RN-to-BSN student reports of work experiences, academic performance, and program progression during the COVID-19 pandemic.

BACKGROUND: Individuals who were RN to BSN students during the COVID-19 pandemic had the unique experience of being both undergraduate students and nurses during a time of exceptional stress for the healthcare system. PURPOSE: The aim of this study was to explore student perceptions of their work experiences during the COVID-19 pandemic and how working as a nurse during this time affected their academic performance and progression through their RN to BSN program. METHODS: This qualitative study was conducted using Braun and Clark's six-step thematic analysis process. CONCLUSION: Students reported experiencing both challenges and adaptability in their RN to BSN program performance and progression during the pandemic. DISCUSSION: Nurse educators and nurse managers can help RN to BSN nursing students during times marked by heavy workloads and increased stress by ascertaining their needs, being flexible, and providing self-care support.

External influencing factors on missed care in Austrian hospitals: Testing the theoretical antecedents of missed care using structural equation modelling.

PROBLEM: Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors. AIMS: This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC. DESIGN: A quantitative cross-sectional study. METHODS: The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases. RESULTS: The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent "resource allocation: labor" had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model. CONCLUSION: In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Implementing a Specifications Grading System in a Nursing Course.

BACKGROUND: Nurse educators are charged with the challenging task of evaluating student learning and abilities effectively using traditional student assessment methods, which come with several inherent shortcomings. New guidelines for nurse educators now present a more competency-based approach to nursing education that calls for objective-driven assessments. PROBLEM: Traditional grading practices lack the ability to connect student learning to their final course grades. However, specifications grading, which directly links grades to learning objectives, has not been not adequately explored in the nursing literature. APPROACH: A specifications grading system was designed and implemented in an online undergraduate nursing research course. Student and faculty feedback on the system were reviewed. CONCLUSIONS: Overall, students and faculty approved of the specifications grading system. Recommendations are presented for adopting specifications grading in nursing courses. Research is needed to explore student perceptions of the grading system and its effects on student learning and performance.

Integration of the 5As Nicotine Cessation Framework in a Primary Care Clinic.

BACKGROUND: Nicotine causes significant morbidity and mortality. Many adults who want to quit using nicotine may not be receiving adequate support from their primary care providers. If used properly, the 5As nicotine cessation guidelines may help patients address their nicotine use. LOCAL PROBLEM: Smokers screened for tobacco use at a primary care clinic were not consistently offered evidence-based interventions using the 5As at each primary care encounter. METHODS: The 5As framework was presented to providers via PowerPoint presentation and printed materials. Provider and patient behaviors were measured using data from pre- and postintervention chart reviews. RESULTS: There was a statistically significant postintervention increase in the proportion of smokers who received the 5As components (P < .001). Patients' nicotine use decreased post-intervention. CONCLUSION: Results suggest that the intervention increased providers' knowledge and use of the 5As, which helped patients reduce their nicotine use.

The Impact of Nurse Education on Heart Failure Readmissions and Patient Education.

BACKGROUND: Heart failure (HF) has become a national concern, with approximately 5.7 million adults in the United States suffering from this life-altering disease. Improved education of these patients prior to discharge helps patients manage their disease adequately and reduce symptom exacerbations. OBJECTIVE: This quality improvement initiative aimed to determine the effectiveness of an educational intervention in improving nurses' knowledge of HF discharge teaching and documentation of this education in patient charts. METHODS: This project was conducted at a Magnet-recognized acute care hospital with 39 critical care step-down beds. Twenty-nine nurses employed on the step-down unit participated in the educational intervention. Pre/post nurse knowledge and chart review data were analyzed. RESULTS: There was a statistically significant increase in the percentage of patients receiving HF education from unit nurses from preintervention 77.0% (n = 81) to postintervention 96.4% (n = 138) (p < .001). There was also a statistically significant increase in the mean number of days patients were educated from 1.64 to 2.58 days (p < .001). Nurse knowledge also increased from pretest (69.7%) to posttest scores (100%) (p < .001). CONCLUSIONS: Providing HF educational opportunities enhanced nurse knowledge and increased their documentation of HF education in patient charts. IMPLICATIONS FOR NURSING: Nurse educators may use the study results to improve nurse education and practices aimed at reducing HF readmissions.

Implementing Sleep Apnea Screening Prior to Conscious Sedation Procedures in a Rural Hospital: A Quality Improvement Project.

BACKGROUND: Screening patients for obstructive sleep apnea (OSA) risk factors is an effective method for helping reduce adverse outcomes in conscious sedation. Patients receiving conscious sedation for endoscopy were not being screened for OSA at a rural hospital. OBJECTIVE: The purpose of this quality improvement project was to implement a nurse education program to improve OSA screening of endoscopy patients, using an evidence-based screening tool, and to increase nurse OSA knowledge and patient education. METHODS: This study was conducted in the outpatient perioperative section of a small rural hospital in northern Michigan. Data were obtained from pre/post chart review and nurse knowledge assessment. Twenty-eight nurses participated in an educational session that included OSA education and instructions on using the STOP-Bang questionnaire for OSA screening. RESULTS: Nurse OSA knowledge increased from 75% preeducation program to 89% posteducation program. Use of the STOP-Bang Questionnaire for patients presenting for outpatient endoscopy procedures requiring conscious sedation and patient OSA education increased from 43.5% to 81.2% pre- to posteducation program. CONCLUSIONS: This study's educational session was successful in promoting use of the STOP-Bang questionnaire among perioperative nurses and increasing education for patients screened positive for OSA. IMPLICATIONS FOR NURSING: Training nurses to use a brief OSA screening tool effectively improved the OSA screening of patients presenting for outpatient conscious sedation involving endoscopy.

Integrating Environmental Sustainability Content Into an RN-to-BSN Program: A Pilot Study.

BACKGROUND: The link between environmental sustainability, climate change, and health outcomes makes environmental sustainability an important topic for educators to include in nursing curricula. METHOD: Students completed a sustainability in nursing learning module, over a 4-week period, during which students created blog posts based on the learning materials and clinical practice observations. The Sustainability Attitudes in Nursing Survey questionnaire was incorporated to measure changes in student attitudes regarding sustainability. RESULTS: Descriptive statistics indicated that students had higher average scores on the posttest for all variables except one measurement. Paired t-test results revealed statistically significant differences in nine sustainability attitude items in the pretest and posttest scores. These findings suggest that the intervention likely contributed to improved attitudes about sustainability in the workplace. CONCLUSION: Results of this study are promising because the brief intervention had a significant effect on practicing nurses' attitudes about sustainability in their work environments. [J Nurs Educ. 2020;59(11):637-641.].

Implementing a Clinical Practice Guideline on Opioid-Induced Advancing Sedation and Respiratory Depression.

BACKGROUND: Opioid-induced respiratory depression (OIRD) is a serious adverse reaction associated with opioid administration. LOCAL PROBLEM: The purpose of this quality improvement study was to evaluate the impact of implementing a clinical practice guideline for OIRD in a medical-surgical setting lacking standardized monitoring techniques and reporting criteria for patients receiving opioid analgesia. METHODS: An American Society for Pain Management Nursing protocol was implemented in 4 medical/surgical units. The impact on OIRD-related nurse knowledge, documentation, and opioid-related rapid response calls was measured pre- and postimplementation. RESULTS: Nurse OIRD-related knowledge significantly increased. The number of naloxone administrations associated with prior intravenous opioid analgesic administration did not significantly change. However, there was a significant decrease in the postimplementation number of respiratory distress-related rapid response calls. CONCLUSIONS: Implementation of the American Society for Pain Management Nursing guidelines had a positive impact on knowledge, documentation, early intervention of OIRD, and the number of opioid-related rapid response calls.

Exploring the development of professional values in an online RN-to-BSN program.

BACKGROUND: Development of professional nursing values is critical within registered nurse-to-bachelor of science in nursing programs to prepare nurses for increasingly complex and diverse work environments. The results of previous studies have been inconsistent, with few studies focusing on online registered nurse-to-bachelor of science in nursing programs. In addition, little is known regarding the effectiveness of the educational methods used to support advancement of professional values and ethical practice. OBJECTIVE: The object of this study was to gain an understanding of nursing students' attitudes and beliefs about professional values at entry and exit of an online registered nurse-to-bachelor of science in nursing program that includes a standalone ethics course and integrates American Nurses Association Code of Ethics provisions throughout the curriculum. RESEARCH DESIGN: For this one-group pretest-posttest, quasi-experimental design, longitudinal matched-pair data were gathered at program entry and exit using the Nurses Professional Values Scale-Revised. PARTICIPANTS AND RESEARCH CONTEXT: In all, 119 students of an online registered nurse-to-bachelor of science in nursing program at a Midwest public university who completed entry and exit surveys between spring 2015 and spring 2018 were included in this study. ETHICAL CONSIDERATIONS: This study was reviewed and determined to be exempt by the university's institutional review board. FINDINGS: The results showed a significant increase in total posttest scores when considering all participants. However, students who took the ethics course after the pretest demonstrated a significant increase in posttest scores, while students who took the ethics course prior to the pretest demonstrated a small increase that was not statistically significant. Significant increases were also found in the professionalism, activism, and trust factors. DISCUSSION: This study supports previous study findings where students scored higher on caring and lower on activism and professionalism factors. The largest gains were made after completing the ethics course. CONCLUSION: The results suggest that requiring a standalone ethics course in the registered nurse-to-bachelor of science in nursing curriculum had a positive impact on self-reported professional values.

A revised MISSCARE survey: Results from pilot testing.

BACKGROUND: Missed nursing care has been recognized as a universal patient care issue that affects outcomes for patients, nurses, and healthcare institutions. The MISSCARE Survey was developed to measure and determine the reasons for missed nursing care episodes. An extensive literature review and expert nurse opinion revealed five additional reasons for missing care that the authors utilized to revise the Survey. METHODS: The revised MISSCARE Survey was pilot tested with a group of 145 nursing staff from a public, non-profit, acute care hospital in the Midwestern U.S. RESULTS: Analysis indicated favorable results for the revised Survey's acceptability, reliability, and construct validity. CONCLUSION: Based on the initial pilot study results, the authors recommend further use and study of the revised MISSCARE Survey with other nursing populations and additional psychometric testing.

Measuring the Gap Between Students' Expectations and Experiences in an RN-to-BSN Nursing Program.

With the nursing profession requiring a more educated workforce, RN-to-BSN program enrollment has increased. Therefore, many nursing schools have expanded these programs and incorporated online learning components. The purpose of this study was to explore student expectations and perceptions of a Midwestern university's RN-to-BSN program. A modified SERVQUAL tool was used to measure student perceptions of six quality dimensions: empathy, assurance, responsiveness, reliability, website content, and e-learning quality. Results showed that the expectation-perception gap was greatest for responsiveness (-0.506) and least for website content (-0.156). Results from this and future gap analyses will be used to develop quality improvement measures.

Student Expectations of an RN-to-BSN Program: A Qualitative Analysis of Student and Faculty Perspectives.

The expansion of RN-to-BSN (registered nurse to Bachelor of Science in Nursing) education is addressing the need for nursing workforce development. However, little is known about what RNs expect from their RN-to-BSN education experience. Lack of understanding of student expectations could lead to student-perceived gaps in service quality. The aim of this study was to explore students' expectations of the RN-to-BSN program compared with the faculty's perceptions of what students expect. A descriptive qualitative research study using structured interviews was conducted at a school of nursing in the Midwest region of the United States. Student and faculty reports revealed the common themes of workload, flexibility, coursework, and support. Congruencies were noted in the areas of workload and coursework, and differences were identified in the areas of flexibility and support. Conducting a gap analysis can be a worthwhile endeavor for educators seeking to understand the needs of their student population. Acknowledging RN-to-BSN student expectations and addressing gaps between their expectations and reality early in the program could improve student perceptions of program quality.

School Nurses and RN to BSN Nursing Students.

Many nursing schools and public schools are facing various challenges including a lack of resources. Schools of nursing strive to provide meaningful clinical experiences despite the challenge of a limited supply of quality placements. Similarly, public schools are expected to provide more nursing services at a time when many school nurses already are overloaded. For example, new state legislation placed additional responsibilities (regarding epinephrine auto-injectors and cardiac emergency response plans) on school nurses in Michigan. Establishing a partnership between the University of Michigan-Flint and the Genesee Intermediate School District (GISD) allowed RN to BSN students in the community health nursing course to complete enriching clinical experiences at selected GISD schools. While gaining valuable clinical knowledge, these nursing students helped school nurses comply with the new legislation's requirements. This partnership benefitted the nursing students, the school nurses, and the schools that served as clinical placement sites. Nursing school administrators and faculty members should consider pursuing similar clinical placement partnerships that could be advantageous for students and local communities.

Outcomes of inpatient mobilization: a literature review.

AIMS AND OBJECTIVES: To review current research evidence on the outcomes of mobilising hospitalised adults. BACKGROUND: Although immobility is known to cause functional decline or complications, inpatient ambulation emerged as the most often missed element of nursing care. This study is designed to review research studies that give evidence as to the consequences of mobilising or not mobilising hospitalised adult patients. DESIGN: A literature review of published peer-reviewed empirical research was undertaken. METHODS: The electronic databases of MEDLINE (Ovid), CINAHL, and PubMed were accessed to search for relevant empirical articles, supplemented by a search of reference lists contained in retrieved articles and citation tracking. RESULTS: Thirty-six studies were identified for inclusion in the review. Four areas (study design, sample size, measurement and statistical analysis) were evaluated for methodological quality, and most studies showed strong quality. A synthesis of the findings generated four themes of the effects of inpatient mobilisation: (1) physical outcomes included pain, deep vein thrombosis, fatigue, etc.; (2) psychological outcomes included anxiety, depressive mood, distress, comfort and satisfaction; (3) social outcomes included quality of life and independence; and (4) organisational outcomes included length of stay, mortality and cost. CONCLUSION: Mobilising hospitalised adults brings benefits for not only physical functioning, but also their emotional and social well-being. Moreover, ambulation yields important organisational benefits. These benefits of mobilisation on four areas required viewing the patient in a holistic manner. Even though each study approached different types of patients, illnesses and procedures, this review showed that most inpatients would benefit from mobilisation and would experience optimal functions. RELEVANCE TO CLINICAL PRACTICE: The importance of mobilisation for positive patient outcomes highlights the need to develop methods to ensure that this nursing action is completed on a systematic basis.