Search results for: clinical nursing

Authors: Kristen Erekson, Sarah Spendlove Caswell

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Nurse educators have the challenge of training future nurses that will provide compassionate care to an increasingly diverse population of patients in a culturally sensitive way. One approach to this challenge is an immersive public and global health experience as part of the nursing program curriculum. Undergraduate nursing students at our institution are required to participate in a Public and Global Health course. They participate in a didactic preparatory course followed by a 3-to-4-week program in one of the following locations: The Czech Republic, Ecuador, Finland/Poland, Ghana, India, Spain, Taiwan, Tonga, an Honor Flight to Washington D.C. with Veterans, or in local (Utah) communities working with marginalized populations (including incarcerated individuals, refugees, etc.). The students are required to complete 84 clinical hours and 84 culture hours (which involve exposure to local history, art, architecture, customs, etc.). As Faculty, we feel strongly that these public and global health experiences help cultivate cultural awareness in our students and prepare nurses who are better prepared to serve a diverse population of patients throughout their careers. This presentation will highlight our experiences and provide ideas for other nurse educators who have an interest in developing similar programs in their schools but do not know where to start. Suggestions about how to start building relationships that can lead to these opportunities, along with logistics for continuing the programs, will be highlighted.

Keywords: global health nursing, nursing education, clinical education, public health nursing

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Authors: Nasir Mustafa

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One of the prerequisites required for an efficient diagnosis in a medical practice is to have a strong command of both functional and clinical anatomy. In this study, we introduce a new collaborative approach to the effective teaching of the knee and hip joints. In the present teaching model, anatomists, orthopedists and physical therapists present the anatomy of the hip and knee joints in small groups. Courses for the hip and knee joints were scheduled during the early stages of the medical curriculum. Students of nursing and physical therapy were grouped together to sensitize to the importance of a collaborative effort. The study results clearly demonstrate that nursing students and physical therapy students appreciated this teaching approach. The collaborative approach further proved to be a suitable method to teach both functional and clinical anatomy of the hip and knee joints. Aside from this training, a collaborative approach between medical students and physical therapy students was also successful for a healthcare organization.

Keywords: hip and knee joint anatomy, collaborative, Anatomy teaching, Nursing students, Physiotherapy students

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Authors: Z. Karakus, Z. Ozer

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Nurses are responsible for the care and treatment of individuals, as well as health maintenance and education. Medication administration is an important part of health promotion. The administration of a medicine is a common but important clinical procedure for nurses because of its complex structure. Therefore, medication errors are inevitable for nurses or nursing students. Medication errors can cause ineffective treatment, patient’s prolonged hospital stay, disablement, or death. Additionally, medication errors affect the global economy adversely by increasing health costs. Hence, preventing or decreasing of medication errors is a critical and essential issue in nursing. Nurse educators are in pursuit of new teaching methods to teach students significance of medication application. In the light of technological developments of this age, e-learning has started to be accepted as an important teaching method. E-learning is the use of electronic media and information and communication technologies in education. It has advantages such as flexibility of time and place, lower costs, faster delivery, and lower environmental impact. Students can make their own schedule and decide the learning method. This study is conducted to determine the impact of e-learning on medication administration of nursing students.

Keywords: e-learning, medication administration, nursing, nursing students

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Authors: Paveenapat Nithitantiwat, Kwanjai Pataipakaipet

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The purpose of this research was to study the happiness level of nursing students, Boromarajonani College of nursing, Ratchaburi, Thailand. A purposive sampling of 652 first to four-year nursing students was used. This research is descriptive research. The instruments were questionnaires that developed by the researcher. It included the demographic data and nursing student’s perception about healthcare, safety, life security, family, proud of oneself, education and activities, dormitories and environment in college, and how to improve their happiness. Frequencies, percentage, mean, and T-test is used to analysis the data. The results of the research have shown that family and moral value was an important thing in nursing student’s life. In addition, the mean of the happiness level was a high level. The first year nursing students had the higher mean score of the happiness level than the fourth year, second year, and the third year, respectively. Therefore, nursing students would realize that the important things in their life are family and Buddhism’s teaching. In addition, dharma is guideline how to be both academic achievements and successful in life.

Keywords: happiness, nursing students, nursing students’ perceptions, bachelor program

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Authors: K. Rowan

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In this paper, the author will discuss how developing a specialized orientation has improved nursing satisfaction and decrease the incidence of incivility among staff. With the predicted shortages in nursing, we must provide an environment that reflects the needs of the current workforce while also focusing on the sustainability of nursing. Each generation has different qualities and methods in which he or she prefers to learn. The Baby Boomer has a desire to share their knowledge. They feel that the quality of undergraduate nursing education has declined. Millennials have grown up with 'helicopter parents' and expect the preceptor to behave in the same manner. This information must be shared with the Baby Boomer, as it is these staff members who are passing the torch of perioperative nursing. Currently, nurse fellows are trained with the Association of periOperative Nurse’s Periop 101 program, with a didactic and clinical observation program. There is no specialized perioperative preceptor program. In creation of a preceptor program, the concept of Novice to Expert, communication techniques, dealing with horizontal violence and generational gap education is reviewed with the preceptor. The fellows are taught communication and de-escalation skills, and generational gaps information. The groups are then brought together for introductions and teamwork exercises. At the program’s core is the knowledge of generational differences. The preceptor training has increased preceptor satisfaction, as well as the new nurse fellows. The creation of a specialized education program has significantly decreased incivility amongst our nurses, all while increasing nursing satisfaction and improving nursing retention. This model of program can translate to all nursing specialties and assist in overcoming the impending shortage.

Keywords: baby boomers, education, generational gap, millennials, nursing, perioperative

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Authors: Wadsana Sarakarn, Pimonpan Charoensri, Baliya Chaiyara

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Objectives: To study the outcomes of the developed nursing model to prevent early postpartum hemorrhage (PPH). Materials and Methods: The analytical study was conducted in Sunpasitthiprasong Hospital during October 1st, 2015, until May 31st, 2017. After review the prevalence, risk factors, and outcomes of postpartum hemorrhage of the parturient who gave birth in Sunpasitthiprasong Hospital, the nursing model was developed under research regulation of Kemmis&McTaggart using 4 steps of operating procedures: 1) analyzing problem situation and gathering 2) creating the plan 3) noticing and performing 4) reflecting the result of the operation. The nursing model consisted of the screening tools for risk factors associated with PPH, the clinical nursing practice guideline (CNPG), and the collecting bag for measuring postpartum blood loss. Primary outcome was early postpartum hemorrhage. Secondary outcomes were postpartum hysterectomy, maternal mortality, personnel’s practice, knowledge, and satisfaction of the nursing model. The data were analyzed by using content analysis for qualitative data and descriptive statistics for quantitative data. Results: Before using the nursing model, the prevalence of early postpartum hemorrhage was under estimated (2.97%). There were 5 cases of postpartum hysterectomy and 2 cases of maternal death due to postpartum hemorrhage. During the study period, there was 22.7% prevalence of postpartum hemorrhage among 220 pregnant women who were vaginally delivered at Sunpasitthiprasong Hospital. No maternal death or postpartum hysterectomy was reported after using the nursing model. Among 16 registered nurses at the delivery room who evaluated using of the nursing model, they reported the high level of practice, knowledge, and satisfaction Conclusion: The nursing model for the prevention of early PPH is effective to decrease early PPH and other serious complications.

Keywords: the development of a nursing model, prevention of postpartum hemorrhage, pregnant women, postpartum hemorrhage

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Authors: E. Maoz

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Background: As a teaching method, project-based learning is strongly linked to developing students’ critical thinking skills. It combines creative independent thinking, team work, and disciplinary subject-field integration. In the 'Introduction to Nursing Research Methods' course (year 3, Generic Track), project based learning is used to teach the topic of 'Evidence-Based Nursing'. This topic examines a clinical care issue encountered by students in the field. At the end of their project, students present proposals for managing the said issue. Proposals are the product of independent integrative thinking integrating a wide range of factors influencing the issue’s management. Method: Papers by 27 groups of students (165 students) were content analyzed to identify which themes emerged from the students' recommendations for managing the clinical issue. Findings: Five main themes emerged—current management approach; adapting procedures in line with current recent research recommendations; training for change (veteran nursing staff, beginner students, patients, significant others); analysis of 'economic benefit vs. patient benefit'; multidisciplinary team engagement in implementing change in practice. Two surprising themes also emerged: advertising and marketing using new technologies, which reflects how the new generation thinks. Summary and Recommendations: Among the main challenges in nursing education is training nursing graduates to think independently, integratively, and critically. Combining PBL with classical teaching methods stimulates students cognitively while opening new vistas with implications on all levels of the profession: management, research, education, and practice. Advanced students can successfully grasp and interpret the current state of clinical practice. They are competent and open to leading change and able to consider the diverse factors and interconnections that characterize the nurse's work.

Keywords: evidence based nursing, critical thinking skills, project based learning, students education

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Authors: Oznur Ispir, Oya Celebi Cakiroglu, Esengul Elibol, Emine Ceribas, Gizem Acikgoz, Hande Yesilbas, Merve Tarhan

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This study was conducted to evaluate the academic staff teaching the 'Nursing Management' course in the undergraduate nursing programs of the state universities in Turkey and to assess the current content of the course. Design of the study is descriptive. Population of the study consists of seventy-eight undergraduate nursing programs in the state universities in Turkey. The questionnaire/survey prepared by the researchers was used as a data collection tool. The data were obtained by screening the content of the websites of nursing education programs between March and May 2016. Descriptive statistics were used to analyze the data. The research performed within the study indicated that 58% of the undergraduate nursing programs from which the data were derived were included in the school of health, 81% of the academic staff graduated from the undergraduate nursing programs, 40% worked as a lecturer and 37% specialized in a field other than the nursing. The research also implied that the above-mentioned course was included in 98% of the programs from which it was possible to obtain data. The full name of the course was 'Nursing Management' in 95% of the programs and 98% stated that the course was compulsory. Theory and application hours were 3.13 and 2.91, respectively. Moreover, the content of the course was not shared in 65% of the programs reviewed. This study demonstrated that the experience and expertise of the academic staff teaching the 'Nursing Management' course was not sufficient in the management area, and the schedule and content of the course were not sufficient although many nursing education programs provided the course. Comparison between the curricula of the course revealed significant differences.

Keywords: nursing, nursing management, nursing management course, undergraduate program

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Authors: Maria Luiza Fulga, Georgeta Truca, Mihaela Alexandru, Andriescu Mariana, Crin Marcean

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The significance of nursing as a subject in the post-secondary healthcare curriculum is a major. We aimed to enable our students to assess the patient's risk, to establish prevention measures and to adapt to a specific learning context, in order to acquire the skills and abilities necessary for the nursing profession. In order to achieve these objectives, during the three years of study, teachers put an emphasis on acquiring communication skills, because in our country after the first cycle of hospital accreditation concluded in 2016, the National Authority for Quality of Health Management has introduced the criteria for the implementation and application of the nursing process according to the accreditation standards. According to these requirements, the nurse has to carry out the nursing assessment, based on communication as a distinct component, so that they can identify nursing diagnoses and implement the nursing plan. In this respect, we, the teachers, have refocused, by approaching various teaching strategies and preparing students for the real context of learning and applying what they learn. In the educational process, the tutors in the hospitals have an important role to play in acquiring professional skills. Students perform their activity in the hospital in accordance with the curriculum, in order to verify the practical applicability of the theoretical knowledge acquired in the school classes and also have the opportunity to acquire their skills in a real learning context. In clinical education, the student nurse learns in the middle of a guidance team which includes a practice tutor, who is a nurse that takes responsibility for the practical/clinical learning of the students in their field of activity. In achieving this objective, the tutor's abilities involve pedagogical knowledge, knowledge for the good of the individual and nursing theory, in order to be able to guide clinical practice in accordance with current requirements. The aim of this study is to find out the students’ confidence level in practice tutors in hospitals, the students’ degree of satisfaction in the pedagogical skills of the tutors and the practical applicability of the theoretical knowledge. In this study, we used as a method of investigation a student satisfaction questionnaire regarding the clinical practice in the hospital and the sample of the survey consisted of 100 students aged between 20 and 50 years, from the first, second and third year groups, with the General Nurse specialty (nurses responsible for general care), from 'Fundeni' Healthcare Post-Secondary School, Bucharest, Romania. Following the analysis of the data provided, we arrived the conclusion that the hospital tutor needs to improve his/her pedagogical skills, the knowledge of nursing diagnostics, and the implementation of the nursing plan, so that the applicability of the theoretical notions would be increased. Future plans include the pedagogical training of the medical staff, as well as updating the knowledge needed to implement the nursing process in order to meet current requirements.

Keywords: clinical training, nursing process, pedagogical skills, tutor

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Authors: Olayide Ogunsiji, Glenda McDonald

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Engendering cultural competence in nursing and midwifery students is germane to reducing disparities in contemporary health care settings, increasingly patronized by people from diverse background. Professional standards for registration in Australia require nurses and midwives to be culturally competent. Nursing and midwifery academics worldwide are responsible for preparing students for clinical practice, yet limited attention is paid to exploring how students are being prepared to care for a culturally diverse population. This paper provides insight into the perceptions of academics about how they are preparing undergraduate nursing and midwifery students for culturally competent health care. Academics were drawn from a tertiary educational institution in metropolitan Australia. They responded to a generic email indicating their interest in participating in the study. A total of nine academics who have taught undergraduate nursing and midwifery students in a unit that focused on health and illness perspectives for culturally diverse communities; and provided written consent to participate were included. These academics were engaged in a qualitative digitally-recorded semi-structured face-to-face or telephone interviews which lasted for about 45-60 minutes. Interview data were transcribed verbatim. Through constant comparison, three themes emerged: experiences of the teachers, strategies used for preparing students and challenges in preparing students. The participants spoke about their experiences of teaching in the unit and with the students. They faced challenges related to physical and relational space. They utilised a number of didactic approaches in teaching the unit and critiqued the adequacy of the content in preparing students for practice. This study demonstrated that didactic classroom approaches need to be supported with clinical practice and cultural immersion for a meaningful preparation of nursing and midwifery students to care for culturally diverse populations.

Keywords: cultural competence, nursing students, preparation, undergraduate

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Authors: R. Bhagwan, M. Subbhan

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Nursing is a very challenging field in South Africa and due to the burden of disease it is critical that nursing students are prepared with the adequate knowledge and skills to deliver effective patient care. Despite this very little research has been done on the teaching strategies used by nurse educators to teach nursing students. It is in this context that a survey of all nurse educators at Nursing Colleges and Universities in Kwa-Zulu Natal was undertaken (n=300) to explore what current pedagogical strategies were being used and which more creative methodologies should be implemented in relation to specific nursing content. Findings revealed that most nurse educators still utlize the lecture approach, but although believe other methodologies such as e-learning are important have not done so because of inadequate training. The recommendations made are that more creative pedagogical strategies such as simultation, portfoloios and case studies be adopted.

Keywords: creative, teaching methodologies, dydactic, nursing

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Authors: Merav Ben Natan, Adam Gharra, Baher Faduos, Abedallah Magadlah, Abedalrahman Biadsy

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Introduction: Mental health nursing is often perceived as an unattractive career choice among nursing students, and it remains unclear whether the type of nursing program influences this view. Aim: This cross-sectional study aimed to explore the association between stigmatizing attitudes in nursing students and their desire for a career in mental health nursing, comparing students in generic and accelerated programs. Method: A total of 220 nursing students from generic and accelerated programs in North-Center Israel participated in this cross-sectional study, completing a questionnaire on stigmatizing attitudes and their interest in a mental health nursing career. Results: Nursing students displayed a generally low desire for mental health nursing, influenced by factors such as enrollment in the generic program, previous mental health work experience, and stigmatizing attitudes. Discussion: Students in the generic program, with lower stigmatizing attitudes and prior mental health experience, exhibited a higher inclination towards mental health nursing. Implications for Practice: Prospective mental health nursing professionals may be identified in the generic program, particularly those with prior mental health experience and lower stigmatizing attitudes. Additional studies are required to confirm and broaden their applicability to other contexts.

Keywords: nursing students, mental health nursing, stigmatizing attitudes, desire for a career in mental health nursing, generic program

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Authors: Yi-Jiun Chou, Ying-Hsuan Li, Yi-Jung Liu, Hsin-Yu Chiang, Hsuan-Ching Wang

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Background: Patients received therapeutic hypothermia (TH) after resuscitation from cardiac arrest are more dependent on continue and intensive nursing care. It involves many difficult steps, especially achieving target body temperature. To our best knowledge, there is no consensus or recommended standards on nursing practice of TH. Aim: The aim of this study is to increase the completion rate of nursing care at therapeutic hypothermia. Methods: We took five measures: (1) Amendment of nursing standards of therapeutic hypothermia; (2) Amendment of TH checklist items to nursing records; (3) Establishment of monitor procedure; (4) Design each period of TH care reminder cards; (5) Providing in-service training sections of TH for ICU nursing staff. Outcomes: The completion rate of nursing care at therapeutic hypothermia increased from 78.1% to 89.3%. Conclusion: The project team not only increased the completion rate but also improved patient safety and quality of care.

Keywords: therapeutic hypothermia, nursing, critical care, quality of care

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Authors: Maha Salah, Hanaa Hashem, Mahmoud M. Alsagheir, Mohammed Salah

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Acute respiratory distress syndrome (ARDS) represents a complex clinical syndrome and carries a high risk for mortality. The severity of the clinical course, the uncertainty of the outcome, and the reliance on the full spectrum of critical care resources for treatment mean that the entire health care team is challenged. Researchers and clinicians have investigated the nature of the pathological process and explored treatment options with the goal of improving outcome. Through this application of research to practice, we know that some previous strategies have been ineffective, and innovations in mechanical ventilation, sedation, nutrition, and pharmacological intervention remain important research initiatives. Developed Clinical pathway is multidisciplinary plans of best clinical practice for this specified groups of patients that aid in the coordination and delivery of high quality care. They are a documented sequence of clinical interventions that help a patient to move, progressively through a clinical experience to a desired outcome. Although there is a lot of heterogeneity in patients with ARDS, this suggested developed clinical pathway with alternatives was built depended on a lot of researches and evidence based medicine and nursing practices which may be helping these patients to improve outcomes, quality of life and decrease mortality.

Keywords: acute respiratory distress syndrome (ARDS), clinical pathway, clinical syndrome

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Authors: Fatma Refaat Ahmed, Sally Mohamed Farghaly

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Context: Intensive care unit (ICU) nurses often face pressure and constraints in their work, leading to the rationing of care when demands exceed available time and resources. Observations suggest that ICU nurses are frequently distracted from their core nursing roles by non-core tasks. This study aims to provide evidence on ICU nurses' multitasking activities and explore the association between nurses' personal and clinical characteristics and their time allocation. Research Aim: The aim of this study is to quantify the time spent by ICU nurses on multitasking activities and investigate the relationship between their personal and clinical characteristics and time allocation. Methodology: A self-observation form utilizing the "Diary" recording method was used to record the number of tasks performed by ICU nurses and the time allocated to each task category. Nurses also reported on the distractions encountered during their nursing activities. A convenience sample of 60 ICU nurses participated in the study, with each nurse observed for one nursing shift (6 hours), amounting to a total of 360 hours. The study was conducted in two ICUs within a university teaching hospital in Alexandria, Egypt. Findings: The results showed that ICU nurses completed 2,730 direct patient-related tasks and 1,037 indirect tasks during the 360-hour observation period. Nurses spent an average of 33.65 minutes on ventilator care-related tasks, 14.88 minutes on tube care-related tasks, and 10.77 minutes on inpatient care-related tasks. Additionally, nurses spent an average of 17.70 minutes on indirect care tasks per hour. The study identified correlations between nursing time and nurses' personal and clinical characteristics. Theoretical Importance: This study contributes to the existing research on ICU nurses' multitasking activities and their relationship with personal and clinical characteristics. The findings shed light on the significant time spent by ICU nurses on direct care for mechanically ventilated patients and the distractions that require attention from ICU managers. Data Collection: Data were collected using self-observation forms completed by participating ICU nurses. The forms recorded the number of tasks performed, the time allocated to each task category, and any distractions encountered during nursing activities. Analysis Procedures: The collected data were analyzed to quantify the time spent on different tasks by ICU nurses. Correlations were also examined between nursing time and nurses' personal and clinical characteristics. Question Addressed: This study addressed the question of how ICU nurses allocate their time across multitasking activities and whether there is an association between nurses' personal and clinical characteristics and time allocation. Conclusion: The findings of this study emphasize the need for a lean evaluation of ICU nurses' activities to identify and address potential gaps in patient care and distractions. Implementing lean techniques can improve efficiency, safety, clinical outcomes, and satisfaction for both patients and nurses, ultimately enhancing the quality of care and organizational performance in the ICU setting.

Keywords: motion study, ICU nurse, lean, nursing time, multitasking activities

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Authors: Sedigheh Salemi, Mahnaz Sanjari, Maryam Aalaa, Mohammad Mirzabeigi

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Clinical governance is the framework within which the health service provider is required to ongoing accountability and improvement of the quality of their services. This cross-sectional study was conducted in 661 nurses who work in government hospitals from 35 hospitals of 9 provinces in Iran. The study was approved by the Nursing Council and was carried out with the authorization of the Research Ethics Committee. The questionnaire included 24 questions in which 4 questions focused on clinical governance defining from the nurses' perspective. The reliability was evaluated by Cronbach's alpha (α=0/83). Statistical analyzes were performed, using SPSS version 16. Approximately 40% of nurses correctly answered that clinical governance is not "system of punishment and rewards for the staff". The most nurses believed that "clinical efficacy" is one of the main components of clinical governance. A few of nurses correctly responded that "Evidence Based Practice" and "management" is not part of clinical governance. The small number of nurses correctly answered that the "maintenance of patient records" and "to recognize the adverse effects" is not the role of nurse in clinical governance. Most "do not know" answer was to the "maintenance of patient records". The most nurses unanimously believed that the implementation of clinical governance led to "promoting the quality of care". About a third of nurses correctly stated that the implementation of clinical governance will not lead to "an increase in salaries and benefits of the medical team". As a member of the health team, nurses are responsible in terms of participation in quality improvement and it is necessary to create an environment in which clinical care will flourish and serve to preserve the high standards.

Keywords: clinical governance, nurses, salary, health team

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Authors: Rabeab Khunpukdee, Aranya Sukchoui, Nonluk Somgit, Chitima Bunnaul

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Endotracheal displacement is a major risk of life threatening among critically ill patients. Standard nursing protocol is needed to minimize this risk and to improve clinical outcomes. To evaluate the effectiveness of the endothacheal care nursing guideline. The incidence rates of endochacheal displacement, oxygen deficiency after extubation, re-intubation, and nurse’s satisfaction on the utilization of the endotracheal care nursing guideline. An evidence-based nursing practice framework was used to develop the endotracheal care nursing guideline. The guideline valid content was review by a 3 panel of experts. The index of item objective (IOC) of the guideline was 0.93. The guideline was implemented in 130 patients (guideline group) and 19 registered nurses at a medicine ward, Had Yai hospital, Thailand. Patient’s outcomes were evaluated by comparison with those 155 patients who received the routine nursing care (routine care group). Descriptive statistics, frequency, percentage, mean, standard deviation and Mann Whitney U-test was analyzed using the computer program. All significantly and better outcomes were found in the guideline group compared to the routine care group. The guideline group has less incidence rates of endotracheal displacement (1.54 % vs 9.03 %, p < 0.05), and none of the guideline group had oxygen deficiency after extubation (0 % vs 83.33%) compared to the routine care group. All of the 2 patients in the guideline group, compared to 6 of 14 patients in the routine care group were re-intubation. The overall rate of re-intubation in the total group (n = 130 vs 155) was seen less in the guideline group than the routine care group (1.54 % vs 3.87). Overall, nurses satisfaction was at high-level (89.50%) on the utilization of the guideline.

Keywords: endotracheal care, nursing guideline, re-intubation, satisfaction

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Authors: Hsiao Lu Lee

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This study was based Quasi-experimental design. The study explored the relationships of nursing ethics education, nursing students’ moral sensitivity and moral judgments in Taiwan. A total of 242 nursing students (NS) participated the study.The proposed teaching nursing ethics from 2 to 16 weeks. Three questionnaires were adopted in this study. First, Demographic of nursing students questionnaire; Second, the questionnaire is Taiwan’s Moral Sensitivity Questionnaire for Student Nurses (TMMSQ-SN); Third, Defining Issues Test (DIT). The pre-test data were collected during the first week, and the post-test data was collected during the 17ᵗʰ week of the semester. The purpose of the study is explored evaluating the effect of nursing ethics education on nursing students’ moral sensitivity and moral judgments. The results of the study showed that moral sensitivities and moral judgments have been significantly improved after 16 weeks (Pair-t=--11.10***; Pair-t=-7.393***). Moral sensitivities and moral judgments were significant in the pretest. There was a negative correlation, but there was no correlation between moral sensitivity and moral judgments in the post-test. There was a significant correlation between the moral judgments (DIT)and the hours of work and other ethical courses (r=.28**; r=.015*). Nursing ethics education is necessary for nursing students in Taiwan. The nursing ethics courses are necessary to improve nursing students’ moral sensitivity and moral judgment (DIT).

Keywords: defining issues test, moral judgments, moral sensitivity, nursing ethics education, nursing students

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Authors: Aline Giardin, Ana Fontoura, Thomas Anderson

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Transsexuality is a condition that requires the work of professionals from various fields for diagnosis and treatment. The correct diagnosis is very important because the surgery is irreversible. Diagnostic elements are essentially clinical and an observation period of two years prior to surgery is recommended. In this review article, we discuss the importance of psychiatric nursing for the care of transgender patients, as well as their mental health. Transsexuality is a phenomenon that contrasts our common understandings of sexuality, but it is not a sexual issue. Also called gender dysphoria is a mismatch between the anatomical sex of an individual and their gender identity. In relation to mental health, among transsexuals, we find variations ranging from psychoses to total normality. As the etiology is still controversial, there is no biological marker and only the clinical criteria can be used. Portaria nº 2803, of November 19, 2013, Brazil, regulates the surgical reassignment of sex by the SUS and the nurse started to work also in operational groups (transsexuals who wish to perform surgery and other procedures of reassignment of sex). Health and education, establishes links and guides the care that female and male transsexual patients will have to have before and after surgery. It is also important to say that the work of health education is not only concerned with aspects related to the sexual reassignment surgery, but also with the mental health of its patients and with the family. One of the main complaints of patients is the impression that professionals seem to find them strange and feel extremely uncomfortable when they talk about their desire to undergo sex-change surgery: Investigate the role of nursing in the process of change sexual. Our methodology was a review of articles produced between 1994 and 2015. It was concluded that nursing should specialize for this new demand, which is growing more and more in our health services. We believe that nursing is specializing to enter this context and the expectations are good for the professionals and for the reception of the transsexual patient.

Keywords: transex, nursing, importance, patient

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Authors: Nanyombi Lubimbi, Josette Niyokindi

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Background: As in many other developing countries in Africa, Rwanda suffers from a chronic shortage of skilled Health Care professionals including Clinical Instructors. This shortage negatively affects the clinical instruction quality therefore impacting student-learning outcomes. Due to poor clinical supervision, it is often noted that students have no structure or consistent guidance in their learning process. The Clinical Educators and the Rwandan counterparts identified the need to create a favorable environment for learning. Description: During orientation the expectations of the student learning process, collaboration of the clinical instructors with the nurses and Clinical Educators is outlined. The ward managers facilitate structured learning by helping the students identify a maximum of two patients using the school’s objectives to guide the appropriate selection of patients. Throughout the day, Clinical Educators with collaboration of Clinical Instructors when present conduct an ongoing assessment of learning and provide feedback to the students. Post-conference is provided once or twice a week to practice critical thinking skills of patient cases that they have been taking care of during the day. Lessons Learned: The students are found to be more confident with knowledge and skills gained during rotations. Clinical facility evaluations completed by students at the end of their rotations highlight the student’s satisfaction and recommendation for continuation of structured learning. Conclusion: Based on the satisfaction of both students and Clinical Instructors, we have identified need for structured learning during clinical rotations. We acknowledge that more evidence-based practice is necessary to effectively address the needs of nursing and midwifery students throughout the country.

Keywords: Rwanda, clinical rotation, structured learning, critical thinking skills, post-conference

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Authors: Rose Chapman Rodriguez

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Problem: Evidence-based practice (EBP) attributes are significantly associated with EBP implementation science, which improves patient care outcomes. Nurses influence EBP, yet little is known of the specific EBP attributes of pediatric nurses in their clinical sub-specialties. Aim: This study aims to investigate the relationship between nursing academic degree, years of experience, and clinical specialty, with mean survey scores on EBP belief, organizational culture, and implementation scales across all levels of nursing in a Children’s Hospital. Methods: A convenience sample of nurses (n=185) participated in a descriptive, cross-sectional, correlational study in May 2023. The electronic surveys comprised 11 demographic questions and nine survey items from the short-version EBP Beliefs Scale (Cronbach α = 0.81), Organizational Culture and Readiness Scale for System-wide Integration Scale (Cronbach α = 0.87), and EBP Implementation Scale (Cronbach α = 0.89). Findings: EBP belief scores were notably higher in nurses working in neonatology (m=4.33), critical care (m=4.47), and among nurse leaders (m=4.50). There was a statistically significant difference in EBP organizational culture among nurse leaders (m = 3.95, p=0.039) compared to clinical nurses (m = 3.34) and advanced practice nurses (m = 3.34). EBP implementation was favorable in neonatology (m=4.20), acute care (m=4.05), and nurse leaders (m=4.33). No significant difference or correlation was found in EBP belief, organizational culture, or implementation mean scores related to nurses' age, academic nursing degree, or years of experience in our cohort (EBP beliefs (r = -.06, p = .400), organizational readiness (r = .02, p = .770), and implementation scales (r = .01, p = .867). Conclusions: This study identified nurse’s EBP attributes in a Children’s Hospital using key variables studied in EBP social cognitive theory and learning theory. Magnet status, shared governance structure, specialty certification, and nurse leaders play a significant role in favorable EBP culture and implementation. Nurses’ unit level ‘group culture’ may vary depending on the EBP attributes and collaborative efforts of local teams. Opportunities for mentoring were identified, which may continue to enhance EBP implementation science across all nursing roles in our pediatric organization.

Keywords: evidence-based practice, peditrics, nursing roles, implementation

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Authors: Susan K. Steele-Moses, Aimee Badeaux

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Background Literature: Nurse anesthesia education placed high demands on students both personally and professionally. High levels of anxiety affect student’s mental, emotional, and physical well-being, which impacts their student success. Whereas more research has focused on the health and well-being of graduate students, far less has focused specifically on nurse anesthesia students (SNRAs), who may experience higher levels of anxiety due to the rigor of their academic program. Current literature describes stressors experienced by SRNAs that cause anxiety and affect their performance, including personal, academic, clinical, interpersonal, emotional, and financial. Sample: DNP-NA 2025 and DNP-NA 2024 cohorts (N = 36). Eighteen (66.7%) students participated in the study. Instrumentation: The DASS-21 was used to measure stress (7 items; α = .87) and anxiety (7 items; α = .74) from the participants. Intervention: The mind-shift meditation app, based on cognitive behavioral therapy, is being used daily before clinical and exams to decrease nurse anesthesia students’ stress and anxiety over time. Results: At baseline, the students exhibited a moderate level of stress, but their anxiety levels were low. The range of scores was 4-21 (out of 28) for stress (M = 12.88; SD = 5.40) and 0-16 (out of 28) for anxiety (M = 6.81; SD = 5.04). Both stress and anxiety were normally distributed [SW = .242 (stress); SW = .210 (anxiety)] without any outliers. There was a significant difference between their stress and anxiety levels (t = 5.55; p < .001) at baseline. Stress and anxiety will be measured over time, with the change analyzed using repeated measures ANOVA. Implications for Practice: The use of purposeful mindfulness meditation has been shown to decrease stress and anxiety in nursing students.

Keywords: mindfulness, meditation, graduate nursing education, nursing education

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Authors: Manar Ahmed Elbadawy

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Background: Empirical evidence suggested that improving nursing teamwork (NTW) may be the key to reducing medical error. The functioning nursing teams require open communication, mutual respect, and shared mental models to activate quality patient care. The complexity and the high demands for specialized nursing knowledge and skill also require nursing staff to consult with one another and work in teams regularly. The current study aimed to evaluate the effect of the nursing teamwork training program on nursing teamwork effectiveness. Design: A quasi-experimental (one group pretest-posttest) design was utilized. Three medical intensive care units at a teaching hospital affiliated to Cairo University Hospital, Egypt. Subjects: A convenient sample of 48 nursing staff worked at the selected units. The Nursing Teamwork Observational Checklist was used. Results: Total (NTW) mean scores exhibited quite elevation post-program implementation compared to preprogram and showed little decrease 3 months later ( = 2.52, SD = ± 0.27, mean % =51.98, = 2.72, SD = ± 0.20, mean %=72.45, = 2.67, SD = ± 0.11, mean %= 67.48 respectively). Conclusion: Implementation of (NTW) training program had a positive effect on increasing (NTW) effectiveness. Regular and frequent short-term teamwork training is important to be introduced as well as sustainable monitoring is required to ensure nursing attitudes, knowledge and skills’ change about teamwork effectiveness.

Keywords: effectiveness, nursing, teamwork, training

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Authors: U.-B. Schaer, M. Wehr, R. Hodler

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Background: Most nursing students require more training time for necessary nursing skills than defined by nursing schools curriculum to acquire basic nursing skills. Given skills training lessons are too brief to enable effective student learning, meaning in-depth skills practice and repetition various learning steps. This increases stress levels and the pressure to succeed for a nursing student with slower learning capabilities. Another possible consequence is that nursing students are less prepared in the required skills for future clinical practice. Intervention: The Bern College of Higher Education of Nursing, Switzerland, started the independent peer practice learning program in 2012. A concept was developed which defines specific aims and content as well as student’s rights and obligations. Students enlist beforehand and order the required materials. They organize themselves and train in small groups in allocated training location in the area of Learning Training and Transfer (LTT). During the peer practice, skills and knowledge can be repeatedly trained and reflected in the peer groups without the presence of a tutor. All invasive skills are practiced only on teaching dummies. This allows students to use all their potential. The students may access learning materials as literature and their own student notes. This allows nursing students to practice their skills and to deepen their knowledge on corresponding with their own learning rate. Results: Peer group discussions during the independent peer practice learning support the students in gaining certainty and confidence in their knowledge and skills. This may improve patient safety in future daily care practice. Descriptive statics show that the number of students who take advantage of the independent peer practice learning increased continuously (2012-2018). It has to be mentioned that in 2012, solely students of the first semester attended the independent peer practice learning program, while in 2018 over one-third of the participating students were in their fifth semester and final study year. It is clearly visible that the demand for independent peer practice learning is increasing. This has to be considered in the development of future teaching curricula.

Keywords: learning program, nursing students, peer learning, skill training

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Authors: Besher Gharaibeh

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This article addressed the issue of using physical exam in nursing. Nurses hold different attitudes toward using physical exam in the clinical settings. These attitudes determine to embrace physical examination in practice. So, the aim of the study was to examine registered nurses’ attitudes and practices, identify perceived barriers, and to identify the factors which influence the performance and the attitudes towards physical examinations. Results showed that even though nurses reported performing physical exam often, they had negative attitudes toward it. Stress and performing physical examinations on someone of the opposite gender (n=236; 87.4%) were the main barriers. Nurse's level of education influenced the attitude (t=-4.3; p < .01). These results indicated that RNs recognize the necessity of physical examinations, but they face many barriers and challenges which hinder the performance of the examination. Cultural factors and experience were the most influential barriers which deter performance of the physical examination.

Keywords: physical exam, nursing, barriers, practices, attitudes

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Authors: W. L. Tsang, H. Y. Li, S. L. Wong, T. Y. Kwok, S. C. Yuen, S. S. Kwok, P. S. Ko, S. Y. Lau

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Introduction: Palliative care is no doubt necessary in surgery. When one looks at studies of what patients with life-threatening illness want and compares to what they experience in surgical units, the gap is huge. Surgical nurses, being patient advocates, should engage with patients and families sooner rather than later in their illness trajectories to consider how to manage the illness, not just their capacity to survive. Objective: This clinical practice guide aims to fill the service gap of palliative care in surgery by producing a quality-driven, evidence-based yet straightforward clinical practice guide based on a focus strategy. Methodology: In line with Guide to Good Nursing Practice: End-of-Life Care recommended by Nursing Council of Hong Kong and the strategic goal of improving quality of palliative care proposed in HA Strategic Plan 2017-2022, multiple phases of work were undertaken from July 2015 to December 2017. A pragmatic clinical practice guide for surgical patients facing life-threatening conditions was developed based on assessments on knowledge of and attitudes towards end-of-life care of surgical nurses. Key domains, including preparation for bereavement, nursing care for imminently dying patients and at the dying scene were crystallized according to the results of the assessments and the palliative care checklist formulated by UCH Palliative Care Team. After a year of rollout, its content was refined through analyses of implementation in routine practice and consensus opinions from frontline nurses. Results and Outcomes: This clinical practice guide inspires surgical nurses with the art of care to provide for patients’ comfort, function, and longevity. It provides practical directions and assists nurses to master the skills on advance care planning and learn how to be clear with patients, families and themselves about the realities of the disease pictures. Through the implementation, patients and families are included in the decision process, and their wishes are honored. The delivery of explicit and high-quality palliative care maintains good nurse-to-patient relations and enhances satisfaction of hospital care of patients and families. Conclusion: Surgical nursing has always been up to the unique challenges of the era. This clinical practice guide has become an island of credibility for our nurses as they traverse the often stormy waters of life-limiting illness.

Keywords: palliative care delivery, palliative care in surgery, hospice care, end-of-life care

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Authors: Valerie A. Conrade

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Introduction: A large body of literature suggests patients who complete fecal immunochemical testing (FIT) kits are likely to identify colorectal cancer sooner than those who do not complete FIT kits. Background: Patients who do not participate in preventative measures such as the FIT kit are at a higher risk of colorectal cancer growing unnoticed. The objective was to see if the method the principal investigator (PI) uses to educate clinical staff on the importance of FIT kit administration provides an increased amount of FIT kit dissemination to patients post clinical education. Methodologies: Data collection via manual tallies took place before and after the clinical staff was educated on the importance of FIT kits. Results: The results showed an increase in FIT kit dissemination post clinical staff education. Through enhanced instruction to the clinical staff regarding the importance of FIT kits, expanding their knowledge on preventative measures to detect colorectal cancer positively impacted nurses and, in turn, their patients.

Keywords: colon cancer, education, fecal immunochemical testing, nursing

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Authors: Merve Aydin, Mağfiret Kara Kaşikçi

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Aim: To determine the perceptions of inpatients about care at Farabi Hospital in KTU. Material and Method: This research was conducted by using the universe known examples of formulas and probability selected by sampling method with 277 chosen patients in the hospital at least 14 days in other internal and surgical clinics except for pediatric, psychiatry, and intensive care unit services between January-March 2014 in KTU Farabi Hospital. The data was collected through the forms of nursing care perception scale of patients and defining characteristics of patients. In the evaluation of data, percentage, mean, Mann Whitney U, Student t and Kurskall Wallis tests were applied. Results: The average point the patients got in nursing care perception scale is 62.64±10.08’dir. 48.7 % of patients regard nursing care well and 36.8 % of them regard it very well. 19 % of the patients regard nursing care badly. When the age, sex, occupation, marital status, educational background, residential place, income level, hospitalization period, hospitalization clinic and having a hospital attendant were compared with nursing care perception average point, the difference among point averages was not found meaningful statistically (p > 0.05). The average point of nursing care perception was found greater in those having chronic disease (p < 0.05). Conclusion: The perception point of patients about nursing care is above the average according to the average of the lowest and highest points. The great majority of patients regard nursing care well or very well.

Keywords: hospital, patient, perception of nursing care, nursing care

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Authors: Kamolrat Turner, Somporn Rakkwamsuk, Ladda Leungratanamart

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The aim of this descriptive study was to determine the perception of 21^st century skills among nursing professors and nursing students at Boromarajonani College of Nursing, Chonburi. A total of 38 nursing professors and 75 second year nursing students took part in the study. Data were collected by 21^st century skills questionnaires comprised of 63 items. Descriptive statistics were used to describe the findings. The results have shown that the overall mean scores of the perception of nursing professors on 21^st century skills were at a high level. The highest mean scores were recorded for computing and ICT literacy, and career and leaning skills. The lowest mean scores were recorded for reading and writing and mathematics. The overall mean scores on perception of nursing students on 21^st century skills were at a high level. The highest mean scores were recorded for computer and ICT literacy, for which the highest item mean scores were recorded for competency on computer programs. The lowest mean scores were recorded for the reading, writing, and mathematics components, in which the highest item mean score was reading Thai correctly, and the lowest item mean score was English reading and translate to other correctly. The findings from this study have shown that the perceptions of nursing professors were consistent with those of nursing students. Moreover, any activities aiming to raise capacity on English reading and translate information to others should be taken into the consideration.

Keywords: 21st century skills, perception, nursing instructor, nursing student

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Authors: Vimarshi Sandamali Godigamuwa

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Background: Breast cancer is the leading cause of cancer mortality in women worldwide. Its incidence is increasing and young women affected more than ever. Nursing students are the future nurses who will have the opportunity to encourage and influence women to be aware of breast cancers. Objectives: To determine the level of knowledge, awareness and practices concerning of breast cancer among Sri Lankan student nurses. Methods: A descriptive cross sectional study was conducted on 150 nursing students who are in their 2nd and 3rd year studies by distributing a standard self-administered questionnaire. The completed questionnaire were retrieved, graded and scored. Results: Mean age of the respondents was 24.27; (SD=1.66) years and ranged from 20-30 years. Most of the students were female which was 85%. 32% of nursing students scored below 55% for the questionnaire and only 7.3% had good overall knowledge and awareness of breast cancer. Out of 128 female students 89.9% were answered that they know how to perform Breast Self Examination (BSE), out of which 37% of them performed BSE regularly. Only 33% were aware of recommended age for BSE and 10% were knew the recommended age for mammography. 9.3% were aware of frequency for Clinical Breast Examination on 20-39 years of age group. Of the female participants, 11.7% reported positive family history of breast cancer. Conclusion: Nursing students should explore to health educational programs on regular basis on breast cancer and its screening methods. Further studies are needed to identify reasons for not practicing BSE.

Keywords: breast cancer, student nurses, knowledge, awareness, practice, BSE

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