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Escape Room: An Interactive Way to Teach Hypertension to Nurse Practitioner Students
No full textBackground: Hypertension is a significant comorbidity in the United States. Nurse Practitioners (NP) should be familiar with the diagnosis and treatment of hypertension to prevent complications for their patients. An escape room provides a fun and interactive way for NP students to learn and build skills (Friedrich et al., 2020). Escape rooms promote engagement, teamwork, and communication, and allow nurses to make mistakes in a safe environment while also building on their leadership skills (Bashir Raja et al., 2022).
Purpose: The purpose of this activity was to increase Nurse Practitioner (NP) students’ knowledge of treating patients with hypertension in the ambulatory setting in a fun and engaging way. Four unfolding case scenarios were presented in an escape room format that covered four types of hypertension: essential hypertension, secondary hypertension, “white coat” hypertension, and malignant hypertension.
Methods: Puzzles requiring critical thinking and clinical reasoning skills were developed and participants were timed throughout their completion and eventual “escape.” Surveys measuring students’ perception of their hypertension knowledge were offered during a pre-brief and debrief, and another survey was conducted to measure students’ satisfaction with the escape room activity.
Results: Students reported increased knowledge of how to treat a patient with hypertension after completing the escape room. Most of the students rated their satisfaction high for this interactive type of education.
Conclusion: The escape room was a fun and engaging way to enhance NP students’ knowledge of hypertension. Further, the NP students were satisfied with this learning experience
Enhancing Community Health Workers\u27 Knowledge on Childhood Tuberculosis Screening in Nigeria
No full textTuberculosis (TB) poses a significant global health challenge, especially in developing countries like Nigeria, where it disproportionately affects children. This Doctor of Nursing Practice (DNP) study seeks to enhance the knowledge of Community Health Workers (CHWs) and Community Health Extension Worker Students (CHEWs) in screening for childhood TB. Given the urgent need for early detection and intervention, the research focused on equipping CHWs and CHEWs with targeted educational resources. A pretest/posttest design was employed to evaluate changes in knowledge related to childhood TB screening among the participants. Statistical data analysis was conducted to assess improvements and ensure the reliability of the findings. Findings support that the use of targeted educational resources increased the knowledge of CHWs and CHEWs in screening for childhood TB. The outcomes of this study have the potential to improve childhood TB screening and referral, ultimately contributing to a reduction in the incidence and mortality of TB in children throughout Nigeria
Newly Graduated Registered Nurses Evolving Identity of Social Justice: A Novel Middle-Range Theory
No full textBackground: Nursing has long been rooted in social justice, with many pioneering figures advocating for health equity in marginalized communities (Pittman, 2019; Thurman, 2017). The 31% attrition rate among New Graduate Registered Nurses (NGRNs), many of whom leave within their first year, may reflect moral distress faced in environments where equity is not prioritized (ANA, 2015; Epstein et al., 2020; National Academies of Sciences, Engineering, and Medicine, 2021). There is a pressing need for a stronger focus on preparing NGRNs to incorporate social justice into practice to improve community health outcomes.Purpose: NGRNs undergo significant professional and personal transformations during their transition into practice. Understanding how NGRNs perceive and integrate social justice into their practice is vital for developing effective strategies to address health inequities. This study aimed to explore NGRNs’ perspectives through an interpretative, constructivist grounded theory (Charmaz, 2014, 2017, 2020) to answer: How do NGRNs understand, cocreate, process, and respond to social justice in their nursing practice?Methods and Procedures: Twenty-eight NGRNs with 6 months to 2 years of practice were recruited via email, social media, and snowball sampling. In-depth interviews were conducted via Zoom from April 2023 to February 2024 with an average interview time of 53 minutes. Data analysis continued until saturation was reached, with line-by-line and focused coding yielding seven categories, which were refined into antecedent and attribute categories.Results: The final theoretical coding process produced four global themes and a core category: the co-creation of a social justice identity. The framework, NGRN’s Evolving Identity of Social Justice, emerged and was connected to Emancipatory Nursing Praxis (Walter, 2017) and Duchscher’s Transition Theory (2008, 2009). This framework has important implications for nursing education, policy, practice, leadership, and research. It also highlights the need for person-centered care to achieve health equity.Implications for Nursing and Conclusions: Fostering a social justice identity in NGRNs is crucial for their development and essential to achieving health equity. Findings support integrating social justice principles into nursing education, onboarding, and policy to empower NGRNs as they transition into practice and advocate for equity-focused care and person-centered care
Inclusion of Students with Physical Disabilities in Nursing Education
No full textPurpose: The purpose of the research was to explore the perceptions of nursing faculty that create educational barriers for academically prepared students with physical disabilities. A case report of a woman who uses a wheelchair and earned her undergraduate nursing degree is presented.Background: The Americans with Disabilities Act requires employers to identify the essential functions of employee positions to prevent discrimination against people with disabilities. For in-patient RN roles this might include standing for 12 hours or ability to lift 50 pounds. Pre-licensure nursing programs often use these functions as technical standards in admission requirements. This is not consistent with the diverse in-patient and community roles for RNs of all abilities. Understanding perspectives of faculty and other decision-makers is an important step to make nursing education more accommodating for students with physical disabilities.Methods: The exploratory study was conducted with 111 nursing faculty across the US. An online survey tool was created from the 22 outcomes in AACN’s 2008 BSN Essentials Standard IX - Generalist Practice. Participants were asked their perceptions regarding the ability of a student who uses a wheelchair to achieve these outcomes on a 6-point scale. For the case report, open-ended questions regarding educational experiences were answered in a virtual interview.Results: Although some outcomes were complex statements, they were separated into predominantly cognitive, affective, or psychomotor domains for analysis. Faculty participant agreement that a student who uses a wheelchair could meet the 14 cognitive and affective domain outcomes was 88-100% but for psychomotor domain outcomes it was 66-90%. The case report provides insight into how students with physical disabilities can achieve psychomotor skills in the clinical and lab setting.Conclusions: These faculty believed students with physical disability could meet cognitive and affective outcomes, but had reservations about psychomotor outcomes. This is not surprising based on the alignment of pre-licensure clinical nursing education with hospital-based bedside nursing. Since RNs who experience disability find meaningful practice, a paradigm shift is needed in nursing education to be inclusive of academically qualified students with physical disabilities. In clinical and lab settings, collaboration can allow these students to meet program outcomes with individualized accommodations
Nurse Practitioners Comparison to Other Hospital Providers: Patient Safety
No full textPurpose: Patient safety remains a critical challenge in healthcare services. According to the World Health Organization, approximately 10% of patients suffered harm within healthcare systems, resulting in an estimated million deaths annually due to unsafe practice. The study objective was to compare advanced practice nurses, physician assistants, and attending physicians’ responses to overall patient safety ratings and error reporting.
Methods: An Agency for Healthcare Research and Quality data set provided responses of patient safety and error reporting submitted by 3,659 advanced practice nurses (APN), 1,044 physician assistants, and 5,140 attending physicians. The Hospital Survey of Patient Safety Cultural version 2.0 consisting of 10 composite measures and 32 survey items was used. A secondary data analysis was conducted with the data set. The statistical approaches used to analyze the categorical, original and scale data included analysis of variance, Kruskal-Wallis test, linear regression, and Chi-square tests.
Results: Respondents identified the hospitals setting as teaching (70.6%) and ownership being public non-government, non-profit (73%). Respondents identified their work area as multiple units, medical/surgical units, patient care units, surgical services or clinical services (76%). Findings showed each of the three hospital positions rated patient safety significantly different. APNs rated patient safety lower (µ=3.4) than physician assistants (µ=3.6) and attending physicians (µ=3.8). Linear relationships found significant different indicating level of position correlates to changes in error reporting and overall patient safety rating. APNs reported errors more frequently than attending physicians and physician assistants.
Implications: The key to meeting the goal of “zero” harm set by the National Steering Committee for Patient Safety’s is for healthcare systems to foster and sustain a robust safety culture is recognizing errors have occurred. APNs should lead healthcare organizations in recognizing and reporting errors. Their reporting add value to prevent future errors. Hospital administrators must be aware of errors to begin the process to decrease and ultimately eliminate these costly events. Recognizing the differences in hospital providers error reporting and overall hospital safety rating suggests APNs have applied their knowledge and skills effectively to recognize and report errors and near misses
Do Community-Engaged Initiatives Promote Mental Health and Well-Being in Under-Resourced Settings?
No full textCommunity-engaged initiatives are recognized as promising strategies for addressing disparities in mental health outcomes in resource-constrained settings. An understanding of the scope/effectiveness of these initiatives in diverse contexts remains limited. Our international team systematically examined community-engaged mental health and wellbeing programs in Low-Middle-Income Countries (LMICs) and under-resourced settings in High-Income Countries (HICs), evaluating level of community engagement and impact on mental health outcomes.
Five academic databases were searched for eligible primary studies published in English up to August 2024. Studies involving community members targeting one or more mental health outcomes were included. Data were extracted using a structured tool, quality appraised using validated tools, and synthesized using the Synthesis Without Meta-Analysis (SWiM) framework.
Thirty-five studies (24 LMICs and 11 HICs) reported on 29 initiatives, categorized by community involvement (low, medium, high, community-led). Low-engagement programs (n=2) showed positive participant experiences without significant mental health improvements. Medium-engagement programs (n=11) involving community consultation, reduced clinical mental health symptoms (e.g. Friendship Bench Program). High-engagement programs (n=9), characterized by substantial collaboration with communities, demonstrated significant improvement in clinical mental health symptoms and personal-recovery indicators such as enhanced social inclusion (e.g. Talking Wellness initiative). Community-led programs (n=10) delivered the most culturally relevant and sustained impacts, with initiatives like the Women’s Circle significantly improving wellbeing, although mental health symptom reduction was variable. Low-medium-engagement programs require additional effort to ensure cultural relevance/feasibility. A lack of involvement of people with lived experience of mental health challenges and social inequity was noted.
It was concluded that higher community engagement improves the effectiveness/sustainability of mental health initiatives, with community-led programs achieving the most significant impacts. These findings have implications for community health and mental health nurses collaborating with communities to foster culturally relevant initiatives. Future research should focus on sustainable programs and include individuals with lived experience of mental health challenges/social inequities
An Innovation Accelerator’s Effect on Early Adopters: Advancing Cultures of Change
No full textBackground: According to Rogers’ Diffusion of Innovation Theory (1971), the process of adoption occurs gradually over time and usually begins with Innovators and Early Adopters, the key enablers of innovation success. As the largest healthcare workforce, it is imperative for nurses to advance their knowledge of innovation adoption, yet there are a limited number of nursing programs or healthcare systems that offer innovation-related education. In 2023, the American Nurses Association Innovation department created the first ever national Innovation Accelerator (IA) outside of academia in the United States. The nine-month IA consisted of monthly virtual meetings, multi-modal learning modules, small group networking sessions, and a final innovation project pitch. The IA was designed to prepare nurses as early adopters equipped with the knowledge, skills, and strategies to drive positive change across healthcare.
Method: The aim of this quasi-experimental study was to evaluate changes in IA participants’ perceptions of organizational (Perceived Organizational Innovativeness Scale) and individual innovativeness (Individual Innovativeness Scale) through a pre/post survey based on Rogers’ Diffusion of Innovation Theory. Paired t-test was used to examine any changes between pre-and post-test scores. A follow up IA feedback survey was used to identify participant experiences and lessons learned.
Results: Although the mean scores from the (n=27) individual and (n=23) organizational innovativeness surveys were not statistically significant, there was a 15% increase of individual innovativeness, and a 17% increase in organizational innovativeness in the pre/post survey for the Early Adopter category. Feedback from the IA survey (n=26) revealed that 100% would recommend the IA to their nursing colleagues, 92% of participants strongly agreed or agreed they used the information to lead in their professional roles, and 100% felt more prepared to advance or lead positive change across nursing and healthcare.
Conclusion: The results of this study indicate the importance of promoting nurses as early adopters through Innovation Accelerators. As an increasing number of nurses incorporate innovation into their daily practice, the support from early adopters will be critical to ensure the sustainability needed to advance cultures of change. A seismic shift in our healthcare ecosystem might occur if the innovative ideas brought forward by nurses are more readily adopted
L.E.A.Ding Change to Prevent Workplace Violence
No full textThe purpose of this project was to enhance nurses’ knowledge and evaluate parts of the current workplace violence prevention program. Learning objective: participants will gain strategies to engage nurses in workplace violence prevention.Healthcare workers are 5 times more likely to experience an injury from workplace violence than other professions. According to the Texas Center for Nursing Workforce Studies (TCNWS) 2022 employer Nurse Staffing Study: Workplace Violence Against Nurses survey workplace violence awareness training was the most common training provided. De-escalation training was cited as an effective workplace violence strategy (TCNWS, 2022).
As part of a comprehensive plan to implement workplace violence prevention measures a series of educational events were planned, these classes were above and beyond de-escalation training. Labeled as L.E.A.D events (Leadership Education Advancement Development) the offerings were open to any nurse and other hospital leaders. Beginning in Fall of 2022, a L.E.A.D. event was held twice a year, once in Spring and once in Fall. Various learner engagement strategies were implemented, including simulation, case studies, roundtable discussions, storytelling and escape rooms.
The L.E.A.D. events broached various topics such as evaluation of current policies and applying the policy to a case study, then sharing the discussion with the other attendees. Working in teams the attendees identified policy gaps and outdated information. The activity engaged leaders and direct care nurses in the process of policy development. Other topics have included crucial conversations, applying de-escalation techniques to escape rooms, round table discussion with legal counsel, district attorney and police chief, legislative updates from the state nursing association, shared experiences from those who have experienced violence in the workplace, the neurobiology of trauma, communications with special populations. To date a total of five L.E.A.D. activities have been offered and evaluations have been positive. Learners have voiced their appreciation of the engagement strategies.
Outcomes: There were a total of 211 nurse attendees and a total of 137 non-nurse attendees for the five L.E.A.D. events. All policies related to workplace violence were reviewed and updated or archived
Examining the Influence of Inlow’s Diabetic Foot Screen on Podiatry Referral Rates
No full textBackground: Implementing Inlow’s sixty-second-foot screening tool to increase the referral rate to podiatry in diabetic patients.
Methods: Assessing for foot abnormalities on diabetic patients using Inlow\u27s tool
Results: 96% of the diabetic patients were referred to podiatry. Decreased complications in diabetic patients.
Conclusions: Inlow’s tool is reliable and valid. It proved to be effective in identifying foot abnormalities in diabetic patients, increasing the referral rate to podiatry
Poverty Experience to Address Clinical Outcomes in Community Health
No full textSimulation serves as a valuable augmentation to direct clinical care or practice within healthcare settings. In Community health, students spend time in a variety of agencies experiencing a variety of vulnerable populations. One issue that crosses over these populations is poverty.The poverty rate in America is 11.1 % (Shrider, 2024).A key competency in nursing education related to population health is understanding how poverty affects patients. This simulation related to the poverty allows students to understand many people in poverty are not all homes less but live next door and may be one paycheck away from catastrophe.The experience starts with a group of students receiving a family that is considered in poverty and experiencing issues within the various the social determinants of health (SDoH). The students are expected to determine and prioritize the family’s needs using the SDoH as a guide. They develop a budget, within the given parameters of the family’s expenses. They address and prioritize housing, job, and healthcare needs then select services in the community that could assist the family. The students then charged with going to the necessary stores using their budget to plan food and meals for a week and use the actual store prices to stay with in budget. The second charge is to use the city’s bus system to move from the given location of their family to two services offices they determined were the priority for the family and return to their starting point.During the post brief, students are expected to discuss how they developed a family plan that is evidence based, holistic, respectful, compassionate, and coordinated. They reflect on the experience of how families in poverty face economic and logistical issues that others who do not live in poverty face.Student stated the simulation/immersive experience contributed to being more empathetic for the patients they see. They felt it prepared them to be more sensitive to the economic and logistical issues families face living in poverty. The students gain an increased understanding of the vulnerability and complexities of living in poverty. Such increases in social empathy and promotion of social justice will inevitably positively affect their future practice. The experience meets the entry level professional nurses to define a target population, use problem solving measures, apply understanding of the public health system, develop an plan describe access and use of available resources