Bridging School and Practice? Barriers to the Integration of 'Boundary Objects' for Learning and Assessment in Clinical Nursing Education.

Introduction: In clinical health professions education, portfolios, assignments and assessment standards are used to enhance learning. When these tools fulfill a bridging function between school and practice, they can be considered 'boundary objects'. In the clinical setting, these tools may be experienced as time-consuming and lacking value. This study aimed to investigate the barriers to the integration of boundary objects for learning and assessment from a Cultural-Historical Activity Theory (CHAT) perspective in clinical nursing education. Methods: Nineteen interviews and five observations were conducted with team leads, clinical educators, supervisors, students, and teachers to obtain insight into intentions and use of boundary objects for learning and assessment. Boundary objects (assessment standards, assignments, feedback/reflection/patient care/development plan templates) were collected. The data collection and thematic analysis were guided by CHAT. Results: Barriers to the integration of boundary objects included: a) conflicting requirements in clinical competency monitoring and assessment, b) different application of analytical skills, and c) incomplete integration of boundary objects for self-regulated learning into supervision practice. These barriers were amplified by the simultaneous use of boundary objects for learning and assessment. Underlying contradictions included different objectives between school and practice, and tensions between the distribution of labor in the clinical setting and school's rules. Discussion: School and practice have both convergent and divergent priorities around students' clinical learning. Boundary objects can promote continuity in learning and increase students' understanding of clinical practice. However, effective integration requires for flexible rules that allow for collaborative learning around patient care.

Constructing an evaluation index system for clinical nursing practice teaching quality using a Delphi method and analytic hierarchy process-based approach.

BACKGROUND: The key step in evaluating the quality of clinical nursing practice education lies in establishing a scientific, objective, and feasible index system. Current assessments of clinical teaching typically measure hospital learning environments, classroom teaching, teaching competency, or the internship quality of nursing students. As a result, clinical evaluations are often insufficient to provide focused feedback, guide faculty development, or identify specific areas for clinical teachers to implement change and improvement. Therefore, the purpose of our study was to to construct a scientific, systematic, and clinically applicable evaluation index system of clinical nursing practice teaching quality and determine each indicator's weight to provide references for the scientific and objective evaluation of clinical nursing practice teaching quality. METHODS: Based on the "Structure-Process-Outcome" theoretical model, a literature review and Delphi surveys were conducted to establish the evaluation index system of clinical nursing practice teaching quality. Analytic Hierarchy Process (AHP) was employed to determine the weight of each indicator. RESULTS: The effective response rate for the two rounds of expert surveys was 100%. The expert authority coefficients were 0.961 and 0.975, respectively. The coefficient of variation for the indicators at each level ranged from 0 to 0.25 and 0 to 0.21, and the Kendall harmony coefficients were 0.209 and 0.135, respectively, with statistically significant differences (P < 0.001). The final established index system included 3 first-level, 10 second-level, and 29 third-level indicators. According to the weights computed by the AHP, first-level indicators were ranked as "Process quality" (39.81%), "Structure quality" (36.67%), and "Outcome quality" (23.52%). Among the secondary indicators, experts paid the most attention to "Teaching staff" (23.68%), "Implementation of teaching rules and regulations (14.14%), and "Teaching plans" (13.20%). The top three third-level indicators were "Level of teaching staff" (12.62%), "Structure of teaching staff" (11.06%), and "Implementation of the management system for teaching objects" (7.54%). CONCLUSION: The constructed evaluation index system of clinical nursing practice teaching quality is scientific and reliable, with reasonable weight. The managers' focus has shifted from outcome-oriented to process-oriented approaches, and more focus on teaching team construction, teaching regulations implementation, and teaching design is needed to improve clinical teaching quality.

Suicide prevention in a virtual environment: a roadmap for simulation-based education.

OBJECTIVE: to build and validate a simulation-based education roadmap on suicide prevention in the virtual environment. METHOD: methodological research subdivided into a development and validation stage. The roadmap was built using a previously drafted template based on international guidelines on good clinical simulation practices and scientific literature on suicide prevention in the virtual environment. For validation, the roadmap was validated by experts through self-application of an assessment form with answers based on "adequate, fair, and inadequate", with a field for suggestions. Descriptive statistics and the Content Validity Index (CVI≥0.8) were used. RESULTS: nine experts took part in the study, the majority of whom were nurses (66.7%), female (55.6%), with an average age of 42.22 years. All the items in the roadmap met the acceptance criteria (CVI≥0.8). CONCLUSION: this study provides a useful roadmap for teaching suicide prevention in the virtual environment. BACKGROUND: (1) Innovative study on suicide prevention, simulated teaching, and the virtual environment. (2) Script validated by experts and available in full for simulated teaching. (3) Introduction of a prototype of a fictional virtual social network for simulated practice. (4) Results indicated the appropriateness of the construction, with good agreement in the analyses. (5) The script enhances professional training and development in the mental health context.

Enhancing prone positioning and skin damage prevention education: A randomized controlled non-inferiority trial comparing a digital education hub (PRONEtect) and a traditional lecture on final-year nursing participants' confidence and knowledge.

INTRODUCTION: The incidence of pressure ulcers remains high in patients with moderate to severe acute respiratory distress syndrome, ventilated in the prone position. A digital platform, dedicated to prone positioning and skin/tissue damage education was developed. OBJECTIVE: To evaluate the impact of the PRONEtect Education Hub versus a traditional lecture on final-year nursing students' confidence levels and knowledge in a non-inferiority study. DESIGN: A multicenter, non-blinded, parallel-group, non-inferiority study with equal randomization (1:1 allocation) was conducted at two nursing schools in Belgium. CLINICALTRIALS: gov (NCT05575869). METHODS: Following baseline assessments, the control group received a 1-h classroom lecture, and the experimental group gained access to the PRONEtect website. Three weeks later, participants completed the knowledge, confidence, and visual knowledge assessment. RESULTS: At baseline, 67 of the 80 participants completed the assessments and post-intervention, 28 and 27 participants respectively completed the confidence, knowledge, and visual knowledge assessments (dropout rate of 66.25%). Confidence levels: a mean ratio of relative change from baseline = 0.96 (Control (C)/Experimental (E)); 97.5% confidence interval (CI): 0.74 to 1.26; p = 0.74. Knowledge assessment: a mean difference in change from baseline = 1.58 (C-E); 97.5% CI: -0.58 to 3.75; p = 0.1. Although confidence and knowledge scores increased in both groups, the study cannot conclude non-inferiority. CONCLUSIONS: The trade-off between the inability to conclude efficacy of the impact of the website and the benefit of having an accessible educational platform on prone positioning and skin damage prevention makes the PRONEtect Education Hub an acceptable adjunct to traditional lecturing.

American Association of Colleges of Nursing: New Essentials, Quality and Safety Domain.

Since 1986, the American Association of Colleges of Nursing (AACN) has published its Essentials, a framework to guide all levels of nursing education and practice. This brief overview will describe the latest AACN Essentials.

Representation of dark skin tones in foundational nursing textbooks: An image analysis.

PURPOSE: This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts. BACKGROUND: The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice. METHODS: Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone). RESULTS: Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks. CONCLUSIONS: Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark. RELEVANCE TO CLINICAL PRACTICE: All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.

Challenges and Facilitators of Using Smartphones in Educational Activities: Medical and Nursing Students' Perspective.

BACKGROUND: Todays, smartphone technologies and applications are used in the medical and nursing fields. Medical and nursing students are among the groups in which the use of these tools is observed. OBJECTIVES: To investigate their views on the barriers and facilitators of the use of these technologies. METHODS: Four hundred people (200 people from each group) were invited randomly. A questionnaire was used to collect data. To collect data, hospitals were referred and the questionnaires were provided to students and after completion, they were collected. Data analysis was performed using SPSS software and descriptive and inferential statistics. RESULTS: The most important barriers from the students' view included internet problems in the university or hospital, lack of technical support for this technology in the hospital or university, the quality of existing applications, lack of appropriate Apps in the local language, non-introduction of appropriate Apps and not knowing the right Apps. The most important facilitators were the appropriate support services in the university or hospital, placing the appropriate Apps on the department or university website, designing native Apps with the participation of experts, and introducing the appropriate Apps by professors or universities. CONCLUSION: The use of Apps is increasing among medical and nursing students. In this regard, attention to the existing barriers and their elimination and strengthening the facilitators, and providing the necessary technical and educational infrastructure to facilitate the useful applications should be considered by decision-makers.

Exploring factors affecting the facilitation of nursing students to learn paediatric pain management in Rwanda: A descriptive qualitative study.

Nurse educators and nurse preceptors play a fundamental role in facilitating nursing students' acquisition and utilization of professional competencies. Previous studies about key elements for teaching and learning about pain in nursing education programs include students' personal characteristics and previous experiences; educators' knowledge, skills, and beliefs; learners' exposure to leaders in pain education; and curricular pain content and delivery approaches. These studies were mainly carried out in developed countries, with a context of educational and health care systems different from those of developing countries. The current study explores academics', clinical nurse preceptors', and nursing students' perceptions about factors influencing the facilitation of nursing students' competency for paediatric pain management in Rwanda. A qualitative descriptive exploratory design was used in this study that utilized in-depth interviews with six nurse educators and eight nurse preceptors, and focus group discussions with nineteen senior year nursing students. The study setting included five sites: two academic institutions and three clinical settings. Narratives from participants were transcribed verbatim and analysed using thematic analysis. The analysis yielded six themes describing factors that affected the facilitation of students' learning about paediatric pain management. The themes included student motivation, facilitators' attributes, collaboration between academics and clinicians, nurses' limited autonomy for decision-making regarding PPM practices, shortage of human and material resources, and educational qualification. Knowing these factors is essential as it provides an opportunity to design targeted interventions aimed to enhance the capacity of nurse educators and clinical nurse preceptors involved in teaching nursing students about paediatric pain management.

Assessing acceptance of augmented reality in nursing education.

The Covid-19 pandemic has negatively affected every aspect of human life. In these challenging times nursing students, facing academic and psychological issues, are advised to use augmented reality applications in the field of health sciences for increasing their motivations and academic performances. The main motive of the study was to examine the acceptance status of nursing students in implementing augmented reality technology in their education and training. The study is a quantitative research study, and it uses the causal-comparative screening method. The data used in the study was collected online from 419 nursing students. The hybrid method was preferred. First, the hypotheses based on the linear relationships were defined between the variables which were then tested by the method of structural equation modeling. Second, the method of artificial neural networks was used to determine the non-linear relationships between the variables. The results show that the nursing students have a high intention of using augmented reality technology as a way of self-learning. It was also found that the most emphasized motive behind this intention is the expectation that using augmented reality technology will increase their academic performance. They also think that AR technology has many potential benefits to offer in the future. It was observed that a considerable number of students already use augmented reality technology for its usefulness and with a hedonic motivation. In conclusion, nursing students have a high acceptance of using augmented reality technology during their education and training process. Since we live in a world where e-learning and self-learning education/training have become widespread, it is estimated that students will demand augmented reality applications as a part of holistic education, and as an alternative to traditional textbooks.

A Commitment to Quality: The History of Nurse Anesthesia Accreditation Part Two: 1983-2019.

In 1934, Gertrude Fife, President of the National Association of Nurse Anesthetists (NANA) sought to elevate the standards of anesthesia practice and standardize the education of nurse anesthetists. NANA members located schools, developed education standards and a school approval process, that eventually led to creation of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) in 1975. Examination of historical documents demonstrated that COA developed into a well-known accreditation agency recognized by both governmental and non-governmental organizations, enhancing the standards of anesthesia education and promoting high-quality educational programs. Note: See the April 2020 issue of AANA Journal for Part One of this article.

Robotics in Teaching-Learning: But in Nursing?

In this teaching-learning column, the use of robotic technology is explored as a possible adjunctive assistant to faculty. Given the advances in technology and the imposed restrictions of the recent COVID-19 pandemic, a discussion of using robotic technology in the teaching-learning of nursing seems timely and relevant. Questions to consider are explored. Then a concern and a possibility are presented for incorporating this advancing technology into teaching-learning from a humanbecoming perspective. Faculty are encouraged to enter into a deeper dialogue with colleagues in exploring options for incorporating robots with the caveat that the core of teaching-learning must remain the presence of teacher with student on the co-created never ending journey of the unfolding mystery in coming-to-know.

Challenges of Preparing Nursing Students for Practice: The Faculty Perspective.

BACKGROUND: A significant challenge facing nursing is new graduate RNs' unreadiness for practice. To better understand the issue, this study presents the challenges nursing faculty encounter in preparing nursing students for clinical practice through semi-structured interviews. METHOD: Eight faculty from a private midwestern university's prelicensure Bachelor of Science in Nursing (BSN) program participated in the study. A modified version of Colaizzi's data analysis method was used to interpret the data. RESULTS: Three main interrelated themes were identified: Facilitating Learning Among Today's Nursing Students, Teaching in an Era of Information Explosion and Health Care Reform, and Providing High-Quality Clinical Education. CONCLUSION: Findings from this study contribute to a deeper understanding of the challenges in preparing competent future nurses and offer insight into factors influencing the underpreparation of some new graduate BSN RNs. [J Nurs Educ. 2021;60(4):225-228.].

Improving Nurse Preceptor Competence With Clinical Teaching on a Dedicated Education Unit.

BACKGROUND: Nurse preceptors have varying backgrounds of teaching experience and often cite insufficient preparation as a common reason for difficulties transitioning from the role of clinician to educator. This project evaluated an online education program for nurse preceptors of prelicensure students. METHOD: Nurse preceptors received online instruction and howto examples in the form of clinical teaching vignettes to improve the teaching component of their role. Pre- and postsurveys were used to help determine program effectiveness. RESULTS: After the training, nurse preceptors indicated they felt more competent when teaching students, and likewise, students reported increased satisfaction with the quality of teaching. CONCLUSION: There are numerous roles assumed by nurse preceptors. Although many nurse preceptors are expert clinicians, they may lack expertise in the teaching role. Preceptor preparation programs that provide practical examples through the use of vignettes can contribute to the development of teaching competencies. [J Contin Educ Nurs. 2021;52(5):226-231.].

Implications of Clinical Shift Length on Nursing Student Learning Outcomes.

BACKGROUND: One area of clinical education that requires further understanding is the role clinical shift lengths play in nursing student learning outcomes. METHOD: This study used a mixed-methods design. Collaborative nursing students were randomly placed into clinical groups. Students either completed two 6-hour clinical shifts per week or one 12-hour shift. Groups completed a survey questionnaire and an NCLEX-based pre- and posttest. RESULTS: Mean scores for the 12-hour group (1.4 grade points) were higher compared with the 6-hour group (0.8 grade points) (p = .043). The survey also measured students' attitudes, and a correlation was demonstrated in several other categories of questions. Qualitatively, students in the 12-hour group valued their time to a greater degree. CONCLUSION: Although there are merits to both 6-hour and 12-hour shift lengths, findings demonstrated students preferred 12-hour shifts, had statistically higher scores in NCLEX preparation, and developed more therapeutic relationships with clients, families, and instructors. [J Nurs Educ. 2021;60(5):253-258.].

A Multicenter Study of Student Engagement and Satisfaction in Online Programs.

BACKGROUND: Students who are more satisfied and engaged in online courses have better learning experiences and outcomes. METHOD: Survey data were collected during a 4-month period in 2019. The research team created a survey to collect demographic information and assess student satisfaction. Student engagement was measured using the 19-item Online Student Engagement Scale. RESULTS: Overall student engagement and satisfaction scores in online programs were moderately high. Generation Z participants and students from PhD programs were the most satisfied and engaged in their programs. CONCLUSION: Students who are more engaged in online coursework are more satisfied and thus are more likely to remain and successfully complete their respective programs. [J Nurs Educ. 2021;60(5):259-264.].

Kirkpatrick Model Evaluation of Accelerated Second-Degree Nursing Programs: A Scoping Review.

BACKGROUND: This scoping review examined the outcomes of accelerated second-degree baccalaureate and master of nursing programs using the Kirkpatrick four-level model. METHOD: A systematic search of four major scientific databases identified 15 articles meeting study inclusion criteria. The articles were assessed for educational outcomes, and extracted data were organized according to the four-level Kirkpatrick model consisting of reaction, learning, behavior, and results. RESULTS: Both second-degree baccalaureate and master of nursing program students showed strong academic achievement, high employment rates, and high program satisfaction but reported lack of perceived preparedness for a clinical position. No studies evaluated the long-term impacts of the programs on graduates' clinical practice or patient outcomes. CONCLUSION: Accelerated second-degree nursing programs quickly and efficiently produce licensed nurses. The care provided by the graduates of these accelerated programs needs to be investigated in both short- and long-term to better determine overall program effectiveness. [J Nurs Educ. 2021;60(5):265-271.].

An Examination and Comparison of Stethoscope Hygiene in Nursing Education Programs.

BACKGROUND: Improper stethoscope hygiene has been found to contribute to the development of health care associated infections, which affects approximately one in every 30 hospitalized patients. Various pathogens have been found on the stethoscopes of health care workers. METHOD: A correlational descriptive design was used to compare stethoscopes from 117 nursing students. Sterile swab samples were obtained from four separate areas of each stethoscope. Samples were plated and incubated for 24 to 48 hours. RESULTS: Bacteria were found on all parts of the stethoscopes from both undergraduate and graduate nursing students, with the earpiece having the highest percentage of contamination. Staphylococcus was the most prevalent microbe found on all four swab sites. CONCLUSION: Educating students about stethoscope hygiene and consistently reinforcing it in practice are essential to reduce the transmission of pathogens in the health care environment. Nurses can model best practice with students and other disciplines to increase the likelihood of adherence. [J Nurs Educ. 2021;60(5):277-280.].

Strategies and criteria targeting the reform and development for the teaching resource of nursing undergraduate: A multi-center cross-sectional study.

ABSTRACT: Teaching resource of nursing students play an important role in improving clinical performance, while there is a little know and dearth of the access and development criteria or guidance of teaching resources for nursing undergraduates.To develop the admission and development criteria of education resources for nursing undergraduates, and to explore and determine its composition and connotation.A cross-sectional survey has been used.A total of 22 Chinese nursing schools and affiliated teaching bases (hospitals and community health centers).A total of 20 nursing experts were consulted to develop the questionnaire of admission and development criteria of teaching resource for nursing undergraduates in China, and then 285 valid experts from 22 Chinese nursing schools and affiliated teaching bases (hospitals and community health centers) conducted the questionnaire survey to evaluate experts' consensus rate and view on the composition and connotation of the developed criteria.There were 6 domains and 43 items included in the admission and development criteria of teaching resource for nursing undergraduates, which domains included educational budget and allocation of resources, infrastructure, clinical teaching bases, books and information services, educational experts, and educational exchanges. The experts' consensus rate was more than 90.2%.The standard is helpful to guide the future admission and development of teaching resource for nursing undergraduates, and favor the education quality improvement of nursing undergraduates.