The experiences of nurse educators in establishing a teaching practice in the care of older persons: A focused ethnography study.

BACKGROUND: Gerontological nursing is not a career choice for most new graduates. Nurse educators, who influence students' career decisions, lack expertise in older person care. The academic culture may affect educators developing gerontological expertise. PURPOSE: The study explored the culture of a Canadian pre-licensure nursing education program in relation to educators' expertise in gerontological nursing. METHODS: In a focused ethnography, 22 nurse educators/researchers/administrators participated in interviews and/or observations conducted from March 2018 to December 2018. Content analysis of interview transcripts and fieldnotes occurred concurrently with data collection. RESULTS: Themes characterizing the culture were: Structure and Hierarchy, Losing Gerontology, Teaching Challenges, and Valuing Older Persons and Their Care. Participants felt: a hierarchy limited gerontologists' support for undergraduate educators and the curriculum; the integrated curriculum reduced the focus on gerontology; limited professional development opportunities and excessive workload constrained building gerontology expertise; and valuing older persons and their care influenced access to gerontology resources. CONCLUSIONS: The culture of a pre-licensure nursing program impacted educators building expertise in older person care. More research is needed to overcome barriers that constrain educators' proficiency in gerontological nursing. Increasing the number of educators adept in gerontology will develop nurse graduates with an appreciation for working with older persons.

Factors affecting undergraduate nurse educators' knowledge, skills or attitudes about older persons and their care: An integrative review.

BACKGROUND: Nurses are increasingly expected to provide care for older persons; however, there are too few nurse educators with expertise in older person care to ensure students graduate with the requisite competencies. METHODS: An integrative review, using Whittemore and Knafl's framework, was undertaken to identify and synthesise evidence about factors affecting nurse educators' knowledge, skills or attitudes about older persons and their care. RESULTS: Forty-four articles met the inclusion criteria. All but three papers originated in the USA. Content analysis yielded three central themes: external-level factors, employer-level factors and individual-level factors. Findings demonstrated that external funding from philanthropic organisations and government agencies supported many of the national, regional and site-specific initiatives, which were, in many cases, underpinned by professional regulatory frameworks. Negative attitudes of administrators and reduced budgets of educational institutions impeded the availability of such initiatives. Negative attitudes of individual educators towards older person care and the specialty of gerontology constrained their pursuit of such learning, as did their lack of awareness of current gerontology resources. CONCLUSIONS: The lack of educators with gerontology knowledge, skills and requisite attitudes requires a focused effort from external and professional bodies, and from educational institutions to ensure the resources are available to enhance educator expertise in gerontology. Rigorous study addressing the factors influencing educators' knowledge, skills or attitudes towards older persons and their care is required. IMPLICATIONS FOR PRACTICE: Addressing the lack of nurse educator expertise in gerontology could help to ensure new nurses have the required competencies to provide quality older person care.

Clinical nurse specialists' approaches in selecting and using evidence to improve practice.

UNLABELLED: ABSTRACT Background: Evidence-based practice (EBP) has become the desired standard within all health disciplines because the integration of the best evidence into clinical practice is fundamental to optimizing patient outcomes. The valuing of research and research-based knowledge as the basis for decision making is explicit in current discourse in the health sciences. Despite the desires of proponents of EBP for use of evidence derived through research, nurses prefer to use knowledge derived from experience and social interactions. The clinical nurse specialist (CNS) is in the ideal position to act as a link between evidence and practice; however, a paucity of knowledge exists on how CNSs select and use evidence in their daily practice. PURPOSE: The purpose of this descriptive, cross-sectional study was to examine the approaches used by CNSs to select and use evidence in their daily practice. METHOD: A telephone survey, developed for this study from a pilot study conducted by the principal investigator (PI), was used to elicit responses from a purposive sample of CNSs living in a western Canadian province who were willing to be contacted for research, and who had practiced clinically as CNSs within the past year. A response rate of 75% (n = 94) was achieved. Descriptive statistics were used to describe and compare the variables of interest. RESULTS: Literature tailored to particular specialties and personal experiences were reported as the most frequently accessed sources of evidence. This evidence was most often used to facilitate improvements in patient care, and least often used to develop further research proposals. CONCLUSION: This study indicates that although CNSs select and use evidence from a wide variety of sources, further development of their capacity to retrieve and transfer knowledge may increase the uptake of research findings in nursing practice.