Integrating the 4Ps in masters-level nursing education.

BACKGROUND: The curriculum for our generalist masters in nursing program required a heavy credit load of science courses shared with the nurse practitioner programs. The bundle of required courses far exceeded the masters in nursing program completion outcomes, increasing tuition costs and prolonging the program of study for students who were not seeking advanced practice credentials. PURPOSE: The purpose of this project was to streamline the curriculum and better align course content with MS program expected learning outcomes, student learning needs, and recent accreditation requirements. PROCESS: Course expected learning outcomes were drafted and mapped to program expected learning outcomes and AACN The Essentials: Core Competencies for Professional Nursing Education (2021) concepts and sub-competencies. A two-course series totaling 5 credits was developed to integrate the 4Ps (pathophysiology, pharmacology, physical/health assessment, and health promotion) into an online master's level nursing curriculum while decreasing the total number of credits. OUTCOMES: A total of 67 students successfully completed the online courses during the first semester. Minor revisions based on student feedback were made after the first implementation. CONCLUSIONS: Integrating the 4Ps into a series of two courses is a feasible option for streamlining a generalist masters in nursing curriculum.

Nursing Students' Cue Recognition in Educational Simulation: A Scoping Review.

BACKGROUND: New nurses often struggle with recognizing cues and applying clinical judgment. Nurse educators develop educational simulation scenarios to support students in developing clinical judgment, which includes the foundational step of recognizing cues. PURPOSE: A scoping review on undergraduate nursing students' cue recognition during simulation was conducted to systematically map the existing research and identify knowledge gaps. METHODS: From initial identification of 228 studies published between 2010 and 2020, a total of 17 quantitative or qualitative studies were independently appraised using the Joanna Briggs Institute scoping review process and PRISMA-ScR reporting guidelines. RESULTS: Cues were missed with varying levels of frequency. Participants frequently failed to recognize respiratory rates and physical assessment changes as salient cues to patient deterioration. Verbal cues from simulated patients were often missed or resulted in distancing behaviors. CONCLUSION: Research is needed to determine the most effective methods for helping learners develop skills in cue recognition and analysis.

Honors students in the health professions: An academic-practice partnership for developing interprofessional competencies through simulation.

Abundant literature supports the value of interprofessional education (IPE) in health profession programs, but few studies focus on undergraduate honors students. The goals of this academic-practice partnership quality improvement project were to increase awareness of IPE, provide experiential opportunities to learn the principles of interprofessional practice, assess perceptions of readiness for practice, and to explore motivations and learning expectations of undergraduate nursing and pre-medical honors students. Average scores on the Readiness for Interprofessional Learning Scale (RIPLS) increased in several areas after the IPE simulation experiences, with small to medium effect sizes (Cohen's d) on individual items and two subscales (Teamwork & Collaboration and Positive Professional Identity). Themes identified in the narrative data were opportunity, fun, self-awareness, situational awareness, and the value of teamwork. These findings add to literature on honor students' expectations and motivations for learning and can be used in designing interprofessional collaborative learning activities for undergraduate health profession students.

Health care provider use of motivational interviewing to address vaccine hesitancy in college students.

BACKGROUND: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors. LOCAL PROBLEM: Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020. METHODS: This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students. RESULTS: Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided. CONCLUSION: MI can be an effective part of a strategy to increase vaccination rates.

A National, Qualitative Study of the Motivators and Outcomes of Nurse Educator Certification.

AIM: This qualitative study sought to describe motivators and outcomes of academic nurse education certification. BACKGROUND: Several studies have explored perceptions of the value of nurse educator certification (CNE). However, there is a gap in understanding motivators and outcomes of certification as a nurse educator. METHOD: As part of a larger, web-based, mixed-method study, a national sample of certified and noncertified nursing educator administrators and faculty responded to nine open-ended questions. The inductive content analysis approach was used to identify constructs and themes. RESULTS: From an overall sample of 721 participants, three constructs and associated themes emerged. CONCLUSION: Motivators for pursing CNE align with previously reported intrinsic values. Participants seek extrinsic rewards as well. Educator outcomes include enhanced teaching and expanded roles. Student outcomes were less clear. Further study of outcomes of CNE is recommended to promote recognition of academic nursing education as an advanced nursing specialty.

The Nature of Nursing Competency in Simulation of Adult Medical-Surgical Nursing: Exploratory Factor Analysis.

BACKGROUND AND PURPOSE: Educators, employers, and regulatory agencies face substantive challenges in evaluating nursing competency. Evidence on what competency is and how to measure it can mitigate the challenges. METHODS: Participants (N = 67) completed three high-fidelity simulation tests. Each video-recorded test was scored by three raters using a 41-item instrument. Exploratory factor analysis was used to define the latent structure of the instrument. RESULTS: A five-factor solution accounted for 56% of the variance, minimized negative loadings, and minimized the number of cross-loadings. The factors were minimally correlated (each r < .30). CONCLUSIONS: The factors, Vigilant Action, Role Nuances, Precision, Procedural Skills, and Risk Reduction, represent integrated dimensions of competency that can be linked to specific tasks underlying safe practice.

From Competence to Continuing Competency.

In 2011, a task force sponsored by an organization that has Accreditation Board for Specialty Nurse Certification-accredited programs published a definition of continuing competence. Eight years later, the organization sponsored the work of another task force to revisit that definition, with the 2018-2019 task force broadening its focus beyond the U.S. borders and beyond nursing. After an extensive literature review, task force members collated their findings into four categories: Identifying Competencies, Validating Competencies, The International Perspective on Competency Assessment, and Competency in Disciplines Other Than Nursing. The task force identified perspectives on continuing competency and found that although licensing and credentialing organizations addressed the topic thoroughly, little attention was devoted to the perspectives of the public, individual clinicians, and recipients of clinicians' services. This article identifies that little consensus exists on definitions of competence and competency, international perspectives have much to offer, and theoretical frameworks for research on competence and competency are lacking. [J Contin Educ Nurs. 2020;51(1):15-24.].

Measuring the Value of Academic Nurse Educator Certification: Perceptions of Administrators and Educators.

BACKGROUND: Certification is one option for validating the professional competence of academic nurse educators. The relative value associated with such certification has not yet been established. METHOD: Psychometric analysis of a new Perceived Value of Certification Tool for Academic Nurse Educators (PVCT-ANE) was conducted. Certified nurse educators (CNE) and noncertified nurse educators and nursing program administrators responded to an online survey using the PVCT-ANE. RESULTS: A sample of 718 nurse faculty members and administrators from 48 states in the United States participated. Academic nurse educator certification was valued by nurse educators and administrators as representing specialized knowledge, attainment of a professional standard, educator competence, and professional credibility. Value statements associated with satisfaction and professional accomplishments were rated higher than statements associated with professional recognition and marketing. CONCLUSION: The PVCT-ANE is useful for assessing how different groups perceive the value associated with academic nurse educator certification. [J Nurs Educ. 2019;58(9):502-509.].

Using Generalizability Theory to Inform Optimal Design for a Nursing Performance Assessment.

The promotion of competency of nurses and other health-care professionals is a goal shared by many stakeholders. In nursing, observation-based assessments are often better suited than paper-and-pencil tests for assessing many clinical abilities. Unfortunately, few instruments for simulation-based assessment of competency have been published that have undergone stringent reliability and validity evaluation. Reliability analyses typically involve some measure of rater agreement, but other sources of measurement error that affect reliability should also be considered. The purpose of this study is three-fold. First, using extant data collected from 18 nurses evaluated on 3 Scenarios by 3 Raters, we utilize generalizability (G) theory to examine the psychometric characteristics of the Nursing Performance Profile, a simulation-based instrument for assessing nursing competency. Results corroborated findings of previous studies of simulation-based assessments showing that obtaining desired score reliability requires substantially greater numbers of scenarios and/or raters. Second, we provide an illustrative exemplar of how G theory can be used to understand the relative magnitudes of sources of error variance-such as scenarios, raters, and items-and their interactions. Finally, we offer general recommendations for the design and psychometric study of simulation-based assessments in health-care contexts.

Testing Nursing Competence: Validity and Reliability of the Nursing Performance Profile.

BACKGROUND AND PURPOSE: There is growing evidence that simulation testing is appropriate for assessing nursing competence. We compiled evidence on the validity and reliability of the Nursing Performance Profile (NPP) method for assessing competence. METHODS: Participants (N = 67) each completed 3 high-fidelity simulation tests; raters (N = 31) scored the videotaped tests using a 41-item competency rating instrument. RESULTS: The test identified areas of practice breakdown and distinguished among subgroups differing in age, education, and simulation experience. Supervisor assessments were positively correlated, r = .31. Self-assessments were uncorrelated, r = .07. Interrater agreement ranged from 93% to 100%. Test-retest reliability ranged from r = .57 to .69. CONCLUSIONS: The NPP can be used to assess competence and make decisions supporting public safety.

Designing Simulation Scenarios to Support Performance Assessment Validity.

This article advances and demonstrates a validation process to guide the development of health care simulation scenarios for assessing performance competency. The development and evaluation of each scenario used in a simulation-based competency assessment must be based on multiple sources of evidence that support the validity of the assessment for its intended use. Procedures are proposed to optimize the validity of simulation-based assessments by linking the scenario directly to the instrument and using a systematic approach for gathering and processing input from experts in the field. This validation process is then applied to the development of an original scenario for use in an assessment of nursing competency that targets objectives through patient simulation scenarios scored by multiple raters.

Designing authentic assessment: strategies for nurse educators.

Increased emphasis on health care safety requires renewed attention to teaching and learning processes for future health care professionals. When presented with problems situated in a clinical context, learners have rich opportunities to demonstrate integration of concepts. Authentic assessment is an approach to evaluation of learning through which students can demonstrate acquired knowledge, skills, and attitudes in the context of real-world or realistic nursing practice activities. This article describes features, approaches, and examples of authentic assessment processes in the context of classroom, clinical, and online nursing education.

Computer-based or human patient simulation-based case analysis: which works better for teaching diagnostic reasoning skills?

AIM: The purpose of this study was to determine whether a difference exists in learner performance and the type and frequency of diagnostic reasoning skills used, based on the method of case presentation. BACKGROUND: Faculty can select from a variety of methods for presenting cases when teaching diagnostic reasoning, but little evidence exists with regard to how students use these skills while interacting with the cases. METHOD: A total of 54 nursing students participated in two case analyses using human patient and computer-based simulations. Participant performance and diagnostic reasoning skills were analyzed. RESULTS: Performance was significantly better with the human patient simulation case. All diagnostic reasoning skills were used during both methods of case presentation, with greater performance variation in the computer-based simulation. CONCLUSION: Both human patient and computer-based simulations are beneficial for practicing diagnostic reasoning skills; however, these findings support the use of human patient simulations for improving student performance in case synthesis.

Constructing the foundations for compassionate care: how service-learning affects nursing students' attitudes towards the poor.

When nurses possess negative attitudes toward people with low socio-economic status it can negatively influence patient care. This study examines whether providing care in a service-learning environment positively affects nursing students' world views and empathy toward the poor. Using a pre-post design, the Attitudes about Poverty and Poor People Scale and the Just World Scale were administered to both a control group and nursing students engaged in a clinical rotation at a low-income housing facility or homeless shelter in spring and fall 2010. Findings show the service learning treatment modestly enhanced empathy and students' views on justice, while not improving superficial perceptions of the poor.