LGBTQIA+ invisibility in nursing anatomy/physiology textbooks

Members of the LGBTQIA+ experience health disparities that are compounded by providers that lack cultural competence, i.e., the skills, attitudes, and knowledge to offer culturally sensitive care. Educational efforts focus on increasing LGBTQIA+ representation across undergraduate nursing curricula and the recruitment and retention of members of this community into nursing programs. However, the ways that classroom materials represent LGBTQIA+ people can perpetuate social norms rather than accurate scientific understandings, thus limiting students' development of cultural competence while also driving LGBTQIA+ students from nursing. This study performs a content analysis for LGBTQIA+ inclusion in four widely adopted undergraduate nursing anatomy/physiology textbooks. We identify specific social beliefs that exclude LGBTQIA+ people and compare the different ways these manifested in each of the four textbooks. We argue that the way these books represent LGBTQIA+ people violate the fundamental ethical principles of nursing. Based on our findings, we challenge educators to consider the impact that language, images, and other classroom materials have on LGBTQIA+ students and all students' ability to develop cultural competence.     

Development of undergraduate nursing entrustable professional activities to enhance clinical care and practice

BackgroundNursing education adopts a time-based approach to assess the multifaceted competencies of student nurses. The competency-based approach is preferred historically as it is practical and ensures that individuals deliver effective healthcare practice. However, there remains a gap on how these competencies are actually applied in nursing practice. To facilitate the connection between competencies, competency-based education, and nursing practice, entrustable professional activities (EPAs) can be utilized to translate competencies into clinical practice. EPAs have shown promising results across multiple healthcare specialties and have become the current driving force to facilitate nursing care and practice. Given the limited information of EPAs in nursing education, it is an opportune time to develop EPAs specific to nursing care and practice.ObjectivesTo provide a detailed breakdown on the development of EPAs in nursing education to inform clinical care and practice.MethodsThe development stages of EPAs included: i) the formation of a team, ii) the development of the conceptual framework, and iii) the pooling, reviewing, and revising of core EPAs.ResultsA total of ten core EPAs were developed, with sub-EPAs nested within these core EPAs. The EPAs include: 1) patient engagement, 2) patient care and practice, 3) care management, 4) common procedures, 5) safety, 6) urgent care, 7) transition care, 8) patient education, 9) interprofessional collaboration, and 10) palliative care.ConclusionThe development of EPAs specific to nursing care and practice may offer nursing programs a guide to assist with curricula planning and a basis for developing entrustment assessment tools. The unfamiliarity of EPAs in nursing education may pose as implementation challenges to EPAs. Future research is warranted to evaluate and improve the developed EPAs.     

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.     

Cultivating LGBTQ+ Competent Cancer Research: Recommendations from LGBTQ+ Cancer Survivors,Care Partners,and Community Advocates

ObjectiveSexual and gender minority (SGM) or LGBTQ+ communities were designated as a National Institutes of Health (NIH) disparity population in 2016, yet research exploring SGM cancer disparities is still limited. Thus, we sought the insight of LGBTQ+ cancer survivors, care partners, and community advocates to learn their recommendations for cultivating competent and inclusive cancer research for LGBTQ+ individuals.Data SourcesWe conducted a focus group with LGBTQ+ survivors and care partners of LGBTQ+ survivors who were 18 years or older (N = 8) and interviews with community advocates who are leaders in LGBTQ+ cancer (N = 8). The focus group and interviews were recorded, transcribed, and qualitatively analyzed using an inductive thematic analysis.ConclusionQualitative analysis elicited an overarching theme of cultivating competent research for LGBTQ+ individuals, including three subthemes: (i) Cisheteronormativity: An inhospitable ecosystem for LGBTQ+ patients, survivors, and care partners, (ii) Study design: Shifting from invasive ‘othering’ to a sustainable community-driven climate, and (iii) Recruitment and data collection: Ways to cultivate ecosystem health. Cultivating inclusive, competent research with SGM populations is crucial for addressing health disparities and improving cancer survivors’ and care partners’ health.Implications for Nursing PracticeRecommendations from LGBTQ+ survivors, care partners, and community advocates ranged from small alterations to systemic changes, highlighting the multifaceted yet feasible process of cultivating LGBTQ+ competent cancer research. The process of cultivating competent research for LGBTQ+ populations will take substantial investment from researchers, providers, and health systems.     

Nursing informatics and undergraduate nursing curricula: A scoping review protocol

AimThis scoping review aims to review contemporary published literature on Nursing Informatics education in undergraduate nursing education.IntroductionNursing is the largest workforce in health care and nurses are increasingly required to work with digital information systems. The need for nurses to understand and embrace information technology is closely linked with the ability to function in the contemporary healthcare workplace. However, despite the early adoption of Nursing Informatics in Australia in the 1980 s, there remain barriers to Nursing Informatics engagement and proficiency, including poor computer literacy, limited professional development and a lack of undergraduate informatics education.DesignThis scoping review will be developed in adherence with the JBI Manual for Evidence Synthesis: Scoping Reviews and the PRISMA-ScR Checklist.MethodsTo be included in this scoping review, papers need to include Nursing Informatics education for undergraduate nursing students in a Bachelor of Nursing program. Undergraduate nursing students are defined as individuals enrolled in a recognised nursing program leading to registration as a Nurse. To meet the requirements for registration as a Registered Nurse, in Australia, individuals are required to complete a Bachelor of Nursing program at a university (Australian Qualifications Framework Level 7) For the purpose of this scoping review, undergraduate nursing students are defined as those individuals undertaking a three year Bachelor of Nursing program at a university. Equivalent international definitions will be also used in the scoping review procedure. Sources of information will be included if they were published between 2015 and 2022 and describe curriculum recommendations (including barriers to implementing Nursing Informatics education). The purpose of the identified timespan is to reflect the rapidly evolving nature of health informatics and digital technologies. The requirement for curriculum recommendations is to reflect the purpose of the scoping review as the basis for a Delphi study, where Nursing Informatics and its integration into Bachelor of Nursing curricula will be explored and described in collaboration with domain experts.Ethics and disseminationEthics approval has been obtained for this scoping review (Project ID: 2156) from the Flinders University’s Human Research Ethics Committee and has been determined to be low risk.     

Association between cultural intelligence and cultural sensitivity in nursing students: A cross-sectional descriptive study

BackgroundBecause of the multicultural composition of the Turkish population, healthcare providers encounter and serve individuals from various cultural backgrounds.AimTo determine the relationship between cultural sensitivity and cultural intelligence levels among nursing students.MethodsThis study was performed with 336 students attending the Nursing Department of a state university in Turkey. Data were collected using a sociodemographic data form, the Intercultural Sensitivity Scale, and the Cultural Intelligence Scale.ResultsMean age of the Nursing Department students was 20 ± 1.76 years. Mean total scores on the Intercultural Sensitivity Scale and Cultural Intelligence Scale were 90.49 ± 12.68 (maximum 120) and 95 ± 15.8 (maximum 140), respectively. Total scores in both the Intercultural Sensitivity Scale and the Cultural Intelligence Scale were higher among those nursing students who had encounters with people with different cultural backgrounds for any reason and those who wanted to work abroad. The nursing students’ Intercultural Sensitivity Scale and Cultural Intelligence Scale total scores were positively correlated (p < .001).ConclusionIntercultural sensitivity increased with higher cultural intelligence. Enhancing nursing education with programs that improve the students’ cultural sensitivity and cultural intelligence will help them to successfully manage cultural differences and provide culturally appropriate care in their nursing practice.     

A concept analysis of social justice in global health

BackgroundFundamental nursing responsibilities include health promotion, disease prevention, and alleviation of suffering both locally and internationally.PurposeTo examine the state of knowledge and provide clarity on the concept of social justice in global health.MethodUsing a modified Walker and Avant approach, literature was synthesized based upon discipline, including: nursing, public health, social work, philosophy, international law, international development studies, and religious studies. A theoretical definition, antecedents, defining attributes, and consequences were identified along with gaps in current knowledge and understanding. A model case was followed by direction for further concept development.FindingsSocial justice in global health nursing is a fundamental human right to be protected and a moral obligation demonstrated by action. It results in change that improves the health of individuals and populations both locally and globally by recognizing and confronting injustice, oppression, and inequity while promoting participation, opportunity, justice, equity, and helping relationships.DiscussionNursing must bring its unique perspective to policies and practices pertinent to issues of inequity. As the largest group of health care providers globally, nursing has the responsibility and political potential to mediate change and address factors integral to ensuring social justice in global health.     

Accelerated programmes in children's nursing to tackle the workforce gap in the United Kingdom: A cost-consequences analysis

BackgroundWith alarming vacancy rates and dipping availability of European nurses, remedies for the shortage of nurses in the UK are urged. To accelerate the registration of new children's nurses, a health education funder commissioned two education programmes within its region. The first is a 1-year programme designed for UK-registered nurses in adult or mental health. The second is a 2-year programme for individuals, not registered as nurses, who are child or social care graduates with experience of working with children and young people.ObjectivesTo evaluate the economic effectiveness of two accelerated children's nursing education programmes.DesignEconomic evaluation.SettingsTwo accelerated children's nursing education programmes in two sites in England.ParticipantsNursing students enrolled in both programmes (N = 20).MethodsWe adopt a cost-consequences analysis to analyse the programmes' costs and outcomes.ResultsAll graduates were heading for posts within the region where they studied, a favourable outcome for the funder. However, the first programme would deplete the workforce in other nursing fields, whereas the second, by quickening the graduates' career progression, would not dent the long-term shortage in entry roles. Given our small sample size, these impacts may differ if the programmes have wider implementation.ConclusionsOur evaluation measures the effectiveness of two novel accelerated education programmes in tackling the nurses' shortage. Concurrently, it contributes to developing a standardised approach for future economic evaluations in nursing education.     

Improving palliative care through teamwork (IMPACTT) in nursing homes: Study design and baseline findings

BackgroundThe 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life.Methods/designThis paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents' outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention.DiscussionSeveral challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more “skilled” care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services.     

Nursing presence during death: An end-of-life simulation created by students and faculty

BackgroundNursing curricula often lack end-of-life (EOL) care training, particularly regarding the nursing skill of “being present.” Collaboration between students and faculty in curriculum design is rare, but may effectively help fill the curriculum gaps in EOL care.AimTo describe the creation of a novel EOL care simulation by students and faculty, and its implementation into a pre-licensure Masters of Science in Nursing (MSN) curriculum.MethodsWith support from expert faculty, three students developed an EOL care simulation focused on nursing presence, comfort care, and compassionate communication. Pilot participants submitted pre- and post-test surveys regarding confidence in providing comfort measures for dying patients. The simulation was integrated into the MSN curriculum and simulation evaluations were collected.FindingsPilot data are limited. Once incorporated into the curriculum, 95% of respondents (N = 38; response rate 35%) reported feeling better prepared to respond to changes in patient condition, more confident in their ability to prioritise care and interventions, and better able to communicate with patients. One hundred percent of respondents recommended the simulation for future use.DiscussionA curricular gap in EOL care provided a unique opportunity for nursing students and faculty to develop clinical EOL care training that focused on compassionate nursing presence.ConclusionThis project demonstrated the potential for collaboration between nursing students and faculty to enhance nursing education in EOL care. Pre-licensure exposure to the general principles of EOL care and nursing presence may be beneficial for new nurses entering the workforce.     

Undergraduate nursing curricula: Numeracy and accreditation

BackgroundNumeracy skills are essential for patient safety; therefore, it is vital that registered nurses are proficient in performing calculations, notably medication calculations. However, the literature indicates that a large proportion of undergraduate nursing students and registered nurses are not competent in numeracy. The manifestation of numerical and calculation errors is thought to stem from failing to comprehend key mathematical principles from primary or secondary school, as well as the minimal admission requirements to enter nursing programs. Tertiary education providers teach and assess numeracy within nursing programs using a diverse range of pedagogical and instructional approaches. These programs of nursing study are underpinned by the Australian Nursing & Midwifery Accreditation Council standards, and lead to nursing registration in Australia. These accreditation standards do not incorporate numeracy, placing the onus on the tertiary education providers to design content and assessment types, as well as establish a benchmark to gauge the competence of the student prior to graduating.QuestionWhy the Australian Nursing & Midwifery Accreditation Council does not require graduates to demonstrate numeracy proficiency, and why there are no recommendations for undergraduate numeracy content and assessment in Australia.MethodAn exploratory sequential mixed methods design across 5 stages will be used.FindingsNo data has been collected to date.DiscussionNo discussion has been written to date.ConclusionTo contribute knowledge to improve the competence of undergraduate nursing students in relation to numeracy education, and ultimately the safety of Registered Nurses when calculating medications in practice.     

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.     

Patient Education Issues and Strategies Associated With Immunotherapy

ObjectiveTo provide education strategies to health care providers caring for patients receiving immunotherapy and who are managing the various potential adverse events related to these treatments.Data Sources: Peer-reviewed literature.ConclusionDelivering patient education on immunotherapy based on a thorough educational needs assessment and identification of learning barriers may contribute to effective patient outcomes and patient safety.Implications for Nursing PracticeIt is a critical role of the nurse to educate and empower patients and caregivers with the ability to identify early signs of impending toxicities related to immunotherapy regimens. With continuous learning and clinical experience, oncology nurses are at the forefront for providing high-quality immunotherapy education to patients and caregivers.     

The Essential Role of Occupational Therapy to Address Functional Needs of Individuals Living with Advanced Chronic Cancers

ObjectiveMedical progress in cancer care has led to increased life expectancy outcomes across all stages of cancer, including in advanced cancers. People now living with advanced chronic cancers have unique, ongoing functional and quality-of-life needs. This article explores the functional considerations of individuals living with advanced chronic cancers in terms of managing chronic palliative care needs, assessing and intervening for functional issues, and consistently using occupational therapy in shared service provision together with medical and nursing teams. The unique and changing functional needs of these individuals may be effectively addressed through consideration of chronic palliative approaches to care; earlier access to occupational therapy services to facilitate continued engagement in everyday activities; and shared service provision with nursing to address both medical wellness and functional status.Data SourcesThese include key databases (Pubmed, CINAHL), international guidelines, and professional guidance documents.ConclusionIndividuals living with advanced chronic cancer have ongoing and fluctuating functional needs that should be addressed in palliative care service provision. The inclusion of occupational therapy as part of inter- and multidisciplinary teams can facilitate maximization of function for individuals living with advanced chronic cancer.Implications for Nursing PracticeTimely early referrals to occupational therapy can address functional issues as they arise, and can prepare individuals for future functional considerations.     

Integrating health care for women diagnosed with HIV infection, substance abuse, and mental illness in Detroit, Michigan.

This article describes the evolution of Personalized Nursing, a comprehensive nursing practice model of care. Findings from several nursing research studies contributed to the development of Personalized Nursing. The model includes a practice model of the art of nursing care based on nursing theory and a specific nursing process that directs nursing care delivery. The process of care delivery includes location of hard-to-reach clients; linkage to health care providers; integration of care among providers for clients diagnosed with HIV, mental illness, and substance abuse; and strategies to promote retention in health care. Use of Personalized Nursing is designed to assist clients to improve their well-being and increase positive health-related behaviors. Personalized Nursing has been used in urban landscapes to serve multiply diagnosed clients at risk for HIV infection. The model is currently being used in a study targeting multiply diagnosed women who are lost to follow-up from medical care.     

Emergency Medical Services Provider Experiences of Hospice Care

Background: Growing numbers of emergency medical services (EMS) providers respond to patients who receive hospice care. The objective of this investigation was to assess the knowledge, attitudes, and experiences of EMS providers in the care of patients enrolled in hospice care. Methods: We conducted a survey study of EMS providers regarding hospice care. We collected quantitative and qualitative data on EMS provider's knowledge, attitudes, and experiences in responding to the care needs of patients in hospice care. We used Chi-squared tests to compare EMS provider's responses by credential (Emergency Medical Technician [EMT] vs. Paramedic) and years of experience (0–5 vs. 5+). We conducted a thematic analysis to examine open-ended responses to qualitative questions. Results: Of the 182 EMS providers who completed the survey (100% response rate), 84.1% had cared for a hospice patient one or more times. Respondents included 86 (47.3%) EMTs with Intermediate and Advanced training and 96 (52.7%) Paramedics. Respondent's years of experience ranged from 0–10+ years, with 99 (54.3%) providers having 0–5 years of experience and 83 (45.7%) providers having 5+ years of experience. There were no significant differences between EMTs and Paramedics in their knowledge of the care of these patients, nor were there significant differences (p < 0.05) between those with 0–5 and 5+ years of experience. Furthermore, 53 (29.1%) EMS providers reported receiving formal education on the care of hospice patients. A total of 36% respondents felt that patients in hospice care required a DNR order. In EMS providers' open-ended responses on challenges in responding to the care needs of hospice patients, common themes were family-related challenges, and the need for more education. Conclusion: While the majority of EMS providers have responded to patients enrolled in hospice care, few providers received formal training on how to care for this population. EMS providers have expressed a need for a formal curriculum on the care of the patient receiving hospice.