Examining moral injury in clinical practice: A narrative literature review.

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included "moral injury" and "moral distress," identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs.

Development of an innovative curriculum-to-career transition program for nurse practitioners in primary care.

BACKGROUND: Unlike physicians, there are no current requirements or funding for the post graduation training of advanced practice nurses. Given the complexity of health care, more post graduate training programs are needed to meet growing demand. PURPOSE: A taskforce was convened to research gaps in preparation for real-world practice, as well as effective models of curricular and clinical support to promote positive patient outcomes. METHODS: Supportive structures for advance practice nurses are dependent upon understanding the barriers, facilitators and structural support required to implement such a program. FINDINGS: Starting a curriculum-to-career program the semester prior to graduation is a relatively untested model for advanced practitioners to receive enhanced mentored education and support to increase resiliency, reduce early burnout and burden on the health setting. DISCUSSION: Advanced practice nurse fellowships should be considered as essential as medical residencies are for physicians in clinical practice.

Competency-based evaluation: Collaboration and consistency from academia to practice.

ABSTRACT: Competency-based evaluation is not a new concept in nursing education. The Essentials: Core Competencies for Professional Nursing Education (AACN Essentials), published in 2021, and the NONPF Nurse practitioner Role Core Competencies (2022) have provided us with the most recent roadmap for curriculum development and student evaluation. Using these two national guidelines and the Standards for Quality Nurse practitioner Education (2022), we examined ways to unify curriculum and competency in clinical practice. Through a review of the available literature, the lack of standardization in evaluating competency in clinical practice was evident. A framework for evaluation was developed including concepts from other health care discipline competency models. This article presents the resulting evaluation of a tool across academia and practice. Clinical preceptors are an extension of the faculty and play a significant role in developing practice competencies in advanced practice nursing students. Providing preceptors with a comprehensive framework we derived from the already existing PRIME model, and which we use with simulated patients, allows for the evaluation of clinical competencies in a variety of clinical settings. Consistency of evaluation across settings assures the attainment of the competencies necessary to perform safely and effectively in the practice environment.

Measuring the contribution of clinical rotations to skills confidence in primary care nurse practitioner students.

ABSTRACT: Primary care providers (PCPs) are essential components of a health care system, but there are shortages of PCPs. Nurse practitioners (NPs) are essential in meeting the needs of an increased demand for primary care, but there is a wide variety in the training offered to NP students. The purpose of this analysis is to determine student self-reported comfort in a variety of care delivery, covering primary care topics, including knowledge and skills. We conducted a preclinical and postclinical survey. Surveys were obtained before and at the conclusion of two clinical rotations in Baltimore, MD. Students were a part of a Health Resources and Services Administration-funded program to prepare NP students to practice in urban, underserved settings. Seventeen NP students NP students responded to both our pre- and postsurveys. Overall, student comfort increased in many focus areas, but no change was seen in important domains, including interpreting imaging studies, filling out common forms, and interpreting certain diagnostic tests. Further study of student skills and confidence at the conclusion of their study would be beneficial in determining if these gaps persist at entry into NP practice. Given wide variation in NP student training programs, it would be additionally beneficial to understand how these differences impact student skills and confidence during their clinical rotations and on entry to practice. Well rounded, broad-based education is necessary for the development of highly trained PCPs; greater understanding of student confidence, knowledge, and skills can assist educators in assuring that all NPs enter practice as safe and competent providers.