Invited Paper: Teaching Nursing Diagnosis to Increase Utilization After Graduation

BACKGROUND. The majority of nursing programs identify the nursing process and diagnosis as critical elements in their curricula, yet it is often absent in classroom and clinical discussions. The failure of faculty to integrate the nursing process and diagnoses into learning experiences creates students spending endless hours creating a care plan document that requires little critical thinking, a document that does not improve the student's likelihood of utilizing nursing diagnosis after graduation. PURPOSE. This paper would outline the educational barriers for integration of these concepts into practice. DISCUSSION. Classroom and clinical strategies that guide the student to focused learning on nursing diagnoses and utilize standardized predicted care plans can produce desired curriculum outcomes, and ultimately, practice utilization will be presented.     

Nursing Diagnosis in the North Carolina Public Health System: A Statewide Project

A group of North Carolina public health nursing leaders initiated a two-phase process of providing a continuing education module on nursing diagnosis for all public health nurses in the state. In the first phase the authors developed the module to teach the skill of nursing diagnosis and evaluation tools, and statewide workshops were held to teach public health nurse administrators and nurse consultants how to use it with their staffs. Results of the evaluation revealed a significant increase in cognitive learning and a more positive attitude overall toward nursing diagnosis among 148 participants. Written comments revealed two major concerns for using nursing diagnoses: the need for additional practice, and charting issues. Both were addressed in this project. Phase two, in which administrative nurses are using the module to teach nursing diagnoses to their staffs, is under way.     

Bridging the theory-practice gap: a practice-relevant research course for RN to BSN students

Wanting to create passion for research and evidence-based practice (EBP), the authors describe how a nursing instructor and the director for research and EBP in a community hospital partnered together to teach a practice-relevant research course for RN to BSN students. Students participated in the steps of the EBP process and presented formal reports in class of their EBP project results. One student described her research experience as awesome-evidence that this course bridged the theory-practice gap.     

Explicating Filipino student nurses' preferences of clinical instructors' attributes: A conjoint analysis

The role of clinical instructor in student nurses' preparation for the professional nursing practice cannot be underestimated. The extent to which such role is achieved depends highly on the instructors' ability to realize the desired qualities expected of them. While a number of empirical studies have qualitatively explored the attributes of an effective clinical instructor, no attempt has ventured yet on the power of experimental vignettes for conjoint analysis in explicating the preferences of a select group of Filipino student nurses relative to their clinical instructors' attributes. Junior and senior nursing students (n = 227), recruited from one of the comprehensive universities in the Philippines, were asked to sort out orthogonal cards generated by Sawtooth Software. As shown, the full-profile conjoint analysis was considerably fit for this study: Pearson's R = 0.988, (p < 0.05) and Kendall's t = 0.944, (p < 0.05). Results indicated that the student nurses are one in terms of their most preferred clinical instructor attribute, which was clinical teaching capacity (38.14%) followed by interpersonal relationship and caring behavior (33.17%). In regard to the clinical teaching capability, a clinical instructor who parallels clinical teaching skills with the students' understanding and experience (0.089) was the highest part-worth. As for the interpersonal relationship and caring behavior, the highest part-worth was a clinical instructor who respects a student nurse as an individual and cares about him/her as a person (0.114). Findings of this study can be a basis for clinical instructors as to which qualities to cultivate best to facilitate a first-rate clinical nursing instruction. Likewise, the results of this study can inform current practices of clinical instructors by making them aware of how they can nurture a pedagogical approach consistent with the student nurses' preferences.     

Wellness Nursing Diagnoses: To Be or Not To Be?

Problem orientation has dominated the nursing diagnosis movement since the early 1970s. The purpose of this article is to discuss how the new nursing diagnosis definition provides opportunity for a wellness perspective to be incorporated into the movement. Wellness is differentiated from illness and health, and a conceptual model is offered to clarify these concepts. Work is reviewed from the growing number of authors who have supported wellness nursing diagnoses and advocated their incorporation into the current taxonomic listing. Cases of ill–well and well–ill clients and examples of wellness nursing diagnoses are included lo emphasize the need for wellness diagnoses across the wide scope of nursing practice. Nurses are challenged lo generate, research, and use wellness diagnoses in their practices.     

Perceived clinical constraints in the nurse student–instructor interactions: A qualitative study

Effective student–instructor interactions impact the quality of nursing clinical education. There are a myriad of different factors related to clinical settings that affect these interactions and they have received less attention in nursing studies. Identifying clinical constraints that impact the nursing student–instructor relationships will help nursing instructors to manage clinical learning situations in a more effective manner.ObjectiveThe goal of this study was to identify the primary factors that influence the student–instructor interactions within clinical settings.MethodsA purposeful sampling strategy was applied to recruit 18 nursing students and instructors to participate in qualitative, semi-structured interviews. In order to identify relevant themes of transcribed interviews, qualitative content analysis was utilized.ResultsData analysis resulted in the development of five main themes that represent essential interaction constraints in clinical contexts. These themes include: outsiders' eyes, dominance of act, close contact, clinical workplaces' disputes, and instability and uncertainty.ConclusionsThe results of this study can serve to improve the understanding and practice of international clinical nursing instructors within the clinical education context. The behaviors that emerged were based on clinical constrains and an awareness each can serve to enhance the instructor–student relationship.     

Application of the Salmon Model: A Tale of Two Cities

This report demonstrates the application of a recently developed conceptual model of public health nursing practice to a specific community problem. The nurse was able to assist one community group and lead another in identifying their needs, developing a plan to meet those needs, implementing the plan, and evaluating the results. The model provided a structure for the nurse to use in determining scope of practice, the importance of values, practice priorities and interventions, and the relevant determinants of health. This project also served to demonstrate faculty practice. Graduate students in community health nursing attended the nonsmokers' group meetings and city council hearings. They participated at various levels, but primarily they observed their instructor putting into practice the role of the public health nurse specialist as described in the classroom. Discussions regarding group dynamics and community action strategies often occurred in the classroom as a direct result of faculty and student involvement. The Salmon model for public health nursing practice has significant potential for application in numerous areas. It can serve as a unifying force in considering the many variables that influence community action. Being specifically designed for public health nursing, it holds great promise for optimizing the practice of the nurse in community settings.     

The Nurse in Clinical Practice

Swedish colleges and universities are now adapting their syllabuses to the new open European labour market. In this respect the syllabus for training of nurses is to be reorganized. Thinking in terms of health will be very important in the training program and will require practical experience of nursing. The aim of this study was to examine the demands made on competent nurses working in clinical practice. An open question was asked and the results were analysed by the constant comparative method. The 23 nurses interviewed had to answer the question: “What do you require of a competent nurse?” From the empirical data, characteristics of six different ideal types were described. A competent nurse has the ability—to create a good atmosphere; concentrate on the patient and always to have an ethical and humanitarian approach; to teach and instruct; to organize, make priorities, cooperate and make documentations; to use her theoretical knowledge and be able to put it to use; to be keen on development and change. The study showed that a competent nurse has a wide field of knowledge, but also highlighted the complex of the nursing profession. If the nursing student can acquire these skills she will be well prepared for her central role in clinical practice.     

The instructor, the student and appeals

The nursing education climate has altered considerably during the past two decades. Changes in the curriculum, in teaching strategies and admission policies as well as public accountability have increased the pressures on nursing instructors. The student nurse of today is ready to challenge her instructor's academic grades and clinical evaluations. Consequently, the relationships between student nurses and nursing instructors have been affected. This article examines the current concerns about academic appeals and the impact upon the nursing instructor and the student nurse.     

Effects of being a patient on student development

Service-user involvement is a growing aspiration for health professionals and those involved in nursing education. This article describes one approach to integrating theory and practice through service-user involvement in a teaching setting. Gwen Carter, a student nurse, tells her story of becoming a patient and how reflecting on this experience affected her approach to patient care. By sharing her experience with peers and mentors, she was able to influence their approach to care, and made a difference to how mentors worked with students in practice.     

Wellness nursing diagnoses: to be or not to be?

Problem orientation has dominated the nursing diagnosis movement since the early 1970s. The purpose of this article is to discuss how the new nursing diagnosis definition provides opportunity for a wellness perspective to be incorporated into the movement. Wellness is differentiated from illness and health, and conceptual model is offered to clarify these concepts. Work is reviewed from the growing number of authors who have supported wellness nursing diagnoses and advocated their incorporation into the current taxonomic listing. Cases of ill-well and well-ill clients and examples of wellness nursing diagnoses are included to emphasize the need for wellness diagnoses across the wide scope of nursing practice. Nurses are challenged to generate, research, and use wellness diagnoses in their practices.     

The use of nursing diagnoses for health promotion in community practice

The use of nursing diagnosis contributes to health promotion by helping nurses define and organize knowledge for community practice. When community nurses assess clients' responses to life and health events, clinical judgment frequently requires formulation of both positive and problem-oriented nursing diagnoses. Clinical examples and research findings are used to illustrate the use of nursing diagnoses for health promotion in community practice.     

Use of Nursing Diagnosis With Population Groups

The authors report findings of a study done to examine the use of nursing diagnosis by community health nurses ( n = 15) and students ( n = 20) who worked with population groups. Results of the analysis of the open-ended questionnaires and student assignments indicate that many of the diagnoses, both wellness and deficit, could be classified in relation to the concepts present in published classification systems. Issues raised by the study about the use of nursing diagnosis with population groups include: incorporating wellness diagnoses in the NANDA Taxonomy, identifying when a group diagnosis is appropriate, determining whether to give priority to a behavioral or an environmental focus, and selecting the level of abstraction.     

Effects of crossing legs on blood pressure measurement

The purpose of this study was to determine if blood pressure measurement is affected by the leg crossed at the knee as compared with feet flat on the floor in a well-senior population. Participants (N = 110) either had their blood pressure measured with feet flat first and then crossed or the reverse of this. Results indicate that blood pressure was significantly higher when legs were crossed versus uncrossed. Systolic pressure changed by 5.9 mmHg, from 127.32 to 133.24, whereas diastolic pressure changed by 2.97, from 72.54 to 75.52. There were no significant differences between those who had their blood pressure measured first with their legs crossed versus uncrossed or between those with and without hypertension. Instructing patients to keep feet flat on the floor during blood pressure measurement is an important nursing intervention that can contribute to the accurate measrement, interpretation, and treatment of a patient's health condition.     

Contamination: Nursing Diagnoses with Outcome and Intervention Linkages

PURPOSE: To relate the collaborative processes involved in the evolution of environmental nursing diagnoses and the linkages between two new nursing diagnoses and their associated interventions and outcomes; to describe the environmental health implications of contamination. DATA SOURCES: Published research articles, official reports, textbooks, and collaborative discussion with experts in community and global health. DATA SYNTHESIS: Reflection following review of the literature and collaboration with experts led to the development of a new schema for environmental diagnoses and development of two new diagnoses, allowing for greater clarity and distinction between the contamination diagnoses and risk for poisoning diagnosis. CONCLUSIONS: An environmental nursing diagnosis schema, with its emphasis on contamination, infection, and violence, provides nurses with a holistic framework for making judgments about environmental influences related to individual, family, community, and global health. The diagnoses of Contamination and Risk for Contamination provide necessary language to describe human responses and risk states that may arise following exposure to environmental contaminants. PRACTICE IMPLICATIONS: Development of environmental diagnostic labels and delineation of the linkages to nursing outcomes and interventions will allow nurses to take active roles in identifying environmental components that affect health and planning care that responds to environmental health needs. Greater clarity in the use of language will allow nurses to incorporate environmental concepts appropriately in nursing assessments and improve the accuracy of the diagnostic process and selection of distinct interventions and outcomes. This will result in better outcomes for patients and communities and permit greater accountability of nursing's contribution to environmental health.     

‘Anyone can have a mental illness’: A qualitative inquiry of pre‐registration nursing students’ experiences of traditional mental health clinical placements

Nurses play a crucial role in mental healthcare provision. Like many countries, Australian nursing students are educated in comprehensive pre‐registration programmes which include mental health clinical placements. Placements play a vital role in students’ education, providing the opportunity to engage with consumers and develop mental health nursing knowledge and skills. There is limited knowledge of student perspectives on traditional placements in contemporary recovery‐oriented mental health services. This interpretive qualitative inquiry aimed to explore nursing students’ experience of traditional mental health clinical placement and how it influenced their practice and their understandings of recovery from mental illness. Data were collected from focus groups with n = 31 nursing students in a large metropolitan public mental health service. Thematic analysis resulted in three themes of experience: humanizing people with mental illness; learning about recovery; and shifting perspectives on mental health nursing. Through a positive placement experience where they felt supported and included by staff, students came to see consumers as people rather than diagnoses, developed greater understanding of mental health nursing work and were more likely to consider mental health nursing as a career choice. Peer‐support workers were an important influence on students’ understandings of recovery and have a key role to play in educating students on placement. Students need to be prepared and supported by university and clinical staff to deal with vicarious trauma that may occur on placement. Mental health placements play a crucial role in attracting students into the field, and it is imperative they remain part of comprehensive pre‐registration education.     

End-of-life: An urgent update in nursing terminology

Although nursing terminologies and classifications represent nursing knowledge across diverse clinical areas, end-of-life care seems under represented in many aspects of these instruments. NANDA- I is an international nursing diagnostic classification widely used in nursing education and research. This taxonomy is based on seven axes, including the axis of time. In this commentary we bring discussion to the need to update nursing terminology by including the term end-of-life in the time axis of NANDA-I. After describing the epidemiologic aspects of end-of-life care and discussing the relevant nursing role, we discuss patients' and family's human responses towards the end-of-life time and circumstance, which are central to defining nursing diagnoses. End-of-life care is one priority in health care, and nursing diagnoses should represent that situation as well. This paper focuses on a specific and international nursing diagnosis classification, NANDA-I, which lacks an end-of-life component to its time axis for defining labels of nursing diagnoses. Attending to the importance of classifications in clinical reasoning, nursing diagnoses could better represent responses towards this health condition, opening new opportunities for increasing nursing roles in clinical practice, and also for new studies aiming to validate nursing diagnoses, and promoting an evidence-based practice by including end-of-life in the axis time.     

Working with American Indians toward educational success

Past research has focused on identifying barriers that American Indian college students experience in attempting to complete programs in higher educational systems. Recommendations to reduce these barriers have not significantly decreased attrition rates or increased the completion rates of this minority group. Nationally, nursing professionals recognize the shortage of minorities in the field of nursing. Likewise, the need for American Indian health care providers is growing in direct proportion to the number of health care issues facing this population. This grounded theory study focused on the enablers that supported educational success of American Indian baccalaureate nursing graduates between the years 1986 and 1995 in a western university. Through constant comparative analysis of 18 interviews, four core variables emerged. The interactive core variables are individual American Indian student, instructor, institutions (university and college of nursing), and external influences. This article focuses on the core variable individual American Indian student and the following seven properties that support success: focuses on goal, adjusts to dominant cultural, invests in self-assessment, develops assertive skills, establishes support community, socializes into roles of student and nurse, and masters content. This central core variable and properties create a gestalt that promotes educational success. The implications are that faculty, in their roles as advisor and instructor, can assist in the development and maintenance of these seven properties. This can be achieved through proactive culturally responsive advisement, creation of a culturally relevant environment, and use of humanistic andragogical approaches to teaching-learning processes.