The importance of critical thinking as an outcome for students graduating from undergraduate nursing programs is well-documented by both the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN). Graduating nurses are expected to apply critical thinking in all practice situations to improve patient health outcomes. Reflective writing is one strategy used to increase understanding and ability to reason and analyze. The lack of empirical evidence regarding the effectiveness of reflective writing interventions on increasing critical thinking skills supports the need for examining reflective writing as a critical thinking strategy. The purpose of this study was to test the effectiveness of a reflective writing intervention, based on Paul’s model of critical thinking, for improving critical thinking skills and dispositions in baccalaureate nursing students during an eight-week clinical rotation. The design for this pilot study was an experimental, pretest-posttest design. The sample was a randomly assigned convenience sample of 70 baccalaureate nursing students in their fourth semester of nursing school at two state-supported universities. All participants were enrolled in an adult-health nursing course and were completing clinical learning experiences in acute care facilities. Both groups completed two critical thinking instruments, the California Critical Thinking Skills Test (CCTST) and the California Critical Thinking Dispositions Inventory (CCTDI), and then the experimental group completed a reflective writing intervention consisting of six writing assignments. Both groups then completed the two tests again. Results showed a significant increase (p=0.03) on only the truthseeking subscale on the CCTDI for the experimental group when compared to the control group. Some other slight differences on subscale scores could be accounted for by the institution, age, ethnicity, and health care experience differences between the control and experimental groups. Strengths of this study included the innovative intervention and the convenient format of intervention administration, completion, and submission. Limitations of the study included institutional differences, the eight-week commitment, and the lack of control of some aspects of the study environment. Evaluation of the qualitative data, replication in a larger sample, inclusion of different levels of students, and alternative design of assignments are all areas for future research.

The purpose of this investigation was to analyze interns’ perceptions of what supervisors considered important supervisory behaviors and to compare those perceptions with what the supervisors considered important. Participants consisted of 33 interns and 23 supervisors. Results of two surveys collected in previous studies were compared and analyzed. Tihen’s (1983) “Tihen’s Student Expectations of their Clinical Supervisor(s) Scale” was used for the intern group. A modified version of the same scale was used for the supervisor group. The scale rated five domains: passive, evaluative, active, cooperative, and affective. Results revealed that interns ranked perceptions of what supervisors considered important supervisory behaviors as less important than what supervisors rated them. Supervisors rated all domains significantly higher than interns. Both groups considered the active domain to be the most important category and the passive domain to be the least important. Groups differed in their rankings for the affective, evaluative, and cooperative domains.

Aim. This investigation aimed to discover if a there is a correlation between a student’s clinical reasoning self-efficacy and a student’s actual clinical reasoning ability. Also, this research sought to discover the connection between an undergraduate nurse’s self-efficacy of clinical reasoning and the locus of control of that student. Finally, this investigation sought to discover if perceived self-efficacy of clinical reasoning changed over time. Background. The ability to successfully navigate the process of clinical reasoning is critical to providing safe, effective care for patients. For nurses, this process begins to develop in nursing school. Unfortunately, evidence suggests that newly graduated nurses struggle to navigate this process successfully, placing patients’ safety in jeopardy. While much research has been dedicated to a student’s clinical reasoning development, little is understood about the variables that impact clinical reasoning development in the student population. Method. Partial correlation was utilized to discover the connection between students’ perceived self-efficacy of clinical reasoning and the students’ actual clinical reasoning ability. Also, a one-way ANOVA, to assess changes over time and reliability assessment of the Nurses’ Clinical Reasoning Scale, was completed. Results. Fifty-two undergraduate nursing students from across 35 states in the United States were included in the sample for this study. Neither a significant relationship between the students’ self-efficacy of clinical reasoning and the students’ actual clinical reasoning ability, nor a significant change over time in perceived self-efficacy scores was detected. Conclusion. By understanding the impact certain factors have on the formation of clinical reasoning ability in students, educators are better equipped to identify those students that might struggle to develop clinical reasoning and intervene in the early stages of development. Additional studies need to be initiated to completely understand the influence these variables have on the development of clinical reasoning.

Acute cystitis (AC) is characterized by a sudden inflammation of the bladder caused by bacteria. The severity of AC ranges from mild to severe and may be recurrent, especially in at-risk populations. Bacteria in the bladder may travel further into the urinary system, causes urinary tract infections (UTI’s) resulting in urosepsis. Hygienic procedures play a large role in decreasing the bacteria that causes AC, so it is important for nursing students to understand and correctly apply the knowledge learned throughout the curriculum. This study focused on the knowledge and understanding nursing students have about AC. To determine this information, a short questionnaire was emailed to nursing students using the Checkbox software. A letter to potential participants included information about the study and consent was obtained when the participant chose to complete the survey. The survey consisted of seven questions on demographic data, AC, sterile versus medical asepsis, and hand hygiene. Frequency tables were used to determine differences in knowledge and understanding of the questions. The results of this study showed that nursing students need to review material on acute cystitis, hand hygiene, and medical versus surgical asepsis. These findings are consistent with literature that has suggested nursing students may need to review information about AC and its related concepts.

Abstract Purpose: An evaluation of the oral chemotherapy patient education process at one ambulatory cancer center identified a deficit in documentation in the electronic medical record (EMR) of many recommendations from the American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) chemotherapy administration and safety standards. Aims: The aim of this quality improvement project is to evaluate the effectiveness of the implementation of two newly developed templates into the EMR at one ambulatory cancer center. Process: The project will evaluate effectiveness by comparing the frequency in documentation of 16 key elements pre and post implementation of the two new EMR templates. These 16 elements are recommended by ASCO/ONS to be included in the documentation of a patient education for oral chemotherapy. This project has been approved by both the East Tennessee State University and Ballad Health IRBs. After EMR system access is granted, there will be two chart reviews of patients newly started on oral chemotherapy. The first review will be prior to template implementation, and the other post implementation. Both reviews will abstract the frequency in documentation of the 16 ASCO/ONS elements using a data abstraction tally tool created by the project investigator. Results: Preliminary evaluation is ongoing. Limitations: This project only includes one cancer center, and therefore includes a small sample size. Conclusion: It is projected that by incorporating these national safety standards into the EMR, this will increase compliance and sustainability in the utilization and documentation of national guideline recommendations. Keywords: Oral chemotherapy, adherence

Nurses make up a significant source of direct care for individuals, families, and communities. The problematic distribution of nurses and the potential to lose practicing nurses emphasizes the importance of retention and support of nursing professionals, especially in rural locations. One of the best ways to discover what is important to nurses is to ask and listen to the replies. The focus for this dissertation is the lived experience of registered nurses in a six-county area in three adjoining states in rural South Central Appalachia. The purpose of this study is to interpret and understand the lived experience of contemporary RN practice in rural Appalachia. The two aims of the study are to 1) understand the lived experience of contemporary nurses in rural Appalachia, and 2) understand the lived experience of nurses as they relate to the place of residence and the place of employment. The chapters include the research proposal and three manuscripts. Chapter 1 contains the background and significance. Chapter 2 is the literature review. Chapter 3 includes sampling and recruitment in rural areas. The findings are discussed in Chapter 4. Chapter 5 contains an integration of all manuscripts, discussion of the contribution to nursing science, direction for future research, and implications for nursing practice. Manuscripts are ready for submission and will be formatted per author guidelines prior to submitting. The first manuscript, “Perceptions of Nursing in Appalachia: A State of the Science Paper,” is a literature review. The manuscript reviews the literature surrounding nurses in Appalachia. It was published in the Journal of Transcultural Nursing in January, 2018 (Brewer, 2018). The second manuscript, “The Lived Experience of Nursing in Appalachia: Sampling and Recruitment,” examines the researcher’s experience with sampling and recruitment. The second manuscript will be submitted to the Online Journal of Rural Nursing and Health Care. The third manuscript, “Living and Working as a Nurse in Appalachia: A Phenomenological Study,” provides findings, implications, and future research. This paper describes findings and identifies themes of the data. The third manuscript is ready for publication to the Journal of Transcultural Nursing. The conclusion presents dissertation summary comments.

Approachability of nursing clinical instructors is largely unknown and misunderstood, yet critical for millennial students which currently comprise 82% of nursing students (National League for Nursing, 2014). Nursing education consists of both a didactic and a clinical component. Clinical education is dynamic and allows the student an experiential learning opportunity. Therefore, clinical nursing educators are vitally important. Approachability has been identified in many studies as a leading characteristic of an effective instructor. Although the importance of approachability of the instructor is established, currently no scale exists to measure this concept. The purpose of this study was to examine the validity and reliability of the newly developed Approachability of Nursing Clinical Instructor (ANCI) scale. Based on the results of this study, the newly developed ANCI scale meets all four aspects of validity (face, content, construct and criterion-related) and reliability is established. The confirmatory analysis indicated a one-factor scale with 56.102 of the variance explained. There are multiple future recommendations for the ANCI scale which include further psychometric testing the new scale, potential theory testing, education and screening of new clinical instructors and expanding the ANCI within nursing and to other disciplines.

Purpose: The purpose of the study was to explore the impact of COVID-19 on undergraduate students’ well-being and the inter-relationships of emotional resilience, physical health, perceived stress, anxiety, quality of life, and perceived social support of undergraduate college students in the Appalachian region during COVID. Aim: The inter-relatedness of the six well-being variables was assessed in a convenience sample (N = 1203) of undergraduate students at an academic institution in the Appalachian region to answer the research question: what is the inter-relationship of undergraduate students’ levels of emotional resilience, physical health, perceived stress, anxiety, quality of life, and perceived social support during the COVID-19 pandemic. Methods: A cross-sectional descriptive design was used to delineate the inter-relationship of areas of well-being. The researcher received approval from the university’s IRB. Participants completed demographic questions, five measurement instruments related to five of the variables, and three physical-health-related items from the Infectious Disease Measurement tool. The survey was published using the online survey platform Qualtrics. SPSS version 28 was used to perform descriptive statistics on the six well-being variable and the correlations between them. A one-way ANOVA test was used to determine the variance between levels of study and between age groups. Results: There were significant statistical differences between participants’ levels of study in the 4-year programs and the following four areas: emotional resilience, perceived stress, quality of life, and perceived social support. Conclusions: This study reveals that students’ emotional resilience and perceived social support are instrumental in promoting students’ mental and physical health.

Nursing students face many stressors throughout their nursing education. These stressors include course assignments, exams, and clinical experiences. At graduation, nursing students face additional stressors due to the requirement of passing the national exam to become licensed as well as finding and starting a job as a graduate nurse. This stress can impact their academic performance, mental health, and the care they deliver to patients. Mindfulness is a way of paying attention to the present moment that can help reduce stress. Nursing students should learn coping skills that they can also use as they transition to practice. This quality improvement project aims to evaluate the implementation of an evidence-based mindfulness-based intervention program to reduce stress in an Undergraduate Nursing Program. Participants will rate their satisfaction with the program, state whether they used exercises for home practice, prefer an in-person or online program, and whether or not the program reduced their stress. Four mindfulness sessions will be recorded and uploaded to YouTube where participants will be able to watch. Once participants have completed the four sessions, they will complete a demographics survey and program evaluation. A foreseeable barrier is participant time and availability. Nursing students are historically busy and may feel they do not have the time to participate in mindfulness.

Purpose: Post-COVID-19 workforce issues have pushed terms like resilience and burnout further into the forefront of professional discourse. Strategies aimed to improve resilience, decrease burnout, and increase retention appear to be less effective in the current climate. One potential unexplored contributor is toxic positivity. The purpose of this research is to analyze the concept of toxic positivity and its relevance to nursing. Aims: Research questions; “1) How is toxic positivity used across contexts?; 2) Whose perspectives are represented and whose are not?; 3) What are the dimensions of toxic positivity?; 4) How are the dimensions related?; and 5) How is toxic positivity constructed and used in nursing? Methods: Using Schatzman’s dimensional analysis approach, the first analytic phase, Identification, elucidates relevant conceptual dimensions. The second analytic phase, Logistics, examines relationships among dimensions and contexts. Finally, a dimensional matrix provides conceptualization of toxic positivity for nursing. Results: Preliminary results reveal roots of toxic positivity in the realm of positive psychology with relevant dimensions including unrealistic optimism, inauthentic platitudes, and emotional invalidation and identified contexts including business, psychology, and medicine with no identified contexts in nursing. Primary limitations include limited time to complete this analysis, lack of empirical evidence regarding toxic positivity, and the potential for other unrealized dimensions or contexts. Conclusions: Results suggest nursing perspectives are missing from the literature about toxic positivity. Identifying toxic positivity as a phenomenon in nursing work environments has potential to inform future research and theoretical work related to nursing workforce burnout, retention, and coping strategies.