Patient & Staff Satisfaction with Integrated Services at Old Town Clinic: A Descriptive Analysis

This quality improvement project provided a descriptive analysis of the patient population that received integrated mental and physical health care at Old Town Clinic, and evaluated patient and staff satisfaction with this model of care. Seventy-three patients and seven staff members were surveyed, using two satisfaction surveys distributed in January 2003. Survey data revealed that the majority of Old Town Clinic patients were homeless. Patients indicated high levels of satisfaction with the clinic’s location, ease of accessing care, and health promotion and illness prevention education. Staff satisfaction with this model of care was reported to be moderate regarding accessibility, response time, communication, support, treatment, completeness of care, and education. Recommendations for further research and implications for practice are offered

Evaluating the Effects of Intimate Touch Instruction: Facilitating Professional and Respectful Touch by Male Nursing Students

Nurses are expected to touch areas of patients’ bodies that are considered private and emotionally sensitive (intimate), yet little is known about how nursing students learn, rehearse, and incorporate appropriate touch strategies. Although touch education is important to all nurses, male students face additional challenges due to gender roles and negative stereotypes. The purpose of this quasiexperimental pilot study was to evaluate whether a 3-hour intimate touch instructional laboratory with subsequent clinical experience (intervention group) facilitated male students’ development of intimate touch knowledge, skills, and attitudes, compared with having only clinical experience and no laboratory (control group). Findings revealed that intervention group participants were significantly more comfortable with cleansing genitalia, less apprehensive about touch being misperceived as sexual, reported less gender requirement rigidity, and scored significantly higher on measures associated with client dignity, comfort, and respect than control group participants in a simulated perineal hygiene demonstration

Embedding Micro-Ethical Dilemmas in High-Fidelity Simulation Scenarios: Preparing Nursing Students for Ethical Practice

Background: Despite the inclusion of ethics education in the formal curriculum, students felt ill-prepared to manage ethical issues and protect patients’ health and wellbeing. Nursing students reported knowing what should be done to promote optimal patient care; however, they also reported an inability to act on their convictions due to fear of reprisal, powerlessness, and low confidence. Method: Bloom’s Taxonomy guided the development and implementation of experiential-applied ethics education via micro-ethical dilemmas embedded in existing high-fidelity simulation (HFS) scenarios. Students were unaware that ethical dilemmas would be presented, replicating complex and spontaneous practice environments. Results: Students reported that the educational strategy was powerful, increasing ethical decision-making confidence, empowering effective advocacy, and building courage to overcome fears and defend ethical practice. Conclusion: Simulation extends ethics education beyond the cognitive domain, ensuring the purposeful integration of affective and psychomotor learning, which promotes congruence between knowing what to do and acting on one’s convictions

Using Multimedia Resources to Enhance Learning During Office Hours

According to Acitelli, Black, and Axelson (2016), instructional methods used during office hours should incorporate active learning strategies that improve the quality of learning. According to the cognitive theory of multimedia instruction (Mayer, 2008), multimedia resources reduce cognitive load and optimize learning when narrations simultaneously accompany corresponding illustrations (temporal contiguity), when essential text is written next to corresponding graphics (spatial contiguity), and when signaling is used to emphasize essential information (signaling principle). Student Reactions Anecdotal student comments endorsed multimedia resources as an active learning strategy, enhancing learning both during and after office hours

Moral distress: What can be done?

Introduction There is a persistent and growing need to educate and retain nurses who are prepared to competently address patient care needs within complex health care systems. Though recruitment efforts are strong, workforce attrition remains problematic. Approximately 17.5% of newly Registered Nurses (RN) leaves the profession within the first year of practice [1]. Moral distress, and its deleterious effects, contributes to workforce attrition [2,3]. Moral distress, or feeling constrained from acting upon one’s ethical knowing, is associated with powerlessness, compassion fatigue, apathy, and burnout [4,5]. One may recover from adversity and attenuate moral distress, via personal, social and professional capabilities associated with resilience. Resilience Protective Factors (RPFs) enable effective adaptation and coping amidst distress [6-9]. Per Monteverde, resilience is associated with the capacity to identify ethical issues, justify moral actions, and effectively cope with adversities inherent in health care practice [10]. Concerns about nurse workforce attrition and moral distress should motivate nurse leaders to develop and evaluate educational strategies that strengthen RPFs, preparing the future nursing workforce to thrive amidst ethical challenges. Through educational interventions, it may be possible to equip nurses with capabilities that reduce the deleterious consequences of moral distress. In this review article, we will first explore literature that clarifies the prevalence of moral distress across healthcare settings and research on RPFs. Second, we synthesize Organizational Communication literature in order to establish why distress is a difficult organizational and professional issue. In reviewing literature across disciplines, we provide a rich understanding of moral distress as a difficult nursing issue and what organizational factors lend to a lack of empowerment. By understanding the factors that lend to distress, the review also establishes the exigencies that call for a new model that promotes a nurse’s capacity to effectively navigate contextual ethical issues within complex health care workplace cultures. Thus, in the third and final portion of the manuscript, we propose and develop a new model, the Nelson-Marsh F.A.C.E heuristic model to enhance resilience and reduce moral distress. Each letter of the acronym represents a step in the process. We explicate each part of the model and offer the Nelson-Marsh Conflict-Risk Assessment Modes and communication strategies for each risk assessment scenario in order to provide nursing educators and post-licensure practicing nurses with effective communication and conflict management strategies. We argue that the Nelson-Marsh F.A.C.E. model and corresponding Nelson-Marsh Conflict-Risk Modes developed in this article will strengthen RPFs and empower one’s ability to act on moral convictions during distressing situations

Student Nurse Perceptions of Effective Medication Administration Education

Nursing faculty strive to educate students in a manner that prevents errors, promoting quality, patient-centered care. This endeavor is dependent upon meaningful and effective education that incorporates educational experiences reflective of the service sector. Anecdotal reports from clinical faculty and student nurses suggest that academic medication administration education may not optimally prepare students for safe entry into clinical practice. The aim of this phenomenologic qualitative research is to understand student nurse perceptions regarding teaching strategies and learning activities that prepared them for safe medication administration in acute care clinical settings. Focus group interviews resulted in two broad themes that are identified as Effective Education and Gaps in Education. Within these broad themes, findings revealed that students value faculty demonstrations, peer-learning opportunities, and repetitive practice with timely feedback. Study findings also pointed to educational gaps. Students reported needing to learn communication and conflict resolution strategies that would help them manage real-world interruptions, distractions, and computer generated alerts. Study findings recommend implementing relevant decision-support technology within academic lab learning activities

Clinical Faculty Development: Using Simulation to Demonstrate and Practice Clinical Teaching

Students spend more time in clinical settings with smaller student-to faculty learning ratios than in the didactic setting, yet many clinical faculty have had little exposure to evidence-based teaching strategies and learning theories. Orientation for newly employed clinical faculty, whether novices or experienced teachers, typically focuses on the details of running the clinical experience and not on teaching and learning. Multiple barriers for clinical faculty limit the ability to provide consistent and comprehensive education. The purpose of this article is to share the use of simulation as a strategy to prepare and support clinical faculty in their teaching role

Examining relationships between resilience protective factors and moral distress among student nurses

Aim: The purpose of this study was to identify relationships between resilience protective factors (RPFs) and moral distress among baccalaureate nursing students. Background: Students report moral distress associated with clinical practicum experiences. Enhancing resilience may minimize moral distress and associated consequences. Method: Correlation, pilot study. Two previously tested instruments were used to measure moral distress (Moral Distress Thermometer) and RPFs (Scale of Protective Factors). Results: Aggregate mean more distress rating was 3.67. Two of four RPF subcategories demonstrated a significant inverse correlation with moral distress rating. Inverse correlations were found between social support and moral distress (r = -.27, p \u3c .05), and between goal efficacy and moral distress (r = -.37, p \u3c .01). Total resilience scores also demonstrated a weak inverse correlation with moral distress (r = -.24, p \u3c .05). Conclusions: Findings help educators prioritize resilience enhancing educational strategies

Examining Relationships Between Resilience Protective Factors and Moral Distress Among Nursing Students.

A correlation pilot study was conducted to examine relationships between resilience protective factors and moral distress associated with clinical practica in nursing students. Aggregate moral distress rating was x = 3.67. Two of four resilience protective factor subcategories demonstrated significant inverse correlations with moral distress rating. Inverse correlations were found between social support and moral distress (r = -.27, p \u3c .05) and between goal efficacy and moral distress (r = -.37, p \u3c .01). The findings should help educators prioritize resilience-enhancing educational strategies