Accessible Technology Course Design Practices for Inclusivity in Nursing Education.

BACKGROUND: Nursing students are diverse in culture, abilities, and challenges. Universal Design for Learning is a logical and social model to support diverse learning methods. Accessibility tools help measure the efficacy of faculty efforts to make nursing courses accessible to all. PURPOSE: The study examines using accessibility software to measure faculty improvements and student engagement in nursing courses over 2 academic semesters. METHODS: One hundred courses were analyzed 1 year apart for accessibility improvements by nursing faculty. RESULTS: Course accessibility scores significantly rose year after year in almost all courses. Student usage also increased significantly. Lessons learned are presented. CONCLUSION: Accessibility improvements are worthwhile for enhancing inclusion in nursing programs and student engagement.

Early career nurses and moral distress: An integrative review.

AIM: The purpose of this integrative review was to evaluate and synthesize literature published in peer-reviewed journals within the past 40 years addressing moral distress in early career nurses (graduation to five years of experience). BACKGROUND: Moral distress experienced in nursing education and practice manifests physically and psychologically, leads to workforce burnout and attrition, and compounds the nursing shortage. The transition to practice period is a vulnerable time for student nurses emerging into professional practice. Nurse educators serve a crucial role in the preparation of nurses for the recognition and management of moral distress in their professional nursing practice. A better understanding of the state of the science pertaining to the reports of moral distress in early career nurses is essential. DESIGN: Whittemore and Knafl's Integrative Review method and the PRISMA 2020 Checklist were utilized in this integrative review. METHODS: Five literature databases (CINAHL, ERIC, PsychInfo, PubMed, and Embase) were searched using 'moral distress' and 'new graduate nurses' as keywords. Studies were included for English language; qualitative and quantitative research; moral distress focus; years of nursing practice experience collected and analyzed in results or discussion; and all areas of clinical nursing practice, geographic locations, and nursing education levels. Studies were excluded for non-peer reviewed publications; moral distress in the academic setting; and the absence of analysis of years of nursing practice experience in the results or discussion. RESULTS: Eight primary research reports, published between 2016 and 2022 met eligibility criteria. Research methods were largely quantitative with six countries geographically represented. Acute care healthcare settings had the greatest representation with considerations for the COVID-19 pandemic in two reports. Various formats of four moral distress research instruments were used. Years of nursing practice experience were collected as a mean or category. Inconsistent reports of moral distress in early career nurses were found based on experience, age, or nursing education level. CONCLUSIONS: Research of moral distress prevalence in early career nurses was an identified literature gap. Varied reports of moral distress in early career nurses indicate a need to further understand this topic contextual to academic and clinical education. Nurse educators can prepare students for experiences of moral distress in their professional nursing practice by implementing teaching strategies that draw upon their diverse backgrounds and experiences. A research and education emphasis on moral distress in early career nurses can promote their transition to practice, support their career progression, and uphold nursing occupational commitment. TWEETABLE ABSTRACT: An integrative review of moral distress in early career nurses found inconsistent reports of moral distress in this population and a need for further research.

Testing the Psychometric Characteristics of the Revised Mastery of Stress Instrument in Adults With Type 2 Diabetes.

Background and Purpose: A promising, yet lengthy measure to identify mastery of patient-identified stress is Younger's (1991, 1993) Mastery of Stress Instrument (MSI). With a goal for a parsimonious and valid measure, this study determined the psychometric properties of a reduced item instrument with adults diagnosed with type 2 diabetes. Methods: First, an expert content analysis was completed. Second, item and confirmatory factor analysis were completed with a sample of 200 adults with a diagnosis of type 2 diabetes. Results: Eight items were removed through content validity and seven items were removed with Item analysis. Factor analysis supported Younger's four sub-concepts. Conclusions: Future research with this revised MSI scale is advocated to identify those who may need strategies to increase their mastery of stress.

Accumulation of Content Validation Evidence for the Critical Thinking Self-Assessment Scale.

BACKGROUND/PURPOSE: Critical thinking skills (CTS) are essential for nurses; assessing students' acquisition of these skills is a mandate of nursing curricula. This study aimed to develop a self-assessment instrument of critical thinking skills (Critical Thinking Self-Assessment Scale [CTSAS]) for students' self-monitoring. METHODS: An initial pool of 196 items across 6 core cognitive skills and 16 subskills were generated using the American Philosophical Association definition of CTS. Experts' content review of the items and their ratings provided evidence of content relevance using the item-level content validity index (I-CVI) and Aiken's content validity coefficient (VIk). RESULTS: 115 items were retained (range of I-CVI values = .70 to .94 and range of VIk values = .69-.95; significant at p< .05). CONCLUSION: The CTSAS is the first CTS instrument designed specifically for self-assessment purposes.

A conceptual framework for developing a critical thinking self-assessment scale.

Nurses must be talented critical thinkers to cope with the challenges related to the ever-changing health care system, population trends, and extended role expectations. Several countries now recognize critical thinking skills (CTS) as an expected outcome of nursing education programs. Critical thinking has been defined in multiple ways by philosophers, critical thinking experts, and educators. Nursing experts conceptualize critical thinking as a process involving cognitive and affective domains of reasoning. Nurse educators are often challenged with teaching and measuring CTS because of their latent nature and the lack of a uniform definition of the concept. In this review of the critical thinking literature, we examine various definitions, identify a set of constructs that define critical thinking, and suggest a conceptual framework on which to base a self-assessment scale for measuring CTS.

Engagement of parents in on-line social support interventions.

The purpose of this scoping review was to determine what the relevant research informs us about which parents of children with chronic disease and/or disability are likely to engage in an on-line social support program and why they choose to be engaged. The review included 16 peer-reviewed research reports about on-line social support offered to parents of children with chronic disease and/or disability. It was conducted using scoping review approaches recommended by H. Arskey and L. O'Malley (2005). A key finding of this review is that it appears that the development of on-line social support interventions for parents may not have integrated what is known in the field of Internet technology as necessary to engage users. This has implications for nurses wishing to provide on-line social support for parents. As well, it highlights future directions for research, including investigations of which parents are likely to engage in on-line social support interventions and the features of the intevention that will attract and sustain them as participants.

Leadership attributes: a key to optimal utilization of the community health nursing workforce.

This research examined leadership attributes that support the optimal utilization and practice of community health nurses (CHNs). Community health nursing is facing challenges in workforce capacity and sustainability. To meet current and future demands on the community sector, it is essential to understand workplace attributes that facilitate effective utilization of existing human resources and recruitment of new nurses. This pan-Canadian, mixed-methods study included a demographic analysis of CHNs in Canada, a survey involving responses from approximately 6,700 CHNs to identify enablers and barriers to community health nursing practice and 23 focus groups to examine organizational attributes that "best" support optimal practice within the public health nursing subsector. Nursing leadership was identified as an important attribute in organizations' utilization and support of CHNs working to work effectively. This effectiveness, in turn, will enhance community health programs and overall healthcare system efficiency. This paper highlights findings related to the role of nursing leadership and leadership development in optimizing community health nursing practice.

Professional failure to thrive: a threat to high-quality care?

The term professional failure to thrive arose from descriptions of non-organic failure to thrive in infants and observations of nurses' behaviours. First coined by Stamler in 1997, subsequent unrelated research results have supported the theoretical construct. In an era when patient safety and high-quality care have never been more important, and nursing retention has reached heretofore unknown levels of global concern, critical examination of factors that may alleviate professional issues and support high-quality healthcare is especially useful. In this paper, we suggest theoretical causes for professional failure to thrive (PFTT) and associated behaviours exhibited by nurses, and draw links to current research to support the theory. Given the theoretical support, PFTT represents an additional avenue that should be considered and explored through research studies.

Scaling up the global nursing health workforce: contributions of an international organization.

In this paper key highlights of the scholarly work presented at the Toronto 2008 Global Alliance for Nursing Education & Scholarship (GANES) conference are summarized, challenges opportunities and issues facing nursing education globally arising from the conference discourse are outlined and initial steps are suggested as a way forward to a shared global view of baccalaureate and graduate nursing education and scholarship. This shared view arises from beginning understandings of the issues and opportunities we face globally starting with and building upon the lessons learned from the literature and from the experiences of nursing educators and nursing education organization locally, regionally, nationally and internationally. The theme of the groundbreaking GANES Toronto conference was "Educating the future nursing and health workforce: A global challenge". One hundred seventy delegates from 17 countries attended the event, with over 80 papers presented. A primary focus of GANES is the contribution of a strategic alliance of national nursing education organizations to contribute to nursing education leading practices and policy that address the scaling up of global nursing and health workforce. The founding members of GANES see a clear link between a strong educational infrastructure and strong scholarship activities in nursing and the ability of a society to be healthy and prosperous. Evidence presented at the recent GANES conference supports that belief. Through the strength of partnerships and other capacity-building efforts, member countries can support each other to address the global nursing education and health challenges while respecting the local issues.

Patient perceptions of satisfaction following diabetes education: use of the mastery of stress instrument.

PURPOSE: The purpose of this study was to test the conceptual congruency of scores from the Mastery of Stress Instrument (MSI) with qualitative data in an effort to identify patients for whom a specific educational intervention was sufficient. METHODS: A convenience sample of patients with diverse age and educational backgrounds was recruited from those who registered for a 4-session diabetes educational experience as new or refresher patients. All 57 patients completed the MSI before and after diabetes educational experiences, and half participated in before and after audiotaped interviews. All patients responded to a query about their perceptions of the educational experience. MSI scores were analyzed by demographic variables as well as compared to qualitative interviews for greater insights and explanation. RESULTS: Consistency was noted between the MSI scores and the information revealed in the interviews. Additional support for the use of the MSI to identify patients at risk and in need of additional educational interventions was realized. CONCLUSIONS: Further research to explore the use of the MSI with persons with different educational experiences and to standardize the MSI scores for adult persons taking diabetes or other patient education classes is needed before generalization can be achieved.

Adolescent girls' personal experience with Baby Think It Over infant simulator.

PURPOSE: To explore adolescent girls' personal experience with an infant simulator that had to be cared for over a period of 1 to 2 weeks. STUDY DESIGN AND METHODS: This qualitative study employed the phenomenological approach and utilized Colaizzi's method of analysis. Participants were nine adolescent high school girls who were interviewed and audiotaped. Interview data were coded using NUD*IST 4 software. RESULTS: Three themes emerged from the data. They were (1) a parenting journey incorporating intellectual, emotive, and physical faculties; (2) recognizing the illusionary nature of previously held ideas about parenting an infant; and (3) offering counsel based on the BTIO experience. CLINICAL IMPLICATIONS: The new perspectives gained by the participants about parenting a newborn infant differed markedly from the romantic fantasies they held prior to the experience. The teens started thinking more seriously about the consequences of sexual activity. Used for 1 to 2 weeks, in conjunction with budgeting exercises and provocative small-group discussions, the BTIO shows promise as an effective tool in helping to modify unrealistic and idealized teen views of adolescent pregnancy and parenting.

Breast health educational interventions. Changes in beliefs and practices of working women.

Health education programs supported by women's groups or workplaces have been successful in reaching large populations and changing intentions to perform breast health behaviors. This study examined the responses women working in the automotive industry had to two health education interventions, mailed pamphlets, and a combination of mailed material and classes at the worksite compared to a control group. A quasi-experimental design was used. Of the 948 women completing the pre-test, 437 also completed the post-test and were highly representative of the initial sample. The findings suggest that although the mailed information produced some change in practices and intentions, the classes in combination with the mailed pamphlets produced greater change. In addition, confidence in breast self examination as a method of detecting an existing breast lump increased from pre-test to post-test across all age groups. The reported influences on the women's decisions related to breast health varied across the life span. The results of this study can be used to support the development of effective health promotion programs for use at workplaces to increase the likelihood of women engaging in healthy breast practices.

Using the internet to identify women's sources of breast health education and screening.

Health professionals, women's groups, the media and the Internet have all played a role in educating the public about breast health and breast screening methods. Yet, with all the information that is available to women, their participation rates have been less than optimal. This paradox has resulted in the need to learn more about the sources that influence women to participate in breast screening. In an innovative study using the Internet, over 800 women, primarily from Canada and the United States, were surveyed about their knowledge, attitudes and influences regarding their breast screening practices. Current health status, screening practices and influences of various health professionals on women's health promotion activities were analyzed. Comparisons of the women's perceptions across age groups and national differences between Canadian and American respondents are presented. Women in the older age group reported receiving more encouragement for breast screening activities from physicians, nurses and others than did younger women. American respondents reported perceiving more support from nurses for breast screening than did their Canadian counterparts. A high number of American respondents reported having been diagnosed with breast cancer, while only a small number of Canadian respondents reported this diagnosis. The results from this study can be used in planning health promotion activities relevant to various populations of women. Benefits and limitations of using the Internet as a research medium are briefly discussed.

Comfort: exploration of the concept in nursing.

BACKGROUND: Comfort is a substantive need throughout life. However, the rise of technological influence coupled with a desire to embrace the medical concept of cure has frequently relegated the importance of nursing comfort interventions to simple tasks that can be provided by non-professional caregivers rather than an integral part of health promotion at all levels. DEFINITION: Comfort is a concept that has been explored by a number of authors. Various definitions have included comfort as an outcome of nursing, a function of nursing, a basic human need, and a process. No consensus on a definition of comfort was found in the literature. THEORY: This investigation attempts to link the ideas of comfort presented in the literature with the theories of Watson (Human Care) and Leininger (Culture Care), and discovers the existence of an integral locus for comfort in both. IMPLICATIONS: Theory-based strategies for nursing education are offered. Further research is clearly required, research methodologies based on Watson and Leininger would be appropriate for additional exploration of this concept. Practice implications include reflecting on the meaning of comfort to the patient in the context of his/her cultural values, and using this one as one of the factors in planning and implementing nursing care. CONCLUSION: Given the current emphasis on health promotion and the importance of comfort to the process of healing, comfort is an indispensable element of holistic, culturally congruent human care.

A national survey of Canadian women: breast health practices, influences, and satisfaction.

In an earlier survey of over 900 women in the local automobile industry, several influences and preferences for breast screening were identified. The purpose of the current study was to extend the survey population to women across Canada, as well as to ascertain women's satisfaction with organized (governmental) screening programs within their geographic areas. Using random-digit-dialing, 1,224 women 25 years and older were interviewed in French or English and their responses entered in a CATI system. The interviewers used a modified version of Health Care Practices: A Worksite Survey. Results were analyzed by age and geographic region. Results indicated support for earlier local findings, as well as high satisfaction, but low knowledge and usage of organized breast screening clinics.