A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers.

COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.

Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review.

OBJECTIVE: To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice. DESIGN: Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES: Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment. METHODS: Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics. RESULTS: Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study. CONCLUSION: In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.

Attitudes and Beliefs of Nurses and Nurse Assistants toward Patients with Sickle Cell Disease: A Mixed Methods Study.

BACKGROUND: Pain experienced among individuals with sickle cell disease (SCD) is the primary requirement for hospitalization. PURPOSE: This study examined the relationship of age, race, and years of experience among medical-surgical nurses and nursing assistants to their attitudes in caring for SCD patients and identified barriers that influence pain management care. DESIGN, SETTING, PARTICIPANTS: An explanatory sequential mixed-methods study design was used. Online survey data were collected among 56 participants and online interviews were conducted among three participants. METHODS: The General Perceptions of Sickle Cell Patients (GPSCP) Scale-17, composed of four subscales, assessed providers attitudes toward patients with SCD. Two subscales assessed providers' attitudes behaviors related to acute and chronic pain management. RESULTS: There was no relationship between age and years of experience to scores on four subscales. White/Caucasian study participants scored higher on the Red Flag Behaviors subscale, indicating that White/Caucasian participants had stronger beliefs concerning drug-seeking behaviors among SCD patients as compared to other ethnicities/races. Themes generated from the qualitative interview data analysis were: 1) reflections on one's own practice compared to others' practice; 2) communication as a barrier/facilitator to providing care; 3) lack of national guidelines; and 4) adjunct staff are critical to facilitating holistic care. CONCLUSIONS: Racial and ethnic differences exist among medical-surgical nurses and nursing assistants' attitudes. Poor communication and lack of national standards of care are barriers to providing high quality care. CLINICAL IMPLICATIONS: Culturally sensitive care, based on current practice guidelines, is needed for improved pain management care for patients with SCD.

Role Clarity and Interprofessional Colleagues in Psychological Safety: A Faculty Reflection.

SUMMARY STATEMENT: Psychological safety in high-fidelity simulation-based experiences ensures that learners feel safe with new experiences in the service of learning. This article is a faculty reflection on breaches in the psychological safety among nursing students in 2 independent, high-fidelity simulation-based experience studies that were conducted in 2019. Demonstrated breaches in psychological safety included fear and anxiety in the sole provider role in multiple-patient simulations and incivility directed toward nursing students in a primary nurse role in interprofessional simulations. This article adds to the growing literature on psychological safety by sharing important lessons learned regarding role clarity and interprofessional colleagues, proposing recommendations, and providing suggestions for future research on psychological safety.

An Integrative Review: The Evolution of Provider Knowledge, Attitudes, Perceptions and Perceived Barriers to Caring for Patients with Sickle Cell Disease 1970-Now.

Approximately 100,000 Americans have sickle cell disease (SCD). In the USA, the majority of patients with SCD are of African descent. Due to persistent racial and ethnic disparities in healthcare in the USA, patients with SCD experience disproportionately more health inequities because of providers' implicit biases regarding patient race. Lack of access to health insurance, lack of transportation to healthcare providers, and inadequate provider knowledge contribute to the morbidity and mortality of patients with SCD. The purpose of this integrative review was to analyze and synthesize the literature on providers' knowledge, perceptions, beliefs, and attitudes toward patients with SCD. A modified (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) method was used to conduct a comprehensive review of the literature yielding 31 publications included in this review. Three connected, yet distinct areas of focus were identified: (1) providers' knowledge, attitudes, and perceptions of patients with SCD; (2) providers' perceived or true barriers to caring for patients with SCD; and (3) interventions to improve providers' attitudes, perceptions, and care of patients with SCD. In each area of focus, research has evolved over time. Also included in this integrative review is a synthesis of measurement instruments used to assess provider knowledge, attitudes, perceptions, and perceived and true barriers to caring for patients with SCD. Adolescents with SCD who are transitioning from pediatric to adult care are at a particularly high risk for morbidity and mortality, so this review focused on the many opportunities that exist to advance the healthcare for young adults with SCD to improve patient outcomes later in life. This includes improving providers' knowledge, perceptions, beliefs, and attitudes, and lessening the real or perceived barriers to care for patients with SCD.

Physical, Mental, and General Health Outcomes Among Childhood Cancer Survivors From the Behavioral Risk Factor Surveillance System Survey.

OBJECTIVES: To examine the physical, mental, and general health among young adult childhood cancer survivors (CCS). SAMPLE & SETTING: This secondary analysis study used data from the Behavioral Risk Factor Surveillance System. The analytic sample included 697 young adult CCS (537 women; 160 men). METHODS & VARIABLES: Chi-square tests of independence were done to compare the rates across cancer survivorship groups on categorical variables. Logistic regression was performed to determine correlates with physical, mental, and general health. RESULTS: Female CCS had a significantly (p < 0.0001) greater number of "no days" in which they reported good physical, mental, and general health compared to male CCS. Female CCS were more likely to experience 30 days of poor physical health compared to male CCS (odds ratio [OR] = 1.8, p < 0.05) when controlling for education, race, and age. Depressed female CCS had higher odds of being in poor physical, mental, and general health (OR = 2.9, 7.6, and 2.6, respectively). IMPLICATIONS FOR NURSING: Findings support the need for continued screening, following published practice guidelines, among young adult female CCS for emotional distress with the use of well-established distress and psychosocial assessment measures.

Disparities in High School Graduation by Identity and Disability Using Intermediate and Long-Term Educational Outcomes.

Multiple factors influence a student's success in high school graduation. Individual factors such as disability, racial or ethnic identity, and gender may result in inequity in the school environment, interfering with learning and possibly leading to poorer educational outcomes. This secondary analysis of student educational records (N = 3,782) from 2008-2018 tested the associations among the disability, racial or ethnic identity, gender, and 5th grade attendance on high school attendance and graduation. Linear and logistic regression analysis identified students without a disability had a 40% greater chance of graduation (AOR = 1.4 [95% CI = 1.15, 1.71]) than those with a disability. Students identifying as Black, Hispanic, or Native American had half the odds of graduating compared to White students. When controlling for 9th grade attendance, these disparities decreased. Attendance in 5th grade, disability, and racial and ethnic identity influenced attendance, being on track to graduate, and high school graduation.

The Use and Effect of the Health Storylines mHealth App on Female Childhood Cancer Survivors' Self-efficacy, Health-Related Quality of Life and Perceived Illness.

BACKGROUND: mHealth apps have been not been well tested among childhood cancer survivors (CCSs) to track physical and psychosocial functioning for improved self-management of post-treatment needs. OBJECTIVES: This pilot study had 3 aims: (1) assess the usage of the Health Storylines mHealth app; (2) examine its effect in improving self-efficacy in managing survivorship healthcare needs, health-related quality of life, and perceived illness; and (3) determine if app usage moderated the effects on the above patient-reported outcome measures among female CCSs. METHODS: Study participants accessed the Health Storylines mHealth app on their own personal device. This single-group, pilot study included 3 measurement points: baseline and 3 and 6 months after initiation of using the app. RESULTS: Use of the mHealth app ranged from 0 times to 902 times. Every study participant who used the app (n = 26) also used the mental health app component of the Health Storylines app. Generalized estimating equations were fit to examine the effect of the mHealth app use on self-efficacy, perceived illness, and health-related quality of life, between baseline, 3-month follow-up, and 6-month follow-up. No statistically significant changes were evident, on average, from baseline to 3- or 6-month follow-up on any outcome. Subsequent testing of effect moderation showed differential trends for high versus low users. CONCLUSIONS: Studies are needed among this clinical population to determine who will benefit and who will perceive the app as a useful aspect of their survivorship care. IMPLICATIONS FOR PRACTICE: Sharing mental health functioning tracked on mhealth apps with healthcare providers may inform needed interventions for young adult female CCSs.

Explaining the Variability in School Nurse Workload and Educational Outcomes.

This secondary analysis examined the variability in the effects of school nurse workload on individual student outcomes of 9th grade attendance, being on track to graduate, and high school graduation. A principal axis factor analysis of the variables underlying school nurse workload and a structural equation model of the latent construct school nurse workload in 5th grade and the three outcome variables was tested using data from student records (N = 3,782). Two factors explained 82% of the variability in school nurse workload: acuity and volume factor and social determinants of health factor. The model had acceptable fit indices and school nurse workload explained between 35% and 52% of the variability in the outcomes with a moderate effect size (.6-.72). Creating school nurse workload assignments that maximize student educational outcomes may improve graduation from high school, which in turn increases the resources available for lifelong health.

A Quantitative Research Study Protocol to Advance Simulation Science in Nursing Education.

AIM: This article describes a quantitative simulation study protocol and identifies important methodological considerations for future high-level, rigorous quantitative simulation studies. BACKGROUND: Quantitative simulation research studies have been found to be lacking in their conceptualization, study design, and measurement of outcomes, with small samples and lack of rigor in overall study methods. METHOD: This protocol reflects research priorities of organizations that drive simulation science and nursing education, published standards of simulation best practice, and use of research methodology within and outside the simulation literature, which includes psychometrically sound instruments and outcomes of importance to cognitive and simulation science. RESULTS: The protocol was a multisite, longitudinal study, guided by the integrative model of clinical judgment, with a high degree of intervention fidelity to measure the study outcomes of clinical judgment and clinical competence. CONCLUSION: To advance simulation science, rigorous study protocols, reflective of the one described in this article, are needed.

Learning environment and evidence among professionals and students satisfaction (LEAPS), experienced during the COVID-19 pandemic.

The COVID-19 pandemic required schools to transition courses to an online platform. This shift to Emergency Remote Teaching (ERT) created gaps in the literature about its impact on students. The purpose of this study was to test the relationship between learner and instructional attributes and learner satisfaction with ERT. A modified version of the Student Satisfaction Survey assessed learner and instructional attributes and learner satisfaction among a convenience sample of 12 graduate and 83 undergraduate nursing students. Open-ended questions assessed students' responses to their satisfaction with ERT. Multiple regression analysis was used to test associations of learner and instructional attributes with student satisfaction. Overall satisfaction with ERT was neutral with a mean of 2.76 on a 1 to 5 scale; students rated instructional attributes higher with a mean of 3.64. Instructional engagement/technology use (single factor) and learner technology competence were associated with student satisfaction, beta = 0.93(0.09), p<.001; beta = 0.24(0.09), p = .008, respectively. Between-class technology use and prior experience with online courses were not associated with student satisfaction, beta = -0.08(0.09), p = .379, beta = 0.26(0.15), p = .079, respectively. Qualitative findings revealed faculty engagement was a major determinant in learner satisfaction with ERT. Supporting faculty competence for the use of technology may increase learner satisfaction with ERT.

Internal Reliability Estimates of the Lasater Clinical Judgment Rubric Among New-to-Practice Nurses in a Simulated Setting.

ABSTRACT: Clinical judgment among new-to-practice nurses is critical for safe patient care. The Lasater Clinical Judgment Rubric (LCJR) is a known instrument in undergraduate nursing education research. This study evaluated the internal consistency reliability and changes in the LCJR in a sample of 17 new-to-practice nurses in a simulated setting across four measurements. Cronbach's alpha reliability for the LCJR was .90. Effect sizes (η2) ranged from .01 to .45, with only the reflecting subscale demonstrating an effect. Study team and study participants' self-ratings on the LCJR were compared; team members' ratings were significantly lower than participants' self-ratings.

Efficacy of a Simulation Program to Improve Clinical Judgment and Clinical Competence Among Graduate Nurses.

AIM: This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses. BACKGROUND: Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses. METHOD: Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points. RESULTS: The simulation program had a large effect on the intervention group's clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time. CONCLUSION: Replication of the study with a randomized controlled trial and large sample size is warranted.

Primary school classmate characteristics and school nursing predicting graduation from high school.

OBJECTIVES: To examine how primary school context variables, such as total students in the school, students with disability, and aspects of school nurse workload, predict later educational outcomes of high school attendance, being on-track to graduate, and graduation. METHODS: This secondary analysis of 3,782 student records from 2008 to 2018 was conducted using United States public-school district data. RESULTS: Classmate attendance in fifth-grade predicted being on-track to graduate (adjusted odds ratio [AOR] = 1.42 [95% confidence interval [CI] = 1.27, 1.60]) and graduation (AOR = 1.14 [95% CI = 1.03, 1.26]). School nurse workload aspects affected being on-track to graduate: (low-income students per school nurse [AOR = 0.77 [95% CI = 0.70, 0.85]; total students per school nurse [AOR = 1.3 [1.18, 1.44]) and graduation (low-income students per school nurse [AOR = 0.82 [95% CI = 0.75, 0.90]; total students per school nurse [AOR = 1.4 [1.26, 1.57]). CONCLUSION: Characteristics of the school population such as classmate attendance and students with limited resources per school nurse are areas for future interventions as they affect student educational outcomes and lifelong health.

The Design and Validation of Three Interprofessional Simulations: A Feasibility Study.

ABSTRACT: This article provides pragmatic guidance on how to operationalize the INACSL Standards of Best Practice: SimulationSM. The purpose of this feasibility study was to determine content validity and intervention fidelity of three interprofessional simulations where clinical judgment is required to provide care to simulated patients. The process met all 11 criteria of the INACSL standards. The mean item-content validity indices for the scenarios ranged from .98 to 1. The scale-content validity indices ranged from .86 to 1. These findings advance the science of simulation design as an exemplar of the integration of best practices in simulation.

A theory analysis of Mastery Learning and Self-Regulation.

This analysis examines the applicability of Mastery Learning and Self-Regulation theories as a combined approach to nursing education. The conclusion may serve as a foundation for an innovative, evidence-based approach to teaching nurses resulting in improved patient care and outcomes. Mastery Learning promotes a teaching approach that supports achievement of content taught. Self-Regulation describes individual student's actions or behaviors that promote learning. The effectiveness of Mastery Learning has been documented in current healthcare literature. Research on Self-Regulation, primarily conducted among students from middle-school through graduate education, confirms that Self-Regulation strategies can enhance skill development and promote job performance. The evidence is void of analysis of the two theories. Literature reviewed was retrieved from ERIC, CINAHL, PubMed, PsycINFO and Sage Premier, for the years 1968-2014. Search terms included: mastery learning, self-regulation and nursing education. Walker and Avant's (2011) Strategies for Theory Construction in Nursing was used as the framework for the analysis. This analysis supports the applicability of both Mastery Learning and Self-Regulation Theories to nursing education. Conducting educational research on the application of Mastery Learning theory and its influence on Self-Regulating practices might reveal a new approach for how nurses are educated resulting in improved patient care outcomes.

The Realities of Collaboration: An Academic and Practice Partnership in Simulation Education With Nurse Residents.

This article details the collaborative effort between a team of academic nurse educators with educators in a practice setting in the planning and implementation of a simulation-focused study to develop clinical judgment and clinical competency among new-to-practice nurses enrolled in a nurse residency program. Competing priorities between achieving the aims of the study and initiatives within the healthcare system are detailed, and suggestions for future joint research-focused efforts between academic and practice-based educators are offered.

Nurse Educators' Guide to Clinical Judgment: A Review of Conceptualization, Measurement, and Development.

AIM: The purpose of this article is to define clinical judgment, examine valid and reliable instruments to measure the construct, review established strategies by which to develop it, and propose key future nursing education research priorities in clinical judgment. BACKGROUND: A pressing interest in prelicensure nursing students' clinical judgment development has emerged in response to the National Council of State Boards of Nursing project Next Generation NCLEX. METHOD: Sequential literature reviews uncovered six instruments that measure clinical judgment and 24 studies that demonstrate the effects of high-fidelity simulation on clinical judgment in prelicensure learners. RESULTS: Six themes emerged: number of simulation-based experience exposures, specific nursing specialty simulations, debriefing and its effect on clinical judgment, assessment, clinical decision-making, and reflection. CONCLUSION: Based on these results, key future research priorities investigating the effects of interprofessional simulation and simulation in the classroom were identified.

Palliative care knowledge and self-awareness in active and observing undergraduate nursing students after end-of-life simulation.

AIM: The purpose of this quasi-experimental one-group repeated measure (pre-test/post-test) study was to determine the effect of an end-of-life (EoL) simulation-based experience (SBE) on active and observer nursing students' palliative care knowledge and self-awareness. BACKGROUND: Baccalaureate nursing (BSN) graduates must demonstrate competence in EoL care; however, gaining EoL experience is challenging given constraints on nursing faculty and clinical sites. Research also is needed to determine whether similar outcomes are achieved by active and observer participants after EoL SBE. METHOD: Senior-level BSN students' palliative care knowledge and self-awareness of active and observer participants were measured before and after an EoL SBE. RESULTS: Knowledge and self-awareness increased (P<0.001) post-SBE in all participants, with equivalent post-test scores (P≥0.248) for active (Mattitude=130.1; Mknowledge=80.5) and observer (Mattitude=128.3; Mknowledge=77.9) participants. CONCLUSION: EoL SBE is an effective method for increasing student palliative care competence. Student observers benefit as much as active participants on knowledge and self-awareness outcomes.

Childhood Disability and Educational Outcomes: A Systematic Review.

PROBLEM: Graduation from high school is an important milestone for all adolescents and affects future health in adulthood. Children with chronic illnesses have additional challenges that affect school attendance, grade retention and graduation. If children with chronic conditions are not able to participate fully in education, this may limit their opportunities for future health. The aim of this study was to integrate the evidence in the past 28 years about educational outcomes of children and adolescents with chronic conditions causing disability. ELIGIBILITY CRITERIA: Quantitative studies reporting on a chronic condition and attendance, grade retention, or high school graduation, from a peer-reviewed journal in the English language, data collection since 1990, and research conducted with a population in the United States were eligible for review. SAMPLE: Forty-three studies from a literature search of CINAHL, MEDLINE, ERIC, Teacher Reference Center, Psychology & Behavioral Science Collection, and Academic Search Elite databases, followed by ancestry searches, were included in this review. RESULTS: In general, chronic conditions are significantly associated with increased absenteeism, grade repetition and not completing high school within four years, although hemophilia does not follow this pattern. Additionally, increased severity of the condition is associated with poorer educational outcomes. CONCLUSIONS: Nurses and other healthcare providers should include an educational assessment as part of psychosocial assessment of children and adolescents to identify risk, intervene early and limit risk.