Indiana University-Purdue University Indianapolis (IUPUI) / It is unknown whether timing of human patient simulation (HPS) in a semester, demographic (age, gender, and ethnicity), and situational (type of program and previous baccalaureate degree and experience in healthcare) variables affects students’ perceptions of their clinical reasoning abilities. Nursing students were divided into two groups, mid and end of semester HPS experiences. Students’ perceptions of clinical reasoning abilities were measured at Baseline (beginning of semester) and Time 2 (end of semester), along with demographic and situational variables. Dependent variable was Difference scores where Baseline scores were subtracted from Time 2 scores to reveal changes in students’ perceptions of clinical reasoning. Students who were older and had previous healthcare experience had higher scores, as well as students in the AS program, indicating larger changes in students’ perceptions of clinical reasoning abilities from Baseline to Time 2. Timing of HPS, mid or end of semester, had no effect on Difference scores, and thus students’ perceptions of clinical reasoning abilities.

The critical shortage of competent nurses, disillusionment, and high attrition rate among graduates entering the workforce provided the impetus for this investigation. The purpose of this study was to determine the perceived level of empowerment among graduating nursing students of two basic nursing educational programs and the relationship of empowerment to selected variables. The selected variables were self-directed learning readiness, self-esteem, level in the program, and demographics. In addition, predictors of empowerment were investigated. A sample of 294 nursing students of associate and baccalaureate degree programs from five schools of nursing in the Mid-Atlantic region participated in the study. Instruments used were the Vincenz Empowerment Scale, Self- Directed Learning Readiness Scale, and Self-Esteem Inventory and a data sheet for demographics. The survey was completed from June to September 1994. Nursing students in general perceived themselves to have fairly high levels of empowerment, self-directed learning readiness, and self-esteem which was significantly higher for graduating students as compared to freshman students. There were no significant differences among the variables under study between baccalaureate and associate degree students or the type of institution they represented as private or public. Similarly, there were no differences in their perceived levels of empowerment, self-directed learning readiness, or self-esteem based on gender, racial/ethnic background, or affiliation with Student Nurses' Association. The wide variation in age and educational background ranging from high school to graduate degrees were associated with the participants' levels of self-directed learning readiness and self-esteem. In addition, participants who were involved in community organizations reported higher levels of empowerment. Regression analysis indicated self-directed learning readiness and self-esteem contributed significantly to the variance in empowerment. The findings add to the empowerment literature. Implications for nursing education include: (a) enhancing students' level of self-directed learning readiness and self-esteem may assist in empowering them, and (b) the basic educational process plays a significant role in nursing students' perceived levels of empowerment. / Ed. D.

The growing diversity of the United States (US) population demands an equally diverse nursing workforce to meet its healthcare needs effectively. It is a priority to assist students who are English Speakers of Other Languages (ESOL) to succeed, not just to take care of ESOL and non-English-speaking clients but to add to the nursing workforce. ESOL nursing and client language barriers in healthcare are challenging, but one leading solution is to help ESOL nursing students succeed. For all nursing students to succeed, they must pass the National Council Licensure Examination - Registered Nurse (NCLEX-RN), a multiple-choice high-stakes assessment offered only in English. The problem: ESOL nursing students, who are otherwise knowledgeable, often do poorly on such tests. The NCLEX-RN can be difficult for ESOL nursing students since their lack of proficiency in American English slows their ability to interpret words and phrases in written format. This hinders the student’s ability to understand the relevancy of the words and how the words combine to produce meaningful scenarios and discourse. If test writers removed slang and words with multiple meanings, ESOL nursing students might have greater success on high-stakes examinations, such as the NCLEX-RN. To find appropriate linguistically challenging questions, a search panel comprised of volunteering ESOL Associate Degree in Nursing graduates assembled relevant, challenging multiple-choice questions from high-stakes examination test banks. Each linguistically challenging question was categorized as containing idioms, unclear or unnecessary wording, or slang/difficult American English words. The researcher created a linguistically modified version by removing or replacing the problematic language identified by the search panel. An examination evaluation committee of experienced nursing instructors examined the linguistically modified questions to ensure that the true nursing clinical intention of the question had not been altered. This study used a convenience sample of ADN nursing students (N=169) who had completed Fundamentals of Nursing and Medical/Surgical Nursing 1. The research control group (n=85) received unmodified questions, whereas the experimental group (n=84) received linguistically modified questions. Examinations were distributed by alternating control and experimental examinations to each student. This dissertation presents three reports on the results of removing linguistic complexity from examination questions. The first report presented in Chapter 2 examines the question, "Does ESOL nursing students' performance on linguistically modified examinations differ from performance on unmodified examinations?" This report examined the differences in scores achieved on the experimental versus the control versions of the examination. Nursing students performed statistically better in the experimental group (M = 79.9, SD 7.48) than in the control group (M = 75.08, SD 10.51), t(151.8) = 2.973, p = .003. The second report, presented in Chapter 3, assesses if specific forms of American English adversely affect the performance of low-acculturated nursing students. This chapter presents an attempt to identify the possible effects of idioms, slang, or difficult vocabulary on the success of nursing students in high-stakes nursing examinations. Furthermore, this chapter compares which form of American English, idioms, slang, or difficult vocabulary is more difficult for low-acculturated nursing students. A mixed ANOVA using control versus experimental tests as the between variable and item category as the within variable showed that the group by item type interaction was nonsignificant (F (2, 56) = .016, p = .984), indicating that idioms, slang, and difficult vocabulary do not differ in the likelihood of leading students to select incorrect answers. The third report, in Chapter 4, presents an investigation of the effect of linguistic bias on ESOL nursing students' success. Chapter 4 presents analyses of pass rates on the unmodified examinations achieved by high-acculturated and low-acculturated nursing students. Chapter 4 also presents an examination of the impact of language acculturation on the pass rates on linguistically modified and unmodified nursing examinations based on modified NCLEX-style questions that remove linguistic biases. This chapter presents an investigation of whether low acculturated nursing students who take the linguistically modified nursing examination achieve higher pass rates than those who take the unmodified examination. Based on the results of the chi-square analysis, 35 (81.4%) of the 43 students in the low acculturation group received a passing grade on the modified (experimental) examination, compared to 12 (30.8%) of 39 students in this group passing the unmodified (control) examination. This difference was statistically significant, χ2(1) = 21.42, p = <.001. Results also showed that there is a relationship between high-stakes nursing examination questions containing idioms, slang, and unnecessary words and ESOL nursing student success. The study supported the impact of substituting idioms, slang, and unnecessary vocabulary with more standard English terms on students’ success on multiple choice high-stakes examinations. Although the results do not indicate that ESOL nursing students are more severely or directly affected by specific forms of American English, it does show that identifying these linguistic obstacles may help provide valuable information that may guide creators of high-stakes examinations in designing more bias-free examinations to assist ESOL nursing students succeed and enter the workforce.

Nurse educators are faced with many challenges while preparing students to safely enter clinical practice. Due to technological advances in the health care field and student demographic changes, educators have been looking for alternative methods to traditional lecture format to meet the needs of current learners. Using the framework of Adult Learning Theory, this quasi-experimental two-group, repeated measures study explored the use of gaming in the classroom on cognitive performance, course engagement, and metamotivational state in undergraduate nursing students. The study was conducted with a convenience sample of 63 nursing students enrolled in a nursing pharmacology course during the second year of the nursing curriculum. The intervention consisted of three sessions of Kahoot! “Teach with Slides” lasting approximately 60 minutes to reinforce course content each week during scheduled class sessions. Instruments to measure outcomes included: (a) Student Course Engagement Questionnaire (SCEQ), (b) Telic/Paratelic State Inventory (T/PSI), and (c) module examination developed by faculty. The English Language Acculturation Scale (ELAS) was used to measure study participants’ use of English providing insight to the effect of gaming on students with varied levels of English acculturation. The sample exhibited a wide range of ELAS scores, 5-25 (M = 19.95; SD = 7.32), indicating students in both groups had varying English language acculturation levels. An independent sample t test showed no significant difference between intervention and control groups, t(54) = 1.093, p = .140. The first study used a quasi-experimental two-group, pretest-posttest design to assess cognitive performance and course engagement. An independent samples t test showed a statistically significant difference in cognitive performance between groups, t(61) = 2.160, p = .035. English Language Acculturation was a statistically significant predictor of cognitive performance; however, there was no difference between intervention and control groups in language acculturation. There was no statistically significant interaction between group and time of testing for course engagement scores between groups over time. There was no correlation between cognitive performance and course engagement, r(34) = .102, p = .565. The second study employed a quasi-experimental two-group, repeated measures design to assess the metamotivational states of students along with the relationship of metamotivational state to cognitive performance and course engagement. Chi-square analyses of metamotivational states between groups revealed no statistical difference between intervention and control groups. A two-way ANOVA revealed a statistically significant interaction between gaming and metamotivational state, F(1,30) = 4.603, p = .041. Paratelic students in the intervention group had statistically significantly higher course engagement, t(18) = -3.06, p = .007. The study findings indicate that gaming is a comparable activity to non-gaming active teaching strategies such as group discussion and case studies. There was an increase in course engagement for those in the paratelic state of the intervention group indicating that those who are playful can be engaged in the classroom. The results of this study indicate that Kahoot! is a gaming activity that can be used in nursing education to increase cognitive performance. Further research is needed to explore other student learning outcomes.

Simulation in nursing education involves an instructor observing students performing a specific task using an anatomical model, standardized patients, or high-fidelity simulation using a simulator. This education method allows creation of realistic clinical scenarios to allow nurses to perform tasks in a safe learning environment. However, accurate performance in the simulation lab must be replicated in the clinical environment to impact patient outcomes. Chapter 2 is a systematic literature review resulting in 21 articles addressing dependent variables, conceptual frameworks, study designs and outcomes measured in new nurses. Knowledge, simulation satisfaction, confidence, and clinical performance were common simulation outcomes studied. Only 7 research articles reported using a theoretical framework. Even though most of the studies used self-reported measures to demonstrate improvement in the studied variables after simulation, none of the studies used objective observation in the actual clinical setting after simulation. Assessing performance in the actual clinical environment after simulation is an opportunity to link simulation education to patient outcomes. Researchers should explore if learned skills in simulation are transferred to the real clinical setting resulting in safe and competent care. This gap in the literature was the impetus for the study described in Chapter 3. Chapter 3 focuses on a quasi-experimental study on new nurses hired at an oncology institution to determine if skills learned in the simulation lab transferred to the clinical setting. The study’s aim addressed if a difference exists in clinical observation scores between the intervention group (involved in simulation) and control group (not involved in simulation) when performing a central line dressing change. Fifty-six participants were consented with 19 nurses completing all data collection points. No significant differences were identified between groups. Chapter 4 is a narrative account applying the concept of resilience to the doctoral dissertation experience during a pandemic. Using Richardson’s Resiliency Model, the challenges of performing research on staff development during a pandemic are presented. The presence of a stressor (pandemic) and the resulting stages of disruption and reintegration are described resulting in resilient reintegration during the doctoral research process. Simulation is an educational methodology in academia and staff development. However, outcomes such as confidence, knowledge and simulation satisfaction are over-studied and there is a need for studies to focus on if skills performed during simulation are replicated accurately in the clinical setting. In addition, simulations should be designed to ensure they are addressing the identified construct (e.g. clinical judgement). In addition, the logistics involved in observing practice at the point of care is challenging due to unpredictable factors such as staffing, patient acuity, and operational decisions that may impact study design present unique challenges. Keywords: Simulation, new nurses, resilience

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

This qualitative study was aimed at exploring and describing the theoretical and practical experiences of second-year critical care nursing students. Purposive sampling was done, and unstructured interviews and narrative descriptions were used as data collection tools. An adaptation of Johns's Framework, the Guideline for the Facilitation of Reflection as Teaching Strategy, was used during interviews to guide participants in reflecting on theory-practice integration. Multiple strategies were used to ensure the trustworthiness of the study. Concerning patient data, communication, and the administration of life-saving medications, theory-practice integration did occur. Regarding treatment and the outcome of nursing interventions, it seemed that knowledge deficiencies and a lack of exposure to practical situations contributed to the inability to apply theory to practice. This apparent inability evoked negative feelings, such as guilt. Discrepancies between practice and theory taught led to confusion. Guided reflection assisted students in gaining a new perspective on nursing and theory-practice integration. / Health Studies / M.A. (Health Studies)

The purpose of this quantitative, descriptive study was to describe how registered nurses utilise teachable moments to enhance students' learning in the clinical setting. The research questions were: What are the problems faced by registered nurses when they teach students in the clinical setting? and How do registered nurses utilise teachable moments to teach students? A pilot study was conducted in the clinical setting involving the respondents who had similar characteristics than the population. The sample consisted of 45 registered nurses who provided direct patient care in the clinical setting. A self­ administered, structured questionnaire was used to collect data. Data analysis was done by using descriptive statistical tests. The findings brought to light strengths and weaknesses with regard to the utilisation of teachable moments by registered nurses, and problems faced by registered nurses with regard to clinical accompaniment in general. Recommendations to improve clinical accompaniment by registered nurses through effective utilisation of teachable moments were made. Further research was recommended to explore some problematic areas that emerged from this study. / Health Studies / M.A. (Nursing Science)

A quantative descriptive study was used to describe the factors that influence the output in the four (4) year nurse training programme. Data was collected by using a self administered questionnaire to 73 participants sampled by stratified random sampling in the Southern Campus of Free State School of Nursing in the Free State Province. Data was analysed by using SPSS computer version 15. The findings of this study revealed that there were difficult subjects like Fundamental Nursing Science, General Nursing Science, Basic Nursing Science, Psychiatric Nursing Science and Midwifery. These were identified per year level of study. The study revealed that difficulty experienced by students resulted in them failing the indicated subjects. Recommendations were made as to how to address the identified factors especially those regarding subjects that were failed in each level, different teaching strategies that could be used to improve the throughput. / M. A. (Health Studies) / Health Studies