A Multisite Study of a Quality Improvement Teaching Strategy to Build Competency.

BACKGROUND: Quality improvement (QI) is an essential part of nursing education. Although there are robust examples of teaching strategies for QI, there is a distinct lack of research on effective strategies for teaching QI in nursing education. METHOD: This multisite study included students from six nursing programs. A treatment fidelity plan was developed and followed to ensure consistency for implementation of the study and data collection. A quasiexperimental, nonpaired, pre- and posttest study design was used to examine changes in student perspectives of QI after participating in a QI teaching strategy. Pre- and posttest questions were mapped to the American Association of Colleges of Nursing's Essentials subcompetency statements for QI. RESULTS: A total of 254 pre- and 116 posttest responses were included for analysis. Significance (p = .05) was found at the beginning level within three questions. CONCLUSION: Findings from this study indicate beginning-level students can benefit from a competency-based QI learning activity. [J Nurs Educ. 2024;63(1):38-42.].

Creating a Community of Nurse Educator Scholars: The QSEN Academic Task Force Success.

BACKGROUND: Engaging in scholarship is a critical component of being an effective nurse educator and can have a significant impact on the nursing profession as a whole. PROBLEM: Nurse educators are expected to teach and simultaneously engage in scholarship. Barriers include heavy workloads and lack of resources including faculty mentors. Evidence supports that organized work groups support success. APPROACH: Members of the Quality and Safety Education for Nurses (QSEN) Academic Task force were queried about scholarly activity as a result of engagement with fellow task force members. OUTCOMES: Scholarly outcomes included numerous peer-reviewed publications, teaching tips, presentations, and grants. CONCLUSION: Participating in national work groups can serve as a platform for fostering a community of scholars to make meaningful contributions to the profession.

Evaluation of a New Faculty Teaching Workload Model.

BACKGROUND: Creating an equitable faculty workload model is an ongoing concern. This research evaluated the effectiveness of and satisfaction with a new faculty teaching workload model 1 year after implementation. METHODS: Data were collected through secondary analysis of faculty assignment spreadsheets, online survey of all full-time nursing faculty members, online survey of college of nursing administrators, and financial analysis. RESULTS: Individual faculty teaching loads were not consistent with the workload model. Tenure-track faculty members were assigned higher workloads than the model. Faculty members strongly preferred to have input into their schedule. Both faculty members and administrators identified strengths and opportunities for the model. CONCLUSIONS: Creating equitable faculty assignments is complex. Administrators and faculty members need to establish a mutual understanding of the process used to calculate equitable workloads and protect time for service and scholarship commensurate with faculty rank.

Original Research: Nurses' Self-Assessed Knowledge, Attitudes, and Educational Needs Regarding Patients with Substance Use Disorder.

BACKGROUND: Substance use disorder (SUD) is a chronic illness, but it's often seen as an intentional choice rather than as a disease. People with SUD are frequently stigmatized, leading to disparate care. Findings from previous studies have indicated that nurses feel inadequately prepared to care for, and tend to have negative attitudes toward, patients with SUD. But it's unknown what kind of education would better prepare nurses caring for this patient population, or whether these negative attitudes vary across practice settings. PURPOSE AND DESIGN: This observational, cross-sectional, mixed-methods study sought to explore nurses' self-assessed knowledge of and attitudes toward caring for patients with SUD (whether formally diagnosed or not) in hospital settings across the United States. A secondary aim was to determine nurses' educational preferences and needs in this area. METHODS: Data were collected over a three-month period in early 2020, using the online social networking platform Facebook. All participants were nurses working in hospital settings throughout the United States. Participants were surveyed using two tools: the Drug and Drug Problems Perceptions Questionnaire, and another questionnaire that included open-ended questions regarding nurses' SUD-related education and their experiences and perceived needs in caring for patients with SUD. Quantitative data were analyzed using analysis of variance and post hoc Tukey tests. Qualitative data were analyzed using thematic analysis. RESULTS: A total of 691 nurses participated. Nurses reported having been educated in SUD but wanted additional face-to-face education from mental health specialists. The nurses working on mental health units had significantly more positive attitudes toward caring for patients with SUD than nurses on other units. Older nurses had significantly more positive attitudes toward patients with SUD than younger nurses. Qualitative analysis uncovered four themes: unmet needs, personal experiences inform care, personal beliefs inform perceptions, and judgmental attitudes. CONCLUSIONS: Study findings indicate that, in general, hospital nurses have negative attitudes toward patients with SUD. The results further reaffirm the need for empathy-based nursing education for nurses who care for these patients. Participants expressed a preference for face-to-face training by mental health specialists experienced in SUD. Given the increasing prevalence of SUD and the expected retirement of older nurses, it is urgent that we prioritize empathy-based nursing education, particularly for newer-to-practice nurses, in order to improve nurses' attitudes and ensure best care for patients with SUD.

A model to understand antecedents of nursing attitudes and perceptions influencing outcomes of patients with SUD.

INTRODUCTION: Substance use disorder (SUD) is a persistent and long-standing public health issue in the United States. While SUD is medically considered a chronic illness, it is also one that is viewed as self-inflicted, thereby resulting in judgmental attitudes and stigmatization from care providers, specifically from nurses. DESIGN: In 2020, the authors completed an analytical cross-sectional study that included open-ended questions to examine nurses' knowledge and attitudes toward caring for patients with SUD across practice settings. METHODS: A conceptual model was constructed by examining original study data and published literature on SUD, re-analyzing themes, determining constructs and variables, then coming to a consensus on critical aspects of the model. CONCLUSION: The resulting conceptual model highlights antecedents of nursing behaviors that directly affect patient care outcomes, providing a roadmap to improving patient outcomes. CLINICAL RELEVANCE: Understanding antecedents that affect nurses' attitudes and perceptions of patients with SUD highlights changes that can influence patient outcomes.

Nursing Faculty Workload: Balancing Fiscal Responsibility and Faculty Satisfaction.

BACKGROUND: Nursing faculty and nursing program administrators share the goal of equitable faculty workload. Faculty teaching assignments and other academic workload can affect productivity and faculty satisfaction. PROBLEM: Models for workload calculation need to account for multiple factors including mission, faculty position and rank, faculty expertise, and financial resources. The nursing faculty shortage, organizational structure, and fluctuations in student volumes further complicate achievement of a balanced workload model. APPROACH: A task force identified existing parameters for workload and assessed faculty satisfaction and teaching assignment preferences at a Midwest metropolitan university college of nursing. OUTCOMES: A new workload model was developed and accepted. The work highlighted course load expectations, financial realities, and negotiations between nursing faculty and nursing program administrators. CONCLUSIONS: Lessons learned suggest considering the academic year overall rather than each semester separately and reaffirm the importance of continual, clear communications between nursing faculty and nursing program administrators.

Leadership, Teamwork, and Collaboration: The Lived Experience of Conducting Multisite Research Focused on Quality and Safety Education for Nurses Competencies in Academia.

AIM: The aim of this study was to explore facilitators and barriers to conducting a multisite national study in nursing academia unsupported by grant funding. BACKGROUND: Scholarship focused on the Quality and Safety Education for Nurses (QSEN) competencies stimulates opportunities for research and collaboration among nurse educators and clinicians. Twelve members of the QSEN Academic Task Force collaborated on a multisite study of the effectiveness of a QSEN teaching strategy and published the findings. METHOD: A descriptive phenomenological reflective approach using Kim's critical reflective inquiry model was used to explore the lived experiences of the original study investigators. Data were analyzed using Colaizzi's phenomenological reduction. RESULTS: Findings revealed seven facilitators and one overarching barrier to conducting academic research projects of this scope. CONCLUSION: Participants found that strong leadership, a commitment to teamwork and collaboration, and a shared interest were critical to conducting a successful national study across academic settings.

Experiences of homeless women in accessing health care in community-based settings: a qualitative systematic review.

INTRODUCTION: Homelessness among women is on the rise in the US and continues to be a concern globally. The challenges homeless women face are unique and vast, yet how they experience health care can greatly affect their desire to access health care in the future. The ability to shed light on what is meaningful to homeless women in their health care experiences can guide the changes necessary to provide appropriate patient-centered, impactful care with the goal of increasing access by this vulnerable population. OBJECTIVE: This review aimed to identify, appraise and synthesize existing qualitative evidence on the experiences of homeless women when accessing community-based health care services. INCLUSION CRITERIA: This review included studies on homeless women, both previously or currently, aged 18 or older. The phenomena of interest were homeless women's health care experiences, including perspectives, narratives and/or reflections, at any time during their period of homelessness. The review included health care services received by homeless women in community-based settings, shelter-based clinics and/or mobile clinics. Qualitative data including, but not limited to, the designs of phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research were considered. METHODS: Using a three-step search strategy, databases of published and unpublished articles were searched from database inception to 2018. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the JBI System for the Unified Management, Assessment and Review of Information. Findings were rated according to their level of credibility, categorized based on similarity in meaning, and subjected to a meta-synthesis. Two reviewers utilized a meta-aggregative approach. RESULTS: A total of 196 qualitative articles were identified of which 24 were included after critical appraisal. Meta-synthesis generated three synthesized findings: (1) Homeless women who access health care services at community-based settings feel as if their homelessness qualifies them as second-class citizens, which impedes future access; (2) Homeless women have an expectation of therapeutic communication from their health care providers, the lack of which can incite negative emotional responses, fear and knowledge deficits; (3) Homeless women with limited resources struggle to prioritize competing needs, such as transportation, time and money, which influences their ability to access health care. These synthesized findings were derived from 47 study findings that were subsequently aggregated into 10 categories. Of the 47 study findings, 32 were rated as unequivocal and 15 were rated as credible. The overall ConQual for each of the three synthesized findings was low due to common dependability issues across the included studies. A total of 454 participants were included. The included studies were published from 1997 to 2017. CONCLUSION: The review identified that homeless women's experiences when accessing health care in community-based settings, particularly in the US, have been poor and have negatively affected their desire to access health care in the future. The synthesized findings illustrate clear indicators for use of cultural competence and addressing provider bias in the delivery of health care to homeless women. This review also highlights the importance of understanding clinical experiences of providing direct care for these women in order to shed light on the type of advocacy needed to ensure equitable access to health care services. While this review uncovered issues with some global health care systems, the predominance of system constraints within the US highlights the need for health policy reform to improve the experiences of homeless women when accessing health care.

Primary care services tailored for adult and adolescent homeless persons: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to explore existing literature on primary care services for adult and adolescent homeless persons, map the evidence and identify gaps in the literature. INTRODUCTION: Homeless adults and adolescents have complicated health needs, increased need for services, and more barriers to care. Recipients of primary care services use less emergency and urgent care resources. More information is needed in order to tailor primary care services for this vulnerable population. INCLUSION CRITERIA: This review will consider studies with participants aged 13 years or older who are currently or previously homeless. Studies will be included regardless of type of primary care service, country of origin, healthcare delivery system, geographic location or cultural setting. METHODS: The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. The search strategy aims to locate published and unpublished studies and will be adapted for each information source. The reference lists of selected studies will be screened for additional citations. The search will be limited to the English language, but not by date of publication. Databases to be searched include MEDLINE (PubMed), CINAHL, Scopus, Embase, PsycINFO, PsychArticles, PsycEXTRA, Academic Search Premier and Web of Science. Gray literature and unpublished studies will be searched. After screening titles and abstracts, two independent reviewers will retrieve potentially relevant, full-text studies and extract data. Data will be presented in diagrammatic form, accompanied by a narrative summary.

Experiences of transgender men in seeking gynecological and reproductive health care: a qualitative systematic review.

OBJECTIVE: The objective of this review was to evaluate the experiences of transgender men in seeking gynecological and reproductive health care. INTRODUCTION: Discrimination has led to barriers in care for the transgender community. This is most evident in gender-based care such as gynecological care. Transgender men may continue to require gynecological and reproductive health care despite having a masculine identity and appearance. It is crucial that transgender men have access to gynecological and reproductive health care that is culturally and clinically competent. This review aimed to identify and synthesize the available qualitative data about their experiences in seeking gynecological care. INCLUSION CRITERIA: This review considered all studies that included natal females who identified as transgender men, gender non-binary, gender expressive, or gender queer. It included studies that explored the experiences of transgender men seeking gynecological care, obstetrical care, fertility care, or reproductive care in all care environments. As patient experience was the primary focus of the review, only qualitative studies where the data were analyzed into findings and where participant voice was prominent were included. METHODS: The databases searched included CINAHL Complete (EBSCO), PubMed, PsycINFO (EBSCO), PsycArticles (EBSCO), ScienceDirect All Subscribed Content (Elsevier), and Web of Science. Sources of unpublished studies and gray literature searched included Google Scholar, MedNar, and ProQuest Dissertations and Theses. Databases were searched between November 2018 and January 2019. Searches were limited to studies published in English after 1979. RESULTS: Twenty-six studies met the inclusion criteria. There was a mix of studies that included only transgender men, as well as studies that included other types of participants. Appraisal of quality was undertaken by two independent reviewers and revealed common concerns found in qualitative reporting. These concerns included the researchers not acknowledging the impact they have on the data and vice versa, as well as not clearly stating the paradigm and methodological underpinnings of the research. All studies that met the inclusion criteria were included in the review regardless of quality appraisal. The 26 included studies comprised 874 participants. They yielded 86 findings and accompanying illustrations. These were categorized into 14 categories and further synthesized into five findings: i) negotiating the binary system, ii) navigating the cis-normative world, iii) healthcare access adaptive behaviors, iv) verbal and nonverbal discrimination, and v) provider knowledge and trustworthiness. CONCLUSIONS: The findings of this review revealed that transgender men face specific challenges in accessing gynecological and reproductive care. The strictly binary system requires patients to be either male or female, and does not allow for any variation in gender. Gynecological and reproductive spaces and resources are geared exclusively toward heterosexual female clients. Transgender men face discrimination that requires they develop adaptive behaviors. While some of these barriers will not be easily overcome, transgender men feel more comfortable and empowered to seek care when their providers are trusted and knowledgeable about their individualized needs. Recommendations put forth as a result of this review cover policy change, changes to education for staff and providers, changes to academic curricula, and further research.

Nursing Students' Perceptions of Just Culture in Nursing Programs: A Multisite Study.

BACKGROUND: While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education. PURPOSE: The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia. METHODS: Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs. RESULTS: The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (χ[2] = 25.09, P < .001). CONCLUSIONS: The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.

Experiences of transgender men in seeking gynecological and reproductive health care: a qualitative systematic review protocol.

OBJECTIVE: The purpose of this review is to synthesize the existing qualitative literature examining the experiences of transgender men seeking gynecological and reproductive health in all healthcare settings globally. INTRODUCTION: Existing literature clearly identifies that fear of mistreatment and discrimination is an ongoing concern among the transgender community. Transgender men face challenges and barriers when seeking health care. When female reproductive organs and genitalia are retained, transgender men will need to access reproductive and gynecological health care and screening examinations. Synthesis of the literature examining those experiences is the focus of this review. INCLUSION CRITERIA: This review will consider all qualitative studies that include natal females who identify as transgender, genderqueer, non-binary or gender expressive and their experiences when seeking and receiving care related to gynecological or reproductive care. All studies on this type of care in any setting will be included. METHODS: CINAHL Complete and PubMed will be searched and eligible studies published in English after 1979 will be included. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. The full text of articles will be assessed for inclusion and all potential articles will then be appraised for methodological quality using standardized critical appraisal tools. Data will be extracted by two independent reviewers. Findings will be pooled with a meta-aggregation approach to categorize findings. These synthesized findings will be graded to establish confidence in the output.

Promoting Nurse Retention Through Career Development Planning.

This is the second article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series will feature exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.

Constructive Feedback Teaching Strategy: A Multisite Study of Its Effectiveness.

AIM: The study purpose was to describe students' perceptions of feedback after participating in a teaching strategy designed to foster a view of feedback as an opportunity for improvement. BACKGROUND: Although delivering and receiving constructive feedback are essential to the role of the professional nurse, feedback has been identified as a trigger for incivility in academia and practice. METHOD: Twelve nurse educators from the Quality and Safety Education for Nurses Academic Task Force, located at nine schools of nursing across the nation, implemented a presentation about giving and receiving constructive feedback in junior and senior courses. RESULTS: Five hundred twenty-three students submitted a total of 985 posts or essays in response to viewing the presentation; seven themes were identified. CONCLUSION: Viewing this teaching strategy enabled nursing students to develop an awareness of the opportunity that constructive feedback presents for professional development, self-improvement, teamwork and collaboration, and patient safety.

Teaching Informatics to Prelicensure, RN-to-BSN, and Graduate Level Students.

Teaching nursing informatics to students in associate, baccalaureate, RN-BSN, and graduate nursing programs poses challenges for curriculum design, as well as developing appropriate instruction and assessment methods. The current state of nursing informatics education provides opportunities for unique instructional design and assessment techniques. Key course content is provided with suggestions for teaching informatics that focus on leveling for prelicensure, RN-BSN, and graduate nursing programs.

Experiences of incivility among faculty and students in online nursing education: a qualitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to synthesize available evidence of nursing faculty's and nursing students' experiences and perceptions of incivility in online education with the objective of identifying the meaning of incivility in online nursing education. The specific questions to be addressed by this review are.

The hospitalised patients' experience of being in protective/source isolation: A systematic review of qualitative evidence.

BACKGROUND: The placement of hospitalised patients in isolation is either done to protect the immunocompromised patient from others (reverse or protective isolation) or to protect others from the patient's infectious process (isolation). Both situations require limiting the contact between the patient and others to prevent the spread of pathogens or to protect the immunocompromised patient. Isolating patients remains a primary treatment in the hospital setting. There is no formal meta-aggregation of the qualitative research literature that describes the meaning of this experience. Explication of the meaning will provide valuable information for clinicians as they care for persons in isolation. OBJECTIVES: The aim of this review was to synthesise the best available qualitative evidence on the experience of hospitalised patients being placed in isolation. INCLUSION CRITERIA: The participants were adult (> 18 years old) hospitalised patients in isolation.The phenomenon of interest was the meaning of being in isolation from the hospitalised patient's perspective.The studies of interest were qualitative studies that focused on adult hospitalized patients and their experience with being cared for in isolation. SEARCH STRATEGY: The search strategy sought to find both published and unpublished research studies from 1971 to May 2010. This review was limited to papers written in English. A three step search strategy was utilised. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Lastly, a final hand search of the reference lists from included papers was employed. METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using the appropriate Joanna Briggs Institute critical appraisal instrument from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. DATA COLLECTION: Data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Categories were formed based on aggregation of similar findings with like meaning. The categories were analysed to identify synthesised findings that were presented as declamatory and generalisable statements to guide and inform practice. RESULTS: A total of 12 studies were reviewed and, of those, 4 were excluded for methodological concerns and 8 were included in the review. The qualitative studies examined the hospitalised patients' experiences of being in isolation. A total of 56 findings were extracted from included studies. Findings were then synthesised in 11 categories. Two synthesised findings were developed from these categories: (1) The isolation experience causes fractured human connectivity and nurses must provide care that mitigates the negative effects of this; and (2) nurses must attend to the reality that a variety of factors affect the patient's ability to adapt to an artificial environment. CONCLUSION: The patient in isolation temporarily resides in an artificial environment, removed from the normalcy of their life. The experience of being in isolation causes severe limitation in or loss of self-determination and autonomy, resulting in the patient being caught in a restrictive environment in which they have little control. The isolated patient must relinquish their autonomy and due to limited contact with others there is disjointed and fractured human connection. IMPLICATIONS FOR PRACTICE: In order to moderate the detrimental psychosocial effects of isolation, institutional policies need to reflect the higher acuity of care required, allow the patient to have choices, design rooms that consider the long-term patient, and support nursing care that is considerate of the unique needs of the isolated patient. IMPLICATIONS FOR RESEARCH: Further exploration of the effects of isolation on the achievement of desired patient outcomes is needed. In-depth comparative studies between nurses' perceptions of the care they provide versus the patients' perception of the care they receive would provide valuable insights. Additionally, studies that explore patients' perception of how helpful they find nursing interventions aimed at meeting their psychosocial care needs would also provide useful data. Lastly, studies that explore the barriers perceived by nursing staff to implementing patient-centered care in the isolation environment would be helpful in informing nursing practice.