Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis.

AIMS: To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP). DESIGN: This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique. METHOD: Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery. RESULTS: Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care. CONCLUSION: The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments. IMPACT: This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments. REPORTING METHOD: EQUATOR guidelines were followed, using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.

Clinical Evaluation of Competence in Nursing Education: What Do We Know?

AIM: The purpose of this article was to examine the research literature to identify objective, replicable measurement of clinical competence in undergraduate nursing education. BACKGROUND: Although a standardized licensure examination is used to determine minimal competence to practice, no consensus on the definition or components of competence exists in the research literature. METHOD: A comprehensive search was conducted to locate studies that evaluated nursing students' general competence in the clinical setting. Twelve reports published from 2010 to 2021 were examined. RESULTS: Measures to evaluate competence were varied and contained multiple concepts including attributes of knowledge, attitudes and behaviors, ethics and values, personal attributes, and cognitive or psychomotor skills. Most studies used researcher-created instruments. CONCLUSION: Although essential to nursing education, competence in the clinical setting is not commonly defined or evaluated. The lack of standardized instruments has contributed to the use of varied methods and measures for evaluating competence in nursing education and research.

Exploration of the Care Giving Dynamic Between NICU Nurses and Mothers with a Substance-Exposed Pregnancy.

PURPOSE: To explore the caregiving dynamic between NICU nurses and mothers with a substance-exposed pregnancy (SEP) by examining how nurses view these mothers compared to mothers without an SEP. DESIGN: A qualitative design using interviews with NICU nurses who care for infants and families with an SEP. SAMPLE: The sample (n = 9) was all female, with an average of approximately 10 years of nursing experience in the NICU, with two-thirds having achieved a Bachelor of Science in Nursing (BSN) or higher. MAIN OUTCOME VARIABLE: Perceptions of nurses working with families affected by an SEP. RESULTS: Stigmatized views and trust issues shaped nurses' views of mothers with an SEP as different from other mothers. Empathy levels toward mothers differed related to nurses' views of substance use as either a moral decision or chronic disease. These viewpoints shaped the nurse's judgment of the mother's potential to provide a safe environment and independently care for the infant at home. Nurses described personal distress when caring for these families.

How Nursing Faculty Experience the Effects of Workplace Incivility.

AIM: The purpose of this study was to describe nursing faculty experiences with workplace incivility and the effect it has on their health. This article reports results of the qualitative portion of a larger study. BACKGROUND: Nursing faculty have reported the physical and psychological impact of incivility on their lives. The negative effects that workplace incivility, specifically, has on nursing faculty require ongoing research and attention. METHOD: Using an electronic survey, 249 nursing faculty from one Southeastern US state responded to two open-ended questions about workplace incivility and its effects. Data were analyzed using qualitative content analysis. RESULTS: Four categories related to experiences with workplace incivility emerged: the experience; personal and professional impact; a reciprocal, organizational culture problem; and survival. CONCLUSION: Nursing faculty experiences with workplace incivility constitute an organizational culture problem with both personal and professional implications.

Workplace Incivility and Its Effects on the Physical and Psychological Health of Nursing Faculty.

AIM: The aim was to explore 1) the relationship between nursing faculty attributes and their experiences with workplace incivility and 2) the impact of experiences with workplace incivility on the physical and psychological health of nursing faculty. BACKGROUND: Qualitative evidence suggests that workplace incivility impacts the physical and psychological health of nursing faculty. This has not been explored in a quantitative manner. METHOD: A cross-sectional, correlational survey was distributed to nursing faculty teaching in the southeastern United States. Data were analyzed using multiple linear regression and hierarchical multivariate multiple regression. RESULTS: Faculty age, full-time status, highest degree earned, orientation programs, and program type were significantly related to experiences with workplace incivility. Workplace incivility was significantly related to an increase in headaches, sleep disturbances, and digestive problems and a decrease in subjective well-being. CONCLUSION: Workplace incivility significantly impacts the physical and psychological health of nursing faculty.

Forging Unique Paths: The Lived Experience of Hispanic/Latino Baccalaureate Nursing Students.

BACKGROUND: The purpose of this study was to describe the lived experience of Hispanic/Latino nursing students, as shared by new graduates of baccalaureate nursing programs in the southeastern United States. METHOD: This research used descriptive phenomenology with in-depth, private, semistructured interviews. Data were analyzed using inductive analysis methods consistent with Braun and Clarke. RESULTS: Data analysis resulted in four main themes: Being an Edge Runner, Connections Matter, Looking Within, and We Are Not All the Same. CONCLUSION: Analysis revealed that the lived experience of Hispanic/Latino baccalaureate nursing students is complex and multifaceted. Fostering these students' connections within nursing, understanding their unique paths, and recognizing the individuality that each brings to the learning environment are key factors in promoting their success. [J Nurs Educ. 2021;60(1):13-19.].

The Validity and Reliability of Professional Self-Concept in Nursing in Accelerated Bachelor's and Master's Nursing Students.

BACKGROUND AND PURPOSE: Accelerated bachelor's and master's nursing students supported through the New Careers in Nursing program were surveyed (n = 3,506) using subscales from Arthur's Professional Self-Concept in Nursing Instrument (PSCNI). Reliability and validity of the instrument was assessed. METHODS: Factor analysis using a random split-half design were conducted and differences investigated based on characteristics. RESULTS: Four factors were revealed: leadership (α = .85), skill (α = .89), career positivity (α = .72), and career negativity (α = .72), with acceptable confirmatory fit. Gender and race/ethnicity differences were found in self-perceived leadership and skill and in career positivity by race/ethnicity. Accelerated bachelor's and master's students were different on skill and career positivity. CONCLUSIONS: Self-perceived leadership, skill, career positivity, and career negativity are distinct PSCNI concepts.

Acculturating Into Nursing for Hispanic/Latinx Baccalaureate Nursing Students: A Secondary Data Analysis.

BACKGROUND: This is a secondary data analysis of an original study describing the lived experiences of Hispanic/Latinx nursing students as they acculturate into the profession of nursing. METHOD: The original study described the experiences of 11 Hispanic/Latinx new graduates from three baccalaureate nursing programs in the southeastern United States. A secondary data analysis using a theoretical thematic analytical approach with data gathered in the original study was done to determine the utility of the theory of cultural marginality in understanding these student experiences. RESULTS: Findings support aspects of the theory, including marginal living, cross-cultural conflict recognition, and adjustment responses of poise and integration. Personal and contextual influences also impact the acculturation process for these nursing students. CONCLUSION: The theory of cultural marginality is valuable and provides important context for understanding the process that Hispanic/Latinx nursing students experience as they acculturate into nursing.

Differences in Gender-related Profile Characteristics, Perceptions, and Outcomes of Accelerated Second Degree Nursing Students.

BACKGROUND: The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points. PURPOSE: The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes. METHOD: An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates. RESULTS: Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts. CONCLUSION: Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male.

Acculturation Into Nursing for Hispanic/Latino Prelicensure Nursing Students and New Graduates: Integrative Review of Literature.

BACKGROUND: Increasing recruitment and retention of Hispanic/Latino nursing students is urgently needed to increase the diversity of the nursing profession and address persisting health disparities. PURPOSE: This integrative review describes current knowledge of Hispanic/Latino prelicensure nursing student and new graduate experiences. METHODS: A comprehensive literature review was performed using several online databases. RESULTS: The Theory of Cultural Marginality provides structure for organizing and synthesizing the literature. Several concepts from the theory are prominent in the literature, including marginal living and across-culture conflict, easing cultural tension and adjustment responses, and contextual, independent, and personal influences. CONCLUSIONS: The process that Hispanic/Latino prelicensure nursing students and new graduates experience as they acculturate into the profession of nursing is complex. Understanding this process is paramount for nurse educators and should be the foundation on which to design, measure, and evaluate educational strategies aimed at fostering student success.

The State of the Science on Clinical Evaluation in Nursing Education.

AIM: The purpose was to synthesize the published evidence to present the state of the science in clinical evaluation research in nursing education. BACKGROUND: Clinical evaluation is key to ensuring nursing students' clinical competence, application of knowledge, and critical thinking, all of which are important to patient safety and quality nursing care. METHOD: Cooper's research synthesis method was used. RESULTS: A comprehensive literature search resulted in 250 documents, of which 88 met study criteria. Topics were exhaustive but not mutually exclusive and included competence, instrumentation, congruence, teaching methods, objective structured clinical evaluation, faculty/preceptor issues with clinical evaluation, essential clinical behaviors, topic-based evaluation, decision-making about clinical grade, and clinical reasoning. CONCLUSION: Nursing education science is in its infancy in many areas. Two areas most in need of future research are the need to accurately define and efficiently measure competence in the clinical area and the need for reliable and valid instrumentation.

Practical strategies for nursing education program evaluation.

Self-evaluation is required for institutions of higher learning and the nursing programs within them. The literature provides information on evaluation models and instruments, and descriptions of how specific nursing education programs are evaluated. However, there are few discussions in the nursing education literature of the practical aspects of nursing education program evaluation: how to get started, how to keep track of data, who to involve in data collection, and how to manage challenging criteria. This article discusses the importance of program evaluation in the academic setting and provides information on practical ways to organize the evaluation process and aggregate data, and strategies for gathering data from students, graduates, alumni, and employers of graduates.

Legal issues in clinical nursing education.

Nurse educators are concerned about legal implications of teaching students in clinical settings. Although literature is available about legal issues in working with students in the classroom, there is little recent information on clinical nursing faculty's legal liability when working with students and ways to reduce the risk of becoming involved in a lawsuit. This article discusses the major issues in clinical settings that contribute to lawsuits against faculty and offers suggestions to reduce legal liability with students in clinical settings.

Implications for nurses and researchers of Internet use by childbearing women.

The purpose of this article is to share the growing body of literature on Internet use by childbearing women and to present findings of our pilot study done to learn more about this population's information-seeking behaviors. In our sample of 42 women, 97 percent used the Internet to seek health information. They searched for the purposes of decision making, anticipatory guidance, connecting and for general information. Nurses and other health care providers should anticipate that women are using the Internet for health information and should be proactive in referring them to reputable websites and helping them identify trustworthy websites as part of routine prenatal care and childbirth education. Because so many women use the Internet, this is also a feasible venue for nursing research recruitment and potential intervention delivery.

Outsiders in nursing education: cultural sensitivity in clinical education.

Cultural competence is a stated value of nursing and nursing education. However, some institutional and traditional practices in nursing education can unintentionally impede nurses from achieving cultural competence. Both the literature and interviews with nurse educators show that despite educators' intentions to treat all students the same, nontraditional students may feel singled out and may in fact be singled out for closer scrutiny because of their difference from the demographic norms of nursing students. To ensure that the nursing profession reflects the composition of the patient population it serves, nurse educators must first acknowledge the Eurocentric culture of nursing education and, then, work to change the environment in which students are recruited, learn, and take on the role of beginning practicing nurses.

To pass or to fail? Understanding the factors considered by faculty in the clinical evaluation of nursing students.

Making the decision to pass or to fail a nursing student is difficult for nurse educators, yet one that all educators face at some point in time. To make this decision, nurse educators draw from their past experiences and personal reflections on the situation. Using the qualitative method of critical incident technique, the authors asked educators to describe a time when they had to make a decision about whether to pass or fail a student in the clinical setting. The findings describe student and faculty factors important in clinical evaluation decisions, demonstrate the benefits of reflective practice to nurse educators, and support the utility of critical incident technique not only as research methodology, but also as a technique for reflective practice.

The influence of culture on breast-feeding decisions by African American and white women.

The purpose of this study was to examine how culture influenced breast-feeding decisions in African American and white women, using the Theory of Culture Care Diversity and Universality as a framework. One hundred eighty-six participants responded to the following: The word culture means beliefs and traditions passed down by your family and friends. How has culture affected how you plan to feed your baby? Qualitative content analysis was used to analyze the data. Four categories of responses were identified: influences of family, known benefits of breast-feeding, influences of friends, and personal choice. The findings suggest that race alone may not be as influential in infant feeding decisions as other factors. Although some women acknowledged the effect of their cultural background and experiences, most women reported that their culture did not affect their infant feeding decision. In this population, breast-feeding decisions were based on the influences of family, friends, self, and the perceived knowledge of breast-feeding benefits. Although breast-feeding statistics are commonly reported by race, cultural influences on infant feeding decisions may transcend race and include the influence of family and friends, learned information from impersonal sources, and information that is shared and observed from other people.