Development of caring behaviour in undergraduate nursing students participating in a caring behaviour course.

BACKGROUND: In today's complex healthcare organisations there is an increasing recognition of the need to enhance care quality and patient safety. Nurses' competence in demonstrating caring behaviour during patient encounters affects how patients experience and participate in their care. Nurse educators are faced with the challenge of balancing the demand for increasingly complex knowledge and skills with facilitating students' abilities essential to becoming compassionate and caring nurses. AIM: The aim was to describe undergraduate nursing students' development of caring behaviour while participating in a caring behaviour course. METHOD: This pilot study used a quantitative observational design. At a university in Sweden, video-recorded observational data from twenty-five students were collected in the first and last weeks of a full-time five-week Caring Behaviour Course (the CBC). In total, 56-min video-recorded simulation interactions between a student and a standardised patient were coded by a credentialed coder using a timed-event sequential continuous coding method based on the Caring Behaviour Coding Scheme (the CBCS). The CBCS maps the five conceptual domains described in Swanson's Theory of Caring with related sub-domains that align with Swanson's qualities of the Compassionate Healer and the Competent Practitioner. The CBCS contains seventeen verbal and eight non-verbal behavioural codes, categorised as caring or non-caring. RESULTS: Between the two simulations, most verbal caring behaviours increased, and most non-verbal caring behaviours decreased. Statistically significant differences between the simulations occurred in the sub-domains Avoiding assumptions and Performing competently/skilfully in the quality of the Competent Practitioner. Most observed caring behaviours aligned with the Compassionate Healer. CONCLUSION: Generally, the students' development of caring behaviours increased while participating in the CBC. Using a structured observational behavioural coding scheme can assist educators in assessing caring behaviour both in education and in practice, supporting caring as the universal foundation of nursing and a key to patient safety.

Quality and safety education for nurses: A bibliometric analysis.

PURPOSE: Since its origin in the United States in 2005, Quality and Safety Education for Nurses (QSEN) has guided nurses' preparation for alleviating preventable harm and improving quality safe care. QSEN's value is illustrated through specific inclusion in the competency-based 2021 American Association for Colleges of Nursing (AACN) Essentials. The purpose of this bibliometric analysis is to explore publication patterns of the extant QSEN literature to assess QSEN's spread and global penetration and to map the available knowledge and data regarding quality and safety education for nurses. DESIGN: Bibliometric analysis. METHOD: Two QSEN investigators and two health science librarians completed database searches to identify articles with keywords QSEN or Quality and safety education for nursing. Inclusion criteria were (1) QSEN-specific and (2) published in a peer-reviewed journal. Using PRISMA screening, the final sample included 221 articles between 2007 and 2021. RESULTS: Average annual QSEN publications was 14.5 articles; the highest was 26 publications in 2017. Article types were 84 research, 77 descriptive/reviews, 28 quality improvement projects or case studies, 20 statements, and 12 editorials. Focus analysis revealed 165 education articles, 35 clinical practice, 17 professional development, and 4 leadership/administration. Fourteen journals published three or more; eight were education journals. Nine topic clusters indicated areas of publication focus, including clinical teaching, simulations, performance, context, and criteria of analysis, factors of efficacy, innovation and advanced practice, patient care and outcomes, academic concepts, and research frameworks. CONCLUSIONS: Results reveal far less QSEN penetration for guiding professional practice, research measuring outcomes and impact, and global collaboration to examine cultural implications for diversity and inclusion. Results present future recommendations to assure all nurses worldwide have access to competency development to alleviate preventable healthcare harm. CLINICAL RELEVANCE: Originating in the United States (US), the QSEN project provided the seminal framework for transforming education and practice through defining the six quality and safety competencies (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) essential to alleviate preventable healthcare harm. Results reveal opportunities to advance QSEN penetration in developing professional practice, guiding research measuring outcomes and impact, and extending global collaboration to examine cultural implications for diversity and inclusion.

Undergraduate nursing students' experiences of practicing caring behaviours with standardised patients.

RATIONALE: Undergraduate nursing students' learning opportunities to practice caring behaviours to assure compassionate and competent nursing practice with standardised patients are few. Earlier studies primarily focused on practicing communication skills in relation to mental health or developing psychomotor skills while caring for a patient with a specific diagnosis. AIM: The study aim was to describe undergraduate nursing students' experiences of practicing caring behaviours with a standardised patient. METHOD: A sample of forty-eight undergraduate nursing students in semester four at a school of nursing in southern Sweden, enrolled in a full-time, 5-week, on-campus elective caring behaviour course, were at the first and last week individually video-recorded during two caring behaviour simulations encountering a standardised patient. After observing each of their video-recordings, students completed written reflections focusing on their own compassionate and competent verbal and nonverbal caring behaviour. In total, 96 individual written reflections were analysed using qualitative content analysis to describe the experience. RESULTS: One main theme emerged: The challenge of being mindfully present in patient encounters. Four themes further described the experience: A challenging but realistic learning experience, learning the impact of nonverbal behaviour, recognising the complexity of verbal behaviour, and learning to be with the patient instead of only doing for the patient. CONCLUSION: When caring is intertwined with visible and realistic nursing practice in simulations using standardised patients it facilitates undergraduate nursing students learning compassionate and competent caring behaviour. The learning experience opened the students' eyes to the impact of practicing caring, recognising that being with is not the same as doing for the patient, and thus, how challenging it is to be mindfully present in patient encounters. Designing caring behaviour simulations with standardised patients is a feasible and efficacious educational learning didactic to facilitate students' learning caring behaviour and enhancing patients' experiences.

Embracing diversity: measuring the impact of an international immersion learning experience on nursing students' cultural beliefs and values.

OBJECTIVES: An international Nursing Leadership Collaborative covened in Japan to hold a patient safety and quality workshop for nursing students from six countries. The purpose was to measure students' self reported beliefs reflecting sensitivity and openness to cultural diversity before and after the international experience. METHODS: A pre-post-test design was used and the Beliefs, Events, and Values Inventory was administered to international undergraduate and graduate nursing students. RESULTS: The group aggregate data analysis indicate that prior to the start of the workshop, the group presented itself as quite introspective and after the workshop the group reported being more sophisticated in making causal explanations about why the world works in the way it does. CONCLUSIONS: Nursing students experienced an expanded awareness of their beliefs and values that reflect a greater degree of intercultural sensitivity for acceptance of inclusivity and diversity after the experience.

Outpatient nurse staffing relationship with organizational, nurse and patient outcomes: A scoping review.

Background: Nurses are an integral part of outpatient healthcare settings and are needed to provide effective patient care. Ample research and reviews have been done on nurse staffing in inpatient settings relationship with a variety of organizational, nurse and patient outcomes, however there is no review of outpatient nurse staffing relationship with organizational, nurse and patient outcomes. Objectives: The purpose of this paper is to present a scoping review that evaluates the state of the literature on relationships among nurse staffing and organizational, nurse and patient outcomes in the outpatient setting. Methods: The review used PRISMA guidelines for scoping reviews. The search focused on nurse staffing and organizational outcome in outpatient settings and synonyms for those terms. PubMed, Ebscohost CINAHL, and Ebscohost Global Health were searched. Articles were included if they measured nurse staffing relationship with any organizational, nurse and patient outcome in an outpatient setting. Extraction was completed in a matrix first then charted into synthesis tables. Results: Thirty-seven studies were included in the review. Nurse staffing was measured in the literature by perceived staffing adequacy, types of healthcare workers staffed, full-time equivalents, nurse vacancies, proportion of nurses to total staff, agency or float nurse use, presence of nurse on the healthcare team and nurse to patient ratios. Nurse staffing of a variety of measures was associated with better patient outcomes, lower costs, and lower nurse turnover. Only one study of the 37 included did not show a positive outcome of better nurse staffing, which showed that increased nurse staffing was associated with less patient engagement in psychotherapy. Conclusions: Outpatient care setting stakeholders and policy makers should consider improving nurse staffing, as stronger nurse staffing is associated with better patient outcomes lower costs and less nurse turnover. In addition, better staffing helps improve nurses' attitudes towards their job and increase job satisfaction. Most of the studies included in this review only focused on the staffing measure of perceived staffing adequacy. While perceived staffing adequacy is a useful measure of nurse staffing able to capture nurses' perception, it should not be used in isolation and more researchers should focus on gaps in outpatient nurse staffing with more objective measures such as fulltime equivalents. Tweetable abstract: A 37 article scoping review on nurse staffing in outpatient care found that stronger staffing was linked with better patient outcomes, lower costs, and less turnover.

Second-order problem solving: Nurses' perspectives on learning from near misses.

OBJECTIVES: Near misses happen more frequently than actual errors, and highlight system vulnerabilities without causing any harm, thus provide a safe space for organizational learning. Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes. This study aimed to explore frontline nurses' perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety. METHODS: A qualitative exploratory study design was employed. This study was conducted in three tertiary hospitals in east China from June to November 2015. Purposive sampling was used to recruit 19 frontline nurses. Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan's 4I Framework of Organizational Learning as a coding framework. RESULTS: Second-order problem solving behavior, based on the 4I Framework of Organizational Learning, was referred to as being a leader in exposing near misses, pushing forward the cause analysis within limited capacity, balancing the active and passive role during improvement project, and promoting the continuous improvement with passion while feeling low-powered. CONCLUSIONS: 4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses' role in promoting organizations to learn from near misses. In this study, nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving. However, additional knowledge, skills, and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.

St. Luke's International University and University of North Carolina at Chapel Hill collaboration project to develop the first DNP program in Japan.

We report an international collaborative project to develop the first Doctor of Nursing Practice (DNP) program in Japan. We described the development and implementation of the first DNP program at the St. Luke's International University in Tokyo and the collaboration with the University of North Carolina at Chapel Hill in the United States. Faculty perceptions in both parties gradually evolved from the traditional perspective of international collaboration to the transitional and the beginning of the holistic partnership perspectives. The collaboration resulted in an innovative DNP program that directly addressed the gap between nursing education programs and Japan's clinical needs. The collaborative project cultivated a holistic international partnership. Rather than reporting a manual for international collaboration, we present our reflections and outcomes as narratives that others could use to achieve a holistic global partnership.

Comparison of Postoperative Pain Management Outcomes in the United States and China.

To compare pain management outcomes in postoperative patients from an American hospital and a Chinese hospital. A convenience sample of 244 patients in the United States and 268 patients in China with similar surgical sites completed the American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and the Pain Management Index (PMI) was calculated on their first postoperative day. Patients in the United States reported a higher score on the "perception of pain management" subscale of the APS-POQ-R and a higher proportion of adequate treatment as measured by the PMI (85.2% vs. 39.0%, p < .001). Patient education and degrees of pain relief predicted patient satisfaction with pain management (item in APS-POQ-R) in patients from both countries. A higher level of compliance with pain management guidelines has contributed to a higher level of perception in patients in the United States. Establishing procedure-specific protocols and clinical pathways may improve pain management outcomes for Chinese patients.

A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience.

BACKGROUND: Systems thinking (ST) is the ability to recognize, understand, and synthesize interactions and interdependencies in a set of components designed for a purpose. Systems thinking has been shown to improve systems and decrease error. Despite these benefits, ST has not yet been consistently integrated into all health care education programs. PURPOSE: This study examined the impact of Friday Night at the ER (FNER), a table-top simulation designed to teach ST to a variety of prelicensure and postlicensure health care students. METHODS: A multisite study was conducted in 5 academic institutions targeting both graduate and prelicensure students enrolled in nursing, medicine, physical therapy, public health, psychology, and pharmacy programs. RESULTS: The FNER simulation was followed by statistically significant improvements in ST scores. CONCLUSIONS: The FNER table-top simulation was found to improve ST in a wide variety of health-related majors.

Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study.

BACKGROUND: High HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+ guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi. METHODS: A qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis. RESULTS: Four categories of strategies were used to support Option B+ guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+ guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations. CONCLUSIONS: Understanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings.

Student outcomes of an international learning collaborative to develop patient safety and quality competencies in nursing.

BACKGROUND: Patient harm is a global crisis fueling negative outcomes for patients around the world. Working together in an international learning collaborative fostered learning with, from and about each other to develop evidence-based strategies for developing quality and safety competencies in nursing. AIMS: To report student outcomes from an international learning collaborative focused on patient safety using the Quality and Safety Education for Nurses competency framework. METHODS: A global consortium of nursing faculty created an international learning collaborative and designed educational strategies for an online pre-workshop and a 10-day in-person experience for 21 undergraduate and graduate nursing students from six countries. A retrospective pre-test post-test survey measured participants' confidence levels of patient safety competence using the health professional education in patient safety survey and content analysis of daily reflective writings. RESULTS: Statistical analysis revealed student confidence levels improved across all eight areas of safe practice comparing-pre and post-education (significance, alpha of P < 0.05). Two overarching themes, reactions to shared learning experiences and shared areas of learning and development, reflected Quality and Safety Education for Nurses competencies and a new cultural understanding. CONCLUSIONS: The international learning collaborative demonstrated that cross-border learning opportunities can foster global development of quality and safety outcome goals.

The experience of culturally diverse faculty in academic environments: A multi-country scoping review.

Evidence supports that the way people work together influences how they perceive the working environment and retention. With increasing migration among health professionals, it is important to better understand the experiences of multi-national faculty in higher education. This scoping review aims to provide a global perspective on the experiences of faculty from diverse cultural backgrounds and explore strategies that promote faculty diversity and contribute to the organizational culture of academic workplaces. CINHAL, PUBMED, and PsycInfo were searched for original studies that examined perspectives of diverse faculty across the world. Seventeen eligible studies were reviewed using PRISMA guidelines. Three themes were extracted: Descriptions of cultural diversity among faculty in the academic workplace, Factors that increase retention among faculty from diverse cultural backgrounds, and Strategies for building an academic culture that values faculty diversity. Faculty reported difficult experiences that limit recruitment and retention of diverse faculty, thus contribute to the lack of faculty diversity and faculty shortages. Expatriate faculty have similar experiences in feeling a lack of support in promoting their professional growth. Still, diversity can also be a positive organizational factor when the commitment of school leaders creates a harmonious work culture for all faculty that fosters and values diversity.

Developing Authentic Leadership Voice: Novice Faculty Experience.

AIM: The aim of this study was to determine the perceptions of 14 novice nurse faculty of a 20-month experiential leadership academy on the leadership development. BACKGROUND: Managing the complexities of nursing faculty roles requires significant leadership skills that often are hard won. Evidence suggests that leadership preparation to prepare nursing faculty through guided mentoring can enhance faculty recruitment, satisfaction, and retention. METHOD: Participants completed open-ended questions about their experiences in Sigma Theta Tau International's Nurse Faculty Leadership Academy. RESULTS: Data analysis revealed a meta-theme of "Finding Authentic Leadership Voice." Four subthemes emerged to shape the meta-theme: Identifying Inner Strengths and Areas for Improvement, Increasing Self-Confidence and Self-Awareness, Increasing Focus on Others, and Clarifying Aspirations for a Leadership Future. CONCLUSION: Reflecting on their experiences, participants recognized changes in their leadership roles as they found an authentic voice that helped them persist and thrive amid the complexities of their faculty roles.

Partnering for Professional Development in the Galápagos Islands.

Nurses living in the Galápagos Islands face barriers to accessing continuing professional development (CPD), particularly in their native language and appropriate for their unique island culture due to their remote location, 1,000 km off the coast of Ecuador. This article reviews the evidence on providing professional development from high-resource countries to low-resource countries; describes a case example of the process of developing, implementing, and evaluating the first professional development program targeting nurses in the Galápagos; and presents recommendations to sustain a culturally relevant international professional nursing development partnership that can be a model for nurses in other remote locations with limited educational access. [J Contin Educ Nurs. 2019;50(9):417-422.].