Thesis (Ph. D.)--University of Wisconsin--Madison, 2003. / Includes bibliographical references (leaves 156-182). Also available on the Internet.

<p> The organizational socialization literature identifies specific needs of newly hired employees: role clarity, occupational self-efficacy, and social acceptance. Organizations help meet these needs by providing onboarding (orientation and engagement) practices that facilitate newcomer adjustment. This leads to increased employee satisfaction and retention. The purpose of this qualitative study was to identify the benefit of onboarding practices that nursing programs use with adjunct clinical nursing faculty and determine if these practices contribute to organizational socialization. Eight nursing adjuncts from three universities completed an online pre-interview survey and participated in a semi-structured interview where they rated the benefit of best and common onboarding practices. An administrator from each university also completed an online version of the survey. Findings from the study revealed consistent benefit ratings of the majority of practices by participants. Some practices were deemed essential and their absence was detrimental for the adjunct, students, and institution. Administrator perceptions of benefit were equal to, or higher than, adjunct ratings. Adjunct participant responses supported their need for an onboarding process that promotes role clarity, self-efficacy, and social acceptance. Those who experienced quality onboarding expressed feelings of satisfaction with their jobs and greater allegiance to their programs than those with poor experiences. This study has implications for nursing education because retention of engaged, satisfied adjuncts is a cost-effective way to supplement the limited pool of full-time nursing faculty. Both adjuncts and administrators identified benefits of the majority of practices, so nursing programs would be well-served by offering a thorough and efficient onboarding process to adjunct faculty. This study also adds to the limited literature that examines the impact that specific onboarding practices have on organizational socialization of new employees.</p>

<p> A college education is, for many in America, part and parcel of the American Dream, and is certainly achievable. For countless reasons, students may enroll at community colleges underprepared, unprepared, anxious, and destined for a high risk of failure. Although community colleges are higher education institutions open and accessible to all who want to pursue an education, some degree programs are selective enrollment programs, such as nursing. Considering the stringent admission criteria and rigors of an associate degree in nursing (ADN) program, few are admitted. However, due to the pending shortage of registered nurses, assistance programs to help high risk nursing students succeed in school and pass their licensure exams to become RNs are needed for the future of the profession. </p><p> The purpose of this exploratory study is to identify factors of the successful Gateway/HRNS program embedded in the community college Associate Degree in Nursing program that fostered student retention, graduation and passing of the NCLEX-RN licensure exam on the first attempt. A qualitative case study methodology was utilized for this comprehensive program evaluation of one very successful ADN nursing program in a Midwest community college. Interviews of graduates of this high risk nursing program, focus groups of faculty teaching in the program, and archival and current document analysis were used to determined program factors that have helped high risk students over the past twenty years to succeed and become licensed, employed RNs. </p><p> Findings revealed that students and faculty highly valued three components of the high risk nursing student assistance program. These components were a) a pre-nursing summer introduction to nursing component comprised of many small courses; b) a mid-curricular second summer LPN option component; and c) regularly-scheduled weekly tutoring sessions throughout the two years of the ADN program. The most valued experience, according to program graduates, was the mid-curricular LPN Option course, which is mandatory for these high risk students and optional for other nursing students. It was felt this second summer component in the assistance program helped students to integrate nursing theory coursework and clinical which provided a substantial benefit as they entered their final year of the ADN program. </p><p> As a result of this study's findings, the O'Sullivan Strive to Thrive (S2T) Model for Student Success was developed to enable community college nursing leaders to develop assistance programs for high risk nursing students. There are eight steps in the Strive to Thrive (S2T) Model, designed to help ADN leaders and faculty promote and orchestrate the successful persistence and graduation of high risk students. Also included are directions for each of the steps as well as corresponding useful forms. This model to plan and design assistance programs for high risk students can be adapted by nursing department leaders in community colleges, as well as other nursing program venues and degree programs.</p>

<p> Despite the rapid growth of online learning and student enrollment at for-profit colleges, previous research has found that employers are wary of job applicants with credentials earned from these sources. This study compared the attitudes of health care recruiters toward four different RN-to-BSN degree options based on the method of instruction (classroom, online) and the type of college (traditional, for-profit). A sample of 116 health care recruiters from across the United States completed an online survey. The study revealed that there were significant differences in the perceived advantage in the hiring process, credibility, concerns about credentials and likelihood to recommend hiring. Applicants with RN-to-BSN degrees from traditional colleges and via classroom instruction were clearly most favored and those with degrees earned through online instruction at for-profit colleges were perceived the least favorably. An online degree from a traditional college was determined to be more acceptable than an online degree from a for-profit college but still less acceptable than a degree earned through classroom instruction at a traditional college. The implication of these findings is that the return on education for students earning college degrees online or from for-profit colleges may be inhibited by employer perceptions regarding the quality of credentials earned in these environments.</p>

<p> Forty years after Kramer's (1974) seminal work, Reality Shock, new graduate nurses continue to have difficulty transitioning to the registered nurse (RN) role. The purpose of this phenomenological study explores the lived experience of new graduate nurses who completed a Veterans Affairs externship program in their senior year of nursing coursework and its perceived impact on their successful transition into the practice role 3-24 months following graduation. Benner's (1984) Novice-to-Expert Model, Karmer's (1974) Reality Shock Theory, and Selder's (1989) Life Transition Theory support a framework for this study. Twelve telephone interviews were conducted using van Manen's (1990) method for researching the lived experience. One overarching theme "feeling confident" and three main categories, "transitioning to the RN role," "making decisions," and "interacting with professionals," were identified from the data. Externship programs assist the student to comfortably and smoothly transition as a new graduate nurse by offering additional clinical and practice experiences. Given the complexity of today's health care environment, there is a growing need to better prepare the graduate nurse for their transition into nursing practice. Externship programs can serve this purpose. </p>

<p> <b>Background:</b> Approximately 25% of newly hired nurses are deficient in critical thinking skills. <b>Purpose:</b> The purpose of the study was to determine if the hybrid design course assisted nursing students to improve critical thinking skills as compared to the traditional face-to-face lecture. <b>Methods:</b> This quasi-experimental study utilized pre- and post-test Assessment Technologies Institute, LLC (ATI) score analyses, course grades, and a demographic survey for students in the hybrid design course and students in the traditional course. The sample size consisted of 26 students in the hybrid design course and 25 students in the traditional lecture course. <b>Results:</b> No statistically significant differences were found between the critical thinking skills of students in the hybrid design section versus the traditional lecture section of the medical-surgical course. Course grades were statistically higher in the hybrid design course when compared to the traditional lecture section of the course.</p>

<p> <b>Background:</b> There is a growing need for skilled gerontological nursing care. Nursing students often fail to appreciate the importance of implementing gerontological nursing competencies. </p><p> <b>Purpose:</b> The problem is that nursing education research on students' attitudes about gerontology has been hampered by a lack of valid and reliable instruments. </p><p> <b>Theoretical framework.</b> This study is based on and tests the propositions of the theory of planned behavior. </p><p> <b>Methods.</b> Qualitative interviews were conducted to determine the terms used to describe the constructs by the target population. Using these terms, an instrument was developed and subjected to tests for psychometric estimates. A pretest-posttest design was used to test the impact of an educational intervention on students' attitudes. </p><p> <b>Results.</b> The instrument demonstrated acceptable reliability and validity. Students' scores increased significantly for attitude, subjective norm and behavioral intention regarding implementing gerontological competencies from pretest to posttest. Attitude and subjective norm predicted behavioral intention in the regression model. </p><p> <b>Conclusions:</b> The results support that an educational intervention can positively impact nursing students' intent to implement gerontological competencies.</p>

<p>The use of high fidelity simulation to educate health care professionals is becoming more common, especially in nursing education. This innovative teaching method bridges the knowledge gaps that are often present in nursing students related to limited clinical experiences and the transition of healthcare to the community setting. In addition, there are limited opportunities to practice in specialty clinical experiences such as pediatrics. This is particularly the case with pediatric immunizations. However, accrediting boards for colleges and future employers expect students to be able to function in these specialty roles despite the lack of clinical opportunities. Therefore, a pediatric immunization and parent education simulation was designed to address this knowledge gap and evaluate student anxiety, knowledge acquisition, satisfaction, and self-confidence with this innovative teaching method. The sample consisted of 21 senior nursing students enrolled in a community health nursing course in a rural baccalaureate nursing program in Illinois. The study design was a one-group, pre-test, post-test repeated measures design guided by Jeffries&rsquo; Nursing Education Simulation Framework. Participants completed a researcher designed demographic questionnaire, the State-Trait Anxiety Inventory Scale for Adults (STAI), a researcher-designed knowledge test, and the Student Satisfaction and Self-Confidence in Learning scale. Results were analyzed with SPSS, Version 20 using descriptive statistics, paired <i>t-tests</i>, and Pearson&rsquo;s Correlation Coefficient. The study results demonstrated that high fidelity simulation was an effective teaching modality that decreased students&rsquo; anxiety, enhanced their knowledge, and increased their self-confidence with administering pediatric immunizations and providing parent education. </p>

<p> Graduate programs in nursing for non-nurses (GPNNN) are rapidly proliferating in response to demands for innovative strategies to increase the number of nurses to meet health care demands, both actual and anticipated. Transitions Theory (Meleis et al., 2000) provided a framework to identify the gaps in knowledge related to how individuals transition to nurse within these programs. One of the gaps in the literature that was identified was a description of the transition to nurse experience of students enrolled in a GPNNN. This qualitative descriptive research was conducted in response to this gap. It examined the transition from non-nurse to nurse through a GPNNN which prepared non-nurses for advanced nursing practice. The study had three aims: to describe the transition experienced by the students; to describe how they used their prior education and experiences in this transition; and to describe the factors they saw as facilitators and hindrances to this transition. </p><p> Responsive interviewing (Rubin &amp; Rubin, 2012) with a purposive sample (n=17) of registered nurses enrolled in the advanced practice curriculum of the GPNNN was used. Data was collected from these nurses between September and December, 2013. Data analysis included initial codification of interviews, and within and between interview comparison of codes, resulting in re-coding and collapsing of codes. To assure the trustworthiness of the data, the criteria thoroughness, accuracy, believability and transparency were used (Rubin &amp; Rubin, 2005).</p><p> Data analysis revealed a process of transition that occurred over three distinct time periods, <i>Coming to Nursing</i> (pre-enrollment), <i> Beginning to Learn the Role as Nurse</i> (pre-licensure), and <i> Practicing as Nurse</i> (post-licensure). Influences that impacted the transition across periods included personal goals, knowledge, skills, and professional growth. Indicators of transition that were known to the individual and to others were described. The individual's utilization of prior education and experiences in their personal transition experience was described as primarily influencing study habits and clinical experiences. Facilitators and hindrances to the transition included experience working as a nurse, self-identification as nurse, personal goals, the accelerated program, the programmatic focus on NCLEX style testing and the nursing pedagogy.</p><p> Interpretation of the findings of this research was informed by the literature. Identification of three periods of transition through nursing education has been described in transition to nurse in other nursing education populations (Shane, 1980a, 1980b; Neill, 2010), and is consistent with transitional patterns (Meleis, 2010). However, the three transitional periods identified in this study are peculiar to the transition experience through a GPNNN, and don't mirror the characteristics identified in transitional periods in other populations. A rich description of the transition experienced by the participants is presented including characteristics of the transitional periods, the influence of prior education and experience within the transition, and identification of factors that facilitated or hindered the transition experience. This description has not previously been described in the literature.</p><p> There are implications of this research for practice, theory, education, policy and research, and these are discussed.</p>

<p> Pressure ulcers (PUs) remain a relatively common and potentially serious health issue among the elderly in any healthcare setting and have been associated with high mortality and morbidity rate. A low incidence of PUs is highly desirable and is considered as an indication of quality care by patients, caregivers, and regulatory authorities on both the state and federal levels.</p><p> Nursing assistants play an integral role in the direct patient care; ongoing training and educational opportunities about pressure ulcer prevention are very important in maintaining their skill, motivation and knowledge. Research findings showed that staff education with reinforcement is the key in decreasing prevalence and incidence of pressure ulcer. This educational curriculum was designed to increase nursing assistants' knowledge about pressure ulcer prevention among elderly in long-term care.</p>