Student Perception of Diversity, Equity, and Inclusion Curricular Threads on Nursing Practice.

BACKGROUND: Compassionate, inclusive, and equitable nursing care begins with integrating concepts of diversity, equity, and inclusion (DEI) and social determinants of health (SDOH) into curricula. PROBLEM: Little is known about RN to BSN students' perception of applying these concepts in practice. The purpose of this pilot project was to assess RN to BSN students' perceptions of DEI-SDOH curricular threads in their nursing practice. APPROACH: Students were surveyed to assess their perceptions about the impact DEI-SDOH curricular content had on their ability to assess and address DEI-SDOH in practice, level of confidence in talking about DEI-SDOH, addressing breaches in DEI, and the influence of DEI-SDOH in nursing. OUTCOMES: Respondents indicated DEI-SDOH curricula promoted self-examination, critical examination of health care systems, and increased DEI-SDOH competence. CONCLUSION: DEI-SDOH curricula build upon professional experiences, strengthen assessment and application competence, and equip nurses with confidence to address DEI-SDOH as an effective strategy to reduce health disparities.

A Visionary Think Tank to Address the Nursing Workforce Crisis.

The COVID-19 pandemic exacerbated an existing problem plaguing hospital systems across the United States: a nursing workforce shortage. This article describes how one institution applied the American Organization for Nursing Leadership Nurse Executive Competencies to convene an immersive think tank to reimagine the nursing workforce.

Mindfulness Training to Improve Nurse Clinical Performance: A Pilot Study.

Health care errors are a national concern. Although considerable attention has been placed on reducing errors since a 2000 Institute of Medicine report, adverse events persist. The purpose of this pilot study was to evaluate the effect of mindfulness training, employing the standardized approach of an eight-week mindfulness-based, stress reduction program on reduction of nurse errors in simulated clinical scenarios. An experimental, pre- and post-test control group design was employed with 20 staff nurses and senior nursing students. Although not statistically significant, there were numerical differences in clinical performance scores from baseline when comparing mindfulness and control groups immediately following mindfulness training and after three months. A number of benefits of mindfulness training, such as improved listening skills, were identified. This pilot study supports the benefits of mindfulness training in improving nurse clinical performance and illustrates a novel approach to employ in future research.

Enacting a Vision for a Master's Entry Clinical Nurse Leader Program: Rethinking Nursing Education.

The need to educate nurses at the graduate level and provide them with a different skill set that broadens their view of health and nursing is clearly articulated by the American Association of Colleges of Nursing. Consequently, the role of the clinical nurse leader (CNL) was born. Responding to the need for providing a highly educated and credentialed professional at the bedside, Rush University College of Nursing made the bold move to phase out baccalaureate education and enact a prelicensure, master's entry CNL program. Although there is a clear need for this type of graduate, there is little in the literature to provide guidance to institutions that wish to develop this type of program. This paper describes the factors that came into play in making that decision, the process of curriculum development and implementation, the challenges encountered in implementing this type of program, and the outcomes that the program has evidenced since its inception.

Long-term outcomes of a postbaccalaureate nurse residency program: a pilot study.

OBJECTIVE: The purpose of this pilot study was to determine what influence a nurse residency program (NRP) has on long-term outcomes including turnover rates, career satisfaction, and leadership development. BACKGROUND: Studies examining short-term outcomes of NRPs have shown positive effects. Long-term studies of NRPs have not been reported. METHODS: This descriptive study surveyed former nurse residents, still employed at the facility. Data were collected by means of a demographic tool and the McCloskey/Mueller Satisfaction Scale, a job satisfaction tool. RESULTS: Although nursing turnover increased past the yearlong residency program, it remained well below the national average. All components of satisfaction were ranked relatively high, but coworker/peer support was most important to job satisfaction. Leadership development in the areas of certification and pursuing an advanced degree increased with longer employment, but hospital committee involvement decreased with successive cohorts. CONCLUSION: Overall, the long-term outcomes of an NRP appear to have benefits to both the organization and the individual.

A decision algorithm for admitting students to advanced practice programs in nursing.

The academic records of 738 master's-level nursing students were reviewed to develop an optimal compound decision rule for selecting candidates who would be successful in advanced practice programs. Chi-square analysis was used to establish the association between various combinations of independent variables and dismissal status. Independent variables included cumulative grade point average (CUMGPA), undergraduate nursing grade point average (NSGGPA), and Graduate Record Examination (GRE) scores (quantitative and verbal). Results indicated that the combination of any two independent variables was as predictive of success as was any combination of three independent variables and that the combination of a CUMGPA of 3.25 and NSGGPA of 3.0 predicted success in 99% of the cases. The addition of the GRE scores added no additional predictive value. On the basis of these analyses, we waived the GRE requirement for applicants who met the GPA criteria and developed decision rules for admitting those who did not.

Working with standardized patients: a primer.

This paper presents concepts and strategies for using standardized patients (SP) in teaching and evaluation of nursing students. SP encounters are an alternative to clinical experiences and a standardized criterion for student performance evaluation. Careful development of encounters, selection and training of SPs, support and debriefing of all participants are essential to a positive SP encounter. SP encounters should be developed based on objectives and competency criteria and relate to actual events. Encounter scripts incorporating any "traditional" language often associated with a specific medical condition are beneficial to standardizing the process. SP preparation involves providing background on medical conditions, feedback when practicing the role-play, and validation of performance consistency. Orientation of students and faculty to the SP experience ensures that participants stay in role. SPs can also be utilized to complete written evaluation tools and provide verbal feedback to students. All participants should evaluate the encounter process for future improvement.

An ontological view of advanced practice nursing.

Identifying, developing, and incorporating nursing's unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may not necessarily reflect those of nursing. A lack of focus may lead current advanced practice nursing curricula and emerging doctorate of nursing practice programs to mirror the logical positivist paradigm and perspective of medicine. This article presents an ontological perspective for advanced practice nursing education, practice, and research.

The phenomenology of deciding about hemodialysis among Taiwanese.

The purpose of this study was to describe the experience of making hemodialysis choices among Taiwanese with end-stage renal disease (ESRD). Using Colaizzi's phenomenological method, 12 ESRD patients provided in-depth, audiotaped interviews that were then transcribed and analyzed. The results of the data analysis revealed three broad categories and ten themes. The first category, confronting the dialysis treatment, included four themes: fear caused by false beliefs, a sense of threat to life, concern about the impairment of self-concept, and fear of physical limitations. The second category, seeking further information, included three themes: getting opinions of family members, seeking professional confirmation, and exploring alternative treatments. The third category, living with dialysis, included three themes: worsening symptoms, support of the family, and law of causation. These categories and themes revealed the difficulties that ESRD patients dealt with and the influence these difficulties and their culture had on the treatment choice.

Psychometric testing of the self-care of heart failure index.

BACKGROUND: Self-care is believed to improve outcomes in heart failure (HF) patients. However, research testing this assumption is hampered by difficulties in measuring self-care. The purpose of this study was to evaluate the psychometric properties of a revised instrument measuring self-care in persons with HF, the Self-Care of Heart Failure Index (SCHFI). The SCHFI is a self-report measure comprised of 15 items rated on a 4-point response scale and divided into 3 subscales. METHODS AND RESULTS: Psychometric testing was done using data from 760 HF patients (age 70.36 +/- 12.3 years, 51% male) from 7 sites in the United States. Reliability of the SCHFI (alpha.76) was adequate. Reliability of the Self-Care Maintenance subscale was lower than desired (alpha.56) but the reliability of the other subscales was adequate: Self-Care Management (alpha.70) and Self-Care Self-Confidence (alpha.82). Construct validity was supported with satisfactory model fit on confirmatory factor analysis (NFI=.69, CFI.73). Construct validity was supported further with significant total and subscale (all P <.05) differences between patients experienced with HF and those newly diagnosed, consistent with the underlying theory. CONCLUSION: Low reliability of the Self-Care Maintenance subscale was expected because the items reflect behaviors known to vary in individuals. The reliability and validity of the SCHFI are sufficient to support its use in clinical research.

The life after gastric surgery index: conceptual basis and initial psychometric assessment.

Understanding the influence of symptoms on an individual's life is important when providing nursing care. Currently, however, there are few clinically useful tools for assessing symptoms in individuals who have had surgery for gastric cancer. The Life After Gastric Surgery Index was developed to address this need by providing a multidimensional measure of symptom experience (frequency, severity, and bothersomeness) of 18 common symptoms patients may experience after gastroesophageal surgery for cancer. Initial psychometric assessment of the Life After Gastric Surgery Index has demonstrated acceptable internal consistency reliability and strong face, content, and criterion-related validity on two small samples. This paper reviews the conceptual basis of the Life After Gastric Surgery Index, the results of its initial psychometric assessments, and the implications this measure has for clinical practice and research.

Frequency and outcomes of transient myocardial ischemia in critically ill adults admitted for noncardiac conditions.

BACKGROUND: Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia. OBJECTIVES: To detect myocardial ischemia and injury in patients admitted for noncardiac conditions and to examine the relationship of myocardial ischemia, injury, and acuity to cardiac events. METHODS: Transient myocardial ischemia, acuity, elevations in serum troponin I, and in-hospital cardiac events were examined in 76 consecutive patients. Transient myocardial ischemia, determined by using continuous electrocardiography, was defined as a 1-mm (0.1-mV) change in ST level from baseline to event in 1 or more leads lasting 1 or more minutes. Acuity was determined by scores on Acute Physiology and Chronic Health Evaluation II. RESULTS: A total of 37 ischemic events were detected in 8 patients (10.5%); 32 (86%) were ST-segment depressions, and 35 (96%) were silent. Twelve patients (15.8%) had elevated levels of troponin I. Transient myocardial ischemia, elevated troponin I levels, and advanced age were significant predictors of cardiac complications (R2 = 0.387, F = 15.2, P < .001). Acuity correlated only modestly with increased length of stay in the intensive care unit (r = 0.26, P = .02) and elevated troponin I levels (r = 0.25, P = .03). Patients with transient myocardial ischemia had significantly higher rates of elevations in troponin I (P < .001) and cardiac events (P < .001) than did patients without. CONCLUSIONS: Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.

Clinical reasoning in experienced nurses.

As an essential component of nursing practice, clinical reasoning is used to assimilate information, analyze data, and make decisions regarding patient care. Little is known about the reasoning strategies of experienced nurses who are not yet experts. This qualitative descriptive study explored the cognitive strategies used by experienced nurses as they considered assessment findings of assigned patients. To date, few studies of nurses' clinical reasoning have been conducted in a practice setting during actual patient care. A small group research design was employed using the think-aloud (TA) method with protocol analysis. A total of 15 experienced nurses were asked to "think aloud" about patient assessment findings. Data were audiotaped, transcribed, and analyzed using the three steps of protocol analysis. The results suggest that experienced nurses used a conceptual language to reason about assessment findings and used heuristics to reason more quickly and efficiently.

Critical thinking and clinical decision making in critical care nursing: a pilot study.

OBJECTIVE: This pilot study examined the relationship of education level, years of critical care nursing experience, and critical thinking (CT) ability (skills and dispositions) to consistency in clinical decision making among critical care nurses. Consistency was defined as the degree to which intuitive and analytical decision processes resulted in similar selection of interventions in tasks of low and high complexity. DESIGN: The study was nonexperimental and correlational. SAMPLE: Critical care nurses (n = 54) from adult critical care units in 3 private teaching hospitals. The majority of nurses held a BSN or MSN and had an average of 9 years of direct clinical experience in the care of the critically ill. RESULTS: Decision-making consistency decreased significantly between low-complexity and high-complexity tasks. Both intuitive and analytical decision processes produced clear intervention selections in the low-complexity task, although the analytical process resulted in a more complete specification of interventions. In the high-complexity task, however, only the intuitive process resulted in a clear, plausible, and safe specification of interventions. Education and experience were not related to CT ability, nor was CT ability related to decision-making consistency. Only greater years of critical care nursing experience increased the likelihood of decision-making consistency. CONCLUSIONS: Overall, intuitive decision processes resulted in more clinically consistent selection of interventions across tasks. More investigation is needed to examine the influence of decision heuristics, and the conceptualization and measurement of CT abilities among practicing nurses.

Self-management decision influences in heart failure: a preliminary investigation.

Self-management decision making places significant cognitive demands on individuals with heart failure (HF). Before theoretically valid decision supports can be developed, a better understanding of underlying decision characteristics is needed. The purpose of this preliminary study was to describe sources of self-management decision influences for individuals (N = 38) with varying levels of HF (New York Heart Association (NYHA) classifications). Therapeutic value was the most influential source of self-management decision making for these patients, followed by personal beliefs and values, information sources, symptom influence, and task difficulty across all NYHA classes. Symptom influence was least influential for persons in Class II, whereas task difficulty was least influential for those in Classes III and IV. Moderate and significant associations were noted between information sources and personal beliefs and values and between information sources and symptom influence. As the disease progressed, a trend toward fewer decision influences, especially in the task difficulty scale, was noted.

A study of clinical decision making by certified registered nurse anesthetists.

Anesthesia outcomes and related risk factors have been studied for more than 100 years. Varying sample sizes and research methods have been used, with research findings that were open to multiple interpretations. Research with closed malpractice claims demonstrates that American Society of Anesthesiologists physical status II patients undergoing elective procedures are most likely to experience damaging events intraoperatively with resultant postoperative adverse outcomes. The process of care, including clinical decision making, contributes to adverse outcomes. Clinical decision making can be difficult to assess and measure. In this study, the cognitive psychology framework of information-processing theory and literature pertaining to the use of heuristics, or rules of thumb, and clinical biases, were used to analyze cases from the AANA Foundation closed malpractice claims database. This database contains more than 300 files involving St Paul Fire and Marine Insurance Company-covered CRNAs from across the United States. These files were analyzed by 10 CRNA investigators on the AANA Closed Claims research team. Variables such as inadequate preinduction activities, e.g., incomplete preanesthetic assessments, and use of cognitive biases and inaccurate probability estimation were associated with adverse outcomes in this research sample. Teaching of decision science in basic and continuing nurse anesthesia education is advocated.

Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study.

Oncologic outcomes of gastroesophageal surgery may be similar, but little is known about the impact on patients' postoperative symptom experience and quality of life (QOL). The purpose of this pilot study was to describe overall QOL and symptom experience of individuals who underwent either total gastrectomy with Roux-en-Y esophagojejunostomy or esophagogastrectomy for adenocarcinoma of the gastroesophageal junction. The Gastroenterology Quality of Life Index (GQLI) and the Life After Gastric Surgery (LAGS), developed by the investigators for measuring symptom frequency, were used to measure variables of interest. The sample (n = 27) had a relatively high QOL, but experienced difficulties with eating patterns, physical functioning, socialization, and happiness. There were significant differences between the two procedures related to QOL and symptom frequency in that individuals who had the total gastrectomy fared somewhat better. Further, patients who had esophagogastrectomy had greater symptom frequency and significantly poorer QOL. Although initially compelling, these data warrant further investigation into the QOL and symptom impact in a more diverse population of patients with cancer of the stomach or esophagus. These results, however, suggest several areas where nursing interventions could help these patients.

The unrecognized paradigm shift in nursing: implications, problems, and possibilities.

An important paradigm (or worldview) shift is occurring in science that affects the nature of nursing education, practice, and research. The shift from positivism to postmodernism and now to neomodernism has received little attention in US nursing and as such may forestall many opportunities related to such change. The nature of this paradigm shift and its effects on selected aspects of nursing education, practice, and research are described, and related implications, problems, and possibilities are explored. Neomodernism is discussed as one future for nursing that encompasses aspects of both positivism and postmodernism but yet goes beyond these to include important metanarratives as traditional values and beliefs of nursing. The work of Laudan and Lakatos are explored as supportive of this neomodernist approach.