Academic integrity, while important for all students, is especially so for those enrolled in nursing programs. Nurses are entrusted by the public to care for those in need from birth through death. A nursing student who graduates through dishonest means jeopardizes the safety of patients in their care. Nursing faculty need to understand the scope of academic integrity violations and develop meaningful, targeted interventions to show students the harm their actions could cause. The purpose of this dissertation is to explore undergraduate nursing students’ knowledge and perceptions of academic integrity and to specifically look at their willingness to report peer violations. This dissertation study was a collaborative effort among three doctoral students. Using a research team-modified version of McCabe’s Academic Integrity Survey as well as a research team-created Knowledge Assessment, 442 nursing students were surveyed. Results confirm a hesitation to report peers for violations of academic integrity. Students’ ability to neutralize their behaviors as harmless, their desire to remain loyal to their peers, and age act as positive predictive variables for willingness to report peer violations. Additionally, participants’ perceptions of the severity of various offenses and their perceptions of their faculty’s support for academic integrity policies are positively correlated with willingness to report peer violations. Program improvement strategies, such as implementing an honor code, were supported by participants and may help foster a culture of academic integrity that promotes peer reporting. Lastly, a targeted intervention designed for nursing students to promote academic integrity and peer reporting is explored.

The problem which prompted the undertaking of this study was that of increasing absenteeism amongst student nurses at one South African Nursing College. The information, obtained from individual and group interviews, was analysed to identify the perceptions developed by student nurses. Absenteeism is shown to be a behavioural response to environmental and other factors in the world of the student nurse. A theoretical model is proposed to explain three main types of absenteeism and the factors which contribute to absenteeism and attendance.

The use of simulation as a clinical learning activity is growing in nursing programs across the country. Using simulation, educators can provide students with a realistic patient situation using mannequins or actors as patients in a simulated environment. Students can practice multiple aspects of patient care without the risk of making mistakes with real patients, and faculty can reinforce course objectives and evaluate student learning. Because of the technology, the environment, and the methods by which simulation is implemented, it may cause anxiety in learners, which may interfere with the learning process. Anxious students may miss an opportunity for learning valuable aspects of nursing care that are reinforced in simulation. This paper will describe a study of the student perspective on simulation, particularly related to the anxiety experienced by many learners. Nursing students in a baccalaureate program who participate in simulation in their clinical courses were recruited for the study, which consisted of a survey and a focus group. Participants were asked to rate nineteen aspects of simulation in regards to the feelings they elicit, from confidence to anxiety. The survey, completed by 73 of the 178 eligible participants, also included open-ended questions in which students could elaborate on their responses. A focus group was held after the survey, during which nine volunteer participants were asked further questions about their feelings and reactions in simulation, specifically as related to their effect on learning. During a facilitated discussion, they also offered suggestions for interventions that they believed would decrease their anxiety and improve the learning environment in simulation. After an analysis of the data, a "comfort-stretch-panic" model (Palethorpe & Wilson, 2011) emerged as a useful framework for understanding the student perspective. Students in the "stretch" zone, in which they perceived a manageable amount of stress, were motivated to perform and experienced optimal learning from the simulation session. The student suggestions for interventions which would aid their learning may be useful for transitioning them into the "stretch" zone, and should be considered as potential tools in simulation practice.

Empathy is the foundation of caring in the nursing profession. It is critical to an effective patient-nurse relationship and impacts decision-making in nursing care. This study aimed to investigate the impact of virtual simulation on nursing students’ empathy and the relationships of empathy to their demographic characteristics. A randomized pretest and posttest control group design was employed in the study with 140 participants from twelve undergraduate nursing programs across Canada. A virtual simulation scenario was created by the author regarding a patient with substance overuse in an acute care setting. Standardized patients were employed to portray the virtual characters to enhance realism and immersive experience. The participants in the control group reviewed a text-based case study, which consisted of an identical storyline of the virtual simulation scenario, while those in the intervention group experienced the virtual simulation activity. The Kiersma-Chen Empathy Scale-Revised (KCES-R), Substance Abuse Attitude Survey (SAAS), and a demographic survey consisting of age, gender, personal, family, and learning experiences related to substance overuse, were used in the study. The results indicated empathy was significantly increased after the learning activities in both groups, but nonsignificantly different between the participants in the text-based case study and virtual simulation groups before and after the learning activities. Meanwhile, the participants’ attitudes toward substance overuse did not change significantly after their learning activities. All demographic characteristics were nonsignificantly correlated to the participants’ empathy as well. However, the participants’ empathy toward the patients with substance overuse was significantly associated with their attitude toward substance overuse. This study is one of the few studies that employed virtual simulation to promote nursing students’ empathy. Although the study did not demonstrate a significant difference between the text-based case study and virtual simulation groups after the learning activities, it supports that virtual simulation is effective for promoting empathy in nursing education as a text-based application. Future studies will be needed to explore different virtual simulation designs and to determine how individual characteristics influence the cognitive process of perspective-taking in promoting empathy.

Educating staff nurses is pivotal in the evolving healthcare environment. Two staff development models used in the healthcare setting are unit-based and centralized. Unit-based education is a staff development model that places educators on individual units. These educators direct the educational development of staff nurses on their assigned units. Centralized education meets generalized learning needs and provides nursing departments with scheduled education sessions or impromptu meetings regarding changes to policies and procedures. In addition, centralized educators are assigned to address the learning needs of the nurses on several units with universal orientation (Cummings & McCaskey, 1992), coordinate and implement intravenous and blood transfusion therapy courses, physical assessment courses, professional update programs, and universal workshops and conferences (Cummings & McCaskey, 1992). In contrast, unit-based educators are more familiar with the unit's practices and staff nurses while providing more individualized staff education than the centralized model. This research was conducted to explore the association between the type of staff development model and staff nurses' evaluations of their clinical educators, their anxiety, and their clinical reasoning. The researcher used a quantitative descriptive comparative, cross-sectional, intact group design. The sample included staff nurses (N = 86) from a tertiary care medical center in New York City. The staff nurses were from two units with a unit-based educator and two units with a centralized educator. Data were collected from the first week of September 2022 to the first week of December 2022. Two reports are described below that are based on this research, which included administering four different scales. Not all respondents completed all four scales. The first report concerns the findings on two instruments that measured the staff nurses' evaluation of clinical educators. The Clinical Educator Evaluation Questionnaire (CEEQ), developed for this study, measured nurses' perceptions of the extent to which their staff educators' methods were consistent with Malcolm Knowles's Adult Learning Theory. The Nursing Clinical Teacher Effectiveness Inventory (NCTEI) measured staff nurses' perceptions of their current staff educators as clinical educators. An exploratory factor analysis was conducted on the CEEQ questionnaire developed by the researcher, a Pearson’s correlation analysis between the two surveys, the CEEQ and the NCTEI, and a Chi-square analysis and independent t test was conducted to compare demographic variable among the unit-based and centralized education groups was also conducted. In addition, differences between group responses for independent sample comparisons were examined using t tests. There were significant differences between the groups, t(100) = 3.31, p = .001, on the CEEQ. The 59 participants in the unit-based group scored higher (M = 119.76, SD = 19.62) than the 43 participants in the centralized group (M = 106.86, SD = 19.17) on perceptions of their instructors' methods as consistent with the adult learning theory. The groups also differed on the perceived effectiveness of their nurse educators as clinical instructors, t(94) = 2.66, p = .009, on the NCTEI. The 55 participants who represented the unit-based group (M = 250.5, SD = 70.34) had higher means than the 41 participants in the centralized group (M = 212.8, SD = 66.14). The second report concerns staff nurses' anxiety during staff education as measured using the State Anxiety Inventory (SAI) and staff nurses' self-report of their clinical reasoning as measured by the Nurses Clinical Reasoning Scale (NCRS). Differences between the group responses for independent sample comparisons were examined using t tests. The anxiety of the 48 participants in the unit-based group (M = 35.7, SD = 11.47) was compared to the anxiety of the 38 participants in the centralized group (M = 37.2, SD = 11.35). No statistically significant differences were found, t(84) = -.633, p = .528. Similarly, there was no significant difference between the groups on the NCRS, t(85) = -.188, p = .852. The 48 participants who represented the unit-based group (M = 59.1, SD = 6.61) did not differ from the 39 participants in the control group (M = 59.3 SD = 6.80) on clinical reasoning. Findings showed that the staff nurses evaluated the unit-based educators more highly but that the two models did not differ regarding their effects on anxiety and clinical reasoning. This is the first study to examine staff nurses’ evaluations of their clinical educators. Findings indicate that staff nurses reported more effectiveness for unit-based educators than centralized educators regarding practices that aligned with Malcolm Knowles’s Adult Learning Theory. In addition, this is also the first research study to examine the relationships of staff development models to anxiety and clinical reasoning during staff education. Although the two models did not differ on their effect on anxiety and clinical reasoning, additional research is recommended to explore other variables that may further justify the investment in unit-based education.

Indiana University-Purdue University Indianapolis (IUPUI) / Clinical simulation is an innovative teaching/learning strategy that supports the efforts of educators to prepare students for practice. Despite the positive implications of clinical simulations in nursing education, no empirical evidence exists to inform effective teaching in simulated learning environments. The purpose of this research is to create an instrument to measure effective teaching strategies in clinical simulation contexts. The conceptual framework for this study is the Nursing Education Simulation Framework. The Student Perception of Effective Teaching in Clinical Simulation (SPETCS) is a survey instrument scored on a 5-point Likert scale with two response scales: Extent and Importance. The Extent response scale measures participants’ perception of the extent to which the instructor used a particular teaching strategy during the simulation, and the Importance response scale measures perception of the degree of importance of the teaching strategy toward meeting simulation learning outcomes. A descriptive, quantitative, cross-sectional design was used. Evidence to support content validity was obtained via a panel of simulation experts (n = 7) which yielded a content validity index of .91. A convenience sample of undergraduate nursing students (n = 121) was used for psychometric analysis. Internal consistency reliability met hypothesized expectations for the Extent (α = .95) and Importance (α = .96) response scales. Temporal stability reliability results were mixed; correlations between administration times met expectations on the Importance scale (ICC = .67), but were lower than expected on the Extent scale (ICC = .52). Both response scales correlated within hypothesized parameters with two criterion instruments (p < .01). The Importance scale was selected for exploratory factor analysis (EFA). EFA revealed 2 factors: Learner Support and Real-World Application. The result of careful item and factor analysis was an easy to administer 33 item scale with 2 response scales. The SPETCS has evidence of reliability and validity and can serve as a tool for the assessment, evaluation, and feedback in the ongoing professional development of nurse educators who use clinical simulations in the teaching/learning process. In addition, results of this study can support the identification of best practices and teaching competencies in the clinical simulation environment.

Indiana University-Purdue University Indianapolis (IUPUI) / There is a critical need for faculty, a shortage of clinical sites, and an emphasis on quality and safety initiatives that drive increasing use of simulation in nursing education. Debriefing is an essential component of simulation, yet faculty are not consistently prepared to facilitate it such that meaningful learning, demonstrated through clinical reasoning, occurs from the experience. The purpose of this exploratory, quasi-experimental, pre-test-post-test study was to discover the effect of the use of a simulation teaching strategy, Debriefing for Meaningful Learning (DML), on the development of clinical reasoning in nursing students. Clinical reasoning was measured in 238 participant students from a Midwestern university school of nursing taking an adult health course that uses simulation. Participants were assigned to either the experimental or control group where the DML was compared to customary debriefing using the Health Sciences Reasoning Test (HSRT) before and after the debriefing experience, and the Debriefing Assessment for Simulation in Healthcare©–Student Version (DASH©–SV) with four supplemental questions about the DML (DMLSQ) process, during the post-debriefing assessment. This research sought to understand if the DML debriefing strategy positively influenced the development of clinical reasoning skills in undergraduate nursing students, as compared to usual and customary debriefing. The data revealed that there was a statistical difference between total mean test scores measured by the HSRT. There was, additionally, statistical significance in the change in scores between pre-test and post-test for those who used the DML as compared to the control. There was also a difference in the student’s perception of the quality of the debriefing measured by the DASH©–SV with the DML rated statistically higher than usual debriefing. Finally, there was a significant correlation, demonstrated through regression analysis, between the change in HSRT scores and students’ perception of quality debriefing and the use of the DML. This study contributes to the growing body of knowledge about simulation pedagogy, provides tools for use in debriefing, and informs faculty on best practices in debriefing.

Indiana University-Purdue University Indianapolis (IUPUI) / Increasing the success of diverse undergraduate students is central to the mission of many nursing programs. Numerous programs administer learning style inventories in order to obtain baseline information about students’ learning needs. However, little is understood about students’ intent to use the learning style preference information. The purpose of this study was to examine variables associated with intent to use learning style preference information by undergraduate nursing students. Variables included demographic, academic, and learning style preference variables as well as students’ ability to explain learning style preference information, obtained from a commercial learning style inventory. A purposive convenience sample (N = 219) was obtained from six baccalaureate nursing programs in different geographical areas to achieve adequate learner diversity for the variables to be studied. A researcher-developed survey entitled Intent to Use Learning Style Preference Information was used to collect study data. Students responded to questions regarding demographic, academic, and learning style preference information. Pearson correlation, independent samples t test, analysis of variance, and multiple linear regression methods were used for statistical analyses. The significant variables of type of BSN program, years of education, person who shared results, perception of usefulness of learning style assessment, and ability to explain learning style preference information, when entered into the regression model, accounted for 32.5% of the variance in the intent to use learning style preference information, F(5, 198) = 19.07, p < .001. Intent to use learning style preference information was greater for BSN students in four-year programs as opposed to accelerated programs, those with fewer overall years of education, whose results were shared by an academic advisor rather than faculty, who perceived their learning style assessment as useful, and who had high ability to explain their learning style preference information. Evaluation of fiscal resources required for administration of learning style inventories and perceived usefulness of the information by students is critical. Implications from this study include ensuring students’ ability to understand and explain their learning style preference information, as well as providing strategies that students can utilize throughout their curriculum. Further research is recommended to determine the impact of implementation strategies.

Indiana University-Purdue University Indianapolis (IUPUI) / The increasingly complex nature of health care requires nursing graduates, upon completion of their formal education, to be fully capable of providing safe and competent patient care. Accrediting bodies for schools of nursing have challenged nursing education to develop and implement innovative, research-based pedagogies that engage students in learning. Narrative Pedagogy is an innovative approach to teaching and learning developed by Nancy Diekelmann after many years of researching nursing education using Heideggerian hermeneutic phenomenology. As a new paradigm for teachers and students gathering in learning, Narrative Pedagogy is understood to be both a strategy and a philosophy of teaching. Narrative Pedagogy as a strategy provides an approach using the interpretation of clinical stories to better understand the experience of the patient, the nurse, and the family. Narrative Pedagogy as a philosophy of teaching offers Diekelmann’s Concernful Practices as a way of comportment for teachers and students as they gather in learning and teachers as they incline toward teaching narratively. This hermeneutic phenomenological study examined the experience of Nurse Educators with Narrative Pedagogy. Findings include overarching Pattern: Narrative Pedagogy as Bridge. Two themes are: 1) Students and teachers gathering in learning, and 2) Inclining toward teaching with Narrative Pedagogy. Positive teaching experiences and positive learning experiences with Narrative Pedagogy will advance the science of nursing education by adding to the body of knowledge of alternative pedagogies.

Simulation using computerized patient mannequins may be a useful mechanism to teach safe and effective nursing care, thus improving the quality of education for nurses. As nursing program enrollments grow, clinical placement is becoming more difficult and may not offer consistent learning opportunities that reinforce safe and effective nursing practice. This study applied Ford, Smith, Weissbein, Gully, and Salas’ (1998) model of learning transfer as the theoretical framework to design a simulated obstetric clinical learning experience to augment the current clinical practice model, an approach that may lead to an improved educational experience. The purpose of this study was to compare learning outcomes of two clinical teaching strategies for obstetric clinical content for undergraduate nursing students: standard clinical instruction and a simulation-enhanced clinical experience. A mixed-method approach was used. A randomized cluster design was chosen to compare the learning outcomes for students participating in a simulation-enhanced clinical experience versus students participating in a traditional clinical rotation. From the study population of 124 students, 40 participated in the simulation-enhanced clinical group, with the remainder of students serving as controls. Four instruments (Obstetric Nursing Self-Efficacy instrument, Goal Orientation Scale, Proxy Measure, and examination knowledge items) were used to measure student characteristics or achievement of outcomes. Learning outcomes for self-efficacy, knowledge, skills, and transfer were compared between the groups using ANCOVA, independent sample t-test, iv and chi-square analyses. A qualitative descriptive analysis of clinical evaluations for all students was also conducted. Demographic characteristics between the groups were not statistically different. The analysis of covariance (ANCOVA) revealed no difference in ONSE posttest scores between the groups after adjusting for goal orientation and ONSE pretest scores. An alternative ANCOVA for sequence (time in semester when the simulation occurred) and group was not significant. However, after adjustment for the covariate of ONSE pretest scores, ONSE posttest scores varied with sequencing (p