Nursing Education Leaders Decision-Making During a Pandemic Crisis.

ABSTRACT: Academic nursing leaders faced unprecedented decision-making during the recent global pandemic. Although some universities had emergency response plans, many did not, and those that did have plans did not address the specific needs of nursing education programs. This descriptive survey study sought to describe the decision-making and response of nursing education leaders during the pandemic and provide recommendations for the future. Themes identified in the study include preparedness, emergency response, uncertainty, leadership and policy, and communication. Results of the study provide nursing program administrators with insights for preparing to lead in future emergencies.

Concept Analysis of Systems Thinking in the Context of Interprofessional Practice and Improved Patient Outcomes.

AIM: The purpose of this study was to explore the definition and application of systems thinking (ST) in interprofessional practice and improved patient outcomes. BACKGROUND: Nurse educators need a universal definition of ST to implement in curricula to foster quality and safety while enhancing outcomes for nursing students. METHOD: The QSEN RN-BSN Task Force used the hybrid model of concept analysis to identify the process of fostering ST in clinical and didactic learning experiences and how ST changed over time from the perspective of educators. RESULTS: The definition of ST in the context of interprofessional practice and outcomes was "a dynamic, analytical process that looks at complex patterns, relationships, and connections within elements and structures, resulting in the ability to recognize the whole picture." CONCLUSION: The concept of ST in the context of interprofessional practice and improved patient outcomes may be integrated within nursing curricula.

A strengths, weaknesses, opportunities, and threats analysis- A study of Association of Community/Public Health Nursing Educators members.

OBJECTIVE: Aims of this study were to identify the Association of Community/Public Health Nursing Educators members' demographics, educational preparation, and research competencies; and, to complete a strengths, weaknesses, opportunities, and threats (SWOT) analysis. METHODS: A descriptive-correlational design was employed. Primary data collection was via electronic survey. Authors developed a survey focusing on demographics and aligning Benner's theory with research skills/experience. SWOT and gap analyses were performed. RESULTS: A 27.2% response rate (N = 352) revealed a lack of diversity among 70% doctorally prepared membership, perceived competence with interprofessional collaboration (80%), and applying research to practice (80%). Doctorally prepared members reported experience using longitudinal designs (p = .05). PhD-prepared members reported experience using psychometrics and evaluations (p = .05). SWOT revealed a lack of service engagement. Gap analysis offered solutions to execute strategic goals. CONCLUSIONS: Association of Community/Public Health Nursing Educators may enhance future direction by advancing member diversity, professional development, collaborative scholarship, and mentoring.

Association of Community Health Nursing Educators 2020 Research Priorities and Research in Action Model.

OBJECTIVE: The Association of Community/Public Health Nurse Educators (ACHNE) Research Priorities Subcommittee presents a report on the state of the science of public health nursing education. DESIGN: Whittemore and Knafl's (Journal of Advanced Nursing, 2005, 52, 546) five-step integrative review was used. SAMPLE: Fifty-two articles were reviewed. MEASUREMENTS: Braun et al's. (Handbook of research methods in health social sciences, 2019, 843) thematic analysis methods were used. RESULTS: Four themes emerged: (a) Community/Public Health Nursing Education and teaching strategies/modalities; (b) Clinical teaching and learning partnerships; (c) Environmental health and emergency response; and, (d) Cultural competence and awareness. CONCLUSIONS: Themes informed the following research priorities: (a) a need for rigorous scientific studies highlighting the impact and effectiveness of Community/Public Health Nursing Education; (b) a need for evidence on faculty development, support and training related to community/public health activities; (c) a need for evidence on impact of Community/Public Health Nursing teaching on communities and students, and (d) a need for evidence on impact of C/PHNE strategies on long-term student knowledge, attitudes or behavior (competencies). Finally, a Research in Action Model is proposed as a means for continued forward movement of the discipline, connecting the three fundamental driving mechanisms.

Promoting civility in nursing practice using systems thinking: Evidence-based teaching strategies for nurse educators.

There is a critical need for nurse educators to promote civility in nursing practice using systems thinking to promote quality and safety and improve patient outcomes by preventing undue patient harm. In this article, evidence is synthesized in order that readers can recognize, respond and manage workplace incivility. Systems thinking is introduced as a best practice solution for advancing a civil workplace culture. The author-created Systems Awareness Model, adapted for civility awareness, guides nurse educators with evidence-based strategies for teaching nurses the essential skills to promoting a civility culture within health systems. The strategies can be used by nurse educators in practice to interface workplace application. Proposed examples of evaluation methods are aligned with the teaching strategies. The purpose of this article is to provide nurse educators in practice with evidence-based teaching strategies and evaluation methods to address incivility in health care using a systems thinking perspective.

Systems Thinking for Managing COVID-19 in Health Care Systems: Seven Key Messages.

This article provides the most current guidelines for nurse educators and nurses to use systems thinking to manage COVID-19 in health systems. A working definition of systems thinking is offered, with a review of basic knowledge and care in the context of the system awareness model (SAM). Seven key messages assist nurse educators and nurses in the management of COVID-19 patients culminating in leadership of complex health care systems using systems thinking. [J Contin Educ Nurs. 2020;51(9):402-411.].

Association of Community Health Nursing Educators', 2020 evidence-based project priorities: A national blueprint for unifying research and evidence-based practice priorities.

The Association of Community Health Nursing Educators (ACHNE) Research Committee Subcommittee on Evidence-Based Practice (EBP) presents a paper on the state of translation of science into public health nursing education practice. The paper builds from the integrative research review completed by the ACHNE Research Priorities Subcommittee (McElroy et al., Public Health Nursing, 2020) offering updated research priorities and a Research in Action model. Four EBP Project Priorities were established using the Johns Hopkins EBP Model guided by Dang and Dearholt's (Johns Hopkins nursing evidence-based practice: Model and guidelines, 2018) 19-step process. The EBP Project Priorities emphasize the need for EBP projects to align ACHNE strategic plans and research priorities. The authors recommend that the Research in Action model guide deliberate unification of both the Research and EBP Project Priorities. Standards and criteria for essential effort unifying collaborative effort between PhD and Doctorate in Nursing Practice scholars, coordination of research efforts, and innovative practice partnerships is provided.

Using Systems Thinking to Implement the QSEN Informatics Competency.

There is an urgent need to improve the use and usability of the electronic health record (EHR) in health care to prevent undue patient harm. Professional development educators can use systems thinking and the QSEN competency, Informatics, to educate nurses about such things as nurse-sensitive indicators in preventing medical errors. This article presents teaching tips in using systems thinking to champion communication technologies that support error prevention (betterment). [J Contin Educ Nurs. 2019;50(9):392-397.].

Systems Thinking for Transitions of Care: Reliability Testing for a Standardized Rubric.

PURPOSE: The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists. DESIGN: The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice. METHODS: Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach's α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric. RESULTS: Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α's ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section. CONCLUSION: The research team recommends using the rubric to reflect application of systems thinking across transitions of care.

Systems Perspective for Incivility in Academia: An Integrative Review.

AIM: The purpose of this integrative review was to identify evidence of systems thinking on civility in academic settings. BACKGROUND: Incivility is present in academic systems, including nursing education. What is learned in academia translates to the workplace. Systems-based solutions may promote quality and safety in health care. METHOD: Whittemore and Knafl's integrative approach guided this study. RESULTS: Forty-nine articles were reviewed. Themes emerged describing incivility in nursing as embedded within layers of a performance-driven, oppressive hostile bureaucracy, trickling down, instilling fear, and reinforcing uncivil behavior among and between members. Other themes defined faculty-to-faculty and faculty-to-student incivilities, reasons for it, reactions to it, and suggestions for improved civility. CONCLUSION: The systems awareness model is offered as a means of promoting civility in nursing education. A lack of evidence to support how incivility in academia transfers to quality and safety in practice settings is identified as a gap for future study.

A crosswalk between the Omaha System and guiding undergraduate public health nursing education documents.

The Omaha System is the hallmark evidence-based clinical information management system used in nursing education, research, and practice. Multiple education documents guide public health workforce preparation. This qualitative study identified similarities and gaps between the Omaha System and seven guiding documents commonly used by nurse educators. A crosswalk design was employed. The setting was virtually based using online technology. Recommendations are for public health nurse educators to update their teaching practices using evidence-based approaches.

Systems Thinking Education in RN-BSN Programs: A Regional Study.

BACKGROUND: Nurses need to take a lead in reducing medical errors. Formal education of systems thinking (ST) can be a catalyst for error prevention. PROBLEM: Integration of ST in RN-BSN education has not been studied. APPROACH: A descriptive, cross-sectional design using survey methods was used. OUTCOMES: Deans of accredited RN-BSN programs across the Midwest reported on ST integration across their RN-BSN programs. Gaps in ST integration were identified as (1) a lack of evaluation tools to determine mastery of systems theory, thinking and awareness, and the application of quality and safety competencies for systems-level synthesis and (2) program outcomes emphasizing autonomy of systems-level decisions. CONCLUSIONS: Systems thinking was integrated across curricula among most accredited RN-BSN programs in the Midwest. Recommendations are to integrate systems theory into program outcomes and to develop evaluation tools that validate ST mastery.

A Concept Analysis of Synergy for Nursing Education.

Background and Purpose: Synergy is a term found widely throughout the sciences. There is a need for improved methods and delivery of instruction that supports learners in their pursuit of academic goals and facilitates their transition into the professional role. Critical for students is teamwork training, both as team members and facilitators. Some teams have outcomes greater than their own individual efforts, while others do not. One possible explanation for this phenomenon is synergy. A concept analysis was conducted to define synergy in the context of nursing education and to gain insight on its impact on learning. Using Walker and Avant's (2011) method, definitions, uses, attributes, antecedents, consequences, and empirical referents were identified. Methods: Six databases were searched, using the keyword synergy (syntactic variations) and search terms (nursing, education, student, learning, training, collaboration, teamwork, and cooperation) with the parameter of English language (1980-2017). Articles were delimited through duplication removal, title, and abstract review. Thirty articles were selected for review based upon the use of synergy within the context of education. Results: Synergy is demonstrated whengroup outcomes exceed the results of individual efforts. Attributes are mutuality of support, actions, goalswith greater than individual effects, and teaching strategies. Consequences are greater problem-solving, creativity, and goal attainment than are accomplished individually. Implications for Practice: Incorporating synergy into nursing education can promote teamwork and collaboration and facilitate learners to collaborate inter-professionally. Recommendations are to research synergy within nursing education.

Using Systems Thinking to Advance Global Health Engagement in Education and Practice.

The integration of global health into nursing practice within complex systems requires a strategic approach. The System-Level Awareness Model (SAM) can be used to guide the process of enhancing systems thinking for global health. The purpose of this article is to explain the SAM and how to use it for integrating systems thinking into nursing education in academic, professional development, and continuing education settings to promote global health across the nursing continuum. Tips are provided on how to teach systems thinking for global health in nursing education and practice, consistent with continuing education national learning competencies for health care professionals. J Contin Educ Nurs. 2018;49(4):154-156.

Systems thinking and incivility in nursing practice: An integrative review.

BACKGROUND AND PURPOSE: There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient-related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level-headed thinking from which patient-centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings? METHODS: Whittemore and Knafl's integrative review method guided this study. The quality of articles was determined using Chu et al.'s Mixed Methods Assessment Tool. RESULTS: Thirty-eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice. IMPLICATIONS FOR PRACTICE: This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety.

Recommendations for Promoting Quality and Safety in Health Care Systems.

Are you a nurse leader or professional development practitioner in a health care facility? This article provides recommendations to promote quality and safety education with a focus on systems thinking awareness among direct care nurses. A key point is error prevention, which requires a shared effort among all nurses. J Contin Educ Nurs. 2017;48(7):295-297.

QSEN Institute RN-BSN Task Force: White Paper on Recommendation for Systems-Based Practice Competency.

The Quality and Safety Education for Nurses (QSEN) Institute RN-BSN Task Force presents a white paper on Recommendation for a Systems-based Practice Competency. The task force proposes a seventh QSEN competency, systems-based practice, to improve patient quality and safety. Recommendations to integrate systems-based practice into both education and practice settings, consistent with job descriptions and promotion criteria, involve a comprehensive continuing education program for nurses upon interview, orientation, residency programming, performance evaluation, and license renewal.

A Concept Analysis of Systems Thinking.

PURPOSE: This concept analysis, written by the National Quality and Safety Education for Nurses (QSEN) RN-BSN Task Force, defines systems thinking in relation to healthcare delivery. METHODS: A review of the literature was conducted using five databases with the keywords "systems thinking" as well as "nursing education," "nursing curriculum," "online," "capstone," "practicum," "RN-BSN/RN to BSN," "healthcare organizations," "hospitals," and "clinical agencies." Only articles that focused on systems thinking in health care were used. The authors identified defining attributes, antecedents, consequences, and empirical referents of systems thinking. FINDINGS: Systems thinking was defined as a process applied to individuals, teams, and organizations to impact cause and effect where solutions to complex problems are accomplished through collaborative effort according to personal ability with respect to improving components and the greater whole. Four primary attributes characterized systems thinking: dynamic system, holistic perspective, pattern identification, and transformation. CONCLUSION: Using the platform provided in this concept analysis, interprofessional practice has the ability to embrace planned efforts to improve critically needed quality and safety initiatives across patients' lifespans and all healthcare settings.