Baccalaureate Nursing Program Research Articles

Barriers and facilitators to the formation of professional identity among nursing students: A four-year longitudinal qualitative study

BackgroundNursing professional identity (NPI) is essential for nurses to develop their nursing profession. It reflects the competencies consistent with the professional practices of nurses and contributes to them providing better healthcare and public health. The formation process of NPI started with undergraduate nursing education and continued throughout the nursing career. ObjectiveTo explore nursing students' perceptions of facilitators and barriers to the formation of NPI during their study. MethodsA 4-year longitudinal, qualitative research design with yearly semi-structured interviews undertaken from 2019 to 2022. The reflexive thematic analysis methodology was applied for the data analysis. ResultsNinety-three nursing students were recruited, joining a group or individual interview. The four-year nursing baccalaureate program revealed a dynamic formation process of NPI: “Outsider of nursing”, “Entering the nursing courses”, “Building nursing competence”, and “Thinking and acting like a nurse”. A total of 12 themes were identified to present the barriers and facilitators to the NPI formation at different stages. Specifically, the six barriers include conflict between their ideals and reality, sociocultural stereotypes about nursing, the negative impact of COVID-19, the pre-internship concerns, struggling to meet expectations, and potential danger and discrimination in the healthcare settings. The enablers were: self-motivation and inner belief towards the nursing profession, the power of role models, the improvement of nursing capacity, well integration into the healthcare professional teams, understanding of the clinical environment, and recognition and encouragement from others. ConclusionsThe formation of nursing students' NPI is an ever-changing process, with various intrinsic and extrinsic influences during their four-year study. Nursing educators are suggested to prepare and develop students' professional comportment in their theoretical and clinical practice to develop their professional identity as a nurse.

Benefits of Using a Free Cloud-Based Electronic Health Record for Simulation in a Baccalaureate Nursing Program.

The rising cost of simulated electronic health record (EHR) software for students in a baccalaureate nursing program was risking student success. The need for faculty to decrease this financial burden on students was apparent. Simulation faculty created a free and cloud-based simulated EHR. High-fidelity features of the simulated EHR include barcode scanning capabilities and real-time diagnostic results. Students report that the simulated EHR is easy to navigate and they are particularly satisfied with the free cost. The EHR template, which can be customized for each simulated patient, and is now being used inside the classroom as an active learning strategy.

The Scope of LGBTQIA+ Health Content in Prelicensure Nursing Curricula

Background: Little is known about the status of lesbian, gay, bisexual, transgender, queer or questioning, and inter-sex and asexual (LGBTQIA+) health content in prelicensure nursing curricula. This study explored curricular and pedagogical practices of LGBTQIA+ health content in nursing curricula in the United States. Design: A quantitative, cross-sectional comparative descriptive design was implemented. Method: Stratified random sampling was used to email a survey to deans and administrators of prelicensure associate degree in nursing (ADN) and baccalaureate nursing (BSN) programs. Results: Private ADN programs included more LGBTQIA+ health content than BSN programs and more LGBTQIA+ health content than public ADN programs in nursing curricula. Conclusion: Although progress has been made to include LGBTQIA+ health content in nursing curricula in the U.S., creative educational strategies can be used to help meet the varying needs of different programs. [ J Nurs Educ . 2023;62(11):623–630.]

Associate Degree to Baccalaureate Nursing Degree: Dual Enrollment in an Asynchronous Online Program.

Without formal collaboration with community colleges, a summer dual enrollment program was designed for associate degree in nursing (ADN) students to complete asynchronous online baccalaureate nursing (BSN) courses. The program aimed to reduce the time for BSN degree completion and increase the proportion and diversity of BSN nurses. Students enrolled in BSN courses during their ADN program completed up to seven courses during three summers, with seamless matriculation into the BSN program. A longitudinal study explored the demographics and experiences of students from 32 ADN programs. There was greater diversity of dual-enrolled students compared with the RN workforce in the state. Students were satisfied with the program and were able to apply their BSN knowledge when completing their prelicensure courses; however, some found students faced challenges in financing their education. The study and subsequent program growth demonstrated the feasibility of using this approach to engage ADN students earlier in their educational journey. [J Nurs Educ. 2023;62(11):606-613.].

Enhancing Geriatric Competencies: Integrating the 4Ms Framework in a Baccalaureate Nursing Program.

Today's nursing students will care for tomorrow's older adult population. Integrating the Institute for Healthcare Improvement's Age-Friendly Health Systems (AFHS) 4Ms framework can improve students' knowledge and ability to care for older adults. The 4Ms framework was pilot tested in a first-semester prelicensure course. Students were evaluated on knowledge and application of the framework through didactic, simulation, and clinical learning experiences; qualitative and quantitative data were obtained. Students' average score on three knowledge checks was 77.2% (range, 73.4% to 81%). Students were assessed for application of the 4Ms during clinical experiences in the Fall (76%) and Spring (92%) semesters. Qualitative data demonstrated that students' ability to apply the 4Ms in patient care increased. Integrating the 4Ms framework in the curriculum fostered nursing students' awareness of the essential components of AFHS. Learning experiences provided students the opportunity to care for older adults and gain competence in age-friendly care. [J Nurs Educ. 2023;62(10):589-592.].

Minority Student Perspectives of Barriers, Supports, and Christian Virtues in an Undergraduate Christian Nursing Program.

Diversity and inclusion are critical priorities in nursing education programs. Literature has focused on minority student experiences of barriers and supports-but not through a Christian worldview. This qualitative study using a phenomenological-hermenuetic approach gave voice to the experiences of 15 self-identified minority student graduates from a Christian baccalaureate nursing program. Data analysis revealed opportunities for growth in providing a supportive climate within the program and how Christian virtues of hospitality, humility, and reconciliation can be employed to achieve this goal.

Implementation of Student Nurse Mentoring in an Entry-Level Baccalaureate Nursing Program.

Pickens-Taylor, Pamela DNP, RN, FNP-BC; Miller, Barbara PhD, RN, ACNS-BC; Spurlock, Amy Y. PhD, RN; Jones-Nelson, Tasha DNP, RN, A-GNP-BC Author Information

Effect of Manikin and Virtual Simulation on Clinical Judgment

Evidence suggests competency in clinical judgment may be lacking in new graduate nurses. Graduates from accelerated baccalaureate nursing (ABSN) programs have even less time to develop clinical judgment competency. Various simulation modalities, including high-fidelity manikin and virtual reality, have been used to develop clinical judgment in prelicensure students. However, the outcomes of these simulation modalities on clinical judgment in ABSN students is not well understood. An integrative literature review was conducted using five databases with primary research that examined the effect of manikin or virtual simulation on clinical judgment in BSN students. Fourteen studies were included in this review. The findings were organized using Tanner's Clinical Judgment Model. Findings from this review were mixed, with a lack of evidence comparing the two modalities. Future research should include comparison studies aimed at examining the effects of these modalities with ABSN students. [J Nurs Educ. 2022;61(12):693-699.].

Perceptions and experiences of psychological trauma in nursing and psychiatric nursing students: A small scale qualitative case study.

Entry-level health care professionals are socialized to accept the norms and values associated with institutions in which violence and suffering is considered an anticipated and even routine and normalized part of frontline care. The objective of the study was to illuminate the subjective experience of psychological trauma in graduates from a baccalaureate nursing and psychiatric nursing program using the McGill Illness Narrative Interview, an ethnographic interview guide. Participants included graduates from each program in a western Canadian province who reflected back on their experiences of trauma as students and newly-graduated nurses within their first year of practice as a regulated health professional. Results: Six key themes were identified. Witnessing sudden change in patient or client status and unexpected death; Emotional labour; Faculty incivility; Sabotage, bullying and verbal abuse from the health care team; Exposure to physical violence and sexual inappropriateness; and Mobilizing supports. All exposures were linked to the participants' definition of psychological trauma. Conclusions: The study findings highlight the power dynamic, abuses, and vulnerability between students, faculty, and their clinical counterparts without adequate recourse. There is a need to foster emotional intelligence, self-efficacy, and resilience when potentially traumatic and stressful experiences occur with student nurse and early-career nursing populations.

Use of Curriculum Mapping to Promote Licensed Practical Nurses' Attainment of a Baccalaureate Nursing Degree.

To increase the number of baccalaureate-prepared nurses, efforts have focused on degree completion for RNs. Less attention has been given to foster baccalaureate nursing (BSN) degree pathways for licensed practical nurses (LPNs). To facilitate the development of an LPN-to-BSN degree pathway, faculty at one BSN program used curriculum mapping as a form of inquiry. A six-step curriculum mapping process was used to examine content congruency and alignment between North Carolina LPN concept-based curriculum and foundational courses in the BSN program. Analysis of the data revealed an alignment between LPN courses and three foundational BSN courses. Findings were used to inform faculty members of the decision-making process for a revised LPN-to-BSN pathway. Curriculum mapping can be used as a tool to facilitate the development of the LPN-to-BSN pathway. LPN-centered curriculum options may be key to increasing the number of BSN nurses. [J Nurs Educ. 2022;61(11):646-649.].

Dropped Courses and Persistence in Online Undergraduate Nursing Programs.

Recent studies have linked dropped courses with an increased likelihood of persistence in nursing education. This study examined the association of dropped courses, demographic characteristics, and persistence among online undergraduate nursing students. A retrospective cohort study was conducted with 29,926 former undergraduate nursing students enrolled from 2015 to 2019. The study sample included 2,073 students formerly enrolled in an online baccalaureate nursing (BSN) program and 27,853 students formerly enrolled in an online RN-to-BSN program. RN-to-BSN students were more than twice as likely to drop a course than BSN students. For students in both programs, higher numbers of courses that were dropped before the course start date were associated with an increased likelihood of graduation. Understanding the extent to which course drops occur and their link to persistence in undergraduate nursing programs can assist academic program leaders in developing strategies to help students be successful. [J Nurs Educ. 2022;61(11):609-615.].

The Quality of Care Delivered in a Simulation Center: A Benchmark Study.

A standardized survey to describe the quality of care received from prelicensure nursing students during simulation can measure simulation program effectiveness. The purpose of this study was to compare national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data with data received from standardized patients (SPs) using a modified HCAHPS survey. SPs completed a modified HCAHPS survey immediately following each in-person simulated encounter. One year of SP responses (N = 385) from one baccalaureate nursing program was compared with the national HCAHPS survey data from the same time. All SP responses were less than the national proportions. However, when the level of stringency was adjusted, the responses more similarly aligned to the national proportions. Findings suggest HCAHPS data can be used to model correlates of the quality of care SPs receive during simulation events.

Use of Nursing Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States.

Ongoing discussions address how and when to introduce nursing concepts in nursing education. To examine whether baccalaureate nursing programs use 4 nursing concepts in their program and course descriptions. Researchers explored websites of 300 US bachelor of science in nursing (BSN) programs and assigned scores based on how many of 4 nursing concepts (context, holism, health, and caring) were represented in program and 3 course descriptions. Mean program and course scores were 2.51, 0.96, 1.17, and 1.18, respectively. Programs and courses included between 0 and 4 concepts in their descriptions. There was a significant difference in program scores between BSN programs in 4 US regions. The most frequently identified concept was "context" in program descriptions and "holism" in course descriptions. Discipline-specific concepts are missing in many baccalaureate programs and course descriptions, which raises questions about how and when nursing students are learning what nursing is.

Building Psychological Capital, Grit, and Well-Being in a Baccalaureate Nursing Program: A Pilot Study

Psychological capital constructs of hope, efficacy, resilience, and optimism can be developed to promote students’ academic and professional success. Grit, consisting of passion and the capacity to persevere over time despite challenges, can also be developed and measured. This pilot project aims to study the implementation of evidence-based interventions within course concepts to improve psychological capital, grit, and wellbeing. A 24-question PsyCap Questionnaire-24 (PCQ-24) and 8-question Grit-8 survey were deployed to 2 cohorts of baccalaureate nursing students fall semester to provide preintervention baseline data. Repeat surveys will be given spring semester. These data will provide formative feedback on interventions.

Use of Private, Parochial, and Public Schools in Baccalaureate Nursing Programs for Pediatric Practicum.

Clinical sites are increasingly difficult to secure due to shorter hospital stays, increased clinical site competition, and limited practicum sites. Little is known about the use of schools for pediatric clinical practicum. To explore utilization of private, parochial, and public primary and secondary schools for pediatric clinical practicum sites. Faculty (n = 108) completed a 38-item online survey. Twenty-seven faculty members (25%) reported using schools for pediatric practicum. Most nursing students (85.1%) spent 23 total hours or less in schools obtaining anthropometric measurements, reviewing immunizations, and providing health education to children, parents, and teachers. Using schools for the pediatric practicum is thought to be a common practice; our findings suggest otherwise. School-based practicums provide students with skills beyond acute care competencies. Nursing faculty need to seriously consider which pediatric clinical settings provide the best experience to prepare future nurses.

Interdisciplinary Faculty: A Tool to address Faculty Shortages in Baccalaureate and Graduate Nursing Programs

Interdisciplinary Faculty: A Tool to address Faculty Shortages in Baccalaureate and Graduate Nursing Programs

A Continuing Mission: Development of a Veterans' Baccalaureate Nursing Program.

With more than two million veterans returning from the wars in Iraq and Afghanistan, programs are needed that prepare veterans for careers in civilian life. Veterans desire to continue their education and require assistance accessing their GI Bill, other financial benefits, receipt of college credit for military training and experience, and adapting to the college environment. A veterans baccalaureate nursing (VBSN) program addresses the challenges of veterans getting into and staying in school. This VBSN program was developed to provide academic structure and support from a dedicated veteran case manager. Policies were created to address the need for student veterans to petition for course credit based on their military training and experience. The VBSN program has been successful, growing from three students to 29 currently enrolled and 34 graduates. This program meets the needs of student veterans while adding to the nursing workforce. [J Nurs Educ. 2021;60(11):646-650.].

Threading QSEN Competencies Across a Baccalaureate Nursing Program: The Development of Dedicated QSEN Labs.

In response to the development of the Quality and Safety Education for Nurses (QSEN) competencies and noting lower standardized test scores, nursing faculty at a midwestern United States university developed three safety and quality labs throughout a traditional baccalaureate curriculum. These labs intentionally integrated the QSEN competencies and occurred over three semesters of the nursing program. Students' learning activities aligned with the QSEN competencies and were leveled across the labs. Throughout all the labs, all six QSEN competencies provided a framework for students to learn the knowledge, skills, and attitudes essential to the profession of nursing. Students spent most of their time in the labs learning the QSEN competency of safety, followed by teamwork and collaboration, quality improvement, patient-centered care, informatics, and evidenced-based practice. The QSEN competencies provided a framework to teach pre-licensure nursing students the knowledge, skills, and attitudes essential in the profession of nursing. Safety and Quality I focused on foundational skills and individual patient safety. Safety and Quality II introduced intermediate skills with an emphasis on safety. The third and final lab introduced students to advanced quality improvement, teamwork and collaboration, and system safety. After the completion of the labs, the students stated they had gained knowledge and confidence in the application of all six QSEN competencies. [J Nurs Educ. 2021;60(9):526-528.].

Challenges of Clinical Education in a Baccalaureate Nursing Program: Student Perspectives

Introduction: Clinical education is an essential element in a baccalaureate nursing program, providing nursing students with the required knowledge, skills, abilities, and attitudes required to deliver professional nursing care after graduation. Objectives: The purpose of this study was to identify the challenges associated with clinical instruction from nursing student perspective. Methods: A cross-sectional design was used to identify the challenges associated with clinical instruction from nursing student perspective. Convenience sampling was used to recruit 187 nursing students from three different Universities in Jordan [one governmental and two private]. Results: The major challenges to clinical education were: fear of committing mistakes; lack of facilities for students; lack of knowledge among community and patients about the nursing profession; fear of infection; lack of availability of equipment in the clinical setting; student lack of preparedness and skill in planning care; and lack of collaboration from clinical staff. Conclusion: Understanding the identified challenges is necessary to formulate strategies to address them, to improve curriculum designed and clinical education for nursing students accordingly.

Improving Physical Assessment and Clinical Judgment Skills without Increasing Content in a Prelicensure Nursing Health Assessment Course.

One hundred twenty-six assessment skills are taught in prelicensure nursing health assessment courses, yet 30 skills are used on a routine basis in practice. New nurses struggle to apply their acquired knowledge in clinical settings. Method: A literature review was completed. Based on the results, a first semester health assessment course in a southeastern accelerated baccalaureate nursing program was redesigned. Lectures and skills labs were adjusted to focus on the most critical assessment skills. To foster critical thinking and clinical judgement, a health assessment post conference was added where students completed concept maps, system specific case studies, nursing priority setting, and patient teaching plans. Results: Outcome surveys were completed by second semester faculty. Prior to course adjustments, 33 percent of students did not meet the benchmark. Following course changes, all students met or exceeded the benchmark. Conclusion: Focusing on critical assessment skills will increase student nurses’ ability to deliver safe patient care.