Registered general nurses' health assessment practices in a tertiary hospital: A focused ethnography study.

AIM: To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards. DESIGN: The study was designed as a focused ethnography. METHODS: A semi-structured interview guide was used to explore prevailing nursing health assessment practices of 13 registered general nurses in an attempt to explore the assumptions and values influencing health assessment practices in the study setting. Data were analysed inductively using an interpretive qualitative content analysis method. RESULTS: Nursing health assessment practices, and underlying assumptions and values were underpinned by a central theme of a culture of low expectation relating to nursing health assessment. The culture of low expectation was highlighted in five themes: (1) Unsystematic Assessment of Health Status, (2) Purpose of Nursing Health Assessment, (3) The Role of Nursing Educational and Regulatory Institutions, (4) Ward Ethos and (5) The Role of Organizational and Ward Leadership. IMPLICATION: The adoption of a holistic nursing health assessment framework with a clearly defined purpose of aiding nursing diagnoses can guide patient-centred care delivery and facilitate early recognition of physiological deterioration. PATIENT OR PUBLIC CONTRIBUTION: Thirteen registered general nurses were interviewed, and the initial findings returned to them for validation. CONCLUSION: The potential contribution of nursing health assessment to nursing practice and patient outcomes may not be fully realized if nursing health assessment is not situated within a holistic health assessment model with a clearly defined purpose for nursing practice.

A Simulation-Based Clinical Nursing Education Framework for a Low-Resource Setting: A Multimethod Study.

Simulation-based clinical education is a useful strategy for teaching, learning, and assessing clinical competence in health professions education. However, the use of simulation-based clinical nursing education (SBCNE) in low-resource settings such as Ghana has been hampered by the lack of a context-specific framework to guide its design, implementation, and evaluation. This study sought to develop a context-specific framework to guide the design, implementation, and evaluation of SBCNE in a low-resource setting. The study employed a sequential multimethod design, comprising a scoping review; qualitative descriptive design (situational analysis) made up of two parts-focus group discussions (FGDs) with post-registration nurses and nursing students, and semi-structured interviews with nurse educators; and narrative synthesis of the scoping review and situational analysis data, used to develop a draft SBCNE framework for a low-resource setting. The draft SBCNE framework was evaluated by stakeholders of nursing education and practice using nominal group discussions. The framework is comprised of five constructs (context, planning, design, community of learning, and outcomes). The user-centric, comprehensive, context-specific SBCNE framework has the potential to enhance the implementation of simulation in nursing education and the development of clinical competence in a low-resource setting. As a result, we urge nursing leaders and nurse educator unions to take the lead in lobbying regulatory bodies, the central government, and their development partners to provide the necessary financial support and resources for the implementation of the framework and adoption of SBCNE in low-resource settings.

Frameworks for the design, implementation, and evaluation of simulation-based nursing education: A scoping review.

This scoping review was conducted to identify and describe constructs of frameworks and theories used to guide the design, implementation, and evaluation of simulation in nursing education globally, with a focus on their applicability in low-resource settings. Six electronic databases, three of which were on EBSCO Host (CINAHL, MEDLINE, ERIC), PubMed, Scopus, and ProQuest, as well as Google Scholar, were searched to retrieve studies published in the English language between 2012 and February 2022. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist, and was guided by Arksey and O'Malley's five-step scoping review methodological framework. Data were extracted from five studies (four frameworks and a theory) and narratively synthesized. Hence, seven constructs were identified and described: context, background, simulation design, educational practices, facilitator, participant, and outcomes. The four frameworks and theory were developed in the context of developed countries, which reveals the lack of a context-specific framework to guide the design, implementation, and evaluation of simulation in nursing education in low-resource settings. Given resource limitations and the apparent gaps in applying simulation-based framework(s) developed in developed countries to low-resource settings, the findings of this review underscored the need for a context-specific framework that is locally tailored to the needs and resources of low-resource settings, to promote access to and use of simulation in enhancing student learning, and the development of clinical competence.

Teaching and Learning of Clinical Competence in Ghana: Experiences of Students and Post-Registration Nurses.

Despite the growing demand for competent nurses to fill the shortage gap, nursing education institutions have not always been able to equip students with the requisite clinical competence needed in the practice setting. Several studies have described the experiences of undergraduate nursing students in the clinical learning environment. No study was found on the experiences of diploma nursing students and post-registration nurses regarding the teaching and learning of clinical competence in Ghana. This study, therefore, sought to describe the experiences and perceptions of diploma nursing students and post-registration nurses regarding the teaching and learning of clinical competence in Ghana. A qualitative descriptive research design was employed in this study. Fifty-five (55) participants, comprising 40 students and 15 post-registration diploma nurses, from six research sites were recruited into focus group discussions (FGDs) using a maximum variation purposive sampling technique. A thematic framework method was used to analyze the data with the aid of ATLAS.ti software. Three themes emerged from the focus group discussions: nursing education institutional factors; clinical placement design, implementation, and system challenges; challenges of clinical teaching and learning. We conclude that the current approach to clinical nursing education, such as the overreliance on clinical placement and the use of more teacher-centered teaching approaches, are ineffective in facilitating the development of clinical competence. A review of the nursing curriculum, inculcating evidence-based simulation modalities, and an adequate investment in nursing education may be required to ensure effective nursing education in the study setting.

Experiences and perceptions of the theory-practice gap in nursing in a resource-constrained setting: A qualitative description study.

AIM: To describe experiences and perceptions of theory-practice gap in nursing in a resource-constrained setting. Theory-practice gap is extensively discussed and studied in some parts of the world. Interventions to bridge the theory-practice gap have been varied and depend on an understanding of the contextual healthcare environment. Experiences and perceptions of the theory-practice gap in a resource-constrained setting have not been comprehensively described. DESIGN: A qualitative description methodology was used. METHODS: Maximum variation sampling based on role in the events of theory-practice gap was used to recruit student nurses, nurse faculty and clinicians from two study sites for focus group discussions. Data were analysed using conventional content analysis. RESULTS: Five themes were identified: system inadequacies; resource constraints; challenges of the clinical learning environment; clinical placement and supervision; and nurse faculty factors. Systems inadequacy and resource constraints formed the spine of the challenges contributing to the theory-practice gap in the research setting.