The relationship between participation in unethical behaviors during the nursing student experience and participation in unethical behaviors as a registered nurse

The effect of unethical behaviors in health care settings is an important issue in the safe care of clients and has been a concern of the nursing profession for some time. The purpose of this study was to examine the relationship between use of unethical behaviors in the nursing student experience and the use of unethical behaviors in the workplace as a registered nurse. In addition, the relationship between the severity of unethical behaviors utilized in the classroom, clinical setting and those in the workplace was examined. To insure greater honesty in self-report, only a limited umber of demographic variables were requested from participants. During the summer of 1997, a 56 item questionnaire was distributed to registered nurses enrolled in either undergraduate or graduate courses in a public or private institution. The participants were asked to self-report their own use of unethical behaviors as well as their peers use of unethical behaviors. In order to assign a severity score for each item, nursing school faculty were asked to rate severity of unethical behaviors which could be used during the nursing student experience and nursing administrators were asked to rate unethical behaviors which could be used in the workplace. A significant positive relationship was found between individuals' use of unethical behaviors during nursing school and those used in the workplace r = .630. A significant positive relationship was found between the severity of unethical behaviors used in the nursing student experience and the severity of unethical behaviors used in the workplace r = .637. No relationship was found between years of practice, type of initial nursing education and whether or not the participant was raised inside or outside the United States and the use of unethical behaviors.

The Metaethics of Nursing Codes of Ethics and Conduct

Nursing codes of ethics and conduct are features of professional practice across the world, and in the UK, the regulator has recently consulted on and published a new code. Initially part of a professionalising agenda, nursing codes have recently come to represent a managerialist and disciplinary agenda and nursing can no longer be regarded as a self-regulating profession.This paper argues that codes of ethics and codes of conduct are significantly different in form and function similar to the difference between ethics and law in everyday life. Some codes successfully integrate these two functions within the same document, while others, principally the UK Code, conflate them resulting in an ambiguous document unable to fulfil its functions effectively. The paper analyses the differences between ethical- codes and conduct-codes by discussing titles, authorship, level, scope for disagreement, consequences of transgression, language and finally and possibly most importantly agent-centeredness. It is argued that conduct codes cannot require nurses to be compassionate because compassion involves an emotional response. The concept of kindness provides a plausible alternative for conduct-codes as it is possible to understand it solely in terms of acts. But if kindness is required in conduct-codes, investigation and possible censure follows from its absence. Using examples it is argued that there are at last five possible accounts of the absence of kindness. As well as being potentially problematic for disciplinary panels, difficulty in understanding the features of blameworthy absence of kindness may challenge UK nurses who, following a recently introduced revalidation procedure, are required to reflect on their practice in relation to The Code. It is concluded that closer attention to metaethical concerns by code writers will better support the functions of their issuing organisations.

Debriefing in simulation conducted in small and large groups : nursing students’ experiences

The debriefing phase in human patient simulation is considered to be crucial for learning. To ensure good learning conditions, the use of small groups is recommended, which poses a major challenge when the student count is high. The use of large groups may provide an alternative for typical lecture-style education and contribute to a more frequently and repeated training which is considered to be important for achieving simulation competency. The purpose of the present study was to describe nursing students’ experiences obtained during the debriefing conducted in small and large groups with the use of a qualitative descriptive approach. The informants had participated in a human patient simulation situation either in large or small groups. Data was collected through the use of five focus-group interviews and analysed by content analysis. The findings showed that independent of group-size the informants experienced the learning strategies to be unfamiliar and intrusive, and in the large groups to such an extent that learning was hampered. Debriefing was perceived as offering excellent opportunities for transferable learning, and activity, predictability and preparedness were deemed essential. Small groups provided the best learning conditions in that safety and security were ensured, but were perceived as providing limited challenges to accommodate professional requirements as a nurse. Simulation competency as a prerequisite for learning was shown not to be developed isolated in conjunction with simulation, but depends on a systematic effort to build a learning community in the programme in general. The faculty needs to support the students to be conscious and accustomed to learning as a heightened experience of learning out of their comfort zone.

Teaching and learning sexuality in nursing education

Sexuality is recognized as part of holistic nursing care, but its inclusion in clinical practice and nursing training is inconsistent. Based on the question "How students and teachers acknowledge sexuality in teaching and learning?", we developed a study in order to characterize the process of teaching and learning sexuality in a micro perspective of cur- riculum development. We used a mixed methods design with a sequential strategy: QUAN → qual of descriptive and explanatory type. 646 students and teachers participated. The quantitative component used ques- tionnaire surveys. Document analysis was used in the additional component. A curricular dimension of sexuality emerges guided by a behaviourist line and based on a biological vision. The issues considered safe are highlighted and framed in steps of adolescence and adulthood and more attached to female sexuality and the procreative aspect. There is in emergence a hidden curriculum by reference to content from other dimensions of sexuality but less often expressed. Theoretical learning follows a communicational model of reality through ab- straction strategies, which infers a deductive method of learning, with a behaviourist approach to assessment. Clinical teaching ad- dresses sexuality in combination with reproductive health nursing. The influencing factors of teaching and learning of sexuality were also explored. We conclude that the vision of female sexuality taught and learned in relation to women has a projection of care in clinical practice based on the same principles.

Effects of two teaching strategies on the relationship between nursing students’ self-efficacy and performance in BLS/AED

Purpose: Nurses and nursing students are often first responders to in-hospital cardiac arrest events; thus they are expected to perform Basic Life Support (BLS) and use an automated external defibrillator (AED) without delay. The aim of this study was to explore the relationship between nursing students’ self-efficacy and performance before and after receiving a particular training intervention in BLS/AED. Materials and methods: Explanatory correlational study. 177 nursing students received a 4-h training session in BLS/AED after being randomized to either a self-directed (SDG) or an instructor-directed teaching group (IDG).1 A validated self-efficacy scale, the Cardiff Test and Laerdal SkillReporter® software were used to assess students’ self-efficacy and performance in BLS/AED at pre-test, post-test and 3-month retention-test. Independent t-test analysis was performed to compare the differences between groups at pre-test. Pearson coefficient (r) was used to calculate the strength of the relationship between self-efficacy and performance in both groups at pre-test, post-test and retention-test. Results: Independent t-tests analysis showed that there were non-significant differences (p-values > 0.05) between groups for any of the variables measured. At pre-test, results showed that correlation between self-efficacy and performance was moderate for the IDG (r = 0.53; p < 0.05) and the SDG (r = 0.49; p < 0.05). At post-test, correlation between self-efficacy and performance was much higher for the SDG (r = 0.81; p < 0.05) than for the IDG (r = 0.32; p < 0.05), which in fact was weaker than at pre-test. Finally, it was found that whereas the correlation between self-efficacy and performance increased from the post-test to the retention-test to almost reach baseline levels for the ILG (r = 0.52; p < 0.05), it slightly decreased in this phase for the SDG (r = 0.77; p < 0.05). Conclusion: Student-directed strategies may be more effective than instructor-directed strategies at promoting self-assessment and, therefore, may help to improve and maintain the relationship between nursing student self-efficacy and actual ability to perform BLS/AED.

Nursing Interventions in Prevention and Healing of Leg Ulcers: Systematic Review of the Literature

Aim: The purpose of this study was to define nursing interventions for patients with venous, arterial or mixed leg ulcers. Methodology: A survey was conducted in EBSCO (CINAHL Plus with Full Text, MEDLINE with Full Text), MedicLatina, Academic Search Complete, with full text articles, published between 2008/01/01 and 2015/01/31, with the following keywords: [(MM "leg ulcer") OR (wound care) OR (wound healing)] AND [(nursing) OR (nursing assessment) OR (nursing intervention)]. Results: The different leg ulcer etiologies require different therapeutic approach to prevention and treatment. Predictive factors were identified associated with healing: patient-centred care, interpersonal relationship, pain control, control of the exudate, education for health self-management, self-care, therapeutic compliance, implementation of guidelines, auditing and feedback on the practices. Conclusion: Evidence-based practice helps to improve efficiency, safety and quality of nursing care directed to people with leg ulcers or at risk of developing this type of wounds.

Teaching and learning sexuality in nursing education

Sexuality is recognized as part of holistic nursing care, but its inclusion in clinical practice and nursing training is inconsistent. Based on the question "How students and teachers acknowledge sexuality in teaching and learning?", we developed a study in order to characterize the process of teaching and learning sexuality in a micro perspective of curriculum development. We used a mixed methods design with a sequential strategy: QUAN-qual of descriptive and explanatory type. 646 students and teachers participated. The quantitative component used questionnaire surveys. Document analysis was used in the additional component. A curricular dimension of sexuality emerges guided by a behaviourist line and based on a biological vision. The issues considered sage are highlighted and framed in steps of adolescence and adulthood and more attacghed to female sexuality and procreative aspect. There is in emeergence a hidden curriculum by reference to content from other dimensions of sexuality but less often expressed. Theoretical learning follows a communicational model of reality through abstraction strategies, which infers a deductive method of learning, with a behaviourist approach to assessment. Clinical teaching adresses sexuality in combination with reproductive lealth nursing. The influencing factors of teaching and learning of sexuality were also explored. We conclude that the vision of female sexuality taught and learned in relation to women has a projection of care in clinical practice based on the same principles

Knowledge, perceptions and attitudes on the sexuality of nursing students and teachers

Introduction: The personal attitudes regarding specific aspects of sexuality are of interest to practices of personal concern, as they are to practices inserted in professional roles. General attitudes towards sexuality and sexual health were evaluated. Objectives: To describe the perceptions and attitudes of students and nursing teachers about sexuality. Methods: We used a mixed methods design with a sequential strategy: QUAN→qual of descriptive and explanatory type. 646 students and teachers participated. The Sexual Attitudes Scale (EAS) of Hendrick & Hendrick (Alferes, 1999) and Attitude Scale Address Sexual and Reproductive Health (EAFSSR) of Nemčić et al (Abreu, 2008) were used. Results: There are significant differences in the level of knowledge about sexuality depending on the sample (χ2KW (2)=18.271; p=.000): students of 1st year have lower levels. The profile of the four dimensions of EAS per sample is identical in all 3 samples, having responsibility the highest average value. In subscales EAFSSR per sample and sex there are significant diferences (p<.05) for all samples and uniform pattern was noted: females have higher median values, indicating that they have more favorable attitudes towards sexual health. Conclusions: Sexual attitudes reveal a multidimensional structure based in the female identity, that shows responsibility towards family planning and sexual education, as well as towards individual self-care regarding the body and sexual and reproductive health. An attitudinal profile by gender emerges, accentuating the polarity between male and female. The importance of the training process in nursing following the personal and social development of students is corroborated.

Nursing Interventions in Prevention and Healing of Leg Ulcers: Systematic Review of the Literature.

Abstract Aim: To identify nursing interventions aimed at persons with venous, arterial or mixed leg ulcers. Methodology: Carried out research in the EBSCO search engine: CINAHL Plus with Full Text, MEDLINE with Full Text, MedicLatina, Academic Search Complete, sought full text articles, published between 2008/01/01 and 2015/01/31, with the following keywords [(MM "leg ulcer") OR (wound care) OR (wound healing)] AND [(nursing) OR (nursing assessment) OR (nursing intervention)], filtered through initial question in PI[C]O format. Results: The different etiologies of leg ulcer require a specific therapeutic and prophylactic approach. Factors that promote healing were identified: individualization of care, interpersonal relationship, pain control, control of the exudate, education for health self-management, self-care, therapeutic adherence, implementation of guidelines of good practice and auditing and feedback of the practices. Conclusion: Person-centred care and practices based on evidence improves health results in prevention and treatment of leg ulcers.

Measuring the effect of patient comfort rounds on practice environment and patient satisfaction : A pilot study

Hourly rounding in the acute hospital setting has been proposed as an intervention to increase patient satisfaction and safety, and improve the nursing practice environment, but the innovation has not been adequately tested. A quasiexperimental pretest post-test non-randomized parallel group trial design was used to test the effect of hourly patient comfort rounds on patient satisfaction and nursing perceptions of the practice environment, and to evaluate research processes and instruments for a proposed larger study. A Patient Satisfaction Survey instrument was developed and used in conjunction with the Practice Environment Scale of the Nursing Work Index. Results on patient satisfaction showed no significant changes. Significant changes were found for three of the five practice environment subscales. Consistent with the aim of a pilot study, this research has provided important information related to design, instruments and process that will inform a larger sufficiently powered study.

The social work & human services workforce : report from a national study of education, training and workforce needs

This report analyses the national curriculum and workforce needs of the social work and human services workforce. Australia’s community and health services are among the fastest growing sectors of employment in the nation but the sustainability of an appropriately qualified workforce is threatened. Yet there is little integration of education and workforce planning for the community services sector. This contrasts markedly with the health services sector, where key stakeholders are collaboratively addressing workforce challenges. Our research confirmed rapid growth in the social work and human services workforce and it also identified: • an undersupply of professionally qualified social work and human service practitioners to meet workforce demand; • the rapid ageing of the workforce with many workers approaching retirement; • limited career and salary structures creating disincentives to retention; • a highly diverse qualification base across the workforce. This diversity is inconsistent with the specialist knowledge and skills required of practitioners in many domains of community service provision. Our study revealed a lack of co-ordination across VET and higher education to meet the educational needs of the social work and human services workforce. Our analysis identified: • strong representation of equity groups in social work and related human service programs, although further participation of these groups is still needed; • the absence of clear articulation pathways between VET and higher education programs due the absence of co-ordination and planning between these sectors; • substantial variation in the content of the diverse range of social work and human service programs, with accredited programs conforming to national standards and some others in social and behavioural sciences lacking any external validation; • financial obstacles and disincentives to social work and human service practitioners in achieving postgraduate level qualifications. We recommend that: • DEEWR identify accredited social work and human services courses as a national education priority (similar to education and nursing). This will help ensure the supply of professional workers to this sector; • VET and higher education providers are encouraged to collaboratively develop clear and accessible educational pathways across the educational sectors; • DEEWR undertake a national workforce analysis and planning processes in collaboration with CSDMAC, and all social and community services stakeholders, to ensure workforce sustainability; and • COAG develop a national regulation framework for the social and community services workforce. This would provide sound accountability systems, and rigorous practice and educational standards necessary for quality service provision. It will also ensure much needed public confidence in this workforce.

Factors influencing health promotion activities in midlife and older Australian women with a chronic disease

Background: Chronic diseases including type 2 diabetes are a leading cause of morbidity and mortality in midlife and older Australian women. There are a number of modifiable risk factors for type 2 diabetes and other chronic diseases including smoking, nutrition, physical activity and overweight and obesity. Little research has been conducted in the Australian context to explore the perceived barriers to health promotion activities in midlife and older Australian women with a chronic disease. Aims: The primary aim of this study was to explore women’s perceived barriers to health promotion activities to reduce modifiable risk factors, and the relationship of perceived barriers to smoking behaviour, fruit and vegetable intake, physical activity and body mass index. A secondary aim of this study was to investigate nurses’ perceptions of the barriers to action for women with a chronic disease, and to compare those perceptions with those of the women. Methods: The study was divided into two phases where Phase 1 was a cross sectional survey of women, aged over 45 years with type 2 diabetes who were attending Diabetes clinics in the Primary and Community Health Service of the Metro North Health Service District of Queensland Health (N = 22). The women were a subsample of women participating in a multi-model lifestyle intervention, the ‘Reducing Chronic Disease among Adult Australian Women’ project. Phase 2 of the study was a cross sectional online survey of nurses working in Primary and Community Health Service in the Metro North Health Service District of Queensland Health (N = 46). Pender’s health promotion model was used as the theoretical framework for this study. Results: Women in this study had an average total barriers score of 32.18 (SD = 9.52) which was similar to average scores reported in the literature for women with a range of physical disabilities and illnesses. The leading five barriers for this group of women were: concern about safety; too tired; not interested; lack of information about what to do; with lack of time and feeling I can’t do things correctly the equal fifth ranked barriers. In this study there was no statistically significant difference in average total barriers scores between women in the intervention group and those is the usual care group of the parent study. There was also no significant relationship between the women’s socio-demographic variables and lifestyle risk factors and their level of perceived barriers. Nurses in the study had an average total barriers score of 44.48 (SD = 6.24) which was higher than all other average scores reported in the literature. The leading five barriers that nurses perceived were an issue for women with a chronic disease were: lack of time and interferes with other responsibilities the leading barriers; embarrassment about appearance; lack of money; too tired and lack of support from family and friends. There was no significant relationship between the nurses’ sociodemographic and nursing variables and the level of perceived barriers. When comparing the results of women and nurses in the study there was a statistically significant difference in the median total barriers score between the groups (p < 0.001), where the nurses perceived the barriers to be higher (Md = 43) than the women (Md = 33). There was also a significant difference in the responses to the individual barriers items in fifteen of the eighteen items (p < 0.002). Conclusion: Although this study is limited by a small sample size, it contributes to understanding the perception of midlife and older women with a chronic disease and also the perception of nurses, about the barriers to healthy lifestyle activities that women face. The study provides some evidence that the perceptions of women and nurses may differ and argues that these differences may have significant implications for clinical practice. The study recommends a greater emphasis on assessing and managing perceived barriers to health promotion activities in health education and policy development and proposes a conceptual model for understanding perceived barriers to action.

Nurses driving change to improve access to education and quality in lcinical teaching : A partnership between Australia and Viet Nam

In Viet Nam, standards of nursing care fail to meet international competency standards. This increases risks to patient safety (eg. hospital acquired infection), consequently the Ministry of Health identified the need to strengthen nurse education in Viet Nam. This paper presents experiences of a piloted clinical teaching model developed in Ha Noi, to strengthen nurse led institutional capacity for in-service education and clinical teaching. Historically 90% of nursing education was conducted by physicians and professional development in hospitals for nurses was limited. There was minimal communication between hospitals and nursing schools about expectations of students and assessment and quality of the learning experience. As a result when students came to the clinical sites, no-one understood how to plan their learning objectives and utilise teaching and learning approaches appropriate to their level. Therefore student learning outcomes were variable. They focussed on procedures and techniques and “learning how to do” rather than learning how to plan, implement and evaluate patient care. This project is part of a multi-component capacity building program designed to improve nurse education in Viet Nam. The project was funded jointly by Queensland University of Technology (QUT) and the Australian Agency for International Development. Its aim was to develop a collaborative clinically-based model of teaching to create an environment that encourages evidence-based, student-centred clinical learning. Accordingly, strategies introduced promoted clinical teaching of competency based nursing practice utilising the regionally endorsed nurse core competency standards. Thirty nurse teachers from Viet Duc University Hospital and Hanoi Medical College participated in the program. These nurses and nurse teachers undertook face to face education in three workshops, and completed three assessment items. Assessment was applied, where participants integrated the concepts learned in each workshop and completed assessment tasks related to planning, implementing and evaluating teaching in the clinical area. Twenty of these participants were then selected to undertake a two week study tour in Brisbane, Australia where the clinical teaching model was refined and an action plan developed to integrate into both organisations with possible implementation across Viet Nam. Participants on this study tour also experienced clinical teaching and learning at QUT by attending classes held at the university, and were able to visit selected hospitals to experience clinical teaching in these settings as well. Effectiveness of the project was measured throughout the implementation phase and in follow up visits to the clinical site. To date changes have been noted on an individual and organisational level. There is also significant planning underway to incorporate the clinical teaching model developed across the organisation and how this may be implemented in other regions. Two participants have also been involved in disseminating aspects of this approach to clinical teaching in Ho Chi Minh, with further plans for more in-depth dissemination to occur throughout the country.

E-portfolios : developing nurse practitioner competence and capability

Objective: This paper aims to integrate nurse practitioner literature on competence and capability with post graduate and nursing literature on e‑portfolios in order to demonstrate the potential merits of e‑portfolios in nurse practitioner education for competence and capability development. Primary Argument In the Nurse Practitioner Standards Project, competence and capability were proposed as key criteria to assess candidates in nurse practitioner educational courses. Portfolios have traditionally been used to demonstrate competence in nursing and are integral to nursing education as well. An examination of the portfolio and electronic portfolio literature in postgraduate nursing education and professional practice indicates that these portfolios fall under two main structures, each with different purposes: 1) A spinal column structure, with evidence and reflective pieces aligned to competency standards or course objectives, for the purposes of meeting prescribed competencies, professional development planning and showcasing evidence for authorisation or potential employers; and 2) A cake mix structure, which consists of a reflective narrative tying evidence together, which enables a greater focus on personal learning journeys, reflection and the development of personal qualities. Finally, evidence from the general nursing literature suggests the complexity of e‑portfolios in assessment and evaluation can be overcome by using qualitative research methods. Conclusion: To meet the competence and capability needs of nurse practitioners, portfolios could be used, for competence and showcasing and for learning and capability. Further research would be useful to refine and explore the use of e‑portfolios to meet the needs of NP candidates and their educators, clinical mentors, authorisation personal and employers. The current evidence on nurse practitioner education, competence, capability and e‑portfolios points to the integration of the use of an e‑portfolio into current nurse practitioner curriculum models to meet the unique needs of nurse practitioner candidates.