Evaluation of DNP program essentials of doctoral nursing education: A scoping review.

BACKGROUND: In 2021, the American Association of Colleges of Nurses revised the core competencies for professional nursing education. The revision includes a call for a transformation from a traditional approach to a competency-based approach for teaching and learning. PURPOSE: The purpose of this systematic scoping review was to provide a fuller understanding of how DNP programs have historically evaluated and documented attainment of the essentials of doctoral nursing education in a summative manner in order to inform developing methods for addressing the newly endorsed advanced-level competencies in nursing education. METHODS: A systematic scoping review was completed using PRISMA for Scoping Reviews Guidelines. Databases searched included PubMed (MEDLINE), CINAHL, Education Full Text, Web of Science, and ProQuest Dissertations and Theses. Included reports needed to discuss student competencies and reflect the summative evaluation of the DNP essentials in a DNP program. Data extracted included title, lead author name, lead author affiliation, type of program, aims, design, process, results, competencies included, and DNP project inclusion. RESULTS: Of the 2729 reports initially identified, five met inclusion criteria. These articles described diverse methods for documenting student attainment of DNP competencies including leadership narratives, electronic portfolios, and clinical logs. CONCLUSION: DNP programs have used summative evaluation methods to document fulfillment of the DNP essentials, but a competency-based education approach requires additional formative evaluations that incrementally support learners' progression toward achieving competencies. Faculty can modify exemplars presented from a review of the literature to serve as summative or formative evaluations of DNP advanced-level nursing competencies.

Examining Stigma and Disclosure Among Women With HIV in the Southern United States: Qualitative Study Guided by the Adaptive Leadership Framework for Chronic Illness.

ABSTRACT: Stigma is a fundamental cause of health inequities. Guided by the Adaptive Leadership Framework for Chronic Illness (ALFCI), this descriptive qualitative study explored the challenges of stigma and disclosure experienced by women with HIV (WWH) in the Southern United States. A convenience sample of 22 WWH aged 36 to 62 years were interviewed for this study. Analysis of participant interviews revealed that WWH face a multitude of stigma-related technical and adaptive challenges, which are consistent with the ALFCI. Once identified, technical challenges, such as recognizing the need for support, lack of trust, and fear of rejection, can be overcome by technical work, including providing assistance with HIV disclosure and building a trusted network. By identifying specific adaptive and technical challenges faced by WWH and engaging in technical and adaptive work, the WWH and the provider can reduce the fear of disclosure and the effect of stigma.

Adaptive leadership in clinical encounters with women living with HIV.

BACKGROUND: Women living with HIV (WLWH) report low engagement in health care, missed office visits, and less engagement in the clinical encounter. Strengthening the clinical encounter for WLWH may improve health outcomes and quality of life. The Adaptive Leadership Framework for Chronic Illness offers specific adaptive leadership strategies for providers to improve patient-provider interactions. The purpose of this study was to examine adaptive leadership behaviors that contribute to the development of effective patient-provider communication from the perspectives of WLWH. METHODS: The descriptive, cross-sectional and qualitative study conducted interviews with 22 WLWH to assess perceptions of the clinical encounter related to HIV-related stigma, engagement in care, medical distrust, and experiences with discrimination and quality of life. Members of the study team using a set of a priori codes analyzed data using NVivo 12.0. RESULTS: Participants described two primary themes and subthemes of each for adaptive leadership behaviors. The primary theme for adaptive leadership of providers was "my provider cares about me"; subthemes were communication, trust building takes time, and supportive providers are trusted. The primary theme for adaptive leadership of WLWH themselves was "I care about me; subthemes were self-advocacy and self-empowerment. CONCLUSIONS: Providers can use adaptive leadership behaviors during clinical encounters to support WLWH, improve patient-provider communication, enhance trust, and improve patient outcomes.

Adaptive Challenges, Adaptive Work, and Adaptive Leadership Among Women Living With HIV in the Southern United States: Findings From a Qualitative Study.

ABSTRACT: Women living with HIV have a higher burden of non-AIDS comorbidities and prevalence of chronic conditions. The Adaptive Leadership Framework for Chronic Illness clarifies living with complex health challenges by delineating the technical work of health care providers as well as the adaptive work and leadership behaviors of patients and their providers. We conducted a descriptive, qualitative study of women residing in the Southern United States who were participating in the Women's Interagency HIV Study in North Carolina. Twenty-two participants (mean age = 52.2 years; 90.9% self-identifying as Black or African American) completed semi-structured qualitative interviews. We identified adaptive challenges (e.g., affective and disclosure challenges) and adaptive work and leadership behaviors. Women learned skills to care for their health and support their families and to work with their providers to manage their care. Findings support the importance of identifying leadership behaviors for the purpose of developing person-centered interventions.

Exploring Resilience Among Black Women Living With HIV in the Southern United States: Findings From a Qualitative Study.

ABSTRACT: Black women living with HIV (WLWH) face individual and sociostructural challenges. Despite these challenges, many exemplify remarkable levels of resilience and coping. Yet, research on resilience and coping in this population is limited. Twenty Black WLWH in the Southern United States completed semi-structured interviews that explored challenges facing WLWH. We identified six themes related to resilience and coping: self-acceptance, disclosure, self-compassion, social support, will to live, and service. Of these, social support was a driving protective element and an essential component to building and sustaining resilience and coping. Women who experienced positive support often expressed a will to live as well as a desire to support other WLWH. Resilience and social support were characterized by patterns of reciprocity, in that they were mutually sustaining, stabilizing, and strengthening.

Role-play simulation to teach nursing students how to provide culturally sensitive care to transgender patients.

OBJECTIVE: Increase student knowledge and comfort with caring for a transgender individual and confronting colleagues when exhibiting poor cultural intelligence. BACKGROUND: Transgender patients often experience health care inequities, including heteronormative microaggressions in communication and policies. Simulation has been a successful means of providing students with the education, tools, and experience necessary to combat systemic injustice in health care. Simulation is an interactive pedagogy that allows nursing students to practice assessment, patient care, and difficult conversations in a controlled, risk-free environment. DESIGN/ METHODS: Prelicensure nursing students role-played a simulation created as an interactive learning strategy to promote culturally sensitive assessment of a transgender patient and their caregiver, including assessing for pronouns and providing patient-centered care. The simulation included preforming a difficult conversation between nurses to cultivate an environment of being an upstander. The simulation demonstrated holistic methods of assessing and supporting unique patient needs for the patient who is transgender. RESULTS: Nursing students reported they felt that their comfort with advocacy and ability to communicate with transgender patients, as well as with their families, and health care team members was enhanced after completing the simulation. CONCLUSION: Simulation has the ability to reduce discomfort and discrimination in health care for transgender patients by equipping students with culturally sensitive and inclusive communication tools and providing them with risk-free environment where they can learn to provide care for this vulnerable population in preparation for successful future encounters.