A Delphi Study to Determine Leveling of the Interprofessional Core Competencies for Four Levels of Interprofessional Practice.

INTRODUCTION: Although the Core Competencies for Interprofessional Education (IPE) provide guidance in developing interprofessional learning experiences, the literature is sparse in how to incorporate them across varying levels of learning activities. Thus, the purpose of this study was to explore consensus for leveling the IPEC Core Competencies for use across four levels of interprofessional practice. Initially, Benner's novice to expert theory was used to develop a leveling document for planning educational experiences appropriate for pre-licensure through practice learners. Using this document, a Delphi study was conducted to gain consensus on leveling the Core Competencies. METHODS: A modified Delphi technique was employed using an expert panel of 48 healthcare faculty experienced in interprofessional education. Participants were asked to select their opinion of the level of learner for which each of the competencies were most appropriate. RESULTS: After three rounds of questionnaires, 34 of the 38 competencies achieved consensus at a 70% agreement. Four competencies did not reach consensus. CONCLUSIONS: Using a developmental approach, this study provides a foundational point for establishing guidelines for progressive organization and consistency in interprofessional learning activities. Although four competencies did not reach consensus, the results suggest that leveling is possible. Ongoing research is needed to further validate or revise the findings from this study.

Refinement of the IPEC Competency Self-Assessment survey: Results from a multi-institutional study.

Effective interprofessional practice requires interprofessional education that facilitates learners' achievement of competency in the interprofessional domains. Unfortunately, educators currently have a limited number of tools to identify the level of competency of their learners. Previous investigations by some of the authors described the initial characteristics of a tool based on the Competencies for Interprofessional Collaborative Practice. Building on this work, this study describes a multi-institutional, three-part study refining this tool. The series of studies further established the validity, reliability, and usability of the assessment tool. Based on the data derived from this study, we created a shorter, more easily utilised version of the tool that retains previous psychometric strengths. This article describes a tool that consists of two domains, one linked to interprofessional interaction and one linked to interprofessional values. It is believed that this assessment tool may help educators define competence in interprofessional practice and guide assessment of both programmes and learners.

Assessment tool for nursing student computer competencies.

Computer skills have been established as important for nursing students and for graduate nurses. No current research was found on the best method to evaluate the skills of incoming nursing students. The purpose of this descriptive, correlational study was to compare student ratings of their computer competency to their performance of those skills on a computer-graded assessment. A convenience sample of 87 nursing students was used. There was a low, but significant correlation between the scores on the survey and the assessment. The results suggest that students rate themselves higher on their skills than their actual performance of computer skills. Implications for educators are presented, and the value of using a computer-graded assessment is discussed.

Nurses' perceptions of evidence-based nursing practice.

AIM: This paper is a report of a study to investigate Registered Nurses' perceptions, attitudes and knowledge/skills associated with evidence-based practice. BACKGROUND: Evidence-based practice has emerged as a marker for healthcare quality. Previous studies have primarily used researcher-developed descriptive surveys to examine nurses' perceptions, as well as facilitators and barriers, related to evidence-based practice. Research suggests the value of understanding the organizational context prior to taking steps to implement evidence-based practice. METHODS: This study, conducted in 2006, had a descriptive, cross-sectional survey design using a psychometrically-validated measure of evidence-based practice. All Registered Nurses (n = 1031) employed by a large medical centre in the United States of America were asked to complete the questionnaires. The final response rate was 40.9% (n = 422). FINDINGS: Participants had moderate scores on practice and attitudes towards evidence-based practice. The knowledge/skills mean scores were somewhat lower. Statistically significant differences were found for attitudes between those with baccalaureate and higher education compared to those with associate and diploma education. The two most cited barriers to implementing evidence-based practice were time and knowledge. CONCLUSION: The findings suggest the value of a methodical assessment when developing a systematic plan for implementing an institutional culture of evidence-based practice.

Contemporary Women's Perceptions of Childbirth Education.

The purpose of this grounded theory study was to describe and understand contemporary childbearing women's perceptions of the role of childbirth education in preparing for birth. Participants were interviewed three times: prior to beginning classes, at the end of classes, and within 2 weeks after giving birth. Constant comparative analysis of the data was concurrent with data collection. The core process that emerged was "Negotiating the Journey," with supporting categories of "Exploring the Unknown," "Making It Real," and "Sensing the Readiness." The findings indicated that, for contemporary women, the value of childbirth education may not be in affecting physiological birth outcomes but rather in helping them to be ready for childbirth and, thereby, completing an important developmental milestone.

Implementing a standardized testing program: preparing students for the NCLEX-RN.

The undergraduate nursing faculty of a large Midwestern university initiated a program of standardized computerized testing for two purposes: to provide students experience with standardized computerized testing prior to taking the National Council Licensure Exam for Registered Nurses (NCLEX-RN) and to increase the students' NCLEX-RN passing rate. This article chronicles the process of implementing a comprehensive testing program developed by the Assessment Technologies Institute (Overland Park, KS). Although the first class of students to have taken the entire testing package has just graduated, midprogram results have demonstrated potential as key indicators for identifying at-risk students. The trends in scores on standardized computerized tests, grades in prerequisite science courses, and grades in medical-surgical courses are used to identify students who are at risk for failure in the program and on the NCLEX-RN. Faculty advisors meet with these students to develop individual plans of study and to provide additional resources. The testing process is going on smoothly, and faculty members are learning to use the extensive information on students' test scores to further assist them in passing the NCLEX-RN.

Experiences of infant-feeding decision-making among urban economically disadvantaged pregnant adolescents.

AIM: The aim of this paper is to report a pilot study of influencing factors in disadvantaged urban pregnant adolescents' decision-making about infant-feeding choices. BACKGROUND: Research related to decision-making among adolescents indicates that attitudinal, social, perceived control, and commitment factors are influential in choosing and initiating breast- or bottle-feeding. However, there is a need for further description of decision-making processes in disadvantaged teenagers before intervention research is done. METHODS: Focus group interviews with the Theory of Planned Behavior guiding the questioning were used with 14 pregnant adolescents between 18 and 39 weeks of gestation and between the ages of 14 and 18 in two obstetric clinics in Midwestern USA urban teaching hospitals. The majority of adolescents were African-American and primiparae. FINDINGS: The experiences of infant-feeding decision-making among pregnant adolescents were captured by two major themes: benefits vs. barriers of breastfeeding and bottle-feeding, and independent choice vs. social influences. A common thread in these themes was ambivalence and uncertainty. The adolescents had both positive and negative attitudes toward methods, with many expressing their desire to combine breast- and bottle-feeding. Many reported the health benefits of breastfeeding, yet identified barriers of pain, public exposure, and the complexity of breastfeeding. They viewed bottle-feeding as automatic and simple, allowing freedom to leave the infant with others. Although adolescents were adamant that choice of feeding method was their independent decision, social and family influences were evident. CONCLUSIONS: Consistent with the Theory of Planned Behaviour and other research, attitudes, perceived social influences, and perceived control factors were influential to adolescents when choosing infant feeding methods. The findings suggest that adolescents need education on decision-making, and are being used to fine-tune the interventions of a randomized clinical trial to investigate promoting and supporting breastfeeding among adolescent mothers.

Curriculum evaluation. Who, when, why, how?

The faculty of a large, Midwestern, public university implemented a community-based baccalaureate curriculum to prepare students for the changing health care environment. Evaluation was planned as the curriculum was developed. The constituents of the School of Nursing were determined to be the students, alumni, employers, clinical agencies, and faculty. Surveys, focus groups, questionnaires, and meetings with agency representatives were some of the methods used to gather data from the constituents. Information gathered during a three-year period resulted in further curriculum revision, increased community partnerships, and more positive feedback from students.

The NDNQI-Adapted Index of work satisfaction.

The valid measurement of nurses' job satisfaction is critical because job satisfaction is important for the retention of qualified nurses to provide patient care in hospitals. Two studies were conducted to adapt the Stamps Index of Work Satisfaction (1997b) to measure work satisfaction at the patient care unit level for use by the National Database of Nursing Quality Indicators (NDNQI). In Study 1 (n = 918 RNs) exploratory factor analysis of data obtained using the NDNQI-Adapted Index replicated the conceptual dimensions of the Stamps measure. Associations with scores on Job Enjoyment were evidence that the Index measured the intended construct. Using theta, the reliability of the composite subscales was .91. The adapted Work Satisfaction subscale scores explained 46% of the variance in Job Enjoyment, with each subscale contributing uniquely (p < .001). In Study 2 (n = 2277 RNs) confirmatory factor analysis using structural equation modeling supported the 7-subscale structure for the Adapted Index (CFI [719] = .88; RMR = .05). Replication of associations between scores on the Index subscales and Job Enjoyment provided further evidence regarding validity of the data, since the Work Satisfaction subscales explained 56% of the variance in Job Enjoyment. The feasibility of using an on-line version of the Adapted-Index for data collection was demonstrated. The findings from the two studies indicate that the adapted Index of Work Satisfaction has a structure similar to the original instrument and is a reliable and valid measure of work satisfaction at the patient care unit level.

Childbirth education outcomes: an integrative review of the literature.

The purpose of this literature review was to identify and describe recent empirical studies of childbirth education outcomes and to identify areas for further study. The search produced 63 studies; only 12 met the inclusion criteria. The literature demonstrated inconclusive evidence regarding the effectiveness of childbirth education. None of the studies used a theoretical framework that proposed multiple factors, as opposed to childbirth education alone, that impact the outcomes. Health-focused versus illness-focused outcomes were also addressed.