Career Intention of Baccalaureate Student Nurses: Understanding the Barriers, Enablers, and Predictors Toward Public/Community Health Nursing.

AIM: This study had two aims: to determine initial career intention of nursing students and to assess whether nursing education variables predict career intentions toward public health/community health nursing. BACKGROUND: Nursing graduates are expected to be prepared to work in community settings. However, there is uncertainty in whether students are attracted to these settings and whether nursing education is impactful in shaping career intention. METHOD: A cross-sectional survey targeted baccalaureate and accelerated students across Oregon. Analyses utilized descriptive statistics and multiple regression. RESULTS: Students reported most interest in acute care. Didactic and clinical learning were not related to intention to pursue a public health/community health career. The strongest predictor was career intention when starting nursing school. CONCLUSION: Students enter nursing school with largely fixed intentions. Educators need to develop greater prenursing outreach and understanding of the drivers toward public and community health to build curricula and passion for this area of nursing.

Oregon PRAMS 2012-2018: Revealing racial inequity in postpartum depression.

Researchers have suggested that some women are undiagnosed and untreated for postpartum depression (PPD). However, there are mixed findings of the factors most likely to predict those most at risk. Recognizing historical racial and ethnic disparities existing in health outcomes, we sought to determine the extent of PPD inequity in Oregon. Using data from the Oregon pregnancy risk assessment monitoring system 2012-2018 and univariate weighted logistic regression models, we explored the relationship between PPD, maternal characteristics, and social variables. These variables included race/ethnicity, social support, life stressors, financial security, and perceived healthcare discrimination. A further phased analysis examined whether race/ethnicity remained a predictor of PPD when combined with other significant variables. Over 8000 respondents were included in the full phased analysis. Almost 17% of women reported they did not discuss depression with a provider during pregnancy, including over 12% who reported PPD symptoms. Black, Asian/Pacific Islander (API), American-Indian, and mixed race mothers had increased odds of PPD compared to White women (odds ratio ranged from 1.55 to 1.87). Less than baccalaureate education, lack of social support, and perceived healthcare discrimination also increased the odds of PPD. The phased analysis showed that significant differences in odds of PPD symptoms remained between Black, APIs, and American-Indian mothers compared to White mothers. Our analysis suggests that race is an important predictor of PPD. The knowledge of who is most at risk, and the provision of adequate assessment and screening, is of fundamental importance in today's society.

Postpartum depression screening in the first year: A cross-sectional provider analysis in Oregon.

BACKGROUND AND PURPOSE: Postpartum depression (PPD) has significant sequelae for mother and child. To aid diagnosis, PPD screening should continue throughout the postpartum year. In primary care, there may be a lack of consistency in how screening is applied. In Oregon, with a reported PPD rate of 18.2%, it is important to determine whether screening is reaching all women. The purpose of this study was to explore primary care provider screening practices in the postpartum year and determine if there are barriers to meeting PPD guidelines. METHODS: A descriptive, cross-sectional survey was conducted with primary care providers in Oregon. Data were sought on screening practices and timing, as well as potential barriers. To aid comparison, screening was compared against both the American Academy of Pediatrics (AAP) and National Association of Pediatric Nurse Practitioner (NAPNAP)/US Preventative Services Task Force guidelines. Data were analyzed using R statistical computing and Pearson chi-square tests. RESULTS: Of the 55 respondents, 29% followed the AAP recommendations and screened at well-child visits; 64% followed the NAPNAP recommendations and screened at least once in the postpartum year; and 31% did not meet any screening guidelines. The most common screening barriers were limited knowledge and/or availability of referral services. Physicians were more likely to meet any recommended guidelines than nurse practitioners (NPs) (p = .023). IMPLICATIONS FOR PRACTICE: A notable number of women may not be receiving PPD screening. It is concerning that most of those not screening were NPs, given the focus of their practice on disease prevention and health management. Further research is warranted to confirm whether women are missing opportunities for early intervention and whether strategies can be established to standardize the approach in primary care.

Enhancing Student Engagement: Innovative Strategies for Intentional Learning.

AIM: This paper presents four innovative teaching modalities conceptually designed and adherent to National Survey of Student Engagement (NSSE) indicators. BACKGROUND: Nurse education has received 'calls' for transformation, demanding a pedagogical refocus that better equips the future workforce. A key aspect is the need to actively engage students in learning, an approach shown to improve outcomes. METHOD: Four innovative teaching modalities were incorporated into a baccalaureate curriculum, aligned to the NSSE indicators, and targeted an area of the curriculum where active student participation had the potential to improve the learning experience. RESULTS: The four modalities: Theater of the Oppressed; Simulation as a Clinical Site for Active Engagement; Legal Simulation; and Creating Student Researchers were introduced at key stages in the curriculum and covered sophomore to senior levels. CONCLUSION: NSSE can be utilized to provide a robust framework on which to plan and deliver educational opportunities that support meaningful, student-centered participation.

Failing to Fail in Undergraduate Nursing: Understanding the Phenomenon.

AIM: The aim of the study was to explore and understand the phenomenon of "failing to fail." BACKGROUND: Phase 1 of a mixed-methods study suggested faculty in clinical settings instructed students that should not have passed preceding placements; students in didactic settings also passed exams that merited a fail. Phase 2 explored this phenomenon. METHOD: A multisite qualitative case study targeted baccalaureate and community college faculty to support analysis using replication logic. Data collection was conducted via semistructured interview. RESULTS: Eighteen demographically diverse cases were recruited (including age, experience, and full-/part-time status). Factors supporting failing to fail included being good enough, clinical/didactic dichotomy, team grading, and being the bad guy. CONCLUSION: The consistency of enabling factors suggests a collective approach is required to address failing to fail, including pedagogical preparation and cross-school mechanisms for ensuring grading parity. Effort must address integrity and teaching excellence in all aspects of nursing education.

Nursing students' experiences of mentorship in their final placement.

AIM: The aim of this study was to explore final-year students' experiences of the mentorship role in their final placement and, in particular, to establish their expectations of the mentorship role, as well as their support and supervision needs. METHOD: Seven final-placement students were recruited from one Scottish university, using purposive sampling. Heideggerian phenomenology was chosen as the underpinning philosophical approach because of its emphasis on the 'lived experience'. Data were generated using unstructured interviews and analysed using a modified version of Colaizzi's procedural steps. RESULTS: Five themes emerged from the data: 'being more independent', 'support', 'belongingness', 'feedback' and 'anticipatory anxiety'. DISCUSSION: Participants who had a positive experience of mentorship were exposed to a 'good' learning environment. As a result, they felt supported, received adequate opportunities to practise management skills, had a sense of 'belonging' within the nursing team and had regular feedback. Those who had a negative experience complained of not getting the opportunity to develop essential management skills and being dismissed for trying to be proactive. In addition, feedback was reported to be lacking. This experience resulted in reduced confidence levels, which left them feeling unprepared for the transition to registered nurse. CONCLUSION: The clinical learning environment itself and support from the mentor are key factors that influence student preparation for registration. Without this level of support, students may be left feeling unprepared to deal with the transition.

Is There Evidence of Failing to Fail in Our Schools of Nursing?

AIM: To assess evidence for "failing to fail" in undergraduate nursing programs. BACKGROUND: Literature on grading practices largely focuses on clinical or academic grading. Reviewing both as distinct entities may miss a more systemic grading problem. METHOD: A cross-sectional survey targeted 235 faculty within university and community colleges in a western state. Chi-square tests of independence explored the relation between institutional and faculty variables. RESULTS: The response rate was 34 percent. Results suggest failing to fail may be evident across the sector in both clinical and academic settings: 43 percent of respondents had awarded higher grades than merited; 17.7 percent had passed written examinations they felt should fail; 66 percent believed they had worked with students who should not have passed their previous placement. CONCLUSION: Failing to fail cuts across instructional settings. Further exploration is imperative if schools are to better engender a climate for rigorously measuring student attainment.

Prenatal care in Oregon and Washington: policy and utilization for vulnerable women.

BACKGROUND: In the prenatal period, women can have sustained contact with nurses and other clinicians, forming relationships that are likely to be health enhancing for both the woman and her unborn child. Yet, first trimester care use in Oregon dropped noticeably over the past decade. In comparison with Washington state, Oregon has not shown substantial recovery. OBJECTIVE: The aim of this study was to explore potential reasons for the declining prenatal trend in Oregon. METHODS: We collated county-level birth data from all Oregon and Washington counties from 2000 to 2010. A descriptive, observational, time-series regression analysis for both states assessed the influence of maternal determinants known to impact first trimester care utilization. RESULTS: In Oregon, two factors were significantly associated with declining first trimester care: Medicaid funding (p<.01) and maternal Hispanic ethnicity (p=.02). In Washington, there was no significant association between any assessed determinant and first trimester care. DISCUSSION: In Oregon, over the period of our study, women dependent on Medicaid and women of Hispanic origin were less likely to utilize first trimester care. A similar trend for these variables was not observed in Washington. At the time of our study, both states had different policy approaches, which may explain some of the observable patterns. Amid current healthcare reforms and rising immigration, our findings suggest the need for strong advocacy for those less able to access or utilize care.

Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds.

BACKGROUND: Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. OBJECTIVES: To determine whether pregnant women's perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). DESIGN: A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. SETTING/PARTICIPANTS: Cases were primigravida women from 'least deprived' (n=9) and 'most deprived' (n=12) geographical areas within one local authority in Scotland. ANALYSIS: Data were analysed using case study replication analysis. RESULTS: There was little difference in access to antenatal services between the 'least' and 'most' deprived groups. Perception of care differed in relation to the level of 'engagement' (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the 'least deprived' cases and almost none of the 'most deprived' cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. CONCLUSION: In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non-engagement.