End-of-Life Heart Failure Education With Staff Nurses; A Quality Improvement Project

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEHeart failure (HF) is a serious diagnosis and a major public health concern. The symptoms can be exhausting and can vary from person to person with periods of acute exacerbations requiring hospital admission. It is important for hospital staff nurses to be able to speak with knowledge and comfort about end‐of‐life planning. The purpose of this quality improvement project was to increase nurses’ awareness of the functional classification systems of HF, options and timing for palliative care, and describe nurses’ intent to use the information in practice. Nurses reported planning on using the information to “Be more Sensitive and Listen.” The prevailing theme to barriers to implementing this into practice was “Not enough time and discomfort.” Nurses who were comfortable having end‐of‐life discussions did not feel they had enough time, and those who were not comfortable did not engage because of discomfort toward the topic. Furthermore, recommendations from this study were the addition of a supportive palliative care team to manage patients with HF.End-of-Life Heart Failure Education with Staff Nurses; A Quality Improvement Project / Abstract / Table of Contents / Project / Background and Significant / Project Purpose / Literature Review / Methods / Analysis and Findings / Dissemination / Discussion / Conclusion / Impact on Practice / References / Appendix A New York Heart Failure Classification System / Appendix B Plan-Do-Check-Act Cycle / Appendix C Consent Form / Appendix D IRB Approval Letter / Appendix E Permission Letter / Appendix F Pre-Education Survey / Appendix G Post-Education Survey / Appendix H Case Study #1 / Appendix I Case Study #2 / Appendix J 'Do' Phase Education Intervention Lesson Plan / Appendix K Themes from QI Projec

Online vs. face-to-face discussions in a web-based research methods course for postgraduate nursing students : A quasi-experimental study

Background: Web-based technologies are increasingly being used to create modes of online learning for nurses but their effect has not been assessed in nurse education. Objectives: Assess whether participation in face-to-face discussion seminars or online asynchronous discussion groups had different effects on educational attainment in a webbased course. Design: Non-randomised or quasi-experimental design with two groups – students choosing to have face-to-face discussion seminars and students choosing to have online discussions. Setting: The Core Methods module of a postgraduate research methods course. Participants: All 114 students participating in the first 2 years during which the course teaching material was delivered online. Outcome: Assignment mark for Core Methods course module. Methods: Background details of the students, their choices of modules and assignment marks were collected as part of the routine course administration. Students’ online activities were identified using the student tracking facility within WebCT. Regression models were fitted to explore the association between available explanatory variables and assignment mark. Results: Students choosing online discussions had a higher Core Methods assignment mark (mean 60.8/100) than students choosing face-to-face discussions (54.4); the difference was statistically significant (t = 3.13, df = 102, p = 0.002), although this ignores confounding variables. Among online discussion students, assignment mark was significantly correlated with the numbers of discussion messages read (Kendall’s taub = 0.22, p = 0.050) and posted (Kendall’s taub = 0.27, p = 0.017); among face-to-face discussion students, it was significantly associated with the number of non-discussion hits in WebCT (Kendall’s taub = 0.19, p = 0.036). In regression analysis, choice of discussion method, whether an MPhil/PhD student, number of non-discussion hits in WebCT, number of online discussion messages read and number posted were associated with assignment mark at the 5% level of significance when taken singly; in combination, only whether an MPhil/PhD student (p = 0.024) and number of non-discussion hits (p = 0.045) retained significance. Conclusions: This study demonstrates that a research methods course can be delivered to postgraduate healthcare students at least as successfully by an entirely online method in which students participate in online discussion as by a blended method in which students accessing web-based teaching material attend face-to-face seminar discussions. Increased online activity was associated with higher assignment marks. The study highlights new opportunities for educational research that arise from the use of virtual learning environments that routinely record the activities of learners and tutors

Conscientious objection – does it also apply to nursing students?

The conscientious clause in nursing can be defined as a kind of special ethical and legal regulation which gives nurses right to object to actively perform certain medical procedures which are against their personal system of values. Usually these values are associated with nurses’ religious beliefs, but not always. Scope of this regulation differs throughout the world. However, it is emphasized that right to the conscientious objection is not absolute and this regulation can not be used in cases of danger to life or serious damage to the health of the patient. Medical procedures to which nurses hold conscientious objection are often within reproductive health services. However, we can also find reports on the use of this right i.e. in end-of-life care and in the process of the implementation of medical experiments. The main issue underlined in the discussion regarding practising conscientious objection in the clinical setting is the collision of two human rights: the right to conscientious objection of medical personnel and the right of patients to specific medical procedures which are legal in their country. If a procedure is legally available in a country it means that patients can expect to receive it, on the other hand, all citizens, including health care workers, have the right to protect their moral identity and the right to object to the implementation of a procedure to which they have a specific objection. It is very difficult to find good ethical and legal balance between these two perspectives

Academic careers: the value of individual mentorship on research career progression

The paper discusses how individual mentoring may impact positively on career pathway development for potential and future clinical academic researchers in nursing and allied health professions. Methods: The paper draws on a number of data sources and methodologies in order to fulfil the aims. Firstly, international literature provides an insight into mentoring processes and impact on career development. This is followed by a review of the mentoring experiences based on a UK study on the professorial populations in nursing and allied health professions. The final section reports on results of interviews with early and advanced researchers on their experiences of mentoring. Results: Individual mentoring is valued highly by health care professionals at all stages of career development. It is considered particularly useful when people are in transition towards a more challenging career role.Individuals in receipt of mentoring both formal and informal, report improved confidence in their cability to achieve their career goals. Mentees report improved levels of competence achieved through knowledge aquisition, networking and ability to probelm solve. Conclusions/Summary: Mentoring is considered an important process for health care professionals at all stages of their career. Opportunities to access and receive mentoring support for health care staff in the UK remain limited and sporadic in nature. There are examples of excellent mentoring schemes in place within some institutons and organisations but a national strategy to support mentoring has yet to be developed Key words: Clinical academic careers, mentoring, nursing, allied health profession

“A Leap of Faith”: Student to Professional

This qualitative, phenomenological study sought to answer the question: How do new graduates view their baccalaureate educational experiences in relation to their transition to professional practice? Eight new graduate nurses from a private nursing school in the western United States participated in this study. Participants wrote reflections describing their transition from student role to professional nurse and reviewed these reflections with the researcher at the end of face-to-face interviews. In-depth interviews using open-ended questions were conducted, recorded, and transcribed by the researcher. The results of the interview and reflections were analyzed by the researcher using Colaizzi’s (1978) method to identify the recurring themes and member checking with the participants to help validate the results. Additional validation strategies included writing rich, thick descriptions; triangulation using interviews, reflections, and field notes; clarification of researcher bias; and peer debriefing. Reliability was enhanced by the researcher using a quality digital audiotape recorder, transcribing the interviews, and utilizing an audit trail during data collection and analysis. Five themes were identified in this study: (a) figuring it out, (b) the learning process, (c) influential people, (d) where you practice matters, and (e) questioning preparation. When describing their transition experiences and retention in both their reflections and interviews, the participants identified how essential their nursing education experiences were in laying the foundation for building their professional practice. This study provided insight into transition and retention experiences as it is the only qualitative study that investigated the entire educational experience and utilized open-ended interviews and reflections. The theory of transition was used to inform the study. The participants’ journeys from student role to professional nurse were unique because their educational and new graduate orientation experiences varied but, ultimately, each participant referenced education in the interview and reflection. The interviews took place in cafés and coffee shops per participants’ request and participants identified issues supporting working night shifts as a new graduate nurse. Results supported the appropriateness of using Meleis’ (2010) theory of transition to provide insight into baccalaureate nursing students’ transition from a student role to professional nurse. Findings from the study provided the rationale for recommendations for nurse educators that included retaining or implementing precepted practicum experiences, retaining or enhancing high quality clinical placements, addressing incivility on nursing units to support both students and staff nurses, supporting and educating preceptors in the clinical setting, providing opportunities for nursing students to care for critically ill or complex patients, providing opportunities for preceptors and clinical faculty to allow students and new graduate nurses to become more independent in providing patient care while continuing to be a resource to insure patient safety, and supporting nurses of all generations in their educational and work place needs to encourage retention. Students take a leap of faith when starting a nursing program and entering practice. They rely on nursing education to provide the necessary foundational knowledge and experiences to support their transition from a student role to professional nurse and to support their retention in their first nursing roles as well as the nursing profession. Key Words: transition to practice, retention, phenomenology, transition theory, preparation for practic

Measures that can be used to teach critical thinking skills in nurse prescribers

Critical thinking is a pervasive skill that involves scrutinizing, differentiating, and appraising information and reflecting on the information gained in order to make judgements and inform clinical decisions. Studies inform us of the need for agreement on the approaches used to teach and measure critical thinking. Nurse prescribers undertake an advanced role that encompass the need to be able to make clinically based decisions about the appropriateness of a specific medication. This requires critical thinking attributes. A variety of teaching and learning approaches are offered which can be used by nurse educators to develop critical thinking skills in nurse prescribers

Horizontal Violence Effect on Nurse Retention

Horizontal violence is known by a variety of terms such as lateral violence, bullying, and incivility. Christie and Jones (2014) describe lateral violence as a problem in nursing where a behavior is demonstrated through harmful actions that occur between nurses. Studies have revealed how horizontal violence affects nurse retention. Horizontal violence is a relevant issue in the healthcare community, yet often goes undiscussed. Walrafen (2012) explains that an outcome of horizontal violence in nursing is directly proportional to a decrease in retention of nurses. Sherman (2012) proclaimed that nurses who are subjected to horizontal violence have low self-esteem, depression, excessive sick leave, and poor morale. As Wilson (2011) identified nurses, who witness or experience horizontal violence have an increased desire to leave the organization where the bullying takes place. Horizontal violence is a pervasive source of occupational stress with physical, psychological, and organizational consequences (Hauge, et al, 2010). Roy (2007) describes this as an unkind, discourteous manner in which nurses relate to their colleagues. As nurses seek to perform their daily tasks, other co-workers may embarrass them for their lack of knowledge, tease them as they participate in informal cliques, or demean them for their technique (Bakker, 2012). Creating excuses, taunting, and refusing to share information, nursing education or knowledge are examples of horizontal violence (Ball, 1996)

Improving Patient Satisfaction with the Virtual Handoff Process through the Utilization of Educational Pamphlets in the Emergency Department

Boarding patients in the emergency room while waiting to transfer the patient to the proper unit can be harmful to clinical care and have significant financial opportunity costs. At one local hospital it was found that on average patients were being boarded in the emergency room (ED) for approximately 85 minutes waiting to be transferred. Several barriers that caused this delay were found including, delay in room cleaning, nurse staff shortage, and inability to give report to the nurse receiving the patient. In an attempt to combat this delay which may be caused by a difficulty in giving patient report, this organization is rolling out a virtual bedside handoff process. While virtual technology is not a new concept, there are many patients that may not be comfortable with the technology. The purpose of the evidence-based project was to provide a written educational pamphlet that details the how’s and why’s of the virtual handoff process to the patient to be given upon admission. The goal of the educational pamphlet was to increase the patients’ satisfaction with the process. A pre-survey was given to a group of patients after they experienced the virtual handoff process to assess their comfort level. These results were compared to the post-survey results of patients that received the educational pamphlet prior to experiencing the virtual handoff process. Ten pre-surveys and seven post-surveys were analyzed utilizing SPSS and descriptive statistics. The analysis concluded that the participants who received the educational pamphlet felt more prepared for the virtual handoff process

An Examination of the Application of Problem Based Learning: A Valuable Tool to Improve Student Learning or a Challenging Teaching Adjustment?

Pedagogic transitions towards constructivist, student-centred learning models have increased applications of active teaching methods such as problem-based learning (PBL), but little research has explored student perceptions of PBL applications within undergraduate geography curricula. This paper aims to determine whether PBL applications are beneficial to student learning and development; and to determine whether PBL applications such as a migration management case study are suitable for continued use within the undergraduate geography degree programme at the University of Hertfordshire. This study examines the utility of PBL by reviewing existing education and discipline specific literature and by studying geography student reflections of a PBL migration management activity. The findings suggest that undergraduate geography students are largely receptive to PBL applications and find the inclusion of PBL activities within lectures to be useful and engaging. Although challenges can be associated with implementing PBL into higher education curricula, these challenges can be alleviated by using recommendations for best practice and it appears that the advantages of PBL applications for student learning and development strongly outweigh initial adjustment challenges. The predominantly positive student feedback demonstrates that the PBL migration case study is a beneficial addition to the geography degree programme at the University of Hertfordshire and that further applications of PBL within the curricula could be extremely valuable for undergraduate geography students