The Effect of Concept Maps on Undergraduate Nursing Students' Critical Thinking.

AIM: The aim of the study was to evaluate the effect of using concept maps as a teaching and learning strategy on students' critical thinking abilities and examine students' perceptions toward concept maps utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. BACKGROUND: Researchers have found that almost two thirds of nurse graduates do not have adequate critical thinking skills for a beginner nurse. Critical thinking skills are required for safe practice and mandated by accrediting organizations. Nursing educators should consider teaching and learning strategies that promote the development of critical thinking skills. METHOD: A literature review was conducted using "concept maps, nursing education, and critical thinking" as the combined search terms. Inclusion criteria were studies that measured the effects of concept mapping on critical thinking in nursing students. RESULTS: Seventeen articles were identified. CONCLUSION: Concept maps may be useful tools to promote critical thinking in nursing education and for applying theory to practice.

Nurse-to-nurse shift handoffs on medical-surgical units: A process within the flow of nursing care.

AIMS AND OBJECTIVES: To qualitatively investigate the medical-surgical nurse shift handoff as a process within the workflow of the exchanging nurses. Specifically, this study sought to identify the ideal handoff, ways the handoff deviated from ideal, and subsequent effect on nursing care. BACKGROUND: The functions as well as information content of the handoff have been studied. However, typical studies look at the handoff as an isolated activity utilising nurse perceptions as the primary measure of quality. DESIGN: Semi-structured focus groups were conducted to discuss nurses' perspectives on ideal handoffs, ways handoffs deviate from the ideal including frequent and significant deviations and the effects on subsequent care. METHODS: Twenty-one medical-surgical nurses participated in one of five audio-taped focus group sessions. Three sessions were conducted at hospital A; two sessions at unaffiliated hospital B. The general inductive approach was used to analyse verbatim transcripts. Transcript segments relevant for answering the research questions were coded as ideal or not ideal. Conceptual themes were then developed. RESULT: Two major themes were identified: teams/teamwork and constructing and communicating a shared understanding of the patients' conditions. The importance of nurse preparatory activities was revealed including the incoming nurses reading patients' health records and outgoing nurses rounding on patients. The impact of shared expectations was identified across the team, where teams include, in addition to the two nurses, the electronic health record, other hospital staff and patients/families with a bedside handoff. New potential nurse-centred process and outcome measures were proposed. CONCLUSIONS: Evaluating handoffs by their effect on the nursing performance both during and after the handoff offers a new framework to objectively assess handoff effectiveness. RELEVANCE TO CLINICAL PRACTICE: The handoff is a process which may significantly affect the incoming nurse's transition into and administration of nursing care.

Formalising the precepting process: A concept analysis of preceptorship.

AIMS AND OBJECTIVES: To elucidate the terminology associated with preceptorships, articulate an operational description of preceptorship that may be useful in formalising the precepting process and provide guidance for constructing a clinical environment where precepting can thrive. BACKGROUND: Precepting facilitates the transition of nurses into new roles. Precepting may improve patient outcomes and safety, as well as enhance nursing satisfaction. Most research focuses on preceptor preparation and perceptions. A comprehensive operational description of what is required to formalise the precepting process is missing from the literature. DESIGN: This concept analysis was completed using a combination of Walker and Avant's and Rodger's methods. METHODS: Existing literature relating to preceptorship was reviewed. Critical attributes, antecedents, consequences and empirical referents were identified. Model, contrary, related and borderline cases were developed. RESULTS: Preceptorships have the specific attributes of being (i) one-on-one relationships, (ii) embedded within formalised programmes, (iii) that evolve over set amounts of time, (iv) to systematically facilitate practical experiences. Antecedents include how precepting is triggered and organisational supporting activities that may facilitate effective precepting. Consequences include new hire preparedness, confidence and increased retention. Empirical referents are provided for assessing hands-on clinical expertise, individualisation of precepting programmes and the preceptor-preceptee relationship. CONCLUSIONS: This concept analysis provides a holistic view of the precepting process that shifts the focus from the people or checklist to formalised preceptorships. RELEVANCE TO CLINICAL PRACTICE: Continuity throughout an organisation's system streamlines the process of hiring new employees and transitioning nursing students to practice. Organisational policies, dedicated resources and engagement in systematically improving the precepting process are critical. Nurse managers must promote and support formalised preceptorships by providing preceptors and preceptees the time and space needed and fostering a culture that supports preceptorships.

Infusing Systems and Quality Improvement Throughout an Undergraduate Nursing Curriculum.

BACKGROUND: Nurse educators are constantly revising curricula to ensure that graduating nurses have the requisite skills for today's fast-paced, rapidly changing, nonlinear complex care environment. Key nursing education and practice organizations identify systems thinking and quality improvement as essential skills for nurses at the point of care. METHOD: Systems thinking and quality improvement were embedded across a Bachelor of Nursing (BSN) curriculum in a manner that does not dislocate other, more traditional content. RESULTS: To date, approximately 500 students have been exposed to the new BSN curriculum. Sustainable approaches, preliminary results, lessons learned, and recommendations for sustainability and replication are discussed. CONCLUSION: Integrating systems thinking and quality improvement with traditional content across the entire undergraduate curriculum exposes students to increasingly sophisticated real-world experiences that highlight the relevance and significance of these skills in the health care context. Feedback from practice partners suggests this approach helps bridge the education and practice gap. [J Nurs Educ. 2017;56(12):752-757.].

Enhancing Critical Thinking Via a Clinical Scholar Approach.

BACKGROUND: Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. METHOD: A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. RESULTS: Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. CONCLUSION: Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.].

An Evaluation of Shared Mental Models and Mutual Trust on General Medical Units: Implications for Collaboration, Teamwork, and Patient Safety.

OBJECTIVES: This study examines nurse-physician teamwork and collaboration, a critical component in the delivery of safe patient care, on general medical units. To that end, we assess shared mental models and mutual trust, 2 coordinating mechanisms that help facilitate teamwork, among nurses and physicians working on general medical units. METHODS: Data were collected from 37 nurses and 42 physicians at an urban teaching medical center in the Northeastern United States. Shared mental model questionnaire items were iteratively developed with experts' input to ensure content validity. Mutual trust items were adapted from an existing scale; items were reliable. Data were analyzed using χ and independent 2-tailed t tests. RESULTS: Physicians and nurses reported significant differences in their perceptions of the professional responsible for a variety of roles (e.g., advocating for the patient [P = 0.0007], identifying a near miss/error [P = 0.003]). Medication reconciliation is only role for which nurses perceive less responsibility than physicians perceive nurses have. Regarding mutual trust, both groups reported significantly more trust within their own professions; both groups reported similar levels of trust in physicians, with physicians reporting significantly less trust in their nursing colleagues than nurses perceive (P < 0.0001). CONCLUSIONS: Although many efforts have been directed at improving nurse-physician collaboration, more work is needed. To that end, we propose increasing knowledge about their respective roles, providing opportunities for nurse and physician collaboration through rounding or committee work and enhancing the preparedness and professionalism of interactions.

Impact of pedagogical approaches on cognitive complexity and motivation to learn: Comparing nursing and engineering undergraduate students.

BACKGROUND: The changing higher education landscape is prompting nurses to rethink educational strategies. Looking beyond traditional professional boundaries may be beneficial. We compare nursing to engineering because engineering has similar accreditation outcome goals and different pedagogical approaches. PURPOSE: We compare students' cognitive complexity and motivation to learn to identify opportunities to share pedagogical approaches between nursing and engineering. METHOD: Cross-sectional data were collected from 1,167 freshmen through super senior students. Comparisons were made across years and between majors. FINDINGS: Overall nursing and engineering students advance in cognitive complexity while maintaining motivation for learning. Sophomores reported the lowest scores on many dimensions indicating that their experiences need review. The strong influence of the National Council Licensure Examination on nursing students may drive their classroom preferences. Increased intrinsic motivation, coupled with decreased extrinsic motivation, suggests that we are graduating burgeoning life-long learners equipped to maintain currency. DISCUSSION: The disciplines' strategies for incorporating real-world learning opportunities differ, yet the students similarly advance in cognitive complexity and maintain motivation to learn. Lessons can be exchanged across professional boundaries.

When teams shift among processes: insights from simulation and optimization.

This article introduces process shifts to study the temporal interplay among transition and action processes espoused in the recurring phase model proposed by Marks, Mathieu, and Zacarro (2001). Process shifts are those points in time when teams complete a focal process and change to another process. By using team communication patterns to measure process shifts, this research explores (a) when teams shift among different transition processes and initiate action processes and (b) the potential of different interventions, such as communication directives, to manipulate process shift timing and order and, ultimately, team performance. Virtual experiments are employed to compare data from observed laboratory teams not receiving interventions, simulated teams receiving interventions, and optimal simulated teams generated using genetic algorithm procedures. Our results offer insights about the potential for different interventions to affect team performance. Moreover, certain interventions may promote discussions about key issues (e.g., tactical strategies) and facilitate shifting among transition processes in a manner that emulates optimal simulated teams' communication patterns. Thus, we contribute to theory regarding team processes in 2 important ways. First, we present process shifts as a way to explore the timing of when teams shift from transition to action processes. Second, we use virtual experimentation to identify those interventions with the greatest potential to affect performance by changing when teams shift among processes. Additionally, we employ computational methods including neural networks, simulation, and optimization, thereby demonstrating their applicability in conducting team research.

Toward creating an optimal acute care clinical learning environment: insights from staff, faculty, and students.

Understanding how a clinical site impacts student learning was the focus for a participatory action research study in which three separate focus groups for students, faculty, and staff were convened. Participants were asked to identify what they enjoyed or liked about the clinical setting, what they disliked about the clinical setting, and what they would change about the clinical setting. Themes identified by a constant comparative method included experiences provided, attitudes, and expectations. Although the researchers anticipated that each group would have a unique and different perspective on the clinical experience, respondents were consistent in their beliefs both within and among groups. Of interest, each participant group attributed an ineffective clinical learning environment to external causes.

Safety checklist briefings: a systematic review of the literature.

Nearly half of all surgical complications are considered preventable. Early research regarding preprocedural surgical safety checklist briefings revealed that this process led to improved surgical complication rates. We conducted a literature search to gather evidence regarding compliance in conducting briefings, outcomes of briefings, and surgical team members' perceptions toward the use and efficacy of checklist briefings. We found 23 studies conducted in 17 countries, the majority published since 2011, addressing these elements. The studies used a variety of methodologies and outcome measures. Common themes in the studies included enhanced patient safety, improved compliance over time, and increased communication among team members when checklists were used. As research continues on surgical safety checklists and briefings, a great opportunity exists for perioperative nurses to make contributions to the evidence.

Enhancing learning through an interprofessional project competition.

This article describes the process of using an interprofessional team project to address one of the most commonly occurring challenges in health care delivery--medication reconciliation. We describe the planning and execution of the process and the lessons learned from the experience. The intent of this article is to document the significance of each process and the importance of each member involved in the process, and to act as a guideline for institutions planning similar interprofessional team project experiences for students.