Showing papers in "Journal of Nursing Education and Practice in 2021"

E-learning in nursing education in Rwanda: A middle-range theory

Abstract: Background: The rapid development of technology has compelled tertiary institutions to devise innovative teaching strategies to meet the students’ needs and market’s demands. Recently, the Covid-19 pandemic has forced educational institutions to shift from in-person to online learning. E-learning is one of the areas advancing rapidly and which provide promises in nursing education. The aim of this study was to develop a middle-range theory to guide the utilisation of an e-learning platform in nursing education in the context of Rwanda. Methods: A grounded theory approach, following Strauss and Corbin, was used. The study population included nurse educators, nursing students, Information and Communication Technologies (ICT) managers, and experts in e-learning and nursing education. The sample size consisted of 40 participants. Data were collected using in-depth interviews, focus group discussion and document analysis. Data analysis was guided by Strauss and Corbin’s grounded theory framework, which facilitated the middle-range theory development. Results: Implementation of e-learning in nursing education emerged as the central concept in this model. E-learning was viewed as a mechanism to advance the country’s political agenda to integrate technology in higher education, a tool to widen access to nursing education, a student-centred approach, and blended learning. The implementation of e-learning was facilitated by catalyst agents such as institutional support, e-readiness, partnerships and collaboration, policies and regulations, effective working learning management system, and bridging the digital divide. Integration of e-learning in nursing education was expected to improve nursing education quality and increase competent nurses and midwives graduates. Conclusions: This study highlights the importance of e-learning in nursing education. The adoption of the innovative, technology-enabled nursing education models would augment capacity to scale up nursing and midwifery education, enhance the quality and relevance of training, and adopt equity-focused policies. This model is a tool to facilitate the establishment of a supported network learning space in nursing education in a fluid and dynamically changing nursing practice context.

Learning nursing during the COVID-19 pandemic: The importance of perceived relatedness with teachers and sense of coherence

Abstract: Background and objective: In March 2020, the COVID-19 pandemic infected populations worldwide. To limit the spread, many countries declared stay-at-home orders. Teachers were suddenly obliged to teach and facilitate learning online, whereas students had to manage online education alone from home. Within self-determination theory (SDT), the need for relatedness is considered crucial for personal growth, well-being, motivation and learning, whereas sense of coherence (SOC) is a salutogenic health concept explaining humans’ coping with stressful situations. The aim of this study was to investigate the importance of teacher relatedness as well as SOC, including the concepts of comprehensibility, manageability and meaningfulness, among nursing students during the COVID-19 pandemic. Methods: Survey data were collected from 329 nursing students at a large university in Norway. Twelve hypotheses of the associations between teacher relatedness, SOC and perceived learning were tested by means of structural equation modelling (SEM) using Stata. Results: The SEM yielded an acceptable fit (χ 2 = 177.60, p = .000, df = 80, χ 2 /df = 2.22, RMSEA 0.063, CFI = 0.96, SRMR = 0.048), showing significant, positive relationships between the latent variables of teacher relatedness, SOC and perceived learning. Eleven out of the twelve hypotheses found support, showing both direct and indirect relationships between the latent variables. Conclusions: The study indicates that caring and close teachers seem very important for nursing students’ learning during the COVID-19 pandemic. Many students do not experience such a teacher relationship, resulting in difficulties studying and learning under crisis. Knowledge about how teachers may mobilize care and close relationships with nursing students is important for students’ learning during a pandemic situation when teaching go digital.

Developing virtual simulation games for presimulation preparation: A user-friendly approach for nurse educators

Abstract: Objective: Engaging presimulation activities are needed to better prepare undergraduate nursing students to participate in clinical simulations. Methods: Design: We created a series of virtual simulation games (VSGs) to enhance presimulation preparation. This involved creating learning outcomes, assessment rubrics, decision point maps with rationale, and filming scripts. Setting: This was a multi-site project involving four universities across Ontario, Canada. Participants: Games were to be embedded within undergraduate nursing courses and used as presimulation preparation before participating in a traditional live simulation. Four existing bilingual peer-reviewed simulation scenarios were transformed into VSGs to be used for presimulation preparation. The team selected critical decision-points from each scenario to form the basis of each VSG, created filming scripts, and filmed and assembled video clips. Results: Our project generated four bilingual presimulation preparation VSGs with a user-friendly, low-cost VSG design process. Conclusions: We have demonstrated that nurse educators can easily create contextually relevant VSGs addressing program gaps.

Why should we care about academic integrity in nursing students

Abstract: Integrity, honesty, and respect are essential values for nursing students. Yet, in recent years the rise of breaches in academic integrity has become alarming. The era of increasing advances in the capabilities of smart technologies may be facilitating rather than deterring students from academic integrity breaches in their work and assessments. This issue raises questions for nurse academics on how they can best ensure that nursing students align their behavior with the expected nursing’s professional values, both during their study years and beyond. This discussion paper aims to examine contributing factors leading to breaches of academic integrity amongst nursing students and determine why we as nurse academics need to both remain alert to these factors, and vigilant about identifying and managing such breaches. Existing factors that may influence academic dishonesty are discussed concerning students; nurse academics; curriculum design; and the apparently growing cultural shift in ethical reasoning. With increased insight into these influencing factors, nurse academics need to take responsibility and prepare students to take on the highest standard of moral values to ensure safe and effective patient outcomes. We need to become more aware of and understand nursing students’ perspectives and adequately prepare our soon-to-become nurse graduates. We are charged with supporting, guiding, and teaching our students to develop skills within a culture of integrity. Ensuring an integrity activity smorgasbord in our practice can counteract the increased risk of academic dishonesty in our undergraduate nursing programs.

Educational technology for people living with implantable heart device

Abstract: Objective: To develop an educational technology for people living with an implantable heart device. Methods: This is a methodological study carried out in the period from August 2020 to April 2021, carried out in two stages: integrative literature review and elaboration of educational technology. Results: Based on the evidence, it was possible to list generating themes such as the perception of people living with an implantable cardiac device, which served as the basis for the creation of a podcast entitled “Alphabet of the pacemaker”, with self-care guidelines from A to Z for the after time implantation of the device. Conclusions: The construction of evidence-based educational technology is a strategy to subsidize health educational practices and pacemaker users' understanding of health care after device deployment.

Teaching during COVID-19: Perceptions of nursing faculty

Abstract: Objective: The COVID-19 pandemic resulted in a significant academic impact for health professions students. As a practice profession, course content in programs of nursing are provided in both web-based or on-line formats and through face-to-face classroom or clinical modalities. In response to social distancing and stay-at-home policies, all course formats became web-based and on-line. This required faculty to transition their course content, assignment, assessment requirements, office hours, and consultations, to an on-line format. Data collected in this qualitative study aimed to describe this experience, from the perspective of undergraduate and graduate nursing faculty teaching in a small, private Midwestern University. Methods: Study data, guided by semi-structured interviews, were collected using a virtual format from a convenience sample of ten nurse educators. Each interview was performed by the same researcher and analyzed separately, by both researchers using content analyses and qualitative research methods. Results: Content analyses identified alterations in course structural changes, flexibility in completion of course requirements, providing course content in smaller sections, and being available for academic and psychological support was needed. These data described the personal and professional experiences of faculty specific to course, clinical, and instructor availability. Conclusions: The necessary adaptations were readily developed and implemented. While the stress and uncertainty associated with change was apparent, clear, pro-active communication resulted in course completion and the ability to maintain the plan of study. Flexibility and adaptability, characteristics inherent in nurses, provided a framework for the necessary changes.

Immediate repeat of a septic shock simulation: Nursing students’ lived experience

Abstract: Background and objective: The COVID-19 pandemic has placed a significant increase for the need of high quality, high fidelity simulation practices to replace limited clinical experiences. Repetitive experiential practice is a training strategy used among professionals to bridge theoretical concepts to action. Furthermore, immediate repetitive experiential practice in a simulation environment is a novel approach that holds promise for learners to improve their response to critical conditions through increased faculty guided reflection. This study aimed to explore student attitudes regarding an immediate repeat of a simulation as a first step to explore training effectiveness. Methods: Students enrolled in a complex health baccalaureate nursing course participated in an immediate repeat of a septic shock simulation. An interpretive phenomenological approach was utilized to better understand undergraduate nursing students' lived experience of learning through a repeat septic shock simulation. Results: Three themes emerged: Appreciation of Knowledge, Awareness of Skill, and Awareness of Attitudes. Conclusions: Learners found an immediate repeat of the simulation a valuable teaching strategy. Participants described a growing sense of differentiating priorities when managing a patient in septic shock. The immediate repeat simulation was deemed impactful to the learners’ knowledge, skills, and attitudes. This is a viable option for educators to incorporate at a time when forced to utilize simulation experiences to replace limited clinical opportunities.

Nurses’ perceptions related to impaired nurses and knowledge of substance use disorder within the nursing profession

Abstract: Objective: Substance Use Disorder continues to be a problem within the nursing profession. Studies have been conducted to examine various aspects of Substance Use Disorder. Although programs have been implemented to help rather than punish nurses, knowledge barriers that affect reporting still exist. The purpose of this study was to examine nurses’ perceptions of impaired nurses, perceptions of reporting an impaired nurse, and perceptions of knowledge regarding Substance Use Disorder within the nursing profession. Methods: A mixed-method descriptive study was conducted using the Perception of Nursing Impairment Inventory tool, as well as three open-ended questions. Lazarus and Folkman’s Transactional Model of stress and coping was used to guide the study and nurses from one state’s nurses’ association in the southeastern region of the United States participated. Results: Based on quantitative findings, most disagreed with the statement there is little that can be done to help impaired nurses and agreed that nurses have an ethical obligation to report if impairment is suspected. Conflicting views were identified for multiple statements on the Perception of Nursing Impairment Inventory. The qualitative findings revealed average or below average knowledge of SUD and identified barriers that may affect reporting. Further, a culture surrounding the ethical dilemma of reporting was evident. Conclusions: Educational gaps exist between recognizing and reporting the problem of Substance Use Disorder. Although nurses acknowledge an obligation to report, many barriers to reporting were identified. Recommendations were made for additional qualitative research related to nursing education including conflicted feelings about doing what is “right.”

Needs of caregivers of children with cerebral palsy: A literature review

Abstract: Background and objective: Cerebral palsy (CP) is the most common motor disability that affects two to three children per 1000 worldwide. Caregivers are most often parents of children with CP (CCP) who are responsible for providing primary care. Caregivers of CCP face multiple challenges, such as the manifestation of the disease and difficulty in providing daily care. They also have psychological, social, financial, and informational needs. These needs may be met through participation in support groups. The objective of this paper is to identify the needs of caregivers of CCP and how participation in support groups may meet those needs. Methods: A literature review was conducted to identify relevant articles on the needs of caregivers of CCP. Eleven articles published between 2008 and 2018 on caregivers’ needs were retrieved and their quality was assessed using the Mixed Methods Appraisal Tool. The data collected were analyzed to identify key themes related to caregivers’ needs. Results: Four key themes of caregivers’ needs were identified: informational, financial, social, and psychological. Support groups may help caregivers to meet their needs. As caregivers receive their needed support, they will able to improve their role in providing a high quality care for their children. Conclusions: Caregivers of CCP have informational, financial, social, and psychological needs which may be met by membership in support groups. Support groups may potentially increase caregivers’ knowledge, receive the needed support, decrease their level of stress, and improve their quality of life.

Nursing higher education mergers: Do the benefits outweigh the risks?

Abstract: Merger as an organizational change has the potential to create turmoil, unrest, and uncertainty among the employees. Despite the shortage of nursing education workforce, global economic hardships have brought on a recent increase in nursing higher education mergers. The focus on integrated operations of the newly merged organization can burden all involved. Financial and business survival factors can create an unintentional oversight of the employee feelings. Nursing education faculty and administrator’s quality of work lives are related to their performance, which ultimately determines organizational performance. The purpose of this qualitative case study was to evaluate the influence of a nursing higher education merger on the quality of work lives of faculty and administrators. Principal results of this research revealed that faculty and administrators perceived the influence of the nursing higher education merger to be negative in the beginning with a transition to a positive influence over 5 years. Challenges in this merger were related to cultural integration and the magnitude of work required for operationalization. Exact timing of transition of the negative influence to positive was not established and needs further research. These results have implications on the nursing higher education institutions planning future mergers. Nursing education leaders must utilize strategies to address the quality of work life factors during the nursing higher education mergers. Implications of maintaining quality of work lives during an organizational change has the potential to address the nursing and nursing education workforce issues.

A narrative inquiry of nursing experiences during the Covid-19 pandemic

Abstract: This research focused on nursing care during the early phase of the Covid-19 pandemic. The experiences of 18 nurses and 3 nurse practitioners were analyzed through qualitative narrative inquiry. Riessman’s analytic approach guided identification of thematic similarities. The nurses in this study were emotionally exhausted by the rapid rise in patients and the daily death toll. The challenge of so many gravely ill cases required creative adaptations to address overcrowding and lack of resources. Teamwork proved immeasurable. Nurses advocated for their patients and families and were proud to have worked in this emergency. Nurses dealt with stressors by maintaining prior coping practices and developing new ones and relied on support from their family, hospital and community. A common objective was to establish and maintain the highest-possible levels of care in spite of challenging conditions. Proficiencies developed in coping with unprecedented challenges can help plan for future healthcare crises.

The presence of humanistic caring before enrolling in nursing undergraduate programs: Perceptions of nursing students and nurses

Abstract: Background and objective: Learning to become a humanistic and caring practitioner is expected by nursing regulatory bodies. Previous investigations revealed that several pedagogical activities used in nursing education programs could facilitate this learning process. There are also studies that underscored the contributions of non-academical experiences to humanistic caring practices. This paper describes nursing students’ and nurses’ lived experiences prior to nursing that contribute to the development of humanistic caring. Methods: The study drew on interpretive phenomenology and 26 participants were individually interviewed. Benner’s (1994) method was adapted and concretized into five iterative phases of phenomenological analysis that cooccurred with data collection. Results: Six themes emerged from the interpretation process, describing how humanistic caring is developed before enrolling in nursing. First, there are natural humanistic and caring dispositions. Second, there are experiences 1) involving family members, 2) related to the public sector, 3) associated with a friend, 4) featuring an encounter with a nurse, and 5) related to spirituality. Overall, relationships that participants had previously developed appeared to be at the core of the development of their humanistic caring. Conclusions: The findings strongly suggest that nursing students hold a variable degree of natural dispositions. These inclinations are enhanced through experiences inextricable to human life that will most likely generate learning. Nursing students thus start their education with a definite potential to humanize care. To facilitate the development of humanistic caring, educators may encourage students to reflect on and become aware of their past experiences and learning.

Training experience with community health agents: Focus on prevention and identification of stroke

Abstract: Objective: To describe the experience of nurses in the process of training community health workers for the prevention and early identification of risk factors and warning signs of Stroke and for community actions before the cerebrovascular event. Methods: This is a report of an educational intervention with 1,302 community health workers from 12 Health Districts of Salvador. Thirty-four four-hour meetings were developed. The strategies and resources used included reflection dynamics on the impact of Stroke, exhibition classes, use of videos and informative pamphlets. Results: The educational activities allowed reflections on the repercussions of Stroke on the daily life of victims and their families, as well as on access to health services and the role of community health workers in those contexts. Conclusions: The experience contributed to the qualification of the work of the community health workers in preventive actions for identification and early intervention in the Stroke.

Script concordance testing to understand the hypothesis processes of undergraduate nursing students - Multiple case study

Abstract: Background: Albeit essential to clinical reasoning (CR), strategies for generating student nursing clinical hypotheses at the time of transition to professional practice are underdeveloped. While script concordance testing (SCT) has been shown to be a valid and reliable assessment tool for CR in nursing education, the thought processes including the hypothesis processes involved in choosing an answer is not examined. Methods: A multiple case study was used to understand the complex phenomenon of students’ hypothesis activation and confrontation with the combined use of SCT questions and the think-aloud method. Structured individual interviews were conducted. Results: A total of 18 students, nine first-year and nine third-year students participated in the study. The results show that the students demonstrate certain CR cognitive processes, including early representation of a clinical situation, semantic transformation of data, and hypothesis comparison. Conclusions: Results suggest promoting knowledge articulation aloud and the frequent use of micro-judgments to compare and differentiate hypotheses involving the uncertainty of clinical practice, which underpin learning in successive layers.

The use of progressive muscle relaxation with classical music in hypertension women

Abstract: Background/Objective: Hypertension is still a public health problem both in the world and in Indonesia. Even though women with hypertension are already taking antihypertensive drugs, often blood pressure remains high. Women are more likely to be stressed, and stress increases hypertension. The study aimed to analyze the use of progressive muscle relaxation with classical music on stress and blood pressure in hypertensive women. Methods: This study used a quasi-experimental design with a control group. There were three groups of hypertensive women who took anti-hypertensive drugs, consisting of those who received progressive muscle relaxation with classical music, accepted progressive muscle relaxation without classical music, and did not get treatment, each of which totaled 36 participants. The activity was carried out from July to October 2020. The stress instrument used was the Cohen’s Perceived Stress Scale, while blood pressure was measured with the OMRON digital tensimeter. Results: The group that received progressive muscle relaxation with classical music from Bach described high significance for stress ( p = .0001), systolic ( p = .0001), diastolic ( p = .0001). The group that received progressive muscle relaxation alone also showed high significance for stress ( p = .010), systolic ( p = .003), diastolic ( p = .006). While the untreated group showed significance for systolic ( p = .013), but did not show significance for stress ( p = .758), diastolic ( p = .123). The use of ANOVA showed a significant difference in the effect of the three intervention on stress ( p = .005), systolic blood pressure ( p = .009), but did not have a significant effect on diastolic blood pressure ( p = .500). Conclusions: Progressive muscle relaxation with classical music and antihypertensive drugs provides a greater chance of controlling stress, lowering systolic and diastolic blood pressure than just progressive muscle relaxation and antihypertensive drugs or antihypertensive drugs alone in women with hypertension.

State of oncology nursing training and practice in a southwestern Nigerian teaching hospital

Abstract: Background and objective: Oncology nursing is a recognized nursing specialty globally but it is yet to be a stand-alone specialty in any accredited degree awarding tertiary institution in Nigeria as at the time of this write up. In most of the hospitals in Nigeria, non-specialist oncology nurses who learn on the job care for the cancer patients. Hence, the urgent need to conduct this study, which aimed to examine the state of oncology nursing training and practice in Nigeria. Methods: A descriptive, cross-sectional study was used to assess 171 nurses’ socio-demographic data, nature of their oncology training, and competency level using a semi-structured questionnaire. Results: Only 3 (1.8%) of the respondents claimed they had a degree in oncology nursing and 89.9% had no formal training in oncology. Few of the respondents (13.5%) rated themselves as experts in oncology nursing practise. Majority of the respondents see the state of oncology nursing practise as very poor with the major challenge being none availability of oncology nursing training institution. Conclusions and implication for study: With the increasing prevalence of cancer in Nigeria and rise in number of new cases daily, there is need for an established programme to train health care professionals especially nurses to combat its increasing rate. There is need for provision of oncology nurse specialist training to improve level of education and skills in order to offer appropriate care to clients living with cancer and improve patient’s outcome of survival ultimately enhancing their quality of life.

Holograms in nursing education: Results of an exploratory study

Abstract: Objective: The purpose of this exploratory and descriptive study was to evaluate the student experience of using the Microsoft HoloLens® headsets and the HoloPatient application (app) to perform a nursing assessment of Jerry, a life-sized hologram of a young man admitted to Emergency Department following a mountain bike accident. Methods: Setting: The research was conducted in 2019 in a New Zealand School of Nursing. Participants were undergraduate (pre-licensure) students (N = 121) enrolled in a 3-year Bachelor of Nursing degree programme. The study was conducted before students went on their first hospital-based clinical placement. Methods: The researchers designed a tutorial that guided students through the first five steps of the clinical reasoning cycle (i.e., look, collect, process, decide, plan) and collect cues and information about Jerry’s condition which worsens as he develops anaphylactic shock. Tutorials were conducted during the week immediately preceding the first clinical placement to assist students to develop clinical reasoning and nursing assessment skills. Results: Data were collected via a post-activity pen and paper survey. Quantitative data showed that this technology enhanced learning. Thematic analysis identified 17 advantages of using holograms, including realism, a reduced level of self-consciousness, and better preparation for clinical practice. Disadvantages mostly related to technical projection issues such as blurry image quality. Conclusions: These findings indicate that spending time carefully observing, and processing information provided via a hologram assisted novice nurses to develop clinical reasoning skills, thereby increasing readiness for the clinical setting.

Implementing social media into nursing education

Abstract: Social media is an aspect of everyday life for many undergraduate nursing students and can also be beneficial from an education perspective. Popular social media platforms can be used as often as daily for many nursing students. The emergence of Generation Z (born between 1995-2010) as the predominant population of nursing students calls for a shift in pedagogical approaches; one that accommodates the needs of the unique demographic. This narrative literature review examines how social media can provide an effective pedagogical tool to engage the modern undergraduate nursing student by providing a platform for accessible educational activities, fostering professional identity and encourages virtual professionalism for this unique Generation. Guided by a constructivist approach and the Social Media for Learning (SM4L) framework, this pedagogical approach could foster student engagement and promote appropriate use of social media in the personal and professional lives of nursing students. Additionally, these innovative nurses can enter the workforce prepared to use social media tools to disseminate health information and patient teaching appropriately and professionally, providing better access and improved care for patients.

Authentic leadership and behavioral integrity as drivers of staff nurses' commitment and work engagement

Abstract: Background and aim: Authentic leadership is relatively a new paradigm that emphasizes leaders' credibility. It can serve the healthcare organization to build an organizational culture that reinforces the healthcare worker in being committed and engaged in work. This study aimed to examine the effect of authentic leadership on staff nurses' affective organizational commitment and work engagement through examining the mediating role of behavioral integrity. Methods: Study design: A descriptive correlational design was used in conducting this study. Setting: The study was conducted at two different hospitals, namely Menoufia University Hospital, and National Liver Institution, Egypt. Sampling: A Convenience sampling of two groups were selected; 64 front-line nurse managers and 320 staff nurses. Tools: Four instruments were used for collecting data; authentic leadership questionnaire, behavioral integrity scale, affective organizational commitment questionnaire, and Utrecht work engagement scale. Spearman correlation (r) and binary logistic regression analysis were used to achieve the study aim. Results: Total behavioral integrity (BI) score was significantly correlated with total authentic leadership (AL) and two of its subscales (internalized moral perspective and balanced processing). Moreover, a significant positive correlation was revealed between the enactment of espoused values at one hand and total authentic leadership and its subscales except for self-awareness. Correlation analysis between BI and organizational commitment revealed a significant positive correlation between the two variables. A significant positive correlation was also found between the BI total and its subscales with work engagement total and its subscales. Conclusions: This study supported the proposition that the relationship between authentic leadership and positive nurses’ outcomes including affective commitment and work engagement is mediated by behavioral integrity.

A first-year, first-semester observership placement to increase nursing students’ satisfaction

Abstract: This paper reports on a two-day nursing observership in the first semester of an undergraduate baccalaureate-nursing program in an Australian university. Of the 392 novice student nurses who completed the observership, 340 provided a written reflection on their experience. The qualitative data were analysed using constant comparative analysis from which four themes were identified. Student nurses reported that the observership provided them with an insight into the nursing world (66.4%), was a revelation (46.4%), met their expectations (16.4%), and was transformative (7.3%). These themes indicated that an observership at the start of a nursing student’s study can provide a professional socialisation experience, link new knowledge to practice, and ease that transition into nursing study. The implication for practice for nurse educators is to consider innovative approaches such as an observership to overcome challenges that first-year nursing students reportedly experience.

Healthcare workers’ knowledge, risk perception, safety-relevant practices, and work situation during the COVID-19 pandemic: A quantitative survey from Switzerland

Abstract: Objective: To determine the impact of the COVID-19 pandemic on healthcare workers and healthcare students in higher education and to assess their clinical knowledge, media use, risk perception, perception of governmental measures, and adherence to preventive guidelines to provide policymakers with field-based evidence. Methods: This cross-sectional quantitative survey was conducted by two-stage cluster sampling among Swiss healthcare workers, who performed patient care during the first pandemic wave, and who also pursued an education at a university of applied sciences at the same time (a Bachelor’s or Master’s degree in nursing or an executive degree in healthcare). 75 individuals participated between 5th May and 1st June 2020. Their data was analyzed by bivariate hypothesis testing and multiple logistic regression. Results: Considerable levels of task-related and emotional stress were prevalent, accompanied by a large proportion of respondents who did not have sufficient protective materials or necessary decisions in place to effectively protect themselves or others from infection with COVID-19. Knowledge was considerably limited, especially regarding the efficacy of standard hygiene as a preventive measure. The preparation of the government and the healthcare sector was perceived as insufficient. Conclusions: Comprehensive management of infodemic challenges and foresighted development of education, human resources, clinical processes, and protective materials are highly recommended.

Perceived representativeness, usefulness and impacts of using the nursing activities score as part of a workload readjustment initiative: A mixed methods study

Abstract: Objective: Nursing workload has been shown to have negative impacts on job satisfaction, retention and turnover. The NAS is one of existing tools targeting nursing workload quantification. Although tested in multiple settings, few studies explored nurses’ perception of its representativeness of workload, and its impacts when used to readjust nurse/patient ratios. This study was conducted to validate nurses’ perception of representativeness and potential usefulness of the Nursing Activities Score (NAS) in regard to nurses’ perceived workload and explore its impacts as part of a workload readjustment initiative. Methods: A mixed method design was selected, combining semi-structured interviews (n = 13), and secondary analysis of project monitoring data for an entire intensive care unit (n = 139). Statistical analysis was performed using SPSS v.22 software for quantitative data, and qualitative data was analyzed through NVivo 12 software using a thematic deductive-mixed content analysis, aiming for the emergence of recurring themes. Results: When taken as a whole, the NAS is perceived to be representative of nursing workload. However, validity concerns were identified at the tool completion level, notably in regard to improper documenting of events and fundamental understanding of the tool by nurses. Numerous impacts related to the use of the NAS were also identified. Conclusions: Although the NAS appears to adequately represent nursing workload, its pertinent utility remains debatable due to high subjectivity described in this study. The sole use of the tool for patient assignment is therefore questionable.

Strategies for innovative teaching and learning Part 1: Foundational discussion of online learning technology

Abstract: The evolution from traditional on campus education to the current distance education modalities using online learning and technology systems have changed how higher education is delivered to thousands of students and faculty. Technology is changing how faculty teach and how students earn higher education degrees. Many students are seeking the flexibility, and independence online distance education offers to earn college degrees often without leaving home. However, some faculty may not be experienced at developing, delivering, and evaluating online distance courses to meet the needs of student learners. This initial paper will guide faculty through a short history of distance learning, the positives and negatives of online learning vs traditional on campus learning, advantages and disadvantages of distance online learning, and the initial considerations for establishing an online course.

Gender disparity among renal transplant recipients receiving immunosuppressive therapy

Abstract: Immunosuppressant therapies are considered vital for the long-term survival of kidney grafts, however it can significantly modify patients’ HRQOL because of their adverse effects and the complex medication schedule they represent Aims: (1) To explore symptom experiences and symptom distress with adverse effects of immunosuppressive therapies, (2) To assess the impact of symptoms experience and symptoms distress on health-related quality of life among renal transplant recipient, and (3) To correlate them with gender One hundred Renal transplant recipients were interviewed using the End-Stage Renal Disease Symptom Checklist Transplantation Module (ESRDSCL-TM) Results: Most of the renal transplant participants reported best and good quality of life, however, there were a statistically significant differences by gender Women reported low satisfaction in quality of life comparing with men In relation to the most frequent distressing symptoms in men and women, the study revealed that women reported higher levels in majority of the given symptoms distress such as back pain, increased hair growth and mood swings Moreover, women perceived higher means levels with respect to increased appetite while men reported more distress for the items as increased appetite, mood swings, decreased interest in sex, depression, and sleeplessness Conclusion: Renal transplant recipients had good quality of life with immunosuppressive therapies, but intensive assessment of patients after transplantation should be done to identify their needs Moreover, consideration should be taken with regards gender variations thus help planning to get better quality of life, as a relatively normal lifestyle is re-established

Social pediatrics in a baccalaureate nursing curriculum

Abstract: This paper describes the use of social pediatrics in one baccalaureate nursing curriculum. Social pediatrics is a conceptual model that considers health as physical health and the social determinants of health. Social pediatrics focuses on community-based primary healthcare services for at-risk children and their families. The social pediatrics model is used by community early childhood education StrongStart sites in one Canadian province; these sites are collaborations between early childhood educators and public health nursing teams for children from infancy through five years of age. Acute care clinical placements are becoming too complex and limited in number to accommodate large undergraduate nursing cohorts. Our undergraduate nursing program recently shifted acute care pediatric placements to StrongStart sites, combining community pediatric and public health nursing learning objectives and learning activities that foreground social pediatrics. The acute care component of pediatric nursing includes classroom theory, clinical laboratory and virtual simulations. This paper describes social pediatrics integration within our undergraduate curriculum between 2018-2019; and a qualitative evaluation of our social pediatrics approach in 2019-2020. We used content analysis to identify common themes from interviews with key actors, including students’ clinical instructors, StrongStart sites’ early childhood educators and managers, and public health nurse managers affiliated with StrongStart sites. Common themes were related to social pediatrics learning opportunities and drawbacks; social pediatrics knowledge, skills and attitudes; and recommendations for curriculum enhancement.

Looking for an answer under the shadow−Life narratives among people living with HIV/AIDS and their caregivers

Abstract: In Taiwan, the number of cases of newly diagnosed AIDS is increasing every year, and those diagnosed tend to be younger people. Antiretroviral therapy has increased the overall survival rate; however, people living with AIDS face many problems in adapting to this lifelong illness. In this study, we investigate the life narrative and interactions of people living with AIDS and their caregivers. Using a narrative approach, 12 participants, consisting AIDS patients and their caregivers, were invited to one-on-one in-depth interviews to explore their life experience. The study’s results identified five themes: an inability to speak to others about AIDS, isolating oneself from the world, promises that cannot be given, condemnation from others for having AIDS, and having an unknown future. The stories were based on these five themes. Understanding the life narratives of those with AIDS can help to address and resolve the problems associated with living with AIDS. When medical science and technology are advancing, the Internet, media, and other more directed education have enabled easy acquisition of AIDS-related knowledge. AIDS has become a chronic disease. However, the public still cannot accept AIDS. People living with AIDS and their caregivers have not been able to walk out of the shadow of the disease, as even for those who are willing to reveal their illness, the results do not always turn out well. People living with AIDS and their caregivers can only secretly take care of and encourage each other.

Strategies for innovative teaching and learning Part 2: How to deliver a distance education online course

Abstract: The second article in a three-part series discusses how to deliver a distance education online course by i) assuring understanding of the learning platform, ii) developing a course model, iii) creating individual assignment rubrics for courses, iv) requiring active participation from both instructor and students, and v) setting-up quality communication. This paper is a continuation of the first paper whereby the history of distance learning, the positives and negatives of online learning, advantages and disadvantages of online learning, and the initial considerations for establishing online courses.

Trauma-informed knowledge, awareness, practice, competence and confidence of rural health staff: A descriptive study

Abstract: Background and objective: By adopting a trauma-informed approach to care at the organisational and clinical levels, health care systems and providers can enhance the quality of care that they deliver and improve health outcomes for individuals with a trauma history. This study aimed to explore the trauma-related knowledge, attitudes awareness, practice, competence and confidence of health service staff from three small rural health services in Victoria, Australia, and examine their self-reported capacity to respond to clients with a trauma history. Methods: Staff from each site were invited to complete a paper-based survey. The survey included demographic information and questions related to knowledge and understanding of trauma, experience of trauma-informed care and confidence engaging in, and perceived importance of, trauma-informed practices. Results: The respondents were predominately nurses. Results showed that 16% of respondents had undertaken training in trauma-informed care and 44% disagreed that they had an understanding of trauma-informed practices. There were high levels of agreement for statements related to knowledge and understanding of trauma and low levels of agreement with statements related to experience of trauma-informed care. More than 70% of respondents reported that they had little knowledge of the principals of trauma-informed care, and little experiencing with practicing trauma-informed care. Discussion and conclusions: Overall, the survey results showed that staff were trauma-aware, but supported the need for more education and training in trauma-informed practices and improved organisational approaches to support trauma-informed approaches. It is important for organisations to shift from being trauma aware to being trauma-informed, by building foundational awareness of these practices and reinforcement through continuing education.

Equitable academic preparation: A structured onboarding program for incoming graduate nursing students

Abstract: Background and objective: Nurses who return to school to obtain higher education come with varying levels of professional, educational and technological competencies. Some are new graduates, others have not been in school for a decade, and several find educational technology difficult to navigate. Returning to school can be challenging because graduate programs require complex skills in order for students to succeed. Onboarding, the process of organizational socialization, also known as the orientation process, is a relevant element in the retention and progression of students in graduate education. Onboarding differs from school to school, ranging from half a day to a weeklong on-campus orientation. This research is about a structured onboarding program built into a graduate nursing course and specifically addresses the needs of students in order to succeed in their studies. This research presents insights into the Graduate Student Onboarding – Professional Development Program (GSO-PDP), a structured onboarding designed to assist graduate nursing students with their adjustment back to school, enhance their learning, and achieve their graduate degree successfully. It is built into the Nursing Informatics class and is a month-long process. The research offers some understanding of the usefulness of the GSO-PDP to incoming graduate nursing students. Methods: The study uses the qualitative paradigm, in particular, a case study design. This is an examination of the four modules of the GSO-PDP: Elements of Research, Scholarly Writing and Nursing Documentation, Academic Support Services, and Student Life. Student volunteers participated in focus group interviews to evaluate the program. Results: The following were recurring themes identified from focus group interviews: “APA Refresher Overload,” “Bridging the Gap,” “Relearning English Grammar,” “Navigating the Learning and University Maze,” and “Not Really Computer Savvy.” It is evident that most of the elements of the GSO-PDP are beneficial to students in enhancing their adjustment and return to school for further education. The onboarding program also facilitates and enhances student learning. Focus group participants offered some helpful recommendations to improve the program. Conclusions & Implications: This is an innovative and structured onboarding approach to help students with diverse backgrounds to succeed in the Master’s program. Participants generally described the program favorably, but did make suggestions for improvement.

Participants’ perspectives of a fall prevention exercise program in older Arab Americans: A focus group study

Abstract: Background and objective: Physical exercise is an important intervention to maintain health, reduce falls and improve quality-of-life outcomes in older adults. Falls are the leading cause of fatal and non-fatal injuries, and the use of Tai Chi exercise is well-supported by the general older population. Currently, there is little evidence to support the acceptance of Tai Chi by Arab Americans who have no cultural ties to Tai Chi. It is important to understand the perspective of participants in order to gain insight into the attitudes and opinions of the target group. Purpose: To explore participants' perspectives in a small group setting about the implementation of a culturally sensitive Tai Chi fall prevention group exercise program. Methods: Participants were eight older Arab American women who completed a 12-week Tai Chi fall prevention exercise program at a non-for-profit Arab community center. A semi-structured interview and focus group study was conducted with the participants and was audiotaped. The audio recordings were translated into English, transcribed, and analyzed for emergent themes. Results: Participants’ views of the program were positive. The key elements that contributed to the positive outcomes reported by participants were the characteristics of Tai Chi, the Tai Chi instructor, and the use of bilingual staff as a facilitator. The data showed three themes of self-reported benefits, including prevention awareness, physical benefits and mental health benefits, and two program-related factors: program barriers and promoters. Conclusions: Findings indicated that the Tai Chi program implemented in a culturally sensitive manner can be accepted by older Arab American women. Collaborating with a community-based organization and using bilingual staff from the same culture are key factors to promote the success of the program.