Do prelicensure nursing students' backgrounds impact what they notice and interpret about patients?

BACKGROUND: Academic educators are challenged to foster the development of clinical judgment in diverse learners. The impact of nursing students' backgrounds on clinical judgment has not previously been studied. AIMS: SAMPLE: Prelicensure/preregistration students, representing three international English-speaking programs in 3 countries, comprised the sample (N = 532). All were enrolled in the first course in which perioperative content was taught. DATA COLLECTION: An online learning activity was designed to elicit responses to a simulated case study of an expert nurse role model caring for an older adult patient experiencing delirium several days post-operatively. DATA ANALYSIS: Dyads of coders did three rounds of coding. Logistic and multinomial logistic regression models used background variables to look for patterns in student responses. FINDINGS: The data strongly suggest that background variables impact clinical judgment, however, not in interpretable patterns. CONCLUSION: Nurse educators must acknowledge that prelicensure students' backgrounds impact their clinical judgment and assist them to learn to think like nurses.

Core components of the rural nurse specialist role in New Zealand.

INTRODUCTION: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. METHODS: A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. RESULTS: Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. CONCLUSION: The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the NP role as having better role clarity; therefore, all participants were considering becoming an NP. There are barriers to becoming an NP, thus an expansion of the current RNS role is recommended. Further recommendations from this study include increased professional leadership to improve RNS visibility and further continued interprofessional education to enhance collaboration.

A transcultural immersion experience: implications for nursing education.

This article is a synthesis and interpretation of field work from a transcultural nursing immersion experience in Italy. The main focus of the field work was to understand the cultural influences on health systems with interpretations related to nursing education. The major recommendations of the paper include strategies for nurse educators to promote cultural competence throughout curricula by providing students with meaningful clinical experiences and addressing healthcare needs of diverse populations in the U.S. and abroad.

DIFE: A new model in undergraduate nursing education.

This article presents a new model of nursing created in 2003 for use in an undergraduate nursing program. It reviews the drivers for the development of an innovative approach to nursing education in a New Zealand educational institution, Whitireia Community Polytechnic. After referring to the literature informing this development, the article briefly outlines the philosophy underpinning a revised curriculum for the program. The article then describes the nursing model created to realize the intention of the revised curriculum, the DIFE framework, consisting of four interrelated phases: Discovery, Interpretation, Facilitation, and Evaluation. It highlights the distinctive educational practices that use of the model in teaching the curriculum produces. In this approach, educational practice embodies a model for clinical practice. Finally, this article reflects on the value of this new model of nursing after 5 years of use.

Specialist nursing framework for New Zealand: a missing link in workforce planning.

The current global nursing shortage challenges the provision of a well qualified and sustainable health workforce to meet future population health needs. An identified area of concern for New Zealand reaching health policy targets in chronic conditions management and primary health care is an adequate specialist nurse workforce supply. This article explores the New Zealand context underpinning this concern and contends that effective workforce planning would be supported by the development of a single unified framework for specialist nursing practice in New Zealand. A consistent national framework has the potential to support accurate data collection and enable service providers to identify and plan transparent and transferable pathways for specialist nursing service provision and development. Advanced practice nursing frameworks assist in increasing productivity through building an evidence base about advanced practice, enhancing consistency and equity of expertise; supporting a reduction in role duplication; and enabling succession planning and sustainability.