Nursing Program Admission Barriers in the United States: Considerations for Increasing Black Student Enrollment.

BACKGROUND: The percentage of Black registered nurses (RN) is disproportionate to Black residents in the population, particularly in Southern states. PURPOSE: This study's purpose was to identify the potential admission barriers for Black students in RN education in the South versus Midwest, Northeast, and West. METHODS: A cross-sectional design was used to compare admission criteria for 1597 accredited associate degree in nursing and bachelor of science in nursing programs by geographic region. RESULTS: Southern programs required a significantly higher count of academic metric criteria (multiple grade point average, standardized tests) and nonacademic criteria (proof of health insurance, background checks). Southern programs had a significantly lower count of holistic admissions review criteria (references, essays, volunteer work). CONCLUSION: Approximately 50% of programs used academic metrics exclusively, and most programs using some holistic criteria assigned greatest weight to academic metrics despite evidence that this disadvantages qualified, underrepresented students. Access to RN education must be improved. Recommendations are discussed for transition to holistic admissions review.

Comparing Virtual Reality Telepresence and Traditional Simulation Methods: A Pilot Study.

Virtual reality (VR) could enable clinical simulation centers to reach the teaching capacity of traditional hospital practica. This study quantitatively tests VR telepresence against two traditional simulation learning methods using a within-subject design and the Presence Questionnaire. Eight nursing students were randomly assigned and rotated through simulation participation, VR observation, and television observation conditions, completing a questionnaire after each condition. Each condition had a significant effect on presence. Simulation participation yielded the highest perceived presence, followed by VR, and lastly by television observation. This pilot study probed for effect and feedback that will inform a larger experiment.

Student Self-evaluation After Nursing Examinations: That's a Wrap.

Examination wrappers are a self-evaluation tool that uses metacognition to help students reflect on test performance. After examinations, rather than focus on points earned, students learn to self-identify study strategies and recognize methods of test preparation. The purpose of the study was to determine if the use of an examination wrapper after each test would encourage students to self-evaluate performance and adjust study strategies. A total of 120 undergraduate nursing students completed self-evaluations after each examination, which were analyzed using content analysis. Three general patterns emerged from student self-evaluation: effective and ineffective study strategies, understanding versus memorization of content, and nurse educator assistance.

Can Clinical Simulation Increase Confidence Levels in Performing Postpartum Care in a Diverse Group of Baccalaureate Nursing Students?

Nursing duties are often sensitive in nature and may contribute to feelings of inadequacy for students, especially when providing postpartum care. Our study assessed confidence levels among 61 junior baccalaureate nursing students before and after a simulation workshop with a follow-up survey administered after completion of two full clinical days on a postpartum unit. The four-hour simulation included stations for breast, fundus, and lochia exam skills. Overall confidence and confidence in performing patient assessments were significantly increased at postsimulation and follow-up (p < .001), demonstrating the efficacy of the simulation.

Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition.

In critical care, malnutrition has a significant, negative impact on a patient's ability to respond to medical treatment. Enteral nutrition is known to counteract the metabolic changes associated with critical illness that increase the risk for serious complications and poor clinical outcomes. Inadequate delivery of nutrition support and underfeeding persist in intensive care units despite the availability of guidelines and current research for best practice. Recent studies have shown that nutrition support protocols are effective in promoting nutritional goals in a wide variety of intensive care patients. It is essential to find approaches that enhance early delivery of enteral nutrition that meets requirements and supports improved outcomes. Nurses are in a unique position to take an active role in promoting the best nutritional outcomes for their patients by using and evaluating nutrition support protocols.

New Guidelines for Assessment of Malnutrition in Adults: Obese Critically Ill Patients.

Recently released recommendations for detection and documentation of malnutrition in adults in clinical practice define 3 types of malnutrition: starvation related, acute disease or injury related, and chronic disease related. The first 2 are more easily recognized, but the third may be more often unnoticed, particularly in obese patients. Critical care patients tend to be at high risk for malnutrition and thus require a thorough nutritional assessment. Compared with patients of earlier times, intensive care unit patients today tend to be older, have more complex medical and comorbid conditions, and often are obese. Missed or delayed detection of malnutrition in these patients may contribute to increases in hospital morbidity and longer hospital stays. Critical care nurses are in a prime position to screen patients at risk for malnutrition and to work with members of the interprofessional team in implementing nutritional intervention plans.

Observed and self-perceived teamwork in a rapid response team.

Teamwork and communication between healthcare workers are vital for patient safety in the high-risk environment of health care. The purpose of this descriptive study was to measure the teamwork among members of the rapid response team (RRT) to design teamwork communication training for team members. Data were collected via live observation of RRT events and from RRT team member ratings of teamwork during events.

The evolution of a statewide network: the Bay Area Simulation Collaborative.

The Bay Area Simulation Collaborative (BASC), established in 2007, is a group of more than 100 schools of nursing and hospitals, totaling more than 600 faculty and hospital educators, from both service and academia in the ten counties that comprise the San Francisco Bay Area. The California Institute for Nursing & Health Care leads the BASC, which was funded through a grant from the Gordon and Betty Moore Foundation. This 3-year project was designed to train and educate nursing faculty and hospital educators in the concepts of simulation. It was also designed to develop clinical simulation scenarios for use within the BASC. Finally, the project implemented a research and evaluation agenda to demonstrate that simulation makes a positive difference in the critical thinking skills of nursing students. This article will describe the evolution, purpose, and goals of the BASC and how the initial investment has been leveraged to create addition regional collaboratives in the state and ultimately, the California Simulation Alliance.

Clinical nurse educators' perceptions of research utilization: barriers and facilitators to change.

Translation of research to practice remains a challenge. The educator, as a role model and change agent, is strategically placed to facilitate staff development and organizational change, thereby helping to close the gap from research to practice. Understanding barriers to research utilization may facilitate the application of evidence-based practice. [corrected] In this study, the BARRIERS scale was used to assess perceptions of research utilization in a convenience sample of 122 clinical nurse educators in California. Greatest barriers were organizational and nurse characteristics, including lack of authority to change, insufficient time, and limited research knowledge and awareness. Educators from Magnet hospitals and educators with advanced degrees perceived the organization as less of a barrier. Strategies to facilitate and implement change are discussed.

Nurses' perceptions of stress and support in the preceptor role.

This study was undertaken to examine whether staff nurses experience stress when they are precepting, and the sources of the stress. Another purpose was to describe preceptors' perceptions of support from others, such as coworkers and managers. A convenience sample of 65 registered nurse preceptors completed an investigator-developed questionnaire asking for their views on stress and support in the preceptor role. Most respondents (89%) reported that precepting is stressful to some degree, with the most common reasons being workload, skill level of the preceptee, organizational support, and preceptor confidence. Despite the high levels of stress reported, most subjects described adequate support as preceptors from coworkers and managers. Preceptors are critical for the training and retention of new nurses. It is important that stressors related to precepting be acknowledged and strategies be employed to reduce stress. Recommendations for support and strategies are included.

Nurses' perceptions of causes of medication errors and barriers to reporting.

This study describes nurses' perceptions about medication errors and the effects of physician order entry and barcode medication administration on medication errors. A convenience sample of 61 medical-surgical nurses was surveyed. All nurses surveyed perceived that information technology decreases medication errors. However, medication errors continue to occur despite the availability of sophisticated information technology systems.

Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally.

BACKGROUND: Inadequate nutritional intake in critically ill patients can lead to complications resulting in increased mortality and healthcare costs. Several factors limit adequate nutritional intake in intensive care unit patients given enteral feedings. OBJECTIVE: To examine the adequacy of enteral nutritional intake and the factors that affect its delivery in patients receiving mechanical ventilation. METHODS: A prospective, descriptive design was used to study 60 patients receiving enteral feedings at target or goal rate. Energy requirements were determined for the entire sample by using the Harris-Benedict equation; energy requirements for a subset of 25 patients were also determined by using indirect calorimetry. Energy received via enteral feeding and reason and duration of interruptions in feedings were recorded for 3 consecutive days. RESULTS: Mean estimated energy requirements (8996 kJ, SD 1326 kJ) and mean energy intake received (5899 kJ, SD 3058 kJ) differed significantly (95% CI 3297-3787; P < .001). A total of 41 patients (68.3%) received less than 90% of their required energy intake, 18 (30.0%) received within +/-10%, and 1 (1.7%) received more than 110%. Episodes of diarrhea, emesis, large residual volumes, feeding tube replacements, and interruptions for procedures accounted for 70% of the variance in energy received (P<.001). Procedural interruptions alone accounted for 45% of the total variance. Estimated energy requirements determined via indirect calorimetry and mean energy received did not differ. CONCLUSIONS: Most critically ill patients receiving mechanical ventilation who are fed enterally do not receive their energy requirements, primarily because of frequent interruptions in enteral feedings.