Comparing the Knowledge, Skills and Attitudes of Newly Hired Nursing Staff Before and After Implementation of a Quality and Safety Competency-Based Nursing Orientation Program

Executive Summary Comparing the Knowledge, Skills and Attitudes of Newly Hired Nursing Staff Before and After Implementation of a Quality and Safety Competency-Based Nursing Orientation Program Problem There was a lack of content regarding quality and patient safety in an urban Veterans Administration (VA) health care system nursing orientation program. A Department of Veterans Affairs culture of safety survey indicated frontline VA nursing staff scored lower in the safety culture dimensions compared to other VA health care professionals. Developing a curriculum for nursing orientation incorporating the six Quality and Safety Education for Nurses (QSEN) competencies and utilizing a trans-theoretical approach guided by Marilyn Ray’s theory of bureaucratic caring and Albert Bandura’s self-efficacy theory was developed to offer a solution. Purpose The purpose of this project is to determine if a theory-guided, competency-based, nursing orientation program will increase the self-reported self-efficacy of the knowledge, skills and attitudes associated with the six QSEN competencies and learner satisfaction of newly hired nursing staff within an urban, Veterans Administration health care system. Goals The goals of this project are to redesign the nursing orientation program to increase quality and safety content in the nursing orientation curriculum; increase learner satisfaction of nursing orientation; and ensure compliance with the VA and Office of the Inspector General standards regarding competency validation of nursing competency, and improve the facility culture of safety. Objectives The objectives of this project are to develop a nursing orientation program within the framework of the existing orientation program; develop a QSEN competency validation form; administer the Nursing Quality and Safety Self-Inventory (NQSSI) as a pre and posttest of the participants in nursing orientation and a post Utilization-Focused Evaluation before and after implementation to compare for any differences in the self-efficacy or learner satisfaction of newly hired nursing staff. Plan/Method Causal-comparative/case control design with a comparative group using interrupted time series pretest, posttest and approximately 30 day post-posttest. Outcomes and Result Results of the NQSSI found no significant difference in all of the KSAs of the six QSEN competencies between the control and intervention groups except for post-posttest results for Knowledge in the Quality Improvement competency. Significantly higher satisfaction is found in the intervention group who had the Quality and Safety Competency-Based Nursing Orientation compared to the control group with usual nursing orientation in all areas except for the classroom being conducive to learning. Differences were found in some of the results of the NQSSI regarding years of experience and having had QSEN in nursing school. Those with 0-3 years of experience or had QSEN in nursing school scored lower in some of the KSAs than those with more experience or those who did not have QSEN or were not sure. There are no significant differences regarding level of nursing education and NQSSI results

Data from: Biomechanical and leaf-climate relationships: a comparison of ferns and seed plants

Premise of the study: Relationships of leaf size and shape (physiognomy) with climate have been well characterized for woody non-monocotyledonous angiosperms (dicots), allowing the development of models for estimating paleoclimate from fossil leaves. More recently, petiole width of seed plants has been shown to scale closely with leaf mass. By measuring petiole width and leaf area in fossils, leaf mass per area (MA) can be estimated and an approximate leaf life span inferred. However, little is known about these relationships in ferns, a clade with a deep fossil record and with the potential to greatly expand the applicability of these proxies. Methods: We measured the petiole width, MA, and leaf physiognomic characters of 179 fern species from 188 locations across six continents. We applied biomechanical models and assessed the relationship between leaf physiognomy and climate using correlational approaches. Key results: The scaling relationship between area-normalized petiole width and MA differs between fern fronds and pinnae. The scaling relationship is best modeled as an end-loaded cantilevered beam, which is different from the best-fit biomechanical model for seed plants. Fern leaf physiognomy is not influenced by climatic conditions. Conclusions: The cantilever beam model can be applied to fossil ferns. The lack of sensitivity of leaf physiognomy to climate in ferns argues against their use to reconstruct paleoclimate. Differences in climate sensitivity and biomechanical relationships between ferns and seed plants may be driven by differences in their hydraulic conductivity and/or their differing evolutionary histories of vein architecture and leaf morphology

Data from: Biomechanical and leaf-climate relationships: a comparison of ferns and seed plants

Premise of the study: Relationships of leaf size and shape (physiognomy) with climate have been well characterized for woody non-monocotyledonous angiosperms (dicots), allowing the development of models for estimating paleoclimate from fossil leaves. More recently, petiole width of seed plants has been shown to scale closely with leaf mass. By measuring petiole width and leaf area in fossils, leaf mass per area (MA) can be estimated and an approximate leaf life span inferred. However, little is known about these relationships in ferns, a clade with a deep fossil record and with the potential to greatly expand the applicability of these proxies. Methods: We measured the petiole width, MA, and leaf physiognomic characters of 179 fern species from 188 locations across six continents. We applied biomechanical models and assessed the relationship between leaf physiognomy and climate using correlational approaches. Key results: The scaling relationship between area-normalized petiole width and MA differs between fern fronds and pinnae. The scaling relationship is best modeled as an end-loaded cantilevered beam, which is different from the best-fit biomechanical model for seed plants. Fern leaf physiognomy is not influenced by climatic conditions. Conclusions: The cantilever beam model can be applied to fossil ferns. The lack of sensitivity of leaf physiognomy to climate in ferns argues against their use to reconstruct paleoclimate. Differences in climate sensitivity and biomechanical relationships between ferns and seed plants may be driven by differences in their hydraulic conductivity and/or their differing evolutionary histories of vein architecture and leaf morphology

Leaf mass, leaf area, petiole width, and leaf physiognomic measurements of globally distributed ferns (Appendices S1a, S1b)

Leaf mass, leaf area, petiole width, and leaf physiognomic measurements of globally distributed ferns (Appendices S1a, S1b

Fern images from Baylor University Herbarium

Zipped folder with images of ferns from Baylor Herbarium. Folder also includes ReadMe file and image key

Fern images from Te Papa Herbarium

Zipped folder with images of ferns from Te Papa Herbarium at the Museum of New Zealand Te Papa Tongarewa. Folder also includes ReadMe file and image key

Fern images from Queensland Herbarium

Zipped folder with images of ferns from Queensland Herbarium. Folder also includes ReadMe file and image key

Fern images from US National Herbarium (part 1)

Zipped folder with images of ferns from USNH. Folder also includes ReadMe file and image key