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With so Much Trauma in the World, it\u27s a No-Brainer : Dissociative Disorders in Nursing Education
No full textBackground: According to the World Health Organization (2024), about 70% of people worldwide will experience trauma at some point in their lives. Dissociative disorders (DDs) can result from experiencing and witnessing trauma, including child maltreatment, abuse, neglect, and more, and although the prevalence of DDs is up to 10% of the general population (American Psychiatric Association, 2022), psychiatric-mental health (PMH) registered nurses lack training and education on how to treat individuals diagnosed with these disorders (Snyder & Keepers, 2023).Methods: Sixty-two PMH nurse educators completed an anonymous online survey that included quantitative (yes/no and multiple choice-style) and qualitative (free-text) questions about their perceptions of teaching DDs to undergraduate and graduate nursing students. Braun and Clarke’s (2006) six-phase framework was used to conduct an inductive, reflexive thematic analysis of the qualitative data. Descriptive statistics from the quantitative data were included to add context and clarity for participants’ free-text responses.Results: Three primary themes were created: differing opinions on the value of teaching DDs, lack of resources, and stigma. Participants mistakenly described DDs as rare, too complicated for students to understand, and outside the scope of practice of a generalist RN. Participants also reported common teaching barriers, including lack of time, lack of resources, as well as their own ignorance about and lack of experience with DDs.Implications for Nursing Practice, Education, & Research: Though roughly 75% of participants reported that they teach DDs to their nursing students, they endorsed concerning misperceptions about the diagnoses. By failing to properly educate future RNs about disorders that affect up to 10% of the population, individuals with DDs are at risk of receiving inadequate and inappropriate nursing care and experiencing poor outcomes. Future research should investigate improvements to nurse educator preparation and training, nursing curricula, textbooks, and other materials that will improve the quality of care and health outcomes of individuals with DDs and other trauma-related disorders
“I Would’ve Froze”- A Multi-Patient Simulation with Diverse Patients in a Rural Setting
No full textNine percent of new graduate nurses meet entry-level expectations for clinical judgement skills (4). The 2021 Essentials called for a transition to competency-based education to better prepare nursing graduates. Simulation allows an opportunity to care for multiple diverse patients in unique settings to develop clinical judgement and communication skills necessary for delivering quality care while being immersed in real-life system process limitations. “Exposure to clinical scenarios including rural concepts helps students develop a broader understanding of rural healthcare disparities and cultural competence. Integrating rural simulation into nursing education can boost students\u27 confidence in their clinical abilities (6). A gap was identified in exposure of students to rural system processes; a rural setting was selected for students to coordinate resources and provide quality care to diverse populations within a complex healthcare system.
The framework was the learning outcome model. Senior students in two BSN programs participated in a multi-patient simulation to enhance their interpersonal and therapeutic communication skills. A non-experimental descriptive study measured satisfaction and self-confidence while caring for and communicating with patients. Students were required to complete the simulation and voluntarily participated in the research study by completing the NLN Student Satisfaction and Self-Confidence in Learning survey and four open ended questions. The sample consisted of 75 of 82 participating students.
Quantitative analysis was completed. 94.7% of students were satisfied with their learning and 96% agreed that they can apply this simulation to the clinical setting. After debriefing, they expressed feeling nervous and confident as they transition into the new graduate nurse role. They recognized the importance of prioritization, communication and teamwork. They appreciated the opportunity to care for a diverse, complex patient population, including a transgender patient, in a rural setting.
This teaching approach challenged students to take a deeper dive into systems thinking and coordination of care in a rural healthcare setting. Students utilized communication skills to engage with a diverse patient population and the healthcare team. This study can be replicated as it was completed at two independent sites. Nursing programs need to explore innovative ways to incorporate systems thinking as they relate to coordination of care
Barriers and Facilitators of Implementing a Novel Pediatric Nurse Preceptor Program in Malawi
No full textPurpose: Examine barriers and facilitators to implementation of a novel pediatric critical care preceptor program in Malawi.
Background: Malawi is a low-middle income country in sub-Saharan Africa with significant gaps in the availability of pediatric critical care nurses. We conducted a needs assessment in 2022 and developed a novel preceptor program to address these shortages.1,2 The program was found to be effective;3 however, to understand barriers and facilitators to the implementation of this preceptor program in Malawi, we conducted followed-up interviews with participants.
Methods: Using the Consolidated Framework for Implementation Research (CFIR), interviews were conducted via Zoom (N=20).4 A predetermined codebook was used to code transcripts using the five CFIR domains of: innovation, outer setting, inner setting, characteristics of individual, and process. Barriers and facilitators were identified per domain and coded using the CFIR constructs and themes were developed using qualitative content analysis.5
Results: Participants reported the program was comprehensive, well designed, and delivered effectively. Partnerships – between the university, hospitals, and non-profit organizations are essential to the program’s initiation and likely important to the program’s sustainability. Participants voiced challenges with lack of physical and human resources, leading to prioritization of patient needs over program attendance at times. Participants were motivated by this program and appreciated the advantage of this program over previous programs offered for continuing professional development. In terms of process, participants felt they needed additional time to devote to this program and fully engage.
Conclusion: This preceptor program had significant strengths across all five CFIR domains, yet participants also discussed areas to improve upon in the future. Participants voiced their enthusiasm for it to expand within and beyond Malawi. Understanding barriers and facilitators to a program is critical to understand from multiple perspectives before scaling-up or scaling-out. Improving on the challenges and building upon the program’s facilitators will strengthen the program in future iterations. Providing nurses with knowledge and skills to precept students may decrease the shortage of quality pediatric critical care nurses through two avenues 1) empowering nurses with confidence and competence and 2) improving the pipeline of well-trained students
Evaluation of Practical-Based Instruction in Oncology Nursing Curriculum for College Students
No full textBackground: Vocational education not only focuses on knowledge transfer but also emphasizes practical application. The cultivation of practical-based learning is a crucial core of vocational education, balancing theory and practice while addressing students\u27 diverse development.
Purpose: The purpose of this study was to develop an oncology nursing practice curriculum aligned with core competencies and to evaluate its effectiveness. The curriculum was designed around a practical-based learning approach, encouraging students to engage in discussions that foster learning engagement, enhance self-efficacy.
Methods: This study utilized a single-group pre-test and post-test design with a convenient sample of 27 students. The questionnaire assessed self-directed learning, learning engagement, and self-efficacy. The five most important units related to nursing care include: post-surgical wound care for cancer patients, handling and protection of chemotherapy closed systems, care for central venous catheters in chemotherapy, care for tumor fungating wounds, and nutritional assessment for cancer patients. Data was analyzed by SPSS 25.0.
Result: The study included 22 females and 5 males, with an average age of 18.1 ± 0.52 years. There was a significant difference in learning motivation scores, the pre-test score was 19.86 ± 3.16 and post-test score was 21.36 ± 3.25(p \u3c .05). Additionally, there was a significant difference in interpersonal communication scores, the average value of pre-test was 12.54 ± 2.61 and post-test value was 14.22 ± 2.28 (p \u3c .05). The satisfaction score for the depth of learning was 88%, while the learning engagement satisfaction for the oncology nursing curriculum was 80%.
Conclusion: Practical-based learning can enhance self-directed learning among college students in their oncology nursing curriculum. This study integrates practical-based learning as a key strategy for the initial learning experience in oncology nursing for students
Shared Decision-Making to Increase the Pre-Establishment Rate in First-Time Dialysis Patients
No full textBackground: The number of people living with kidney disease (acute kidney injury, chronic kidney disease, and treated kidney failure) worldwide is reported to exceed 850 million (Bello et al., 2024). The number of people undergoing maintenance dialysis globally has increased dramatically. Chronic kidney disease (CKD) is not only a public health issue but also creates an economic burden (Lee et al., 2023). For patients with ESRD, a planned approach to establishing dialysis access is a critical priority.
Purpose: The pre-establishment of permanent vascular access and peritoneal catheters for dialysis is essential to reduce the need for repeated temporary tube placements, thereby decreasing hospitalization days and infection rates. This study explores the impact of shared decision-making (SDM) on the pre-establishment of these dialysis access routes.
Methods: Participants in this study included both outpatient and inpatient cases from a medical center in northern Taiwan who had chronic renal failure for more than three months and a glomerular filtration rate (GFR) below 15 mL/min/1.73 Square meter in two consecutive outpatient visits. During the first stage of SDM, physicians initiated discussions about dialysis mode selection. Nephrology case managers and health education nurses acted as counselors, guiding patients and their families to decide on a preferred dialysis mode using SDM tools (such as educational leaflets, videos, and templates). When patients’ blood creatinine levels reached ≥6 mg/dL, the second stage of dialysis preparation was initiated, referring patients to the surgical clinic for hemodialysis vascular access or coordinating with a general surgeon for peritoneal dialysis catheter placement.
Results: Following the introduction of SDM and the facilitator model in 2019, statistics from 2019 to 2023 show that 689 out of 763 patients (90.30%) diagnosed with end-stage renal disease completed dialysis mode selection and met the criteria for permanent vascular access or peritoneal catheter pre-establishment. Of these, 185 out of 253 patients (73.12%) completed pre-establishment of permanent access (including both autologous and synthetic arteriovenous access and peritoneal dialysis catheters). The implementation of SDM and counseling models significantly increased the pre-establishment rate of permanent access, from 46.51% before SDM implementation to 73.12% afterward, demonstrating a statistically significant difference (t = -5.208, df = 5, p \u3c .001)
Improve Exclusive Breastfeeding Rates Through Early Initiation
No full textExclusive breastfeeding can be challenging to maintain. At the project site there was an inconsistent process for breastfeeding support, so an evidence-based solution was sought. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if or to what degree the implementation of the World Health Organization (WHO) Guideline’s Baby-Friendly Hospital Initiative (BFHI) Step Four would impact exclusive breastfeeding rates (EBFRs) when compared to current practice among adult postpartum patients in an acute care hospital in Southern California over four weeks. Nola Pender’s middle-range nursing theory utilizing the health promotion model (HPM), and Kurt Lewin’s change theory provided the project’s theoretical underpinnings. The total sample size was 318, with n = 150 in the comparative group and n = 168 in the implementation group. Data were extracted from the electronic health record. A chi-square test was used and showed X 2 (1, N = 318) = 4.18, p = .041, and was both statistically and clinically significant. Clinical significance was further noted with an 11.4% increase in exclusive breastfeeding rates. Based on these findings, the WHO Guideline’s BFHI Step Four may impact EBFRs in this population. Recommendations include maintaining the intervention at the project site, providing consistent nursing education and cultural competency training, and disseminating the results
Impact of High-Fidelity Simulation Training on Pediatric Nurses\u27 Competence in Seizure Management
No full textPurpose: Traditional training methods for new graduate nurses often rely on bedside experiences and lectures, which may limit the development of clinical skills essential for hands-on patient care. This study evaluates the effectiveness of high-fidelity simulation training in improving clinical competencies among newly graduated pediatric nurses in Taiwan, specifically in managing seizure emergencies. The study examines gains in cognitive, psychomotor, and affective domains.
Methods: A one-group pre- and post-test design was implemented using the Sim Junior high-fidelity simulation model alongside situational teaching strategies. Participants included Nurse Post Graduate Year (NPGY) pediatric nurses who received a structured “High-Fidelity Simulation Training Plan for Emergency Management of Seizures.” Assessments focused on emergency assessment skills, seizure management knowledge, and psychomotor performance. Participant satisfaction was measured using a five-point Likert scale.
Results: Post-training analysis showed a significant increase in knowledge scores, with average post-test results increasing by 37.9% compared to pre-test scores (p \u3c 0.05). Skill competency scores also demonstrated improvement, with gains between 30% and 35% (p \u3c 0.05). Participants rated their overall satisfaction with the simulation training course at an average of 4.7 out of 5.
Conclusion: The study findings indicate that high-fidelity simulation training, combined with Objective Structured Clinical Examinations (OSCE), effectively enhances clinical competencies in pediatric NPGY nurses in Taiwan. The training improved clinical skills, professional attitudes, and team communication. Integrating high-fidelity simulation into NPGY training programs is recommended to strengthen emergency response skills and support clinical decision-making in managing pediatric seizure emergencies
Development of a Patient Decision Aid for South Korean Couples Undergoing IVF
No full textBackground: Infertility is a global health issue, and it is estimated that around 48million couples and 186 million individuals are affected worldwide1,2. South Korea is currently facing a significant demographic challenge, with a fertility rate of 0.72 in 2023—the lowest among OECD countries3. Notably, 9.3% of births in 2022 were from government-supported fertility treatments4. Despite an increasing proportion of births resulting from such treatments, there are still no established guidelines to protect couples\u27 confidentiality.Purpose: The purpose of this ongoing study is to develop a patient decision aid (PtDA) tailored for South Korean couples undergoing IVF treatment to facilitate the shared decision-making (SDM) process by outlining available treatment, care, and support options.
Method: Ottawa Decision Support Framework (ODSF) that conforms to IPDAS standards was chosen as the theoretical framework to guide the decision aid’s development and piloting5.Results and Plans for Further Works: The ongoing development of the PtDA is proceeding in two phases: 1) construction phase and 2) pilot testing phase. In the construction phase, decisional needs assessment and content selection are conducted through systematic literature review. Commencing with focusing on couples’ ‘decisional needs’, systematic review will be utilized to identify existing decisional conflicts, knowledge gaps, and the specific values of couples undergoing IVF treatment. Balanced, evidence-based information on possible treatment options, including risks, benefits, and tools will be selected through systematic literature review6. During the pilot testing phase, we will conduct interviews with a representative sample of South Korean women undergoing IVF to evaluate the PtDA’s usability, clarity, and emotional impact. Feedback from these interviews will provide inform revisions of the PtDA to increase quality and effectiveness of couples\u27 decision-making process.
Conclusion: This PtDA is being developed to assist couples in IVF treatment, focusing on informed, values-based choices. Beyond enhancing treatment quality, it also seeks to support higher birth rates in South Korea
A Systematic Review Of Caregiver Burden of Children with ADHD
No full textBackground: Raising a child with Attention Deficit Hyperactivity Disorder (ADHD) is a key challenge for the primary caregiver. This systematic review aims to identify major burdens facing primary caregivers of a child with ADHD.
Methods: The electronic databases CINAHL, PubMed, and Google Scholar were searched for studies published in English from 2017 to 2023 assessing the challenges facing caregivers of a child with ADHD.
Results: Eleven articles included in this review revealed that caregivers of children with ADHD have poor quality of life and high-stress levels. Supportive parenting programs can be effective for improved coping and adaptation mechanisms with children with ADHD.
Conclusion: Caregivers of children with ADHD can benefit from strategies to improve their quality of life and reduce their stress levels. Targeted parenting programs can positively impact the well-being of caregivers and children with ADHD.
Implications: Additional research is needed to address the evidence-based effectiveness of parenting suppor
LGBTQIA+ Identifying Parents\u27 Experiences of Bias and Discrimination in Pediatric Healthcare
No full textDespite advancements aiming to promote better inclusion of LGBTQIA+ identifying individuals in our nation, there still remains to be a great deal of discrimination towards this population, particularly within our healthcare system. LGBTQIA+ individuals in our nation still presently continue to face discrimination across different aspects of society (Medina and Mahowald, 2024).
The purpose of this study is to examine the experiences of LGBTQIA+ parents in pediatric healthcare settings and the ways in which those experiences impact LGBTQIA+ parents\u27 trust in their children’s healthcare providers. In order to better address the needs of LGBTQIA+ parents within our nation’s healthcare system, we must first begin to understand the bias and perceived discrimination they have faced and how this in turn may impact their ability to trust and sustain confidence in American healthcare providers. An online Qualtrics survey, consisting of multiple choice questions and free response questions, will be distributed via Facebook groups for LGBTQIA+ identifying parents, through emails to various national and state-level LGBTQIA+ organizations, and through a flier with a QR code linked to the survey posted in several pediatric healthcare settings. The multiple choice survey questions consist of demographic questions, a section of questions including statements to be rated utilizing a five-point scale to quantify experiences of perceived bias and discrimination, and another section utilizing a five-point scale utilizing a modified version of the Trust in Physician Scale(Anderson & Dedrick, 1990) to quantify parents’ trust levels in their children’s providers. The five-point scale for the bias and discrimination questions is also a modified version of a scale utilized in a similar study that looked to examine the experiences of LGBTQIA+ identifying critically ill patients and their caregivers with their healthcare providers (Stein et al., 2023). There are three optional free-response questions at the end of the survey asking the parents’ to describe one positive and one negative experience in relation to their identity as an LGBTQIA+ identifying parent, and one additional question asking about their generalized experience as an LGBTQIA+ identifying parent. The survey will remain open through January and February 2025 and will close in the beginning of March