A Clinical Incivility Management Module for Nursing Students: A Quasi-Experimental Study.

BACKGROUND: Incivility experienced by pre-licensure nursing students in clinical settings continues to grow. Interventions for clinical incivility to nursing students are needed. Our study aimed to examine the effects of a piloted two-hour interactive incivility management module on nursing students' perceived stress and general self-efficacy levels and preparedness for responding professionally to clinical incivility. METHODS: A quasi-experimental post-test-only non-equivalent comparison design with control and experimental groups was used. Senior nursing students enrolled in a Bachelor of Science in Nursing program from a nursing college located in Seoul, South Korea, were recruited. The control group (n = 94) completed a self-administered online survey without the clinical incivility management module. The experimental group (n = 93) completed the same survey after receiving the clinical incivility management module. The two groups' survey data were compared; qualitative data from the experimental group's post-module debriefing session were also analyzed. RESULTS: The prevalence of reported clinical incivility was 72.73% (n = 137 out of 187 participants). Clinical incivility experienced by the experimental group was significantly lower than that of the control group (z = -4.865, p < 0.001). However, there was no significant difference in stress levels and self-efficacy between the two groups. The mean score of the experimental group on preparedness for responding professionally to clinical incivility was statistically higher than the control group's mean score (z = -2.850, p = 0.004). CONCLUSIONS: Interventions to prepare students for the experience of clinical incivility are useful; they can positively affect the students' ability to respond professionally.

Effect of Korean nursing students' experience of incivility in clinical settings on critical thinking.

Clinical experience is essential to helping nursing students to achieve and practice professional knowledge and skills. Published reports indicate nursing students often experience incivility during clinical practice. The purpose of this study was to investigate nursing student incivility experience during their clinical rotations and the relationship of these experiences with their critical thinking dispositions. A cross-sectional descriptive correlational study design was utilized. Data were collected from junior (n = 195) and senior (n = 180) students in a Bachelor of Science in Nursing (BSN) program in Seoul, Korea between October 15, 2017 and November 20, 2017 using a self-administered survey. Three instruments were used in the survey: six sociodemographic questions, the 13-item Korean version of Uncivil Behavior in Clinical Nursing Education (K-UBCNE) and the 27-item Yoon Critical Thinking Disposition (YCTD) tool. Data analysis revealed junior students reported significantly more incivility from nurses than the senior students (p = .038) during clinical learning experiences. Among YCTD subscales, the Prudence (p = .007) and Self-Confidence critical thinking (p = .007) scores from the senior nursing students were significantly higher than the junior students' scores. No significant relationship was found between experience of incivility and critical thinking disposition scores. Based on the study results, nursing educators, staff nurses, and administrators/managers in nursing should identify incivility toward nursing students during clinical practicums and especially toward junior nursing students. Additional investigation of the relationship between critical thinking and experiences of incivility is warranted, including longitudinal investigations and qualitative studies among junior nursing students to understand their personal experience of incivility in the clinical setting. Findings could inform the development of targeted programs to reduce clinical incivility.

Effectiveness of autogenic training on headache: A systematic review.

PURPOSE: To investigate the impact of length of autogenic training (AT) use, alone and with the addition of adjunct treatments, on intensity and duration of primary headache in adults age 19 and older. METHODS: We searched articles published in English and Korean from 1926 to 2016. A search of seven domestic and foreign databases was conducted from September 25, 2016 to December 30, 2016 using the search terms "autogenic training," "autogen," "relaxation," and "headache." The search was documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search yielded a total of 262 papers; a multi-step screening and selection process ultimately yielded six articles of randomized controlled trials (RCTs) for the systematic review. Cochrane's Risk of Bias Tool was used to evaluate the quality of the selected papers. RESULTS: Five of the six studies demonstrated statistically significant reduction in headache by AT-only or biofeedback-assisted AT. The reviewed studies varied in characteristics of subjects, length of autogenic training and practice, use of adjunct therapies, and use of headache measures. CONCLUSIONS: The small number of studies retrieved in this review, with their variations in AT interventions used, in AT training/practice time, and headache measures used, did not facilitate rigorous evaluation of the effectiveness of specific AT approaches nor of the optimum length of AT practice for reduction of headache. More research is needed on the effectiveness of AT-only for headache, the most effective duration of autogenic training and practice, and the type(s) of headache for which it is most effective.

Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals.

PURPOSE OF STUDY: The Early Screen for Discharge Planning (ESDP) is a decision support tool developed in an urban academic medical center. High ESDP scores identify patients with nonroutine discharge plans who would benefit from early discharge planning intervention. We aimed to determine the predictive performance of the ESDP in a different practice setting. PRIMARY PRACTICE SETTING: Rural regional community hospital. METHODOLOGY AND SAMPLE: We designed a comparative, descriptive survey study and enrolled a convenience sample of 222 patients (identified at admission) who provided informed consent. Sample characteristics and ESDP scores were collected during enrollment. The Problems After Discharge Questionnaire, EuroQoL-5Dimensions quality-of-life measure, length of stay, and use of post-acute care services were recorded after discharge. We compared outcomes between patients with low and high ESDP scores. RESULTS: More than half of the sample (51.8%) had a high ESDP score. Patients with high ESDP scores reported more problems after discharge (p = .02), reported lower quality of life (p < .001), had longer length of stays (p = .04), and used post-acute care services (p = .006) more than patients with low ESDP scores. The difference in the average percentage of unmet needs was not statistically significant (p = .12), but patients with high ESDP scores reported more unmet needs than patients with low ESDP scores. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The value of systematically proactive approaches to discharge planning is increasingly recognized, but establishing the performance capacity of support tools is critical for optimizing benefit. These study findings support use of the ESDP in regional community hospitals, making it a useful, open-source decision support tool for various health care delivery systems.

Accelerated Second-Degree Bachelor of Science in Nursing Graduates' Transition to Professional Practice.

BACKGROUND: Few studies have investigated accelerated second baccalaureate degree nursing program (ASBSN) graduates' transition to practice. METHOD: ASBSN graduates (N = 7) were interviewed within 12 to 15 months of graduation about their transition to practice. Using interpretive description, data were analyzed to identify common themes. RESULTS: Eleven themes emerged, including (a) Intense Situations Evoked Strong Emotions, (b) Patient Safety Was Paramount as I Built Confidence, (c) Being on My Own Was Frightening, and (d) The ASBSN Program Mirrored the Intensity of Real-Life Nursing and Helped Me Transition to Practice. CONCLUSION: ASBSN graduates' transition shared similarities with traditional baccalaureate nursing program graduates. They experienced stress, needed support, and contributed to the health care team as they gained confidence. The intensity of the interviewees' ASBSN program prepared them for real-life nursing practice. Graduates' accounts of their transition should persuade staff development professionals to plan postorientation development that considers previous education, work experience, and potential for organizational leadership. J Contin Educ Nurs. 2017;48(1):14-19.

Faculty to faculty: advice for educators new to teaching in accelerated second baccalaureate degree nursing programs.

BACKGROUND: Despite a growing faculty shortage, accelerated second baccalaureate degree nursing programs (ASBSN) proliferate. To prepare faculty for this teaching role, guide their development, and enhance recruitment and retention, ASBSN faculty in this descriptive study offered advice to new ASBSN educators. METHOD: Data were collected online from ASBSN faculty (N = 93) across the midwestern United States. RESULTS: Six themes emerged: (a) Plan for Program Intensity That Stresses Students and Faculty, (b) Be Available, Flexible, Open-Minded, and Patient, (c) Uphold Early-Established Expectations and Rigorous Standards, (d) Be Prepared for Challenging Questions: Know Your Material and Be Organized, (e) Integrate Students' Diversity Into Teaching and Learning, and (f) Adapt Content and Teaching Strategies to Align With Student and Program Characteristics. Consistency with the Suplee and Gardner new faculty orientation model was explored. CONCLUSION: Respondents viewed new ASBSN faculty as active agents who can influence their own effectiveness and success. [J Nurs Educ. 2015;54(6):343-346.].

The faculty voice: teaching in accelerated second baccalaureate degree nursing programs.

BACKGROUND: Although accelerated second baccalaureate degree in nursing (ASBSN) programs are growing, little is known about how faculty help ASBSN students to learn. METHOD: In this descriptive qualitative study, faculty in 25 ASBSN programs in 11 midwestern states were asked to describe factors about their teaching. These focused on a comparison with traditional education and an in-depth examination of teaching strategies. RESULTS: Faculty (N = 129) responded to six open-ended questions on the online survey; a thematic analysis resulted in 24 themes. Themes included Appreciate the Adult Learner With Previous Experiences; Connect Students With Structured Professional Activities; Role Model Professional Learning; and I Like It, I Love It, I Enjoy the Challenge of It. CONCLUSION: Because findings are from the faculty perspective, they enhance understanding of this teaching experience. Implications for faculty development and further research are included.

Experiences and emotions of faculty teaching in accelerated second baccalaureate degree nursing programs.

The number of accelerated second baccalaureate degree nursing (ASBSN) programs has mushroomed over recent decades, with more than 225 currently in existence. Scholars have described students and programs, but research examining the faculty experience is limited. The purpose of this study was to describe the experiences and emotions of faculty teaching students in ASBSN programs. Using a descriptive qualitative survey design, faculty (N = 138) from 25 randomly selected programs in 11 midwestern states were surveyed using an instrument developed for this study and distributed online. Ten themes emerged, including (a) Engaging With Motivated, Mature, and Diverse Students, (b) Students Choosing Nursing for the "Wrong Reasons," (c) Too Much Work, Too Little Time for Students and Faculty, (d) Amazement, (e) Pride, and (f) Frustration. These findings will help novice and seasoned ASBSN faculty interpret their experiences, strengthen precepting and mentoring activities, and support administrators in determining staffing plans and designing ASBSN programs.

Study of older adults' use of self-regulation for COPD self-management informs an evidence-based patient teaching plan.

PURPOSE: People with chronic obstructive pulmonary disease (COPD) have frequent hospitalizations and emergency department visits, often due to COPD exacerbations which worsen disease status. Recognizing exacerbations is challenging; patients must distinguish between day-to-day COPD symptom variations and exacerbation symptoms. Self-regulation theory (Bandura, 1999) is useful for understanding symptom recognition, interpretation, and response. In this article a qualitative study of self-regulation use by 28 older adults with COPD (Brandt, 2005) is summarized. METHODS: Twenty-eight community-dwelling older adults were interviewed. Data were analyzed using the interpretive description method. RESULTS AND DISCUSSION: Informants used self-regulation behaviors in varying degrees. Most attended primarily to their breathing, comparing their usual degree of breathlessness and intensifying their everyday self-management practices if breathlessness worsened. CLINICAL RELEVANCE: A theory- and evidence-based COPD teaching plan for use by rehabilitation nurses is presented that includes attention to exacerbation recognition.

Clinical consensus statement: tracheostomy care.

OBJECTIVE: This clinical consensus statement (CCS) aims to improve care for pediatric and adult patients with a tracheostomy tube. Approaches to tracheostomy care are currently inconsistent among clinicians and between different institutions. The goal is to reduce variations in practice when managing patients with a tracheostomy to minimize complications. METHODS: A formal literature search was conducted to identify evidence gaps and refine the scope of this consensus statement. The modified Delphi method was used to refine expert opinion and facilitate a consensus position. Panel members were asked to complete 2 scale-based surveys addressing different aspects of pediatric and adult tracheostomy care. Each survey was followed by a conference call during which results were presented and statements discussed. RESULTS: The panel achieved consensus on 77 statements; another 39 were dropped because of lack of consensus. Consensus was reached on statements that address initial tracheostomy tube change, management of emergencies and complications, prerequisites for decannulation, management of tube cuffs and communication devices, and specific patient and caregiver education needs. CONCLUSION: The consensus panel agreed on statements that address the continuum of care, from initial tube management to complications in children and adults with a tracheostomy. The panel also highlighted areas where consensus could not be reached and where more research is needed. This consensus statement should be used by physicians, nurses, and other stakeholders caring for patients with a tracheostomy.