A Quality Improvement Project: What First-year Nursing Students Include in Their Nursing Care Plans for Patients With Acute or Chronic Wounds.

Nursing education research is lacking with regard to nursing care plans for patients who have a wound and use of the nursing diagnosis impaired skin integrity. The purpose of this quality improvement project was to inform teaching about nursing care planning for patients with wounds by examining what rst-year nursing students attending a fundamentals of nursing course in a Bachelor of Science in Nursing program included in a nursing process assignment when caring for an assigned patient who had an acute or chronic wound. Because they were in their clinical rotation, students had access to the patients' medical records to facilitate composing the care plan; they also could ask the patient for information. Assessment data were entered on a predetermined form based on Gordon's Functional Patterns. Using this information, students had to provide 3 possible diagnoses and select 1 upon which they developed the care plan intended to include patient description, wound description, dressing, and nursing diagnoses and impressions. The forms then were ana- lyzed for assessment completeness. Thirty-eighty (38) care plans completed by students were collected on patients that included 23 men and 28 African-Americans; mean age of the patients was 60.11 ± 14.17 (range 20-87) years. Wounds included 25 surgical incisions, 4 pressure ulcers/injuries, 7 "other" wounds, and 2 not identi ed. None of the students' assessments provided a detailed wound description. The most common wound descriptors were location (n =19) and drainage (n = 15). For 8 patients, students stated the wound was covered by a dressing. Thirty (30) nursing diagnoses were listed. The most common nursing diagnoses were impaired physical mobility or activity intolerance, impaired com- fort, impaired skin integrity, imbalanced nutrition, and risk for infection. These nursing students had beginning skills in patient and wound assessment and writing nursing care plans about patients with impaired skin integrity. Students need to increase their depth of wound assessment and need more experience planning care for patients with wounds.

Student Immersion in Perioperative Nursing.

The aging workforce and the lack of perioperative clinical practice and theoretical content in nursing education programs are factors contributing to the perioperative nursing shortage. This article discusses the implementation of a creatively designed perioperative program, which includes a didactic course and a 210-hour clinical course, developed by the faculty members of a Michigan school of nursing in collaboration with administrators at area hospitals. The didactic content covers materials presented during the first three months of orientation for newly employed perioperative nurses. Interested baccalaureate nursing students in their senior year are selected to participate in the program after being interviewed by hospital personnel and university faculty members. To date, the program has 18 student graduates in two semesters; all have been offered positions in the perioperative setting, and 14 have accepted positions. The active learning strategies used in the course are described with examples.

Student Nurses in the OR: Improving Recruitment and Retention.

Changes in nursing education have made it difficult for students to find or participate in perioperative clinical experiences, which makes it difficult for employers to find experienced perioperative nurses. We developed a perioperative preceptorship for senior-level nursing students, to provide them with the opportunity to learn RN circulator skills based on AORN's Guidelines for Perioperative Practice. Senior nursing students had the opportunity to demonstrate critical thinking skills within the context of patient-centered care while integrating knowledge and skills learned in the classroom. The students applied the knowledge and skills learned in the classroom in the OR setting during a required minimum 210-hour clinical commitment. We believe the course has been successful in providing the foundation needed to become a competent perioperative nurse, because, to date, all students who were hired are still employed in the OR.

Using an age-specific nursing model to tailor care to the adolescent surgical patient.

A surgical experience can be stressful for any patient. When the patient is an adolescent, however, the surgical experience can create significant stress, which is related to normal adolescent development. Perioperative nursing care should address what adolescent patients perceive as stressful and should provide a safe environment so that a successful surgical outcome can be achieved. To accomplish this, a nursing model specific to perioperative nursing practice should be developed to guide nurses when providing care to adolescents. The Adolescent Perioperative System Stability Model based on the Neuman Systems Model provides a framework for defining scope of practice and organizing nursing care that is appropriate for the adolescent during a surgical experience. In addition to guiding nursing practice, this model provides direction and guidance for future studies of adolescents in the perioperative setting.