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Learning from experience: nurse tutors' and student nurses' perceptions of experiential learning in nurse education: some initial findings.

Experiential learning and experiential learning methods have been widely described in the literature as aids to learning about nursing. This paper describes a descriptive study of nurse tutors' and student nurses' perceptions of experiential learning. Two research methods were used: in-depth semi-structured interviews of 12 nurse tutors and 12 student nurses, followed by a questionnaire survey of a total population of nurse tutors in Wales, U.K. (n = 184) and a 100% stratified sample of student nurses in Wales (n = 325). The questionnaire items were devised out of the interview data. This report offers a description of how the study was conducted and some of the findings. Notably, student nurses tended to perceive experiential learning in terms of learning in the clinical setting whilst tutors referred more to experiential learning as a classroom activity. Other findings are described and discussed.

Attitude↗

Intensive Care Nursing Scoring System Part 2: nursing interventions and nursing outcomes.

Different medical classifications and scoring systems have been developed to measure and compare intensive care outcomes in international contexts. Many of them, however, do not include outcome variables to describe autonomous nursing and its effects on the patient's experiences and restrictions as a result of the onset and process of illness, or relatives' or significant others' distress in the intensive care environment. The Intensive Care Nursing Scoring System (ICNSS) is a new instrument to describe and highlight nurses' work and its effects on the patients and their relatives in a way not allowed by medical classifications and scoring systems. ICNSS can be used to evaluate a single intensive care nursing process from admission to discharge or to compare patients in different intensive care units for certain variables. ICNSS can also be used to measure nurses' workload. The classification of nursing diagnoses was described in a previous article. This paper describes nursing outcomes and nursing interventions as well as the use of ICNSS in a computer-based information management system in three adult intensive care units in the Oulu University Hospital.

Finland↗

Effect of staff turnover on staffing: A closer look at registered nurses, licensed vocational nurses, and certified nursing assistants.

PURPOSE: We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels. DESIGN AND METHODS: We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the Area Resource File for 2003. After examining factors associated with staff turnover, we tested the significance and impact of staff turnover on staffing levels for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs). RESULTS: All three staff types showed strong dependency on resources, such as reimbursement rates and facility payor mix. The ratio of contracted to employed nursing staff as well as RN turnover increased LVN turnover rates. CNA turnover was reduced by higher administrative expenditures and higher CNA wages. Turnover rates significantly reduced staffing levels for RNs and CNAs. LVN staffing levels were not affected by LVN turnover but were influenced by market factors such as availability of LVNs in the county and women in the labor force. IMPLICATIONS: Staffing levels are not always associated with staff turnover. We conclude that staff turnover is a predictor of RN and CNA staffing levels but that LVN staffing levels are associated with market factors rather than turnover. Therefore, it is important to focus on management initiatives that help reduce CNA and RN turnover and ultimately result in higher nurse staffing levels in nursing homes.

Cross-Sectional Studies↗

The impact of nurse managed care on the cost of nurse practice and nurse satisfaction.

How are costs of nursing care effected when professional nurses practice nursing based on patient's needs as opposed to institutional policy? The author discusses a different nursing care delivery system that builds on primary nursing but frees the nurse from institutional constraints. The results were a 20 percent decrease in nursing costs and increased satisfaction among the nursing staff participants.

Connecticut↗

Legal issues in neonatal nursing: considerations for staff nurses and advanced practice nurses.

A neonatal nurse is a professional with special training, skill, and knowledge in the care of newborns and their families. The neonatal nurse is accountable to the patient, profession, and employer. Failure of the neonatal nurse to meet these obligations can result in liability in the profession, liability in the employment, a civil suit, or a criminal conviction. Regardless of the health care setting, professional nurses, whether at the bedside or in advanced practice, are morally, ethically, and legally accountable for their nursing judgments and actions. Although most nurses assume they will never be named in a lawsuit, and it is true that few are, their professional actions can be the focus of a suit. An overview of the legal implications found within neonatal nursing practice is presented. Two recent legal cases are presented and discussed to illustrate neonatal nursing and advanced practice liability.

Colorado↗

[Can contact nurses point the way to competence in practice? Nurses as practice mentors in nursing education].

UNLABELLED: The contact nurse is a central person as a carrier of knowledge and experience in nursing practice, which is important that the student nurse has access to. In order to gain insight into the passage of knowledge between 3 contact nurses and their students, I have carried out a qualitative investigation. METHOD: The method chosen is that of participation, open observation and semi-structured interviews. FINDINGS: While guiding the student, the contact nurse made explicit her way of judging specific nursing situations. She appealed to the use of perceptive insight, and made explicit the complexity in an "everyday situation" in nursing practice. Counselling in patient-situations thus reflects the value of the traditional master-apprentice roles. Professional argumentation delving deeper than more down-to-earth judgements, appears to be absent from the investigation. This shows the importance of a greater degree of reflection in the contact nurse's role as a counsellor.

Clinical Competence↗

A demystification of the clinical nurse specialist role: perceptions of clinical nurse specialists and nurse administrators.

Differences of nurse administrators and clinical nurse specialists regarding components of the clinical specialist role were investigated. To be effective in facilitating the maximum use of the abilities of the clinical specialist, it is essential that nurse educators establish a data base about the clinical nurse specialist role from the perspective of employers and the clinical nurse specialists themselves. Subjects were 54 nurse administrators and 35 clinical specialists from a large metropolitan area. The results indicated that, generally, both groups were in agreement except for the research component. Administrators placed a higher value on research than did the clinical specialists. Both groups valued the clinical practice component with the clinical specialists tending to see themselves more heavily committed to direct specialized patient care than did the administrators. The educational component was also valued with the consultant function receiving the highest rating of all the functions surveyed. The administration component was valued least highly of all the components. It is recommended that nurse educators evaluate their educational endeavors in preparation of clinical specialists especially for research functions, and, also, consultation and those functions supportive of nursing staff.

Administrative Personnel↗

The role of the infection control nurse as a clinical nurse specialist or advanced nurse practitioner.

The specialty of infection control is examined regarding the role of the infection control nurse and the educational requirements for practitioners in this field in relation to post titles of clinical nurse specialist and advanced nurse practitioner. Whilst not fulfilling all the role constituents of a clinical nurse specialist, the infection control nurse is seen as more akin to a clinical nurse specialist than an advanced nurse practitioner.

Cost-Benefit Analysis↗

The relationship between clinical decision-making skills in nursing and general critical thinking abilities of senior nursing students in four types of nursing programs.

This descriptive study was undertaken to investigate the relationship between clinical decision-making skills in nursing and critical thinking abilities of senior nursing students in four types of nursing education programs: generic baccalaureate, associate, and diploma--the basic RN programs, along with the upper division baccalaureate (specifically RN completion) program. Fifty senior students from each type of program were conveniently selected. Clinical decision-making in nursing was measured by the Nursing Performance Simulation Instrument. General critical thinking abilities were determined by the Watson-Glaser Critical Thinking Appraisal. Among the basic RN programs, the higher level of general critical thinking ability was attained by generic baccalaureate seniors (mean score, 61.3) compared with the associate (50.0) and diploma (51.3) seniors. The clinical decision-making scores in nursing skills were virtually identical for the three basic programs--generic (32.2), associate (32.2), and diploma (32.3). That is, mean performance scores of the 2-year associate degree, 3-year diploma, and 4-year generic baccalaureate degree students on the Nursing Performance Simulation Instrument showed no statistically significant difference. The mean critical thinking score for the upper division baccalaureate seniors (61.1) was comparable to that of the generic baccalaureate seniors. Clinical decision-making mean score for the upper division seniors was significantly higher (38.0) than those of the other three groups. A weak though significant positive correlation (r = 0.249) between clinical decision-making and critical thinking across all four types of programs was found.

Clinical Competence↗

Nurse to nurse: consultation in geriatric nursing practice.

The complexity of clients in today's health care environment requires a close, collaborative working relationship among disciplines. However, nurses, who are often key decision-makers in the planning, management, and movement of clients throughout the health care system, may not use the expertise of their best allies: nurses in other settings, institutions, and specialty areas. Many care problems-at home or in the hospital, nursing home, or rehabilitation center-can be effectively resolved by nurse-to-nurse consultation. The importance and benefit of nurses relying on their own profession to answer nursing care questions are illustrated with vignettes that apply a model of consultation to the practice of geriatric nursing.

Consultants↗

Nurses' attitudes towards suicidal behaviour--a comparative study of community mental health nurses and nurses working in an accidents and emergency department.

The purpose of this study was to explore and compare the attitudes towards suicidal behaviour of community mental health nurses (CMHNs) and registered nurses working in an accidents and emergency (A&E) department. The sample consisted of 80 nurses working in the same locality. An instrument was designed using statements from Domino's 'Suicide Opinion Questionnaire' (SOQ) and new statements based on a comprehensive survey of research in this area. The instrument contained four attitudinal categories consisting of; acceptability; morality and mental illness; professional role, work and care; and communication and attention. Results reveal that both groups of nurses held generally positive attitudes towards suicidal behaviour, contrasting with previous studies where more negative attitudes amongst nurses were found. A t-test showed no statistically significant differences between the two groups of nurses in any of the four attitudinal categories. Attitudes were significantly different in accordance with nurses' length of experience and age within both groups. Further research is needed in this area if nurses are to develop their role alongside other professionals working towards the objectives of suicide prevention policies.

Adult↗

[Work satisfaction and absenteeism of nursing staff--comparative study of 1021 nurse trainees and nurses].

PURPOSE: To analyse the high level of absenteeism among nursing trainees compared with nursing staff. Unlike previous studies, the present study focussed on work satisfaction and motivation. Specifically, combining satisfaction with absenteeism was a novel approach. METHOD: For assessing work satisfaction, a standardised form with 73 items in four areas was drafted and checked in a pre-test (n = 150). 861 nurses and 159 trainees were interviewed. The absenteeism data given by the nursing staff were compared with the 'missing' records of the personnel department. RESULTS: In all areas it was found that, in particular, problems of organisation, personnel management and working atmosphere in the hospital were a burden on the employees. In detail, however, there were considerable differences between nurses and trainees in respect of appraisal. Work organisation: Although trainees rated work organisation aspects lower than nurses, direct relationship to work satisfaction was less pronounced. For the trainees, improvements are imperative in respect of active self-responsibility. Leadership/co-operation: Trainees rated supervisor behaviour and working atmosphere lower than their colleagues. There was a direct relation to satisfaction and absenteeism. Workload/stress: Although their responsibility was less, a larger proportion of the trainees felt stressed. This was directly related to work satisfaction and absenteeism. Fluctuation and turnover: 44% of the trainees would be prepared to work up to the age of retirement, but only 25% of the qualified staff. Nevertheless, three-quarters of the trainees and two-thirds of the nurses would choose the same profession again. Hence, unfavourable local (internal) circumstances led to the discontent and not the profession as such. CONCLUSIONS: The extremely high absenteeism of nursing trainees calls for action on the part of school and hospital management. There is a need for better information and care before and during professional training, because workload will be higher at the end of the training. The study indicates possibilities of increasing work satisfaction and decreasing absenteeism of trainees.

Absenteeism↗

Smallpox nursing in Britain, Part II: Nursing care and nurse training.

Part I of this paper attempted to justify the need for this research for historical purposes, that is, to fill a gap in the history of nursing, and sought to raise awareness of possible bioterrorist activity with the smallpox virus. The disease process, now unfamiliar to most nurses, was briefly described, and reference was made to the change from a predominantly childhood to adult disease. The gradual removal of patients from home to hospital or other institutions was considered and the diverse nature of their attendants was discussed. Smallpox was then explained from two nursing perspectives: firstly, the concept of smallpox as a nurses' disease. In this, it was universally acknowledged that only nurses could make some difference to a patient's survival and minimal disfigurement, but secondly, in so doing, they put their own lives at risk. Examples were given of nurses who succumbed. Finally, some central and local government measures which endeavoured to prevent the spread of the disease were outlined. Part II focuses specifically on nursing care and training as it is through this medium that knowledge may be passed from earlier to present day nurses.

Disease Outbreaks↗

A descriptive study of mentoring relationships experienced by Army nurses in head nurse or nursing supervisor roles.

Mentoring relationships experienced by Army Nurse Corps officers in head nurse or nursing supervisor roles were examined via a survey questionnaire. Findings indicate that career development relationships are occurring among these nurses, but less than half of the relationships consist of mentoring. Nursing supervisors comprised the largest group of career developers, while head nurses were the second most likely group to assist with the development of a novice nurse. Approximately half of the nurses indicated that the career development relationship had a "substantial" influence on their personal lives, and a "very great" influence on their professional lives.

Adult↗

Clinical nurse specialist and staff nurse colleagues in integrating nursing research with clinical practice.

To advocate for cost-effective patient care and to strengthen the registered nurse's professional practice, the CNS must support nursing research in acute care facilities. This support for research includes sparking the staff nurse's interest and involvement in all segments of the research process. We must recognize our clinical nurses' efforts on behalf of research through greater financial reward; the CNS is challenged to use his or her influence to persuade administrators to grant this support. How the CNS and staff nurse, working together, can disseminate the findings of nursing research, thus promoting cost-effective care and solidifying the nurse's professional practice, is discussed in this article.

Clinical Nursing Research↗

Post-basic cancer nursing education in Belgium: an innovative collaboration between a nursing school, a comprehensive cancer centre and the Oncology Nursing Society.

Since 1989, the Nursing School attached to the Free University, Brussels, has organized post-basic courses in cancer nursing, with the collaboration of the Belgian Oncology Nursing Society (French speaking) (SIO) and a comprehensive cancer centre, the Jules Bordet Institute. The 1-day-a-week course evolves over 30 weeks and is open to registered nurses. Its structure and its content respect the recommendations of the Core Curriculum for a Post-Basic Course in Cancer Nursing (EONS, 1989). However, there are some differences related to the entry requirements, the clinical experience, and the evaluation of both the course and the students' performance. So far, 72 nurses from different cancer units from the southern part of Belgium have obtained the certificate at the end of this course. In parallel with the 1-day-a-week course, seven modular courses were set up during the first semester of 1992, with the financial support of the 'Europe against Cancer' Programme. Each module tackles a specific theme: Basic Principles in Oncology Nursing; Training the Trainers; Prevention and Early Screening; Rehabilitation--Palliative Care--Psycho-oncology (one short and one long module); Radiotherapy; and Chemotherapy.

Adult↗

The learner-centredness of two registered general nursing and two registered mental nursing courses as perceived by third-year nursing students.

Using the conceptual framework of the Nottingham Andragogy Group, two first-level British courses in general nursing and two in psychiatric nursing were studied to investigate their degree of perceived learner-centredness. Boydell's Scale for Measuring the Learner-Centredness of a Course was administered to a non-random sample of all 172 third-year students at three schools of nursing. Preference for learner-centred nursing education was investigated using Boydell's Preferred Teaching Style Rating Scale with the student sample and by 31 nurse teachers. Results indicated that first-level nursing courses were perceived to be highly teacher-centred in terms of planning, direction, sequence, pace and evaluation of learning. The climate of learning proved to be moderately learner-centred though teacher-student relationships were perceived as formal. Variety of learning approach was seen as limited with a tendency towards positivism rather than relativism of knowledge. Both students and teachers of nursing expressed a slight preference for teacher-centred courses despite the former's dissatisfaction with lack of participation in determining learning objectives. Significantly greater perceived learner-centredness of a psychiatric course was attributed to variations in the philosophy of learning within a particular school rather than to the course per se.

Adult↗

Nurse practitioners, certified nurse midwives, and nurse anesthetists: changing care in acute care hospitals in New York City.

To respond to the shrinking pool of primary care physicians and to demands from managed care programs for cost containment, hospitals in New York City have increased their use of nurse practitioners, certified nurse midwives, and nurse anesthetists, creating an increased demand for these personnel. We report here on a survey of hospitals and schools of nursing in New York City and present findings on (a) current use of, and projected demand for nurse practitioners (NPs), certified nurse midwives (midwives) and nurse anesthetists (anesthetists) in hospitals in New York City; (b) the practice patterns of NPs, midwives, and anesthetists currently employed in hospitals; and (c) current and projected enrollment and curriculum in NP, midwifery, and anesthetist education programs in the New York metropolitan area.

Adult↗