Initiatives aimed at retaining ethnically diverse student nurses in undergraduate programmes: An integrative review.

AIMS AND OBJECTIVES: To identify initiatives aimed at retaining ethnically diverse students in Bachelor/Baccalaureate undergraduate nursing programmes. The review focused on identifying strategies attempting to address this issue. BACKGROUND: There is a recognised shortage of ethnically diverse registered nurses (RN) worldwide. Multiple strategies have been implemented internationally to create a more linguistically and culturally diverse RN workforce. Governments have invested significant resources into these strategies, but the outcomes have been variable. If a future RN workforce is to be representative of their populations, then effective evidence-based interventions are required. DESIGN: An integrative review of the literature published from January 2006-December 2015. METHOD: CINAHL, PubMed, ProQuest, ERIC and Cochrane databases were searched using the key terms student nurse, attrition and retention to identify papers. The CASP tools were used to evaluate relevant studies for rigour (Critical Appraisal Skills Programme [CASP], 2017). Seventeen papers were identified for inclusion. The findings from these studies were analysed using thematic analysis. RESULTS: Four themes emerged from the analysis: prediction, recruitment and retention, single approach and multiple approaches. CONCLUSIONS: Many factors affect the processes of retaining ethnically diverse student nurses in a Bachelor/Baccalaureate undergraduate programme. Programme single approaches appear to be limiting; however, implementation of a broad range of strategies across the continuum from recruitment to graduation is likely to be a more appropriate solution to achieving higher graduation rates amongst ethnically diverse students. RELEVANCE TO CLINICAL PRACTICE: Supporting the recruitment and retention of ethnically diverse students assists in greater numbers of RNs graduating and provides a more linguistically and culturally diverse workforce representative of their population.

Enhancing rigour in the validation of patient reported outcome measures (PROMs): bridging linguistic and psychometric testing.

BACKGROUND: A strong consensus exists for a systematic approach to linguistic validation of patient reported outcome measures (PROMs) and discrete methods for assessing their psychometric properties. Despite the need for robust evidence of the appropriateness of measures, transition from linguistic to psychometric validation is poorly documented or evidenced. This paper demonstrates the importance of linking linguistic and psychometric testing through a purposeful stage which bridges the gap between translation and large-scale validation. FINDINGS: Evidence is drawn from a study to develop a Welsh language version of the Beck Depression Inventory-II (BDI-II) and investigate its psychometric properties. The BDI-II was translated into Welsh then administered to Welsh-speaking university students (n = 115) and patients with depression (n = 37) concurrent with the English BDI-II, and alongside other established depression and quality of life measures. A Welsh version of the BDI-II was produced that, on administration, showed conceptual equivalence with the original measure; high internal consistency reliability (Cronbach's alpha = 0.90; 0.96); item homogeneity; adequate correlation with the English BDI-II (r = 0.96; 0.94) and additional measures; and a two-factor structure with one overriding dimension. Nevertheless, in the student sample, the Welsh version showed a significantly lower overall mean than the English (p = 0.002); and significant differences in six mean item scores. This prompted a review and refinement of the translated measure. CONCLUSIONS: Exploring potential sources of bias in translated measures represents a critical step in the translation-validation process, which until now has been largely underutilised. This paper offers important findings that inform advanced methods of cross-cultural validation of PROMs.

Innovations aimed at improving the physical health of the seriously mentally ill: an integrative review.

AIMS AND OBJECTIVES: The aim of this paper is to report an integrative review of the literature that focused on innovations aimed at enhancing the physical health of people with serious mental illness. BACKGROUND: Despite the abundance of literature that highlights the relationship between serious mental illness and physical ill health, the provision of physical health care for the seriously mental ill remains a challenge. Many different strategies have been developed, which endeavour to address the poor physical health of people with serious mental illness. However, there is inadequate evidence to establish the success of these strategies. DESIGN: Integrative literature review. METHOD: The review was conducted using an adapted version of Whittemore and Knafl's review method to critically appraise and evaluate the literature. Results. Three main themes derived for the types of intervention in the studies emerged from the review. These included assessment, health education/health promotion and multimodal interventions. CONCLUSION: Although there is some evidence to demonstrate that health assessments are effective in highlighting physical health problems, the evidence to support health education and multimodal interventions is far from conclusive. Further research is needed, in particular larger intervention and longitudinal studies, to help nurses decide on the best possible interventions that will improve the physical health of the seriously mentally ill. RELEVANCE TO CLINICAL PRACTICE: Whilst nurses' continued attempts to develop health-enhancing interventions are commendable, there needs to be a greater focus on conducting research to develop the evidence base to guide and support nurses in this area of their practice. Until robust and convincing evidence is available, policy relating to the advancement of the physical health of people with serious mental illness should be developed cautiously.

The role of midwives and health visitors in promoting intergenerational language maintenance in the bilingual setting: perceptions of parents and health professionals.

AIMS AND OBJECTIVES: The increasing status and regard of indigenous minority languages across Europe, means the advantages of bilingualism for individuals and communities are now well established. We set out to elicit parents' and health professionals' views of the role of health visitors and midwives in promoting bilingualism in the family and to consider whether health professionals acknowledge the contribution that bilingualism makes to public health. BACKGROUND: A three-year study was completed to measure the impact of a language transmission initiative which depends on the input of midwives and health visitors with new parents and how its effect could be improved. This paper reports on one element of that study. DESIGN: A qualitative approach was used. METHODS: Six focus group interviews were conducted with health visitors and midwives and 33 postnatal interviews were completed with parents across four counties in Wales. Thematic content analysis was undertaken by two researchers, a third trailed decision processes and scrutinised categories and themes. RESULTS: Findings suggest that health visitors and midwives perceive their roles relating to the promotion of bilingualism differently. Influences on their involvement include their language profile, contact with parents, personal experience, timing of the interaction and time in their workload. The relationship between promoting bilingualism and public health was accepted by some and denied by others. Data from the interviews with parents suggested that few health professionals discuss issues of language transmission with new parents. CONCLUSIONS: Some individual health visitors and midwives are willing to promote bilingualism with parents. However, there are challenges in enlisting the support of health visitors and midwives to discuss language transmission and bilingualism with parents. RELEVANCE TO CLINICAL PRACTICE: These findings challenge practitioners to consider their role in promoting bilingualism and its effect on public health and suggest the need for more defined responsibilities.

Identifying priorities for establishing bilingual provision in nurse education: a scoping study.

Research evidence demonstrates that offering language choice to patients enhances the quality of healthcare provision. This has implications for the preparation of nurses for practice in bilingual settings, where legislation often leads to demands for health services in both languages and bilingual competence amongst healthcare providers. This paper reports on a scoping study of bilingual provision in nurse education in the bilingual context of Wales, UK, as a means of informing the evidence base for national strategic planning. The study incorporated three elements: (i) literature analysis (ii) policy review and (iii) stakeholder consultation (n=70). Six themes emerged from the stakeholder consultation, reflecting the main drivers and barriers associated with bilingual provision in course delivery. These themes aligned with findings identified from the policy and literature review that related to strategic, organisational and individual influences on bilingual educational provision. Strategic planning for bilingual provision in nurse education in Wales should take account of the factors that affect provision at different levels. These factors feature across bilingual settings outside the UK, thus giving the study international relevance and scope to inform the delivery of nurse education that meets the needs of wider diverse language communities.

Inconsistent use of the critical incident technique in nursing research.

AIM: This paper is a critique of the use of critical incident technique in nursing and a demonstration of how its development has resulted in inconsistency and confusion. BACKGROUND: Critical incident technique is used globally by nurse researchers to explore a plethora of nursing issues. Its main strengths are flexibility and adaptability, but its popularity has resulted in ambiguity and confusion. DATA SOURCES: A search of the CINAHL database for the period 1956-2007 was performed using the search terms critical incident technique and nursing. Together with hand searching, this produced a total of 59 papers. The papers were analysed according to country of origin, research topic, sample size, data collection method, inclusion/exclusion criteria, data analysis and terminology. We then categorized the results of this analysis depending on similarities and differences in the papers. DISCUSSION: We focus on two areas: methodology and terminology. From a methodological perspective critical incident technique has become inconsistent and in relation to terminology, the diverse language associated with the technique has created confusion. Moreover, issues of rigour may be compromised as a result of this inconsistency. A great deal of inconsistency has been created by nurse researchers' attempts to advance critical incident technique. This has led to confusion, which is not helpful for advancing nursing knowledge. CONCLUSION: While embracing the continued development of critical incident technique, we advocate a standardized approach to its use. Unless nurse researchers are alert to the methodological and terminological inconsistencies in use of the critical incident technique, it risks becoming an interminable quagmire through which navigation will be impossible.

Using the critical incident technique to explore student nurses' perceptions of language awareness.

Current evidence demonstrates that language awareness in nursing contributes to high quality patient care. Although language awareness amongst qualified nurses has been considered, there is a dearth of literature that examines how student nurses respond to language sensitivity in the healthcare setting. The critical incident technique was used to elicit the perceptions of student nurses regarding language awareness. Twenty students produced written descriptions of incidents that they had encountered during clinical practice and they subsequently reflected on these incidents. Data were analysed using framework analysis whereby meaning units were organised into themes and categories. Four distinct themes emerged from the analysis; namely, facilitating language choice, vulnerable groups, quality of care and student learning. Each theme was characterised by a number of subcategories. Student nurses identified positive and negative instances of language matters in health care that are driven by personal and organisational strategies and impact on patient care and student learning. Student nurses were conscious of the influence of language awareness on patient care and noted that structural and process elements relating to language awareness were in play in the healthcare setting. Moreover, they indicated that the consequent outcomes of these elements influenced the quality of care and student learning.

Research awareness: making learning relevant for pre-registration nursing students.

This paper outlines efforts to improve the teaching and learning methods for research on a second year pre-registration nursing programme in one university in Wales, UK. This focussed on experiential approaches supported by electronic learning resources. A subsequent evaluation aimed to elicit participating students' and lecturers' perceptions of the success of the experiential approaches and the supporting resources. A questionnaire was distributed to 53 student nurses who participated in the experiential learning and this was supplemented with an informal qualitative 'graffiti board' evaluation with the cohort; and a group interview with 4 of the lecturers who had acted as group facilitators during the experiential research sessions. The findings revealed that similar issues were pertinent for both lecturers and students and these were contained within three distinct themes relating to the structure, process and outcomes of the teaching and learning approaches. The student-led approach to evaluation offers a fresh outlook which ensures that the emic perspective is included through the study. The study sheds light on the strengths and limitations of experiential approaches to research teaching and suggest that this is a challenging approach both for students and lecturers, which should not be entered into lightly.