<p> The purpose of this study was to examine new graduate nurses (NGN) perceived comfort/confidence over time using the Casey-Fink Graduate Nurse Experience Survey (2006). This information may help reduce barriers to improving their comfort/confidence level and transition to professional practice. The purposive convenience sample consisted of 53 NGNs enrolled into a Dedicated Education Unit (DEU) in a large academic medical center from May 2015 through June 2016 with the last data collection in June 2017. </p><p> Data analysis revealed the perceived confidence level was the lowest at the start of employment and highest when leaving the DEU. The confidence level declined at the six-month data point and trended upward at twelve months. The NGN&rsquo;s confidence at the 12 month data point remained somewhat lower than at the three month data point when they completed the DEU. The most vulnerable time for NGNs is between six and twelve months. The findings are consistent with other studies predicting that NGNs require at least one year to become comfortable/confident in their professional role. In this study the demographics had no bearing on the comfort/confidence of the participants.</p><p>

<p> In the U. S. approximately 795,000 people experience a new or recurrent stroke yearly. Stroke survival has increased with advances in medical technology. The impact of stroke on a patient&rsquo;s neurological status poses critical challenges for nurses. Communication is one area impacted by stroke. Strokes affecting the brain&rsquo;s right hemisphere (RHS) have been described in the literature as negatively impacting communication behaviors of patients, often in a subtle manner. The purpose of this exploratory descriptive study was to examine the knowledge that RNs in North Carolina possess about communication impairments associated with RHS and how these nurses anticipate using knowledge gained about these impairments in the care of these patients. The study also explored perceived barriers and facilitators to participating in continuing education about RHS associated communication impairments. </p><p> The RHS Communication Impairment Knowledge Assessment tool assessed demographic variables, knowledge of RHS associated communication impairments, perceived barriers and facilitators to participating in continuing education about communication clusters associated with RHS, as well as how nurses anticipate using education about these impairments in caring for patients following RHS. The study setting was North Carolina. A purposive sample of North Carolina RNs was contacted through email; and a sample size of 2495 was recruited. The study was guided conceptually by Ajzen&rsquo;s theory of planned behavior. </p><p> Results indicated that a large percentage (78.2%) had received education about RHS associated communication impairments in their undergraduate nursing programs. The mean score on the 12-item knowledge assessment was 6.15 with less than 50% answering 3 specific application of knowledge questions correctly. The KR-20 for these 12 items was 0.532 which is an acceptable KR-20 for short tests (10&ndash;15 items). Cost of continuing education courses (23.5%), work responsibilities (32.9%), and family responsibilities (23.7%) were infrequently reported as barriers to participating in continuing education about these communication impairments while identified education need (87.1%), interest in learning (72.2%), providing better patient care (89.3%), improved decision making (87%), and increased competency (71.4%) were all frequently reported as facilitators to participating in RHS communication cluster continuing education. Three themes emerged regarding how RNs would use knowledge gained to change their patient care. These themes were: awareness of the need for education, improved nursing management of patients, including patient teaching and critical thinking, and better communication with survivors of RHS. The research contributed to the current body of nursing science by identifying knowledge gaps of NC RNs on RHS associated communication impairments, barriers and facilitators to participation in RHS continuing education, and intended changes in care based on continuing education.</p><p>

<p> Although gout is the most prevalent form of inflammatory arthritis, its diagnosis can be complex. To meet the gold standard for diagnosis, providers need to perform a joint aspiration and identify the presence of monosodium urate crystals (MSU) in the synovial fluid or from tophi, a challenging skill in the primary care setting. In its absence, patients have to meet several criteria before a diagnosis can be made. Not surprisingly, gout has been inconsistently diagnosed by Primary Care Providers (PCPs). Thus in 2015, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) worked collaboratively to develop a new set of clinical criteria for the diagnosis of gout. </p><p> For this Doctor of Nursing Practice (DNP) Capstone Project, a review of the literature was conducted using the Chronic Care Model (CCM) as a guide to examine the evidence regarding the use of clinical guidelines for the diagnosis of gout in the primary care setting. Using a pretest-posttest reflexive control design, chart abstraction was performed and, subsequently, an educational session was conducted to see if a short learning lunch would increase PCP knowledge and documentation in the medical record related to use of the 2015 ACR/EULAR diagnostic criteria. </p><p> A total of 36 PCPs from six different primary care settings participated. Chart abstraction revealed that only 31 out of the 54 charts (57%) had adequate documentation to support a diagnosis of gout. A statistically significant improvement in knowledge was demonstrated for several domains of the diagnostic criteria at the posttest. Results from this project indicated that a short learning lunch was effective for increasing PCP knowledge of the 2015 ACR/EULAR gout classification criteria. Through clinical support, easier access to updated evidence based clinical guidelines, and continuing education, PCPs acquired new knowledge and skills essential for providing evidence-based, quality care to their patients.</p><p>

<p> The purpose of this quantitative study was to evaluate the self-efficacy of novice nursing and allied health educators as it pertains to their overall desire to enhance their knowledge of educational instruction. Many nursing and allied health faculty transition from clinical practice to teaching with little to no formalized knowledge in education (Cangelosi, 2014; Gresham-Anderson, 2015). Bandura&rsquo;s (1977a) theory of social learning and self-efficacy was utilized as the theoretical framework for the study. This study was guided by four research questions used to investigate how the self-efficacy of nursing and allied health professionals changed as participants became more experienced educators, the types of learning opportunities the contributors participated in, and the supports and barriers novice educators faced when making the transition from being a practitioner to becoming a teacher. A survey was utilized to gain the data needed. A total of 202 surveys were sent to allied health personnel in higher education institutions in a Midwest state. The results were analyzed using descriptive statistics. In the findings, most of the survey respondents noted their self-efficacy was lower when entering the teaching field as compared to working in their designated allied health field. However, by participating in self-directed learning, professional development, and mentoring, the survey respondents noted self-efficacy increased as they became more skilled as instructors. Implications for practice included providing a formalized orientation process, investment in faculty development, as well as mentoring for novice teachers. Future research studies could gain a more comprehensive understanding of the barriers novice educators face when transitioning from clinical practice to academia and the steps taken to improve self-efficacy. </p><p>

This descriptive, correlational study explored the relationship between nurse practitioner students' (NPSs') (N = 238) perceptions of mentoring by their nurse practitioner preceptors (NPPs') and NPSs' self-efficacy. Bandura's Self-Efficacy Theory (1977) and Role Theory provided the theoretical framework. NPSs in this study overall were highly mentored and highly self-efficacious as their mentoring and self-efficacy scores demonstrate (mean mentoring scores = 4.3, range 1-5; mean self-efficacy scores = 4.15, range 1-5). Significant findings (p. =.0000) included a positive correlation between mentoring and self-efficacy (r =.37), positive correlations between two measures of mentoring (r =.81) and two measures of self-efficacy (r =.54), higher self-efficacy scores among mentored NPSs (mean = 4.4) compared with non-mentored NPSs (mean = 3.9) (p. =.00006), and significant differences in mentoring scores (p. =.029) among NPSs depending on the manner of the initiation of the NPS/NPP relationship. NPSs who chose NPPs whom they knew from a previous relationship had higher mentoring scores (mean = 4.5, p. =.031) than those who accepted faculty assignment (mean = 4.2). Multiple regression analysis showed that the mediating variables most predictive of increases in mentoring scores included NPSs' length of time in the clinical practicum (p. =.025) and the precepting experience of the NPPs (p =.042). Nine characteristics of mentoring emerged from interview data with selected NPSs (n = 33), whose experience contrasted sharply with that of the non-mentored. The interviewed NPSs confirmed that they were well mentored in direct patient care by humanistic NPs or MDs, but they rarely saw or participated in other advanced practice nursing activities. The interviews also suggested difficulties in NPS/NPP relationships for NPSs whose age varied widely from that of the NPP, very young and inexperienced NPSs, older NPSs who have not practiced clinically for sometime, or NPSs who were experts in another nursing role previously. NPSs' choice of NPPs whom they knew from a prior relationship, length of time in the practicum, NPP precepting experience, age and experience of NPSs have implications for the clinical placement of NPSs. Capacity of NPPs to model fully the advanced practice nursing role remains an issue and NPP preparation as part of NPS graduate study may be one way to address this problem.

The United States is rapidly becoming a more racially diverse nation. Racial minority groups are projected to make up 47% of the total population in 2050 and if current population trends continue, they are projected to surpass the non-minority population by the end of the twenty-first century. Furthermore, the Latino population, already the nation’s largest minority group, is expected to triple in size and is projected to account for 29% of the total U.S. population by 2050. Unfortunately, the educational pipeline has created a shortage of Latinos in higher education. At the same time, the United States is suffering from a national shortage of registered nurses. It is, therefore, of great concern that the proportion of minority students in nursing education programs is also not keeping up with population trends. Moreover, persistent inequalities in educational opportunities have led to persistent social inequalities between majority and minority groups, including inequalities in healthcare. Increasing racial diversity among health professionals is essential, not only as a matter of educational equity, but also because evidence indicates that diversity among providers is associated with improved access to healthcare for racial minorities. A main route to upward mobility and equality of opportunity for minorities in the healthcare industry is equity of access and success in achieving the baccalaureate nursing degree. There is an increasing body of literature which addresses retention and persistence of minority nursing students; however, the greater majority has focused on Chicano Hispanics and Black students. Further research is needed to identify factors associated with retention and persistence of other Latino groups. This study uses a qualitative design with Spradley’s method of ethnographic interviewing to learn about the experiences of Puerto Rican nursing students attending college in the Northeast. Obligations to family, financial constraints and academic under-preparedness are some of the key findings gleaned from analysis of the data.

Background: Women have experienced increased mortality from coronary heart disease over the last two decades, while men's rate has declined. This suggests that current treatment and prevention strategies are less effective for women. Furthermore, since most women don't participate in cardiac rehabilitation, alternatives to these programs must be explored. Purpose: This study sought to refine an intervention for rural women with coronary heart disease designed to promote self-management and provide pilot data evaluating the efficacy of the intervention. Design and Methods: The study design was mixed methods. Focused qualitative interviews provided data regarding the self-management program. In-depth interviews determined the efficacy of the intervention including adoption of health promoting behaviors, self-awareness, and self-efficacy. The Self-efficacy for Managing Chronic Disease 6-Item Scale provided additional efficacy data and was administered over the course of the study. Ten women from rural New England, diagnosed with coronary heart disease within the last year, comprised the purposeful sample. Findings: The self-learning program met the women‘s needs; however they provided suggestions for improvement. While the women reported varying degrees of self-awareness, many believed the self-learning program influenced their adoption of health-promoting behaviors. In the interviews, the women expressed confidence in their ability to manage their disease; a finding that was congruent with the findings of the self-efficacy scale. Improvement was seen in five of six items on the self-efficacy scale from pre- to post intervention. The women‘s confidence in managing other symptoms or health problems and management of problems related to heart disease saw a statistically ( p > .05) significant increase post intervention, and that increase persisted. One item, emotional distress, was flat over the series of administrations. Conclusions: Since women differ from men in the development, expression, and treatment outcomes for coronary heart disease, educational programs that address those differences and meet their needs must be developed. This study demonstrated that a paper-based, holistic, self-management program is a viable alternative or supplement to traditional cardiac rehabilitation programs. Using the self-and family management framework, this intervention enabled women to learn how to care for themselves. Key words: coronary heart disease (CHD), women, self-management, self-efficacy

The battering and abuse of women is a problem which adversely affects the health of millions of women in the United States. Nurses are in a particularly strategic position to identify and provide helpful interventions for women who come in contact with the health care establishment. The feminist literature argues for helping strategies which do not blame women for their abuse and which attempt to empower women to take control of their own lives. However, often the past educational preparation of the nurse has not included content on battering, leaving them unprepared to assess for abuse or to provide intervention aimed at fostering independence and personal empowerment. The purpose of this study was to determine the perceived model of helping preferred by nurses in their interventions with battered women and to determine those factors in the nurses' educational experiences and clinical practice which affect their preference for a specific helping model. Data was obtained from 116 registered nurses, 57 nurses practiced in the emergency department setting, and 59 nurses had attended a three day national nursing conference on violence against women. The data of this study were collected through self-administered questionnaires: the Education/Experience Questionnaire and the Help Orientation Test. The results of this study indicate that the medical model of helping, in which the client is attributed low responsibility for both problem cause and solution, not a particularly empowering model but one tending to foster dependency, is characteristic of the helping orientation of all nurses in the study sample. This is true regardless of practice setting, or whether or not nurses have acquired specific knowledge on the topic of battering. All nurses reported significant clinical and personal contact with battered women but few reported having acquired specific education on battering. It was found that nurses who had acquired specific knowledge on battering did perceive themselves as knowledgeable and well prepared in their practice with battered women. This research pointed to the relevance of the type of education about woman abuse which is necessary to permit nurses to not just help battered women but to help in such a way as to foster independence.

Little research has been done to identify effectiveness in nursing practice. This is especially true in home care nursing practice. Nurse leaders and educators express concern for effectiveness, and the profession seems to be advancing in the development of that body of knowledge. The purpose of this study was to examine effectiveness in home care from the perspectives of those intimately involved with its enactment: the nurse, the nurse supervisor, and the client. Conceptually organized within the particular philosophic context of the interpretive paradigm, this study employed the ethnographic methodology of focused interviews as the main resource for gathering data. Findings. The definition of effective nursing was a complex mixture of structure, process, and outcome activities. There were shared perceptions among the subjects and subject groups in this study about knowledge, skills, and personal qualifications and attributes of the effective nurse. There was also considerable agreement about effective home care nursing behaviors which included a range of complex clinical activities, communication, teaching, and the ability to cultivate family involvement. Each sample group also identified unique categories of effective home care nursing behaviors based on its own subjective view of ideal practice. Effective care outcomes were not readily identified by any of the groups except in vague terms. The implications for nursing practice, education, and research were discussed.

This study shows the relationship of a theoretically based nursing curriculum and the integration of the specific conceptual model by students as a technique for thinking and/or delivering care. A descriptive correlational design was used to evaluate the integration of the Neuman Systems Model into a baccalaureate nursing program and measures the degree of student integrated learning. This summative evaluation identifies baseline data on ten baccalaureate nursing programs and the degree of model integration into the philosophy of the program, course objectives, course syllabi, classroom and clinical areas, and teaching-learning activities such as student papers and nursing care plans. Ten baccalaureate nursing programs and 94 senior nursing students from the eastern and midwestern United States participated in the study. Schools were selected because of model use. All participant programs claimed the use of the Neuman Systems Model as the theoretical framework of the nursing program. National League for Nursing Self-Study reports were reviewed and scored as to degree of integration on the Neuman Systems Model Integration Grid. Results of this study confirm a positive relationship between an integrated nursing curriculum and integrated student learning. A direct correlation between program score of levels of model integration and student scores from written papers and nursing care plans was observed.