TEACHING STATISTICS ONLINE: COMPARING COMPETENCY-BASED AND TRADITIONAL LEARNING.

Background: Interdisciplinary undergraduate students are expected to develop statistical competence to interpret research findings as they advance in their healthcare studies and careers. However, students often report anxiety related to learning statistical course content.This descriptive study examined differences in statistical knowledge and self-efficacy scores of undergraduate students enrolled in online competency-based and traditional learning statistics courses.A sample of 20 nursing and interdisciplinary, undergraduate students from a Midwestern University who were enrolled in introductory statistics courses were recruited for this study. Methods: Significant differences between pre-test and post-test statistical knowledge and self-efficacy scores were compared for students receiving online competency-based learning and traditional learning statistical course content. The Current Statistics Self-Efficacy (CSSE) and the Self-Efficacy to Learn Statistics (SELS) measures determined the statistics self-efficacy scores. Results: There was a significant difference in knowledge scores from pre- to post-test in the areas of hypothesis testing (p =.02), measures of central tendency (p =.001), and research design (p =.001), but there was not a significant difference in overall mean scores between competency-based learning and the traditional learning groups (p =.10). The pre-test to post-test Current Statistics Self-Efficacy student scores improved significantly in both the competency-based learning (p <.001) and traditional learning (p <.001) statistics course sections; and the Self Efficacy to Learn Statistics pre-test to post-test scores were also significantly improved in the competency-based (p <.001) and traditional (p =.02) learning groups. Conclusions: Both online competency-based and traditional learning methods improved interdisciplinary undergraduate students' statistical knowledge and self-efficacy scores. Online competency-based learning was described by the students as at least as beneficial as traditional learning for studying statistics while allowing more flexibility to repeat content until it was mastered. Purpose: This study compared pre- and post-test differences in statistical knowledge and self-efficacy scores of students enrolled in online competency-based learning and traditional learning statistics class sections.

Prelicensure Undergraduate Nursing Student Perceptions of Professional Identity in Nursing.

ABSTRACT: This qualitative descriptive study explored the perceptions of 63 prelicensure undergraduate nursing students about their learning experiences and the formation and development of professional identity in nursing (PIN). Students enrolled in a required course that included PIN concepts completed a guided reflective writing assignment. Four themes emerged with data analysis: 1) learning and applying ethics and values, 2) nursing knowledge is specific to nursing practice, 3) all nurses should be leaders, and 4) demonstrating professional comportment. Implications include effective use of reflective writing assignments to facilitate student PIN formation. Future research is warranted.

Comfort and Satisfaction Among Women Who Used Different Options for Analgesia During Labor and Birth.

OBJECTIVE: To determine if comfort and satisfaction with the birth experience differed among women who used nitrous oxide (N2O), epidural analgesia, or no analgesia during labor and birth. DESIGN: Nonexperimental, cross-sectional, between-subjects. SETTING: Maternity care units in three U.S. Midwest hospitals from June to October 2019. PARTICIPANTS: A total of 84 women with spontaneous vaginal birth at term gestation (≥37 weeks). METHODS: Women were grouped according to self-selected pain management method: N2O and oxygen (50%/50% mixture) only (n = 28), epidural analgesia (may have been in combination with other analgesia options; n = 28), or no analgesia (n = 28). We collected data within 6 hours after childbirth using the Birth Satisfaction Scale-Revised and the researcher-modified Childbirth Comfort Questionnaire. We analyzed data for differences in comfort and satisfaction scores among the three groups of women using analysis of variance. RESULTS: We found no statistically significant differences related to comfort during labor and birth among women who used N2O only, epidural analgesia, or no analgesia during labor and birth, F(2, 81) = 1.11, p = .34. We also found no statistically significant differences related to satisfaction with the birth experience among women who used N2O only, epidural analgesia, or no analgesia during labor and birth, F(2, 81) = .084, p = .92. CONCLUSION: Our finding of no statistically significant differences in comfort and satisfaction with the birth experience across groups highlights the need to present comprehensive pain management options to women for labor and birth, such as N2O.

Preoperative Nutritional Status and Risk for Subsyndromal Delirium in Older Adults Following Joint Replacement Surgery.

BACKGROUND: Subsyndromal delirium following surgery in older adults is related to increased lengths of hospital stay and increased admissions to long-term care. Impaired nutrition increases risk for delirium, but its relationship to subsyndromal delirium remains unclear. PURPOSE: This correlational study examined the relationship between nutritional status and subsyndromal delirium in older adults. METHODS: Assessments for subsyndromal delirium in 53 adults 65 years or older were completed for three consecutive days following joint replacement surgery. Relationships between nutritional status and subsyndromal delirium were analyzed. Level of significance for all tests was set at p ≤ .05. RESULTS: Participants' scores from the Mini Nutritional Assessment screen were significantly related (p = .05) to subsyndromal delirium severity after accounting for variability posed by age and cognition status. CONCLUSION: When preoperative risk assessment of older adults indicates nutritional risk, preoperative optimization may improve effectiveness of delirium prevention efforts.

Pain, Opioid Intake, and Delirium Symptoms in Adults Following Joint Replacement Surgery.

This study examined the effects of pain and opioid intakes on subsyndromal delirium in older adults who had joint replacement surgery. Delirium assessments of 53 older adults were completed on the first, second, and third days following joint replacement surgery using the Confusion Assessment Method (CAM). Statistical relationships were analyzed using correlations and multiple regressions. Subsyndromal delirium developed in 68% (n = 36) of participants. Pain was significantly related (p < .05) to increased delirium symptoms after accounting for preoperative risk factors of comorbidity, cognitive status, fall history, and preoperative fasting times, whereas opioid intake was not significantly associated with increased delirium symptoms. Findings suggest older adults with increased pain levels are at higher risk for subsyndromal delirium as well as delirium after joint replacement surgery.

Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression.

BACKGROUND: Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. METHODS: Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. RESULTS: Six studies, with an overall level of evidence grade of "B," representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. CONCLUSION: Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.

Exploration of Relationships Between Postoperative Pain and Subsyndromal Delirium in Older Adults.

BACKGROUND: Subsyndromal delirium is associated with serious adverse outcomes of longer lengths of stay, increased long-term care admissions, and higher 6-month mortality rates. Postoperative pain is a risk factor for delirium, but the relationship between pain and the severity of subclinical delirium symptoms is unclear. A better understanding will inform nursing interventions to reduce adverse outcomes associated with delirium symptoms. OBJECTIVES: The purpose of this correlational study was to determine the relationship between pain and subsyndromal delirium in older adults following joint replacement surgery. METHODS: Delirium assessments were completed on postoperative Days 1, 2, and 3 for 49 adults of ages 65 years or older following joint replacement surgery. Multiple linear regression was used to analyze data for relationships between postoperative pain and subsyndromal delirium and, secondarily, postoperative opioid intake and subsyndromal delirium while accounting for known preoperative risk factors. RESULTS: Increased age, cognitive impairment, current smoking, and higher levels of self-reported pain were significantly related to subsyndromal delirium (p < .001). After accounting for preoperative risk factors of age, cognitive status, smoking status, and opioid intake, pain was significantly related to subsyndromal delirium (ß = .28, p < .05); however, opioid intake did not contribute to subsyndromal delirium. DISCUSSION: Higher pain levels were significantly related to subsyndromal delirium when age, cognitive status, smoking status, and opioid intake were accounted for (p < .05), although opioid intake was not significantly related to subsyndromal delirium after accounting for age, cognitive status, smoking status, and pain. Nurses caring for older adults who undergo joint replacement surgery are encouraged to ensure effective pain management to reduce onset and severity of delirium symptoms.

Preoperative Risk Factors for Subsyndromal Delirium in Older Adults Who Undergo Joint Replacement Surgery.

BACKGROUND: Older adults with subsyndromal delirium have similar risks for adverse outcomes following joint replacement surgery as those who suffer from delirium. PURPOSE: This study examined relationships among subsyndromal delirium and select preoperative risk factors in older adults following major orthopaedic surgery. METHODS: Delirium assessments of a sample of 62 adults 65 years of age or older were completed on postoperative Days 1, 2, and 3 following joint replacement surgery. Data were analyzed for relationships among delirium symptoms and the following preoperative risk factors: increased comorbidity burden, cognitive impairment, fall history, and preoperative fasting time. RESULTS: Postoperative subsyndromal delirium occurred in 68% of study participants. A recent fall history and a longer preoperative fasting time were associated with delirium symptoms (p ≤ .05). CONCLUSIONS: Older adults with a recent history of falls within the past 6 months or a longer duration of preoperative fasting time may be at higher risk for delirium symptoms following joint replacement surgery.

Patients' experiences with cholecystitis and a cholecystectomy.

Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.

Undertreatment of pain in older adults: an application of beneficence.

Inadequate pain control, especially in older adults, remains a significant issue when caring for this population. Older adults, many of whom experience multiple acute and chronic conditions, are especially vulnerable to having their pain seriously underassessed and inadequately treated. Nurses have an ethical obligation to appropriately treat patients' pain. To fulfill their ethical obligation to relieve pain in older patients, nurses often need to advocate on their behalf. This article provides an overview of the persistent problem of undertreated pain in older adults and explores how nurses can meet this ethical duty through the application of Beauchamp and Childress' three principles of beneficence.