Advanced Practice Nursing Students Research Articles

Lessons learned: Why study-abroad remains a critical component of nursing curriculums

BackgroundCaring for an increasingly older and multicultural patient population requires nurses and APNs who are able to integrate cultural competency in meeting the needs of their patients while decreasing health care disparities. A study-abroad immersion experience is one way to instill deep learning and cultural competency. PurposeThe purpose of this study was to understand the lived experience of baccalaureate nursing students and APN students working together in a study-abroad, service-learning experience. MethodUsing Interpretive Phenomenological Analysis (IPA) (Smith & Osborn, 2003), we explored the lived experience of Baccalaureate and Advanced Practice Nursing Students in a service-learning, study-abroad experience in Belize. ResultsEmergent themes derived from students' journal transcripts were: (1) Allowing learning to take place; (2) Practicing nursing with limited resources (3) A different take on culture; and (4) Kinship with peers. From this theme two sub themes emerged: 1) students' connection with the people and the country, and 2) students' connection with each other. ConclusionCultural immersion prepared students to work in Belize with different patient groups, having varied perspectives related to their health. Students learned that the core values of dignity and caring require that we, as nurses, go where the patient is-not where we want the patient to be. This is tested when students are confronted with a culture not their own.

Ensuring Advanced Practice Nursing Students Meet the 2023 Drug Enforcement Agency Requirements.

All advanced practice nursing students in the doctor of nursing practice program at Johns Hopkins School of Nursing are required to complete 3 core courses (pathophysiology, pharmacology, and physical assessment). As of June 2023, the Drug Enforcement Agency (DEA) required all prescribers of controlled medications to attest to at least 8 hours of substance use training. To quantify the amount of time advanced practice nursing students learn substance use-related content and engage in teaching/learning activities across the 3 courses as a basis for meeting the DEA requirement. Lead course faculty teaching identified content related to substance use disorders, including reading assignments and skill-building activities, and the minimum amount of time that students spend in those teaching/learning experiences. Advanced practice nursing students complete a total of 14 hours of substance use-related content in the 3 core courses. This article describes substance use-related content and strategies that can be integrated in advanced practice nursing programs for students to meet the new DEA requirement.

Adolescent Simulation in a Health Assessment Course for Advanced Practice Nursing Students.

Advanced practice registered nurse (APRN) students face challenges transitioning to practice. They benefit greatly from simulated learning experiences that build confidence and increase competence in the skills needed to perform in an APRN role. The purpose of this quality improvement project was to evaluate the effectiveness of a simulated adolescent well visit in an advanced health assessment course. Using a pretest/posttest design, qualitative and quantitative data were collected from participants. Results included high learner satisfaction, an increase in both self-reported competence and confidence, and an appreciation for the "safe space" of learning.

Stepping outside national borders: International active learning educational collaboration events.

This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency. Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships. Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency. Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences. The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century. Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.

The Impact of Clinical Experience in Advanced Practice Nursing Education-A Cross-Sectional Study of Norwegian Advanced Practice Nurses' Perspectives.

An Advanced Practice Nurse (APN) is a specialized nurse who has acquired context specific knowledge, complex decision-making skills, and clinical competencies. Previously in Norway, APN education programs had a prerequisite of a minimum of two years of clinical nursing experience. Recently, the government decided to abandon this prerequisite. The objectives of this study were to assess APN's and APN students' (1) perspectives on the impact of clinical nursing experience on various aspects of nursing practice, (2) perspectives on the association between APN students' previous clinical experience and the ability to achieve the learning outcomes in the education program, and (3) attitudes towards clinical nursing practice as a prerequisite before entry to APN education programs. An observational, cross-sectional design. APN and APN students were invited to respond to a researcher-developed questionnaire. A snowballing sampling method was used. The questionnaire included 24 questions scored on a five-point Likert scale, and two questions with text responses. Quantitative data were analyzed using descriptive statistics, and text responses with thematic analysis. In total, 1767 APNs (92.9%) and APN students (7.1%) responded. Between 93.6 and 98.2% of the respondents (n = 1767) agreed that clinical nursing experience leads to experience with communication, collaboration, basic procedures, medical equipment and documentation, and to the development of situation awareness, increased awareness on own role in teams, the ability to provide person-centered nursing, an independent nursing identity, and feeling of security. Over 90% of the respondents agreed that students' previous clinical experience was associated with the ability to achieve the learning outcomes in the APN program. In addition, 93.7% of the respondents agreed that clinical nursing experience should be a prerequisite before entry to APN programs. Advantages of clinical experience were reported as 'Professional identity', 'Intuitive grasp', 'Integration of technical skills', and 'See the whole picture'. Disadvantages were reported as 'Prejudice and bad habits', 'The importance of relevant experience', and 'Recruitment issues'. This study adds insights into the impact of clinical nursing experience as a prerequisite to APN education programs. The results indicate that clinical nursing experience is an essential contributor to the development of nursing competence and a nursing identity. This study was not registered.

Simulation Utilized for Mentoring and Measuring Integrative Thinking: A Model for Advanced Practice Nurse Competence Evaluation.

S.U.M.M.I.T (Simulation Utilized for Mentoring and Measuring Integrative Thinking) to practice is a summative advanced practice nurse (APN) evaluation model using virtual simulation to assess clinical decision-making competencies of APN students. Students engage as grand round participants in an unfolding recorded patient encounter. Competence is assessed through their application of evidence-based rationales for diagnosis, diagnostics, interpretation, and care plan. S.U.M.M.I.T incorporates an objective competency-based rubric and concurrent feedback. Results demonstrate clear details of clinical reasoning, communication, diagnosis-focused care plan, patient safety, and education, allowing specific competency need mentoring by faculty.

Virtual Reflection Group Meetings as a Structured Active Learning Method to Enhance Perceived Competence in Critical Care: Focus Group Interviews With Advanced Practice Nursing Students

Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master's degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs' competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students' achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs' development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed. This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students' development of the required competence to become APNs in critical care. This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data. The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations. Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs' required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education.

In-person and virtual delivery of a multigenerational, unfolding case study to support student learning and skill development in interprofessional collaboration

A multigenerational case study in an outpatient clinic setting was utilized to allow advanced practice nursing and graduate level social work students to practice interprofessional collaboration. The primary objective of this event was for the learners to better understand each other's roles and practice communication techniques to facilitate the development of a collaborative plan of care. The learning activity included pre-event didactic education, collaborative plan of care development with unfolding case details, and facilitator-led debriefing. A pre/post reflection and survey were used to assess the impact and value of the experience and understanding of the partnering profession. In the third year, the delivery format was switched to virtual. Analysis showed that students valued the learning opportunity whether delivered in person or virtually. Overall, the event was shown to be effective both in-person and virtually implemented in promoting integrated care.

Exploring the Impact of Virtual Reflection Groups on Advanced Practice Nurse Students During the COVID-19 Pandemic: Focus Group Study With Master's Students.

BackgroundIn the master’s program of advanced practice nursing at a Norwegian university college, the learning activity reflection groups were converted into virtual reflection group (VRG) meetings during the COVID-19 pandemic. Regardless of the students’ clinical practices in different hospitals, they could participate in the same VRG meeting on the web together with the educator from the university college, and the clinical supervisors were invited to participate. The students were in the process of developing the core competence required in their role as advanced practice nurses (APNs), and they had increased responsibility in the implementation of the VRG meetings.ObjectiveIn this study, we aimed to explore how master’s students of advanced practice nursing experienced VRG meetings during the COVID-19 pandemic.MethodsA qualitative exploratory design was adopted using focus group interviews. A group of students in the master’s program of advanced practice nursing participated in an interview that lasted for 60 minutes. They had experienced participating in the VRG meetings following a rigorous guide during their clinical practice. The data from the focus group were analyzed using qualitative content analysis.ResultsThe main findings of this study highlighted the importance of structure in VRG meetings, the role of increased responsibility in students’ learning processes, the development of APN students’ competencies, and increased professional collaboration with clinical supervisors. The APN students and clinical supervisors also continued their discussions in the clinical setting afterward, which strengthened the collaboration between students’ education in the master’s program and their clinical practice.ConclusionsVRG meetings gave the students the opportunity to lead professional discussions while reflecting thoroughly on the chosen patient cases from clinical practice. They experienced receiving feedback from fellow students, supervisors, and educators as stimulating their critical thinking development.

Educating APRN Students About Telehealth Credentialing, Licensing, and Billing.

An essential component of advanced practice nursing (APRN) education includes how to facilitate and adopt telehealth into practice, which includes becoming familiar with what is needed to practice telehealth and how to effectively bill for this service. This article describes the integration of telehealth credentialing, licensing, and billing into a preexisting APRN Role Practicum course. Participants consisted of two cohorts (n = 129) of APRN students enrolled in a role preparation course within a Doctor of Nursing Practice curriculum. Students' knowledge and perceptions regarding the content of a prerecorded lecture were assessed using a pretest/posttest design. The posttest also included optional module assessment questions. Student knowledge regarding the information presented increased, and overall student feedback was positive. Telehealth content was successfully integrated into a preexisting APRN Role Practicum course. Students found the information relevant to future practice and became knowledgeable regarding telehealth laws and regulations. [J Nurs Educ. 2022;61(7):413-416.].

An Interprofessional Yearlong Geriatrics Fellowship Program for Advanced Practice Nursing and Social Work Students.

The care of older adults with complex medical conditions requires effective team-based care. Nursing and social work students need a curriculum that provides them with immersive experiences in geriatrics to prepare them for competent practice. This Geriatric Workforce Enhancement Program supported 5 advanced practice nursing (APN) and 5 master of social work (MSW) student fellows in a 2-semester program, with 3 cohorts completing the fellowship over 3 years (N = 30). By the completion of the fellowship, students had (1) demonstrated increased knowledge of age-related changes and health problems experienced by older adults, (2) developed clinical competencies in providing patient-centered health care for older adults, and (3) assessed the fellowship as helpful in preparing for interprofessional team care. An interprofessional gerontology fellowship for APN and MSW students can develop knowledge and skills in team-based care for older adults. Recommendations for creating a fellowship curriculum are provided.

Peer Learning for Advanced Practice Nursing Students: Teach Us What You Know.

Peer Learning for Advanced Practice Nursing Students: Teach Us What You Know.

Self-Care for Advanced Practice Nursing Students in Rural Primary Care.

Advanced practice RNs (APRNs) working in rural primary care provide a spectrum of health care needs that can lead to professional burnout. As a preventative for burnout, the Institute of Medicine developed a strategy focused on self-care. Understanding the importance of self-care as a preventive for building professional resilience to manage workplace stressors during students' academic years may improve retention. Twenty-two APRN students participated in a rural primary care immersion course with a specific component on self-care. Preand postsurveys, student journaling, class discussions, and a posttraining focus group were used to assess students' progress. Students reported strengthening patient and team relationships, enhanced interpersonal communication, and increased self-awareness of stressors for managing their emotions. These self-imposed processes improved student confidence, job satisfaction, and workplace resilience. Heath-promoting behaviors via self-care during APRN students' formal education may assist them in their clinical practice as rural primary care providers. [J Nurs Educ. 2022;61(4):187-191.].

Moving toward AI-assisted decision-making: Observation on clinicians' management of multimedia patient information in synchronous and asynchronous telehealth contexts.

Artificial intelligence (AI) intends to support clinicians' patient diagnosis decisions by processing and identifying insights from multimedia patient information. We explored clinicians' current decision-making patterns using multimedia patient information (MPI) provided by AI algorithms and identified areas where AI can support clinicians in diagnostic decision-making. We recruited 87 advanced practice nursing (APN) students who had experience making diagnostic decisions using AI algorithms under various care contexts, including telehealth and other healthcare modalities. The participants described their diagnostic decision-making experiences using videos, images, and audio-based MPI. Clinicians processed multimedia patient information differentially such that their focus, selection, and utilization of MPI influence diagnosis and satisfaction levels. To streamline collaboration between AI and clinicians across healthcare contexts, AI should understand clinicians' patterns of MPI processing under various care environments and provide them with interpretable analytic results for them. Furthermore, clinicians must be trained with the interface and contents of AI technology and analytic assistance.

Telehealth Professionalism Education for Advanced Practice Nursing Students.

Telehealth professionalism is an often-overlooked element when performing telehealth visits, but it is one that can impact patient and provider satisfaction with this health care delivery modality. This article describes a telehealth professionalism activity that was integrated into the education of advanced practice registered nursing students as one part of their telehealth education. Attainment in knowledge with this activity, in conjunction with positive student feedback, shows promise regarding the impact of the educational intervention and its sustainability.

A Pediatric Telehealth Simulation for Prelicensure and Advanced Practice Nursing Students.

Patients who are remote, underserved, or require specialized care services are not always able to seek appropriate care when necessary. Telehealth technology allows health care providers to connect virtually with their patients to provide safe and personalized care. To prepare future nurses and nurse practitioners for the use of technology, educators are responsible for integrating telehealth education into the curriculum. This article presents a clinical simulated approach that includes an interprofessional telehealth experience with prelicensure and nurse practitioner students within a pediatric focused simulation.

Simulation as a Disruptive Innovation in Advanced Practice Nursing Programs: A Report from a Qualitative Examination

Simulation as a pedagogy is used extensively to educate healthcare professionals in both academic and clinical arenas with the intent to improve the delivery of care and patient outcomes. Advanced practice nursing (APN) programs use simulation as a pedagogy even though APN accreditation and certification organizations prohibit substituting simulation hours for the minimum 500 clinical hours. The purpose of this qualitative study was to explore faculty perceptions of educating APN students using simulation. Focus groups were conducted with a convenience sample of APN simulation faculty. Disruptive innovation theory was used by the researchers to guide the data analysis. Themes emerging during analysis included: 1) extrinsic tension and pressure in the midst of chaos, 2) internal vulnerability, and 3) passion and tenacity to remain resilient. The study results provide clarity to understand integration of APN simulation in the current environment, and introduce the impact of simulation as a disruptive innovation.

Motivational Interviewing Training for Advanced Practice Nursing Students to Address Prescription Opioid Use Disorder: A Mixed Methods Approach.

Prescription opioid use disorder in the United States has increased to epidemic proportions and poses a challenging problem to health care providers. Motivational interviewing (MI) is a patient-centered counseling style that can effectively reduce substance abuse, but MI training has not been well incorporated into advanced practice nursing curricula. Standardized patient (SP) simulation is an educational tool that is growing in popularity because of its success in improving nursing skills. Medical students and residents who underwent a formalized MI training with an SP simulation showed positive results. This study aimed to determine whether an MI training with an SP simulation improved NP students' knowledge, confidence, and skills in MI. A one-group pretest-posttest repeated measures design was used. Quantitative data were analyzed using descriptive statistics and repeated measures analysis of variance, and qualitative data were analyzed using content analysis. Results indicated that the MI training showed a significant impact on students' confidence in MI and promising impacts on students' MI knowledge and skills. Students valued the training, favoring the SP component, and plan to use MI in future practice. An MI training can be effectively incorporated into an advanced practice nursing program and would better prepare students to address prescription opioid use disorder and effectively encourage behavior change among their patients.

An Innovative Wellness Partner Program to Support the Health and Well-being of Nurses During the COVID-19 Pandemic: Implementation and Outcomes.

Responding to the coronavirus disease-2019 (COVID-19) pandemic is likely to exacerbate anxiety, burnout, fatigue, and distress already being experienced by nurses in ever greater numbers. An innovative Wellness Partner Program was developed with an aim to enhance the health and well-being of nurses on the front lines during the COVID-19 pandemic and beyond. Nurses across the country opted in to the program, and were paired with advanced practice nursing (APN) graduate students who served as the nurses' wellness partners. Areas emphasized in the program included (1) personalized support for wellness; (2) prioritizing physical activity, healthy eating, sleep, and stress management; and (3) establishment of strength-based, sustainable solutions to improve health and well-being. Partnerships were implemented for 188 nurses who were coached by 49 APN students; 104 nurses participated for 6 weeks. In the program evaluation, 98% of nurses shared that the wellness support program helped them engage in self-care and wellness, and 94.7% agreed or strongly agreed that The Wellness Partner Program helped them improve their mental and physical health. In the midst of the pandemic, nurses were supported to cope with stress, focus on self-care and wellness goals, and address challenges to their well-being.

Child Abuse Response Simulation for Advanced Practice Nursing Students.

The purpose of this project was for advanced practice nursing students to gain experience taking a history from a parent or caregiver and communicating the treatment plan for an infant in which child abuse is suspected. Fifty-three students participated in a 1:1 simulated encounter with a standardized patient acting as the mother of an infant with a leg injury that reportedly resulted from a fall from the couch. Students received feedback from the standardized patient via an assessment tool and debriefed with faculty immediately after the simulation. All students demonstrated empathy, acknowledged the mother's emotions, and communicated the concern for abuse. Additionally, all students explained the x-ray findings, need for hospital admission, and referral to investigative agency for further evaluation. Simulations designed to provide advanced practice nursing students with experience interviewing a parent and responding in the case of suspected child abuse are an important method of preparing them for initial clinical encounters.