Nursing Instruction Research Articles

Abstract 4138578: NICE-Support program effectively improves symptom and psychological distress in patients with heart failure

Background: Patients with heart failure may suffer from symptom distress, affecting their overall quality of life and psychological well-being including depression. Limited researches focused on the effects of intervention on symptoms and psychological distress for patients with heart failure. Research Hypothesis: Nutritional education and exercise intervention can significantly improve symptoms and psychological distress in patients with heart failure. Aims: To investigate the effectiveness of the Nutrition Instruction Combined Exercise and Support program (NICE-Support) on symptom and psychological distress in patients with heart failure. Methods: This randomized controlled trial recruited 240 patients with heart failure from two medical centers in Taiwan by convenience sampling. Participants were divided into two subgroups based on participation in the "Post-Acute Care Integration Program (PAC)." Each group was randomly assigned to the experimental group and control group, including PAC, PAC+NICE, N-PAC, and N-PAC+NICE groups. The experimental group received a 12-week NICE-Support intervention, encompassing nursing instruction, nutritional counseling, exercise, and support. The control group followed routine hospital care. Data were collected through a structured questionnaire, including basic information, the Heart Failure Symptom Distress Scale, Hospital Anxiety and Depression Scale at baseline, 4, 12, and 24 weeks after enrollment. Data were analyzed using SPSS 24, including descriptive, t-tests, one-way ANOVA, Pearson correlation coefficients, chi-square tests, and generalized estimating equations. Results: The overall symptom distress score was 45.02 (SD = 13.50). Anxiety and depression were reported in 23.8% and 30.9% patients, with the mean anxiety and depression score of 5.01 (SD = 4.50) and 5.98 (SD = 4.16), respectively. Compared with the N-PAC control group, the PAC+NICE group and N-PAC+NICE group exhibited significant greater improvements in symptom distress at 4, 12, and 24 weeks post-intervention, while the N-PAC+NICE group showed statistically significant greater improvement in anxiety at 12 and 24 weeks. Conclusion: The NICE-Support program effectively improves symptom and psychological distress in patients with heart failure and could implement in patients with heart failure.

Role of Nurse Instructor in Integrating Theory-Practice Gap: A Cross-Sectional Study in Teaching Hospitals of Peshawar

Background: Bridging the gap between theory and practice in nursing education is essential for ensuring competent clinical practice. However, this gap remains a challenge in nursing programs worldwide.Objective: This study aimed to evaluate the perceptions of BSN students regarding the role of clinical instructors in integrating theory and practice in teaching hospitals in Peshawar, Pakistan.Methods: A descriptive cross-sectional study was conducted in three institutions in Peshawar. A total of 203 BSN students from semesters 4, 5, 6, and 7 were randomly selected. Data were collected using a structured questionnaire adapted from validated tools. Statistical analysis was performed using SPSS version 25, with an ANOVA test to compare mean scores across semesters, and a post-hoc Tukey test to identify significant differences.Results: The mean score for the role of clinical instructors varied significantly across semesters (F = 4.646, p = 0.004). Semester 4 had the highest mean score (75.73), while semester 5 had the lowest (67.00). Group 1 (25.1%) believed the role was not fulfilled, while Group 4 (23.6%) believed it was completely fulfilled.Conclusion: Clinical instructors play a critical role in addressing the theory-practice gap. Tailored teaching strategies are recommended to meet students' evolving needs.

What do Adjunct Nursing Instructors Want?

Adjunct nursing instructors (ANIs) are used to meet the needs of nursing education programs, but challenges of adjusting to unfamiliar academic settings often lead to poor job satisfaction and low retention of ANIs. The Adjunct Instructor Survey (Milliken & Jurgens, 2008) was used to query 25 ANIs regarding the importance and availability of support services pre-COVID-19 pandemic and post-pandemic. Mentoring was identified as most important pre- and post-pandemic, with a reported decrease in mentoring opportunities post-pandemic. Developing quality mentoring programs for ANIs needs to be a priority.

Improvement on the Integrit Rate of the first fime inpatient hemodialysis nursing instruction

<p>治療前進行完整的護理指導可減輕病人對治療與照護的焦慮並提升自我照顧能力。統計本單位2019年11月-2020年3月護理指導完整率僅59.6%，經調查護理指導不完整原因為：護理人員因忙碌而忘記護理指導、透析中衛教時護理師被其他病人叫喚而中斷、護理師憑經驗衛教缺乏一致性、病人因透析中不舒服而未執行護理指導、部份護理指導沒有衛教單張、衛教單張字體不合適且都是文字缺乏圖表說明、介入護理指導時機太晚、缺乏護理指導後交班與查核機制。透過文獻查證後選定七項改善對策：修訂護理指導執行內容、規劃交班內容並將衛教紀錄單資訊化導入提醒設計、審閱與制定衛教單張並集結成透析前訪視手冊、新增首次血液透析前訪視護理指導方式、制定護理指導查核作業、製作多媒體影片、QR code連結指導單張及影片。經改善對策後，住院病人首次接受血液透析護理指導完整率由59.6％提升至100％，並間接提升病人滿意度，達本專案目標且對護理照護品質有正面肯定。</p> <p> </p><p>This project is aiming to increase the integrity rate of the nursing instruction for the first time hospitalized patients hemodialysis. complete rate of nursing instruction can reduce patients’ anxiety about their treatment and care as well as improve their self-care ability. Statistic showed, from November 2019 to March 2020, the Integrity rate of nursing instruction was only 59.6%. </p> <p>After clinical investigation, incomplete nursing instruction is the cause, nine improvement countermeasures were provided after literature review they are: revising the implementation content of nursing instruction, specifying guidance items to be included in the shift handover, formulating health education leaflet, making the pre-dialysis visit pamphlet and multimedia video, Standardizing the information and reminder design of health education recording sheet, adding nursing instruction for the first Pre-hemodialysis visit, developing nursing guidance inspection program and QR code linked guidance leaflet and videos. </p> <p>After these strategies were executed, the complete rate of the first time hospitalized patients receiving hemodialysis nursing instruction increased from 59.6% to 100%, and the patient satisfaction has been indirectly improved. This project successfully achieved its objectives, and the quality of nursing care was also improved positively.</p> <p> </p>

Assessing disaster preparedness of emergency nurses in Saudi Arabia: A study on educational needs

This study aimed to evaluate how well emergency nurses (ENs) at a leading hospital in Saudi Arabia are prepared for disasters by conducting an assessment of their educational needs. The research explains the importance of this assessment for the nurses, discusses the expected outcomes based on existing literature, and describes the process of collecting data from 29 ENs using a specific questionnaire. The study used statistical methods to analyze the data and found significant gaps in the nurses' knowledge and training for disaster preparedness. The results of the assessment can help educators understand the learning needs of the nurses and suggest ways to improve their training. The study proposes a 30-hour training course based on the assessment findings and recommends revising the current methods of instruction for nurses to better prepare them for disasters.

Taking High-Fidelity Simulation to the Next Level: Nursing in Nontraditional Environments.

Nurse educators must prepare nursing students to be competent first responders and providers in nontraditional situations. We developed a course that provides in-depth experiential instruction in disaster nursing, remote/austere nursing, and global health. The Nursing in Nontraditional Environments course provides nursing students with the knowledge and skills to provide quality care to patients in environments outside traditional hospitals and clinics. The course merges survival skills with austere care using evidence-based practice derived from the US Military and the Wilderness Medical Society.

Evaluation of Short Training Program on Nurse’s Knowledge and Practice Regarding Vital Signs Measurement

Background: Vital signs are a reliable way to assess the essential physiological processes of a living being. The reason they are called "vital" is that figuring out how valuable and important they are is a crucial first step in any clinical evaluation. One of the first clinical evaluations is looking at the patient's vital signs. Following orientation, education and training are two crucial components of nursing staff advancement. Objectives: of study: the current study aims to evaluate effectiveness of short training program on nurse’s knowledge and practice regarding vital signs measurement. Methods: A quasi-experiment, a type of research approach, was employed. The subjects of this study were thirty nurses who worked directly with patients at the Heevi Teaching Hospital and were selected at random. Three instruments were used to collect the data: a questionnaire, sociodemographic information, and the nurses' proficiency in taking vital signs. Results: The current study found that nurses' overall mean acquaintance and competence degrees increased with a statistically significant difference 30 days following the program's deployment. The nurses' performance and comprehension both significantly improved once the vital signs measuring nursing instruction was put into practice.

Culture of patient care among international nursing students: a focused ethnographic study

BackgroundThis study was conducted to describe and explain the culture of patient care in international nursing students.MethodsThis qualitative study was conducted using focused ethnography. Participants (n = 21) were purposefully selected from non-Iranian international students and their nursing instructors. Data collection included semi-structured interviews, and field-note taking. Data were analyzed with the Roper and Shapira inductive approach of ethnographic content analysis.ResultsThe cultural model of the study included the acquisition of cultural competence through acceptance of differences and finding commonalities. Subcategories were: “avoiding cultural bias”, “trying to be on the path of adaptation”, “appealing to the support and companionship of colleagues”, “coping with culture shock”, “acculturation”, “getting help from cultural intelligence”, “cultural empathy”, and “language and communication enhancement”.ConclusionCultural competence is teachable. The pattern of formation is through accepting differences and searching for commonalities. Suggestions for promoting the culture of care among international students include effective use of peer groups and teaching different national ethnicities and cultures.

The Past, Present, and Future Implications for Buddhist Nursing in Japan: A Narrative Review

This study aimed to clarify the past, present, and future implications for Buddhist nursing in Japan through a review of literature. Using Ichushi-Web, the medical literature database in Japan, a search was undertaken for papers containing the keyword “Buddhist nursing,” resulting in 10 hits. These were carefully perused, contents extracted and then organized using the matrix method (Garrard, 2020). These were qualitatively described through discussions among five researchers. Buddhism was officially introduced to Japan in 538 CE, after which the practice of Chinese medicine began, also based on Buddhist thought. Japan’s oldest nursing book was written by the monk Ryochu around 1240 CE. From 1868, however, Buddhist nursing fell into disuse following Shinto’s establishment as the state religion. In 1885, nursing education began as a profession, and nurses began caring for the affluent. Terminal-stage patients have concerns about the meaning and purpose of life, as well as the afterlife, and Buddhist nursing is currently practiced in Vihara terminal care facilities. One problem, however, is that no system of certification of qualifications for Buddhist nurses presently exists. Nonetheless eight Buddhist nursing colleges or universities offer instruction in Buddhist nursing. Previous studies on Buddhist nursing have been insufficient to produce evidence. From a historical perspective in Japan, it is believed that the essence of Buddhism, which is “teachings to bring happiness to the living,” can be applied to nursing. We believe that Buddhist nursing can serve as one of the keys to solving nursing problems in a modern society that is fraught with difficulties.

Barriers and Challenges Against the Utilization of Novel Teaching Methods for Nursing Students: Perspectives of Nursing Instructors

Background: The first step in effectively applying novel teaching methods is identifying barriers and challenges to implementing appropriate interventions. A literature review revealed no studies exploring nursing instructors’ viewpoints on the reasons for not using novel teaching methods.Purpose: The present study aimed to explore the challenges and executive barriers against using novel approaches in instructing nursing students from the perspective of nursing instructors. Methods: In this descriptive-analytical study, 163 nursing instructors from three nursing schools in Fars Province, Southwest Iran, were selected using convenience sampling. A researcher-developed questionnaire comprising 17 items scored on a five-point Likert scale was utilized to collect data. These items were categorized into three domains: challenges related to students (n=4), instructors (n=8), and structural-managerial aspects (n=5). The questionnaire’s reliability coefficient was found to be 0.89 using the test-retest method. The Kolmogorov–Smirnov test was used to test the normality of variables and the independent t-test was employed to examine the relationship between genders and educational degrees across all three domains. Results: The mean scores for challenges and barriers related to the instructors, students, and structural-managerial aspects were 33.24(7.16), 16.31(3.93), and 22.14(3.64), respectively. A significant relationship between gender and educational degree was observed across all three domains (p<0.001).Conclusion: The barriers and challenges against using novel teaching methods for nursing students from the perspective of nursing instructors included challenges related to instructors, students, and structural-managerial aspects. The support and encouragement of educational institution managers in executing these methods could help promote the utilization of these techniques and improve the quality of education.

Online Teaching Effectiveness of Nurse Instructors: A Systematic Literature Review

The online teaching effectiveness of nurse instructors builds a systematic literature review that aimed to identify and critically assess available research publications for identifying online teaching effectiveness in nursing education. The review process undergoes five stages namely: framing of questions for review, identifying relevant work, data screening, assessing the quality of studies, and interpretation of findings. The articles were thematically analyzed. The articles' patterns were observed and grouped accordingly. The themes were subsequently aggregated and organized into a thematic map. The thematic map served as the basis for the generation of item statements. The three main themes that emerged based on the thematic analysis of the systematic literature review were: active learning, instructor-learner connection, and modern teaching. Keywords: Nurse instructors; Online education; Online teaching, Online teaching effectiveness

Effect of Post Cesarean Nursing Instructions on Woman’s pain Level and Bowel Motility: Comparative study

Effect of Post Cesarean Nursing Instructions on Woman’s pain Level and Bowel Motility: Comparative study

ADVANCING NURSING STUDENTS’ DEMENTIA KNOWLEDGE THROUGH ENGAGEMENT WITH PEOPLE LIVING WITH DEMENTIA

Abstract The numbers of people living with dementia are overwhelming. Dementia education is important to prepare nursing students to care for this population. To better understand the reality of dementia, we incorporated an expert by experience in teaching a pilot course on dementia. This training was offered to senior nursing students as an elective in their final semester of undergraduate work. Our goal was to teach students about dementia, what it’s like to live with dementia, and actions they can take to support people living with dementia in nursing homes and other settings. The course incorporated clinical experiences at a community memory care facility and small group discussions co-led by a person with dementia and a nursing instructor. Students also participated in an adult day program by leading activities and interacting with people with dementia. Eleven students participated in the pilot course. At program completion, students were invited to share their experiences in a focus group. Qualitative analysis of student feedback identified the benefits of the pilot, including reduced stigma of dementia, increased empathy of those living with dementia, and improved skills in explaining the impact on those diagnosed with dementia. Students appreciated the clinical experiences because it allowed them opportunities to apply their knowledge of dementia and experience the individuality of dementia. This pilot empowered nursing students during their final semester to appreciate, provide care, and support the needs of the people living with dementia.

Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: A multicenter correlation study

BackgroundIn nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context. ObjectiveTo analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates. MethodsThe study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators’ CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P < .05. ResultsThe total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p = .007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p = .187), with statistically significant differences only observed in the intellectual and cognitive indicator (P = .022). ConclusionsCT levels are high in teaching healthcare professionals in the clinical environment.

Committing Students to God.

Lyla L. Taft, MSN, RN, CMSRN, CNE, is a nursing instructor at Darton College of Health Professions at Albany State University in Albany, GA. She has been a nurse for 13 years, specializing in medical-surgical nursing and nursing education. The author declares no conflict of interest.

Knowledge of Pakistani Nurses about Theory Practice Gap in Nursing

Aims: To evaluate the knowledge of the participants about theory practice gap and to determine the association of knowledge with demographic variable like age and educational level of the participants. Methodology: A cross sectional study design was used to conduct this study. This study was conducted at Government and private Universalities or Hospitals Lahore. Approximately 09 months after the approval of synopsis from Research Ethical Committee (REC). Sample size of 192 cases is calculated with 95% confidence interval, 7% margin of error and convenient sampling was used. Target population of the present study was nursing instructors and clinical nurses. SPSS version 21.0 was used for data analysis. Quantitative variables mean and standard deviation was be used. For categorical variables frequency and percentage was used.Chi-square test was be used. P-Value ≤ 0.05 was being considered statistically significant. The study was conducted in private and public sector in Lahore. Results: In out of 192 respondent about 65.63% having score less than 13.8 and 34.38% scored between 13.8-18.4. However non of the participents have score greater than &gt; 18.4. Its mean that most of the study particepents fall in the poor knoweledge score. It further illustrated that regarding to assess the knowledge level of the participents about theory practice gap; show that there were no awearness regarding the thory practice gap in nursing. The finding of this study as helpful for the future researcher and educational institute how to reduce this theroy prectice gap. Conclusion: It is not enough to have good knowledge about the existence of the gap; efforts must be made to minimize it in order to close the theory-practice gap. The theory-practice gap can be reduced or minimized through effective collaboration, improved knowledge acquisition, continuous education, periodic curriculum updates, and the incorporation of evidence-based practices into the curriculum of learning. Keywords: Theory-Practice Gap, Knowledge, Pakistani Nurse, Educators, Private and Government Institute

Environmental Challenges to the Clinical Supervision of Nursing Instructors

Context: Nursing students must have the minimum necessary competencies to enter the nursing profession, and supervision in clinical education is one of the critical strategies to improve students' clinical skills. Clinical supervision in clinical education for nursing students leads to developing the desired standards in patient care. Accordingly, as was the objective of this study, an awareness of the challenges facing nursing instructors' clinical supervision can help improve the effectiveness of clinical supervision. Methods: This qualitative study was conducted using a conventional content analysis approach. The participants were 18 individuals, including 11 instructors, three students, and four experienced nurses, who were selected using purposive sampling. The sampling process continued until data saturation. The data were collected using semi-structured interviews and analyzed via the conventional content analysis approach. Results: Clinical supervision in nursing education is influenced by a non-constructive setting, which is characterized by (1) student overcrowding, (2) clinical education with limited equipment, (3) negative attitudes in the clinical setting, (4) physician-oriented education, and (5) the inefficiency of the education-treatment system to support students. Conclusions: Non-constructive supervisory settings disrupt the instructor's performance as a supervisor and increase the complexity of clinical supervision. Thus, recognizing the challenges in the environment and solving them by educational managers can pave the way for the effective implementation of clinical supervision in nursing education.

Optimizing Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study.

Deep inferior epigastric perforator (DIEP) flap surgery commonly involves multiday hospitalization, although data suggest 95% of complications after unilateral DIEP flap breast reconstruction occur within the first 24 hours. The aim of this study was to decrease hospitalization time and optimize care of patients undergoing unilateral DIEP flap breast reconstruction. Our study followed Six Sigma's DMAIC (define, measure, analyze, improve, control) framework. First, we delineated the stakeholders involved in the process and defined workgroups based on temporal relation to the operation. We measured performance according to project SMART (specific, measurable, achievable, relevant, time bound) goals and subsequently conducted an analysis of inefficiencies. We then created new interventions for quality improvement. Control will entail ongoing monitoring to ensure progress is sustained after study completion. Our interventions lasted 6 months and included 70 patients. By actively striving to advance patients through postoperative milestones during their inpatient stay and creating an outpatient nursing roadmap including aspects of inpatient care, we decreased the median length of stay from 67.8 to 44.8 hours ( p < .001). After receiving nursing instruction, 77% of patients agreed that they felt ready to be discharged. Our study suggests that the DMAIC framework can decrease hospitalization time after DIEP surgery and spare resources for additional patients.

Who Did God Want You to Be?

Kelly Cole, MSN, RN, CAPA, is a nursing instructor in Tennessee. She graduated from St. Mary's School of Nursing in 1985, the King College RN-BSN program in 2010, and obtained her MSN in nursing education in 2012. The author declares no conflict of interest.

MO1051: Standardized Simulation Education Program with Summative Assessment on Exchange Procedure of Ultrabag System for Peritoneal Dialysis: Innovations in Practical Recommendations

Abstract BACKGROUND AND AIMS Inexperience in practicing peritoneal dialysis (PD) and lack of standard education program under the instruction of qualified renal nurses are known causes of peritonitis in patients with chronic renal failure [1]. Thus far, the standardized and validated curriculum for Continuous Ambulatory Peritoneal Dialysis (CAPD) training has not been well-established under simulation-based education model [2]. We aimed i) to develop a well-structured and standardized educational training program on exchange procedure of Ultrabag system and ii) to evaluate the degree of acquisition in domains of cognitive (knowledge) and psychomotor (skills) by summative assessment using valid and reliable knowledge evaluation index and performance checklist. METHOD Following an invention of 3D-printed CAPD device, ‘Helping Hands’ in closed system operation, the Renal Unit in the Department of Medicine and Multi-Disciplinary Simulation and Skills Centre (MDSSC) in Queen Elizabeth Hospital (QEH) formulated a standard 5-day CAPD training to equip PD patients with knowledge and skills for safe Ultrabag exchange. In order to optimize training effectiveness and assessment standards, the program was designed with ‘6 (+2 additional) guiding questions’ from the International Society for Peritoneal Dialysis (ISPD) document [3]. Scoring Checklist with specific and relevant items, such as fixation of the connecting catheter, parallel point-to-point connection and procedures in placing disinfection cap, could strengthen internal validity. RESULTS In 2021, 17 CAPD patients with partial impairment in vision (12, 71%) or eye-hand coordination (13, 77%) attended this education program. Post-training assessment showed that participants had improved cognitive knowledge (M = 71%; A Grade (&amp;gt;80 marks) = 5, 29% B Grade (60–80 marks) = 9, 53%; C Grade (&amp;lt;60 marks) = 3, 18%) and psychomotor skills (100% achievement in simulation task). Except for 1 participant who required additional training session and re-assessment, 94% of them passed the simulation examination by completing all procedures without any assistance in one-take. A validated educator-guided scheme of psychomotor skills in proper use of CAPD is recommended with six operational phases: CONCLUSION Repetitive performance in task-specific procedure of bag exchange, coupled with constructive feedback from experienced renal nurse educators and well-validated assessment (with a standardized scoring sheet and checklist), resulted in improved skill performance. The training program, correspondent with traditional concept of Miller's pyramid (1990), demonstrated how CAPD novice turns skillful user by developing competence in cognition with factual knowledge of dialysis (‘Knows’) and verbalization of rationale and flows of PD (‘Knows How’); and competence in behavior with simulation practice with CAPD device (‘Shows’) and summative assessment demonstrating mastery of safe bag exchange skills to be integrated into everyday practice (‘Does’). Further studies may be warranted to investigate whether knowledge and skills acquired before use of CAPD could be carried over time and on how education program accounts for risk minimization of CAPD-related peritonitis and survival rate.