Development of Nurse Practitioner Student Self-Perception of Clinical Reasoning and Diagnostic Ability.

ABSTRACT: Nurse practitioner faculty identified student struggles to gain diagnostic reasoning competence. The National Council of State Boards of Nursing developed a clinical judgment action model (CJAM) for the NCLEX (NextGen) that can be used in prelicensure nursing education to design educational interventions and has potential applicability toward diagnostic reasoning development in nurse practitioner students. The purpose of this project was to evaluate the impact of a didactic education intervention aligned with the CJAM on the development of clinical reasoning cognitive skills. The use of the CJAM demonstrated a positive outcome among nurse practitioner students in clinical reasoning development.

Nurses as Instruments of Healing: Self-Care Practices of Nurses in a Rural Hospital Setting.

OBJECTIVE: To better understand current self-care practices and health-promoting behaviors of nursing staff in a rural hospital and determine if there is a need for further development of a holistic self-care program for nursing staff in the hospital. METHOD: In this cross-sectional, descriptive study, a structured questionnaire was used to collect data on current self-care practices and health needs and interests of hospital registered nurses, licensed practical nurses, and certified nursing assistants from inpatient, outpatient, and emergency departments. A convenience sample of 45 was employed. RESULTS: Most prevalent self-care practices included humor/laughter/play, music, spirituality/prayer, healthy sleep habits, reading, healthy nutrition, and walking. At least 75.6% answered to be extremely or likely to use three of five fitness programs (95% confidence interval [CI: 63.05%, 88.15%]). All four nutrition education programs were rated extremely likely or likely by at least two thirds of respondents (66.7%; 95% CI [52.93%, 80.47%]). Other programs of interests included health education programs and job stress management programs. Majority would participate in self-care program at work if one was offered (73.3%; 95% CI [60.37%, 86.23%]). CONCLUSIONS: Majority of nursing staff recognize the importance of self-care. There is a strong preference toward fitness programs and nutrition education programs at work to other programs.

Implementation of a Progressive Mobilization Program in a Medical-Surgical Intensive Care Unit.

BACKGROUND: Current literature supports implementation of progressive mobility protocols in intensive care units. Education can help nurses overcome barriers to mobility and increase knowledge about the positive effects of mobility. OBJECTIVE: To evaluate the effect of education for a progressive mobilization program for intensive care nurses on knowledge and performance. METHODS: A pretest-posttest evaluation was conducted for 41 nurses, and a chart review was performed before and after implementation of the educational intervention to evaluate changes in knowledge and mobilization. RESULTS: Scores after the educational intervention were significantly higher than scores before the intervention (t = 2.02; P < .001). Overall mobilization (P = .04) and dangling (P = .01) increased significantly after the education. No significant increases occurred in ambulating or getting patients up to a chair. CONCLUSIONS: Mobilization education was effective and increased nurses' knowledge about the benefits of mobility for critically ill patients. The educational program also affected how nurses performed mobility interventions. Although provision of education had positive effects on patients' mobility, leadership and coaching are still important components in implementing change.

Available screening tools for adults suffering from bipolar affective disorder in primary care: An integrative literature review.

PURPOSE: To assess the efficacy of six tools utilized in primary care for the screening of bipolar affective disorder (BPAD). BPAD has historically been underdiagnosed or misdiagnosed followed by inappropriate treatment leading to detrimental relapses, suicide, and increased risks for comorbidities. DATA SOURCES: An electronic search was conducted to identify articles in the following databases: MEDLINE, CINAHL, Cochrane Library, ERIC, National Guideline Clearinghouse, PsycINFO, Psychology and Behavioral Sciences collection, and PsycARTICLES. Other information was also collected from the NIH, CDC, Healthy People 2020, the Black Dog Institute, and the Center for Quality Assessment and Improvement for Mental Health. CONCLUSION: Evidence indicates that primary care providers are often the first and sometimes sole provider, which signifies the importance of early detection and screening of BPAD in primary care. By implementing the use of appropriate screening tools and following recommended treatment and intervention guidelines, the prevention of relapse is increased, and comorbidities are more frequently diagnosed leading to an overall improved quality of life. IMPLICATIONS FOR PRACTICE: Primary care practitioners play a vital role in appropriately screening for BPAD and implementing the recommended treatments to increase prevention of relapse and promote a healthier and more socially successful quality of life.

Can script concordance testing be used in nursing education to accurately assess clinical reasoning skills?

The Script Concordance Test (SCT) has been used successfully in medical schools to assess clinical reasoning in medical students, but it has not been widely used in nursing education. The purpose of this study was to provide additional evidence of the validity and reliability of the SCT in evaluating clinical reasoning in nursing students by replicating a previous study. The test was administered to 48 first-year Bachelor of Science in Nursing students. A scoring grid was developed using the aggregate scores method based on the modal responses of 13 panel members. The reliability of the scores was measured by Cronbach's alpha coefficient, and the scores of the students and the panel were compared using a t test. The difference between the panel's and the students' scores was statistically significant, and the reliability of the scores is high. The SCT provides a reliable, standardized, and easy-to-administer method of evaluating clinical reasoning in nursing students.

Transitions in a wicked environment.

AIM: The aim of this review is to synthesize the current body of knowledge concerning transitional care for patients 65 years of age and older moving from the acute care setting to home. BACKGROUND: Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations. EVALUATION: This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included. KEY ISSUES: The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated. CONCLUSIONS: While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care. IMPLICATIONS: Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.

Do lean practices lead to more time at the bedside?

The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside.

Blended versus lecture learning: outcomes for staff development.

Critical care pharmacology education is crucial to safe patient care for nurses orienting to specialized areas. Although traditionally taught as a classroom lecture, it is important to consider effectiveness of alternative methods for education. This study provided experimentally derived evidence regarding effectiveness of blended versus traditional lecture for critical care pharmacology education. Regardless of learner demographics, the findings determined no significant differences in cognitive learning outcomes or learner satisfaction between blended versus lecture formats.

Exploring the value of an international service-learning experience in Honduras.

The purpose of this study was to determine the effect of an international service-learning experience in Honduras on the cultural competence of the participants. The study included a quantitative portion in which participants utilized the Cultural Competence Assessment instrument as a pretest-posttest evaluation of change in cultural competence, and a qualitative portion in which students discussed their feelings about the experience. The quantitative portion showed an increase in cultural competence behaviors following the experience. The qualitative portion resulted in four themes that emerged from the interviews: a) stepping outside my world, b) connecting with culturally different people, c) awe of community, and d) learning innovation. These results indicate that the international service-learning experience was successful in increasing the participants' ability to provide culturally congruent care.