COVID-19 Pandemic: Effects of Replacing Clinical Hours With Virtual Simulation in BSN Prelicensure Nursing Education.

ABSTRACT: At the onset of the COVID-19 pandemic, many academic institutions suspended in-person instruction and clinical experiences. Virtual simulation played an essential role in providing alternatives. The current study used faculty and student surveys, along with standardized exit exams and NCLEX-RN® pass rates, to determine the effect of using virtual simulation instead of traditional hospital clinical experiences during the final semester of a prelicensure BSN program. Results indicated a small decrease in exit exam scores compared to those who completed the traditional clinical experience and no significant relationship between NCLEX-RN pass/fail rates.

Academic and Nonacademic Predictors of BSN Student Success on the HESI Exit Exam.

First-time success rate on the NCLEX-RN examination has significant implications for BSN students, faculty, and schools of nursing. Many nursing programs utilize standardized examinations such as the HESI Exit Exam to quantify student success on knowledge of nursing concepts and to prepare students for success on the NCLEX-RN. Nursing faculty must be able to identify predictors of student success early in the nursing program in order to offer appropriate support and remediation. The purpose of this retrospective, correlational study was to determine predictive variables of BSN student success on the HESI Exit Exam in a southeastern university. Students who reported higher test anxiety scored significantly lower on the HESI Exit Exam. Higher medical-surgical I HESI examination scores, higher medical-surgical II HESI examination scores, higher obstetrics HESI examination scores, and higher final grade point average were significant predictors of students' HESI Exit Exam scores and accounted for 39% of the variance in the scores. Results from this study suggest implementing remediation based on HESI Specialty Exam scores and interventions aimed at reducing test anxiety.

Perceptions of Black Children's Narrative Language: A Mixed-Methods Study.

Purpose In this mixed-methods study, we address two aims. First, we examine the impact of language variation on the ratings of children's narrative language. Second, we identify participants' ideologies related to narrative language and language variation. Method Forty adults listened to and rated six Black second-grade children on the quality of 12 narratives (six fictional, six personal). Adults then completed a quantitative survey and participated in a qualitative interview. Results Findings indicated that adults rated students with less variation from mainstream American English (MAE) more highly than students with greater variation from MAE for fictional narratives, but not for personal narratives. Personal narratives tended to be evaluated more favorably by parents than teachers. Black raters tended to assign higher ratings of narrative quality than did White raters. Thematic analysis and conversation analysis of qualitative interviews supported quantitative findings and provided pertinent information about participants' beliefs. Conclusion Taken together, quantitative and qualitative results point to a shared language ideology among adult raters of variation from MAE being more acceptable in informal contexts, such as telling a story of personal experience, and less acceptable in more formal contexts, such as narrating a fictional story prompted by a picture sequence.

Impact of a modified early warning score on nurses' recognition and response to clinical deterioration.

AIMS: (a) Improve nurse knowledge of and confidence in responding to clinical deterioration through implementation of the Modified Early Warning Score tool and (b) improve nurse ability to react to patient deterioration in a timely manner. BACKGROUND: Recognition of clinical deterioration in hospitalized inpatients often occurs far after those signs initially present. The Modified Early Warning Score has been shown to assist with recognition earlier in the deterioration process. METHODS: Eighty-five nurses participated in a simulation-based intervention to implement the Modified Early Warning Score into their rural hospital. Group classroom sessions and individual high-fidelity simulation experiences were provided for participants. Twenty-nine nurses also participated in self-confidence and knowledge assessment testing. RESULTS: The simulation-based intervention significantly improved nurse knowledge (t = 4.029, p < .01) and self-confidence (t = 3.698, p = <.01). Chart reviews found a 34.1% increase in nurse action taken in response to signs of clinical deterioration. CONCLUSION: Current study found that the Modified Early Warning Score tool as taught through a simulated patient experience is useful to prevent unrecognized deterioration. IMPLICATIONS FOR NURSING MANAGEMENT: Suggests that a simulation-based intervention is effective for teaching and evaluating post-licensure nurses on acute clinical deterioration in inpatients.

Comparing Outcomes of Active Student and Observer Roles in Nursing Simulation.

BACKGROUND: Because of large class sizes and limited resources, students participating in high-fidelity simulation experiences may be assigned to an observer role as opposed to an active nursing role. PURPOSE: Educators need to determine if anxiety levels and student learning outcomes are comparable for students in active and observer roles. METHODS: A quasi-experimental study was conducted with 132 prelicensure baccalaureate students. Active nursing roles consisted of primary care, documentation, and medication nurse roles. Observer role students were provided with resources to guide them with developing their observational skills and achieving the simulation objectives. RESULTS: There were no significant differences between simulation roles for anxiety levels, satisfaction with learning, self-confidence in learning, clinical ability, problem solving, confidence in clinical practice, and collaboration. CONCLUSIONS: These findings suggest that either role is an appropriate assignment during simulation. Educators should identify ways to be supportive and reduce anxiety in students during simulation experiences.

Improving discharge planning using the re-engineered discharge programme.

AIMS: (a) Assess nurses' readiness to learn (RTL) before receiving education on the re-engineered discharge (RED) programme and (b) measure utilization of the RED discharge process from patient chart reviews following an educational intervention. BACKGROUND: Preventable readmissions are of great concern. Rural areas are at a disadvantage, due to decreased access to health care and other disparities. METHODS: Sixty-nine participants completed the Self-Directed Learning Readiness Scale prior to the RED education intervention. Thirty-minute education interventions were provided addressing various learning preferences. RESULTS: Participants scored high M = 219.8 (SD 23.7) on the SDLR, indicating nurses' high RTL prior to educational intervention. Chart reviews found usage of the RED 12 actionable item pre-intervention, (n = 60) M = 6.55 (SD 1.478) compared to post-intervention (n = 60) M = 10.08 (SD 1.544) indicated statistically significant improvement in pre-discharge patient education and planning (t = 17.730, p = 0.000 [CI 3.13-3.93]). CONCLUSION: Current study found that nurses with higher levels of RTL who underwent RED educational sessions significantly improved delivery of the RED process documented in the medical record. IMPLICATIONS FOR NURSING MANAGEMENT: Those responsible for education initiatives must make understanding nurses' learning preferences a priority to improve the quality of bedside practice.

Factors Influencing Female Caregivers' Appraisals of Their Preschoolers' Behaviors.

INTRODUCTION: This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to explore family factors associated with primary female caregivers' appraisals of children's behaviors, distortion of their appraisals, and children's risk of having behavioral problems. METHOD: A cross-sectional, correlational design was used. Data were collected from female caregivers of preschoolers. Instruments measured demographic characteristics, comfort in parenting, appraisal of behaviors, daily and parenting stress, depressive symptoms, social support, ratings of children's behaviors, and distortion in ratings. Analyses included χ2 and simultaneous linear regression. RESULTS: Greater parenting discomfort and daily stress were associated with lower appraisals of children's behaviors. Caucasian race and higher distortion in behavioral ratings were associated with higher risk of behavioral problems. Caregiver's appraisal was associated with daily stress level and parenting comfort. DISCUSSION: Additional research is needed regarding how these factors affect children's behavior and causes of distorted parental views of children's behaviors.

Family Typology and Appraisal of Preschoolers' Behavior by Female Caregivers.

BACKGROUND: Children with vulnerable caregivers may be at risk for being labeled as having behavior problems when typical behaviors are viewed by their caregivers as problematic, and therefore, research examining the accuracy of the caregivers' perceptions of children's behaviors is needed. OBJECTIVE: The purpose of this study was to use the resiliency model of family stress, adjustment, and adaptation as the theoretical foundation to explore family factors associated with the primary female caregiver's appraisal of her child's behavior, the extent to which the primary female caregiver's appraisal of her child's behavior may be distorted, and the child's level of risk of having a behavioral problem. METHODS: A cross-sectional, correlational design was used. Data were collected from female caregivers of preschoolers (N = 117). Family factors, demographic characteristics, comfort in parenting, appraisal of behaviors, daily stress, parenting stress, depressive symptoms, social support, ratings of children's behaviors, and distortion in the ratings were measured. Associations were studied using ANOVA, ANCOVA, and chi-squared tests. RESULTS: Family typology was not associated with the female caregiver's appraisals of her child's behavior (p = .31). Distortion of the caregiver's rating of her child's behavior was not associated with family hardiness (high or low; p = .20.) but was associated with having a child with an elevated risk for behavioral problems (p < .01). Families classified as vulnerable were significantly more likely to have a child with elevated risks of having behavioral problems than families classified as secure or regenerative. DISCUSSION: Findings emphasized the association between family factors (hardiness and coherence) and young children's behaviors. Additional research is needed into how these factors affect the young child's behavior and what causes a caregiver to have a distorted view of her child's behavior.

Smoking cessation in women at the time of an invasive cardiovascular procedure and 3 months later.

BACKGROUND: Female smokers with coronary heart disease (CHD) are at an increased risk for negative health effects. The time of invasive cardiovascular (CV) interventions is a critical opportunity to make lifestyle changes to reduce future CV interventions. OBJECTIVE: The purpose of this study guided by the Health Belief Model was to determine which factors predict smoking cessation (SC) in women after an invasive CV procedure. METHODS: A correlational, prospective design was used. Data were collected from female smokers at the time of an invasive CV intervention (baseline) and 3 months later. Instruments measured commitment to stop smoking, perceived threat of CHD and future interventions, cessation self-efficacy, barriers to SC, benefits of SC, cues to action, and motivation. Analyses included χ2 and t tests and multiple, hierarchical, and logistic regression. RESULTS: On average, women (N = 76) were middle aged (mean [SD] age, 55.9 [8.0] years), smoked 15.3 (9.8) cigarettes per day, and on average smoked for 33.6 (10.2) years. At baseline, fewer perceived barriers to SC, high cessation self-efficacy, and being more autonomously motivated to quit smoking explained 67% of variance in commitment to stop smoking (P < .001). At 3 months, of 54 women responding, only 8 had quit smoking. Women reported smoking fewer cigarettes per day at 3 months compared with baseline (paired t51 = 3.43, P < .01). Higher baseline cessation self-efficacy and lower CHD threat were predictors of SC at 3 months (χ2(4) = 18.67, n = 54; P = .001). CONCLUSIONS: Although commitment, motivation, and self-efficacy to stop smoking were high, perceived threat of CHD and future invasive CV interventions were high, and perceived barriers to SC were low, most women continued to smoke after their heart catheterization. Referrals for assistance from healthcare providers to decrease anxiety and nicotine dependence and to address ongoing challenges to SC are needed.

Perceptions of cardiac risk factors and risk-reduction behavior in women with known coronary heart disease.

BACKGROUND: Risk factor reduction has been linked to personal perceptions of risk, yet few data exist about women's personal perceptions of coronary heart disease (CHD) risk, especially women who have experienced a cardiac event or intervention. OBJECTIVE: The purpose of this study was to explore perceptions of risk for CHD and to examine perceptions of risk-reducing behaviors in women with known CHD. METHODS: Because women's attitudes are conceptualized to be embedded in their everyday practices, an interpretative qualitative approach was chosen to reveal this phenomenon. The purposive sample consisted of 7 women with CHD. Interviews were conducted and transcribed verbatim. Data collection continued until saturation occurred. Efforts were made to increase trustworthiness through participant review of transcripts, peer debriefing, and using field notes. RESULTS: Three major themes emerged from the data: "out of sight, out of mind," "why doesn't he talk to me like that?" and "it's scary." The women indicated their CHD was currently not a major problem because they were asymptomatic or did not "feel sick," which led to decreased focus on their CHD, including risk factor reduction. They expressed the desire to return to normal, rather than focus on the chronicity of CHD. Participants felt that physicians treated them differently because they were women and that their concerns were taken less seriously. They perceived that the patient-physician relationship lacked open dialogue. Fear was experienced by all women, and many feared the unknown, especially not knowing when something was wrong with their heart. CONCLUSIONS: Data indicated that, during stable periods in the CHD trajectory, women may not understand the chronicity of their disease and may not recognize the importance of reducing their risk for future cardiac events. Helping women understand CHD chronicity even when they may not feel sick may assist them in engaging in risk-reducing behaviors.