Learning Nursing Skills of Practice Virtually: The Rough Ground of Engagement.

BACKGROUND: In spring 2020, nursing education programs abruptly transitioned the teaching and learning of nursing practice skills to virtual environments as the result of the coronavirus disease 2019 (COVID-19) pandemic. METHOD: This study sought to describe ethnographically how faculty and students formed and integrated clinical judgment and other nursing practice skills within this quickly formed virtual subculture. Thirty-seven associate-degree nursing students participated in small group interviews, and four faculty participated in one-to-one interviews. RESULTS: Two overarching themes were identified: (1) the pervading mood of learning through the pandemic; and (2) the primacy of the nursing traditions of direct care experience. Themes were nested further within the five essentials for human learning: curiosity, authenticity, emotion, sociality, and failure. CONCLUSION: Virtual simulation cases with focused prebriefing and debriefing sessions provided experiences that were targeted, shared, guaranteed, and safe. Adequately supported virtual simulation platforms can enhance the learning of nursing skills. [J Nurs Educ. 2023;62(10):541-547.].

Experiences of critical care nurses during the early months of the COVID-19 pandemic.

BACKGROUND: Critical care nurses have risked their lives and in some cases their families through hazardous duty during the COVID-19 pandemic and have faced multiple ethical challenges. RESEARCH/AIM: The purpose of our study was to examine how critical care nurses coped with the sustained multi-faceted pressures of the critical care environment during the unchartered waters of the COVID-19 pandemic. It was anticipated that our study might reveal numerous ethical challenges and decision points. RESEARCH DESIGN: A qualitative descriptive study, utilizing an interpretivist paradigm. PARTICIPANTS AND RESEARCH SETTING: Critical care nurses, working in either intensive care units or emergency departments (N = 11) who were primarily from Northern California hospitals. Individual in-depth ZOOM® session interviews, guided by semi-structured questions, were used to collect data. Interviews lasted between 18 and 59 min, with an average length of 33 min. Session interviews were transcribed and analyzed. ETHICAL CONSIDERATIONS: This study was approved by the researchers' university Institutional Review Board. FINDINGS: Five main themes emerged: Fear of the Unknown, Adapting to Practice Changes and Challenges, Patient Advocacy and Moral Distress, Isolation and the Depersonalization of Care, and Professionalism and a Call to Duty. DISCUSSION AND CONCLUSION: Fear of becoming ill or bringing COVID-19 home to their families was a constant source of anxiety for nurses. There were numerous changes in policy and challenges to standard practice protocols, including most notably shortages in personal protective equipment, which nurses navigated resourcefully. Most nurses interviewed were motivated by a sense of professional duty. The nurses experienced some moral distress in their inability to advocate as they might like for their patients, especially at end of life. Infection control requirements for isolation.

Utilizing an SBAR Workshop With Baccalaureate Nursing Students to Improve Communication Skills.

This study evaluated the effectiveness of the Situation-Background-Assessment-Recommendation (SBAR) technique to reduce anxiety and increase self-confidence levels regarding health care communication among undergraduate nursing students. Baccalaureate nursing students (n = 35) completed anxiety and self-confidence questionnaires before and after an SBAR communication workshop and subsequent simulation. A statistically significant increase in postintervention self-confidence scores was noted with no significant difference in anxiety levels. The findings support the use of SBAR as an organizing tool to promote nursing students' self-confidence during communication; however, further efforts are needed to qualitatively examine how this tool promotes these changes.

Barriers to Skin-to-Skin Contact after Cesarean Birth.

OBJECTIVES: The aim of this research was to understand obstetric nurses' perceived barriers to immediate skin-to-skin contact (SSC) in the operating room (OR) after cesarean birth. METHODS: Semistructured, open-ended interviews were conducted via videoconferencing. Conventional content analysis methods were used to analyze the data for common themes. Investigation team consensus was reached to validate the analysis findings. RESULTS: Ten nurses who care for women during labor and birth were interviewed. The primary overarching theme was performing safe and effective SSC after cesarean birth. Nurses strongly believe in the benefits of SSC after cesarean and try to implement it as often as possible, but various factors prevented SSC in the OR from occurring on a regular basis. Providing immediate SSC is not considered a priority during the cesarean by all members of the team. All participants reported that there were no formal policies and procedures in their facilities for SSC in the OR. Challenges with safety, nurse staffing, and logistics were described as well as professional barriers, and varying practices between geographical location and facilities. Nurses discussed concepts that were facilitators for changing their current practices to support SSC after cesarean. CLINICAL IMPLICATIONS: Implications: Developing effective policies and procedures that support SSC in the OR after cesarean and changing practice accordingly is recommended. Adequate nurse staffing in the OR is essential.

New Mothers' Experiences with Online Postpartum Forums.

PURPOSE: To explore women's experiences with an online forum during the postpartum period. STUDY DESIGN AND METHODS: All women involved in an online postpartum "birth club" on Babycenter.com during the first 6 months postpartum were invited to participate in the study. Participant characteristics and baseline mental well-being data were obtained along with their response to three open-ended questions about their experiences participating in an online mothers group. Descriptive statistics and qualitative content analysis were used to analyze data. RESULTS: Women (N = 393) who responded to open-ended questions were 29.2 (SD = 5.3) years old, Caucasian (85%), married or in a committed relationship (81%), and lived in the United States (75%). Ninety percent (n = 354) completed the Edinburgh Postnatal Depression Screening Scale, of whom 18% (n = 65) scored ≥13, indicating risk of developing postpartum depression. Data analysis revealed five themes. The themes were integrated under the holistic concept of community and included 1) social support; 2) anonymity; 3) in-groups; 4) drama; and 5) entertainment/pastime. CLINICAL IMPLICATIONS: Findings suggest online forums can provide social support for new mothers. They can facilitate sharing of information, act as a source of entertainment, and provide a sense of community for participants who might otherwise feel isolated due to the demands of new motherhood. Nurses working with childbearing women should be aware of the positive and negative aspects of online forums so they can support new mothers who choose to participate.

Postpartum Depression Among Asian Indian Mothers.

PURPOSE: To explore Asian Indian mothers' perspectives of postpartum depression (PPD) and mental health help-seeking behavior. STUDY DESIGN: Qualitative exploratory design. METHODS: Using convenience sampling, postpartum mothers were recruited through flyers posted in public places and on social media sites. Postpartum depression risk was assessed with the Edinburgh Postnatal Depression Scale (EPDS) prior to qualitative interviews. Content analysis methods were used to extract themes from participant narratives. RESULTS: Twelve self-identified, married, Asian Indian mothers, aged between 29 and 40 years, living in Northern California, who gave birth to a healthy infant within the last 12 months, took part in this study. Scores on the EPDS indicated two participants were at an increased risk for developing PPD. Content analysis revealed two emerging themes: (1) Culture-specific postpartum practices and ceremonies and their role in maternal-infant postpartum recovery; and (2) Maternal mental health help-seeking behavior. CLINICAL IMPLICATIONS: Nurses taking care of women during the extended prenatal and postpartum period have the unique opportunity to build rapport with their patients which can offer a window of opportunity to educate and help dispel myths about PPD symptoms and treatment. To promote successful maternal-infant outcomes, PPD education should be initiated at the first prenatal appointment, continue during the pregnancy, and be incorporated into well-baby visits through the first postpartum year. Education should include signs and symptoms of PPD as well as importance of timely mental-health help-seeking.

Cultural Norms of Clinical Simulation in Undergraduate Nursing Education.

Simulated practice of clinical skills has occurred in skills laboratories for generations, and there is strong evidence to support high-fidelity clinical simulation as an effective tool for learning performance-based skills. What are less known are the processes within clinical simulation environments that facilitate the learning of socially bound and integrated components of nursing practice. Our purpose in this study was to ethnographically describe the situated learning within a simulation laboratory for baccalaureate nursing students within the western United States. We gathered and analyzed data from observations of simulation sessions as well as interviews with students and faculty to produce a rich contextualization of the relationships, beliefs, practices, environmental factors, and theoretical underpinnings encoded in cultural norms of the students' situated practice within simulation. Our findings add to the evidence linking learning in simulation to the development of broad practice-based skills and clinical reasoning for undergraduate nursing students.

Methods of evaluating an accelerated associate degree registered nurse to baccalaureate degree continuation program.

Program evaluation guides curricular decision making and change. This article describes a comprehensive program evaluation of an accelerated associate degree to baccalaureate continuation program and includes some findings and lessons learned. Educators need to be responsible and accountable for the curricular changes that they make and assure that rigor is maintained and essentials are met. The use of comprehensive program evaluation adds significant value and richness of data because use of multiple study methods leads to data from multiple vantage points. Although a comprehensive program evaluation can be time consuming, not all of the methods described in this article may be required. Using the matrix provided, the reader may choose to carry out 1 or 2 of the methods described here.

Students' lived experience in an associate's degree to baccalaureate degree continuation program: opening doors, opening eyes, opening minds.

BACKGROUND: Major nursing organizations, federal agencies, and researchers are recommending that all nurses be educated to at least the baccalaureate level. METHODS: This article reports the results of a qualitative study of the experiences of students enrolled in a direct associate's degree to baccalaureate degree nursing program. Based on multiple small group interviews conducted during an 18-month period, a multistep interpretive analytic process was used that ultimately described themes within a holistic view of the phenomenon. FINDINGS: The results showed an overarching theme of transformative change over time, centered within the "place" of the university. CONCLUSION: The study suggested that there are differences beyond additional coursework that describe a transformative process in associate's degree to baccalaureate degree education. An atmosphere, or "space created," for reflection on learning is significant to consider in the development of education programs.

Exploring barriers to organ donation in the African-American communities of California.

There are a disproportionate number of African-Americans on transplant waiting lists across the country. The outcomes of a transplant are greatly improved when the donor and the recipient are from the same ethnic group. Sadly, the demand for cadaver organs in the African-American community exceeds the supply. Researchers in the past have sought to identify barriers to organ and tissue donation. To date, the studies have been conducted in the eastern and southern regions of the United States. This study examines whether the previously identified barriers are applicable in the African-American communities of California. A revised version of the Bone Marrow Donation Intention Tool was administered both in person and online. A t-test was used for analysis. The findings revealed statistically significant agreement/disagreement statements. These statements indicated that the barriers to organ donation from other areas of the United States were not representative of the respondents on the west coast.

Integrating a professional apprenticeship model with psychiatric clinical simulation.

In this article, we present a theory-based application of clinical simulation in psychiatric-mental health nursing education. As described by Benner, Sutphen, Leonard, and Day, a three-pronged apprenticeship that integrates intellectual, practical, and ethical aspects of the professional role is critical in the development of practical reasoning in nursing education and training. Clinical encounters are often fraught with ambiguity and uncertainty. Therefore, educating for a practice discipline requires experiential and situated learning. Using the three-pronged experiential model in simulated psychiatric-mental health nursing practice supports the development of critical nursing skills, ethics, and theoretical concepts. A clinical scenario is presented that demonstrates the application of this model of professional apprenticeship in psychiatric-mental health education. Applications of the concept presented may be used in training nurses new to the practice of psychiatric-mental health nursing.

The composite first person narrative: Texture, structure, and meaning in writing phenomenological descriptions.

This paper illustrates the use of composite first person narrative interpretive methods, as described by Todres, across a range of phenomena. This methodology introduces texture into the presently understood structures of phenomena and thereby creates new understandings of the phenomenon, bringing about a form of understanding that is relationally alive that contributes to improved caring practices. The method is influenced by the work of Gendlin, Heidegger, van Manen, Gadamer, and Merleau-Ponty. The method's applicability to different research topics is demonstrated through the composite narratives of nursing students learning nursing practice in an accelerated and condensed program, obese female adolescents attempting weight control, chronically ill male parolees, and midlife women experiencing distress during menopause. Within current research, these four phenomena have been predominantly described and understood through quantified articulations that give the reader a structural understanding of the phenomena, but the more embodied or "contextual" human qualities of the phenomena are often not visible. The "what is it like" or the "unsaid" aspects of such human phenomena are not clear to the reader when proxies are used to "account for" a variety of situated conditions. This novel method is employed to re-present narrative data and findings from research through first person accounts that blend the voices of the participants with those of the researcher, emphasizing the connectedness, the "we" among all participants, researchers, and listeners. These re-presentations allow readers to develop more embodied understandings of both the texture and structure of each of the phenomena and illustrate the use of the composite account as a way for researchers to better understand and convey the wholeness of the experience of any phenomenon under inquiry.

The lived experience of students in an accelerated nursing program: intersecting factors that influence experiential learning.

The goal of this interpretive research study was to articulate the lived experience of students in an accelerated master's of nursing entry program learning the practice of nursing within a clinical setting. Specific questions included: How did previous life experiences, education, and career choices influence the experience of second-degree students? What were the potential effects on learning of condensing and accelerating the curriculum as is requisite in second-degree programs? Data from small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Akin to the experience of tourists or new immigrants, students were confronted with new physical demands, new equipment, new time patterns, and most importantly, new ways of relating to people, all within a condensed time frame. What stood out most in these students' accounts was the ubiquitous context of inpatient nursing care in which lives were at stake.

Learning formative skills of nursing practice in an accelerated program.

The purpose of this qualitative research study was to describe how students in an accelerated master's degree entry program experientially learned the practice of nursing. One research question examined in this study was: What formative experiences did students identify as helping them develop and differentiate their clinical practice? Data from clinical observations and a combination of small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Students identified formative skills learned through the independent care of a patient as pivotal in their identity and agency development. By experiencing the responsibility and action from within the body and from within concrete situations, students developed a new understanding that changed their embodied ways of perceiving and orienting to the situation, as well as their skills and sense of agency.

Demonstrating holistic clinical judgment: preceptors perceptions of new graduate nurses.

There has been little research on what beginning yet competent clinical judgment "looks like" to preceptors, those individuals charged with evaluating the performance of new graduate nurses during the orientation/training process. This phenomenological study explicates how preceptors interpret clinical judgment in new nurses during their orientation to labor and delivery.