Development of a Self‐Management Theory‐Guided Discharge Intervention for Parents of Hospitalized Children

Background Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self‐management of their child\u27s care at home after discharge. Problem No theory‐based discharge intervention exists to guide pediatric nurses\u27 preparation of parents for discharge. Purpose To develop a theory‐based conversation guide to optimize nurses\u27 preparation of parents for discharge and self‐management of their child at home following hospitalization. Methods Two frameworks and one method influenced the development of the intervention: the Individual and Family Self‐Management Theory, Tanner\u27s Model of Clinical Judgment, and the Teach‐Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine‐domain conversation guide for use in acute care pediatric hospitals. Conclusions The theory‐based intervention operationalized self‐management concepts, added components of nursing clinical judgment, and integrated the Teach‐Back method. Clinical Relevance Development of a theory‐based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention

Using Omaha System Documentation to Understand Physical Activity Among Rural Women

Rural women are more inactive and have different barriers to physical activity than those who live in more urban settings, yet few studies have specifically examined physical activity and associated factors in this population. Clinical data documented with standardized terminology by nurses caring for rural women may provide an opportunity to generate evidence that informs and improves nursing care. However, the knowledge to be gained and utility of nurses\u27 clinical documentation in regard to physical activity have not been explored. Accordingly, the purpose of this study was to increase understanding of physical activity and associated factors among rural women by analyzing clinical data documented by local health department (LHD) nurses using the Omaha System standardized terminology. The study was guided by the ecological model for health promotion. A two-phase, retrospective, mixed-methods design was used. Phase One involved quantitative secondary analysis of a de-identified dataset derived from a convenience sample of women who received care from LHD nurses in a rural, Minnesota county (N=852). Measures included demographic data, baseline physical activity Knowledge, Behavior, and Status (KBS) ratings, physical activity signs/symptoms, and ecological factors operationalized with the Omaha System Problem Classification Scheme and Problem Rating Scale for Outcomes. Results revealed rural women had more than adequate Knowledge (M=3.41), inconsistent Behavior (M=3.27), and minimal to moderate signs/symptoms (M=3.56) for physical activity. Hierarchical regressions indicated ecological factors influenced physical activity behavior; however, age, BMI, and physical activity knowledge had more impact. Phase Two involved a focus group session with a purposive sample of LHD nurses (N=12) in the study setting. A semi-structured interview guide was used to elicit their perspectives about the quantitative findings. Three themes emerged with qualitative thematic analysis: (a) knowledge is good, behavior is the issue; (b) clients may be more complex than what is captured; and (c) assessment and coding are impacted by professional judgment, time constraints, and priorities. The outcomes of this study provide support for measuring and analyzing physical activity from an ecological perspective with clinical information documented by nurses using the Omaha System. The results indicate physical activity Behavior among rural, female, LHD clients in the Midwest is inconsistent and influenced by demographic factors of age, BMI, physical activity Knowledge, and environmental factors. However, LHD nurses perceive physical activity Behavior remains an issue, despite more than adequate physical activity Knowledge. In addition, nurses reported that documented data may not have fully captured client complexity due to nursing time constraints and client priorities. Future studies are needed with attention to these assessment and coding challenges. Providing nurses with ongoing education on KBS rating and information regarding potential research applications of client clinical data may help address these challenges and strengthen future research in this area

A qualitative study exploring the relationship between nursing and health promotion language, theory and practice

The definitions and meaning qualified nurses employed in an acute NHS hospital setting in the UK gave to health education and health promotion practice and how these fitted established language and theory were investigated qualitatively. These concepts, and the concomitant frameworks and models of practice, have been the subject of considerable debate in the literature. While unresolved both in general and in nursing, a degree of theoretical convergence was established in the 1990s [Bunton, R., Macdonald, G., 1992. Health promotion: disciplines and diversity. Routledge, London; Maben, J.M., Macleod Clark, J. 1995. Health promotion: a concept analysis. Journal of Advanced Nursing 22, 1158–165] helped by The Ottawa Charter [WHO, 1986. Ottawa Charter for Health Promotion. http://www.who.int/hpr/archive/docs/ottawa.html]. For many of the participants in this study however, the meanings given to these concepts and the predominant use of health education were inconsistent with much of the language of the wider debate and this has potential implications for nurse education. For, if the findings are considered transferable then there is a need to develop education strategies and curricula that articulate the ideological foundations of policy and practice and to use mainstream terminology to assist nurses both to understand and contribute to the contemporary health promotion debate

Threshold concepts in research and evidence-based practice: Investigating troublesome learning for undergraduate nursing students

Across healthcare, evidence-based practice (EBP) has been recognised as a core component of providing safe and effective patient care and, consequently, research and EBP are important components of the undergraduate nursing curriculum. Despite the attention given to research and EBP in nursing education literature, the evidence base for effective learning and teaching strategies is weak. There is also evidence that undergraduate nursing students find aspects of these topics difficult and that negative attitudes may be a barrier to learning. However, little is known about the detail and processes of learning in this area. This narrative research study investigated the difficulties that nursing students encountered in learning about research and EBP and explored changes and transformations in their understanding. Using threshold concepts as a theoretical framework, the study aimed to identify thresholds associated with research and EBP, in the context of undergraduate nursing education. Seventeen third year students, from a large school of nursing, took part in at least one unstructured narrative interview and 13 of these gave two interviews, at the beginning and end of a research and EBP module. The interviews explored learning during the module, as well as students’ experiences in the first two years of their study. This included learning in practice and university settings. The findings show that the learning environments were characterised by variability and complexity. Students encountered different sources of trouble in their learning and they demonstrated varying degrees of change and transformation, which also linked to their developing nursing identity. From the narratives, a set of academic thresholds concepts emerged that underpins acquisition of a professional threshold of evidence-based thinking and practising. These findings have implications for undergraduate nursing curricula and suggest that there are changes required in education and practice settings, for EBP to be embedded in nursing practice and identity

Gerontological nursing: professional priority or eternal Cinderella?

Over thirty years ago geriatric nursing, as it was then called, was at the forefront of nursing research in the United Kingdom. Concurrent with the emergence of geriatric medicine as a distinct speciality, the pioneering study of Doreen Norton and colleagues (Norton et al. 1962) served to highlight both the deficits that existed in the hospital care of older people and the enormous potential of nursing to improve the situation, particularly for the ‘irremediable’ patient (Norton 1965). Caring for those who could not be cured but required on-going support was seen to constitute ‘true nursing’ and was identified as an area of practice in which nurses should excel (Norton 1965, Wells 1980). Such potential went largely unrealised, however, as nursing focused on acute, hospital-based care (Nolan 1994). As a consequence, those working in continuing care struggled to find value in their work and patients were subjected to ‘aimless residual care’ (Evers 1991), a situation exacerbated by the continued application of the biomedical model (Reed and Watson 1994). Despite claims that nurses working with older people have ‘special skills’ (Royal College of Nursing 1993), the nature of such skills has therefore never fully been explicated. Indeed, Armstrong-Esther et al. (1994) asked what nurses currently contribute to the well-being of elderly people and, following their study, suggested that nurses must take the initiative and expand their role if ‘we are going to avoid simply warehousing the elderly until they die’. The need to act is particularly pressing at present as the spectre of ‘bed-blockers’ emerges once more and there is growing professional concern that older people may soon be denied the right to receive care from a qualified nurse (Nursing Times 1996)

Burnout Triggers in the Novice Registered Nurse

Nurse burnout has been strongly associated with decreased patient satisfaction and reduced retention rates in the novice registered nurse. This phenomenon is exacerbating the already rising global nursing shortage. A strong correlation is established between novice registered nurses who endure repeated or multiple triggers, such as unsafe staffing ratios, inadequate preceptorship, and ineffective leadership to those who succumb to burnout. Burnout is a significant problem in the United States, impacting how healthcare is perceived by the public. In 2019 there were more than six million nurses, making up the largest segment of the healthcare population and directly affecting the safety and well-being of patients in the United States (Shak et al., 2021). Being able to sustain the number of nurses needed to provide adequate care for patients has become challenging. Novice registered nurses are leaving the profession after developing burnout from repeated exposure to triggers. The purpose of this project is to identify the correlation between triggers and burnout in the novice registered nurse and mitigate those triggers. An analysis of the literature promotes the need to identify triggers and mitigate those triggers as a method to decrease burnout experienced in the novice registered nurse

Simulation in Nursing Education: A Family Approach

Purpose Statement: The project’s purpose is to determine if the use of low-fidelity simulation (role-play) is an effective teaching-learning strategy to educate sophomore level baccalaureate nursing students on the importance of family assessment and communication. Another purpose for the project was to design and develop a credible and reliable simulation rubric which can be used for faculty to evaluate nursing student abilities to conduct family assessment and communication skills in a simulation setting. Finally, this systems change project (SCP) was designed to help redesign the Minnesota State University, Mankato (MSM) basic undergraduate nursing curriculum by integrating a family as client care emphasis within the curriculum. Background: There is a gap in the literature as to whether simulation may be used to teach family assessment and communication skills to undergraduate nursing students. Effectiveness of simulation in these two areas requires further research. The new curriculum will focus on a conceptual model of learning rather than content, with the assumption that students will be better prepared to think critically, adjust to quickly changing work environments, and ultimately deepen the learning experience of the students. Methods: A descriptive study using a pre-survey and 11 week post survey single group design was used to compared pre-intervention data to post-intervention data for sophomore nursing students (N=24) attending a simulation (role-play) teaching-learning experience. Four theories guide this SCP to enhance nursing students’ learning about health and families: The Calgary Family Assessment Model (CFAM), Calgary Family Intervention Model (CFIM), Social Learning Theory, and Fink’s Creating Significant Learning Experiences. Research Questions: Will the use of simulation role-play increase the perceived importance of family as client care in sophomore nursing students? Will sophomore nursing students perceive simulation role-play an effective learning tool for family communication and assessment skills? Will the Van Gelderen Simulation Rubric (2010) indicate to be a reliable and valid instrument for measuring nursing student assessment and communication skills? Hypotheses: Sophomore nursing students will perceive family as client care as more important on post survey versus pre survey results. Sophomore nursing students will perceive simulation role-play an effective learning tool to build family communication and assessment skills. The Van Gelderen Simulation Rubric (2010) will indicate to be a reliable and valid instrument for measuring nursing student assessment and communication skills. Results: The students’ level of perceived importance of family care on post surveys as compared to pre surveys overall showed a trend towards increasing (M=3.79; pre-survey) vs. (M=3.83; post-survey). However, no level of significance was found. The implementation of simulation role-play in undergraduate, sophomore nursing students to build family communication and assessment skills was perceived by the students as a positive learning experience by recommending (3.92/4.0 Likert Scale) that this simulation experience be replicated for future MSM nursing students. All male students endorsed replicating this experience by rating this experience as 4.0/4.0 on a Likert Scale whereas female students endorsed this experience as 3.89/4.0. Using Intra-class Correlation Coefficient, the Van Gelderen Simulation Rubric (2010) was found to have all of its eleven constructs significant at a 5% level (p=.000); indicating agreement among three raters. Cronbach’s Alpha indicated that nine of eleven constructs within the rubric were found to have reliability at (.852 or higher). Two constructs were found to have lower reliability; the construct pertaining to ‘Issues & Concerns’ was (.599) and the ‘Family as Client’ construct was (.671). Implications: Implications for future nursing practice and research are that simulation may be an effective method to transfer family knowledge into clinical practice for nursing students. However, simulation was found to be a better learning experience for male versus female nursing students. With further replication and verification, the Van Gelderen Simulation Rubric (2010) may be used as a tool for nurse educators to measure nursing student ability to conduct family assessment and communication skills. Further Research: An area requiring further research is to investigate whether simulation may be an effective tool for current practicing nurses and graduate nursing students to learn about family based care