Violent Event Severity Tool for Reporting Violent Incidents.

OBJECTIVES: To explore the usefulness of the Violent Event Severity Tool (VEST). BACKGROUND: The Joint Commission and many governing bodies require establishing workplace violence prevention programs in hospitals. Inconsistent processes have hampered the efficacy evaluation of such programs for collecting and reporting violence. The VEST was developed as a standardized tool for capturing violence data. METHODS: Ninety-six healthcare workers attending the 2022 Magnet® conference completed the survey. The VEST includes 6 types and 4 intensities of violent incidents. RESULTS: Most participants reported that the VEST is easy to use (79%), relevant (85%), and useful (85%). Fewer than half were satisfied with their incident report filing processes. Only 38% of participants experiencing grade 1 physical assault filed an incident report, whereas 70% and 100% experiencing grades 3 and 4 physical assaults filed. CONCLUSIONS: The VEST appears to be a useful and relevant tool for consistent collection and reporting of various violence types and severities.

Nurses' mental health from early COVID-19 pandemic to vaccination.

AIMS: The influence of the COVID-19 vaccine and the evolution of the pandemic over time on nurses' mental health have not been thoroughly examined. This study aimed to explore the changes in nurses' mental health from the early pandemic to the early vaccination period over a 1-year time span and examine vaccination and coping mechanisms as predictors of nurses' poor mental health and burnout. METHODS: Three cross-sectional surveys were conducted: Early-pandemic (n = 320), pre-vaccination (n = 228), and early-vaccination cohorts (n = 292). FINDINGS: About 72% of nurses in the early-vaccination cohort were fully vaccinated with two doses of mRNA COVID-19 vaccines. There were significant decreases in moderate/severe anxiety and moderate/severe depression for the early-vaccination cohort compared to the other cohorts. In multivariate analyses, vaccination had almost three-fold higher odds of moderate/severe anxiety (Odds Ratio [OR] = 2.87; 95% Confidence Interval [CI] = 1.28-6.44). High resilience, family functioning, and spirituality were associated with two- to five-fold lower odds of poor mental health and burnout. CONCLUSIONS: Although nurses in the early-vaccination cohort had lower anxiety and depression than earlier cohorts, COVID-19 vaccination had minimal associations with nurses' mental health. Coping mechanisms and organizational support appear to be important predictors of nurses' poor mental health and burnout. CLINICAL RELEVANCE: The evidence gathered over 1 year of the pandemic may be helpful for a better understanding of the challenges facing frontline nurses and preparing for future healthcare crises. As a part of the preparedness plan for the future, evidence-based interventions that raise frontline nurses' resilience, as well as family and spiritual support, should be considered.

COVID-19: Update on Health Care Workers' Mental Health and Coping During the Pandemic.

During the COVID-19 pandemic, health care workers experienced much higher symptoms of anxiety or depression than during the prepandemic period. As coping mechanisms, high resilience, spirituality, and satisfaction with family functioning were associated with 2- to 3-fold lower odds of anxiety or depression. Health care organizations may consider implementing evidence-based and practical supportive measures to help health care workers maintain good mental health during and after the pandemic.

Severe Burnout and Poor Mental Health Among Healthcare Workers 6 Months After COVID-19 Pandemic Declaration: What Can We Learn for Future Emergencies?

OBJECTIVES: The aim of this study was to examine the predictors associated with severe burnout and poor mental health among healthcare workers during the COVID-19 pandemic as a learning opportunity for future emergent situations. BACKGROUND: Modifiable predictors of mental health need to be further examined and quantified to prioritize human resource support in organizations as healthcare workers confront stressful situations. METHODS: A cross-sectional survey was conducted among 271 healthcare workers from September 8 to October 10, 2020. RESULTS: Approximately one-third reported severe burnout, as well as moderate/severe anxiety and depression. Feeling protected working with COVID-19 patients, high family functioning, and spirituality were associated with 2- to 4-fold lower odds of severe burnout. Satisfaction with the organization's communications predicted 2-fold lower odds of anxiety, whereas high resilience was associated with almost 4-fold lower odds of stress and depression. CONCLUSIONS: Healthcare organizations may consider adopting programs to foster resilience, family and spiritual support, and effective communication strategies to reduce burnout and poor mental health among healthcare workers during pandemics and other situations of high stress.

Impact of an extracurricular, student-led journal club on evidence-based practice among baccalaureate nursing students.

Objective Journal clubs are accepted as an effective strategy for promoting evidence-based practice (EBP). However, journal clubs are underutilized in nursing education, and little is known about the impact of extracurricular, student-led journal clubs on EBP implementation among baccalaureate nursing students. The purpose of this study was to estimate the impact of journal club attendance on EBP implementation. Methods A web-based survey was conducted in April 2019 following eight sessions of monthly journal club among senior nursing students (n=78). Results Fifteen students attended four or more extracurricular, student-led journal club sessions (19.2%). EBP practice score was significantly higher among frequent journal club attendees. In multivariate analysis, journal club attendance was the significant predictor of EBP practice (ß=0.34; p=0.006). Conclusion Graduating senior nursing students who attend extracurricular, student-led journal club sessions are more likely to carry out EBP practice. Participation in journal clubs may help increase their EBP competencies.

Aggressive behaviour risk assessment tool for long-term care (ABRAT-L): Validation study.

This prospective cohort study was conducted to validate the usefulness of the Aggressive Behaviour Risk Assessment Tool for Long-Term Care (ABRAT-L) in predicting aggressive events. A total of 615 newly admitted residents at 22 long-term care homes in Canada were included. The risk of aggression was assessed using the six-item ABRAT-L within 24 hours of admission, and incident reports of aggressive events occurring within 30 days of admission were collected. Forty-seven residents out of 615 had one or more aggressive events (7.6%). The receiver operating characteristics analysis of ABRAT-L showed a good discriminant ability at the previously recommended cut-off score of 4, with satisfactory sensitivity and specificity. The usefulness of ABRAT-L in identifying potentially aggressive residents at the time of admission was confirmed. This validation study supports the adoption of a proactive risk assessment tool, ABRAT-L, as a part of routine admission assessments at long-term care homes.

Aggressive Behaviour Risk Assessment Tool for newly admitted residents of long-term care homes.

AIM: The aim of this study was to revise the 10-item Aggressive Behaviour Risk Assessment Tool for predicting aggressive events among residents newly admitted to long-term care homes. BACKGROUND: The original tool had acceptable sensitivity and specificity for identifying potentially aggressive patients in acute care medical-surgical units, but its usefulness in long-term care homes is unknown. DESIGN: A retrospective cohort study design was used. METHODS: All residents admitted to 25 long-term care homes in western Canada were assessed for the risk of aggression using the original tool within 24 hours of admission from January 2014 - December 2014 (n = 724). Incident reports of aggressive events occurring within 30 days of admission were collected. Multiple logistic regression and receiver operating characteristics analyses were performed. RESULTS: Fifty-three residents of 724 exhibited aggressive behaviours. The demographic variable of age less than 85 years was found to be a positive predictor of aggressive events in multivariate logistic regression model and was added to the tool. The revised six-item Aggressive Behaviour Risk Assessment Tool for Long-Term Care consists of one new item, age less than 85 years and five items from the original tool: History of physical aggression, physically aggressive/threatening, anxiety, confusion/cognitive impairment and threatening to leave. The receiver operating characteristics of the revised tool with weighted scoring showed a good discriminant ability with satisfactory sensitivity and specificity at the recommended cut-off score of 4. CONCLUSION: The revised six-item tool may be useful in identifying potentially aggressive residents newly admitted to long-term care homes.

Six-Month Follow-up of a Regional Evidence-based Practice Fellowship Program.

OBJECTIVE: This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units. BACKGROUND: The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain. METHODS: A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants. RESULTS: Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017). CONCLUSIONS: The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants' units.

Utility of the Aggressive Behavior Risk Assessment Tool in long-term care homes.

This study was conducted to determine the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) and the Aggressive Behavior Scale (ABS) for predicting aggressive incidents among newly-admitted and existing residents of two long-term care homes in Canada. Of 316 residents, 27 had at least one aggressive incident (8.5%). Receiver operating characteristics analysis showed that the area under the curve for the ABRAT was 0.86 (95% Confidence Interval [CI], 0.81-0.92) and that for the ABS was 0.75 (95% CI, 0.64-0.85). Sensitivity and specificity at the optimal cutoff score of 2 for the ABRAT were 96.3% and 65.4%, respectively, and those for the ABS at the optimal cutoff score of 3 were 59.3% and 80.6%, respectively. The ABRAT appears to be promising for use in long-term care homes for identifying potentially aggressive residents. However, further studies are needed to test the utility of the ABRAT among newly-admitted residents.

Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model.

BACKGROUND: The Advancing Research and Clinical practice through close Collaboration (ARCC) model postulates that improvement in nurses' evidence-based practice (EBP) beliefs results in improved EBP implementation, which in turn improves nurse-related outcomes, such as nurses' job satisfaction and group cohesion. However, there is a dearth of interventional studies that evaluate the relationships among these variables. AIMS: This study evaluated whether a regional EBP fellowship program improved participants' EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness, and examined the relationships among these improvements, using structural equation modeling. METHODS: A pretest-posttest design was used among three annual cohorts of a regional, 9-month EBP fellowship program, from 2012 to 2014, in San Diego, California. Matched pretest and posttest questionnaires, including EBP Beliefs, EBP Implementation, Job Satisfaction, Group Cohesion, and Group Attractiveness scales, were analyzed (N = 120). RESULTS: Paired t-tests showed statistically significant improvements in EBP beliefs, EBP implementation, job satisfaction, and group cohesion (p < .05). Structural equation modeling showed that improvement in EBP implementation had no direct effect on improvements in job satisfaction, group cohesion, or group attractiveness. However, improvement in EBP beliefs had direct effects on improvements in job satisfaction (ß = .24; p = .002) and group attractiveness (ß = .22; p = .010). LINKING EVIDENCE TO ACTION: A regional, collaborative EBP fellowship program was effective in improving EBP beliefs, EBP implementation, job satisfaction, and group cohesion. Improvement in EBP beliefs appears to have had direct effects on improvements in job satisfaction and group attractiveness. Regional fellowship programs that educate and support EBP champions and their mentors may enhance EBP adoption in nursing practice across multiple health care institutions.

Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants.

BACKGROUND: A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. AIMS: This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. METHODS: A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. RESULTS: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (ß = 0.33; p <.001) and job satisfaction (ß = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. LINKING EVIDENCE TO ACTION: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality.

INTRODUCTION: Emergency nurses play a key role in the initial triage and care of patients with potentially life-threatening illnesses. The aims of this study were to (1) evaluate the impact of a nurse-initiated ED sepsis protocol on time to initial antibiotic administration, (2) ascertain compliance with 3-hour Surviving Sepsis Campaign (SSC) targets, and (3) identify predictors of in-hospital sepsis mortality. METHODS: A retrospective chart review investigated all adult patients-admitted through either of 2 academic tertiary medical center emergency departments-who were discharged with a diagnosis of severe sepsis or septic shock (N = 195). Pre- and post-protocol implementation data examined both compliance with 3-hour SSC bundle targets and patient outcomes. Multivariate logistic regression analysis identified predictors of in-hospital mortality. RESULTS: Serum lactate measurement (83.9% vs 98.7%, P = .003) and median time to initial antibiotic administration (135 minutes vs 108 minutes, P = .021) improved significantly after protocol implementation. However, one quarter of antibiotic administration times still exceeded the 3-hour target. Significant predictors of in-hospital mortality were respiratory dysfunction, central nervous system dysfunction, urinary tract infection, vasopressor administration, and patient body weight (P < .05). There were no in-hospital mortality rate differences between the pre- and post-protocol implementation groups. DISCUSSION: Compliance with serum lactate measurement and blood culture collection goals approached 100% in the post-protocol group. However, compliance with medical interventions requiring multiple health care-provider involvement (ie, antibiotic and fluid administration) remained suboptimal. Efforts focused on multidisciplinary bundle elements are necessary to achieve full compliance with SSC targets.

Adherence to colorectal cancer and polyps screening recommendations among filipino-americans.

This cross-sectional study explored the perceptions and behaviors toward colorectal cancer screening and the predictors of adherence to colorectal cancer and polyps screening recommendations among Filipino-Americans. A total of 188 participants were recruited from community churches in southern California from September to November 2011. About half of the participants were found to be adherent to the screening recommendations. Multivariate logistic regression analysis revealed the following significant predictors of adherence: having a relative with colon or rectal cancer (odds ratio [OR] = 6.17), having heard of fecal occult blood test (OR = 4.58), strong agreement with benefit of screening in reducing worry about cancer (OR = 2.81), age ≥ 65 years (OR = 2.64) and very easy communication with providers (OR = 2.43). Patient awareness of colorectal cancer screening and its benefits through effective patient-provider communication were significant modifiable predictors of adherence to colorectal cancer and polyps screening recommendations. Nurses could have a major impact in improving screening behaviors through patient education in increasing patient awareness and benefits of cancer screening.

A workplace violence prevention program targeting high-risk patients in emergency departments.

Objective: Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool. Methods: A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed. Results: Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; p = 0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; p = 0.418). Conclusion: The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.

Validity and reliability of the modified John Hopkins Fall Risk Assessment Tool for elderly patients in home health care.

This prospective cohort study was conducted to evaluate the validity and reliability of the modified Johns Hopkins Fall Risk Assessment Tool (mJH-FRAT) among elderly patients receiving home health care visits. Out of 107 patients, 33 (30.8%) had one or more falls and seven (6.5%) experienced falls with injury. Receiver Operating Characteristics of the tool in predicting falls showed an Area Under Curve (AUC) of 0.66 (p = 0.011) with sensitivity and specificity of 72.5% and 52.2% at the cutoff score of 14. For predicting falls with injury, the AUC was 0.82 (p = 0.016) with sensitivity and specificity of 100% and 65.9% at the cutoff score of 17. Inter-rater reliability of the tool was 85.7% agreement with Cohen's kappa of 0.714 (p < 0.001). The mJH-FRAT is a simple and easy-to-use multi-factor fall risk assessment tool with promising sensitivity, specificity and inter-rater reliability for prospectively identifying patients at risk of falls with injury among community-dwelling elderly populations.

Usefulness of Aggressive Behaviour Risk Assessment Tool for prospectively identifying violent patients in medical and surgical units.

AIM: The aim of this study is to evaluate the usefulness of the Aggressive Behaviour Risk Assessment Tool for prospectively identifying violent patients in medical-surgical units. BACKGROUND: Although patient violence against nurses is a serious occupational hazard, there is a lack of simple screening tools with acceptable sensitivity and specificity for identifying potentially violent patients in medical-surgical units. METHODS: A prospective cohort study involving patients admitted to six medical-surgical units at an acute care hospital was conducted from August 2009 to December 2009. Primary nurses completed the 17-item checklist within 24 hours of admission. A second identical checklist was completed by another nurse to assess the inter-rater reliability. Following a violent event or just prior to discharge, the violent event outcome section was completed to collect information about violent event, if any. A multivariate logistic regression model with backward elimination was used to select a set of parsimonious items that best predict violent behaviours. RESULTS: Fifty-six patients out of 2063 (2·7%) had one or more violent events. A parsimonious set of ten items were selected for the tool. Receiver Operating Characteristics analysis of Aggressive Behaviour Risk Assessment Tool showed that the area under the curve was 0·82 (95% Confidence Interval, 0·75-0·90). The sensitivity and specificity at the cut-off score of 1 were 70·9% and 89·3%, respectively. The Cohen's Kappa for inter-rater reliability was 0·647. CONCLUSION: The Aggressive Risk Assessment Tool is a simple, easy-to-use assessment tool with acceptable inter-rater reliability, sensitivity and specificity that may be useful for prospectively identifying violent patients in medical-surgical units.

Staff practice, attitudes, and knowledge/skills regarding evidence-based practice before and after an educational intervention.

BACKGROUND: Today's clinicians have different levels of knowledge and skill related to evidence-based practice, depending on their educational background, level of experience, and interest. This multidisciplinary study assessed nurses' baseline and posteducation practice, attitudes, and knowledge/skills regarding evidence-based practice. METHODS: A descriptive pre- and postsurvey design study evaluated clinical staff's practice, attitudes, and knowledge/skills regarding evidence-based practice with the Clinical Effectiveness and Evidence-Based Practice Questionnaire. RESULTS: A total of 327 participants (24%) completed the presurvey and 282 (20%) completed the postsurvey. No statistically significant changes were found in practice, attitudes, and knowledge/skills after the online education. In the multivariate analysis, online education was not a significant predictor of practice, attitudes, or knowledge/skills regarding evidence-based practice; graduate educational degree, formal evidence-based practice classes, and registered nurse status were statistically significant positive predictors. CONCLUSION: Administering self-learning online modules may not be the most effective method for expanding evidence-based practice abilities and knowledge/skills of nurses.

Multisite study of Aggressive Behavior Risk Assessment Tool in emergency departments.

Objective: Violence is a major preventable problem in emergency departments (EDs), and validated screening tools are needed to identify potentially violent patients. We aimed to test the utility of the Aggressive Behavior Risk Assessment Tool (ABRAT) for screening patients in the ED. Methods: A prospective cohort study was conducted among adult and pediatric patients aged ≥10 years visiting 3 emergency departments in Michigan between May 1, 2021, and June 30, 2021. Triage nurses completed the 16-item checklist using electronic health records (EHRs), and the occurrence of violent incidents were collected before ED disposition. A multivariate logistic regression model was applied to select a parsimonious set of items. Results: Among 10,554 patients, 127 had ≥1 violent incidents (1.2%). The regression model resulted in a 7-item ABRAT for EDs, including history of aggression and mental illness and reason for visit, as well as 4 violent behavior indicators. Receiver operating characteristics analysis showed that the area under the curve was 0.91 (95% confidence interval [CI], 0.87-0.95), with a sensitivity of 84.3% (95% CI, 76.5%-89.9%) and specificity of 95.3% (95% CI, 94.8%-95.7%) at the optimal cutoff score of 1. An alternative cutoff score of 4 for identifying patients at high risk for violence had a sensitivity and specificity of 70.1% and 98.9%, respectively. Conclusion: The ABRAT for EDs appears to be a simple yet comprehensive checklist with a high sensitivity and specificity for identifying potentially violent patients in EDs. The availability of such a screening checklist in the EHR may allow rapid identification of high-risk patients and implementation of focused mitigation measures to protect emergency staff and patients.

A confirmatory study of violence risk assessment tool (M55) and demographic predictors of patient violence.

AIM: The aims of this study were to confirm the usefulness of Violence Risk Assessment Tool (M55) for prospectively identifying violent patients in medical-surgical units and to explore predictors of Code-55 activation for violent behaviour or physical attack. BACKGROUND: A previous retrospective case-controlled study claimed moderate sensitivity and high specificity of the M55 in identifying potentially violent patients. However, the usefulness of M55 needs to be confirmed in a prospective study before wide adoption. METHODS: A prospective cohort study of patients in medical-surgical units of a hospital in southern California was conducted from August 2009 to December 2009. A checklist containing the M55 was completed on admission. Following a violent event or just prior to discharge, the violent event outcome section of the data collection tool was completed. The sensitivity and specificity of M55 for identifying the violent patients were calculated using the original M55 flagging criteria. RESULTS: Of 2063 patients, 32 (1·6%) had a violent event of Code-55 activation (12), physical attack (26) or both (6). The M55 showed a low sensitivity (41%) and acceptable specificity (99%) for prospectively identifying violent patients. The multivariate logistic regression model indicated higher odds of violent events for patients ≥70 years of age [odds ratio (OR) = 2·3; 95% confidence interval (CI): 0·9-5·7], males (OR = 2·7; 95% CI: 1·2-6·1) or Caucasian (OR = 3·4; 95% CI: 0·8-14·7). CONCLUSION: The M55 does not appear to be useful for prospectively identifying violent patients in medical-surgical units because of low sensitivity. Older, male or Caucasian patients had higher odds of becoming violent.

Impacts of peer tutoring on academic performance of first-year baccalaureate nursing students: A quasi-experimental study.

BACKGROUND: Peer tutoring has multiple benefits for students and the nursing program. However, little is known about the impacts of a peer tutoring on students' academic success. OBJECTIVES: This study aimed to examine the impacts of a peer tutoring program on the course failure rates and exam scores among first-year baccalaureate nursing students. DESIGN: A quasi-experimental study was conducted at a public university in the USA. A formal peer tutoring program was offered to the Class of 2020 over their first three semesters (n = 317), and the Class of 2018 without peer tutoring served as a historical comparison group (n = 285). The peer tutoring program provided free, one-on-one assistance to any students who needed additional academic support. RESULTS: The overall course failure rate was 3.47% for the class with peer tutoring compared to 7.02% without peer tutoring (χ2 = 3.87; p = 0.049). For the class with peer tutoring, about one half attended the sessions. The attendees had lower first exam scores compared to the non-attendees, but the final exam scores of attendees improved by 4 points out of 100 possible (p < 0.001). For the non-attendees, the exam scores did not change significantly. Students who attended two or more sessions per semester improved their scores by about 5 points. There was a positive association between the improvements in exam scores and the frequency of tutoring sessions attended per semester (p = 0.002). CONCLUSIONS: It appears that the peer tutoring was effective in reducing course failure rates as well as improving exam scores among first-year baccalaureate-nursing students. Peer tutoring may be a useful and cost-effective strategy to help at-risk nursing students as they adjust to the challenges of academic demands in nursing programs.