Development and validation of an instrument to measure scope of practice in school nurses.

AIMS: The aim of the study was to develop and psychometrically test a new instrument to measure the scope of school nursing practice. DESIGN: Methodological study. METHODS: Data were collected in Spring 2018. Frontline school nurses in the United States (N = 3099) completed the 39-item Scope of School Nursing Practice Tool (SSNPT) with two domains (current practice and importance to practice). One half of sample data (N1 = 1521) were used for exploratory factor analysis, item analysis, Cronbach's alpha, and Spearman-Brown to estimate validity and reliability of the instrument. Sample data from the other half (N2 = 1578) were retained for future analysis. RESULTS: Factor analysis resulted in a stable four-dimension solution: (A) Using the Nursing Process; (B) Applying Evidence to Improve Practice; (C) Connecting with Community; and (D) Leveraging the School and Family Team, accounting for 50.48% (current practice) and 53.31% (importance to practice) of total variance. Cronbach's alpha and Spearman-Brown ranged from .73 to .90 and .73 to .92, respectively. Item-total correlations ranged from .36 to .82. CONCLUSION: Initial psychometric properties indicate the new SSNPT is valid and reliable to assess the scope of practice of frontline school nurses. IMPACT: School nurses play a key role in population health and frequently serve as the sole provider of healthcare in schools worldwide. However, variability in school nursing practice affects the health, safety and educational outcomes of children and youth. No instrument exists that measures the scope of practice of school nurses. Frontline school nurses can use the SSNPT to assess practice, school nurse administrators can use the tool for resource utilization and school nurse researchers can use the tool to examine school nursing practices' impact on student/community health and academic outcomes. The SSNPT may provide a template for others who wish to examine specialty nursing scope of practice.

School Nursing for the 21st Century: Assessing Scope of Practice in the Current Workforce.

A gap analysis was used to examine the scope of school nursing practice in the United States. An investigator-developed 39-item self-assessment survey of scope of school nursing practice was modified from an existing validated tool, organized around the five principles of the National Association of School Nurses' Framework: Standards of Practice, Quality Improvement, Care Coordination, Community/Public Health, and Leadership and also explored barriers to practice. The survey was sent to a national convenience sample of practicing school nurses. The survey was completed by 3,108 practicing school nurses. Gaps were identified for all principles and were greatest for Quality Improvement and Community/Public Health practice. All practice items were rated more important than the ability to practice that item (p < .001). Self-identified barriers including workload, school/district expectations, and state regulations accounted for significant variances in practice across four of five principles (p < .05, p < .001). Recommendations include support for population-focused evidence-based school nursing practice.

Mentoring students engaging in scholarly projects and dissertations in doctoral nursing programs.

BACKGROUND: Doctor of Nursing Practice (DNP) programs in the US have grown exponentially, outnumbering Doctor of Philosophy (PhD) in Nursing programs. Faculty are mentoring increasing numbers of students on DNP projects or PhD dissertations. PURPOSE: This descriptive study explored faculty characteristics and examined support, engagement, and outcomes of American Association of Colleges of Nursing member nursing faculty mentoring student DNP projects or PhD dissertations. METHOD: A researcher-developed survey tool was emailed to 550 Deans and Program Directors of AACN doctoral programs for distribution to their doctoral faculty. Survey data were analyzed using descriptive statistics. FINDINGS: 177 DNP and 53 PhD (N=230) program surveys were completed. Faculty described challenges in the mentoring role including: time constraints, workload allocation, resources, faculty role preparation, student readiness, and variability in student outcomes. CONCLUSIONS: Additional dialogue and consensus is required to promote mentoring of students in nursing doctoral programs to ensure rigor of scholarly outcomes.

Relationship Between Self-Directed Learning, Grit, and Compassionate Teaching in Doctoral Nursing Education.

BACKGROUND: The capacity to be self-directed, take responsibility for one's learning, and possess grit, perseverance, and passion for long-term goals is fundamental to doctoral education. Compassionate teaching (CT) strategies may help foster these traits. PURPOSE: This study explored CT strategies, self-directedness, and grit in doctoral nursing education. METHODS: A mixed-methods design examined doctor of nursing (DNP) graduates' (N = 227) perceptions of self-directedness, grit, and CT using an online survey and interviews. RESULTS: A weak direct correlation existed between CT strategies and grit. A weak-to-moderate direct significant correlation existed between CT strategies and self-directedness. Participants were moderately self-directed with postmasters-DNP graduates being more self-directed than postbaccalaureate-DNP graduates. Qualitative results validated that CT strategies include committing time to relationship building, providing timely critical feedback while being kind, and treating students fairly. CONCLUSIONS: Faculty who embrace rigor and compassion are appreciated by students and are perceived to foster self-directedness and grit.

The effect of remote patient monitoring on discharge outcomes in post-coronary artery bypass graft surgery patients.

ABSTRACT: Coronary artery bypass graft (CABG) surgery is a lifesaving procedure for patients with coronary artery disease but ranks highest (13.5%) for preventable hospital readmissions and second highest in average Medicare payment ($8,136) per readmission. Care transitions after hospital discharge warrant exploration to improve outcomes. The purpose of this brief report was to compare the effect of remote patient monitoring (RPM) on 30-day outcomes in Medicare beneficiaries after isolated CABG surgery. Results demonstrated no statistically significant difference in 30-day readmission (p = .568) or emergency department encounters (p = .785) between groups. However, time to achieve a cardiology follow-up appointment decreased from 19.8 to 13.7 days (p = .062) in the RPM group. Although the findings were not statistically significant, this study demonstrated a reduction in CABG readmissions and timely provider follow-up with RPM. In addition, study findings contribute to the body of nursing knowledge and support the need for further studies to identify high-risk CABG patients who may benefit from RPM after hospital discharge.

Extern Programs Promote Confidence and Reduce Anxiety With Clinical Decision Making in Nursing Students.

BACKGROUND: Clinical decision making (CDM), expected of professional nurses, affects patient outcomes but is arduous for nursing students to learn. Psychological barriers (low self-confidence [SC] and high anxiety with CDM) have an impact on its achievement. Externship programs help mitigate these barriers. PURPOSE: The aim was to examine the impact of summer employment (nurse extern [NE], nursing assistant, and non-health care employed) on students' confidence and anxiety with CDM. METHODS: The study used a quasi-experimental before-and-after design using the Nursing Anxiety and Self-Confidence with Clinical Decision Making scale. Associate and baccalaureate degree students (N = 134) from 2 nursing and 2 extern programs were included. RESULTS: The NEs reported significantly increased SC (F = 14.02, P < .001) and reduced anxiety (F = 8.64, P < .001). Nonsignificant improvements were noted in other groups. CONCLUSIONS: Externships appear to enhance students' SC and lessen their anxiety with CDM.

Perceived Evidence-Based Practice Competency Acquisition in Graduate Nursing Students: Impact of Intentional Course Design.

BACKGROUND: Acquisition of evidence-based practice (EBP) competencies in graduate-level nursing programs bridges the research-practice gap in professional practice. This study evaluated the impact of the Star Model of Knowledge Transformation as a framework for course design on graduate-level nursing students' perceived EBP competencies. METHOD: Data were collected from 2012 to 2017 (N = 544). Repeated-measures ANOVA was used to analyze pre- and postassessment data over time. Data were collected for each of the five stages or Star Points of EBP competencies. RESULTS: Significant postcourse improvement in perceived EBP competencies was demonstrated (p ≤ .000) for all Star Points and years. The greatest pre- and postassessment percentage change occurred in the Translation Star Point scores and the least percentage change occurred in Discovery. CONCLUSION: These data support the use of intentional course design based on a recognized EBP model to improve perceived EBP competencies in Master of Science in Nursing students. [J Contin Educ Nurs. 2019;50(2):79-86.].

Development and validation of a tool to measure self-confidence and anxiety in nursing students during clinical decision making.

Clinical decision making (CDM) is a cornerstone skill for nurses. Self-confidence and anxiety affect the learning and adeptness of CDM. This study aimed to develop and test a quantitative tool to assess undergraduate nursing students' self-confidence and anxiety during CDM. The 27-item Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM) scale is a 6-point, Likert-type tool with two subscales. Two samples of prelicensure associate and baccalaureate nursing students participated in the pilot (n = 303) and main testing (n = 242) phases of the study. Construct validity assessment, using exploratory factor analysis, produced a stable three-dimensional scale. Convergent validity assessment produced positive, moderate, and statistically significant correlations of the tool sub-scales with two existing instruments. Internal consistency reliability was assessed for each subscale (self-confidence, α = .97; anxiety, α = .96). The NASC-CDM scale may be a useful assessment tool for nurse educators to help novice clinicians improve CDM skills.

Bronchiolitis obliterans organizing pneumonia.

Bronchiolitis obliterans organizing pneumonia (BOOP) is a diffuse infiltrative pulmonary disorder that has an insidious onset. The patient often presents with flu-like symptoms and radiological findings showing bilateral patchy infiltrates. Histological features show fibromyxoid connective tissue plugs that are evenly spaced in small distal airways and alveolar spaces. Treatment for BOOP is corticosteroid therapy. Critical care nurses must be cognizant of BOOP as a differential diagnosis for patients for whom antibiotic therapy has not resolved symptoms.