Qualitative descriptions of patient perceptions about fall risks, prevention strategies and self-identity: Analysis of fall prevention Motivational Interviewing conversations.

BACKGROUND: Older adults are often reluctant to engage in fall prevention activities. OBJECTIVES: To understand how older adults respond to fall prevention and identify attributes that affect their responses to fall prevention. METHODS: Qualitative content analysis of Fall Prevention Motivational Interviewing conversations that were conducted as an intervention for a fall prevention study in the USA. We report the methods, results and discussions using the COnsolidated criteria for REporting Qualitative research checklist. RESULTS: Conversations from 30 participants were analysed. Participants showed various responses to fall prevention from acceptance and engagement to ambivalence to denial or giving up. Three attributes affecting how they responded to fall prevention were as follows: (a) their perception of fall risks, (b) their perception about fall prevention strategies and (c) self-identity. If participants perceived that their fall risks were temporary or modifiable, they were more likely to engage in fall prevention. If participants perceived that their fall risks were permanent or unmodifiable, they seemed to have difficulty accepting fall risks or gave up engaging in fall prevention strategies. Participants were more willing to adopt fall prevention strategies that involved minor adjustments but expressed more resistance to adopting strategies that required major adjustments. Further, their response to accepting or not accepting fall prevention was influenced by their perception of whether the fall risks and fall prevention strategies aligned with their self-identity. CONCLUSION: Findings underscore the importance of understanding older adults' self-identify and perceptions about fall prevention. RELEVANCE TO CLINICAL PRACTICE: Exploring older adults' self-identity and perceptions about fall prevention can be useful to support their engagement in fall prevention.

Can students spare the time? Estimates of online course workload.

BACKGROUND: Literature on student workload focuses on land-based courses. Online students primarily participate by typing or reading. AIM: An online program was assessed for concerns about increased student workload using a qualitative design. METHODS: A qualitative case study method was used to assess online course activities to determine workload in five courses. Courses were explored using Barre and Esarey's (2016) estimator. Course faculty were included in assessment discussions and in course revisions. A data collection tool was developed to determine workload expectations for the courses' first week, a heavy week, and a light week. Within each of these weeks, activities included all writing, all reading, discussion posts, and literature searches. Workload assessment rules gauged student time on task, focusing on page density, text difficulty, reading or writing purpose and number of revisions. Authors developed a guideline for student evidence search time. RESULTS: Workloads in most courses were over the required institutional credit hours by 6-24 h per week. CONCLUSIONS: Using the Assessment of Student Workload and the data collection tool, faculty were able to review the courses and consider reading rates and out of class hours for activities improving alignment with institutional credit guidelines.

Longitudinal Analysis of Postlicensure Student Competency Perceptions.

BACKGROUND: A longitudinal evaluation of the final year of the Oregon Consortium of Nursing Education (OCNE) curriculum was undertaken to explore students' perception of competency and benchmark proficiency. METHOD: A retrospective, longitudinal mixed-methods study of postlicensure students was tracked from the initial Transition course to the final Capstone course to evaluate levels of attainment. Researchers used previously developed language categories of attainment for each benchmark to determine perceived competence. RESULTS: Researcher analysis tested the narrative language of attainment levels using prior developed themes. Researchers coded student attainment levels in the Capstone course compared with the initial Transition course, with higher confidence for Competencies for Relationship-Centered Care and Clinical Judgment and lower confidence for Leadership and Population Care Competencies. CONCLUSION: This analysis provided a deeper understanding of RN-to-baccalaureate student confidence toward attaining 10 OCNE competencies, supporting the continued development of a curriculum to address areas of low perceived competence. Tracking these competencies may strengthen accreditation processes. [J Nurs Educ. 2019;58(9):510-518.].

Older hospital inpatients' fall risk factors, perceptions, and daily activities to prevent falling.

PURPOSE: To identify associations among patient fall risk factors, perceptions, and daily activities to improve patient engagement with fall prevention among hospitalized older adults. BACKGROUND: The risk of falling increases for older patients but few researchers have reported patient-centered measures on this topic. METHODS: Surveys and chart reviews of inpatients aged ≥ 65 with Morse Falls Scale scores of ≥ 45. Measurements included validated tools and the modified Fall Behavioral Scale-Inpatient (FaB-I). RESULTS: A fall within 3 months before hospitalization was associated with an increased level of importance to preventing falls and higher FaB-I score (more fall prevention behaviors) but decreased level of confidence related to preventing falls (p < 0.05). Perception measures (concern: r = 0.52; patient activation: r = 0.46) were positively associated with FaB-I (p < 0.001). CONCLUSIONS: Addressing patient-centered measures such as perceptions of and daily activities for fall prevention could add value to existing fall prevention programs.

Student Competency Perceptions From Associate Degree to Bachelor Degree Completion.

BACKGROUND: A curriculum evaluation gap was addressed by exploring the final year of the Oregon Consortium of Nursing Education (OCNE) curriculum through student perception of competency and benchmark proficiency. METHOD: Researchers used a mixed-methods design to explore RN to baccalaureate (RNBS) student self-assessment data on perceived benchmark proficiency. Students' written statements were coded into four attainment categories, ranging from not attained to strong. RESULTS: Researchers categorized strong attainment in the competencies of intentional learning, relationship-centered care, and clinical judgment, with moderate attainment in ethics, communication, health care team collaboration, and reflection on self-care. Competencies related to leadership, practicing within a broader health care system, and application of evidence in practice had limited attainment. CONCLUSION: The results support using attainment categories in the measurement of student self-reported competency. The findings could be used to support course and curriculum evaluation, student advising, and coaching, as well as to improve professional development opportunities for students moving through the curriculum. [J Nurs Educ. 2017;56(10):581-590.].

Thinking beyond "the wheelchair to the car": RN-to-BSN student understanding of community and public health nursing.

The purpose of this study was to explore the online discussions of postlicensure nursing students taking a community health course in an RN-to-BSN program. Final discussion forums asked students to share their perceptions and understandings of the public and community health nurses' role and practice after participating in a community health clinical course. Inductive content analysis was used to assess the narratives. Analysis of the discussions yielded two categories: (1) awareness by the RNs of their individual community and the context of the public and community health nursing role, and (2) increased understanding of the patients' experience with transitions between health care settings (home-hospital-home). This research suggests a need to assess practicing RNs' professional understanding and teaching of the public and community health nurses' role if they are to facilitate effective patient transitions home and into community-based settings.

Newly recognized pathways of exposure to lead in the middle-income home.

Most official childhood lead-poisoning prevention efforts focus on children living in poor neighborhoods in older houses. But a current trend in home decorating that promotes the use of expensive antiques or used artifacts with chipped, chalky, or peeling paint may be exposing a different population of children to lead. The objectives of the research reported here were (1) to assess the extent to which antiques with damaged paint are promoted in the popular home-decorating print media and over the Internet and (2) to gauge whether a casual shopper is apt to purchase lead-hazardous antiques in the United States. The study found that antiques that tested positive for lead on a qualitative test were easily purchased from antique stores throughout the United States. Many of the items were toys or other items that would be attractive to children.