience.

Staff perceptions of leadership during implementation of task-shifting in three surgical units.

BACKGROUND: Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting. OBJECTIVE: This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses. METHODS: Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey. RESULTS: Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses' opinions of leadership. CONCLUSION: Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting. IMPLICATIONS FOR NURSING MANAGEMENT: Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership.

Perspectives of unlicensed assistive personnel on career development.

BACKGROUND: An equivalency program, Method 3, is a viable but underused option for unlicensed assistive personnel (UAP) who pursue licensure. This study describes the perceptions of UAP on opportunities for career development. METHODS: Eighteen UAP participated in three focus groups. Thematic analysis was conducted with verbatim transcription. RESULTS: Three major themes represented the lively discussions that occurred: core driving forces, processes of career development, and anticipated and desirable outcomes. Various subthemes described these major themes. CONCLUSION: Method 3 provides a realistic approach to help UAP persevere with career development. Collaboration with management and peers, encouragement, and effective communication contributed to the success of participants, despite obstacles and challenges. Camaraderie and flexible scheduling were critical elements in participants' pursuit of first licensure. Taking small steps was described as an effective approach for UAP to persevere with career development. Support for informal career development is essential. Nursing leaders should consider an equivalency approach to accommodate individual preferences and learning needs for career development.