Effects of two intervention strategies on the behavior of nurses and nurse students related to advance directives

Advance directives are one mechanism for preserving the rights of individuals to exercise some control over their health care when serious illness may prevent them from direct participation. Nurses, as the health care providers with the closest and most sustained contact with critically ill and dying patients, are positioned to assist patients to plan for future health care needs. Although a majority of nurses favor the concept of advance directives for their patients and for themselves, they have not played a significant role in facilitating advance health care planning with their patients nor implemented advance health care planning for themselves.^ Research has also shown that differing forms of education and counseling increase the completion rates for advance directives in selected populations, mostly the elderly and seriously ill. Not yet developed are effective educational strategies to assist nurses and nurse students to make optimal contributions in assisting their clients' plans for future health care decision-making. This study sought to determine whether specific learning strategies (a) increased the involvement of nurses and nurse students in facilitating advance care planning with patients and (b) increased the percentage of the nurses' and nurse students' own personal advance care planning activities.^ The study compared two learning interventions and two populations, nurses and nurse students. The participants were randomly assigned to one of the two learning interventions, L1 or L2. Participants in L1 received a lecture, discussion and exploration of the forces impacting on advance directive behavior. Participants in L2 received the same intervention components with the additional component of group practice completing advance directives.^ Analysis of the data by chi-square and logistic regression did not support the hypotheses that the practice component would make a difference in the participants' facilitation of advance care planning with patients or in their own personal advance care planning activities. There were significant differences in post-intervention behavior between the nurse and nurse student groups. The nurses in the study did significantly more facilitation of advance care planning with patients and completed significantly more advance care documents than the nurse students post-intervention. However, the nurse students held more post-intervention family discussions than did the nurses. ^

A study of state and trait anxiety and perceived causes of anxiety identified by licensed practical nurses returning to an associate degree nursing program

The purpose of this study was to identify the state and trait anxiety and the perceived causes of anxiety in licensed practical nurses (LPNs) returning to an associate degree nursing program in order to become registered nurses (RNs). The subjects for this study were 98 students enrolled in a transitional LPN/RN associate degree nursing program in two community colleges in the state of Florida. The State-Trait Anxiety Inventory (STAI) developed by Spielberger (1983), was used as the measuring instrument for this study.^ In addition, a Q-sort technique was used to obtain information from the subjects regarding perceived causes of anxiety. Anxiety causes for the Q-sort cards used in the study were developed from the themes identified by a sample of LPN/RN students in a pilot study. The state and trait anxiety levels were obtained using the STAI for college students scoring key and scales. Descriptive statistics were used to determine the state and trait anxiety of the students. Correlational statistics were used to determine if relationships existed between the state and trait anxiety levels and perceived causes of anxiety identified by LPN students returning to an associate degree nursing program.^ The analysis of the Q-sort was performed by computing the means, standard deviations, and frequencies of each cause. The mean trait anxiety level of the students was 57.56, $SD=29.69.$ The mean state anxiety level of the students was 68.21, $SD=25.78.$ Higher percentile scores of trait anxiety were associated with higher ranks of the Q-sort category, "failing out of the program," $\rm r\sb{s}=.27,\ p=.008.$ Implications for future nursing research and application of the findings to nursing education are presented. ^

Beliefs and attitudes of nurses regarding visitation in the pediatric intensive care unit

The purpose of this study was to investigate the beliefs and attitudes of nurses regarding the effects of visitation in pediatric intensive care units (PICU).^ Questionnaires were used to gather data from nurses (n = 48) in four study sites. Data were analyzed according to the Theory of Reasoned Action.^ A predominant theme among the beliefs was that visitation should be individualized. It was found that PICU nurses have more positive attitudes regarding traditional visitation as opposed to open visitation (p $<$.01). Significant relationships were found between nurses' years of education and attitudes toward traditional (p $<$.01) and open (p $<$.05) visitation.^ In light of the literature suggesting the positive effects of open visitation, it appears that PICU nurses' attitudes may present a barrier when implementing open policies. Since years of education shows a positive correlation with nurses' attitudes, educational intervention may be helpful in overcoming this obstacle. ^

The impact of selected factors in nurses' attitudes toward bedside computers

The purpose of this study was to determine the impact of selected factors on nurses' attitudes toward bedside computers. Bedside computer systems, also referred to as point-of-care systems, are clinical information systems that allow documentation of patient care and retrieval of data at the patient's bedside, or in close proximity to where care is delivered. The adoption of bedside computer systems appears to be increasing among U.S. institutions. As healthcare institutions undertake automation projects, they face many challenges associated with implementing large-scale change. ^ The study explored four factors and their relationship to nurses' attitudes toward bedside computers. A pre-bedside implementation survey of 184 staff nurses did not demonstrate a relationship between previous computer experience and nurses' attitudes toward bedside computers (p > .05). The data did not indicate a relationship between nurses' formal education and their attitude toward bedside computers (p > .05). The data did support a relationship between nurses' previous computer experience and their comfort in the use of bedside computers (p < .0005). Using a quasi-experimental control group design, attitudes of nurses were studied over an 18 month period. The Pre versus Post Survey data indicated that nurses who used bedside computers, the experimental group, had more positive attitudes than the nurses who did not use bedside computers, the control group (p < .0005). ^ The findings are significant to institutions implementing bedside computers, to the human resource development staff overseeing bedside computer training, and to the practice of clinical nursing. ^

The theory of margin as a predictor of success on the National Council Licensure Examination for Registered Nurses

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the examination that all graduates of nursing education programs must pass to attain the title of registered nurse. Currently the NCLEX-RN passing rate is at an all-time low (81%) for first-time test takers (NCSBN, 2004); amidst a nationwide shortage of registered nurses (Glabman, 2001). Because of the critical need to supply greater numbers of professional nurses, and the potential accreditation ramifications that low NCLEX-RN passing rates can have on schools of nursing and graduates, this research study tests the effectiveness of a predictor model. This model is based upon the theoretical framework of McClusky's (1959) theory of margin (ToM), with the hope that students found to be at-risk for NCLEX-RN failure can be identified and remediated prior to taking the actual licensure examination. To date no theory based predictor model has been identified that predicts success on the NCLEX-RN. ^ The model was tested using prerequisite course grades, nursing course grades and scores on standardized examinations for the 2003 associate degree nursing graduates at a urban community college (N = 235). Success was determined through the reporting of pass on the NCLEX-RN examination by the Florida Board of Nursing. Point biserial correlations tested model assumptions regarding variable relationships, while logistic regression was used to test the model's predictive power. ^ Correlations among variables were significant and the model accounted for 66% of variance in graduates' success on the NCLEX-RN with 98% prediction accuracy. Although certain prerequisite course grades and nursing course grades were found to be significant to NCLEX-RN success, the overall model was found to be most predictive at the conclusion of the academic program of study. The inclusion of the RN Assessment Examination, taken during the final semester of course work, was the most significant predictor of NCLEX-RN success. Success on the NCLEX-RN allows graduates to work as registered nurses, reflects positively on a school's academic performance record, and supports the appropriateness of the educational program's goals and objectives. The study's findings support potential other uses of McClusky's theory of margin as a predictor of program outcome in other venues of adult education. ^

The role of the health care organization in supporting nurses in the delivery of culturally competent care

This study was designed to explore ways in which health care organizations (HCOs) can support nurses in their delivery of culturally competent care. While cultural competence has become a priority for the federal government as well as the major health professional organizations, its integration into care delivery has not yet been realized. Health professionals cite a lack of educational preparation, time, and organizational resources as barriers. Most experts in the field agree that the cultural and linguistic needs of ethnic minorities pose challenges that individual care providers are unable to manage without the support of the health care organizations within which they practice. While several studies have identified implications for HCOs, there is a paucity of research on their role in this aspect of care delivery. Using a qualitative design with a case study approach, data collection included face-to-face interviews with 23 registered nurses, document analysis, and reports of critical incidents. The site chosen was a large health care system in South Florida that serves a culturally diverse population. Major findings from the study included language barriers, lack of training, difficulty with cultural differences, lack of organizational support, and reliance on culturally diverse staff members. Most nurses thought the ethnic mix was adequate, but rated other supports such as language services, training, and patient education materials as inadequate. Some of the recommendations for organizational performance were to provide the expectations and support for culturally competent care. Implications and recommendations for practice include nurses using trained interpreters instead of relying on coworkers or trying to "wing it", pursuing training, and advocating for organizational supports for culturally competent care. Implications and recommendations for theory included a blended model that combines both models in the conceptual framework. Recommendations for future research were for studies on the impact of language bathers on care delivery, develop and test a quantitative instrument, and to incorporate Gilbert's model into nursing research.

Caring for the Caregiver: Emotional Challenges of Pediatric Palliative Care Nurses

Pediatric Palliative Care (PPC) nurses provide quality-of-life for critically ill children. This paper looks at how PPC nurses cope with caregiver emotions within the conceptual framework of emotional labor and emotional intelligence.

Increasing nurse's knowledge of neonatal pain assessment through inservice education program

Recognizing neonatal pain is a challenge for nurses working with newborns due to the complexity of the pain phenomenon. Pain is subjective, and infants lack the ability to communicate, and their pain is difficult to recognize. The purpose of this study is to determine the effectiveness of education on the NICU nurses' ability to assess neonatal pain. With a better understanding of pain theory and the effects of pain on the newborn the nurse will be better able to assess newborns with pain. Designed as a quasi-experimental one-group pretest and posttest study, the data was collected on a convenience sample of 49 registered nurses employed in the neonatal and special care nursery units at a Childrens Hospital in the Miami area. The nurses were surveyed on the assessment of neonatal pain using the General Information and Pain Sensitivity Questionnaire. After the initial survey, the nurses were inserviced on neonatal pain assessment using a one hour inservice education program. One week after the intervention the nurse was asked to complete the questionnaire again. Data analysis involved comparision of pre and post intervention findings using descriptive methods, t test, correlation coefficients, and ANOVA , where applicable. Findings revealed a significant ( p=.006) increase in nurse's knowledge of neonatal pain assessment after completing the educational inservice when comparing the pre-test and post-test results.

Evaluation of a One-Day Meditech Magic Training Program for Registered Nurses and Licensed Practical Nurses in a long term care program

Background: An evaluation was completed on the One-Day Meditech Magic Training Program for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) developed for the Long Term Care (LTC) Program. Methods: Both a literature review and consultation with stakeholders were completed to determine possible evaluation methods, expected outcomes, and ways to measure the effectiveness of the education program. A pretest/posttest design and questionnaire were chosen as the evaluation tools for this project. Results: No significant difference was found between the pretest and posttest total scores indicating that learners retained information from the orientation session (Z = -1.820, p = 0.069). Additional Wilcoxon matched-pairs signed rank tests were performed on the individual sections of the tests and revealed a significant decrease in the posttest scores for entering a Diagnostic Imaging requisition (Z = -1.975, p = 0.048). No other significant findings were present. Questionnaires were also analyzed revealing that most participants were pleased with the Meditech documentation education they received and did not indicate barriers that would affect electronic documentation. Conclusions: Further testing is required to ensure reliability and validity of the evaluation tools. Finally, caution is needed due to a small sample size. However, problematic documentation tasks were identified during the evaluation, and as a result both the training session and support materials will be improved as a result of this project.

Development of an education resource for families and clients navigating through end-of-life care with at-home palliation

Background: Community health nurses (CHNs) play a pivotal role in providing end-of-life care to clients diagnosed with a life-threatening illness. Providing quality end-of-life care is an ethical obligation. Eastern Health’s palliative end-of-life care program (PEOLC) offers nursing care, equipment, services, and support. However, the caregiver’s need for practical information about end-of-life issues is not addressed. Purpose: To develop an educational resource to assist clients and families during end-of-life and to provide a framework for new CHNs in home palliation. Methods: An informal Needs Assessment, a literature review, an environmental scan, and consultations with four CHNs involved with home palliation. Results: An educational resource was developed to address the practical end-of-life issues identified in the literature review and consultations. Conclusion: An improved delivery of care for at-home palliation in the community for clients and families, and a framework for new CHNs.

The transition experience for registered nurses new to case management in the community

Case management is increasingly being used within today‟s healthcare system in an effort to reduce healthcare costs while meeting the complex needs of populations within the community. Registered nurses (RNs) are often recruited for the role of case managers in the community because of their specific skill set and ability to navigate the healthcare system. There is a vast amount of literature related to the client and system benefits of case management, the roles and responsibilities of RN case managers, and job satisfaction among RN case managers. However, there is a literature gap noted in relation to the transition experience for RNs new to case management in the community setting. This research study used grounded theory methodology, guided by Glaser and Strauss (1967) to explore the process of RNs transitioning to case management in the community setting. Eleven RNs new to case management in the community were interviewed using semi-structured interviews. Data analysis was carried out using the constant comparative method. Three stages of adjusting to case management in the community were identified: slugging it out, seeing the job as it is, and finding the way. By gaining an understanding of this transition experience, recommendations for nursing practice and administration, education, and research that are based on the evidence from this study can be implemented to improve the transition experience for RNs new to case management in the community setting

Caring and anxiety among registered nurses in an acute hospital setting

Background: Even though caring remains the essence of nursing it is still an ambiguous concept as the lens through which each nurse perceives caring differs. The differences are due to multiple factors including the setting in which the nurse works. Nurses experience high levels of anxiety when caring for patients in acute settings. Despite an abundance of published studies on caring there is a dearth of research available that focuses on the relationship between caring and anxiety. Aim: The aim of this research study was to investigate caring and anxiety in a sample of registered nurses working in an acute hospital and to determine the relationship between these and other variables. Method: A quantitative descriptive study using a correlational design was employed, with a sample of 280 registered nurses. The Caring Behaviours Inventory-24 was used to measure caring and the State Trait Anxiety Inventory to measure Anxiety. The study was guided by the Theory of Human Caring (Watson 2008). Findings: Nurses reported high levels of caring and low levels of anxiety. A statistical significant relationship was found between caring and anxiety and between caring and supportive work environment and job satisfaction. A statistical significant relationship was found between anxiety and work environment, job satisfaction gender, age, relationship status and education. Conclusion: This is the first study to investigate the relationship between caring and anxiety in an acute hospital setting. This research contributes to advancing nursing knowledge by providing evidence of the relationship between caring and anxiety among nurses in an acute hospital setting. Despite nurses reporting high levels of caring and low levels of anxiety, it is important to further enhance caring and reduce anxiety levels among all nurses. Thus, educators and managers need to explore strategies for the alleviation of anxiety among nurses, practising in acute care settings.

Proving My Competency One Test at a Time: Internationally Educated Nurses and the Canadian English Language Benchmark Assessment for Nurses

Abstract Professional language assessment is a new concept that has great potential to benefit Internationally Educated Professionals and the communities they serve. This thesis reports on a qualitative study that examined the responses of 16 Canadian English Language Benchmark Assessment for Nurses (CELBAN) test-takers on the topic of their perceptions of the CELBAN test-taking experience in Ontario in the winter of 2015. An Ontario organization involved in registering participants distributed an e-mail through their listserv. Thematic analyses of focus group and interview transcripts identified 7 themes from the data. These themes were used to inform conclusions to the following questions: (1) How do IENs characterize their assessment experience? (2) How do IENs describe the testing constructs measured by the CELBAN? (3) What, if any, potential sources of construct irrelevant variance (CIV) do the test-takers describe based on their assessment experience? (4) Do IENs feel that the CELBAN tasks provide a good reflection of the types of communicative tasks required of a nurse? Overall, participants reported positive experiences with the CELBAN as an assessment of their language skills, and noted some instances in which they felt some factors external to the assessment impacted their demonstration of their knowledge and skill. Lastly, some test-takers noted the challenge of completing the CELBAN where the types of communicative nursing tasks included in the assessment differed from nursing tasks typical of an IENs country or origin. The findings are discussed in relation to literature on high-stakes large-scale assessment and IEPs, and a set of recommendations are offered to future CELBAN administration. These recommendations include (1) the provision of a webpage listing all licensure requirements (2) monitoring of CELBAN location and dates in relation to the wider certification timeline for applicants (3) The provision of additional CELBAN preparatory materials (4) Minor changes to the CELBAN administrative protocols. Given that the CELBAN is a relatively new assessment format and its widespread use for high-stakes decisions (a component of nursing certification and licensure), research validating IEN-test-taker responses to construct representation and construct irrelevant variance is critical to our understanding of the role of competency testing for IENs.

No second chance: junior neonatal nurses' experiences of caring for babies at the end-of-life and their families

Death of an infant is acutely stressful for parents and professionals. Little is known about junior nurses' experiences providing end-of-life care in Neonatal units (NNU). This study aimed to better understand junior nurses' experiences providing end-of-life care in NNU. Neonatal nurses (n = 12) with less than 3 years experience participated in a focus group. Nominal Group Technique (NGT) was used to build consensus around the challenges faced, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision-making whilst secondary analysis involved thematic analysis. All issues, whether environmental, professional or social appeared driven by an awareness on the part of nurses, that there was no ‘second chance’ which created a huge pressure to ‘get if right’ for the infants and families. Regarding future care 2 areas of improvement identified were ‘Education and Training’ and Support. This paper unpacks these findings making recommendations for practice.

From teaching clinician to research academic- changing focus within UK nurse education; a discussion paper

The focus of this discussion paper is the need for effective professional socialisation of student nurses and the degree to which core values and culture are transferred through University schools of nursing, the academic teaching staff and to the student nurses.
UK schools of nursing had progressively transferred into university institutions more than two decades ago. Schools of nursing and the teaching academics within them, to a greater or lesser extent, impact on and help to professionally socialize student nurses. Professed core values of universities whilst including a focus on excellence and innovation, perhaps also include, collegiality, integrity and social commitment to care. These are all qualities, which should be core values and elements
of the transferable professional culture to student nurses. Notwithstanding the professed core values, at least in some areas of UK universities there is some evidence of increasing competition and a disproportionate research market driven focus. This can reflect back into schools of nursing and is inconsistent with nursing professional values.

This paper explores the degree to which the professed core values of universities and the institutional culture are necessarily enacted, and the degree to which
any dissonance in the institutions professed/enacted core values and culture reflect through the schools of nursing and impact in the professional socialisation of student nurses. The paper also explores the degree to which effective leadership in schools of nursing can help to maintain professional core values and a culture of nursing professional