Indiana University-Purdue University Indianapolis (IUPUI) / Despite outstanding employment opportunities and high demand to address the global nursing shortage, men who consider becoming nurses are less likely to enroll in and to graduate from nursing programs. Many barriers that men commonly encounter during nursing education have been found in the literature; however, there is a lack of theoretically based research that examines factors that help men succeed as they study nursing. Based on a conceptual model derived from O’Lynn’s construct of male friendliness in nursing education and Frankl’s theory of will to meaning and purpose in life, this study examined facilitators for men during nursing education. This was accomplished through the development and psychometric testing of the Survey of Facilitators for Men (SFM) in a sample of 145 men in nursing. Strong evidence of reliability and validity was provided for the SFM consisting of three subscales (Internal facilitators, External Connections facilitators, and Institutional facilitators). Internal facilitators consist of intrapersonal strengths, experiences, and motivators. External Connections facilitators are interpersonal connections that emerge from relationships that men develop. Institutional facilitators involve structural or organizational aspects of institutions that ease barriers. Testing provided satisfactory evidence of internal consistency (α = .85) and test-retest reliability (intraclass coefficient = .72; confidence interval = 0.57–0.83). Dimensionality of three facilitator subscales was supported by Principle Axis Factoring with Varimax rotation and satisfactory factor loadings (.49–.72). Support for the conceptual model was provided using multiple regressions explaining 17% of the variance in purpose in life [F(4, 140) = 6.99, p < .001], 13% of the variance in GPA [F(6, 114) = 2.88, p < .01], and 49% of the variance in perception of nursing success [F(9, 128) = 13.42, p < .001]. Purpose in life was associated with Internal facilitators and comfortable income, GPA was associated with External Connections facilitators and age at BSN, while perception of nursing success was associated with purpose in life, holding an MSN, having a comfortable income, and having children. Future research is warranted to determine the usefulness of the SFM in designing strategies to recruit and retain men in nursing programs.

Indiana University-Purdue University Indianapolis (IUPUI) / Clinical nursing faculty members often work with students who underperform in the clinical area. Underperforming students are those who exhibit deficits in nursing knowledge, the application of nursing knowledge, psychomotor skills, motivation, and/or interpersonal skills. The outcomes of faculty work with underperforming students have implications for patient safety and the nursing workforce, yet little is known about how faculty work with underperforming students. The purpose of this project was to develop a theoretical framework that describes how clinical faculty work with underperforming students in the clinical area. Twenty-eight nursing faculty who had worked with underperforming nursing students during clinical rotations were interviewed and invited to tell stories about working with these students. Their narratives were analyzed using constant comparison analysis, and a theoretical framework was developed. The framework included three stages that unfolded as faculty worked with underperforming students over time. The first stage, Being Present, was the process by which faculty came to know students were underperforming. They did this by noticing red flags, taking extra time with students, working side-by-side with students, and connecting with students "where they were at." The second stage, Setting a New Course, was the process by which faculty attempted to provide remedial experiences to improve the performance of those students determined to be underperforming. The participants did this by beginning a new course of instruction for the students, bringing in new people to help the students, and creating new learning experiences for them. This process could result in students turning it [their performance] around, making it through [the clinical rotation], or not making it. The final stage, Being Objective, was the process by which participants made negative progression decisions. They did this by relying on objective indices, documenting problematic student behaviors, and obtaining validation for their decisions.

Indiana University-Purdue University Indianapolis (IUPUI) / Educating a sufficient nursing workforce to provide high quality, compassionate, and ethical care to an increasingly diverse population is an ongoing challenge and opportunity for nurse educators. Current literature highlights the importance of engaging students in learning to strengthen student achievements. Fostering student engagement within nursing courses is particularly important. Grit (consistency of interest and perseverance of effort) is a factor that may be associated with student course engagement. Demographic characteristics of age, gender, race/ethnicity, prior education, degree program, and self-reported grade point average (GPA) also may be factors associated with student course engagement. Guided by a conceptual model derived from the literature, the purpose of this study was to determine whether grit and demographic characteristics were associated with student course engagement (skills, emotion, participation/interaction, and performance) within a nursing course. Using an exploratory, descriptive, cross-sectional design, a convenience sample of 97 nursing students in a didactic health assessment course was administered the Student Course Engagement Questionnaire (SCEQ), visual analog scales for student engagement, Grit-S Scale, and a Student Demographic Characteristics form. Using multiple regression, 22% of the variance (21% Adjusted) of total student engagement (SCEQ) was explained by total grit scores (Grit-S) F(1,95) = 26.54, p<.001. Further analyses of student engagement were conducted using the SCEQ subscales and visual analog scales with similar results. Findings provided support for the conceptual model used to guide the study, although replication of the study was recommended across varied learning environments. Findings warrant further study regarding grit as a potential area for the future development of strategies to foster engagement of nursing students in the classroom.

Background: The experience of stress and anxiety in nursing students can reach a high level because of fear of making an error or causing fatal harm to a patient. Unmitigated stress and anxiety can hinder learning and the performance of psychomotor skills in the clinical setting, eventually affecting patient care.Aim: This study aimed to examine anxiety, stress, self-efficacy for nursing clinical skills, and self-efficacy for therapeutic communication in undergraduate nursing students who were randomized to either an intervention with a standardized patient or the comparison group who participated in role play. Method: An experimental study with randomization was conducted with prelicensure nursing students (N = 87) recruited from associate and bachelor’s degree nursing programs in the Finger Lakes region of New York State, using the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), Clinical Skills Self-Efficacy Scale (CSES), and Self-Efficacy in Therapeutic Communication (SETC). Data collection occurred at preintervention, postintervention, and at follow-up, approximately 2 weeks after the intervention. Results: The first report describes the development of the Self-Efficacy for Therapeutic Communication Scale (SETC) developed by the principal investigator and used in this study. Exploratory factor analyses with a Varimax rotation of the 15 items yielded two factors accounting for 51.3% of the variance. Two subscales were formed by summing the items loading above .4 on each factor. The first subscale was Communication Techniques, which included 9 items and had a Cronbach’s alpha of .91 The second subscale was Intuitive Practices with 6 items and a Cronbach’s alpha of .79. The correlation between the two subscales was r = .67 (p < .001). Test-retest reliability for the scale from pre- to posttest was .68, pre- to follow-up was .41, and posttest to follow-up was .68. In the second report, Pearson’s r was used to determine that state anxiety, trait anxiety, and stress were highly correlated with each other, with a range of correlations, r = .53 to .91, p < .001. Inverse contemporaneous correlations were found for trait anxiety and for stress with self-efficacy for clinical skills at all time points, whereas state anxiety was inversely related to self-efficacy for clinical skills at posttest and follow-up. Inverse correlations for self-efficacy for therapeutic communication were statistically significant with state anxiety, trait anxiety, and stress, but only at posttest. In the third report, mixed Analysis of Variances (ANOVAs) determined that there was a statistically significant interaction between time and group on state anxiety scores, F(2, 170) = 3.551, p = .031, η2 = .040. Simple main effects analyses showed that the intervention and comparison group means did not differ at any of the three testing times. Paired samples t tests indicated that the scores on anxiety in the intervention group did not show any statistically significant change over time, whereas anxiety in the comparison group was significantly higher at follow-up than at any other time. Mixed ANOVAs showed no interaction between time and groups for self-efficacy for clinical skills or for self-efficacy for therapeutic communication. Results indicated that the intervention and comparison group means on self-efficacy for clinical skills and self-efficacy for therapeutic communication improved over time. Both intervention and comparison groups reported increased self-efficacy in clinical skills and therapeutic communication at follow-up data collection. In addition, two separate mixed ANOVAs were performed to determine if stress had a moderating effect on the intervention. Students in the high stress group (PSS greater than 18), did not experience a change in anxiety over time, while the comparison group of participants with low stress (scores less than or equal to 18), had significant changes in anxiety from pretest to follow-up and posttest to follow-up, while the intervention group did not. Conclusion: Stress and anxiety can have detrimental effects on nursing students’ self-efficacy for clinical skills and self-efficacy for therapeutic communication. Prioritizing and mitigating the effects of stress and anxiety to improve self-efficacy in nursing students is one way of preparing nursing students for competency-based education, as outlined in the American Association of Colleges of Nurses, The Essentials: Core Competencies for Professional Nursing Education. Throughout the Domains of The Essentials, therapeutic communication is found in 13 competencies, indicating that this once considered soft skill, is a critical skill required for safe patient care. Teaching methods that include interactions with standardized patients and managing difficult conversations can be helpful for the nursing student to experience in pre-clinical preparation. Keywords: Anxiety, self-efficacy, standardized patients, therapeutic communication, clinical nursing skills

Indiana University-Purdue University Indianapolis (IUPUI) / Nursing education is faced with addressing the challenge of educational reform as a result of the rapid changes in the complexity of health care delivery systems, increased technology and biomedical knowledge, a shortage in nursing faculty, and increased enrollment in schools of nursing. Although national nursing organizations have called for reform and innovation in nursing education little is known about the factors that are related to educators’ adoption of such changes. The purpose of this descriptive, exploratory, correlational, survey study was to explore the adoption of socioculturally-based teaching strategies (SCBTS) by examining the following variables in relation to their adoption using Everett Rogers’ diffusion of innovations model: (a) clinical nurse educators’ perceived characteristics of SCBTS, (b) clinical nurse educators’ perceived organizational support for innovation, and (c) selected demographic characteristics. Minimal research has been conducted regarding the factors related to clinical nurse educators’ adoption of SCBTS, which may better prepare nurse graduates for today’s health care system. Findings from this study suggest that adoption is not straightforward, but the perceived characteristics of teaching strategies play an important role in the clinical nurse educator’s decision to adopt or not adopt SCBTS. Rogers’ model was partially supported based on the findings that clinical nurse educators were more likely to adopt a teaching strategy if it was perceived to be advantageous, compatible, and not too complex. On the other hand, clinical nurse educators were more likely not to adopt teaching strategies that they must “try out” or that must be observable by others, which was not supportive of Rogers’ model. Adopters of SCBTS were more experienced clinical educators who felt supported by their academic organizations in terms of innovation; however organizational support for innovations was not associated with adoption of the teaching strategies. Holding a certificate in a nursing specialty, the type of program in which the educator taught, and the age of the educator were not associated with the adoption of SCBTS. Future research using Rogers’ model or other appropriate models is called for to further explore the adoption of SCBTS by clinical nurse educators.

Indiana University-Purdue University Indianapolis (IUPUI) / Founded in 1876 by a small group of young women who resolved to deliver bouquets to patients in the City Hospital, the Indianapolis Flower Mission quickly grew to become one of the most respected philanthropic organizations in the city. During its almost one hundred and twenty year history, the Indianapolis Flower Mission created lasting institutions such as a nurses’ training school, a visiting nurse program, and two hospitals. While historians may be tempted to dismiss flower missions like the one in Indianapolis as naïve or sentimental groups, closer inspection reveals they were much more. My main argument is that though the work of the Indianapolis Flower Mission may at first glance appear trite, it was actually practical and life-saving and deserves serious consideration from historians. First, delivering flowers to the sick and poor had value, especially when we understand how people at the time thought about flowers and what emphasis people placed on spiritual as well as physical health. Second, the Indianapolis Flower Mission quickly transitioned away from simply delivering flowers into work like providing healthcare to the poor. Third, the Indianapolis Flower Mission provided women a respectable way to work outside their homes and gain experience in philanthropic, business, and political activity. Finally, the Indianapolis Flower Mission provides a specific case study that sheds light on other flower missions around the nation and the world.

Text in English / The current changes in health care systems challenges knowledgeable, mature and independent practitioners to be able to integrate theoretical content with practice. The study aims to investigate the problems of integrating theory with practice in selected clinical nursing situations. The study focused on the rendering of family planning services to clients which is a component of Community Nursing Science. The findings of the study reveal that there is a need for an integrated holistic curriculum which will address the needs of the community. It was concluded that a problem-based and community-based curriculum, safe and patient-friendly clinical environments, intersectoral collaboration between college and hospital management and student involvement in all processes of teaching and learning will improve the integration of theory and practice. There also appears to be a need for tutors to be more involved in clinical teaching, accompaniment and the continuous evaluation of students. / Health Studies / M.A. (Nursing Science)

Text in English / In Swaziland, family nurse practitioners (FNPs) are professional nurses who have undergone preparation as general nurse, midwife and FNP. These nurses play an important role in the delivery of primary health care (PHC). Family nurse practice is an evolving concept introduced in Swaziland in 1979. It is a means of exploring nursing roles and primary health care services for deployment in under-served areas and to enable nurses to serve as the primary providers of health care services in clinics, health centres and in the outpatient departments of hospitals. Changing responsibilities within the health care setting require different skills and more knowledge. The expansion and extension of the nurses' role, including the techniques of diagnosing and treating, was a priority of the Ministry of Health and Social Welfare (MOH&SW) in Swaziland's five-year development plan for 1978-1983. It was regarded as a necessary component for raising the quality and effectiveness of PHC services. Some of the major and urgent challenges that confront FNPs today are the advent of the human immune virus/acquired immuno-deficiency syndrome (HIV/AIDS) scourge and the re-emergence of the tuberculosis epidemic. Both these health problems require proficient diagnosis and case management skills as well as new approaches. If FNPs are to remain relevant and to continue to provide quality services in spite of prevailing challenges, they have to engage in continuing education (CE). The main aim of this study was to investigate the perceptions of the FNP role, CE needs and issues relevant to the current practice of FNPs in Swaziland. A further aim was to establish a structure or framework for a CE programme that would contribute to the strengthening of CE for FNPs and identify enabling factors and barriers in the practice and education ofFNPs. Both quantitative and qualitative research methods were used for data collection. A survey was conducted to collect data from 5 7 FNPs and 11 nurse managers and nurse educators. The transcript from the questionnaires was subjected to quantitative-based content analysis. A total of thirty nurse managers, nurse educators and MOH&SW nurse executives participated in the focus group interviews. The collected data was subjected to qualitativebased content analysis. The findings identified the role of the FNP as manager, clinical practitioner, educator and researcher. The analyses highlighted the CE needs of FNPs, and the question of updating and upgrading the skills of practising FNPs. The identified enabling factors and barriers, although perceived as issues that are peripheral and auxiliary to the curriculum, appeared to have a strong bearing on programme planning. The findings from this study have implications for a structured CE programme for FNPs at the University of Swaziland. / Health Studies / D. Litt et Phil. (Nursing Sciences)

Text in English / The current changes in health care systems challenges knowledgeable, mature and independent practitioners to be able to integrate theoretical content with practice. The study aims to investigate the problems of integrating theory with practice in selected clinical nursing situations. The study focused on the rendering of family planning services to clients which is a component of Community Nursing Science. The findings of the study reveal that there is a need for an integrated holistic curriculum which will address the needs of the community. It was concluded that a problem-based and community-based curriculum, safe and patient-friendly clinical environments, intersectoral collaboration between college and hospital management and student involvement in all processes of teaching and learning will improve the integration of theory and practice. There also appears to be a need for tutors to be more involved in clinical teaching, accompaniment and the continuous evaluation of students. / Health Studies / M.A. (Nursing Science)

Text in English / In Swaziland, family nurse practitioners (FNPs) are professional nurses who have undergone preparation as general nurse, midwife and FNP. These nurses play an important role in the delivery of primary health care (PHC). Family nurse practice is an evolving concept introduced in Swaziland in 1979. It is a means of exploring nursing roles and primary health care services for deployment in under-served areas and to enable nurses to serve as the primary providers of health care services in clinics, health centres and in the outpatient departments of hospitals. Changing responsibilities within the health care setting require different skills and more knowledge. The expansion and extension of the nurses' role, including the techniques of diagnosing and treating, was a priority of the Ministry of Health and Social Welfare (MOH&SW) in Swaziland's five-year development plan for 1978-1983. It was regarded as a necessary component for raising the quality and effectiveness of PHC services. Some of the major and urgent challenges that confront FNPs today are the advent of the human immune virus/acquired immuno-deficiency syndrome (HIV/AIDS) scourge and the re-emergence of the tuberculosis epidemic. Both these health problems require proficient diagnosis and case management skills as well as new approaches. If FNPs are to remain relevant and to continue to provide quality services in spite of prevailing challenges, they have to engage in continuing education (CE). The main aim of this study was to investigate the perceptions of the FNP role, CE needs and issues relevant to the current practice of FNPs in Swaziland. A further aim was to establish a structure or framework for a CE programme that would contribute to the strengthening of CE for FNPs and identify enabling factors and barriers in the practice and education ofFNPs. Both quantitative and qualitative research methods were used for data collection. A survey was conducted to collect data from 5 7 FNPs and 11 nurse managers and nurse educators. The transcript from the questionnaires was subjected to quantitative-based content analysis. A total of thirty nurse managers, nurse educators and MOH&SW nurse executives participated in the focus group interviews. The collected data was subjected to qualitativebased content analysis. The findings identified the role of the FNP as manager, clinical practitioner, educator and researcher. The analyses highlighted the CE needs of FNPs, and the question of updating and upgrading the skills of practising FNPs. The identified enabling factors and barriers, although perceived as issues that are peripheral and auxiliary to the curriculum, appeared to have a strong bearing on programme planning. The findings from this study have implications for a structured CE programme for FNPs at the University of Swaziland. / Health Studies / D. Litt et Phil. (Nursing Sciences)