Cultivating Clinical Judgment in Pharmacological Decision-Making Through Reflection on Practice.

BACKGROUND: Competent clinical judgment about pharmacological therapies by nurses is essential for safe medication outcomes. This study examined the impact of postclinical pharmacology-focused reflective debriefing sessions on clinical judgment in prelicensure senior nursing students. METHOD: A nonrandomized repeated measures design was used to compare clinical judgment of students who participated in an additional learning activity with students who did not. Data were collected using Lasater's Clinical Judgment Rubric. RESULTS: Within-groups analysis of variance demonstrated statistically significant increases in clinical judgment scores at mid- and late-semester timepoints for the entire cohort of participants (n = 128). However, analysis of covariance showed no statistically significant differences in the clinical judgment scores for the intervention (n = 62) and control (n = 66) groups. CONCLUSION: Clinical experiences provide opportunities for prelicensure students to develop clinical judgment about pharmacological therapies. Nurse educators must implement and evaluate strategies to foster this process. [J Nurs Educ. 2022;61(3):143-146.].

Enhancing diabetes care through care coordination, telemedicine, and education: Evaluation of a rural pilot program.

OBJECTIVE: To provide a comprehensive evaluation of a grant-funded pilot diabetes care program. Rural adult patients living with poorly controlled diabetes were targeted for care. DESIGN AND SAMPLE: Retrospective study using a purposive sample of patients at select primary care sites with a glycated hemoglobin (A1C) greater than 8%. Interventions included nurse care management, telemedicine endocrinology consults, as well as diabetes self-management education (DSME), to enhance disease management and prevention of complications. MEASURES: Pre/post labs, DSME test scores, hospital claims data, satisfaction surveys, and a focus group were evaluated. RESULTS: Fifty-nine adults, 21-76 years of age, participated. Interventions demonstrated statistically significant reduction in A1C (10.10 vs. 9.27; p value = 0.002); DSME test score improvement (76.23 vs. 96.04; p < 0.05) and reduced hospital utilization (Emergency Department use 0.86 vs. 0.40; p value = 0.04; inpatient admissions 0.09 vs. 0.02; p value = 0.02). Patients and providers indicated strong satisfaction with the program components. Less hospital utilization reduced emergency department costs by 51.4% and inpatient costs by 96%. A rural community advisory network indicated satisfaction in delivery of program activities and outcome measures. CONCLUSIONS: This rural model shows potential for improving diabetes control, access to specialty care through telemedicine, and reduction of health care utilization costs.

Communicating Patient Status: Comparison of Teaching Strategies in Prelicensure Nursing Education.

Research indicates that nurses lack adequate preparation for reporting patient status. This study compared 2 instructional methods focused on patient status reporting in the clinical setting using a randomized posttest-only comparison group design. Reporting performance using a standardized communication framework and student perceptions of satisfaction and confidence with learning were measured in a simulated event that followed the instruction. Between the instructional methods, there was no statistical difference in student reporting performance or perceptions of learning. Performance evaluations provided helpful insights for the nurse educator.

Clinical Judgment Scripts as a Strategy to Foster Clinical Judgments.

BACKGROUND: Clinical judgment encompasses how nurses use their knowledge of the patient to generate, assess, and prioritize patient care alternatives. Previous research has identified debriefing as critical to developing clinical judgment. Best practice for debriefing has yet to be identified. The purpose of this research was to investigate whether a standard debriefing script, based on Tanner's clinical judgment model, could foster clinical judgment. METHOD: Participants were senior nursing students in their final semester of study. Data were gathered and analyzed from three sources: independent raters observing students in simulation, participating students, and the students' clinical instructors. RESULTS: Students identified the script as an effective debriefing tool, and significant improvements were observed in clinical judgment scores from all data sources. CONCLUSION: The standardized debriefing script helped students focus on the learning process, resulting in student improvement in all areas of clinical judgment: noticing, interpreting, responding, and reflecting. [J Nurs Educ. 2016;55(12):691-695.].

WHERE Are the Faculty? Fulfilling the Traditional Faculty Role at a Distance.

Innovative approaches are needed to retain seasoned nursing faculty. Technology provides opportunities for faculty to fulfill the traditional roles of teaching, research, and service from a site removed from the traditional campus. The purpose of this article is to encourage faculty and administrators in traditional, land-based colleges and universities to thoughtfully consider the advantages and challenges of the remote worksite for faculty based on the experience of one faculty. Some faculty are better suited to a remote work environment than others. Long-term established faculty may be better able to successfully transition to the tripartite faculty roles with greater ease than novice nurse educators as a result of their familiarity with the institutional resources and comfort in the teaching role. Preparation for the remote experience must be diligent and thoughtful, considering equipment needs, connectivity, and support personnel and strategies for ensuring continued engagement within the nursing education program. Institutional policies must also be considered related to fulfillment of the faculty role via distance technology. A pilot experience for one faculty, as described here, may be useful for evaluating the cost-benefit to the individual and the institution.

Daily Spiritual Experiences of Nurse Educators and Relationship to Depression and Health.

This research describes the first reported assessment of spirituality in nurse educators. Faculty members at a public university in a southern U.S. state participated in a study to investigate the relationship between daily spiritual experiences (DSE), self-reported health, and depression. All participants viewed themselves as spiritual, had a religious affiliation, and recognized a difference between spirituality and religiosity. Many who reported spiritual experiences at least daily rated their health as good or excellent; those reporting less frequent DSE reported more depressive symptoms. Nurse educators' self-awareness of spirituality is important as they prepare future nursing professionals who will integrate spirituality into healthcare.

Interactive Multimedia Tailored to Improve Diabetes Self-Management.

A pilot program was initiated to improve self-management of type 2 diabetes by rural adults. Using an iOS-based, individually tailored pre-/postintervention to improve diabetes self-management, undergraduate students developed a native mobile application to help participants effectively manage their diabetes. Brief quizzes assessed diabetes knowledge. A diabetes dictionary and physical activity assessment provided additional support to users of the app. On completion of the pilot, data analysis indicated increased diabetes knowledge and self-efficacy, and ease of use of the technology. Native app technology permits ready access to important information for those living with type 2 diabetes.

Evaluation of a breast and colon cancer survivorship program.

This article describes a cancer survivorship program that addressed quality of life (QOL) changes related to chemotherapy. The program focused on adult breast and colon cancer survivors at a community oncology practice in the southeastern United States, and consisted of an educational visit designed to identify and address QOL changes that occurred as a result of chemotherapy. The QOL of Cancer Survivors (QOL-CS) survey administered before and after the visit analyzed QOL metrics, which were combined with program evaluation data to assess physical, psychosocial, social, and spiritual well-being changes that may have occurred as a result of program participation. Differences in QOL-CS scores did not represent statistically significant changes in QOL for program participants. However, program evaluation responses identified perceived changes in QOL as a result of participating in cancer treatment and a subsequent cancer survivorship program, which demonstrated clinical significance for program participants. Physical, psychosocial, social, and spiritual well-being measures were affected by program participation. Improvement in distress related to the initial cancer diagnosis and family distress were the most significant reported changes, and male gender and advanced age were associated with improved psychosocial well-being.

Educating supervisors of employees with diabetes.

The worksite presents special challenges not only for employees with diabetes, but also for their supervisors. Supervisors wonder whether certain behaviors are willful misconduct or indicative of health problems, as well as if and how to accommodate employees with diabetes to meet the needs of the employees and the company, within the law. The purpose of this research was to pilot test an innovative educational program for supervisors of employees with diabetes to benefit employees' health and diabetes control while meeting the legal requirements of the Americans with Disabilities Act (ADA). Nine supervisors completed a 6-hour program that included innovative teaching strategies--"living the life" of a person with diabetes for 2 days and case studies to practice decision making according to the ADA. The program increased supervisors' reported self-efficacy for supervising employees with diabetes and should improve work life for employees with diabetes, ultimately decreasing employers' health care costs.

Contributions of children to the care of adults with diabetes.

PURPOSE: The purpose of this study was to determine the occurrence of child caregivers among adults with diabetes and the type of assistance they provide. METHODS: In this exploratory descriptive study, 51 diverse adults with diabetes from 9 clinics in 3 states completed a survey in English or Spanish about themselves and their child caregivers. Topics addressed in the survey were the duration and types of assistance, the children's education about diabetes, and the impact of children's caregiving on attendance at school and work. RESULTS: The occurrence of child caregiving for adults with diabetes was 15.7%, and greatest for Hispanics. Most adults and caregivers were female; 14 adults reported more than 1 child caregiver. The children ranged in age from 5 to 18 years and began caregiving at a mean age of 11. Children provided from 1 to 10 services, including planning meals, drawing up or administering medications, testing blood glucose, interpreting results, and transporting. Most children provided care several times a week, and nearly half had no education about diabetes care. CONCLUSIONS: Children of both sexes and 4 racial/ethnic groups provided a broad range of services to adults with diabetes with little preparation. Diabetes educators should consider if and how they can assess and include child caregivers in diabetes education.

Leisure time activity of Mexican Americans with diabetes.

BACKGROUND: Diabetes is a worldwide health problem with increasing prevalence, particularly among ethnic minorities. Activity is a major component of diabetes management that can help to prevent the deadly complications of the disease. Assessment of the activities in which individuals with diabetes from specific ethnic groups such as Mexican Americans engage may facilitate identification of strategies to encourage activity among those who do not participate in activity or have only minimal, sporadic participation. AIMS: The aims of this research were to determine: (1) What proportion of Mexican Americans with diabetes do and do not exercise? (2) What are the preferred types of leisure time activity by gender and age? (3) What the relationship is between leisure time activity and treatment of diabetes? METHODS AND INSTRUMENT: A secondary analysis of data from the third National Health and Nutrition Examination Survey (NHANES) (1988-1994) was conducted to explore leisure time activities of self-identified Mexican Americans with diabetes. RESULTS: Mexican American adults in this study indicated gardening (33.7%) and walking (31.5%) as the leisure time activities in which they engaged most frequently in the month preceding data collection. Gardening and walking were frequent leisure activities of study participants for all categories of pharmacological management of the diabetes. Many did not participate in any leisure time activity in the month preceding data collection. Only six of every 10 Mexican Americans (61%) with diabetes exercised. Males (n = 136; 71%) were more likely to engage in physical activity than females (n = 171; 54%). LIMITATIONS: Only leisure time activity was assessed; occupational activity and household activity were not included. Data were based on self-report rather than an objective measure of subject activity. Subject knowledge of the need for activity as a component of diabetes management was not assessed and may not be recognized as an integral part of care. CONCLUSIONS: Diabetes is a significant health problem for many ethnic groups, including the Mexican American population, and regular physical activity is a critical component of disease management. Facilitating activity in this ethnic group is integral to controlling complications of this chronic disease.

Ethnic differences in exercise among adults with diabetes.

The purposes of this secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) III Household Adult Data File (1988-1994) were to describe and compare exercise practices and preferences of adult Caucasians, African Americans, and Hispanics with diabetes and to relate that information to diabetes treatment modalities. The research questions were: (a) What proportion of ethnically diverse adults with diabetes do and do not exercise? (b) What are the preferred types of exercise by ethnicity, gender, and age? and (c) What are the relationships among exercise participation, exercise preference, and treatment of diabetes by ethnic group? More than one third of the total sample reported no exercise within the last month. There were no significant differences in amount of exercise by ethnic group. Gardening and walking were the preferred forms of exercise across age, gender, ethnicity, and treatment.