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<p> Within the health care system, patient safety outcomes have been criticized for many years. Medical malpractice, common errors, and nosocomial infections (i.e., hospital-acquired infections) are safety concerns, and represent a public health problem. Since the Institute of Medicine (1999) published To Err is Human: Building a Safer Health System in 1999, changes have been made to improve the use of technology and leverage advancements in research that improve patient safety. Nurse leaders can also help to facilitate process improvements in the patient safety culture. The purpose of this capstone project was to explore the nursing leader role in improving patient safety in a hospital setting. The method utilized for this study was a literature review. Prominent articles identifying the role of nursing leadership were included. Seven drivers of patient safety were identified (Sammer, Lyken, Singh, Mains, &amp; Lackan (2011), and subsequently informed this project. The targeted populations were patients, families, nurses, nurse administrators, and medical personnel. Findings regarding the nurse leader role, patient improvements, and barriers to improvements were reviewed. Nurse leaders were found to be of critical importance to patients, medical personnel, and the health care system. The limitations of this review and implications for policy and practice are discussed. </p>

This research examines the transition from student nurse to Registered Nurse (child). Earlier studies suggest the transition always involves a period of discomfort and uncertainty. However, there is a dearth of longitudinal studies of children‟s nurses, revealing a gap in the evidence that this study aims to fill. This longitudinal study commenced in one HEI in England where the six participants were completing their undergraduate programme in child nursing. A phenomenological interpretive design was used to answer the research question: „What is the experience of making the transition from student to RN (child) like?‟ Data was collected using focused qualitative interviews at three stages: mid final year, and at 3–4 months and 12–14 months post-employment as an RN. The data was analysed using descriptive and interpretive methods. The thesis draws out the changes in the participants experience over time and suggests the transition extends beyond the first year of practice. It involves development within four overarching themes: Personal and Professional Identity, Primacy of Practice, Working with People, and Managing Newness. These key themes are present across the participants‟ experience but their importance changes over time. The transition is characterised by the visibility of being a nurse and the invisibility of being a „new‟ nurse. This study supports the findings of some earlier studies and introduces some new evidence in relation to children‟s nursing, such as responding to crises, coping with grief and the difficulties and challenges of working with parents. The main limitations are that this is a small-scale study within a specific branch of nursing, with participants drawn from one HEI and conducted by a single investigator. However, because the participants took up employment in different locations in England, the findings may have some resonance with other neophyte children‟s nurses beyond the original setting of the research. Recommendations are made for undergraduate programme providers and employers to strengthen and develop the preparation of RN (child) pre- and post-qualification, particularly in the areas of preceptorship, prioritising care and managing time, working with parents, and coping with emergencies or the death of a child

This study focuses on the practice component of United Kingdom (UK) pre-registration nurse education. In particular, the research has concentrated on one school of health - part of a larger higher education institution, in the UK and has explored how the institution ensures the quality of the practice component of two of its pre-registration nurse education programmes, the Adult and Mental Health branch programmes. A ‘Major Review’ inspection of these programmes was undertaken in 2005 as part of the requirement of the Quality Assurance Agency (QAA) (2001). The research analysed whether the precepts that relate to the practice component of the school’s pre-registration programmes were being implemented, enacted and experienced by those engaged in them. To achieve this Yin’s (2003) qualitative case study approach was adopted, involving interviewing senior lecturers (n=9), mentors (n=7) and student nurses (n=8) and undertaking in depth analysis of relevant documentation. The findings identified that the precepts themselves did not directly influence what the link tutors and mentors did. As a result, the student nurses experienced different levels of support from link tutors and mentors. This prevented students from experiencing a standardised approach to the practice component of the programmes studied. From this it has been concluded that the ethos of the Major Review process has had no long term impact with regards to standardising and quality assuring the practice component of the programmes studied, a finding that has not been formally reported elsewhere. Instead individual values, beliefs and practices dominated the way in which the players studied operated. The study also highlights how broad and non-descript the precepts themselves are in guiding the school towards a standardised approach to the practice component of the programmes in question. All but one of the precepts ‘Staff Development’ were evidenced as being implemented and/or experienced. Having researched the placement learning precepts (QAA 2001) in their entirety, which has never been done before, it became evident that whilst the content of all of the precepts had been included in the documentary data studied (Clinical Assessment of Practice Documents, School Plan and Pathway Guide), this did not guarantee that all of the precepts were fully implemented and enacted by relevant players. This was because the instruction and guidance within the documents studied were often broad and non specific, to which the design of the precepts allowed. The outcome of this enabled a) link tutors to interpret their roles and responsibilities in different ways; b) theory practice gaps to emerge, which ranged from weak partnership relationships between link tutors and practice placement mangers; c) mentors and link tutors interpreting the CAPD differently and d) mentors mentoring and assessing students in different ways. This resulted in students nursing experiencing different types of learning opportunities and assessment practices that did not always match the learning and development that may be needed in order to practice as a competent and confident registered nurse, at the point of registration. Additionally, there was a lack of understanding by all players about local quality assurance systems and processes. This ranged from none of the participants being familiar with the complaints procedures, or being clear about how placement learning experiences were monitored and evaluated. As a result of these findings the competence of the personnel (link tutors and mentors) studied has been questioned. A phenomenon that highlighted that precept 6 ‘Staff Development’ (which required institutions to ensure that staff who are involved in placement learning are competent to fulfil their role), was not being demonstrably implemented or enacted. A series of recommendations have been designed to meet both the needs of the school studied and others similar. Some of the recommendations relating to the school studied have already been implemented with positive effect. This was evidenced when the researched school was confirmed as having an ‘Outstanding Level of Achievement’ for practice learning following a more recent quality assurance inspection by HLSP on behalf of the Nursing and Midwifery Council.

This thesis explores the impact of simulation upon learning for undergraduate nursing students. A brief history of the evolution of pre-registration nurse education and the development of simulation for nursing provide background and context to the study. The conceptual frameworks used for this study draw upon the work of Benner and Sutphen (2007) and Engeström (1994). Benner and Sutphen’s work highlights the complex nature of situated knowledge in practice disciplines such as nursing. They suggest that knowledge must be constantly integrated within the curriculum through pedagogies of interpretation, formation, contextualisation and performance. These pedagogies present a framework, which enhances the understanding of the impact of simulation upon student learning. Engeström’s work on activity theory, recognises the links between learning and the environment of work and highlights the possibilities for learning to inspire change, innovation and the creation of new ideas. His notion of expansive learning offers nurse education a way of reconceptualising the learning that occurs during simulation. Together these frameworks present an opportunity for nurse education to articulate and theorise the learning inherent in simulation activities. Conducted as a small-scale narrative case study, this study tells the unique stories of a small number of undergraduate nursing students, nurse mentors and nurse educators and explores their experiences of learning through simulation. The nurse educators viewed simulation as a means of helping students to learn to be nurses, whilst, the nurse mentors suggested that simulation helped them to determine nursing potential. The students’ narratives revealed that they approached simulation learning in different ways resulting in a range of outcomes: those who were successfully becoming nurses, those who were struggling or working hard to become nurses and those who were not becoming nurses. A theoretical analysis of learning through simulation offers a means of conceptualizing and establishing different perspectives for understanding the learning described by the participants and offers new possibilities towards an expansive approach to learning nursing. The study concludes by examining what this interpretation of learning might mean for nurse education, nursing research and nursing practice.

This portfolio presents a schema of publication outputs developed from different stages of a journey of research framed by supporting commentary. Collectively these provide a portfolio of study that explores the learning potential of simulation in undergraduate nurse education. A brief history and overview provides context and background into the positioning of simulation within undergraduate nurse education that influenced the design and implementation of this research enquiry. Exploration of the literature base revealed a lack of consensus and understanding of simulation at that time. A concept analysis to search for common use and meaning of simulation as a learning strategy provided initial clarity, a foundation for further research and the first publication within this portfolio. This further informed the research aims and subsequent publications which focus on fundamental aspects of simulation which offer different perspectives for exploring and understanding this educational choice. A qualitative methodology was adopted as the optimum research design to establish a theoretical analysis of how simulation contributes to learning from the perspectives of undergraduate adult nursing students. An adapted form of classic grounded theory (Glaser, 1978) maintaining close association with the original approach (Glaser and Strauss, 1967) enabled data to be collected contemporaneously with student performance and reflection. Deep understanding developed from the multiple methods of dynamic data collection and analysis that captured the interactions of individual as they engaged in the simulation experience. Data was analysed through multiple lenses, including context and through the lens of both the researcher and learner. Findings suggest that immersive simulation engages and enables students to actively participate in professional context resulting in reflection and a motivation to learn. Simulation in this study has been found to enable curiosity and intellect engendered through activity which is enhanced through social collaboration and assists in embedding and contextualising theory. Ultimately students need to make identity shifts and evidence from this study would indicate that simulation enables students to think like a nurse as they make connections between theory and practice illuminated through activity and working together. The collective publications, findings and supporting commentary within this portfolio, serve to strengthen the existing evidence base for educators to consider when designing and developing simulation-based learning opportunities.

<p> The AACN has asked academic leaders to align the performance of their organizations to the prescribed standards within the <i>Essentials of Baccalaureate Education for Professional Nursing Practice</i> document and has provided indicators of quality suggestions for program enhancement as a means of promoting continuous performance improvement. However, the AACN has not prescribed a strategy that specifies the manner in which colleges should achieve these benchmarked standards, which has created uncertainty among administrators about whether the indicators of quality lead to improvements that are actually indicative of improved performance.</p><p> This dissertation used multiple linear regression research design to determine whether predictive relationships exist between the American Association of Colleges of Nursing (AACN) indicators of quality and the Baldrige core values and concepts of performance improvement within Commission on Collegiate Nursing Education accredited baccalaureate colleges of nursing.</p><p> The purpose of this study was to determine whether the behaviors associated with specific AACN indicators of quality reflect behaviors that the Baldrige core values and concepts have already proven to be successful in achieving continuous performance improvement. The results revealed nine AACN indicators of quality behaviors most likely to enhance performance improvement outcomes within baccalaureate colleges of nursing. They include; (1) Resources are budgeted for research, development, business operations, public relations, marketing, and human resources; (2) Establishing and upholding policies that reflect faculty and leadership development resources; (3) Student experiences include service learning opportunities; (4) Practice partnerships include collaborative practice initiatives; (5) Collecting data and making program changes that focus on the level of graduate satisfaction with their preparation for the profession; (6) Faculty have input into the governance of the college/school; (7) The majority of faculty have a presence in state, regional, national, and international professional activities; (8) Opportunities for baccalaureate graduate's employment with practice partnerships; and (9) Formal mentoring program for clinical preceptors.</p><p> The results underline the fact that continuous performance improvement within baccalaureate colleges of nursing is a deliberate and dynamic analysis-driven endeavor dependent on an organization's ability, willingness, and initiative to continually strive to narrow the chasm between actual and potential performance results.</p>

Over 15,000 master’s and doctoral degree students in the United States were denied admission to nursing schools in 2014 because of insufficient nursing faculty. In 2016, over 64,000 undergraduate and graduate students were unable to gain admission to nursing school due to the effects of faculty shortages. This project explored the role of the Doctor of Nursing Practice (DNP)-prepared nurse in academic settings using a systematic review of the literature to determine the role of DNP-prepared nurses in academia. Souza’s systematic review model and Melnyk’s levels of evidence were used to guide the search, review, and the selection of scholarly articles published between 2005 to 2019. A chart of preferred reporting items for systematic reviews and meta-analyses chart was used to organize and select 14 articles meeting the review criteria and included in the analysis. Four themes emerged from the analysis of literature: role in academia from the dean’s and director’s perspective, DNP role as a teacher, preparation for faculty role, and leaving the faculty role. Confusion over the role of the DNP in academia was also identified as a factor affecting DNPs in academic practice settings; however, DNPprepared nurses have the clinical experience, knowledge, and skills to provide evidence-based teaching and fill the gap in practice needed in academic settings. This project may promote positive social change by raising awareness of the role of the DNP in academia to reduce the faculty shortage.