A comparison of competencies between problem-based learning and non-problem-based graduate nurses.

Competence is essential to ensuring safe, ethical and legal nursing practice. Various teaching strategies are used in nursing education in an effort to enhance graduate competence by bridging the gap between theory learned in the classroom and professional practice as a nurse. The objective of this comparative descriptive research was to determine if there was a difference in self reported competence between graduates from PBL and non PBL (NPBL) nursing programs. A convenience sample of 121 graduate nurses in one Canadian province, who had been practicing for at least 6 months took part in the study. The researcher designed questionnaire included both forced choice and open ended questions. There was no statistical significance difference between the PBL and NPBL graduates on self reported entry-to-practice competence. However, several significant themes did emerge from the answers to open ended questions which asked graduates how their nursing programs prepared them to meet the entry-to-practice competencies and what program improvements they might suggest. Unlike the NPBL graduates, the PBL graduates identified the structure and process of their programs as instrumental in their preparation to meet the entry-to-practice competencies. PBL graduates associated their abilities to think critically and engage in self-directed evidence-based practice as key to enabling them to meet the competencies. A common theme for program improvement for both PBL and NPBL graduates was a request for more clinical time.

Employer perceptions of knowledge, competency, and professionalism of baccalaureate nursing graduates from a problem-based program.

Employer evaluation of graduates is a critical component of professional program evaluation and contributes a viewpoint rarely reported in the literature. It has been proposed that Problem-Based Learning (PBL) enhances knowledge acquisition, clinical competency and professional behavior. Students assume the role of a registered nurse as they work through real practice scenarios on a daily basis in the classroom. The purpose of this study was to explore employer perceptions of graduates' knowledge, competency and professionalism, following completion of a PBL program. Nurse employers (N=53) participated in 10 focus group discussions. Four main themes were derived from employer descriptions of their experience with PBL graduates: still rough around the edges, we want them to succeed, a new generation of practitioner, and potential to lead the profession into the future. Please add what the implications of these findings are to nursing education.

Undergraduate nursing students' knowledge of and attitudes toward aging: comparison of context-based learning and a traditional program.

The purpose of this study was to investigate nursing students' knowledge of and attitudes toward older adults in the first and fourth years of a baccalaureate program, following the introduction of a context-based learning (CBL) curriculum, and to compare the fourth-year CBL student findings to those of fourth-year students in the final year of the traditional, lecture-based baccalaureate program. The Facts on Aging Questionnaire was used to assess knowledge, and the Aging Semantic Differential was used to assess attitudes toward aging related to societal influences. Although there were differences in knowledge and attitudes between fourth-year CBL and fourth-year traditional students, the differences were not significant. These findings support earlier work that an integrated curriculum may not significantly improve knowledge of age-related changes nor positively influence attitudes that are already positive. The Reactions to Ageing Questionnaire was used to examine students' attitudes toward personal aging. There was a significant positive increase in CBL students' attitudes toward personal aging from the first to fourth years of the program. This suggests that CBL learning fosters an inner maturity toward personal aging.

Challenges for new nurses in evidence-based practice.

AIM: The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment. BACKGROUND: These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care. EVALUATION: This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them. KEY ISSUES: The key issues relate to the need to support new nurses in evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process. CONCLUSIONS: We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice.

Perceptions of patient education in spinal cord injury rehabilitation.

PURPOSE: Patient education is a key part of spinal cord injury (SCI) rehabilitation with the goal of preparing persons with SCI to meet life's daily challenges. The purpose of this study was to evaluate experiences of the patient education program from the patients' perspective. METHODS: The qualitative design of this study involved a semi-structured interview format to gather descriptive information relevant to the aspects of the patient education program identified to facilitate or impede learning. Twenty-two patients participated in the individual interviews. RESULTS: The framework that emerged from the analysis of the interview transcripts included a total of six main categories, two subcategories and two main themes. There were two central categories of Need to know and Information access and delivery that were influenced by categories of: Learning readiness, Learning affects, Problem exploration and Family involvement. The category of Information access and delivery included two subcategories labeled Resources and Learning strategies. From these categories the main themes of Learning partnership and Individuality were identified. CONCLUSIONS: This research provides valuable information from the patients' perspective that may be used to enhance patient education programs. The importance of incorporating principles of adult learning is highlighted.

Professional socialization: students becoming nurses.

Usually colleges are evaluated by the quality of the knowledge and technical training offered to the students. Little attention is given to the acquisition of the values, behaviors and attitudes necessary to assume their professional role. This exploratory study aims to increase understanding of the professional socialization process that occurs at nursing schools and the results obtained through the socialization of professional values and standards. The educational experience of nursing students involves more than a body of scientific knowledge and the acquisition of abilities to provide care to patients. Questionnaires were filled out by 278 students of two public Nursing Schools in São Paulo state, 164 in school A and 114 in school B. The results indicated that some professional values, norms and behaviors are influenced by College years, studying at a College of Nursing during four years leads to a difference in values, norms and professional behavior.

Socialização profissional: estudantes tornando-se enfermeiros

Habitualmente, as faculdades são avaliadas pela qualidade do conhecimento e treinamento técnico propiciados ao estudante e pouca atenção é dada à aquisição dos valores, comportamentos e atitudes necessários para assumir seu papel profissional. Este estudo exploratório tem o objetivo de aumentar a compreensão do processo de socialização profissional que ocorre nas faculdades de enfermagem e dos resultados obtidos através da socialização dos valores e normas profissionais. A experiência educacional vivenciada pelos estudantes de enfermagem envolve mais do que um corpo de conhecimentos científicos e a aquisição de habilidades para cuidar do paciente. Uma amostra de 278 estudantes de duas faculdades públicas de enfermagem no estado de São Paulo preencheu questionários, 164 da faculdade A e 114 da faculdade B. Os resultados indicam que alguns valores, normas e comportamentos profissionais são influenciados pelo tempo de permanência na escola, e que estudar durante quatro anos em uma faculdade de Enfermagem leva a diferenças de valores, normas e comportamentos profissionais.

Evaluation of patient education in spinal cord injury rehabilitation: knowledge, problem-solving and perceived importance.

PURPOSE: Through inpatient education programmes the person with spinal cord injury (SCI) learns to understand and monitor his or her own physical, emotional and social well-being. The purpose of this study was to determine the patients' knowledge and problem-solving skills regarding SCI at admission, discharge and follow-up at 6 months after discharge; and to determine the perceived importance of each content topic included in the education programme. METHODS: A one-group repeated measures design was used to evaluate the outcomes. Knowledge was evaluated with a Multiple Choice Questionnaire (MCQ). Problem-solving ability based on participants' responses to Life Situation Scenarios relevant to each topic area was rated on a standardized four-point criterion reference scale. Perceived importance for each topic area was rated on a five-point Likert scale. RESULTS: Twenty-three participants completed all assessments. There was significant improvement in MCQ scores from admission to discharge (P = 0.04) and admission to follow-up (P = 0.02). For problem-solving ability, there was a trend toward improvement in all content topics with significant improvement from admission to follow-up for the topic of bowel care (P = 0.004). However, many participants continued to demonstrate poor problem-solving ability. Bowel, Bladder and Skin Care were consistently perceived as the most important education topics. CONCLUSIONS: Improvements in knowledge do not necessarily translate to improvements in problem-solving ability even for the topics perceived as important. This may indicate the need to incorporate more active learning strategies or contextually based strategies within patient education programmes to facilitate the transfer of knowledge within life situations.

Preparing health science students to be effective health care team members: the InterProfessional Initiative at the University of Alberta.

The InterProfessional Initiative at the University of Alberta in Edmonton, Alberta, Canada, provides learning strategies to be effective health care team members for over 800 undergraduate students in 14 health professions. This paper traces the evolution of the initiative over the past decade and describes future directions. Particular attention is given to the administrative and academic structures and processes required to launch, develop and sustain an initiative of this scale in a major research-intensive university. The paper concludes by reviewing the evaluative work underway and reflecting on the key success factors.

Evidence-based nursing education: myth or reality?

This article explores the concept of evidence-based nursing education. Because nurse educators incorporate evidence-based practice as a basic tenet of their programs, they assume nursing education itself is evidence based. Nursing education has a body of knowledge on which nurse educators base teaching, educational strategies, and curricular designs, but most of this knowledge is tacit, experiential, and based on practice. This knowledge relates to the art of teaching in nursing and can warrant the practice of nurse educators. However, research is also necessary to demonstrate the effectiveness of teaching approaches and strategies. Nurse educators need to develop the science of nursing education through qualitative and quantitative research, to add to the tacit knowledge underpinning nursing education strategies. When the science of nursing education is adequately developed through rigorous research, we will truly be able to say that nursing education is evidence based. Until then, it may be only a myth.

An inventory of nursing education research.

PURPOSE: To describe nursing education research literature in terms of quality, content areas under investigation, geographic location of the research, research designs utilized, sample sizes, instruments used to collect data, and funding sources. DESIGN AND METHODS: Quantitative and qualitative research literature published between January 1991 and December 2000 were identified and classified using an author-generated Relevance Tool. FINDINGS: 1286 articles were accepted and entered into the inventory, and an additional 22 were retained as references as they were either literature reviews or meta-analyses. Not surprisingly, 90% of nursing education research was generated in North America and Europe, the industrialised parts of the world. Of the total number of articles accepted into the inventory, 61% were quantitative research based. The bulk of the research was conducted within the confines of a course or within a program, with more than half based in educational settings. Sample sizes of the research conducted were diverse, with a bare majority using a sample between 50 and 99 participants. More than half of the studies used questionnaires to obtain data. Surprising, 80% of the research represented in these articles was not funded. The number of publications of nursing education research generated yearly stabilised at approximately 120 per year. CONCLUSION: Research programs on teaching and learning environments and practice in nursing education need to be developed. Lobbying is needed to increase funding for this type of research at national and international levels.

The questioning skills of tutors and students in a context based baccalaureate nursing program.

This paper explores, describes and compares the types and levels of questions asked by 30 randomly selected tutors (nurse educators) and their 314 students in context-based learning tutorial seminars in a Canadian baccalaureate nursing program. Thirty 90-min seminars were audio taped, transcribed and coded using a Questioning Framework designed for this study. The framework includes types and levels of questions, related wording and examples. The results of this study indicate that the majority of questions asked by tutors and students in the first three years of the program were framed at the low level (knowledge, comprehension, and application) and were aimed at seeking yes/no responses and factual information more so than probing. Although these questions are important to facilitate the teaching/learning process, educators and students need to increase the number of questions requiring analysis, synthesis, and evaluation as well as questions that involve probing, exploration, and explanation - questions believed to activate and facilitate critical thinking skills. Recommendations include the need for students and tutors to be taught how to question, the creation of a supportive environment for questioning and the use of appropriate strategies to teach the use of higher order questions. Future research using a cross sectional longitudinal design and qualitative approaches are also recommended. This study has direct implications for enhancing student learning and the development of nurse educators.

A pilot study comparing two methods of intermittent catheterization: limitations and challenges.

Given a complex research design, a pilot study was conducted to compare a closed catheter system for intermittent catheterization to the traditional open system. Based on 33 urine samples for 11 subjects, the closed system yielded fewer positive cultures. Efforts to obtain this preliminary data proved beneficial in identifying unanticipated design limitations that will guide modifications of the main study, which will include multiple centers.

Pathogenesis of urinary tract infections: a review.

Pathogenesis of urinary tract infections (UTIs) is not well-understood. In this paper, we review the current understanding of UTIs, particularly in relationship to individuals using intermittent catheterization. Relationships exist between the human host, infectious agent and the environment. In the human host, the urethra connects the bladder to potential infectious agents on the perineum. A high-pressure zone exists within the urethra at a point where the urethra passes through the urogenital diaphragm. This zone creates a natural barrier to ascent of organisms colonized in the distal urethra and the bladder itself has natural defences against invading organisms. The interaction of host defences with bacteria (infectious agent) determines whether or not the bacteria persist. A small number of bacteria and some types of bacteria are controlled more effectively by natural bladder defence mechanisms and frequent bladder emptying than a large number of bacteria. Escherichia coli, coliforms and enterococci are considered common bacterial causes of UTIs and are found in high numbers on the perineum. Intermittent catheterization is an effective way of bladder emptying but as an invasive procedure it remains a risk factor in the development of UTI.