Teaching Systems Transformation

BACKGROUND Students in the undergraduate and graduate programs at Saginaw Valley State University (SVSU) are taught to use NANDA, NIC, and NOC to guide their practice. The nursing faculty developed a population‐focused, phenomenon‐based curriculum incorporating standardized nursing languages. The population focus of the undergraduate program changes each semester. Students begin by learning to intervene with individuals, and spend their final semester focusing on special populations and health systems. The graduate program expands on previous learning, focusing on leadership activities with special populations, communities, and health systems. Students in both undergraduate and graduate programs build competence in systems change while completing assignments based on the NIC Health System and Community Domains. The complexity of assignments and expected outcomes vary by the level of student, with undergraduates learning how to influence health system transformation and graduate students learning how to lead the transformation process. MAIN CONTENT POINTS Seniors in the nursing program have three assignments that provide experience with health system transformation. The professional issues class has an assignment based on the NIC intervention of “health policy monitoring,” which is found in the classes of “information management” and “community health promotion.” Students learn to access action alerts on nursing organization Web sites and use them as a guide for communicating with legislators, with the goal of transforming health policy. In the practicum course, seniors use case studies to describe how NANDA, NIC, and NOC guide their clinical practice related to the several NIC classes, including those of “health system mediation” or “health system management.” Another practicum assignment requires utilization of “health policy monitoring” interventions for health system transformation that is community based and population specific. Master's students also have multiple assignments providing experience with health system transformation. One of the required core courses contains an assignment comparable to that used to teach seniors to influence health policy, but also provides the opportunity to develop skill in policy analysis. In addition to analyzing legislative policy, all graduate students learn to evaluate and develop organizational policy using national standards (including the Health System Domain of NIC) as a guide. Students in the Health System Specialist track are preparing for positions in nursing administration, education, and informatics. They have a three‐part assignment that requires analysis of NIC's usefulness for decision support by nurse educators, administrators, and informaticists. They evaluate learning process and management process roles as they relate to selected NIC “health system management” interventions. They also evaluate the information process role as it relates to selected NIC “health system management” and “health information management” interventions. CONCLUSIONS The learning activities engaged in provide experience in practical application of standardized language. This model of applied learning can be used in any setting to facilitate staff or student understanding of NIC's applicability to situations where system improvement is desired. NANDA, NIC, and NOC have been well developed when it comes to guiding clinical practice. While NIC has incorporated Health Systems and Community into its taxonomic structure, the linkages of those interventions with diagnoses and outcomes need further refinement.     

Critical care nursing interventions and the time required for their completion in Intensive Care Units: A Delphi study

ObjectiveTo determine which interventions within the Nursing Interventions Classification are most often applied in intensive care units and to validate the time required for each.MethodologyA three-stage e-Delphi was conducted; 21 panelists were recruited, seven manager nurses and 14 clinical nurses with higher degrees and more than five years experience in intensive care nursing. The first round explored the most common interventions applied. Additionally, panelists were asked to propose others. In the second round, participants reflected on the interventions where no consensus was reached as well as to estimate the time required for each intervention. In the third, panelists were queried about the time required for the interventions for which consensus regarding the time was not reached.ResultsA total of 183 interventions were included; 50% of the “Physiological: Complex” domain. The list included 52 (90%) of the 58 “core interventions for critical care nursing” identified in the Nursing Interventions Classification. The time required for 89.1% of the interventions was the same as in the Nursing Interventions Classification seminal work recommendations.ConclusionResults provide a clear picture of nursing activity in general intensive care units, allows to tailor the Nursing Intervetions Classification in Catalonia context and to confirm findings of previous studies.     

My First Patient as a Nurse Practitioner: A Man With Low Literacy

PURPOSE: The purpose of this case study is to demonstrate the use of the nursing process and the standardized nursing languages of NANDA‐I, the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a man with low literacy to self‐manage his medication regimen. DATA SOURCES: The data sources for this article are clinical nursing practice, research evidence related to helping people with low literacy, and the books that explain NANDA‐I, NOC, and NIC. DATA SYNTHESIS: This case study demonstrates nurses’ clinical decision making in providing care for a person with low health literacy. CONCLUSIONS: Low health literacy should be considered when nurses identify the nursing diagnosis of Ineffective Self‐Health Management. After trust is established, a screening tool should be used to evaluate the person's literacy level. Active partnership of the nurse and the person supports interventions to assist the person implement the medication regimen. IMPLICATIONS FOR NURSING: Inadequate evaluation of health literacy may result in mislabeling a person as “nonadherent” or “noncompliant” to a medication or treatment regimen. Low literacy is often an unrecognized barrier to effective self‐health management.     

Reflecting on Holistic Nursing: The Contribution of an Academic With Lived Experience of Mental Health Service Use

The educational preparation of registered nurses is presumed to reflect a holistic approach with emphasis on the bio-psycho-social model of care. The broader literature suggests this goal is not always realised. The aim of this study is to present the views, experiences, and perceptions of undergraduate nursing students who were taught by an academic with a lived experience of mental health service use. In particular, we wanted to look at the expected impact of this approach to learning on their nursing practice. A qualitative, exploratory approach was used, involving in-depth individual interviews with 12 undergraduate nursing students completing the course, “Recovery for Mental Health Nursing Practice,” as part of a major in mental health nursing in a university in Queensland, Australia. Students were asked to reflect upon and discuss their experiences of being taught by a person with lived experience of mental health service use. Data were analysed following Colaizzi's steps to identify the main themes. The three main themes were (1) Recovery—Bringing Holistic Nursing to Life; (2) Influencing Practice; and (3) Gaining Self-Awareness through Course Assessment: Challenge and Opportunity. These themes suggest an appreciation for holistic nursing and an increased capacity for reflective understanding. The responses from participants suggest the Recovery course had a significant impact on their attitudes to nursing and that their nursing practice would be positively enhanced as a consequence.     

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

Exploring undergraduate nursing students' perceptions of working in aged care settings: A review of the literature

ObjectivesTo explore undergraduate nursing students' perceptions of working in the aged care setting through a review of the literature.DesignA review of available literature relating to undergraduate nursing students' attitudes, perceptions and experiences in the aged care setting, or in the care of older adults.Data sourcesCINAHL Plus with Full Text was the primary database used. Other databases include PsycINFO and Health Source: Nursing/Academic Edition.Review methodsStudies focused on undergraduate nursing students and their experiences in the aged care setting and on the perceptions and attitudes of nursing students toward older adults, were included. Studies that did not present an original study or those that did not meet the aim of the study were excluded from the review.ResultsFollowing removal of duplicates and exclusion of articles not meeting the aim of this paper, 24 articles remained. Three main themes emerged from the review of the literature: perceptions of aged care placement, attitudes to working in aged care, and experiences in aged care.ConclusionThe experiences of nursing students employed as undergraduate AINs in the aged care setting can provide an immersive clinical learning experience in preparation for their new graduate (NG) year. Furthermore, it is an opportunity to challenge ageist attitudes and instil core nursing values in novice nurses such as promoting compassionate care.     

Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education

BackgroundSince the ground-breaking report ‘To Err is Human: Building a Safer Health Care System’ was published nearly two decades ago, patient safety has become an international healthcare priority. Universities are charged with the responsibility of preparing the future nursing workforce to practise in accordance with relevant patient safety standards. Consequently, simulation-based learning is increasingly used for developing the technical and non-technical skills graduates require to provide safe patient care.AimTag Team Patient Safety Simulation is a pragmatic group-based approach that enhances nursing students’ knowledge and skills in the provision of safe patient care. The aim of this paper is to describe the Tag Team Patient Safety Simulation methodology and illustrate its key features with reference to a medication safety scenario.MethodsInformed by the National Safety and Quality Health Service Standards and the Patient Safety Competency Framework for Nursing Students, Tag Team Patient Safety Simulation methodology actively engage large numbers of nursing students in critical conversations around every day clinical encounters which can compromise patient safety.ConclusionTag Team Patient Safety Simulation is a novel simulation methodology that enhances nursing students’ skills and knowledge, fosters critical conversations, and has the potential to enhance students’ resilience and capacity to speak up for safe patient care.     

Undergraduate registered nursing students working as assistants in nursing within the acute care environment: Program development and discussion

BackgroundMost pre-registration nursing students require employment during their studies which may entail undertaking another qualification.This paper describes how one university developed a program whereby undergraduate nursing students complete the national vocational education – HLT33115 Assistant in Nursing qualification through recognition of prior learning, a self-directed education package and completion of an objective structured clinical examination.ObjectiveTo discuss the development of an ‘Assistant in Nursing’ in the acute care environment program for pre-registration undergraduate nursing degree students using the national vocational education framework.DesignThis program maps the national ‘Assistant in Nursing- Acute Care’ vocational qualification to the pre-registration registered nurse degree. Upon successful completion of this program students can work as Assistants in Nursing within the acute care environment.ConclusionsThis program enables student nurses to work as Assistants in Nursing within the acute care environment. This provides employment in a health facility and opportunities for students to immerse themselves in the clinical environment whilst continuing their studies. This may assist students to gain a deeper insight into their future role as a nurse, build networks within the nursing community and assimilate into the clinical environment. This program design may prove useful as a template for other nursing faculties wishing to implement a similar program.     

Use of a flipped classroom “Leadership in Nursing” course on nursing students' achievement and experiences: A quasi-experimental study

BackgroundProviding the undergraduate “Leadership in Nursing” course using an innovative approach is regarded to be very important in terms of enhancing leadership skills.PurposeThe purpose of this study was to evaluate the effect of using the “flipped classroom” strategy on nursing students' learning achievements and to describe their experiences of this technique.MethodThe course of “Leadership in Nursing” was delivered in flipped classroom format for 20 students while another 19 were exposed to traditional teaching methods. Therefore, the study was completed with 39 students. Data was collected using “Student Introductory Information Form”, “Exams (a midterm exam, a final exam and 4 assignments)”, “In-Class Observation Form” and “Student Feedback Form”.FindingsStudents in the flipped classroom group had obtained significantly higher scores than the students in the traditional teaching group regarding the assignments, the final exam, and overall grade. Concerning the flipped classroom, students reported flexibility as the most positive aspect and problems related to the system infrastructure as the most negative aspect.ConclusionThe usage of a flipped classroom for nursing students in the leadership course provided valuable results in terms of the students' exam scores and achieving course objectives. The flipped classroom strategy for the “Leadership in Nursing” course was shown to be effective in improving abilities such as distinguishing leadership skills, visioning, developing a new perspective, willingness to share experiences regarding leadership, also enabling students to work in harmony in group activities and to participate in classroom discussions, which are all essential elements of leadership.     

Blended learning in undergraduate nursing education – A scoping review

ObjectivesTo provide a comprehensive scoping review of the existing literature regarding the use of blended learning in undergraduate nursing education. To align the varied educational terms and definitions with the broad definition of blended learning.DesignScoping review following established methodology.Data sourcesIn consultation with library services, the academic literature was searched. Electronic databases searched included ERIC (OVID), Medline (OVID), PubMed, Nursing and Allied Health, and CINAHL Plus.Review methodsA total of 189 potentially relevant nursing research articles published between the years of 2009 and 2019. Three reviewers independently reviewed the articles, leaving 37 relevant primary articles in the nursing field to be included in the scoping review.ResultsNursing content delivered using blended learning approaches were organized into 8 themes. Themes include Professional Nursing Skills; Mental Health Nursing; Bioscience; Pharmacology, Specialty Populations; Nursing Assessment; Acute Care Nursing; and the Art of Nursing. A variety of blended learning approaches are being utilized in Undergraduate nursing education, the majority of which are happening in the classroom.ConclusionThis scoping review presents explicit the degrees to which blended learning is referred to in the nursing education literature and expanded the definition of blended learning to encompass the terminology associated with distributed, decentralized, hybrid, and flexible learning. There is a wide, varied, and expanding number of blended learning approaches currently being utilized in nursing education to teach a wide range of nursing content and skills. An expanded scoping review focused on blended learning in psychiatric nursing, licenced practical nursing, nurse practitioners, and all graduate level nursing education programs is recommended as is additional research into the use of blended learning in the lab or clinical setting.     

Proactive personality,professional self-efficacy and academic burnout in undergraduate nursing students in China

BackgroundAcademic burnout can affect nursing students' academic performance and psychological well-being. Little is known about the associations between proactive personality, professional self-efficacy and academic burnout.PurposeTo assess the prevalence of academic burnout in undergraduate nursing students and to explore the associations between proactive personality, professional self-efficacy and academic burnout among nursing students in China.MethodsThis study used a cross-sectional design. Undergraduate nursing students were recruited from five medical schools in China to participate in an online survey from April to May 2020. The Proactive Personality Scale, Professional Self-Efficacy Scale for Nursing Students and Academic Burnout Scale were used to measure students' proactive personality, professional self-efficacy and academic burnout.ResultsA total of 1219 nursing students completed the questionnaire. The prevalence of academic burnout was 31.5% in nursing students, and improper behaviour showed the highest subscale score. Proactive personality, professional self-efficacy and academic year were negatively associated with nursing students' academic burnout.ConclusionsAcademic burnout is prevalent in undergraduate nursing students in China. This study contributes to the understanding of the associations between proactive personality, professional self-efficacy and academic burnout in nursing students. Nursing educators should develop strategies to enhance students' proactivity and professional self-efficacy to decrease their academic burnout.     

Impact of ELNEC-undergraduate curriculum on associate degree nursing student primary palliative care knowledge

BackgroundPrimary palliative care (PPC) education is deficient in nursing curricula. The Endof-Life Nursing Education Consortium (ELNEC) curricula are frequently utilized PPC educational interventions; however, there is limited evidence exploring the impact of the new undergraduate curriculum on student knowledge.PurposeThe purpose of the study was to determine the impact of ELNEC-Undergraduate curriculum on associate degree nursing students’ knowledge of PPC.MethodsThe quasi-experimental study implemented a pretest/posttest design with a single cohort of associate degree nursing students enrolled in their final semester. Knowledge was assessed using the Undergraduate Nursing Palliative Care Knowledge Survey. Paired sample ttests analyzed change in knowledge. Hierarchical linear regressions analyzed the effect of student demographics on knowledge.ResultsKnowledge significantly increased after the implementation of the ELNECUndergraduate curriculum. No significant effects of demographic variables were identified.ConclusionThe ELNEC-Undergraduate curriculum is effective in improving associate degree nursing students’ knowledge of PPC.     

Cross-mapping the ICNP with NANDA,HHCC, Omaha System and NIC for unified nursing language system development. International Classification for Nursing Practice. International Council of Nurses. North American Nursing Diagnosis Association. Home Health Care Classification. Nursing Interventions Classification

Nursing language plays an important role in describing and defining nursing phenomena and nursing actions. There are numerous vocabularies describing nursing diagnoses, interventions and outcomes in nursing. However, the lack of a standardized unified nursing language is considered a problem for further development of the discipline of nursing. In an effort to unify the nursing languages, the International Council of Nurses (ICN) has proposed the International Classification for Nursing Practice (ICNP) as a unified nursing language system. The purpose of this study was to evaluate the inclusiveness and expressiveness of the ICNP terms by cross-mapping them with the existing nursing terminologies, specifically the North American Nursing Diagnosis Association (NANDA) taxonomy I, the Omaha System, the Home Health Care Classification (HHCC) and the Nursing Interventions Classification (NIC). Nine hundred and seventy-four terms from these four classifications were cross-mapped with the ICNP terms. This was performed in accordance with the Guidelines for Composing a Nursing Diagnosis and Guidelines for Composing a Nursing Intervention, which were suggested by the ICNP development team. An expert group verified the results. The ICNP Phenomena Classification described 87.5% of the NANDA diagnoses, 89.7% of the HHCC diagnoses and 72.7% of the Omaha System problem classification scheme. The ICNP Action Classification described 79.4% of the NIC interventions, 80.6% of the HHCC interventions and 71.4% of the Omaha System intervention scheme. The results of this study suggest that the ICNP has a sound starting structure for a unified nursing language system and can be used to describe most of the existing terminologies. Recommendations for the addition of terms to the ICNP are provided.     

Intensive care nurses’ perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care—A quality improvement project

BackgroundTrauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses’ knowledge.ObjectivesThe purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement.MethodsThe project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients’ care. The rounds were evaluated to assess the nurse’s perception of improvement.ResultsThere were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues.ConclusionsInter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.     

The impact of volunteering in mental health settings on nursing students' attitudes

Nursing faculties are working to improve students’ attitudes towards mental illness and people with severe mental illness, given the repercussions a lack of knowledge and negative attitudes may have on the quality of care. Complementing undergraduate programmes with volunteering activities affords students the opportunity to interact with people with a severe mental illness, and allow them to develop positive attitudes and overcome prejudice. Aim: to explore and deepen in nursing students attitudes prior to and following volunteering on an Acute Mental Health Inpatient Unit. By means of mixed methods approach, students were assessed at two time points by questionnaires including “Community Attitudes to Mental Illness” and “Semantic Differential”, and by testimonies gathered from interviews. Positives changes in attitudes were identified and monitored over time capturing a destigmatizing tendency. The participation in educational strategies such as volunteering in Acute Mental Health Inpatient Unit, complementary to undergraduate programmes and clinical placements in mental health, allows nursing students to develop more diversified and positive attitudes towards mental illness and people with severe mental illness. The impact of an interventional education strategy is not as powerful in nursing students as it might be in students of other non-healthcare oriented university degrees due to their baseline attitudes.