Predictive value of selected admission criteria for graduate nursing education.

To determine if there are admission criteria that predict success in graduate nursing education, an investigation was conducted of 193 graduates who had successfully completed the masters nursing program at a private eastern university. Admission criteria and other variables chosen were nursing, nonnursing, and cumulative undergraduate grade point averages (GPAs); verbal, quantitative, and combined Graduate Record Examination (GRE) scores; age at entrance; number of years intervening between attainment of the bachelors and completion of the masters degree; and, number of years intervening between the basic nursing education and the completion of the masters degree. Each variable was correlated with masters GPA for degree of association. Pearson's coefficient of correlation was used to analyze the data. Subgroups were analyzed in relation to the chosen area of clinical concentration: community health, psychiatric, medical-surgical, and maternal-child nursing; basic nursing education: diploma or generic baccalaureate; and, marital status: single or married. Nursing, nonnursing, and cumulative undergraduate GPAs were found to be weakly associated with the masters GPA except for the psychiatric subgroup which showed a moderate correlation between the cumulative under-graduate and the masters GPAs. Weak associations were found between verbal, quantitative, and total GRE scores and the masters GPA, with two exceptions: for psychiatric and community health subgroups there were moderate degrees of association between verbal GRE scores and the masters GPA. Age was not an effective criterion for predicting degree of success in the program. Both measures of intervening years were found to be weakly associated with the masters GPA.     

Relationship between college success and employer competency ratings for graduates of a baccalaureate nursing program

This expost facto correlational study sought to determine which measures of academic success in one class of BSN graduates predicted their competence as employees one year after graduation, as judged by their employers. The relationship between pre-entrance test scores, clinical experience grades, GPA, State Board Test Pool examination scores, and employer competency ratings were also determined. In keeping with the literature in fields other than nursing, the findings suggest that there may be little relationship between academic performance in a nursing program and subsequent job performance as a nurse, even though verbal ability may be predictive of success in school. While significant positive correlations were found between pre-entrance test data and final grade point averages, as well as pre-entrance test scores and State Board Test Pool examination scores, there was little evidence that pre-entrance test scores were predictive of nursing abilities. Isolated correlations were found between the clinical components of some nursing courses and specific nursing abilities. Using multiple regression analysis, no clinical course grade was found to be a significant predictor of the mean employer competency rating. Significant predictors were found for only four of the individual nursing abilities, with the clinical component of Leadership in Nursing being the most frequent and best predictor.     

Critical thinking and nursing education

This study evaluated the impact of nursing education on students' critical thinking abilities, as measured by the Watson-Glaser Critical Thinking Appraisal (WG). In addition, the WG and the NLN Pre-Admission Test were related to GPA and NCLEX. A sample of 108 AS and BS students at the University of Hawaii School of Nursing were tested at entry and exit. AS and BS students showed comparable improvement in critical thinking ability. NCLEX was best predicted by the GPA, which in turn summed up effects of WG and NLN. The results confirm the efficacy of nursing education in improving critical thinking skills and suggest that the GPA is more important than the WG in predicting the NCLEX. The latter effect was more prominent in the BS group. Further investigation of the role of critical thinking in nursing and academic performance is suggested.     

Assessing the job performance of nursing home staff

Nursing employees at four nursing homes participated in the development of Behavioral Anchored Rating Scales (BARS) to measure the job performance of individual nurses and aides. The reliability of the BARS performance measures was examined by having the immediate supervisors evaluate the job performance of nurses and aides in ten nursing homes. The BARS evaluations had significant convergent reliability between two independent evaluations of the same employees. There were no significant differences in the employees' performance ratings provided by two independent raters. Moreover, both raters tended to agree on the direction and magnitude of the changes in job performance ratings that were recorded over a six-month interval. The BARS evaluations, however, indicated a leniency bias because the performance ratings tended to cluster in the upper half of the scale ranges. There was also a "halo" effect in the evaluations, resulting in little discriminant reliability between the employees' performance ratings on different job dimensions.     

Clinical hours and program types effects on NCLEX pass rates

Clinical education is an essential portion of prelicensure clinical education. However, little is known about the relationship between clinical hours and NCLEX pass rates, or if the program type is predictive of NCLEX pass rates. The purpose of this study was to examine the relationship between clinical hours, program type and NCLEX pass rates. A total of 722 nursing schools were surveyed, with a final sample size of 107. Multiple linear regression analysis revealed there was no correlation between program type and NCLEX pass rates or the total number of clinical hours in a school and NCLEX pass rates. The results may reflect that both program types adequately preparing students for the NCLEX exam. Future research could be conducted to determine if the type of clinical education students receive is related to NCLEX pass rates.     

Quality assessment and comparison of grading between examiners and supervisors of Bachelor theses in nursing education

This study compares supervisors' and examiners' grading of quality of theses at Bachelor level in nursing. An instrument developed to asses the quality of theses was used. Eight aspects of quality were rated. One hundred and fifteen theses were rated by both examiner and supervisor. Significant correlations were found between examiners' and supervisors' ratings of all aspects of quality. Good agreement was found in 89-96% of the ratings on individual aspects of quality. The means of differences between ratings were small but significantly differed from zero in four out of eight aspects. In theses rated low for quality of language and formality, differences between examiners' and supervisors' ratings on all aspects of quality were significantly larger than in theses rated high for quality of language and formality. The general conclusion is that the evaluations made by examiners and by supervisors corresponded well. Differences found indicates that examiners in general give lower scores than supervisors especially on quality aspects that are most closely related to research methods and experiences. This study is part of a larger project that is investigating quality of theses and the student's attitudes and learning experiences of writing theses.     

Registered nurses' self-perceived level of competence following completion of a specialist graduate certificate.

Utilising the Competency Standards for Specialist Critical Care Nurses (CSSCCN) as a framework, this study sought to examine the perceived level of competence (PLC) of the graduates of a Graduate Certificate in Intensive Care Nursing (GCICN) and the level at which the GCICN influenced the graduates' PLC. A rating scale of 1-5 and an open-ended questionnaire were utilised. The graduates' mean PLC in the competency 'engaging in research' was rated as the lowest and 'recognising own abilities and professional competence' as the highest. Graduates of 1991-1994 rated their PLC on all the competencies lower in comparison to graduates of 1995-1997. Graduates' PLC on enabling and clinical problem solving domains were rated better than the reflective and leadership domains. A significant correlation was demonstrated between the graduates' PLC and their perceptions as to the course's influence on their PLC.     

Economic Evaluations and Usefulness of Standardized Nursing Terminologies

PURPOSE: To review different types of economic analyses commonly found in healthcare literature, discuss methodologic considerations in framing economic analyses, identify useful resources for economic evaluations, and describe the current and potential roles of standardized nursing terminologies in providing cost and outcome data for economic analysis. DATA SOURCES: The Advanced Billing Concepts Code Resource-based Relative Value Scale and Nursing Outcomes Classification. DATA SYNTHESIS: Using case studies, the applicability of standardized nursing terminologies in cost-effectiveness analysis is demonstrated. While there is potential to inform specific questions, comparisons across analyses are limited because of the many outcome measures. CONCLUSIONS: Including a standardized quality-of-life measure in nursing terminologies would allow for the calculation of accepted outcome measures and dollars per quality adjusted life years gained. IMPLICATIONS FOR PRACTICE: The nurse's ability to assess and contribute to all aspects of rigorous economic evidence is an essential competency for responsible practice.     

Using Patient Care Quality Measures to Assess Educational Outcomes

Objectives To report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine. Methods A workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness. Results The workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty‐six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality. Conclusions Numerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high‐stakes use, will require resolution of significant measurement issues.     

Postsurgical pain outcome assessment

Reliable and valid measures of pain are essential for conducting clinical trials of pain treatments. Perhaps the most important aspect of a pain measure's validity is its sensitivity, or ability to detect changes in pain over time and due to treatment. Several factors may affect a measure's sensitivity, including the complexity of the rating task for the measure, the number of pain intensity levels assessed by the measure, the dimension of pain assessed (e.g. pain intensity vs. pain relief), and the number of individual ratings (e.g. single rating vs. composite score) used to create the measure. The purpose of this study was to compare the relative sensitivity of three measures of outcome and a composite made up of all three measures for detecting analgesic effects in two samples of persons participating in a randomized controlled trial. One hundred and twenty-three patients who had undergone knee surgery and 124 women who had undergone a laparotomy were given one of three medications in the day after their surgery: morphine, ketorolac, or placebo. Two measures of pain intensity (a visual analog scale (VAS) and a 4-point verbal rating scale (VRS)) were administered at baseline, and these measures plus a 5-point VRS of pain relief were administered at 16 additional time points up to 24 h following surgery. As predicted, we found variability in the sensitivity of the outcome measures used in these studies, with the 4-point VRS showing less sensitivity than the VAS or relief ratings. However, contrary to our prediction, a composite measure of outcome made up of all three measures was not consistently superior to the individual measures for detecting treatment effects. Finally, we found that pain relief ratings were related to, but also distinct from, change in pain intensity as measured by changes in pain intensity ratings from baseline to each postmedication assessment point. These findings have important implications for the assessment of pain in clinical trials.     

The role of nonacademic variables in passing the National Council Licensure Examination

This study addressed the relationship between performance on the National Council Licensure Examination (NCLEX) and differences in test anxiety, cognitions related to testing, and academic performance among 102 senior bachelor's degree nursing students. The study design was correlational and prospective in nature. Test anxiety was measured by the Test Anxiety Inventory; cognitions were measured by the Cognitive Assessment Tool; quality point average and Student Aptitude Test scores measured academic aptitude. Subjects, recruited from two universities in western Pennsylvania, were interviewed and completed the self-report measures. Three months later, NCLEX scores were collected on each subject. Pearson's product moment correlation, multiple regression, and chi 2 statistics were used to analyze the data. Research findings indicated that test anxiety was inversely related to passing score on the NCLEX. Academic aptitude positively correlated with passing score on the NCLEX. Negative cognitions were not inversely related to pass rate on the NCLEX. Multiple regression demonstrated that self-perceived grades and self-predicted NCLEX scores were the best predictors of actual NCLEX scores. Significant chi 2 statistics indicated that subjects successful on the NCLEX were more likely to believe they were good test-takers and reported more facilitative thoughts during exams than those who failed the NCLEX.     

The use of progressive indicators as predictors of NCLEX-RN success and performance of BSN graduates.

Successful performance during the student's academic career contributes to his success on the NCLEX-RN. The purpose of this study was to determine predictors of success on the NCLEX preadmission and years 2, 3, and 4 variables in relation to NCLEX-RN scores. Data were obtained retrospectively from records of 408 baccalaureate nursing students. Preadmission variables were sex, age, race, and admission grade point average (GPA). Year 2 variables were numerical grades for the first two clinical nursing courses. Year 3 variables were numerical grades for clinical courses in mental health, adult health, and maternal child nursing. Year 4 variables were numerical grades in two senior clinical courses, percentile rank on NLN comprehensive exam, and graduate GPA. In NCLEX-RN scores, 67% of the variance was accounted for by admission GPA and race (33%), one 2nd year grade (an additional 14%), the 3rd year adult health grade (an additional 14%), the 3rd year adult health grade (an additional 11%), one 4th year theory grade, and the NLN comprehensive exam (an additional 9%). These results suggest that there are preadmission and sophomore year predictors of NCLEX-RN success which could be used to design early interventions for students performing poorly and at risk of failing the NCLEX-RN.     

Relationship between scores from the Knee Outcome Survey and a single assessment numerical rating in patients with patellofemoral pain

Objective: To determine the relationship between patient-reported single numeric ratings and actual scores obtained from a validated instrument, the Knee Outcome Survey (KOS). Background: Patient-reported outcome (PRO) measures are an important component of patient management. Information obtained from PRO measures can be used to prioritize goal setting, assist with clinical decision-making, provide evidence for effectiveness of interventions, monitor progress, and assess organizational or clinician performance. Methods: Scores from the KOS activity of daily living (ADL) and Sports subscales completed at the time of initial examination of patients with patellofemoral pain (n?=?29) were retrospectively analyzed and compared to a single assessment numerical rating. Results: Bi-variate Pearson product correlation was used to determine association between the KOS-ADL and KOS-Sports with respective single assessment numerical ratings. A high correlation was observed between the KOS-ADL (0.85, p?<?0.01) and KOS-Sports (0.88, p?<?0.01) with a single assessment numerical rating. Conclusions: Administration and scoring of standardized outcome measures such as the KOS-ADL and KOS-Sports require several minutes to administer but correlate well with a single assessment numerical ratings. The high correlation of single assessment numerical scores to actual KOS-ADL and KOS-Sports scores may provide support for discretionary use of single numerical ratings during interim patient care visits and/or in instances when time is limited. Additional studies are needed with larger patient populations and specific diagnostic subgroups to determine additional clinical relevance.     

Engaging students in a QI/QM presentation to enhance QSEN concept learning

The Quality and Safety Education for Nurses (QSEN) Initiative addresses goals to better prepare future nurses by proposing and defining 6 competencies addressing knowledge, skills, and attitudes (KSA) needed for undergraduate, pre-licensure nursing students to be successful, competent, and qualified registered nurses. Educators maintain the responsibility to bridge education and clinical preparation to enable nursing students to practice at a level that projects quality and safety. This article introduces and explains a guided Quality Indicator/Quality Measure (QI/QM) teaching-learning strategy aimed at the promotion of learning about QSEN competencies, in which students identify a clinical QI/QM issue, gather data, collaborate, apply research techniques, create a presentation, and report their findings. Specific QSEN competency sub-scores from an NCLEX test preparation strategy were used to measure students’ learning, and improvements on these sub-scores were observed. Introducing QSEN concepts sets the stage for competent nursing care in the future and this valuable teaching-learning strategy suggests how to infuse QSEN competencies into an undergraduate nursing curriculum.     

The use of selective admissions tools to predict students' success in an advanced standing baccalaureate nursing program

The judicious selection of nursing school applicants is important, and universities are increasingly incorporating non-academic criteria into their admission processes. We undertook a retrospective, correlational study of the predictive utility of an admissions process for nursing students' "in-program" success. The sample consisted of all 249 students admitted to a Canadian accelerated baccalaureate nursing program over a four-year study period. The students' arithmetic mean grade for six nursing courses (both theoretical and clinical) and their final grade point average (GPA) at graduation were the outcome measures of student success. The predictor variables included the applicants' demographic characteristics (e.g., age, gender, ethnic minority status, and previous educational attainment), their supplemental application materials and interview scores (assessing non-academic criteria), and their admission GPA. Linear regression was conducted on the outcome measures to determine whether the selection tools added information over that obtained through the use of admission GPA in predicting success. Although their admission GPAs were consistently predictive of the students' success, neither the supplemental application nor the interview scores had predictive utility. The variables consistently predictive of student success were age, ethnic minority status, and admission GPA, accounting for 26% of the variance in the selected nursing grades and 36% of the variance in GPA at graduation. The results provided little evidence to justify using the selective admissions tools.     

Patient dependency in the emergency department (ED): reliability and validity of the Jones Dependency Tool (JDT)

BACKGROUND: Rising patient demand in emergency departments is an international problem. Patient dependency (the degree of nursing care required) has major implications for nursing. Nurse skill mix and staffing levels can be addressed more effectively when dependency can be measured. A valid and reliable method of determining patient dependency in the emergency department in the United Kingdom is required. AIM: To test the validity, reliability and generalisability of the Jones Dependency Tool. METHODS: Six emergency departments across England were included. The sample was 140 adult patients from each site (n=840). Information was collected by nurses on: demographics, triage, chief complaint, vital clinical signs, nurse's own subjective rating of patient dependency, Jones Dependency Tool ratings and a comparative tool ratings. For a sub-sample of 40 patients, observation data were collected. RESULTS: There was a highly significant correlation between the Jones Dependency Tool scores and the nurses' subjective ratings of patient dependency (R=0.786,P<0.001). There was a significant correlation between triage rating and Jones Dependency Tool scores (R=0.58,P<0.001). The higher the dependency, the higher the proportion of patients with abnormal pulse rates (chi2=7.45,df=1,P=0.006), abnormal respiratory rates (chi2=15.683,df=1,P<0.001) and abnormal oxygen saturation (chi2=15.583,df=1,P<0.001). The higher the amount of time spent by nurses in direct care of patients the higher the patient's level of dependency (R=0,72,P<0.001). Length of time spent by nurses with patients was also significantly and positively correlated with the nurses' subjective ratings of patient dependency (R=0.49,P=0.001). There was a positive and significant correlation between Jones Dependency Tool scores and comparator scores (R=0.726,P<0.001). There was a good correlation between JDT scores measured over time (kappa=0.68) and good inter-rater reliability (kappa=0.75). CONCLUSIONS: The Jones Dependency Tool can be recommended as a valid and reliable tool for the measurement of patient dependency in the emergency department.     

Responsiveness of isokinetic dynamometry parameters, pain and activity level scores to evaluate changes in patients with capsulitis of the shoulder

OBJECTIVE: To determine the responsiveness to change of isokinetic dynamometry of the shoulder and to compare this responsiveness with outcome measures of pain and activity level. DESIGN: Responsiveness was evaluated as the change in outcome after intra-articular steroid injection in patients with capsulitis of the shoulder. Effect sizes of all outcome measures, quantified as standardized response means, were compared. Relationships between change scores of shoulder function and activities were assessed. SUBJECTS: Ten patients with unilateral capsulitis of the shoulder. MAIN OUTCOME MEASURES: Muscle strength and active range of motion were measured by isokinetic dynamometry. We then calculated involved/uninvolved ratios of the maximal peak torques of abduction, adduction, external and internal rotation, active range of motion of abduction and external rotation. In addition, pain was scored using the numeric rating scale (NRS-101) and activity level was scored using the Shoulder Disability Questionnaire. RESULTS: The standardized response mean of all outcome parameters was equal to or greater than 0.8, except for active range of motion of abduction. No significant differences between the standardized response means were found. There is a significant correlation between the change scores of NRS-101 and Shoulder Disability Questionnaire. No significant correlations were found between the change scores of NRS-101 and Shoulder Disability Questionnaire on the one hand, and involved/ uninvolved ratios of peak torques and active range of motion on the other. CONCLUSIONS: Responsiveness of all outcome measures is good. Parameters of isokinetic dynamometry may provide additional information as compared with the usual outcome measures of pain and functional level.     

Nursing power as viewed by nursing professionals

Background: The concept of nursing power has not been extensively reported in the nursing literature. Power is an extremely abstract concept, making it difficult to define and study. However, when defined as the capacity to achieve goals, power becomes a significant resource in nursing. Aims: The aim of this study was to describe how nursing professionals perceive the level of nursing group power in public healthcare organizations. Additionally, the connections between the background variables and nursing group power were analysed. Methods: The participants in the study consisted of 289 Finnish nurses working in the specialist healthcare sector in Finland. The Sieloff‐King Assessment of Group Outcome Attainment within Organizations^© (SKAGOAO) instrument was utilized to assess the level of nursing group power within the selected organizations. Findings: According to the present study, nursing professionals rated the outcome attainment (mean, 1.93), as well as goals/outcome competency (mean, 2.24), as very good. The position of nursing (mean, 2.55) as part of the healthcare service system was considered fairly respected. The role of nursing (mean, 2.54) was also considered to be at a good level. As regards to the actualization of power or outcome attainment capacity, respondents gave the lowest ratings to controlling the effects of environmental forces (mean, 2.75), resources (mean, 3.48), communication competency (mean, 3.00) and group supervisor’s outcome attainment competency (mean, 2.87). Age, education, type of employment and work experience had an impact on how nursing group power was perceived. Conclusions: The results of the present study indicated that the nurses perceived the lowest levels of group power in relation to the subscales of controlling the effects of environmental forces, resources, communication competency and group supervisor’s outcome attainment competency.