More than a cultural experience: Assessing the impact of a medical-surgical international clinical on nursing students' academic performance.

A review of the extant literature suggests that there remains a dearth of evidence regarding the evaluation of well-defined outcomes related to international nursing clinical experiences. The purpose of this study was to explore the relationship between students' clinical experience (traditional versus international) and a number of academic outcomes including final medical-surgical course grades, performance on relevant Assessment Technologies Institute (ATI) proctored exams, and National Council Licensure Examination (NCLEX) pass rates. A non-experimental design was implemented using retrospective data obtained from a small university in the Midwest. Students complete a medical-surgical clinical in India during the interim of their third semester in the nursing program. Results of the t-tests show a statistically significant difference in final grades for Adult Health II theory when comparing students who completed a traditional clinical (M = 83.1, SD = 3.8) with those who completed an international clinical (M = 81.6, SD = 5.2); t(100) = 2.0, p = .043. The difference in mean scores for traditional clinical students (M = 70.3, SD = 6.6) versus international clinical students (M = 66.2, SD = 7.2) for the Adult Medical-Surgical proctored exam reached statistical significance, t(119) = 4.5, p ≤ .001. In contrast, there was no significant difference in means scores between the two groups with regard to scores on the Comprehensive Predictor proctored exam (traditional clinical, M = 76.1, SD = 5.9; international clinical, M = 75.2, SD = 6.4); t(121) = 1.0, p = .316. Finally, a chi square test of independence found that the relationship between clinical status and performance on NCLEX was not statistically significant, χ2 (1, N = 197) = 0.132, p = .716. Further research is needed to examine the impact of international clinicals on a broader range of outcomes including academic, cultural competency, and clinical performance measures.

Pregnancy unshackled: Increasing equity through implementation of perinatal depression screening, shared decision making, and treatment for incarcerated women.

BACKGROUND: Perinatal depression (PD) is one of the most common medical complications of pregnancy. The prevalence of women in correctional settings has grown eight-fold in the last 30 years. A quarter of these women were either pregnant or within a year postpartum when entering custody. Recommendations to screen and treat all pregnant women for PD are being implemented nationwide. LOCAL PROBLEM: In 2016, 71% of pregnant women entering Milwaukee County Jail had minimal or no prenatal care and significant rates of high-risk medical and social risk factors. The jail system was not screening for PD. METHODS: The Plan-Do-Study-Act method of quality improvement (QI), with four rapid cycles, was utilized. Patient tracer interviews and refusal rates were collected for baseline data two months preceding implementation. Data was analyzed using run charts to evaluate the impact of interventions on outcomes. INTERVENTION: PD screening was implemented with the Edinburgh Perinatal Depression Scale, and if scored positive, the Healthwise shared decision-making tool was utilized for therapy options and treatment initiated. RESULTS: A total of 101 women were seen, 93 were offered screening, 76 were screened, 43 were positive, and 37 started treatment within the facility. That is, 46% to 57 % of this aggregate of women who screen positive for PD and a decrease in patient refusal rates was seen throughout the process. CONCLUSION: Rapid cycle QI was effective in standardizing PD screening and treatment. Replication of this project across correctional systems would help to bridge a gap of equitable care for incarcerated women.