NURSING STUDIES: PROMOTERS AND BARRIERS FOR ADHERENCE TO CLINICAL PRACTICE GUIDELINES AMONG NURSES

Clinical practice guidelines (CPGs) are designed to improve the care and safety of patients in hospitals. This thesis explores the promoters and barriers for CPG adherence among nurses. The research is based on a combination of a systematic literature review, qualitative research and a quantitative study. The systematic literature review included searching three data bases, namely, the British Nursing Index (BNI), Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The qualitative research study included one-to-one interviews and focus groups. The quantitative study consisted of a questionnaire distributed to nurses to extend and check the findings of the qualitative studies. The systematic literature review revealed that the attitude of doctors to any CPG is influenced most by the level of their agreement with the guideline and by its applicability in practice. The adherence of nurses to CPGs is influenced most by the support and feedback they receive and by team interactions. A previous framework for CPG adherence by doctors has been produced by Cabana (1999) based on a literature review. This thesis extends that framework to nurses, and adapts it on the basis of my original research findings. Three principal themes emerged from the qualitative studies; namely, nurses’ attitudes to CPGs, their knowledge of CPG and external factors that influence CPG adherence. Within these, the most prominent promoters of CPG adherence were nurses’ sense of their accountability, professional values and self-efficacy, as well as managerial monitoring and belief that a CPG would achieve the expected desirable outcome. The last of these depended to a large extent on nurses’ trust in the credibility of the guideline authors. The main barriers to CPG adherence were lack of knowledge about the guidelines caused by insufficient time to read them, poor presentation and inadequate dissemination of CPGs and the low priority given to training within a nurse’s schedule. Other barriers included lack of staff resources to apply CPGs, the exigencies of individual patient problems and wishes, the frequent movement of nurses between specialisms and a general failure to involve nurses in drafting the guidelines. All these results were confirmed by the results of a questionnaire survey. The revised framework presented here could help health care organisations, medical educators, policy makers and managers to develop better models for CPG development and awareness, especially among nurses, and to have a greater insight into the factors that promote or inhibit CPG adherence. Based on the framework, recommendations are made to help these groups of people, and nurses themselves, improve nurses’ adherence to CPGs. These are presented below, and are found as Table 7.1 in the thesis

Chronic disease prevention in college students: assessment of perception and intention to use a health management app

2018 Summer.Includes bibliographical references.The relationship between intention to use a hypothetical health management app and other variables from a conceptual framework of the Health Belief Model (HBM) and the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) was assessed using a convenience sample of college students (N= 176). The self-reported online survey measured perceived susceptibility to chronic diseases, perceived seriousness of chronic diseases, perceived benefits of the app, perceived barriers to the app, cues to action, social influence, facilitating conditions and intention to use the app, on 5-point Likert type scales adapted from previous studies. Multiple linear regression was used to determine relationships between the predictor variables and criterion variable. The results of the data analysis showed that individually there were a low perception of susceptibility to diseases, perception of barriers to the app and perception of social influence, and a high perception of seriousness of diseases, perception of benefits of the app, cues to action, facilitating conditions, and intention to use the app. Perceived susceptibility, perceived benefits, perceived barriers, social influence and facilitating conditions had a significant influence on college students' intention to use the app to manage different aspects of their health. However, perceived seriousness and cues to action were not found to predict college students' intention to use the health management app

Promotion of physical activity in physical therapy practice within North Carolina

Physical inactivity has been established as one of the most important issues affecting health-related quality of life. In contrast, participation in regular physical activity has been shown to be one of the most effective interventions to treat and prevent a wide variety of chronic diseases. Although well positioned, physical therapists have been found to ineffectively and inconsistently promote physical activity within patient care. The purpose of this study was to determine the extent of physical activity promotion as well as identify perceived barriers and facilitators affecting physical activity promotion in physical therapy practice within North Carolina. Licensed physical therapists who practice within North Carolina were recruited to complete an online survey assessing areas related to physical activity including knowledge, promotion, role perception, confidence, barriers, feasibility, caseload perception, and personal physical activity participation (n = 1,067). Open-ended questions were also included to further explore physical therapists’ perceived barriers and facilitators affecting physical activity promotion. Data analysis included 13.8% (n = 1067) of physical therapists currently practicing in North Carolina. Results demonstrate that nearly all participants promote some form of physical activity; however, only about one-fourth promote physical activity at the highest extent with their current patients as part of the management plan. Additionally, results suggest the highest promoters were significantly different in every variable with relatively small differences in personal physical activity (d = .48), role perception (d = .32), and knowledge (d = .18) and moderate differences in feasibility (d = .70), confidence (d = .55), caseload perception (d = .54), and perceived barriers (d = .50). Open-ended responses suggest accessibility of resources, patient education, and available time were the highest contributors to facilitating physical activity promotion among the highest promoters. Targeted policy and education addressing extrinsic and intrinsic factors by providing accessible resources, education on patient counseling, and actions to implement physical activity promotion should be initiated

Canadian Post-Secondary Students, Stress, and Academic Performance – A Socio-Ecological Approach

The purpose of this integrated-article dissertation was to examine stress and health in Canadian post-secondary students. Data from the spring 2013 National College Health Assessment (NCHA) was utilized in study one and two. This dataset is comprised of 34,039 students from 34 self-selected Canadian postsecondary institutions who took part in the NCHA survey. Study one examined the impact of stress, identified stressors and predicted which students were more likely to experience stress. Stress was the most commonly identified impediment to academic performance and 57.6% of students reported more than average stress. Most frequently reported stressors include; academics, finances, and sleep difficulties. Female students, graduate students, Caucasian students, non-international students, or students in a relationship were most likely to have elevated stress levels, as are those with a mental health diagnosis, learning disability, disability, or chronic illness. In study two, NCHA data was analyzed descriptively and structural equation modeling was used to examine the relationship between health behaviours (e.g., physical activity, sleep, and nutrition), stress, and academic performance. A total of 13.2 % of students reached Canada’s Food Guide Nutrition Guidelines, while 17.2% met Canadian Society of Exercise Physiology’s Guidelines for Physical Activity, and 44.8% identified that sleep was not a problem. Overall, 3.3% of students met recommendations for all three health behaviours. Sleep, exercise, and nutrition had a direct effect on stress and academic performance respectively. Stress also had a direct effect on academic performance. All health behaviours demonstrated significant indirect effects, influenced through stress, on academics. Lastly, via focus groups, study three investigated Canadian university students’ perceptions of individual and institutional factors that impact health and well-being. Students suggested that stress, health behaviours, accountability, and social capital affected their individual health. At an institutional level, a supportive campus culture mediates health; leading to engagement, cohesion, and empowerment. A lack of integration related to student health can result in; disconnection, disempowerment, and decreased motivation adversely impact health. Findings from all three studies support a comprehensive approach to addressing stress and overall health of students at post-secondary institutions

Using Logbooks to Enhance Students’ Learning: Lessons From a Mixed-methods Study in an Undergraduate Surgical Rotation

Background: Logbooks are frequently used in medical education to enhance and monitor students’ learning. However, some barriers that may diminish their benefits have been reported. This study aims to evaluate the usefulness of logbooks to students’ learning and identify the factors, which may contribute to their outcomes in learning milieus. Methods: The study used a mixed-methods approach. Quantitative and qualitative data were collected from the medical students in the fourth- and sixth-year classes and their teachers in the department of surgery at the Faculty of Medicine at University of Tabuk in the academic year 2016–2017. Data were collected using questionnaires, focused group discussions, and personal interviews. Results: Eighty-nine (49 fourth year and 40 sixth year) students and six teachers participated in the study. Logbooks were perceived as useful to students’ learning by 83.3% of the teachers and 75.3% of the students. Logbooks enhanced students’ learning through identification of areas of weaknesses, encouraged seeing more patients’ problems and reading in-depth about some topics, and improved students’ writing skills. Barriers to learning from logbooks included poor-quality feedback, no opportunities for feedback discussion, and unfair marking. Differences in the students’ perceptions of the usefulness of logbooks were observed based on their learning stage. Conclusion: Logbooks are useful to students’ learning in many aspects; however, certain factors could diminish their benefits. Students’ attitude toward the logbook was more favorable during their early clinical experience. Faculty development programs and careful supervision of students’ work may improve the outcome of logbooks in clinical placements. Keywords: logbooks, clinical teaching, written feedback, surgery, Saudi Arabi

Health information dissemination among undergraduate students in Zimbabwe with particular reference to the National University of Science and Technology : a study in developing an integrated framework for health information dissemination

University students in Zimbabwe lack immediate access to accurate health information. There is lack of explicit and integrated structures for disseminating health information to students in Zimbabwe. This inductive study proposes a needs-based, integrated information dissemination framework for promoting health amongst students at the National University and Science and Technology (NUST). The study assessed the health information needs of students and evaluated existing health information dissemination methods at NUST in developing a framework for disseminating health information. The study is informed by the Salutogenetic Theory of health which culminated into an integrated theoretical framework that combines information dissemination and behaviour change theories. A case study strategy was used to gather data within the pragmatic paradigm of grounded constructivism. The population comprised of undergraduate students, the Dean of Students, the Student Counsellor, and the Nursing Sister. Within-method triangulation with complementary data gathering instruments was used to improve reliability of data. Questionnaires, interviews and focus group discussions were used to gather data. A sample of 426 students and 3 members of staff participated in the study. Qualitative and quantitative content analysis was used to determine the confounding factors that informed the design of the framework. The data was supplemented with health information dissemination principles and procedures drawn from literature. The findings reveal that students need health information on a wide range of health topics. Students prefer mobile electronic media, workshops, qualified health professionals, and peers for their health needs. There are significant gaps between the strategies that are being used by NUST to disseminate health information and the health information needs of the students. The university is using traditional information dissemination media and channels that are not in line with the needs of the students. NUST needs to use more interactive and ICT based information dissemination methods. There is also a need for staff recruitment, training and infrastructural development. The proposed framework emphasizes the need for integration of activities, a viable policy, health information literacy training and the use of a mix of persuasion techniques

Interprofessional education activities and new practitioner competence: Implications for practice in nutrition and dietetics education

Interprofessional education (IPE) and interprofessional collaborative practice (IPCP) are associated with improved perception, values, attitudes towards collaborative practice, and therefore benefits patients, practitioners, and health care systems. Notable organizations have long promoted standardized guidelines for best practices in interdisciplinary team-based learning to improve patient safety and health outcomes. The state of IPE in nutrition and dietetics practice was recently addressed by the Nutrition and Dietetic Educators and Preceptors (NDEP) practice group of the Academy of Nutrition and Dietetics. The authors generated a call to action to engage in IPCP while pushing the boundaries of leadership in teaching, research, and practice. Present understanding of IPE demonstrates the need for further research particularly focused on the relationship between the types of IPE activities and the outcomes of self-confidence and competence surrounding IPCP achieved by new RDN practitioners. Unique in its approach, this study deployed mixed methods research to ascertain current IPE practices within nutrition and dietetics programs. RDN practitioners within the first few years of independent practice were surveyed to collect data on program type, IPE activities, and reactions to these learning experiences. This information was then analyzed to determine significant findings and indications for the second phase of focus groups comprised of current program directors. The qualitative portion provided detailed information such as thematic elements, IPE activities within programs and recommendations. Information gathered helped to identify opportunities to improve the IPE practices in the education and training of future nutrition and dietetics professionals

2017 EURēCA Abstract Book

Listing of student participant abstracts

Simulation Psychological Safety Ecosystem: A Grounded Theory Study of Nurses’ Experience with Psychological Safety in Prelicensure Simulation

Over the past couple of decades, the utilization of simulation-based education in prelicensure nursing expanded in both frequency and functionality. Learning through simulation requires psychological safety where participants feel comfortable engaging to their fullest extent and can speak up or ask questions without fear of embarrassment to themselves or others. Professional simulation organizations provide recommendations for creating psychological safety, yet anecdotal stories from nurses report variability in their experiences ranging from positive to negative. Research regarding psychological safety in nursing education revealed some consistent themes of anxiety due to being observed or unfamiliar with simulation environments or expectations. The evolving literature also discussed some issues of anger, humiliation, and fear that result from participating in an environment that lacked psychological safety. Some of the findings were limited due to being at schools of nursing where the researchers were faculty for the population being studied and highly skilled in simulation pedagogy. The lack of understanding of the nurses’ perceptions of psychological safety and what factors could influence that feeling deserved further exploration. Seventeen recently graduated nurses were interviewed regarding their experiences with psychological safety during prelicensure simulation. Using Constructivist Grounded Theory, the data from these interviews were analyzed and the resultant theory was Simulation Psychological Safety Ecosystem. The theory explains that psychological safety is a dynamic, complex process with a spectrum of outcomes from feeling psychologically safe to suffering psychological harm. Factors that influence this outcome include: clarification of simulation expectations, guidance from the instructor during scenarios, experience with watching and being watched by peers and faculty, and quality and tone of feedback received. The overall sense of psychological safety can also be influenced by nurses’ relationships with faculty and peers, and their desire to achieve meaningful clinical learning during the simulation. Findings of this study offer insight into the complex process of establishing, maintaining, and repairing psychological safety in prelicensure nursing simulation. The results are useful in guiding nursing education practices and suggest areas for future research

Quiet Lampshade in the Corner?: Exploring Fourth Year Nursing Students' Narratives of Transition to Professional Practice

Recruitment and retention issues continue to be prevalent in all domains of nursing practice. Nursing students’ transition into practice is an understudied area of this concern. This study specifically explored the question: How do fourth year nursing students make meaning of their transition to professional practice? Data was collected from twenty-two field note journals and seven face-to-face interviews emerging from a capstone nursing theory course focused on nursing leadership, relational ethics, complex healthcare contexts and responsive action. For the participants of this study, the meaning of transitioning to practice manifested as: developing complex identity awareness, mediating expectations in the struggle with uncertainty; and longing to belong in the midst of feeling alien. The paper provides recommendations for pedagogical practice and for capacity building to bridge the tensions of the competing discourses of transition to professional practice within complex health care setting