Prolonged silent carriage, genomic virulence potential and transmission between staff and patients characterize a neonatal intensive care unit (NICU) outbreak of methicillin-resistant Staphylococcus aureus (MRSA).

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in neonatal intensive care units (NICU) that confers significant morbidity and mortality. OBJECTIVE: Improving our understanding of MRSA transmission dynamics, especially among high-risk patients, is an infection prevention priority. METHODS: We investigated a cluster of clinical MRSA cases in the NICU using a combination of epidemiologic review and whole-genome sequencing (WGS) of isolates from clinical and surveillance cultures obtained from patients and healthcare personnel (HCP). RESULTS: Phylogenetic analysis identified 2 genetically distinct phylogenetic clades and revealed multiple silent-transmission events between HCP and infants. The predominant outbreak strain harbored multiple virulence factors. Epidemiologic investigation and genomic analysis identified a HCP colonized with the dominant MRSA outbreak strain who cared for most NICU patients who were infected or colonized with the same strain, including 1 NICU patient with severe infection 7 months before the described outbreak. These results guided implementation of infection prevention interventions that prevented further transmission events. CONCLUSIONS: Silent transmission of MRSA between HCP and NICU patients likely contributed to a NICU outbreak involving a virulent MRSA strain. WGS enabled data-driven decision making to inform implementation of infection control policies that mitigated the outbreak. Prospective WGS coupled with epidemiologic analysis can be used to detect transmission events and prompt early implementation of control strategies.

A closer look at first-time pass rates as the primary measure of program quality.

BACKGROUND: The NCLEX pass rate is considered the premier indicator of program quality. Nursing programs utilize first-time pass rates (F-TPR) as a basis for making program decisions - especially when confronted with a falling rate. PURPOSE: This survey was conducted to identify the array of strategies implemented to improve or maintain F-TPRs. Additionally, we sought to ascertain whether responding programs had experienced a problematic F-TPR and their experience in the aftermath. METHODS: This study utilized a descriptive survey of nursing programs. Data analysis included thematic analysis of an open-ended item and descriptive analysis of forced-choice items. RESULTS: Nursing programs report F-TPRs heavily influence decisions and policy making especially regarding admission/progression policies, use of standardized exams, and most consider it one of the most influential factors in program decision-making. CONCLUSION: A recommendation is made for changing the requirement to the percentage of students passing within two attempts.

First-time NCLEX-RN pass rate: measure of program quality or something else?

The first-time NCLEX-RN(®) pass rate is considered by many to be the primary, if not sole, indicator of the quality of prelicensure nursing education programs. Used by state boards of nursing, educational program accreditors, and nursing faculty, the first-time NCLEX-RN pass rate influences important decisions about overall program quality, admission and progression policies, curricula, and teaching and learning practices. In this article, the authors call for a professional dialogue about the use of first-time pass rate (F-TPR) as an indicator of program quality, offer alternative methods for using the F-TPR as one measure of program quality, and suggest further research. One program's experience with low F-TPRs is offered as an exemplar of the unintended negative consequences that occur when the F-TPR is used as a sole criterion by a state board of nursing in judging a program's quality.

Lifelong learning in nursing: a Delphi study.

BACKGROUND: In order to foster a culture of lifelong learning in nursing, it is important to identify what the concept means in the nursing profession as well as the characteristics of a lifelong learner. OBJECTIVES: The purpose of this Delphi study was to conceptualize lifelong learning from the perspective of nursing, and to identify characteristics and essential elements of lifelong learning. DESIGN AND METHOD: A Delphi Study technique in three phases was completed using an online survey tool. Data were analyzed for conceptual description, ratings of characteristics and attributes, and expert consensus in these three phases. SETTING: An online survey tool was used in this study. PARTICIPANTS: Recognized experts in nursing education, administration and public policy participated in this study. RESULTS: Lifelong learning in nursing is defined as a dynamic process, which encompasses both personal and professional life. This learning process is also both formal and informal. Lifelong learning involves seeking and appreciating new worlds or ideas in order to gain a new perspective as well as questioning one's environment, knowledge, skills and interactions. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge, and engaging in learning by actively seeking learning opportunities. Keeping the mind active is essential to both lifelong learning and being able to translate knowledge into the capacity to deliver high quality nursing care. CONCLUSIONS: It is hoped that a clearer understanding of lifelong learning in nursing will foster more discussion and research about intentional, active inclusion of lifelong learning behaviors in nursing curricula.

Measures of cultural competence in nurses: an integrative review.

BACKGROUND: There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals. DESIGN: An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure. METHOD: There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing. RESULTS: The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence. CONCLUSIONS: The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use.

A comparative analysis of cultural competence in beginning and graduating nursing students.

The ethnic proportions of the population in the United States are rapidly changing, with the nation's minority population at approximately 101 million. This is also true for the West Texas region, where locally in a city with 183,000 residents, 43 different languages are spoken suggesting that cultural education needs to be included in nursing program curricula. Therefore, a study was conducted during a period of curriculum revision to determine if the current nursing curriculum at a public university offers enough education and experience for graduating nurses to care for such a diverse population by comparing their perceptions of cultural competence with beginning sophomore nursing students' perceptions. Participants were asked to complete the Cultural Competence Assessment (CCA) tool in order to evaluate perceptions of cultural competence. Upon analysis of the data, perceptions of cultural competence among graduating nursing students were significantly higher (P = .002) than the perceptions of cultural competence among beginning nursing students. These results support that nursing students perceive that they have become culturally competent during their nursing education, leading to implications of the need for continued education relating to this concept, beginning with the first course and continuing throughout the nursing curriculum.

The impact of employment on nursing students' academic performance.

As more nursing students are employed, it is essential that schools of nursing examine the relationship between student employment and academic performance. In this study, we found a statistically significant negative relationship between students who work at least 16 hours a week and academic performance, especially in high-attrition courses. Current practices in nursing education must be assessed to ensure that students who must work have every opportunity to succeed.

Self-efficacy and resilience in baccalaureate nursing students.

The attrition of admitted students from nursing programs has been attributed to the perceived stress of nursing school. Students who possess the characteristics of self-efficacy and resilience may be persistent and therefore academically successful as demonstrated by test scores over the course of their education. In this article, the authors report on a study that explored self efficacy and resilience in relation to test scores among 136 baccalaureate nursing students in multiple courses during one, 16 week semester. No statistically significant differences were found in perceived self-efficacy or resilience total scores between early semester and late semester measurements. Significant differences were found on the Resilience Scale subscales of Perseverence and Existential Aloneness. Test scores were weakly correlated with resilience and self-efficacy scores.

An end-of-life care interdisciplinary team clinical simulation model.

To provide quality end-of-life care, nursing students must have clinical experiences participating on interdisciplinary teams. The authors present the structure and processes of a clinical simulation experience that help students embrace the importance of interdisciplinary collaboration in clinical practice.

West Texas nursing education portal project: developing a regional centralized application system.

Because of the nursing shortage and a demand for maximum enrollment, a group of five baccalaureate and seven associate degree nursing programs in West Texas first met in 2007 to form the West Texas Nursing Education Consortium (WTNEC). To emphasize the importance of scale and distance, the West Texas region is larger than all of the northeastern states combined. The founding group agreed that the first mission of WTNEC should be to pool resources in order to increase admission and graduation rates for WTNEC schools. Two years later, this mission is being accomplished by the implementation of a plan designed to increase participating schools' admissions, retention, and graduation rates. A grant proposal was written and funded to develop a central regionalization of the application process for entry into WTNEC generic programs (associates degree in nursing and bachelor of science in nursing), with the goal of decreasing and possibly eliminating student vacancy rates in member schools and perhaps reducing the resources needed by each school for the admission process. The implemented centralized application system allowed prospective students to apply online to the centralized admission portal. Students maintained the freedom to choose the nursing program(s) they wanted to attend, but they were also made aware of possible openings in other participating schools. The admission portal also saved potential students time and money by submitting one centralized application, resulting in consolidation of the nursing school application process. Eleven of the 12 consortium schools participated in the centralized application system.