A Systematic Review: Instruments to Measure Educator Retention Concepts.

AIM: The purpose of this study was to identify quantitative instruments that measure characteristics that support nurse educator education, specifically social support, motivation, and work opportunity. BACKGROUND: Vacancies in nurse faculty positions have left nursing education unable to increase the number of nurses prepared to enter the workforce. METHOD: A review of education, nursing, and psychological databases was undertaken to identify reported instruments. Identified instruments were analyzed to match three framework-derived concept categories: social support, internal motivators, and work opportunity. Search terms, retrievals, and quality assessments are discussed; identified instruments are ranked by concept categories. RESULTS: Of 98 articles retrieved, 85 underwent full review, and 7 met the inclusion criteria. From these reports, 20 unique instruments were identified and analyzed. CONCLUSIONS: There are quantitative instruments that measure the concepts found in the Nurse Educator Retention Framework.

Are Nursing Students Learning About Social Determinants of Health?

Nurses must be knowledgeable about social determinants of health (SDH) to provide holistic care with improved patient outcomes. When evaluating the Baccalaureate of Science in Nursing curriculum, it is unclear if SDH are adequately identified, assessed, and discussed, or if students grasp their importance. To move to a population health approach, faculty need to be more inclusive of community and public health. For purposes of this study, the factors comprising SDH were identified as childhood experiences, housing, education, social support, family income, employment, communities, and access to health services. These eight factors were used to categorize participants' qualitative responses to baseline and completion surveys.

Academic policies and practices to deter cheating in nursing education.

AIM: The aim of this systematic literature review was to assess the evidence available to facilitate nursing faculty in policy development and implementation of strategies to deter cheating. BACKGROUND: No previous comprehensive summary of successful faculty practices was found in the literature on which to base academic practice. METHODS: A search of six databases was undertaken using the combination of terms: nursing and policy, nursing and student misconduct, nursing and cheating, and nursing and integrity. More than 28,000 publications were reviewed for English language, US higher education system, and health care programs. Excluded articles described bioethical and research misconduct, admission policy, or workforce issues. RESULTS: Forty-three articles met criteria; a matrix table lists specific faculty action plans and deterrent strategies by category of misconduct for each publication. CONCLUSION: Clearly defined behaviors, processes, and consequences should be delineated by school policies to guide implementation of specific cheating deterrent strategies.

Valid items for screening dysphagia risk in patients with stroke: a systematic review.

BACKGROUND AND PURPOSE: Screening for dysphagia is essential to the implementation of preventive therapies for patients with stroke. A systematic review was undertaken to determine the evidence-based validity of dysphagia screening items using instrumental evaluation as the reference standard. METHODS: Four databases from 1985 through March 2011 were searched using the terms cerebrovascular disease, stroke deglutition disorders, and dysphagia. Eligibility criteria were: homogeneous stroke population, comparison to instrumental examination, clinical examination without equipment, outcome measures of dysphagia or aspiration, and validity of screening items reported or able to be calculated. Articles meeting inclusion criteria were evaluated for methodological rigor. Sensitivity, specificity, and predictive capabilities were calculated for each item. RESULTS: Total source documents numbered 832; 86 were reviewed in full and 16 met inclusion criteria. Study quality was variable. Testing swallowing, generally with water, was the most commonly administered item across studies. Both swallowing and nonswallowing items were identified as predictive of aspiration. Neither swallowing protocols nor validity were consistent across studies. CONCLUSIONS: Numerous behaviors were found to be associated with aspiration. The best combination of nonswallowing and swallowing items as well as the best swallowing protocol remains unclear. Findings of this review will assist in development of valid clinical screening instruments.

Predicting NCLEX-RN Success: the Seventh Validity Study HESI Exit exam.

The findings of six previously conducted studies indicated that the HESI (E) was highly accurate in predicting NCLEX-RN success. The purpose of this study-the seventh study to investigate the validity of the E-was to examine the accuracy of three parallel versions of the Ein predicting licensure success and to describe program practices regarding E benchmark scores, remediation programs, and retesting policies. The findings of this study again indicated that the E was highly accurate in predicting NCLEX-RN success. Additionally, all three versions of the E were found to have a predictive accuracy above 90%. The most common E benchmark score designated by faculty at the participating schools was 850, and most schools required students to retest with different versions of the E until the faculty-designated E benchmark score was achieved. Remediation seemed to be effective in raising students' E scores, and it was recommended that future research investigate the effectiveness of specific remediation strategies.

Prototype to practice: Developing and testing a clinical decision support system for secondary stroke prevention in a veterans healthcare facility.

A clinical decision support system that guides nurse practitioners and other healthcare providers in secondary stroke prevention was developed by a multidisciplinary team with funding received from the Veterans Health Administration Office of Nursing Services. This article presents alpha-testing results obtained while using an integrated model for clinical decision support system development that emphasizes end-user perspectives throughout the development process. Before-after and descriptive methods were utilized to evaluate functionality and usability of the prototype among a sample of multidisciplinary clinicians. The predominant functionality feature of the tool is automated prompting and documentation of secondary stroke prevention guidelines in the electronic medical record. Documentation of guidelines was compared among multidisciplinary providers (N = 15) using test case scenarios and two documentation systems, standard versus the prototype. Usability was evaluated with an investigator-developed questionnaire and one open-ended question. The prototype prompted a significant increase (P < .05) in provider documentation for six of 11 guidelines as compared with baseline documentation while using the standard system. Of a possible 56 points, usability was scored high (mean, 48.9 [SD, 6.8]). These results support that guideline prompting has been successfully engineered to produce a usable and useful clinical decision support system for secondary stroke prevention.

Predicting NCLEX-PN success with the HESI Exit Exam.

Surveys were mailed to directors of 72 randomly selected practical nursing (PN) schools that administered Elsevier's HESI Exit Exam for Practical Nurses (E2-PN) during the 2006-2007 academic year. Data were collected regarding students' NCLEX-PN outcomes and the schools' benchmarking and remediation policies. The first version of the E2-PN was 99.48% accurate in predicting NCLEX-PN success. Versions two and three of the E2-PN, which were administered to students who were remediated because they did not achieve the faculty-designated benchmark, were also highly accurate in predicting NCLEX-PN success. Most faculties set 850 as their school's E2-PN benchmark, and 73% of the respondents required remediation for students who did not achieve the benchmark score. The most frequently cited remediation strategy was tutoring.

Knowledge management: organizing nursing care knowledge.

Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.

Using telehealth to educate Parkinson's disease patients about complicated medication regimens.

Parkinson's disease (PD) primarily affects older adults, who manage their symptoms with complex medicine regimens. This mixed-methods study evaluated the usefulness and usability of follow-up telehealth medication counseling with a sample of community-based PD patients. Patients taking three or more medications for Parkinson's disease were randomly assigned to the teaching modalities of videophone or telephone. A self-care standardized medication educational session lasting 20 to 30 minutes was conducted, and patient and nurse usefulness of the intervention was evaluated by responses to a 15-question Likert scale and elicited comments. Patients' satisfaction with the intervention involved patterns of time, education, and technology. Videophone users were more satisfied with the equipment and counseling. Videophones were considered easy access to supportive, expert neuroscience nurses. Overall, videophone counseling sessions were significantly more useful than the telephone sessions (t[34] = 0.896, p = 0.004, 95% confidence interval = 1.90 to 3.12). Nurses found visualization via videophone significantly more useful for medication and self-management interactions.

Triad Mentoring Model: Framing an Academic-Clinical Partnership Practicum.

BACKGROUND: The triad mentoring model was developed to frame the implementation of innovative student-centered academic-clinical partnerships for online graduate students in nursing leadership and administration practicums. METHOD: The nurse leader and faculty member jointly mentored each student to achieve the academic program's objectives through clinical learning experiences that were relevant and important to the clinical organization. Partnerships with nurse leaders within the student's locality were sought, and capstone practicum projects were developed and implemented during four courses. RESULTS: Both formative and summative results were obtained from all members of the triad team throughout the practicum courses. The processes undertaken to establish, implement, and evaluate the student-centered academic-clinical partnerships identified project modifications throughout the course of study. CONCLUSION: Implementation of the triad mentoring model created academic-clinical partnerships that promoted a fusion of evidence-based practice, quality improvement, and clinical knowledge that produced positive outcomes for the health care setting and student learner. [J Nurs Educ. 2019;58(8):463-467.].

Clinical decision support systems in nursing: synthesis of the science for evidence-based practice.

The aim of this article is to present a synthesis of the research literature on the state of nursing science regarding the development, use, and application of clinical decision support systems for the implementation of evidence-based practice in nursing. The authors sought to answer three specific questions in this metasynthesis: (1) What progress has nursing science made regarding the development and use of clinical decision support systems?; (2) What research methods and theoretical models are being applied by nurse researchers in this area?; and (3)Are there evidence-adaptive clinical decision support systems designed specifically to aid nurses' decisions related to evidence-based practice? Of 183 articles, 17 were included in the final analysis, and six were specific for clinical decision support systems to aid nurses in evidence-based practice. Implications for practice are considered, and recommendations for future research are made.

Determining predictors of delayed recovery and the need for transitional cardiac rehabilitation after cardiac surgery.

PURPOSE: To examine the relationship between demographic and clinical characteristics of cardiac surgery patients with postoperative length of stay (PLOS) greater than 7 days and determine the demographic, social, and clinical predictors of the need for transitional cardiac rehabilitation (TCR) after cardiac surgery. DATA SOURCES: A retrospective review of characteristics, clinical indices, caregiver availability, and patient status (whether living alone) was completed for 304 patients undergoing cardiac surgery over 24 consecutive months. Univariate analyses and multivariable logistic regression models were used to evaluate risk factor characteristics for PLOS greater than 7 days and to predict discharge disposition to TCR or home. CONCLUSIONS: Older patients, those with preoperative comorbidities, and those without a caregiver at home experience delays in functional recovery and discharge and are more likely to need TCR services. IMPLICATIONS FOR PRACTICE: Our findings support the addition of functional recovery and social support risk items to the preoperative cardiac surgery risk assessment.

Faculty Experiences Developing and Implementing Policies for Exit Exam Testing.

Nursing schools use standardized exit examinations to determine student readiness for the NCLEX-RN. Yet little is known about how nursing programs develop policies for using the examinations, set benchmarks scores, and implement remediation strategies with their students. In a phenomenological study, faculty identified a testing policy process that fell into the major themes of triggers for change, policy modification, and reactions to change.

Predicting early academic success: HESI Admissions Assessment Exam.

Student retention is a major challenge for undergraduate nursing programs, with the highest attrition occurring in the first year of the nursing curriculum. Admission criteria have been studied extensively but usually as related to end-of-program outcomes such as National Council Licensure Examination for Registered Nurses success. The purpose of this study was to examine the relationship between HESI Admission Assessment (A(2)) scores and academic performance in the 2 first-semester nursing courses of an associate degree program, Nursing-1 and Nursing-2. Findings indicated that the composite A(2) scores were strongly correlated with both Nursing-1 and Nursing-2 final course grades. Of the scores on the 4 component A(2) exams completed by the sample students (basic math skills, reading comprehension, vocabulary/general knowledge, and grammar), vocabulary/general knowledge scores had the strongest relationship to final course grades in both nursing courses. The authors concluded that A(2) scores facilitated evidence-based admission decisions.

Online case studies: HESI Exit Exam scores and NCLEX-RN outcomes.

Using data obtained for the 7th HESI Exit Exam (E(2)) validity study, the value of Elsevier's online case studies in assisting students to prepare for the E(2) and the National Council Licensure Examination for Registered Nurses (NCLEX-RN) was investigated. Of the 137 randomly selected schools of nursing, 72 (52.55%) participated in the study. The student sample consisted of 4,383 students from associate degree, baccalaureate, and diploma schools of nursing. Findings indicated that the mean E(2) score and the NCLEX-RN pass rate were significantly higher for students attending schools that used the case studies than they were for students attending schools that did not use the case studies. Descriptive data indicated that the case studies were most often used for remediation and examination preparation.

A pilot test of videoconferencing to improve access to a stroke risk-reduction programme for Veterans.

We conducted a pilot study to determine the feasibility of using videoconferencing for a programme of self-management to prevent stroke (V-STOP). A total of 37 Veterans with a history of stroke, or with multiple risk factors for stroke, were enrolled in the study from two rural sites. The V-STOP intervention consisted of 6 weekly sessions of self-management classes and clinic visits delivered via videoconferencing, with one or two individual telephone counselling sessions. Participants' mean satisfaction scores were 4.7 out of 5, indicating very high approval of the programme. Attendance was 87%, almost twice as high as at an equivalent in-person programme. Access was improved as participants saved, on average, 160 km by travelling to a community centre instead of the main Veterans Administration facility. Stroke risk knowledge and self-management behaviours such as communication with healthcare providers significantly improved from baseline. Overall, videoconferencing is feasible for delivering self-management classes and clinic visits and the V-STOP programme shows promise as a method for delivery of self-management education and preventive care services to reduce stroke risk.

Feasibility of using cranial electrotherapy stimulation for pain in persons with Parkinson's disease.

Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinson's disease (PD) with cranial electrotherapy stimulation (CES). Design. Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants. Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention. Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure. Average daily change in pain intensity. Results. Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon Z = -2.20, P = .028). Conclusion. Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided.

A qualitative approach to developing a patient-derived intervention to increase exercise in peripheral arterial disease.

OBJECTIVE: In designing a patient-physician communication intervention, we explored patients' perceptions of the role of exercise in the treatment of peripheral arterial disease (PAD). METHODS: We conducted qualitative interviews (5 focus groups and 13 one-on-one interviews) involving 35 patients with known PAD. We analyzed verbatim transcripts for significant dimensions of patients' explanatory models of PAD and exercise, perceptions of patient-physician communication, and other factors that would increase their participation in exercise (ie, walking). We used Atlas.ti software to facilitate data sorting and storage. RESULTS: Based on 30 emerging codes, we identified primary themes that constitute patients' perceptions of (1) the causes and outcomes of PAD, (2) the importance of patient-physician communication, (3) the impact of PAD on their lives, and (4) the factors that would lead to their exercise participation to treat PAD. From this information, our conceptual model focuses on an intervention plan that includes addressing the known causes of PAD, the patient's behavior prior to the diagnosis of PAD, and the factors that shape a patient's overall assessment of the role of exercise for PAD. An integral aspect of our model is the impact of the physician's perception of PAD coupled with the patient's perception in order to shape the intervention-a partnership between the physician and the patient-that we posit is likely to lead to behavior change. CONCLUSION: Based on qualitative data analysis, we developed a patient-derived model to influence exercise participation. This model highlights those factors most likely to influence behavior change in patients with PAD. The next step is to enact and assess an intervention based on this model, to increase physical activity in patients with PAD.