Effect of Clinical Reasoning Seminars on Medical-Surgical Specialty HESI Examination Scores.

BACKGROUND: Clinical reasoning and clinical judgment have been identified as essential skills for the delivery of quality patient care. PURPOSE: The purpose of this study was to determine the impact of clinical reasoning seminars (CRSs) on medical-surgical specialty HESI examination scores of high-risk students. METHODS: A retrospective correlational design was used for this study, which involved a review of medical-surgical HESI scores for 115 junior-level baccalaureate nursing students who were identified as academically high-risk and who participated in a series of CRSs. RESULTS: The participation in CRSs by high-risk students did not have a statistically significant impact on the medical-surgical HESI scores. Students who attended CRSs, however, had a higher mean medical-surgical HESI score than students who did not attend any CRSs. CONCLUSION: Although statistical differences were not found, it appears that high-risk students may have benefitted from participation in CRSs.

Development of the Barriers to Error Disclosure Assessment Tool.

OBJECTIVES: An interprofessional group of health colleges' faculty created and piloted the Barriers to Error Disclosure Assessment tool as an instrument to measure barriers to medical error disclosure among health care providers. METHODS: A review of the literature guided the creation of items describing influences on the decision to disclose a medical error. Local and national experts in error disclosure used a modified Delphi process to gain consensus on the items included in the pilot. After receiving university institutional review board approval, researchers distributed the tool to a convenience sample of physicians (n = 19), pharmacists (n = 20), and nurses (n = 20) from an academic medical center. Means and SDs were used to describe the sample. Intraclass correlation coefficients were used to examine test-retest correspondence between the continuous items on the scale. Factor analysis with varimax rotation was used to determine factor loadings and examine internal consistency reliability. Cronbach α coefficients were calculated during initial and subsequent administrations to assess test-retest reliability. RESULTS: After omitting 2 items with intraclass correlation coefficient of less than 0.40, intraclass correlation coefficients ranged from 0.43 to 0.70, indicating fair to good test-retest correspondence between the continuous items on the final draft. Factor analysis revealed the following factors during the initial administration: confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers to medical error disclosure. α Coefficients of 0.85 to 0.93 at time 1 and 0.82 to 0.95 at time 2 supported test-retest reliability. CONCLUSIONS: The final version of the 31-item tool can be used to measure perceptions about abilities for disclosing, impressions regarding institutional policies and climate, and specific barriers that inhibit disclosure by health care providers. Preliminary evidence supports the tool's validity and reliability for measuring disclosure variables.

Learning Preferences and Engagement Level of Generation Z Nursing Students.

BACKGROUND: Minimal information exists about the educational environment that will foster learning and engage Generation Z students. PURPOSE: The purposes of this study were to identify the teaching methods that Generation Z nursing students preferred and felt were the most engaging and effective for learning and to determine their engagement level in the classroom setting. METHODS: This study employed a descriptive, cross-sectional design. RESULTS: Lecture with audience response clickers was the most preferred/most engaging and effective method for helping Generation Z nursing students learn, whereas assigned reading was the least preferred method. Students preferred a traditional classroom model instead of a flipped classroom. Acquiring skills was the dimension of engagement rated the highest by this group of students. CONCLUSIONS: Innovative lectures that incorporate applicable visual images and audience involvement combined with simulation, videos, and case studies may encompass a teaching formula that will engage and foster learning for Generation Z students.

Work Values of Generation Z Nurses.

OBJECTIVES: To determine the work values of Generation Z nurses, a new generation in the current workforce. BACKGROUND: A new generation of nurses is now part of the nursing workforce. Generation Z nurses, born in 1995 (aged ≤24 years), will bring new expectations and ideals about life and work into healthcare work settings. METHODS: A descriptive, cross-sectional survey design was used to assess the work values of traditional baccalaureate Generation Z nursing students using the Lyons Work Values Survey. RESULTS: The work value component ranked most important by participants was social/altruistic, followed by instrumental/extrinsic, cognitive/intrinsic, and prestige. CONCLUSION: Helping people and having a job that is interesting and engaging while also offering job security and good benefits were the most important future Generation Z nurse work values.

Individual and Team-Based Medical Error Disclosure: Dialectical Tensions Among Health Care Providers.

Researchers from disciplines of education, health communication, law and risk management, medicine, nursing, and pharmacy examined communication tensions among interprofessional (IP) health care providers regarding medical error disclosure utilizing patient simulation. Using relational dialectics theory, we examined how communication tensions manifested in both individual-provided medical error disclosure and IP team-based disclosure. Two dialectical tensions that health care providers experienced in disclosure conversations were identified: (a) leadership and support, and (b) transparency and protectionism. Whereas these tensions were identified in an IP education setting using simulation, findings support the need for future research in clinical practice, which may inform best practices for various disclosure models. Identifying dialectical tensions in disclosure conversations may enable health communication experts to effectively engage health care providers, risk management, and patient care teams in terms of support and education related to communicating about medical errors.

Student Perception of Improvement in Communication and Value in 2 Interprofessional Education Delivery Formats.

A preferred format to deliver interprofessional education (IPE) has not been described. The aim of this study was to compare students' (N = 150) perceived value and improvement in communication between an IPE activity delivered using a comprehensive versus an abbreviated format. Although both formats were perceived by students to improve their communication skills and add value to their education, students indicated the abbreviated format was more effective than the comprehensive format.

Self-Efficacy Measurement and Enhancement Strategies for Medical-Surgical Clinical Nurses.

The Nursing Care Self-Efficacy Scale, a tool for measuring nurses' confidence in their nursing abilities, was developed and tested in a subset of medical-surgical clinical nurses. Scale construction, nurses 'self-efficacy, beliefs, and strategies for enhancing self-efficacy are described.

Transitioning to a new nursing home: one organization's experience.

Restructuring of long-term care in Western Health, a regional health authority within Newfoundland and Labrador, created a unique opportunity to study the widespread impacts of the transition. Staff and long-term-care residents were relocated from a variety of settings to a newly constructed facility. A plan was developed to assess the impact of relocation on staff, residents, and families. Indicators included fall rates, medication errors, complaints, media database, sick leave, overtime, injuries, and staff and family satisfaction. This article reports on the findings and lessons learned from an organizational perspective with such a large-scale transition. Some of the key findings included the necessity of premove and postmove strategies to minimize negative impacts, ongoing communication and involvement in decision making during transitions, tracking of key indicators, recognition from management regarding increased workload and stress experienced by staff, engagement of residents and families throughout the transition, and assessing the timing of large-scale relocations. These findings would be of interest to health care managers and leadership team in organizations planning large-scale changes.

Nutrition intervention to decrease symptoms in patients with advanced heart failure.

For a majority of patients with advanced heart failure, there is a need for complementary, non-pharmacologic interventions that could be easily implemented by health care providers to provide palliative care. Three major pathologic pathways underlying heart failure symptoms have been identified: fluid overload, inflammation, and oxidative stress. Prior research has demonstrated that three nutrients-sodium, omega-3 fatty acids, and lycopene-can alter these pathologic pathways. Therefore, the purposes of this study are to test the effects of a 6-month nutrition intervention of dietary sodium reduction combined with supplementation of lycopene and omega-3 fatty acids on heart failure symptoms, health-related quality of life, and time to heart failure rehospitalization or all-cause death. The aims of this double blind-placebo controlled study are (1) to determine the effects of a 6-month nutrition intervention on symptom burden (edema, shortness of air, and fatigue) and health-related quality of life at 3 and 6 months, and time to heart failure rehospitalization or all-cause death over 12 months from baseline; (2) compare dietary sodium intake, inflammation, and markers of oxidative stress between the nutrition intervention group and a placebo group at 3 and 6 months; and (3) compare body weight, serum lycopene, and erythrocyte omega-3 index between the nutrition intervention group and a placebo group at 3 and 6 months. A total of 175 patients with advanced heart failure will be randomized to either the nutrition intervention or placebo group.

Low-sodium diet self-management intervention in heart failure: pilot study results.

BACKGROUND: Self-care management of a low-sodium diet is a critical component of comprehensive heart failure (HF) treatment. AIMS: The primary purpose of this study was to examine the effectiveness of an educational intervention on reducing the dietary sodium intake of patients with HF. Secondary purposes were to examine the effects of the intervention on attitudes, subjective norm, and perceived behavioural control towards following a low-sodium diet. METHODS: This was a randomized clinical trial of an educational intervention based on The Theory of Planned Behavior. Patients were randomized to either a usual care (n=25) or intervention group (n=27) with data collection at baseline, 6 weeks, and 6 months. The intervention group received low-sodium diet instructions and the usual care group received no dietary instructions. Nutrition Data Systems-Research software was used to identify the sodium content of foods on food diaries. Attitudes, subjective norm, and perceived behavioural control were measured using the Dietary Sodium Restriction Questionnaire. RESULTS: Analysis of covariance (between-subjects effects) revealed that dietary sodium intake did not differ between usual care and intervention groups at 6 weeks; however, dietary sodium intake was lower in the intervention group (F=7.3, df=1,29, p=0.01) at 6 months. Attitudes subscale scores were higher in the intervention group at 6 weeks (F=7.6, df=1, 38, p<0.01). CONCLUSION: Carefully designed educational programmes have the potential to produce desired patient outcomes such as low-sodium diet adherence in patients with heart failure.

Meaning in life: the perspective of long-term care residents.

A qualitative approach was used in the exploration of meaning in life for long-term care (LTC) residents. This hermeneutic phenomenological study, as described by van Manen, was conducted using semi-structured interviews with 11 LTC residents from a rural region in Atlantic Canada. Four themes emerged as enhancing meaning in life for the residents in this study: Connectedness, Survival Despite Declining Functional Capacity, Engaging in "Normal" Activities, and Seeking a Place of Refuge. In this article, we describe the emerging themes and the implications for LTC education, practice, and future research.

Theory-based low-sodium diet education for heart failure patients.

Theory-based teaching strategies for promoting adherence to a low-sodium diet among patients with heart failure are presented in this article. The strategies, which are based on the theory of planned behavior, address patient attitude, subjective norm, and perceived control as patients learn how to follow a low-sodium diet. Home health clinicians can select a variety of the instructional techniques presented to meet individual patient learning needs.

Predictors of depressive symptoms in female medical-surgical hospital nurses.

Predictors of depressive symptoms were identified in a sample of 150 female medical-surgical hospital nurses. Participants completed a demographic questionnaire and instruments to measure occupational stress (Nursing Stress Scale), major life events (Social Readjustment Rating Scale), somatic symptoms (Patient Health Questionnaire-15), and depressive symptoms (Center for Epidemiologic Studies-Depression Scale; CES-D) during a one time survey. Thirty-five percent of the nurses scored > or = 16 on the CES-D, the cutoff for mild to moderate depressive symptoms. Fatigue or low energy (43%), pain in their extremities or joints (30%), trouble sleeping (29%), back pain (28%), and headaches (18%) were the primary somatic complaints. Depressive symptoms were positively correlated with somatic symptoms (r = .55, p < .01), major life events (r = .41, p < .01), and occupational stress (r = .29, p < .01). Years employed in the hospital setting (r = -.22, p < .01) and household income (r = -.18, p < .05) were inversely related to depressive symptoms. Hierarchical multiple regression was used to identify predictors of nurses' depressive symptoms. Somatic symptoms (beta = .39, p < .01), occupational stress (beta = .18, p < .05), major life events (beta = .18, p < .05), and income (beta = -.15, p < .05) accounted for 34% of the variance in nurses' depressive symptom scores. The information from this study can guide the development of interventions to reduce depressive symptoms among hospital nurses. Reductions in depressive symptoms can advance health and quality of life for the hospital nurse. Symptom alleviation or reduction may improve nursing care delivery when distressing symptoms interfere with professional performance among nurses.

Sponsored professional seminars: enhancing professionalism among baccalaureate nursing students.

If we are to emphasize professionalism within nursing, students need to understand the opportunities, responsibilities, and concerns that are integral to the nursing profession. Sharing ideas related to nursing practice in a specified area with practicing nurses, expert faculty, and a speaker provide students with a sense of excitement about their chosen career. The sponsored seminar series permits undergraduate nursing students to converse with their future colleagues over dinner, develop lasting relationships, and advance their learning in an area of interest.