The development of knowledgeable nursing assistants as creative caregivers (KNACC).

Certified nursing assistants (CNAs) provide 80% of direct care in long-term care settings and are critical to maintaining resident well-being. Arts-based approaches to enhancing meaningful engagement have the potential to empower CNA ownership in the process of improving patient-centered care. We held a series of focus groups with CNAs (n = 14) to adapt arts-based creative caregiving (CCG) techniques for use in long-term care. Iterative revisions focused on CCG techniques, factors influencing implementation, and usability. The Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) manual developed from the adapted CCG describes training guidelines and instructions to facilitate CNA use of creative caregiving techniques in direct care.

Pilot testing the knowledgeable nursing assistants as creative caregivers (KNACC) guide.

Knowledgeable Nursing Assistants as Creative Caregivers (KNACC) was developed to train certified nursing assistants (CNAs) to apply arts-based techniques to enhance care and support to older adults in long-term care (LTC) settings. We piloted (n=8) KNACC techniques for use in LTC and assessed its potential for influence on the CNA outcomes of structural empowerment and job satisfaction. During preliminary implementation, CNAs working in memory care units were more open to applying all techniques. The techniques in KNACC have the potential to improve CNA skills in working with long-term care residents.

Development of a Long-Term Care Nurse Residency Program.

Nurses working in the long-term care (LTC) setting provide increasingly complex patient care, often without formal training on the specific needs of LTC patients, which can lead to burnout and high turnover rates. Nurse residency programs (NRPs) have been used effectively to orient novice RNs to their work setting, address transition-to-practice challenges, and promote retention, yet few LTC NRPs have been developed. The University of Utah Geriatric Education Consortium Geriatric Workforce Enhancement Program created an online LTC NRP to provide LTC nurses with the knowledge and skills to succeed in the LTC environment. RNs with <1 year of LTC experience were paired with experienced nurse mentors working within the same LTC facility. Synchronous and asynchronous curricular modules addressed leadership and communication, caring for older adult patients, quality improvement, and the LTC regulatory environment. A distance-based LTC NRP allows nurses flexibility in gaining gerontological nursing and leadership expertise that supports their professional goals. [Journal of Gerontological Nursing, 47(2), 37-43.].

Rules of performance in the nursing home: A grounded theory of nurse-CNA communication.

This study offers an initial theoretical understanding of nurse-CNA communication processes from the perspectives of nurses and CNAs who are providing direct care to residents in nursing homes. A grounded theory approach provided an understanding of nurse-CNA communication process within the complexities of the nursing home setting. Four themes (maintaining information flow, following procedure, fostering collegiality, and showing respect) describe the "rules of performance" that intertwine in nuanced relationships to guide nurse-CNA communication processes. Understanding how these rules of performance guide nurse-CNA communication processes, and how they are positively and negatively influenced, suggests that nurse-CNA communication during direct care of nursing home residents could be improved through policy and education that is specifically designed to be relevant and applicable to direct care providers in the nursing home environment.

Collaboration Between Licensed Nurses and Certified Nurse Aides in the Nursing Home: A Mixed Methods Study.

The current mixed methods study explored how nursing team collaboration is perceived and experienced in four nursing homes (NHs) in the western United States. Licensed nurses (LNs) and certified nurse aides (CNAs) completed two survey tools to assess their perception of collaboration and team-work in their current work environment. LNs and CNAs were paired and interviewed individually and as a caregiving pair to explore the lived experience of collaboration in NH residents' care. Quantitative survey results were analyzed, and participants reported a collaborative working environment with equally strong ratings in the following categories: partnership, cooperation, and coordination; they agreed with statements reflective of teamwork, including team structure, leadership, situation monitoring, mutual support, and communication. No significant differences were found between LN and CNA responses or between team members in any of the four participating facilities. Qualitative survey data were analyzed using a thematic analysis approach. Findings revealed five primary themes, including essential elements in successful team collaboration-perspective, coworker connection, communication, mutual support, and "it makes a difference"-and ways teamwork and collaboration impact resident care. These findings provide rich insights into successful LN/CNA collaboration for academic and clinical LN and CNA educators. [Research in Gerontological Nursing, 15(1), 16-26.].

Creating a National Standard for Prelicensure Clinical Evaluation in Nursing.

BACKGROUND: Measuring clinical outcomes in prelicensure students is desired by key stakeholders but is fraught with challenges. There are currently no standardized, psychometrically validated clinical-outcome measures available for prelicensure nursing programs, requiring each program to design its own measures. METHOD: We conducted a review of the potential antecedents of this gap, as well as models for standardized clinical outcome measures and recommendations from within health-professions education. RESULTS: There are benefits to pursuing a standardized clinical outcome tool, including an improved student learning experience and unifying our communication regarding graduate nurse preparation to valued stakeholders. CONCLUSION: Nursing education has a unique opportunity to emulate our colleagues in medicine and pharmacy by working at the national level to create a standardized tool using current psychometric methods for development and validation. [J Nurs Educ. 2021;60(12):686-689.].

Certified nursing assistants as agents of creative caregiving in long-term care.

AIM: Certified nursing assistants (CNAs) provide most of the direct care for long-term care (LTC) residents, yet there are few CNA-led interventions aimed at improving quality of care. In our preliminary work developing a CNA art-based intervention, we describe CNA definitions and perceptions of creativity in relation to care of LTC residents. METHODS: Data from six sequential focus groups with CNAs (n = 14) in two LTC facilities were analysed to describe the concept of creativity in relation to LTC caregiving and its meaning to CNAs working in LTC. RESULTS: Certified nursing assistants defined creativity as formal art-making, yet they also described creative approaches to engaging residents in order to build relationships and reduce challenging behaviour. While most linked creativity with discerning and responding to resident needs, creativity was also foundational to time management, teamwork and navigating challenges. CONCLUSION: Developing CNA-centred interventions to promote creative caregiving may enhance both person-centred LTC and CNA empowerment, improving resident care. IMPLICATIONS FOR PRACTICE: CNA creativity should be viewed as a skill with the potential to enhance care and increase CNA empowerment. Interventions should be developed, in partnership with CNAs, to promote creative caregiving.

The complete clinician model.

Historically, medical education has focused on acquiring knowledge of basic science and clinical medicine. Relationship management skills are an essential aspect of excellent clinicians that may have been overlooked in the educational curriculum and undervalued in practice. The complete clinician model is a theoretical model for clinician development that describes why knowledge acquisition and relationship management are both imperative skills to refine when progressing to be an excellent clinician. Four quadrants are described, with ideal progress going from the trainee quadrant to the golden quadrant, ultimately aiming for competence in both knowledge acquisition and relationship management. The pediatric resident milestones from the Accreditation Council for Graduate Medical Education were placed in the model to underscore the importance placed on both knowledge acquisition and relationship management skills. Relationship management training should be integrated into the medical curriculum. This model may be applicable to professional education in other health care disciplines.

The Impact of the End-of-Life Nurse Education Consortium on Attitudes of Undergraduate Nursing Students Toward Care of Dying Patients.

This mixed methods study explored the impact of the End-of-Life Nursing Education Consortium (ELNEC)-Undergraduate Curriculum on perceived preparedness of undergraduate nursing students in the care of dying patients and the relationship between personal loss experience and undergraduate nursing students' attitudes regarding the ELNEC-Undergraduate Curriculum. Of the 36 undergraduate nursing students who completed ELNEC, 24 reported a personal loss of a close family member or friend to death and 12 reported no loss. Findings confirmed the overall positive impact and acceptability of ELNEC, but this effect was observed differently between students with and without previous loss. Students with personal loss were more aware of the challenges of end-of-life care before taking ELNEC and incorporated the content into a greater sense of preparedness. Study recommendations include placing ELNEC within didactic instruction by well-prepared faculty, creating simulation debrief groups composed of both students with and without loss, and faculty attention to the loss experiences of students.

Nurse residency program implementation: the Utah experience.

Recently, nurse residency programs have been shown to improve satisfaction and enhance the retention of new graduate nurses, offering one solution for hospital executives, administrators, and managers searching for innovative ways to address nursing staff shortages. This article identifies crucial lessons that will assist leaders in designing and implementing a nurse residency program in their own institutions. The lessons are drawn from the experience of the successful University of Utah program. Four important practical components of such programs are described: an adaptive curriculum, promotion of autonomy, mentoring, and meeting the needs of participants with associate degrees. Although the lessons are based on the perspective of one nurse residency program, they hold import for the design of nurse residency programs in diverse settings.

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff.

BACKGROUND: Care in nursing homes (NHs) often overlooks individual values and preferences. Residents' voices are critical to discussions about preferences, yet there remains limited research on conversations about the end of life (EOL) from the perspective of older adults who reside in NHs. OBJECTIVE: The aim of this study was to describe the communication, content and process, related to EOL conversations among residents, family, and staff. METHODS: We used semistructured interviews in this qualitative, descriptive study to describe conversations about EOL preferences. We examined participants' conversation, when it occurred, and what was discussed. We queried about barriers to and facilitators in discussing EOL care in the NH setting. We interviewed residents (n=16), family (n=12), and interdisciplinary staff (n=10) from four NHs. RESULTS: The overarching theme­missed conversations­describes EOL-related communication. Residents, families, and staff rarely talked about EOL care preferences, nor did they pass along information about preferences or initiate conversations about EOL care with each other. Three categories explained missed conversations: inquiry ("No one asked"); assumptions (presence of an advance directive [AD], "They know me"); and conveying (lack of conveying information or wishes). Existing barriers and lacking facilitators resulted in missed opportunities to hold conversations about EOL preferences. CONCLUSIONS: Not all residents wanted to have conversations, but many wanted to be asked about their preferences. Missed conversations may adversely affect the quality of EOL care. Conversations with residents can be initiated by asking residents who they would like involved in the conversation and drawing upon the experience of others.

Awaiting diagnosis of breast cancer: strategies of enduring for preserving self.

PURPOSE/OBJECTIVES: To explicate the emotional experiences of women undergoing breast cancer diagnosis who are waiting for the results of breast biopsy. RESEARCH APPROACH: Glaserian Grounded Theory. SETTING: Urban area in western Canada. PARTICIPANTS: 37 women aged 32-76 years. The breast cancer diagnosis was positive for 11 women, negative for 24 women, and two results were unclear. METHODOLOGIC APPROACH: Unstructured, recorded telephone interviews. FINDINGS: Undergoing breast cancer diagnosis is a profoundly distressing experience dictated by diagnostic processes and procedures. Women rapidly transitioned from wellness to frightening phases of facing cancer to continuing terror during the testing phase. While waiting to hear results, women controlled their emotions, which enabled them to get through the experience and highlighted the protective function of enduring and its necessity for survival. The basic social psychological process, preserving self, is the outcome of enduring. CONCLUSIONS: A mid-range theory, Awaiting Diagnosis: Enduring for Preserving Self, was developed. This theory explicates the emotional responses of women who were undergoing diagnosis for breast cancer and provides a theoretical behavioral basis for responding to cues and signals of suffering. INTERPRETATION: The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.

The discourse of aging.

Historical and epistemological developments contribute to and reinforce the underlying framework that categorizes antiaging discourse and healthy aging discourse. This discourse creates the question "Can we live longer or better?" and encompasses issues of quality versus quantity, dependency versus autonomy, and risk versus benefit. By positing this discourse as a dichotomous tension, the development can be traced through the examination of select examples of influential studies in the field of aging. For nursing, the risk of these continued oppositions is potential oversimplification that may limit discernment of the complexities of care of older adults. Through understanding of the evolution and imposition of this dichotomizing discourse, nursing can provide older adult care within the reality of the aging experience, and develop frameworks, theories, and multidisciplinary discursive practice to optimize nursing care in the real-world spaces that exist between antiaging and healthy aging boundaries.