How, and under what contexts, do academic-practice partnerships collaborate to implement healthcare improvement education into preregistration nursing curriculums: a realist review protocol.

INTRODUCTION: Internationally, healthcare improvement remains a clinical and educational priority. Consensus in Europe, Canada and the USA to implement quality improvement (QI) education into preregistration nursing curricula ensures students become equipped with the skills and knowledge required to improve practice. Now, New Zealand and Australia are beginning to implement QI education into their nursing curricula. However, QI education is complex; comprising multiple components, each influenced by the contexts under which they are developed and implemented. Evaluation studies of QI education unanimously acknowledge that academic and practice partnerships (APPs) are essential to optimally embed QI into preregistration curricula, yet it is not understood how, and under what contexts, APPs collaborate to achieve this. METHODS AND ANALYSIS: A realist review to determine how, and under what contexts, APPs collaborate to implement QI education in pre-registration nursing will be conducted using the Realist and Meta-narrative Evidence Syntheses: Evolving Standards Guidelines. International stakeholders will be consulted at each stage which includes (1) clarifying the scope of the review through empirical literature and tacit expert knowledge, (2) searching for evidence in healthcare and social science databases/grey literature, (3) appraising studies using the Evidence for Policy and Practice Information and Co-ordinating Centre weight of evidence framework and extracting data using Standards for QUality Improvement Reporting Excellence in Education Publication Guidelines, (4) synthesising evidence and drawing conclusions through the creation of context, mechanism and outcome configurations and (5) disseminating findings through conferences and peer-reviewed publications. ETHICS AND DISSEMINATION: Ethical approval was not required for this study. Findings will be disseminated to international nurse educators, leaders and front-line staff implementing QI education within their own academic and practice contexts through conferences and peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42021282424.

Preadmission predictors for first semester course success in a baccalaureate nursing program.

BACKGROUND: Identifying students' who are able to complete a rigorous course of study, graduate on time, and pass the NCLEX-RN© is a principle role of nursing program admissions teams. PURPOSE: To examine which preadmission factors predict students' success in the first semester of a baccalaureate nursing program. METHODS: Undergraduate students' data from the academic years 2013 to 2017 were analyzed (N = 927). Bivariate and multiple regression analyses were used to examine potential predictors of first semester course success, and scores on standardized NCLEX preparation exams. RESULTS: Preadmission cumulative GPA (OR = 3.82, 95% CI = 1.43-10.16) and prerequisite science GPA (OR = 2.57, 95% CI = 1.14-5.78) predicted success in the pathopharmacology course. Preadmission cumulative GPA (OR = 6.53, 95% CI = 1.59-26.85) and TEAS composite score (OR = 1.15, 95% CI = 1.09-1.22) predicted success in the health assessment course. Preadmission cumulative GPA (OR = 3.42, 95% CI = 1.18-9.92) and TEAS composite score (OR = 1.05, 95% CI = 1.01-1.10) predicted success in the foundations course. Higher preadmission cumulative GPA (B = 14.19, p < 0.01), prerequisite science GPA (B = 12.62, p < 0.01), and TEAS composite score (B = 0.48, p < 0.01) predicted a higher pathopharmacology-KAPLAN, Inc. test scores. Higher preadmission cumulative GPA (B = 62.52, p < 0.01), prerequisite science GPA (B = 61.18, p < 0.01), and TEAS composite score (B = 4.76, p < 0.01) predicted a higher fundamentals-HESI test scores. CONCLUSIONS: Preadmission cumulative GPA, prerequisite science GPA, and TEAS composite score were significant predictors of success in first semester courses and performance on standardized tests.

An evaluation of approaches used to teach quality improvement to pre-registration healthcare professionals: An integrative review.

BACKGROUND: Improving the quality of healthcare remains central to UK and international policy, practice and research. In 2003, The Institute of Medicine's 'Health Professions Education: A Bridge to Quality', advocated quality improvement as a core competency for all healthcare professionals. As a result, developing capacity and capability of those applying improvement methodologies in the pre-registration population has risen, yet, little is known about the teaching approaches employed for this purpose. OBJECTIVES: To describe and analyse educational approaches used to teach quality improvement to pre-registration healthcare professionals and identify enabling and impeding factors. DESIGN: Integrative review. DATA SOURCES: CINAHL, PsychINFO, MEDLINE, ERIC, ASSIA, SCOPUS and Google Scholar were accessed for papers published between 2000 and 2016. REVIEW METHODS: Publications where quality improvement education was delivered to pre-registration healthcare professionals were eligible. One author independently screened papers, extracted data using a modified version of the Reporting of Primary Studies in Education Guideline and evaluated methodological quality using the Weight of Evidence Framework. The Kirkpatrick Education Evaluation Model was used to explore the impact of teaching approaches. Enabling and impeding factors were thematically analysed. A narrative synthesis of findings is presented. RESULTS: Ten papers were included, representing nursing, pharmacy and medicine from UK, Norway and USA. Studies comprised four quantitative, four mixed method, one qualitative and one cluster randomised trial, all allocated medium Weight of Evidence. Teaching approaches included experiential learning cited in all studies, didactics in seven, group work in four, seminars in three, self-directed learning in three and simulation in one. Most studies measured Level 1 of the Kirkpatrick Model (reaction), all but one measured Level 2 (skills, knowledge or attitudes), none measured Level 3 (behaviour) and one measured Level 4 (patient outcomes). Enabling and impeding themes included: Teaching Approaches, Clinical/Faculty support, Information Provision, Curriculum Balance and Data. CONCLUSIONS: Evaluating quality improvement education is complex. Experiential learning combined with didactics is the favoured approach; however, attributing causality to educational intervention proves difficult in light of poor methodological rigour, lack of validated tools and complex clinical settings. Clarity regarding which quality improvement competencies are priority for this population would be useful to streamline future educational development and evaluation. Stronger collaboration between educators and clinicians is recommended to explore the multiple components and contextual factors associated with quality improvement education in practice. Ethnographic enquiry may be a logical next step to advance knowledge within the field.

Time, fear and transformation: Student nurses' experiences of doing a practicum (quality improvement project) in practice.

BACKGROUND: Improving and sustaining quality in healthcare continues to be a global challenge, resulting in the necessity of developing quality improvement (QI) skills and knowledge to use in practice. This paper reports student nurses' experiences of conducting a quality improvement project (Practicum) as a compulsory assessment whilst on clinical placement areas across Scotland. METHODS: Telephone and face-to-face interviews (n = 18) were conducted using a semi-structured interview schedule. Discussions were transcribed verbatim and data were analysed thematically. Data were extracted from Practicum assignments (n = 50). RESULTS: Three key themes emerged from the analysis: 1) Time; students highlighted the necessity of time in practice areas to acclimatise, socialise and conduct the Practicum. Timing of the Practicum within the curriculum was also important. 2) Fear; was experienced by many students at the perceived enormity of the assignment, the bravery needed to attempt to change practice and the adjustment to a unique type of assignment. 3) Transformation; students shared their shifted perceptions on completing a Practicum, including a sense of achievement and acknowledgement of key improvement skills for the future. CONCLUSIONS: Student nurses need to be stretched beyond their comfort zones to rise to the challenge of the Practicum, whilst ensuring adequate support mechanisms are in place from a range of sources.

An evaluation of methods used to teach quality improvement to undergraduate healthcare students to inform curriculum development within preregistration nurse education: a protocol for systematic review and narrative synthesis.

BACKGROUND: Despite criticism, quality improvement (QI) continues to drive political and educational priorities within health care. Until recently, QI educational interventions have varied, targeting mainly postgraduates, middle management and the medical profession. However, there is now consensus within the UK, USA and beyond to integrate QI explicitly into nurse education, and faculties may require redesign of their QI curriculum to achieve this. Whilst growth in QI preregistration nurse education is emerging, little empirical evidence exists to determine such effects. Furthermore, previous healthcare studies evaluating QI educational interventions lend little in the way of support and have instead been subject to criticism. They reveal methodological weakness such as no reporting of theoretical underpinnings, insufficient intervention description, poor evaluation methods, little clinical or patient impact and lack of sustainability. This study aims therefore to identify, evaluate and synthesise teaching methods used within the undergraduate population to aid development of QI curriculum within preregistration nurse education. METHODS/DESIGN: A systematic review of the literature will be conducted. Electronic databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO), Education Resources Information Centre (ERIC), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Applied Social Sciences Index and Abstracts (ASSIA), will be searched alongside reference list scanning and a grey literature search. Peer-reviewed studies from 2000-2014 will be identified using key terms quality improvement, education, curriculum, training, undergraduate, teaching methods, students and evaluation. Studies describing a QI themed educational intervention aimed at undergraduate healthcare students will be included and data extracted using a modified version of the Reporting of Primary Studies in Education (REPOSE) Guidelines. Studies will be judged for quality and relevance using the Evidence for Policy and Practice Information and Co-ordinating Centre's (EPPI) Weight of Evidence framework and a narrative synthesis of the findings provided. DISCUSSION: This study aims to identify, evaluate and synthesise the teaching methods used in quality improvement education for undergraduate healthcare students where currently this is lacking. This will enable nursing faculty to adopt the most effective methods when developing QI education within their curriculum. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42014013847.

The use of imatinib (STI571) in chronic myelod leukemia: some practical considerations.

BACKGROUND AND OBJECTIVES: The new Abl tyrosine kinase inhibitor imatinib (imatinib mesylate, STI571) is very effective in the treatment of patients with chronic myeloid leukemia (CML). It induces complete hematologic control in >90% of patients with CML in chronic phase and preliminary data suggest that the incidence of complete cytogenetic remission may exceed 60% in previously untreated patients, though its capacity to prolong life in comparison with other agents has not yet been clearly established. It is also active in the management of patients in advanced phases of CML. INFORMATION SOURCES: We present here provisional indications for the use of imatinib in CML patients and give details of the dosage regimens we have used and side-effects we have encountered. STATE OF THE ART AND PERSPECTIVES: It is likely that the optimal usage of this important new agent will become better defined as more experience is gained.