Knowledge and perceptions of adverse childhood experiences (ACEs) among prelicensure nursing students.

OBJECTIVES: Adverse childhood experiences (ACEs) impact health outcomes in adulthood. Positive childhood experiences (PCEs) are associated with resiliency and improved mental and physical health outcomes. There is often a lack of content on ACEs in nursing education. The purpose of this project was to determine the knowledge and perceptions of ACEs and PCEs among prelicensure nursing students. METHODS: A mixed-method pilot study was implanted. Prelicensure nursing students received didactic instruction on ACEs and PCEs and completed online, anonymous ten-item pre- and post-surveys about knowledge on ACEs and PCEs. RESULTS: A positive percent change was observed with all ten statements from pre- to post-surveys. Six themes emerged from qualitative analysis, revealing the importance and benefits of education on ACEs and PCEs. CONCLUSIONS: This study shows that nursing students valued education regarding ACEs, were willing to incorporate their knowledge of ACEs into their practice, and discovered they might have been exposed to ACEs themselves. Implications for International Audience: All nursing programs must include content on ACEs and PCEs to prepare better nurses to care for patients.

Virtual Collaboration in Academia.

More nurses and nurse educators today are working distantly in different geographic locations from others, and this includes working from home or satellite locations (Poulsen & Ipsen, 2017). Can we work collaboratively in a purely distance relationship? In academia, collaboration between colleagues is common and often mandated. Being able to engage with others in a collegial manner is necessary, and in some instances the relationship may be purely virtual. This revolution in cognitive capability uses long-distance interactive technology and the structure of professional learning communities. Successful group collaboration is driven by high expectations, shared goals, professionalism, and peer accountability. Such collaboration may be viewed as involving a nonlinear theory of change, with multiple factors influencing processes and outcomes. Factors impacting success include academic considerations (professional goals, disciplinary expertise), nonacademic issues (personal preferences, financial factors), and the development of a culture of trust and collective leadership. Practical strategies to implement such virtual collaboration are discussed.

Self-efficacy and concerns of nursing students regarding clinical experiences.

BACKGROUND: It is important for nurses to provide safe, high-quality care for patients, and clinical experiences allow nursing students to integrate theory into practice. However, many students have anxiety about clinical rotations. OBJECTIVES: The concerns of nursing students about clinical experiences and factors relating to self-efficacy in a rural Bachelor of Science in Nursing (BSN) program were examined. DESIGN: This was a mixed-methods study, and students were surveyed prior to and at the end of their clinical experiences. SETTING: The study location is a public liberal arts university in the rural, southeast United States. PARTICIPANTS: Junior level students (first and second semester) and senior level students (first and second semester) levels of BSN students participated in this project. RESULTS: Qualitative themes were identified, including concerns regarding clinical competence, expectations of learning, aspects of patient/peer/instructor interactions, as well as learning strategies and preferences. The student's level of confidence regarding communication to patients and physicians, assessment of heart and lung sounds, interview skills, documentation, and discussion of nursing procedures increased significantly from pre to post-survey. Confidence levels in physical assessment skills rose significantly after the clinical experience (t' = -6.3718 with 140 df, p < .001). CONCLUSION: Strategies that nurse educators can use prior to, during, and after the clinical experience to address student concerns about clinical experiences include the use of caring, competent clinical instructors, orientation to clinical sites, laboratory and simulation days, self-reflection, peer-support, and debriefing.

Unconscious Weight Bias Among Nursing Students: A Descriptive Study.

There has been both an increase in obesity and anti-obesity bias in the United States. The Harvard Weight Implicit Association Test (IAT) is a reliable, valid test that can measure unconscious weight bias. First semester Bachelor of Science in Nursing (BSN) students were surveyed anonymously mid-semester and at the end of the semester after completing the Harvard Weight IAT. Sixty-nine out of 77 students completed pre- and post-surveys. Weight preference towards others was not shown to be related to the respondent's own self-reported body mass index (BMI). The majority of respondents exhibited more weight-related bias on the IAT than they realized. The three qualitative themes that emerged included Awareness of Personal Beliefs and Stereotypes, Reminder to be Impartial, and Skepticism about the IAT. It is important for undergraduate nursing students to be aware of possible unconscious weight bias in order to provide high-quality care to patients.

Student Perceptions Regarding Collaborative Intraprofessional Nursing Education.

BACKGROUND: Teamwork is an important factor in the provision of high-quality health care. There is a lack of research on collaboration between nursing students at different program levels. PURPOSE: The purpose of this project was to determine student perceptions about collaborative learning activities between prelicensure BSN and MSN students. METHODS: Community assessments by BSN students identified health needs and issues for 6 underserved populations. Online MSN students used these assessments to create low-literacy patient education pamphlets. In turn, BSN students provided educational sessions at community sites using the pamphlets. Both groups completed presurveys and postsurveys assessing their perceptions of collaborative learning. RESULTS: There were statistically significant differences between the respondent groups for 3 survey questions about how this project helped prepare them for future practice and professional collaboration. Eight qualitative themes were identified. CONCLUSION: Although desiring more face-to-face interaction between groups, students reported that collaboration was important.

Knowledge, Attitudes, and Experience With Advance Directives Among Prelicensure Nursing Students.

BACKGROUND: End-of-life decision making can be distressing for nursing students, and the purpose of this investigation was to assess undergraduate nursing students' knowledge, attitudes, and experiences with advance directives. METHOD: One hundred sixty-six Bachelor of Science in Nursing students at four different program levels were surveyed about their knowledge, personal and professional experience, and personal and professional attitudes regarding advance directives. RESULTS: There was a statistically significant progression of knowledge from the junior 1 to the senior 2 semesters. In addition, there was a statistically significant difference in personal attitudes about advance directives by progressive semesters, in personal and professional attitudes between White/Caucasian and Black/African American students, and in knowledge of advance directives and professional attitudes between students 18 to 25 years old and those 26 years and older. CONCLUSION: It is important that nursing students are exposed to advance directives in the prelicensure curriculum to prepare them for their role as professional nurses. [J Nurs Educ. 2018;57(1):35-39.].

Use of Service-Learning to Teach Health Literacy with Online Graduate Nursing Students.

To meet Healthy People 2020 goals, health literacy must be included in health care program curricula. In a fully online graduate nursing course, an innovative service-learning activity asked students to collaborate in the creation of low-literacy patient education pamphlets for practice partners at a community rehabilitation facility. Involvement with community stakeholders such as support groups and interprofessional team members enhanced interdisciplinary educational outcomes. Through this innovative project-based activity, students were able to meet the clinical education and decision support needs of rehabilitation patients while translating academic coursework to support actual community needs.

Student Perceptions and Acceptance of Mobile Technology in an Undergraduate Nursing Program.

Mobile technology allows healthcare students to access current evidence-based resources. The purpose of this study was to evaluate the student experience of implementing point-of-care (POC) smartphone applications in a first-semester undergraduate nursing program. Teaching methods included using case studies in the laboratory to familiarize students with the apps. At community screening sites, evidence-based guidelines were referenced when students discussed screening results with patients. Surveys were administered prior to implementing this innovation and after the students utilized the apps in direct patient interactions. Survey results were analyzed to evaluate student perceptions and acceptance of mobile technology. Students felt that healthcare smartphone apps were a helpful and convenient way to obtain evidence-based clinical information pertinent to direct care settings. Over 90% of students planned to continue using healthcare smartphone apps. In conclusion, healthcare smartphone apps are a way for students to become comfortable accessing evidence-based clinical resources. It is important to encourage students to use these resources early in the curriculum. Community screenings are an independent health promotion activity which assists in the attainment of health equity and fosters nursing leadership.

Use of Smartphones With Undergraduate Nursing Students.

BACKGROUND: It is important for nursing students to become comfortable with accessing point-of-care technology to support provision of safe, evidence-based care to patients. METHOD: Smartphone applications (apps) were introduced into community screening settings in a first-semester undergraduate nursing health assessment course. The apps provided information about body mass index, as well as United States Preventive Services Task Force-recommended preventive services using the Agency for Health Research and Quality electronic preventive services selector app. Classroom activities prepared students using mock cases and real data, and evidence-based guidelines were used when counseling patients about individual results. RESULTS: Smartphone apps were well accepted by students and allowed students to transfer learning from the classroom and laboratory to the community setting. CONCLUSION: Smartphone apps promote active learning and the long-term retention of knowledge. This community-based activity supports the validity of independent health promotion activities in nursing practice. [J Nurs Educ. 2016;55(7):411-415.].

Shared Decision Aids: Increasing Patient Acceptance of Long-Acting Reversible Contraception.

Unintended pregnancies are an important public health issue. Long-acting reversible contraceptive methods (LARCs) are reliable, safe, highly effective methods for most women; however they are underutilized in the United States. Shared decision aids were added to usual care in five public health family planning clinics in the Southeastern United States, staffed by advance practice nurses and registered nurses. All five sites showed an increase in the use of LARCs during the time period that shared decision aids were used (results statistically significant to p < 0.001). It is important for women to make informed choices about contraception, and shared decision aids can be utilized to support this decision making. This resource has been adopted for statewide use in all public health clinics, and implications for practice suggest that the use of shared decision aids is an effective method to support informed patient decision making and acceptance of LARC methods of contraception.

Oral sucrose for pain control in nonneonate infants during minor painful procedures.

PURPOSE: To provide information regarding the effective use of oral sucrose as an analgesic for immunization and venipuncture procedures in the older infant. DATA SOURCES: Evidence-based literature including original clinical trials, reviews, and clinical practice guidelines. CONCLUSIONS: Most infants are exposed to multiple minor painful procedures during the first year of life. Oral sucrose solution in a 24% concentration at a dose of 2 mL approximately 2 min prior to the painful procedure has been shown effective in reducing pain during immunizations and venipuncture in the outpatient setting in infants aged 1-12 months old. IMPLICATIONS FOR PRACTICE: Oral sucrose solution should be used as a pain reduction intervention in infants up to 12 months of age undergoing minor painful procedures. Its proven effectiveness as an analgesic, low rate of minor adverse events, ease of administration, and excellent availability make sucrose a good choice for this purpose. Additional research is needed regarding dose response in different infant age groups, optimal concentration of sucrose solution, need for multiple sucrose dosing, adjustment for multiple painful procedures, and addition of optimal nonpharmacologic interventions as a combination approach.

Blending technology in teaching advanced health assessment in a family nurse practitioner program: using personal digital assistants in a simulation laboratory.

PURPOSE: This article describes the development and implementation of integrated use of personal handheld devices (personal digital assistants, PDAs) and high-fidelity simulation in an advanced health assessment course in a graduate family nurse practitioner (NP) program. A teaching tool was developed that can be utilized as a template for clinical case scenarios blending these separate technologies. DATA SOURCES: Review of the evidence-based literature, including peer-reviewed articles and reviews. CONCLUSIONS: Blending the technologies of high-fidelity simulation and handheld devices (PDAs) provided a positive learning experience for graduate NP students in a teaching laboratory setting. Combining both technologies in clinical case scenarios offered a more real-world learning experience, with a focus on point-of-care service and integration of interview and physical assessment skills with existing standards of care and external clinical resources. Faculty modeling and advance training with PDA technology was crucial to success. IMPLICATIONS FOR PRACTICE: Faculty developed a general template tool and systems-based clinical scenarios integrating PDA and high-fidelity simulation. Faculty observations, the general template tool, and one scenario example are included in this article.

Empowering the primary care provider to optimally manage mild traumatic brain injury.

PURPOSE: This article provides current, evidence-based information regarding the management of mild traumatic brain injuries for the primary-care provider. DATA SOURCES: Literature review of the evidence-based literature, including peer-reviewed articles and reviews of published randomized controlled trials and clinical practice guidelines. CONCLUSIONS: There are lessons to learn from the civilian and military care of mild traumatic brain injuries. As acute injury management improves and more patients survive their trauma to live in the chronic-care community setting, primary care clinicians will be responsible for providing and coordinating total care. A team approach is required to meet the unique clinical and personal challenges these patients face. IMPLICATIONS FOR PRACTICE: These patients are at risk of receiving suboptimal care once released to the community, in part due to an incomplete understanding of the condition by primary care providers. Other difficulties in recommending care for these patients include nonuniform clinical terminology, the lack of a uniform set of diagnostic criteria, and the lack of endorsed professional society guidelines. A clinical practice toolkit is provided to assist the primary care provider to optimize delivery of comprehensive care for this population in the community.

How can primary care providers manage pediatric obesity in the real world?

PURPOSE: To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. DATA SOURCES: Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. CONCLUSIONS: Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. IMPLICATIONS FOR PRACTICE: Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided.

Use of propofol and emergence agitation in children: a literature review.

Emergence agitation (EA) is an important issue in pediatric anesthesia. This phenomenon arises more frequently with the use of inhalational agents. Three commonly used general anesthesia techniques in children were evaluated as to the associated incidence of emergence reactions. An extensive literature review was performed to evaluate these anesthetic practices and the occurrence of EA in young children. Relevant literature was obtained from multiple sources, including professional journals, professional websites, and textbooks. Three categories of anesthesia techniques were reviewed: sevoflurane inhalational general anesthetic, Emerpropofol as an adjunct to sevoflurane general anesthetic, and propofol total intravenous anesthesia (TIVA) techniques. Several variables within each category were evaluated with respect to the outcome of EA: prevention, intraoperative adjuncts, type of surgery, and patient-related factors. According to the literature evidence base, there is an advantage to either propofol TIVA or adjunctive propofol with sevoflurane (compared with sevoflurane alone). We conclude, based on the current evidence, that the use of propofol is associated with a reduction in the incidence of emergence agitation.

Anal Pap smears: Should we be doing them?

PURPOSE: To identify the need to perform anal Papanicolau (Pap) smears for diagnosing histologic changes associated with human papilloma virus (HPV) infection in order to provide early intervention for the prevention of anal cancer. To offer the primary care provider information, based on evidence-based research, about identifying the high-risk patient using risk factors, instructions on performing the anal Pap smear, interpreting the results, and initiating treatment interventions and/or referrals for care. Additionally, the possibility of an HPV vaccine for men will be discussed. DATA SOURCES: Evidence-based literature, theoretical framework, and peer-reviewed articles. CONCLUSIONS: Performing anal Pap smears is a valuable tool to detect cytologic changes associated with some strains of HPV infection. For persons participating in receptive anal intercourse, this diagnostic procedure provides the opportunity for early detection to guide appropriate follow-up and interventions. IMPLICATIONS FOR PRACTICE: Appropriate screening can be incorporated easily into a primary care practice. High-risk groups that would benefit from this screening include men who have sex with men, HIV-infected men and women, immunocompromised men and women, women with a history of cervical or vulvar cancer (or high-grade cervical lesions), and women participating in receptive anal intercourse.

Smoking cessation readiness: are your patients ready to quit?

PURPOSE: To explore the assessment of patient readiness to receive smoking cessation interventions using the transtheoretical model (TTM) and the five stages of change; and to give the primary care provider an evidence-based toolkit to assist in evaluating for readiness and supporting the smoking cessation process. DATA SOURCES: Evidence-based literature, theoretical framework, and peer-reviewed articles. CONCLUSIONS: Utilizing the TTM along with proper training and education of the provider and patient increases the probability that smoking cessation will occur. Combinations of pharmaceutical and nonpharmaceutical interventions are the most effective in smoking cessation. IMPLICATIONS FOR PRACTICE: Providers can be prepared at every patient visit to address the smoking cessation needs of all patients. The toolkit provided in this article will help facilitate evaluation of readiness and support of effective, long-term smoking cessation and reduce eventual smoking-related morbidities.

Educating advanced practice nurses for collaborative practice in the multidisciplinary provider team.

PURPOSE: To describe the use of a clinical decision-making work sheet as a tool to teach communication skills to advanced practice nurse (APN) students. Achievement of competencies in communication and documentation that utilize language and communication strategies that are shared with other health professionals promotes effective collaborative practice among members of the multidisciplinary provider team. DATA SOURCES: Review of the recent Institute of Medicine report on health professions education and other health professional literature. CONCLUSIONS: The Clinical Decision-Making Work Sheet helps APN students effectively communicate in real-world clinical settings. The clinical work sheet allows nurse practitioner students to communicate more effectively and efficiently, using a vocabulary that is shared with other members of the multidisciplinary health care provider team. Use of the tool in students' clinical-rotation settings facilitates effective application and refinement of the clinical decision-making skills that students learned in the advanced health assessment course. IMPLICATIONS FOR PRACTICE: Faculty have the responsibility to assist nurses as they transition from traditional nursing to APN roles. The work sheet facilitates learning the common language for data collection, clinical decision making, documentation, and reporting that is shared with other health professionals. Using the tool, students learn to efficiently organize information that supports communication and documentation that enhances their clinical problem-solving skills. Case presentation and documentation using the work sheet provide a basis for preceptor and student interaction and for student evaluation.