Students who witness critical events in the clinical setting: Recommendations for prevention of psychological trauma.

BACKGROUND: Student nurses often do not receive adequate preparation, support, and debriefing related to witnessing or experiencing critical events in the clinical setting. PURPOSE: The purpose of this analysis was to describe the experiences of student nurses who have witnessed critical events in the clinical setting, the support and preparation they received, and staff and faculty actions they perceived as facilitating or hindering their processing of the event. METHODS: This is a sub-analysis of a Straussian Grounded Theory qualitative study. RESULTS: Staff and faculty actions that helped and hindered the processing of the critical event were identified at four time points: pre-event, during the critical event, immediately post-event, and in the days and weeks following. CONCLUSIONS: Students exposed to critical events during their clinical rotations can experience psychological trauma. If unresolved, this can result in new nurses entering the profession already in distress. Preparation and support for witnessing critical patient events should start at the beginning of nursing school. During critical patient events, students need faculty or staff to be actively present to explain the event and support the student throughout the event. Immediate debrief and follow-up is recommended and should continue weeks or months after the event.

Nursing Student Success: A Concept Analysis.

AIM: The aim of this concept analysis was to develop a comprehensive definition of nursing student success. BACKGROUND: Nursing student success has traditionally been viewed as timely program completion and passing the licensure exam on the first attempt. Little consideration has been given to holistic indicators of success that are inclusive of student well-being and mastery of self-care skills. METHOD: Nursing student success was examined using Walker and Avant's eight-step process of concept analysis. RESULTS: This concept analysis defined nursing student success in a holistic manner characterized by the achievement of performance standards, acquisition of nursing knowledge, skills, and competencies, and attainment of educational goals while experiencing a state of personal thriving. CONCLUSION: This concept analysis highlights the need for academic programs and accrediting bodies to embrace holistic perspectives of nursing student success that are inclusive of student well-being and mastery of self-care skills.

Caring in the Context of Risk: Moving Beyond Duty.

Hospital-based nurses face many occupational risks. In the early days of the coronavirus disease-2019 (COVID-19) pandemic, questions were raised regarding nurses' responsibilities to provide care in the context of risk of exposure to this infectious disease. In the United States, these questions were answered relatively swiftly using a deontological framework. If nurses did not have access to appropriate personal protective equipment, they were not duty bound to provide nursing care to patients with a known infection. Another occupational risk hospital-based nurses face is exposure to patient violence. Questions about nurses' responsibilities to provide care in the context of this occupational risk have not been addressed. The purpose of this article is to examine these 2 occupational risks and ethical decision-making frameworks that can be used to answer questions about the provision of nursing care in the face of personal risk. While useful in the context of COVID-19, a duty-based framework seems insufficient to capture the contextual nuances and moral complexity of providing nursing care to hospitalized patients who exhibit violent behavior. Professional duties are explored as are other ethical frameworks. Ethics of the everyday, virtue ethics, and care ethics are introduced as additional perspectives that can help inform nurses' decision-making and actions when they are exposed to occupational risks such as patient violence and COVID-19.

Shaming: A Concept Analysis.

Nurses in a variety of settings frequently use behavior modification strategies to promote health behavior change. Shaming is one such behavior modification tool, but its use in nursing is poorly understood. A concept analysis using Walker and Avant's method was performed. After an extensive literature review, a conceptual definition of shaming is proposed and defining attributes, antecedents, and consequences are presented. Shaming is also differentiated from related concepts often used synonymously such as stigmatization and incivility. Shaming as a behavior modification strategy is incongruous with nursing values and its utilization in nursing warrants further investigation.

Conceptualizing transgender and gender-diverse older adults as a vulnerable population: A systematic review.

BACKGROUND: While extant literature clearly illustrates the negative experiences of transgender and gender-diverse (TGD) people, the intersection between TGD identity and older age in producing vulnerability is poorly understood. The Vulnerable Populations Conceptual Model (VPCM) provides a framework for identifying vulnerable communities. Understanding access to resources, relative risks, and health status experienced by TGD older adults is critical in developing person-centered interventions. METHODS: A systematic review using PRISMA guidelines was used. CINAHL, Medline, PubMed, and PsycINFO were searched for studies published from 2017 to 2022. RESULTS: Of the seventeen articles included, no articles were based from a nursing journal. Synthesis of findings described TGD older adults as a vulnerable population with limited access to resources and several risks leading to poor health status. CONCLUSION: Identifying TGD older adults as a vulnerable population is critical to understand their unique needs. The findings underline implications in nursing education, practice, and research.

Liberal arts and ethics education in nursing: A national survey.

BACKGROUND: Liberal arts education is foundational to nursing yet its integration in nursing curriculum is unknown. Ethics content is crucial in nursing education and holds potential as an area in which integration can occur. Research on the liberal arts and ethics in nursing education is lacking. PURPOSE: The purpose of this study was to conduct an assessment of liberal arts, particularly ethics, education in schools of nursing. METHODS: A cross-sectional, descriptive design was used. An anonymous, online survey was sent to representatives from 871 accredited schools of nursing across the United States. RESULTS: Representatives from 218 schools responded. Most programs covered liberal arts content in pre/corequisites and embedded ethics content. Most faculty members teaching ethics had no ethics training/education. There was a mismatch between what respondents reported as the most important ethics content to cover and the content covered. Common teaching strategies used to deliver ethics content were case studies, textbooks, small group discussions, and lectures. CONCLUSION: Liberal arts content can be disconnected from nursing education. There is a need for consensus regarding ethics education in nursing. There is a need for research related to the integration of the liberal arts and research on ethics in nursing education in general.

Stigmatization in nursing: Theoretical pathways and implications.

Stigmatization of patients exists in nursing and results in less than optimal nursing care and poor patient outcomes. It is also a violation of our code of ethics. In order to eliminate stigmatization from nursing practice, it is necessary to understand how it develops. Two possible theoretical pathways are proposed to explain the development of stigmatization in nursing. These pathways are informed by a conceptual understanding of stigma and theories of professional socialization, professional formation, symbolic interactionism, and social cognitive theory. Re-labeling and role-taking and moral disengagement are proposed as two possible processes that may lead to stigmatization of patients. Both proposed pathways have implications on professional socialization, formation, and the development of professional identity. Devoting attention to and reframing normative behavioral expectations, eliminating labeling, developing empathy, focusing on relationships, and cultivating ethical comportment and moral maturity during nursing formation may reduce the stigmatization of patients by nurses.

Student Nurses' Experiences of Critical Events in the Clinical Setting: A Grounded Theory.

BACKGROUND: Nursing students often experience critical events in the clinical setting and clinical instructors may not be prepared to adequately support them. These students often feel alone and abandoned, increasing their risk of psychological distress. PURPOSE: A grounded theory study was conducted to explore pre-licensure nursing students' experiences of critical events in the clinical setting. Specific attention was paid to understanding how they are prepared for and supported before, during, and after critical events, and their experiences of psychological distress and psychological recovery. METHOD: Strauss and Corbin's Grounded Theory methodology was used for this study. RESULTS: Fourteen undergraduate student nurses from universities in the western United States were interviewed. Ten concepts were identified, and a theory of Student Nurses' Experiences of Critical Events in the Clinical Setting emerged. CONCLUSION: Findings indicate that student nurses need active instructor and/or staff support during critical events, and pre-briefing whenever possible. Debriefing positively affected students' post-event stress response and lack of debrief was associated with post-event psychological distress. Support for students exposed to critical events during clinical experiences should continue in the days, weeks, and months following the event; clinical instructors need to be prepared to provide this support. All faculty members should monitor students for signs of psychological distress and better support students' mental health and emotional wellbeing.

Acute care nurses' attitudes toward nursing students with disabilities: A focused ethnography.

Discrimination towards individuals with disabilities is problematic within nursing. There have been calls to increase diversity in nursing and this includes embracing nurses with disabilities. Increasing diversity in nursing requires increasing diversity among nursing students; in this way, nurse educators are gatekeepers to the profession. Clinical education is a crucial element of nursing education, yet there have been very few studies related to the clinical education of nursing students with disabilities. There have been no studies of attitudes of acute care nurse preceptors toward students with disabilities in the United States. This gap is important as the majority of clinical experiences occur in the acute care environment. Utilizing a focused ethnography, semi-structured interviews were conducted with 20 acute care nurses with at least two years' experience precepting students. While positive feelings about nursing students with disabilities were shared, thoughts and behavioral intentions remained negative. Six themes emerged: safety, barriers, otherness, communicating to meet needs, disclosure, and student versus colleague. Attitudinal barriers are the primary barriers faced by individuals with disabilities in becoming and practicing as nurses. Nurses in practice and education must embrace more inclusive attitudes towards individuals with disabilities.

The moral dilemma of interpreting workplace violence.

Workplace violence is a significant problem in healthcare. It was believed that in the context of patient violence nurses faced a moral dilemma regarding conflicting duties to self and patients. A qualitative study was conducted with nurses who experienced physical violence perpetrated by a patient. The aim was to examine the ethical decision-making process nurses used to determine the "right" course of action. Nurses did not perceive the conflict between these two duties as the primary dilemma they faced. They appreciated their patients' vulnerability and the power differential inherent in the RN-patient relationship and maintained that their primary responsibility was patient safety. Interpretation of the event was the primary dilemma they described. Patient violence was framed as a dichotomous experience: an expected part of the job or a crime. The middle space between these two choices was bounded by a fuzzy, porous, extremely difficult to interpret line. The dichotomous interpretation resulted in a perception of dichotomous responses: do nothing or file criminal charges. Violence in the context of the RN-patient relationship is a complex phenomenon involving a host of factors. We need to direct more attention to this complexity, to individualized responses to workplace violence, and to depolarizing this issue.