Use of nursing homes in Baccalaureate nursing education

Abstract Although the use of nursing homes in nursing education has been described in the published research, no current report exists outlining guidelines for faculty if they desire to use nursing homes for their undergraduate nursing courses. Thus, the purpose of this paper is to identify courses that are best taught in nursing homes and the approaches faculty can implement when using nursing homes for student experience. The use of nursing homes for the courses in fundamentals, leadership and management, research and community health is discussed. A step-by-step approach for faculty to initiate the use of nursing homes for undergraduate teaching is also provided. The nature of the faculty, the characteristics of nursing home settings and the characteristics within the community will affect students' learning experiences and effectiveness. Thus, it is important to consider nursing homes as appropriate for certain types of learning needs.     

Improving the quality of nursing students' clinical placements in nursing homes: An evaluation study

The aim of this study was to explore students' experiences during their clinical placements in five nursing homes after implementing measures to improve the learning environment.It is vital to stimulate more future nurses to consider a career within geriatric wards and nursing homes. One way to achieve this, is to enhance nursing students' learning experiences during clinical placements in these settings.Measures to improve the learning environment were implemented as a result of a joint effort between a university college and five nursing homes. An explorative design was developed to collect empirical data concerning the students' experiences expressed through questionnaires and logs.The results generally conveyed more positive than negative experiences. Students expressed most satisfaction with peer collaboration, the placement's contribution to awareness of future nursing role and described the learning arena as exciting and interesting. They expressed less satisfaction with supervision from preceptor and how the practice site was prepared for and organized students' placements.Clinical placement arenas and educational institutions should collaborate closely to explore and develop models of supervision appropriate for the nursing home context, to build on existing potentials and resolve the issues that represent barriers for creating interesting and effective learning environments.     

Baccalaureate nursing education at extension sites: a survey

The use of extension sites in baccalaureate nursing education has increased significantly since 1978. This survey found that the majority of extension sites were developed for RNs although large numbers of generic students are also served. The use of extension sites ranges from delivering selected courses away from the lead campus to delivering an entire program. Extension sites may be located on other university campuses or may be found in a store front setting or other community agency. Administrative control of extension sites emanates from the lead campus. Faculty participation in faculty activities, such as school of nursing or university committees, is expected. The degree to which this is accomplished, however, may vary. In order to maintain program integrity, the curriculum must remain the same regardless of where it is implemented. One of the primary ways of doing this is to use the same syllabi, texts and, in many cases, the same exams. Faculty may be stationary at established extended sites or may travel from the lead campus to teach, carrying with them educational materials. Extension sites are a phenomenon of the here and now. They provide a way of delivering baccalaureate nursing education to students who might otherwise be denied this level of education. Extension sites may be operationally cumbersome, challenging, and costly, but they are meeting a need. With the advent of more sophisticated telecommunications and the continued demand for baccalaureate level education, the possibility exists for even greater variation and potential for this type of program.     

Improving clinical experiences for nursing students in nursing homes: An integrative literature review

Well-organized clinical placements in older adult care settings will prepare nursing students to provide care for this growing population and may influence career choices. The purpose of this integrative review is to identify strategies that can be used to provide student nurses with effective clinical education experiences in residential aged care facilities offering skilled nursing (RACF-SNs). Twenty-three studies evaluating teaching and learning models and experiences were reviewed. Four themes were identified related to effective strategies for providing gerontological clinical education to students in residential aged care environments, principally nursing homes. These were: developing a partnership, comprehensive orientation, effective supervision for students, and supporting staff. Eight different models were described for enhancing clinical learning experiences in these environments. These models reflect the themes highlighted in the review. Relevance of the findings to a conceptual framework for evaluating gerontological clinical placements, the Senses Framework, is considered. Strong partnerships between schools of nursing and residential aged care environments can provide well-organized clinical education to undergraduate nursing students. To be sustainable, these partnerships must be developed in ways that do not require significant additional resources. A guideline for this process based on findings of the review has been developed.     

The impact of a gerontology nursing course with a service-learning component on student attitudes towards working with older adults: A mixed methods study

A growing older adult population requires educational programs which prepare nursing students to care for and increase their interest in working with this population. Faculty at a large public university developed a course specific to gerontology to address this need, including designing a service-learning intervention entitled Aging is Very Personal. The purpose of this study was to explore the impact of this course on student attitudes towards working with older adults. Using a convergent parallel mixed-methods design, 79 students completed pre-course and post-course quantitative surveys and open-ended questions using the Senses Framework survey. Quantitative data were analyzed using a paired-sample t-test. Qualitative data were analyzed using Krippendorff's method of qualitative content analysis. Participants showed statistically significant positive changes in attitudes towards working with older adults on 11 of 15 items. Qualitative findings included 5 themes: acknowledgement of preconceptions prior to course; positive shift in perceptions about older adults; growing interest in working with older adults; appreciation of gerontological nursing as a highly skilled profession; and service-learning as a valuable opportunity to form connections with older adults. A designated course in gerontology with a service-learning component can markedly improve student attitudes towards working with older adults.     

Staff characteristics and care in Chinese nursing homes: A systematic literature review

The need for institutional long-term care (LTC) services, including nursing homes (NHs), is increasing in Mainland China in part due to the aging population and changing family structures. In developing NH staff training programs, a review is needed to synthesize knowledge about staff and resident characteristics, and care provided in NHs. This systematic review aims to describe, in Chinese NHs, 1) NH staff characteristics and the care they provide, 2) resident characteristics and care needs, and 3) the role of family members. The 45 articles included in this review covered both urban and rural areas of Mainland China. We found that staff in Chinese NHs were older and had lower education levels in comparison with those in western countries. Most direct caregivers in urban areas were migratory workers from rural area. Chinese NHs had few qualification standards for staff preparation for their roles in NHs. Also, functional levels of residents in Chinese NHs were higher compared to NH residents in western countries. In addition, family members played important roles in caring for NH residents. These findings suggest a need for staff development programs that tailor for lower educated NH staff and care needs of residents with widely varying levels in function from independent to bedbound in Mainland China. The findings also suggest that staff qualification standards require critically policy development to improve the capacity of Chinese NHs to provide competent and safe care.     

养老机构中护工对分级护理认知的相关因素调查

目的 了解养老机构中护工对分级护理的认知现状及影响因素. 方法 采用问卷调查法对116名护工进行有关分级护理及内容方面的调查.结果 护工对分级护理的认知较低,角色认知、操作和培训情况、工资待遇及护理工作量对分级护理认知有差异,工作年限、文化程度对分级护理认知无差异.结论 护工对分级护理认知不足,应加强对护工的角色认知教育,加大操作和培训力度,提高福利待遇及合理配备护工,从而提高护工对分级护理的认知,保证分级护理质量及老年人的满意度.     

Preparing nursing students for the future: An innovative approach to clinical education

A clinical education model was developed and implemented by nursing faculty in the Oregon Consortium for Nursing Education undergraduate curriculum to improve clinical learning for preparation of nurses to practice in the 21st century. This clinical education model, developed though collaborative work by nursing practice and education representatives throughout the state, moves away from a “random access opportunity” model of clinical education reliant on “total patient care” experiences to an intentional design of clinical learning activities based on course competencies appropriate to student level. Five elements of the model were proposed: case-based, concept-based, intervention skill-based, focused direct client care and integrative experiences. Different elements are dominant in early, middle and late clinical experiences to best support the developmental level of the student. Expectations for faculty, students and clinical staff were also developed to enhance best practices in clinical learning. Preparation of clinical partners for a change in clinical learning and student accountability are essential for optimal learning. This paper provides an overview of the model with clinical application examples for each element with a particular emphasis on case-based, concept-based and integrative clinical experiences.     

中专护理教育后继续高等教育的调查

对南京２０所医院中专护理人员继续高等（大专）教育后在护理技术操作、护士长任职人数、护理教学、护理科研及论文撰写４方面能力进行调查，同时与护理中专、护理大专、护理本科进行对照比较。结果表明：在调查期间护理中专后继续大专教育组在护理技术操作、护士长任职人数、护理科研方面明显优于护理本科组（Ｐ＜０．０１），在护理技术操作、护理科研方面明显优于护理大专组（Ｐ＜０．０１）。中专护理教育后继续大专教育仅是目前我国高等护理教育的形式之一，该教育形式为我国护理质量的提高、护理事业的发展发挥了极其重要的作用，是快速培养我国护理后备力量的一种切实途径。     

护理学生心理健康教育与临床护理能力的关系研究

目的探讨对护理学生(以下简称护生)实施心理健康教育干预与提高临床护理能力的关系。方法我校2007级中专护生共4个班,随机选取一、二班为实验组(心理干预组),三、四班为对照组(未心理干预组)。实验组共90人,对照组共92人。对照组仅在学生入校后第2学期进行症状自评量表(SCL-90)评分;实验组采用心理健康教育方法进行心理健康干预,分别在学生入校后第2学期和实习末进行SCL-90问卷调查,并对两组的临床护理能力进行评价。结果通过心理健康教育干预后,实验组护生SCL-90得分均显著下降,心理健康水平明显提高(呈全面性正向反应)。实验组护生的护理技术操作能力、交流沟通能力、应付复杂护理工作能力等方面明显高于对照组护生。结论护理教育在强化基础知识与专业理论知识教育的基础之上,更要加强心理健康教育,从而有利于临床护理能力的培养和提高。     

The value of reflective journaling in undergraduate nursing education: a literature review

OBJECTIVES: The purpose of this literature review was to ascertain the evidence for the use of reflective journaling as a tool to promote the pedagogical strategy of reflection for the purpose of learning from practice for practice in undergraduate nursing education. DESIGN: Concept-centric. DATA SOURCES: The literature review involved structured searches of all OVID gateway databases, EBSCO host databases, and Blackwell Synergy. Qualitative and Quantitative Studies from 1992 to 2006 were included if they focused on reflective journaling in undergraduate clinical education. REVIEW METHODS: Due to the vast plethora of literature on reflection, keywords were utilized to focus the search. Approximately 150 abstracts were reviewed for primary sources of research. A total of nine studies met the inclusion criteria. The review subsequently divided the literature into four content themes allowing for appraisal and analysis of the findings, followed by summary and key recommendations for nursing education and research. RESULTS: There was evidence that educators struggle to incorporate reflective processes into education; however, the research provided rationale and support for engaging undergraduate students in the reflective process. Researchers found reasonable levels of reflection in undergraduate students' journaling and educators reported students' learning as a result of reflective journaling. Further to this, there was evidence that writing reflectively improved over time; a learned skill also dependent on a good facilitator and trust. Unfortunately, there was a paucity of research that explored the undergraduate nurses' experiences with the process of having to create written communication, with a critical reflective focus on practice. CONCLUSION: Nursing educators are correct in pursuing the teaching and learning of the reflective process in undergraduate nursing education. Nurse educators need to utilize various tools and strategies for facilitating the growth of undergraduate students into reflective practitioners. Indeed there was only limited evidence to support reflective journaling as an appropriate tool to promote reflection for the purpose of learning from practice for practice in undergraduate nursing education. Research that provides insight into the undergraduate student experience and perceptions of reflective journaling is needed to facilitate the structuring and use of reflective journaling as a tool in undergraduate nursing education.     

Use of HIT for adverse event reporting in nursing homes: Barriers and facilitators

Background & objective

Approximately 8 million adverse events occur annually in nursing homes (NHs). The focus of this research is to determine barriers and health information technology (HIT)-related facilitators to adverse event reporting among U.S. NHs.

Methods

Surveys were returned by 399 nursing home administrators using a mailed survey approach. Respondents were asked to report on their adverse event reporting processes focusing on barriers and role of HIT facilitators.

Results

About 15% of NHs had computerized entry by the nurse on the unit and almost 18% used no computer technology to track, monitor, or maintain adverse event data. One-third of nursing directors conducted data analysis “by-hand.” NHs without HIT were more likely to not be accredited (p = 0.04) and not part of a chain/corporation (p = 0.03). Two of the top three barriers focused on fears of reporting as a barrier.

Conclusions

This study found numerous barriers and few HIT-related facilitators to assist with adverse event reporting. Improvements in facilitating adverse event reporting through the use of HIT approaches may be warranted.     

Risk factors associated with dehydration in older people living in nursing homes: Scoping review

BackgroundDehydration in the older people is a prevalent problem that is often associated with physiological changes, physical limitations and environmental conditions.ObjectivesThe scoping review was carried out to identify risk factors associated with dehydration in older people living in nursing homes.DesignThe revised scoping methodology framework of Arksey and O’Malley (2005) was applied. Study selection was carried out in accordance with Davis et al. (2009) and focused on the inclusion criteria (people over 65 years old and living in nursing homes). Risk factors were classified using the geriatric assessment.Data sourcesAn electronic database search was performed in PubMed, Scopus and CINAHL. The literature search was carried out between October 2016 and January 2017.Review methodsThematic reporting was performed and study findings were validated through interdisciplinary meetings of experts. The quality of the papers consulted was also evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional, cohort and case-control studies.ResultsIn all, 16 papers were analysed, all of which were observational studies. The risk of bias ranged from very low (n = 1), to medium (n = 13) and high (n = 2). The risk factors were classified in line with the different components of the geriatric assessment. In the socio-demographic characteristics age and gender were identified. In the clinical component, infections, renal and cardiovascular diseases and end-of-life situations were the most common factors highlighted in the papers analysed. With reference to the functional component, its limitation was associated with dehydration, while for factors of mental origin, it was related to dementia and behavioural disorders. Finally, the factors relating to the social component were institutionalisation, requiring a skilled level of care and it being winter.ConclusionsThe most commonly repeated factors highlighted in the review were age, gender, infections, end of life and dementia, with it being important to highlight the large number of factors in the clinical component. Even so, the great majority of the factors were unmodifiable conditions associated typically associated with the physiology of ageing.     

护理学专业临床见习教学模式的改革与实践

目的对临床护理见习教学方法进行探讨,为提高临床护理见习教学质量提供参考意见。方法选取2006级护理本科生182名,随机分成两组,对实验组见习进行Seminar教学法干预,见习后对两组分别采用护理表现六维量表进行调查,同时对期末考试成绩进行分析比较。结果实验组学生的单科病例分析成绩、总成绩及护理专业表现方面与对照组学生比较,差异有统计学意义（P〈0．05）。结论新的见习教学方法能够提高护生的临床护理、人际沟通、计划与评估等能力,值得推广。     

A conceptual model for culture change evaluation in nursing homes

This article describes the development and particulars of a new, comprehensive model of nursing home culture change, the Nursing Home Integrated Model for Producing and Assessing Cultural Transformation (Nursing Home IMPACT). This model is structured into four categories, “meta constructs,” “care practices,” “workplace practices,” and “environment of care,” with multiple domains under each. It includes detailed, triangulated assessment methods capturing various stakeholder perspectives for each of the model's domains. It is hoped that this model will serve two functions: first, to help practitioners guide improvements in resident care by identifying particular areas in which culture change is having positive effects, as well as areas that could benefit from modification; and second, to emphasize the importance in culture change of the innumerable perspectives of residents, family members, staff, management, and leadership.     

Prescribing for older people in nursing homes: strategies to improve prescribing and medicines use in nursing homes

Interventions to improve prescribing in the nursing home environment are many and varied. The critical literature review presented in Paper 1 (Parsons et al., 2011, International Journal of Older People Nursing 6, 45-54) in this series discussed the main issues repeatedly identified as problematic, and this paper summarises the main approaches which have been used to attempt to improve prescribing. These include national legislation which demands documented justification for the prescribing of medicines, medication review, approaches to reducing medication errors, improving communication across care boundaries and assessment teams and alternative service models. It is difficult to make global recommendations as some of these approaches are country specific or have been delivered in different ways, involving different professionals. However, a series of prompt questions have been provided which may assist nursing home staff in deciding whether prescribing is optimal in a resident or if an intervention is required which may lead to an overall improvement in outcomes.     

Nursing students' and preceptors' perceptions of using a revised assessment form in clinical nursing education

Assessment of students' learning is a crucial question when great changes occur in the higher education sector. One such educational reform is the Bologna declaration, the requirements of which have resulted in significant modifications in documents as assessment forms for clinical education. The aim of this study was to investigate students' and preceptors' perceptions of using the revised version of an assessment form, the AssCE form. Using convenience sampling, a questionnaire survey was completed by 192 nursing students and 101 preceptors. Most of the participants found that the revised AssCE form was possible to use during different years of the programme, and factors in the AssCE form were possible to combine with learning outcomes in the course syllabus. Most participants perceived that the scale added to each factor facilitated the assessment dialogue and offered possibilities to illustrate the students' development during clinical periods. Findings also showed that students were most often prepared with self-assessment before the assessment discussions. More information about the use of the AssCE form, also in combination with learning outcomes in the course syllabus, may further support the use of the form and contribute to students' development during clinical practice.