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 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.

Fostering completion of the doctor of philosophy degree through scholarly collegial support.

The doctor of philosophy (PhD) degree in nursing science prepares nurses to be scientists through a rigorous program of scholarship and research. Nurses who complete this degree are recognized globally as researchers who are expected to pursue a career of intellectual inquiry. Today, the internationally small cohort of PhD-prepared nurses contributes empirically to the generation and development of nursing science. There is currently a shortage of doctorally prepared nurses to meet the increased demands for researchers and educators in schools of nursing and experts in patient care. The Institute of Medicine has recommended doubling the number of doctorally prepared nurses by 2020 and has emphasized that nurses achieve higher levels of education and training through an improved educational system that promotes seamless academic progression. However, in the United States, the overall PhD completion rate is only 57%. This article reports on the process undertaken by a collegial support group of students in a PhD in nursing science program who encouraged each other's progress through the dissertation process within a calendar year.

Mothers and daughters: intertwining relationships and the lived experience of breast cancer.

No relationship is more profound than the positional mother- daughter dyad. Each shares a physical, emotional, and spiritual link not experienced by others. The intrusion of breast cancer alters this normative dyadic relationship. In this article we explore this change through a hermeneutic reflective narrative inquiry, incorporating Bakhtinian dialogism, of the behavioral science literature, popular press, and other resources, and use of the motet to uncover the lived experience of women in this dyadic relationship.

Rediscovering.

The aim of this hermeneutic phenomenological inquiry was to explore the lived experience of aging for late-midlife women via reflective journaling and a photo elicitation interview, and to demonstrate how the creation of a collage allows women to make meaning of the aging experience. Using van Manen's philosophical framework, four themes were discovered: Invisibility, Conflicted Self, Freedom, and Relationality. Invisibility was expressed by the women as disregard, not being seen by others, or overlooked in daily activities. Conflicted Self involved the conflict between the inner being and the outer physical body. Freedom related to the ability to let go of others' expectations and allow themselves to be the people they were in their own reality. Relationality was the interconnectedness the women felt with family, friends, and colleagues, and the changes in these relationships. The women's narratives and collages portrayed a holistic picture of aging, not confined to decline but rather a life of anticipation.

Collaborative testing: assessing teamwork and critical thinking behaviors in baccalaureate nursing students.

The purpose of this study was to foster teamwork and critical thinking behaviors in baccalaureate nursing students using a collaborative testing environment. Collaborative testing affords the nurse educator a unique opportunity to actively influence the development of critical thinking skills directly influencing the nursing student's ability to solve complex patient problems. Using a quasi-experimental approach exam scores from students in prior semesters were compared to students in several semesters using collaborative testing in one undergraduate course taught by the same faculty. In the experimental group collaborative testing was used in the two unit examinations, while the final examination remained individual. For collaborative testing the students were grouped by random assignment. They were not allowed the use of notes, textbooks, or other resource materials. Any student who wished to work alone was allowed do so and any student coming late (within 15 min of examination beginning) was required to work alone. Each student submitted individual examination answer forms, and groups were not required to reach consensus. Collaborative testing is one means to foster critical thinking by allowing students to solve complex patient problems within an examination environment. This better prepares them for national certification exams.

Creating the self: exploring the life journey of late-midlife women.

Studies on aging reflect the losses inherent in the aging process. How the aging process is viewed, either as a loss or as a natural process of living, may affect the adaptation by late-midlife women to life changes. Self-transcendence is a means of broadening one's perspective of the inner being. This article explores the meaning of life transitions, the role of life-course development, self-transcendence, and creativity in the evolution of the inner being as women age.