Pilot Study Focused on Knowledge, Attitudes, and Health Access Behaviors of Psychiatric-Mental Health Nurses Regarding Suicide Prevention.

OBJECTIVE: The purpose of this pilot study was to evaluate the effect of a web-based education module on the knowledge, attitudes, and ratings of willingness to access help related to suicide prevention in psychiatric-mental health nurses. METHODS: A quasi-experimental pretest-posttest design was employed. Registered nurses from two academic health center units and a 239-bed Psychiatric Hospital were invited to participate. Scores on knowledge of suicide risk and prevention, attitudes, subjective norms, perceived behavioral control, and intent to seek help upon experiencing suicidal ideations were obtained before and after administering a 25-min web-based training. RESULTS: Twenty-nine participants completed the pre-survey, web-based education module, and post-survey. Significant increases from baseline in the scores on knowledge, attitudes, subjective norms, and intentions related to help-seeking behaviors for nurse suicide prevention were noted. Perceived behavioral control median scores increased but were not statistically significant. More than 40% of the participants reported having experienced suicidal thoughts. CONCLUSIONS: Further study is needed to determine contributors to this higher rate. Understanding the effectiveness of strategies to reduce nurse suicide can provide insights into building better nurse suicide prevention programs.

The DNP project: Two decades of impact.

ABSTRACT: Twenty years ago, pioneer Doctor of Nursing Practice (DNP) program students completed the first DNP projects. Today, DNP projects remain a requirement for graduation. This article illustrates how the DNP project can be integrated throughout the DNP curriculum to maximize effectiveness and promote the introduction, reinforcement, and evaluation of competencies in the new American Association of Colleges of Nursing Essentials.

Evaluation of the Impact of Discharge Clinic Follow-Up Interventions on 30-Day Readmission Rates.

Care transition programs can result in cost avoidance and decreased resource utilization. This project aimed to determine whether implementation of a discharge clinic, referral to a community paramedicine program, or a second postdischarge call affected 30-day readmission rates. This single-center retrospective exploratory design study included 727 discharged patients without access to a primary care provider who were scheduled for a discharge clinic transitions appointment. Readmission rates were 17.7% for those who completed a discharge appointment and 24.7% for those who did not; 4% for those completing a second postdischarge call and 26% for those who did not; and 11.1% for those referred to a community paramedicine program and 24.9% for those not referred. A completed discharge clinic appointment resulted in 36% lower odds of readmission. A completed discharge clinic appointment was effective in reducing 30-day readmission rates as was a follow-up call.

Celebrating over 20 years: Outcomes from the first doctor of nursing practice program.

The first Doctor of Nursing Practice (DNP) program was opened at the University of Kentucky College of Nursing (UKCON) in 2001. As the CON celebrates 20 plus years of DNP education, leaders decided to do an assessment of the accomplishments and outcomes from the work of graduates. The purpose of this study was to delineate the achievements, outcomes and perception of the impact of graduates from the UKCON DNP program and assess the correlations of specific "perception of impact" variables. DNP graduates from 2005 to 2021 (n = 348) received an email about the study and a link to the survey. Ninety graduates who resided in 14 states responded. Over 84 % of participants indicated that their DNP degree helped them stand out as a leader. Participants reported that having a DNP education increased their knowledge and expertise in multiple areas, including how to lead, to influence, and to improve outcomes within their organizations. Narrative feedback related to top achievements since graduation included career advancement/promotion (n = 22), improving patient care quality/implementation of evidence-based initiatives (n = 21), and becoming a better leader (n = 19). This study illustrated the broad return on investment and the quantification of value that a DNP education brings, both to practice and academia.

Assessing the Value of Huddle Implementation in the Perioperative Setting.

Communication is essential for safe, effective patient care. In perioperative services, where interdisciplinary teamwork is crucial, communication breakdowns may lead to increased errors, decreased staff member satisfaction, and poor team performance. This process improvement project focused on instituting perioperative huddles for two months and measuring the effect that they had on staff members' satisfaction, engagement, and communication effectiveness. We used validated, Likert-style survey tools to gauge participants' satisfaction, level of engagement, communication practices, and opinions about the value of huddles before and after implementation, in addition to an open-ended descriptive question in the postsurvey. Sixty-one participants completed the presurvey and 24 participants completed the postsurvey. Scores across all categories increased post huddle implementation. Benefits of the huddles noted by participants included timely and consistent messaging, sharing essential information, and increased feelings of connection between perioperative leaders and staff members.

Impact of Case Review Debriefings on Moral Distress of Extracorporeal Membrane Oxygenation Nurses.

BACKGROUND: Moral distress occurs when nurses know the ethically correct action to take but are restrained from taking it. Moral distress is prevalent in nurses who work in intense stress situations, as do extracorporeal membrane oxygenation nurses. LOCAL PROBLEM: Nurses who work in critical care settings have higher levels of moral distress than nurses who work in other practice areas. The purpose of this project was to evaluate the effectiveness of case review debriefings on moral distress of extracorporeal membrane oxygenation nurses. METHODS: Thirty-nine critical care registered nurses with specialty training in extracorporeal membrane oxygenation were invited to participate in this clinical improvement project. The intervention consisted of 2 case review debriefings. The Moral Distress Scale-Revised and the Moral Distress Thermometer were used to measure long-term and acute (short-term) moral distress. RESULTS: Of a potential range of 0 to 336, the mean Moral Distress Scale-Revised score was 134.0 before intervention and 131.8 after intervention. The frequency of experiencing moral distress did not change after intervention, but the level of moral distress increased after intervention. Moral Distress Thermometer scores decreased for 80% of participants and increased for 20%. Five items related to perceptions of prolonging death and suffering were the most frequent causes of moral distress. CONCLUSIONS: Developing strategies and providing opportunities to mitigate moral distress are crucial to a healthy future nursing workforce. Implications include the potential for improved patient care, decreased turnover rates and costs, and improved nurse satisfaction rates.

Promotion of Student Engagement Through the Application of Good Practices in Nursing Online Education.

The purpose of this article is to review Chickering and Gamson's principles of good practice in teaching and to illustrate their applicability to nursing online education delivery. An additional purpose is to present examples of teaching methods used by faculty to promote engagement in online education courses during the pandemic. The original 7 best practices in education, including ( a ) encourages contact between students and faculty, ( b ) develops reciprocity and cooperation among students, ( c ) uses active learning techniques, ( d ) gives prompt feedback, ( e ) emphasizes time on task, ( f ) communicates high expectations, and ( g ) respects diverse talents and ways of learning, remain evidence-based guidelines today. The authors recommend the addition of 2 new best practices: ( a ) incorporating assignment flexibility to meet student learning preferences; and ( b ) applying learning to real-life situations. Having evidence-based guidelines for supporting the role of a teacher in the online learning setting is of paramount importance.

Using unfolding case scenarios to promote clinical reasoning for nurse practitioner students.

ABSTRACT: This article describes how an unfolding case study can be used to promote the development of clinical reasoning through students' self-reported perceptions, although at the same time facilitating collaboration among providers from various specialties. An unfolding case (evolving case) provides sequential information about a patient's illness trajectory as they experience the illness and related symptomology. An unfolding case study was implemented during a college skills laboratory immersion experience for 33 nurse practitioner (NP) students who were in their final year of the NP program. Students were invited per email to complete a confidential REDCap survey after the case presentation and discussion. Twenty-three students completed the survey. More than half of the students (52%) stated the review of the unfolding case offered "significant learning value" and 78% rated the unfolding case as being "very to extremely" helpful in creating opportunities for critical thinking and engagement in clinical reasoning. Implementing unfolding case studies in NP student program curricula promotes critical thinking, clinical reasoning, and allows opportunities to engage in interprofessional collaboration.

Strengthening Professional Values of Doctoral-Level Nursing Students.

Introduction: Multiple recent critical societal/world events have impacted nurses' beliefs and emphasized the importance of the standards of behavior that frame nurses' professional values. Objectives: This study focused on the professional values of students in a Doctor of Nursing program (DNP), including the relationship between professional values, time in program, and intentions to participate in professionalism-focused activities. Methods: From fall 2019 through Spring 2021, 227 participants were invited to participate in this study through the completion of an online survey at several points in time. The survey contained various demographic variables, items from the Nurses Professional Values Scale-3 representing the dimensions of caring, activism, and professionalism, and Likert scale items that measured intentions to participate in professionalism-focused activities. Results: The overall mean NPVS-3 score was 118.30 (out of a possible range of 28-140). The highest mean score among the three dimensions was for caring (45.38), followed by activism (40.20) and then professionalism (32.71). Students indicated high intentions to participate in activities focused on professionalism (5.77 on a scale of 1 to 7). A moderate correlation between intentions and professionalism (r = .44, p < .0001) was noted. The association of intentions to caring and activism was weaker but significant (r = 0.26; p = .012) and (r = 0.37; p = .0003), respectively. Conclusion: DNP curricular efforts can strengthen nurses' professional values by focusing on the development of critically important professional attributes. Nurses, especially those who have a doctoral-level education, need to have strong professional values and understand the importance of their voice and impact as a leader in the profession.

Intentions to advance professional identity attributes among DNP students: The make it POP series leadership pilot program study.

BACKGROUND: Make It POP (Pathway Optimizing Professionalism) Series (MIPS) leadership educational sessions were developed and taught by the Dean as a curricular focus on professionalism for Doctor of Nursing Practice (DNP) students. PURPOSE: Evaluating the association between Behavioral Beliefs, Normative Beliefs, Control Beliefs, and Intention to advance professional identity and values was a focus of this study. A secondary focus was to discern whether these Belief measures and attendance to the MIPS education series were predictive of Intention to increase professional identity and values. METHOD: Over a two-year period, 227 students were invited to attend the MIPS courses, which included four once per semester sessions. Students were invited to complete a survey structured around the tenants of the Theory of Planned Behavior prior to attending the MIPS and following each session; 91 students completed the survey at least once. RESULTS: A significant relationship was not noted between attendance to one or more MIPS sessions and Intention to advance professional identity and values. Behavioral Beliefs and Control Beliefs had the strongest associations with Intentions, but normative beliefs were not significantly associated with Intentions. CONCLUSION: Integrating curricular innovation with meaningful engagement and reflection in DNP education may advance DNP student's commitment for sustained professional growth.

The effect of amino acid-oral rehydration solution (Enterade®) on chemotherapy related diarrhea and quality of life in solid tumor cancer patients: A non-randomized experimental study.

PURPOSE: The purpose of this study was to evaluate use of a proprietary amino acid-oral rehydration solution (AA-ORS) known as Enterade® to reduce the severity of chemotherapy related diarrhea (CRD), to improve patient reported Quality of Life (QOL), and to reduce treatment holds, delays, dose modifications, prevention of weight loss, and subjective improvement of associated gastrointestinal mucositis physical symptoms. METHODS: An experimental pilot study without randomization in a single population with two separate measurements over time was performed in a National Cancer Institute (NCI) designated cancer center in the South-Central United States. The variables included sociodemographic data, cancer diagnosis, chemotherapy treatment regimens, Common Terminology Criteria for Adverse Events (CTCAE) v5.0 grade of diarrhea, stool consistency using the Bristol Stool Scale, use of antidiarrheals, associated gastrointestinal mucositis symptoms affecting QOL, and QOL measured with the Functional Assessment of Chronic Illness Therapy-Diarrhea survey. RESULTS: A total of 22 participants enrolled in the study. Sixteen completed both the pre-survey and post survey. A statistically significant difference was not found between the patient's subjective report of quality of life when comparing pre and post survey responses. There was a statistically significant improvement from baseline in the QOL questions specific to bowel concerns due to diarrhea with a mean pre-survey response score of 35.3 versus a post survey score of 29.2 (p = .003). There was a reduction in the CTCACE grade of diarrhea demonstrating a reduction in the frequency of stools per day (p = .001) and a change in the consistency of stools moving from watery to more formed stools using the Bristol Stool Scale (p = .049). CONCLUSION: Use of AA-ORS in this study was found to be useful in the reduction of CRD in patients receiving systemic oncology therapies. This study needs to be replicated with a larger, more inclusive sample size to further support the use of AA-ORS in the reduction of CRD and QOL.

Nursing Faculty Resilience During a Time of Disruption and Change.

ABSTRACT: Assessing the resilience level of nursing faculty during a time of unprecedented change in nursing education was the focus of this study. A descriptive cross-sectional survey that incorporated demographic data and the 10-item Connor-Davidson Resilience Scale was used. Participants ( n = 78) had an average resilience score of 32.6. No correlation was found between resilience and demographic variables such as age, years of teaching experience, and type of nursing program. Resilience is important because it helps faculty assimilate various protective factors and persist during times of rapid change.

A Multicenter Study About Resilience of Nursing Students and Faculty in Online Courses.

BACKGROUND: Resilience is the process of adapting well in adverse situations. Due to the challenges of teaching in online programs and the adaptations needed by students, it is important that faculty and students maintain a high level of resilience. PURPOSE: The purpose of this study was to assess the resilience level of undergraduate and graduate nursing students and faculty who interact in an online environment and to determine factors that impact resilience. METHODS: This study employed a descriptive cross-sectional study design using a convenience sample of undergraduate and graduate students and faculty at six accredited universities in the United States. Faculty and student resilience were measured using the Connor Davidson 10 Resilience scale instrument. RESULTS: The sample included 92 faculty who taught at least one online course and 200 students who were enrolled in at least one online course. There was no difference in faculty or student resilience by generation or program. Overall resilience scores were at the moderate level for both students and faculty. CONCLUSION: Resilience has multiple benefits for both students and faculty, and is a critical concept for focus in nursing education at all levels.

Adapting clinical experiences during a pandemic: One college of nursing's approach.

ABSTRACT: Graduate level nursing programs are having increasing difficulty obtaining clinical sites for their students. Nurse practitioner (NP) students need a minimum of 500 direct care hours in addition to indirect hours. Simulation experiences may not be used as direct patient care hours for NP students, but telehealth experiences may be used if the focus is on obtaining similar competencies to what would be acquired with face-to-face patient experiences. One college of nursing adapted several opportunities for NP students to acquire indirect clinical experiences and specific NP competencies during the coronavirus (COVID-19) pandemic. Several different clinically focused teaching methodologies were planned and implemented. These varied by NP specialty track and included complex case analyses, virtual (Zoom) rounds, well-child cases, and objective structured clinical examinations. These adapted clinical experiences are effective methods of helping students acquire clinical competencies and skills; however, they bring their own challenges. Post-COVID may be a time of new beginnings, moving nursing education forward on finding new and better ways to ensure that students acquire clinical competencies. What the new normal will be for nursing education is yet to be determined, but nursing education will likely never return to where we were before the pandemic.

Strengthening the impact of Doctor of Nursing Practice projects in education and clinical practice.

ABSTRACT: The significance and value of Doctor of Nursing Practice (DNP) projects can be potentiated by collaboration between educators and practice leaders and when students build on previous DNP projects, as demonstrated in this article. Projects can have a longstanding financial, quality, and outcome impact, helping demonstrate the worth and efficacy of the DNP degree.

Professional values and role socialization of new NPs.

ABSTRACT: This cross-sectional study focuses on assessing factors related to role socialization of new NPs. Participants identified caring as the most important professional value, followed by activism and professionalism. Role socialization factors including a sense of belonging and forming professional identities were higher for experienced NPs.

Transitioning to Teaching Online During the COVID-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic many nursing educators have been required to abruptly convert to an online delivery model. Faculty need resources and support to transition face to face courses into an online format. PURPOSE: The purpose of this article is to highlight nursing faculty perceptions of the effectiveness of resources, support, and methodologies for online teaching during the COVID-19 Pandemic. METHODS: A cross-sectional descriptive survey design was used to collect data about nursing faculty resources, support and methodologies used to transition at least one undergraduate or graduate degree nursing course to an online format during the COVID-19 pandemic. RESULTS: Eighty-four faculty who taught in ten university colleges of nursing used varied teaching methodologies in online courses, but included some consistent methods such as websites and web based tools. The student engagement strategies that faculty were most satisfied with were journal writing and projects. Most faculty reported having information technology support and access to instructional design resources. CONCLUSION: Nursing faculty were resourceful, adaptive, and willing to use both novel and existing resources and methodologies to meet their teaching objectives and engage students. They were also, overall, satisfied with the administrative support they received from their respective institutions. Many of these resources, methodologies, and supports will continue to be used by faculty as likely more programs and courses will continue to be managed online.

Perception of online teacher self-efficacy: A multi-state study of nursing faculty pivoting courses during COVID 19.

BACKGROUND: COVID-19 forced many colleges and schools of nursing to abruptly pivot face-to-face learning to online formats. Online teaching is not new, but some faculty have not taught in a virtual environment and rapidly transitioning courses online was challenging. It is not known if teacher self-efficacy was impacted by these circumstances. OBJECTIVES: We aimed to assess online teacher self-efficacy of nursing faculty who transitioned at least one-face-to face course to an online format. We hypothesized that faculty with previous online teaching experience and greater self-rated instructional support would demonstrate higher online teacher self-efficacy scores compared to faculty who had little or no online teaching experience or reported less satisfaction with instructional support. DESIGN: A cross-sectional, descriptive design was used. SETTING: Faculty from ten universities across the United States were recruited. PARTICIPANTS: Nursing faculty (N = 84) who transitioned at least one face-to-face course to an online format during COVID-19 were included in the study. METHODS: Participants completed the 32-item Michigan Nurse Educators Sense of Efficacy for Online Teaching (MNESEOT) instrument and a demographic questionnaire which included items about prior online teaching experience and instructional support. RESULTS: Participants scored overall teacher self-efficacy high (75th percentile). "Computer skills" were scored highest while "student engagement" scored lowest. Prior online teaching was a predictor of higher online teacher self-efficacy; however, instructional support was not a predictor of higher online teacher self-efficacy. CONCLUSION: Nursing faculty reported a high level of online teacher self-efficacy during an abrupt pivot from face-to-face teaching to a virtual format. Pre-emptive opportunities to teach online can build self-efficacy for novice faculty. Faculty and students will benefit from improving student engagement skills, especially during isolating and overwhelming events such as the COVID-19 pandemic.

A Multicenter Study of Student Engagement and Satisfaction in Online Programs.

BACKGROUND: Students who are more satisfied and engaged in online courses have better learning experiences and outcomes. METHOD: Survey data were collected during a 4-month period in 2019. The research team created a survey to collect demographic information and assess student satisfaction. Student engagement was measured using the 19-item Online Student Engagement Scale. RESULTS: Overall student engagement and satisfaction scores in online programs were moderately high. Generation Z participants and students from PhD programs were the most satisfied and engaged in their programs. CONCLUSION: Students who are more engaged in online coursework are more satisfied and thus are more likely to remain and successfully complete their respective programs. [J Nurs Educ. 2021;60(5):259-264.].