Clinical decision making: validation of the nursing anxiety and self-confidence with clinical decision making scale (NASC-CDM ©) into Spanish and comparative cross-sectional study in nursing students.

BACKGROUND: Decision making is a pivotal component of nursing education worldwide. This study aimed to accomplish objectives: (1) Cross-cultural adaptation and psychometric validation of the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale from English to Spanish; (2) Comparison of nursing student groups by academic years; and (3) Analysis of the impact of work experience on decision making. METHODS: Cross-sectional comparative study. A convenience sample comprising 301 nursing students was included. Cultural adaptation and validation involved a rigorous process encompassing translation, back-translation, expert consultation, pilot testing, and psychometric evaluation of reliability and statistical validity. The NASC-CDM© scale consists of two subscales: self-confidence and anxiety, and 3 dimensions: D1 (Using resources to gather information and listening fully), D2 (Using information to see the big picture), and D3 (Knowing and acting). To assess variations in self-confidence and anxiety among students, the study employed the following tests: Analysis of Variance tests, homogeneity of variance, and Levene's correction with Tukey's post hoc analysis. RESULTS: Validation showed high internal consistency reliability for both scales: Cronbach's α = 0.920 and Guttman's λ2 = 0.923 (M = 111.32, SD = 17.07) for self-confidence, and α = 0.940 and λ2 = 0.942 (M = 80.44, SD = 21.67) for anxiety; and comparative fit index (CFI) of: 0.981 for self-confidence and 0.997 for anxiety. The results revealed a significant and gradual increase in students' self-confidence (p =.049) as they progressed through the courses, particularly in D2 and D3. Conversely, anxiety was high in the 1st year (M = 81.71, SD = 18.90) and increased in the 3rd year (M = 86.32, SD = 26.38), and significantly decreased only in D3. Work experience positively influenced self-confidence in D2 and D3 but had no effect on anxiety. CONCLUSION: The Spanish version (NASC-CDM-S©) was confirmed as a valid, sensitive, and reliable instrument, maintaining structural equivalence with the original English version. While the students' self-confidence increased throughout their training, their levels of anxiety varied. Nevertheless, these findings underscored shortcomings in assessing and identifying patient problems.

An Environmental Scan and Appraisal of Patient Online Resources for Managing Rheumatoid Arthritis Flares.

OBJECTIVE: To conduct an environmental scan and appraisal of online patient resources to support rheumatoid arthritis (RA) flare self-management. METHODS: We used the Google search engine (last search March 2023) using the terms "rheumatoid arthritis" and "flare management." Additional searches targeted major arthritis organizations, as well as regional, national, and international resources. Appraisal of the resources was conducted by 2 research team members and 1 patient partner to assess the understandability and actionability of the resource using the Patient Education Materials Assessment Tool (PEMAT). Resources rating ≥ 60% in both domains by either the research team or the patient partner were further considered for content review. During content review, resources were excluded if they contained product advertisements, inaccurate information, or use of noninclusive language. If content review criteria were met, resources were designated as "highly recommended" if both patient partners and researchers' PEMAT ratings were ≥ 60%. If PEMAT ratings were divergent and had a rating ≥ 60% from only 1 group of reviewers, the resource was designated "acceptable." RESULTS: We identified 44 resources; 12 were excluded as they did not pass the PEMAT assessment. Fourteen resources received ratings ≥ 60% on understandability and actionability from both researchers and patient partners; 10 of these were retained following content review as "highly recommended" flare resources. Of the 18 divergent PEMAT ratings, 8 resources were retained as "acceptable" following content review. CONCLUSION: There is high variability in the actionability and understandability of online RA flare materials; only 23% of resources were highly recommended by researchers and patient partners.

Investigating the Influence of Patient Eligibility Characteristics on the Number of Deferrable Rheumatologist Visits: Planning for a Patient-Initiated Follow-Up Strategy.

OBJECTIVE: Patient-initiated follow-up (PIFU) for rheumatoid arthritis (RA) is a model of care delivery wherein patients contact the clinic when needed instead of having regularly scheduled follow-up. Our objective was to investigate the influence of different patient eligibility characteristics on the number of potentially deferred visits to inform future implementation of a PIFU strategy. METHODS: We conducted a retrospective chart review of 7 rheumatologists' practices at 2 university-based clinics between March 1, 2021, and February 28, 2022. Data extracted included the type and frequency of visits, disease management, comorbidities, and care complexities. Stable disease was defined as remission or low disease activity with no medication changes at all visits. The influence of patient characteristics on the number of deferrable visits in patients with stable disease was explored in 4 criteria sets that were based on early disease duration, medication prescribed, presence of care complexity elements, and comorbidity burden. RESULTS: Records from 770 visits were reviewed from 365 patients with RA (71.5% female, 70% seropositive). Among all criteria sets, the proportion of visits that could be redirected varied between 2.5% and 20.9%. The highest proportion of deferrable visits was achieved when eligibility criteria included only stable disease activity and patients with RA on conventional synthetic disease-modifying antirheumatic drugs or no medications (n = 161, 20.9%). CONCLUSION: PIFU may result in a more efficient use of specialist healthcare resources. However, the applicability of such models of care and the number of deferred visits is highly dependent on patient characteristics used to establish eligibility criteria for that model. These findings should be considered when planning implementation trials.

Relationship Between Self-Directed Learning, Grit, and Compassionate Teaching in Doctoral Nursing Education.

BACKGROUND: The capacity to be self-directed, take responsibility for one's learning, and possess grit, perseverance, and passion for long-term goals is fundamental to doctoral education. Compassionate teaching (CT) strategies may help foster these traits. PURPOSE: This study explored CT strategies, self-directedness, and grit in doctoral nursing education. METHODS: A mixed-methods design examined doctor of nursing (DNP) graduates' (N = 227) perceptions of self-directedness, grit, and CT using an online survey and interviews. RESULTS: A weak direct correlation existed between CT strategies and grit. A weak-to-moderate direct significant correlation existed between CT strategies and self-directedness. Participants were moderately self-directed with postmasters-DNP graduates being more self-directed than postbaccalaureate-DNP graduates. Qualitative results validated that CT strategies include committing time to relationship building, providing timely critical feedback while being kind, and treating students fairly. CONCLUSIONS: Faculty who embrace rigor and compassion are appreciated by students and are perceived to foster self-directedness and grit.

Development and validation of an instrument to measure scope of practice in school nurses.

AIMS: The aim of the study was to develop and psychometrically test a new instrument to measure the scope of school nursing practice. DESIGN: Methodological study. METHODS: Data were collected in Spring 2018. Frontline school nurses in the United States (N = 3099) completed the 39-item Scope of School Nursing Practice Tool (SSNPT) with two domains (current practice and importance to practice). One half of sample data (N1 = 1521) were used for exploratory factor analysis, item analysis, Cronbach's alpha, and Spearman-Brown to estimate validity and reliability of the instrument. Sample data from the other half (N2 = 1578) were retained for future analysis. RESULTS: Factor analysis resulted in a stable four-dimension solution: (A) Using the Nursing Process; (B) Applying Evidence to Improve Practice; (C) Connecting with Community; and (D) Leveraging the School and Family Team, accounting for 50.48% (current practice) and 53.31% (importance to practice) of total variance. Cronbach's alpha and Spearman-Brown ranged from .73 to .90 and .73 to .92, respectively. Item-total correlations ranged from .36 to .82. CONCLUSION: Initial psychometric properties indicate the new SSNPT is valid and reliable to assess the scope of practice of frontline school nurses. IMPACT: School nurses play a key role in population health and frequently serve as the sole provider of healthcare in schools worldwide. However, variability in school nursing practice affects the health, safety and educational outcomes of children and youth. No instrument exists that measures the scope of practice of school nurses. Frontline school nurses can use the SSNPT to assess practice, school nurse administrators can use the tool for resource utilization and school nurse researchers can use the tool to examine school nursing practices' impact on student/community health and academic outcomes. The SSNPT may provide a template for others who wish to examine specialty nursing scope of practice.

School Nursing for the 21st Century: Assessing Scope of Practice in the Current Workforce.

A gap analysis was used to examine the scope of school nursing practice in the United States. An investigator-developed 39-item self-assessment survey of scope of school nursing practice was modified from an existing validated tool, organized around the five principles of the National Association of School Nurses' Framework: Standards of Practice, Quality Improvement, Care Coordination, Community/Public Health, and Leadership and also explored barriers to practice. The survey was sent to a national convenience sample of practicing school nurses. The survey was completed by 3,108 practicing school nurses. Gaps were identified for all principles and were greatest for Quality Improvement and Community/Public Health practice. All practice items were rated more important than the ability to practice that item (p < .001). Self-identified barriers including workload, school/district expectations, and state regulations accounted for significant variances in practice across four of five principles (p < .05, p < .001). Recommendations include support for population-focused evidence-based school nursing practice.

The effect of remote patient monitoring on discharge outcomes in post-coronary artery bypass graft surgery patients.

ABSTRACT: Coronary artery bypass graft (CABG) surgery is a lifesaving procedure for patients with coronary artery disease but ranks highest (13.5%) for preventable hospital readmissions and second highest in average Medicare payment ($8,136) per readmission. Care transitions after hospital discharge warrant exploration to improve outcomes. The purpose of this brief report was to compare the effect of remote patient monitoring (RPM) on 30-day outcomes in Medicare beneficiaries after isolated CABG surgery. Results demonstrated no statistically significant difference in 30-day readmission (p = .568) or emergency department encounters (p = .785) between groups. However, time to achieve a cardiology follow-up appointment decreased from 19.8 to 13.7 days (p = .062) in the RPM group. Although the findings were not statistically significant, this study demonstrated a reduction in CABG readmissions and timely provider follow-up with RPM. In addition, study findings contribute to the body of nursing knowledge and support the need for further studies to identify high-risk CABG patients who may benefit from RPM after hospital discharge.

Mentoring students engaging in scholarly projects and dissertations in doctoral nursing programs.

BACKGROUND: Doctor of Nursing Practice (DNP) programs in the US have grown exponentially, outnumbering Doctor of Philosophy (PhD) in Nursing programs. Faculty are mentoring increasing numbers of students on DNP projects or PhD dissertations. PURPOSE: This descriptive study explored faculty characteristics and examined support, engagement, and outcomes of American Association of Colleges of Nursing member nursing faculty mentoring student DNP projects or PhD dissertations. METHOD: A researcher-developed survey tool was emailed to 550 Deans and Program Directors of AACN doctoral programs for distribution to their doctoral faculty. Survey data were analyzed using descriptive statistics. FINDINGS: 177 DNP and 53 PhD (N=230) program surveys were completed. Faculty described challenges in the mentoring role including: time constraints, workload allocation, resources, faculty role preparation, student readiness, and variability in student outcomes. CONCLUSIONS: Additional dialogue and consensus is required to promote mentoring of students in nursing doctoral programs to ensure rigor of scholarly outcomes.

Perceived Evidence-Based Practice Competency Acquisition in Graduate Nursing Students: Impact of Intentional Course Design.

BACKGROUND: Acquisition of evidence-based practice (EBP) competencies in graduate-level nursing programs bridges the research-practice gap in professional practice. This study evaluated the impact of the Star Model of Knowledge Transformation as a framework for course design on graduate-level nursing students' perceived EBP competencies. METHOD: Data were collected from 2012 to 2017 (N = 544). Repeated-measures ANOVA was used to analyze pre- and postassessment data over time. Data were collected for each of the five stages or Star Points of EBP competencies. RESULTS: Significant postcourse improvement in perceived EBP competencies was demonstrated (p ≤ .000) for all Star Points and years. The greatest pre- and postassessment percentage change occurred in the Translation Star Point scores and the least percentage change occurred in Discovery. CONCLUSION: These data support the use of intentional course design based on a recognized EBP model to improve perceived EBP competencies in Master of Science in Nursing students. [J Contin Educ Nurs. 2019;50(2):79-86.].

Extern Programs Promote Confidence and Reduce Anxiety With Clinical Decision Making in Nursing Students.

BACKGROUND: Clinical decision making (CDM), expected of professional nurses, affects patient outcomes but is arduous for nursing students to learn. Psychological barriers (low self-confidence [SC] and high anxiety with CDM) have an impact on its achievement. Externship programs help mitigate these barriers. PURPOSE: The aim was to examine the impact of summer employment (nurse extern [NE], nursing assistant, and non-health care employed) on students' confidence and anxiety with CDM. METHODS: The study used a quasi-experimental before-and-after design using the Nursing Anxiety and Self-Confidence with Clinical Decision Making scale. Associate and baccalaureate degree students (N = 134) from 2 nursing and 2 extern programs were included. RESULTS: The NEs reported significantly increased SC (F = 14.02, P < .001) and reduced anxiety (F = 8.64, P < .001). Nonsignificant improvements were noted in other groups. CONCLUSIONS: Externships appear to enhance students' SC and lessen their anxiety with CDM.

Effect of Increased Evaluation Objectivity on Grade Inflation: Precise Grading Rubrics and Rigorously Developed Tests.

This retrospective, comparative study examined the effect of increasing objectivity of evaluation methods on grade inflation in a graduate nursing research course. Multiple-choice testing and increased precision in grading rubrics were added to the course. Outcome measures of student grade distributions for the course were measured pre/post course revision. Statistically significant reductions in grade distributions were observed after course evaluation method revisions were implemented (U = 4575.0, P < .001).

Accuracy of intuition in clinical decision-making among novice clinicians.

AIMS: To assess the reliance on intuitive and analytical approaches during clinical decision-making among novice clinicians and whether that reliance is associated with accurate decision-making. BACKGROUND: Nurse educators and managers tend to emphasize analysis over intuition during clinical decision-making though nurses typically report some reliance on intuition in their practice. We hypothesized that under certain conditions, reliance on intuition would support accurate decision-making, even among novices. DESIGN: This study utilized an experimental design with clinical complication (familiar vs. novel) and decision phase (cue acquisition, diagnosis and action) as within-subjects' factors, and simulation role (observer, family, auxiliary nurse and primary nurse) as between-subjects' factor. METHODS: We examined clinical decision-making accuracy among final semester pre-licensure nursing students in a simulation experience. Students recorded their reasoning about emerging clinical complications with their patient during two distinct points in the simulation; one point involved a familiar complication and the other a relatively novel complication. All data were collected during Spring 2015. RESULTS: Although most participants relied more heavily on analysis than on intuition, use of intuition during the familiar complication was associated with more accurate decision-making, particularly in guiding attention to relevant cues. With the novel complication, use of intuition appeared to hamper decision-making, particularly for those in an observer role. CONCLUSION: Novice clinicians should be supported by educators and nurse managers to note when their intuitions are likely to be valid. Our findings emphasize the integrated nature of intuition and analysis in clinical decision-making.

Development and validation of a tool to measure self-confidence and anxiety in nursing students during clinical decision making.

Clinical decision making (CDM) is a cornerstone skill for nurses. Self-confidence and anxiety affect the learning and adeptness of CDM. This study aimed to develop and test a quantitative tool to assess undergraduate nursing students' self-confidence and anxiety during CDM. The 27-item Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM) scale is a 6-point, Likert-type tool with two subscales. Two samples of prelicensure associate and baccalaureate nursing students participated in the pilot (n = 303) and main testing (n = 242) phases of the study. Construct validity assessment, using exploratory factor analysis, produced a stable three-dimensional scale. Convergent validity assessment produced positive, moderate, and statistically significant correlations of the tool sub-scales with two existing instruments. Internal consistency reliability was assessed for each subscale (self-confidence, α = .97; anxiety, α = .96). The NASC-CDM scale may be a useful assessment tool for nurse educators to help novice clinicians improve CDM skills.

Increased bisecting N-acetylglucosamine and decreased branched chain glycans of N-linked glycoproteins in expressed prostatic secretions associated with prostate cancer progression.

PURPOSE: Using prostatic fluids rich in glycoproteins like prostate-specific antigen and prostatic acid phosphatase (PAP), the goal of this study was to identify the structural types and relative abundance of glycans associated with prostate cancer status for subsequent use in emerging MS-based glycopeptide analysis platforms. EXPERIMENTAL DESIGN: A series of pooled samples of expressed prostatic secretions (EPS) and exosomes reflecting different stages of prostate cancer disease were used for N-linked glycan profiling by three complementary methods, MALDI-TOF profiling, normal-phase HPLC separation, and triple quadropole MS analysis of PAP glycopeptides. RESULTS: Glycan profiling of N-linked glycans from different EPS fluids indicated a global decrease in larger branched tri- and tetra-antennary glycans. Differential exoglycosidase treatments indicated a substantial increase in bisecting N-acetylglucosamines correlated with disease severity. A triple quadrupole MS analysis of the N-linked glycopeptides sites from PAP in aggressive prostate cancer pools was done to cross-reference with the glycan profiling data. CONCLUSION AND CLINICAL RELEVANCE: Changes in glycosylation as detected in EPS fluids reflect the clinical status of prostate cancer. Defining these molecular signatures at the glycopeptide level in individual samples could improve current approaches of diagnosis and prognosis.

Bronchiolitis obliterans organizing pneumonia.

Bronchiolitis obliterans organizing pneumonia (BOOP) is a diffuse infiltrative pulmonary disorder that has an insidious onset. The patient often presents with flu-like symptoms and radiological findings showing bilateral patchy infiltrates. Histological features show fibromyxoid connective tissue plugs that are evenly spaced in small distal airways and alveolar spaces. Treatment for BOOP is corticosteroid therapy. Critical care nurses must be cognizant of BOOP as a differential diagnosis for patients for whom antibiotic therapy has not resolved symptoms.