Differential Grading of Reflective Writing Between Clinical Instructors and Faculty Type.

BACKGROUND: It is important for instructors to give equivalent grades for comparable student performances on an assignment. Students complain of differential grading, especially when multiple instructors grade a course assignment. METHOD: This descriptive comparative study examined clinical instructor-assigned grades for reflective thinking and writing components. Grades for 480 critical reflective papers by 80 undergraduate nursing students were assessed for differences between clinical group instructors and part-time versus full-time instructors. RESULTS: Despite evidence of comparable student performance on the assignment across both groups, grades differed among the 10 instructors on both components. Grades differed between part-time and full-time faculty on reflective thinking but not writing, with part-time faculty grading reflective thinking higher than full-time faculty. CONCLUSION: Differential grading was identified between clinical instructors and type of faculty. The merit of multiple instructors grading a single course assignment warrants reconsideration. Enhanced grading training is recommended for part-time instructors who are expected to grade written assignments. [J Nurs Educ. 2023;62(2):101-104.].

Structured Outpatient Diabetes Education and Telehealth Follow-up to Improve HbA 1c.

BACKGROUND: More than 10% of Americans have diabetes, with higher rates in Hispanics and African Americans. National Healthy People 2030 goals for expected decrease in HbA 1c levels have not been met. LOCAL PROBLEM: No standardized diabetes education or follow-up existed at a free clinic. Patients exhibited diabetic self-management inadequacies and elevated HbA 1c levels. METHODS: A pre/postimplementation study design was used to evaluate changes in HbA 1c levels, medication adherence, missed appointments, and emergency department visits. INTERVENTIONS: Structured diabetes education and follow-up text/phone messages for patients with HbA 1c levels 8% or higher were implemented over 3 months. RESULTS: Outcome data were available for 27 of the 34 participants. Postimplementation, there was a significant 1.7% decrease in mean HbA 1c levels ( P < .001). No significant differences were found for the other outcome measures. CONCLUSIONS: Structured diabetes education and follow-up text/phone messages in a free clinic improved patients' HbA 1c levels.

New nurse graduates and rapidly changing clinical situations: the role of expert critical care nurse mentors.

OBJECTIVES: New nurse graduates may be prone to instances of failure to rescue. Mentoring programs may be an opportunity to assist them with clinical decision making in situations of patient decline. We explored the experiences of new nurse graduates and expert nurses after participation in a mentoring program. METHODS: In this exploratory-descriptive study, five seasoned nurses were paired with five new nurse graduates. After four months, the new nurse graduates were interviewed, and the expert nurses participated in a focus group. RESULTS: Themes emerged for the new nurse graduates: 1) importance of the charge nurse, 2) differences in practice areas, and 3) supportive healthcare teams. The focus group revealed three themes: 1) remembering what it was like, 2) desiring to help, and 3) having confidence in their preparation as mentors. CONCLUSIONS: New nurse graduates relied on charge nurses for assistance. Therefore, it is imperative that charge nurses receive adequate support.

Implementing a New Capstone Leadership Clinical Course.

BACKGROUND: Nurse educators are challenged to ensure clinical education meets the changing health care environments and needs. PROBLEM: New nurses remain unprepared for practice, have insufficient foundational leadership capacities, and lack systems-thinking awareness. APPROACH: Responding to educational gaps, increased enrollment, and scarce clinical placements, faculty used an eclectic education model to develop a new capstone leadership clinical course that included 5 types of experiences. The total acute care clinical hours were reduced, while adding leadership-focused experiences and simulated learning. OUTCOMES: Stakeholders' evaluations indicate the pilot provided opportunities to strengthen students' leadership capacity, systems thinking, and professional identity while still providing sufficient practice managing care of multiple patients, engaging in teamwork, and applying evidence. CONCLUSION: The new clinical course addressed students' transition into practice needs and enrollment capacity issues. Thoughtful planning by invested stakeholders, communication among faculty, and clear expectations are necessary to implement eclectic clinical models.

Collaborative student-faculty research to support PhD research education.

This paper describes a three-semester hour applied research course taught over three semesters in a revamped PhD research curriculum at a Midwestern high research activity (R2) university-based nursing program. Faculty developed this strategy to help students become adequately prepared nurse scientists. Students and faculty engaged in a collaborative research project to provide students with opportunities to develop, integrate, and apply research knowledge, skills, and attitudes while concurrently advancing through the related research courses. A summary of these experiences and what was learned is organized within a knowledge, skills, and attitudes (KSA) framework. The collaboration between faculty and student peers was essential to students' success in the course. Student and faculty perspectives were used to describe what was learned during the first year this course was taught, together with future recommendations.

Lessons Learned in Implementation of an Expert Nurse Mentor Program.

Experienced critical care nurses have the expertise to respond quickly and appropriately in emergency situations. New graduate nurses, however, typically lack this expertise and may benefit from mentoring as they learn to manage rapidly deteriorating patients. The purpose of this article is to describe the lessons learned during implementation of an Expert Nurse Mentor Program. Nurse educators may benefit from this information as they strive to establish and maintain mentoring programs.

Enhancing Critical Thinking in Graduate Nursing Online Asynchronous Discussions.

BACKGROUND: Graduate nursing students in online courses often have limited success in developing the critical thinking (CT) skills essential for advanced roles. This study describes the use of complementary strategies in a graduate-level nursing course to enhance CT in online discussions. METHOD: Using Paul and Elder's framework for understanding the components of CT, the authors designed an asynchronous online course using multiple strategies to promote CT. We used mixed methods to collect descriptive and numerical data and content and repeated measures analyses to identify changes in CT skills and student perceptions across the semester. RESULTS: CT scores increased significantly and aligned with students' perceived improvements in CT. CONCLUSION: Evidence of CT in online discussions increased significantly across the semester with the use of multiple instructional strategies and substantial student and faculty efforts. The findings are a useful benchmark for future studies comparing combinations of strategies to identify those most effective and least arduous. [J Nurs Educ. 2016;55(9):514-521.].

Patient and physician perceptions after software-assisted hospital discharge: cluster randomized trial.

BACKGROUND: Hospital discharge software potentially improves communication and clinical outcomes. OBJECTIVE: To measure patient and physician perceptions after discharge with computerized physician order entry (CPOE) software. DESIGN: Cluster randomized controlled trial. SETTING: Tertiary care, teaching hospital in central Illinois. PATIENTS: A total of 631 inpatients discharged to home with high risk for readmission. INTERVENTION: A total of 70 internal medicine hospital physicians randomly assigned (allocation concealed) to discharge software vs. usual care, handwritten discharge. MEASUREMENTS: Discharge perceptions from patients, outpatient primary care physicians, and hospital physicians. RESULTS: One week after discharge, 92.4% (583/631) of patients answered interviews. For 78.6% (496/631) of patients, their outpatient physicians returned questionnaires 19 days (median) postdischarge. Generalized estimating equations gave intervention variable coefficients with 95% confidence intervals (CIs). When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005-0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = -0.937-0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015-0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011). CONCLUSIONS: Discharge software with CPOE caused small improvements in discharge perceptions by patients and their outpatient physicians. These small improvements might balance the difficulty perceived by hospital physicians who used discharge software.

Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial.

BACKGROUND: One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown. OBJECTIVE: To measure effects of a discharge software application of computerized physician order entry (CPOE). DESIGN: Cluster randomized controlled trial. SETTING: Tertiary care, teaching hospital in central Illinois. PATIENTS: A total of 631 inpatients discharged to home with high risk for readmission. INTERVENTION: Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge. MEASUREMENTS: Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event. RESULTS: A total of 590 (94%) patients provided 6-month follow-up data. Generalized estimating equations gave intervention variable coefficients with 95% confidence interval (CI). When comparing patients assigned to discharge software versus usual care, there was no difference in hospital readmission within 6 months (37.0% versus 37.8%; coefficient -0.005 [95% CI, -0.074 to 0.065]; P = 0.894), emergency department visit within 6 months (35.4% versus 40.6%; coefficient -0.052 [95% CI, -0.115 to 0.011]; P = 0.108), or adverse event within 1 month (7.3% versus 7.3%; coefficient 0.003 [95% CI; -0.037 to 0.043]; P = 0.884). CONCLUSIONS: Discharge software with CPOE did not affect readmissions, emergency department visits, or adverse events after discharge. Future studies should assess other endpoints such as patient perceptions or physician perceptions to see if discharge software has value.

Brief scale measuring patient preparedness for hospital discharge to home: Psychometric properties.

BACKGROUND: Adverse events occur when patients transition from the hospital to outpatient care. For quality improvement and research purposes, clinicians need appropriate, reliable, and valid survey instruments to measure and improve the discharge processes. OBJECTIVE: The object was to describe psychometric properties of the Brief PREPARED (B-PREPARED) instrument to measure preparedness for hospital discharge from the patient's perspective. METHODS: The study was a prospective cohort of 460 patient or proxy telephone interviews following hospital discharge home. We administered the Satisfaction with Information about Medicines Scale and the PREPARED instrument 1 week after discharge. PREPARED measured patients' perceptions of quality and outcome of the discharge-planning processes. Four weeks after discharge, interviewers elicited emergency department visits. The main outcome was the B-PREPARED scale value: the sum of scores from 11 items. Internal consistency, construct, and predictive validity were assessed. RESULTS: : The mean B-PREPARED scale value was 17.3 +/- 4.2 (SD) with a range of 3 to 22. High scores reflected high preparedness. Principal component analysis identified 3 domains: self-care information, equipment/services, and confidence. The B-PREPARED had acceptable internal consistency (Cronbach's alpha 0.76) and construct validity. The B-PREPARED correlated with medication information satisfaction (P < 0.001). Higher median B-PREPARED scores appropriately discriminated patients with no worry about managing at home from worriers (P < 0.001) and predicted patients without emergency department visits after discharge from those who had visits (P = 0.011). CONCLUSIONS: The B-PREPARED scale measured patients' perceptions of their preparedness for hospital discharge home with acceptable internal consistency and construct and predictive validity. Brevity may potentiate use by patients and proxies. Clinicians and researchers may use B-PREPARED to evaluate discharge interventions.

Prediction of early readmission in medical inpatients using the Probability of Repeated Admission instrument.

BACKGROUND: In the absence of an instrument to predict risk of early readmission, examination of the well-validated probability of repeated admission (Pra) for this new purpose is indicated. OBJECTIVE: The objective of this study was to examine the use of the Pra in accurately identifying and predicting adult medical inpatients at risk of early readmission. METHODS: Over 20 months, 1,077 consecutively admitted medical patients were enrolled in this prospective cohort study at a Midwestern tertiary care medical center. Pra score values were calculated within 2 days of discharge. Databases at the index medical center and other institutions were queried to identify readmission within 41 days. RESULTS: Prevalence of readmission was 14% (confidence interval = 12.4%-15.6%). Pra score values ranged from .16 to .75. Indices to identify and predict readmission for a range of cut points were reported to minimize loss of information. The likelihood ratio for patients with a Pra score value > or = .53 was 1.67. Using a Pra cut point of > or = .45, readmission of patients with a high Pra was 2.3 times more likely than that of patients with a low Pra (p < .001, confidence interval = 1.63-3.27). Comparisons between cohorts indicated that differences existed with four of the eight variables used to calculate the Pra score: diabetes (p = .01), self-rated health status (p = .007), and number of doctor visits (p < .001) and hospitalizations (p < .001) in the past year. DISCUSSION: Within this heterogeneous sample, prediction of readmission using the Pra was better than chance. These findings may facilitate development of a better predictive model by combining select Pra variables with other variables associated with early readmission.

A cross-section of readability of Health Information Portability and Accountability Act authorizations required with health care research.

The Health Information Portability and Accountability Act (HIPAA) regulations require that agencies provide authorizations that can be read and understood. Agencies are responsible to comply with this regulation. It is estimated that half of Americans read at an eighth-grade reading level. All institutional review boards (IRBs) listed on the website of the U.S. Department of Health and Human Services were contacted by investigators in this study. Fifty-one IRBs returned HIPAA templates on which readability tests could be completed. Three readability tests were used on all templates, including the Flesch Reading Ease formula, the Dale-Chall formula, and the Fry formula. For the returned templates, the mean of the Dale-Chall readability formula gave a ninth-grade level; the mean scores for the Flesch Reading Ease and Fry formulas were at a high-school reading level or above. The readability scores ranged from sixth-grade to college graduate. This study demonstrates that HIPAA authorization forms are written at too high a level for most of the population. Based on the results of this study and other similar studies, it can be concluded that consumers/patients are currently being asked to read important health-related documents that may be beyond their reading level.