Clinical Inquiry and Problem Identification.

This is the second article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

National evaluation of DNP students' use of the PICOT method for formulating clinical questions.

BACKGROUND: The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood. AIMS: This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects. METHODS: Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus. RESULTS: Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0-5). LINKING EVIDENCE TO ACTION: Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.

Cultivating an Evidence-Based Decision-Making Mindset.

This is the first article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

National evaluation of DNP projects based on 2015 AACN white paper and 2019 DNP project roadmap.

The AACN expectation to prepare DNP graduates with EBP and QI competencies using the project was clarified with the 2015 White Paper and these expectations have not changed with the new Essentials. Evidence suggests DNP projects continue to be a mix of research and QI. Using the DNP Project Roadmap, we reviewed 214 projects from 120 schools from publicly available sources for the presence of EBP and QI project elements. Of the 27 Roadmap elements evaluated, only two had a significant (p ≤ .05) positive change after the release of the White Paper 1) a question to frame the problem/issue (pre-48.4 %, n = 45, post-64.5 %, n = 78) and 2) an evidence search (pre-26.9 %, n = 25, post-39.7 %, n = 48). Nineteen of the 27 elements had positive change; however, were still not present in >50% of the project papers. These findings can be used to engage in a national conversation on DNP curricular expectations of projects that demonstrate student competency in EBP and QI.

Public Service Announcements: An Innovative Strategy for Introducing Competencies in Population Health.

BACKGROUND: Teaching health concepts using a variety of strategies has been shown to enhance students' critical thinking skills and learning outcomes. Educational strategies highlighting the effects of social determinants of health (SDOH) on communities and populations are considered essential nursing curricula by the American Association of Colleges of Nursing. METHOD: A public service announcement (PSA) assignment was developed and implemented for a community nursing course with approximately 100 students. RESULTS: The PSA assignment was a multifaceted project that incorporated knowledge development (e.g., public health topics, group dynamics, and SDOH factors) as well as skill development (e.g., navigating web-based databases, creating an annotative bibliography, designing developmentally and culturally appropriate educational messages, and conducting self-evaluation and peer-evaluation). CONCLUSION: This assignment allowed faculty to assess 28 subcompetencies of student learning and provided students with the opportunity to explore a population health issue that considered cultural, developmental, and social determinants of health needs. [J Nurs Educ. 2023;62(11):650-652.].

Implementation of a Standardized National HIV Curriculum in a Primary Care Nurse Practitioner Program.

BACKGROUND: Although efforts have been made to improve and integrate an HIV curriculum in schools of nursing, little has been done to standardize the integration of competencies related to HIV care in primary care nurse practitioner (NP) programs. PURPOSE: The purpose of this study was to understand the effect of integrating the 6 core competencies from the National HIV Curriculum (NHC) on NP students' perceived knowledge about HIV care. METHOD: This was a quasi-experimental study with a pre/posttest design that measured NP students' self-perceived knowledge of the 6 core competencies from the NHC. RESULTS: A total of 375 student NHC training sessions were implemented across 5 semesters (fall 2019 through fall 2021 academic years). In each of the 3 courses that integrated the NHC, there were statistically significant increases in student knowledge from pre- to posttest for each of the 6 competencies. CONCLUSION: This project supports using a standardized HIV curriculum as part of primary care NP curricula.

Nursing Student and Faculty Perceptions of Just Culture.

BACKGROUND: Just culture is essential for quality improvement and patient safety. METHOD: This descriptive study measured perceptions of just culture among nursing students and faculty using the Just Culture Assessment Tool for Nursing Education (JCAT-NE). RESULTS: There were no significant differences in JCAT-NE scores for students (M = 133.43, SD = 19.12) and faculty (M = 136.34, SD = 22.73) (t[159] = 0.82, p = .42); however, there were significant differences in JCAT-NE scores based on level of experience. For students, JCAT-NE scores were significantly higher for sophomores than for seniors (F[2, 114] = 4.9, p = .01). For faculty, advanced beginner and competent faculty had significantly higher scores compared with proficient and expert faculty (t[42] = 2.36, p = .02). CONCLUSION: More needs to be done to establish a fair and just culture in schools of nursing. [J Nurs Educ. 2022;61(5):257-260.].

An Integrative Review of the Barriers and Facilitators to Nurse Engagement in Quality Improvement in the Clinical Practice Setting.

BACKGROUND: Nurse engagement in quality improvement (QI) improves health care quality and outcomes but is typically low in clinical settings. PURPOSE: An integrative review was conducted to identify facilitators and barriers of nurse engagement in QI. METHODS: This integrative review was conducted using an electronic search of databases with search terms specific to nursing engagement in QI. The Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide was used to rate quality and level of evidence. RESULTS: Nine articles met the criteria for review. Top barriers were leadership, education and training, resource constraints, data, culture, and time. Top facilitators were leadership, education and training, culture, mentors, and champions. CONCLUSION: High-quality literature exploring barriers and facilitators of nurse engagement in QI is lacking. Research is needed to examine the degree to which these barriers and facilitators impact engagement and how they can be addressed to increase it.

Nursing Students' Perceptions of Just Culture in Nursing Programs: A Multisite Study.

BACKGROUND: While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education. PURPOSE: The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia. METHODS: Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs. RESULTS: The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (χ[2] = 25.09, P < .001). CONCLUSIONS: The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.