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- ItemAlternative Learning Strategies to Increase Clinical Judgment for the NCLEX Next Generation Exam(Bryan College of Health Sciences, 2021-12)Purpose: To evaluate alternatives to traditional clinical experiences that can increase students’ clinical judgment and clinical competencies in order to better prepare them for the Next Generation NCLEX exam. Literature Review: An important goal of nursing education is to improve the competencies and clinical judgment of nursing students. Traditional clinical is utilized to help develop student’s clinical judgment skills and clinical competencies. In many locations, nursing programs are limited in enrollment due to lack of clinical resources. The field of nursing is growing rapidly with nursing educators working diligently to meet the challenges of faculty shortages and limited clinical sites (Curl, E. D. et al., 2016). The Theoretical Framework that was utilized was NCSBN Clinical Judgment Measurement Model. The Third layer was primarily utilized due to it being the measurable cognitive aspects of clinical decision making. Methods: A fishbone diagram was utilized to determine a gap. IRB approval was obtained. An extensive literature review was conducted and a coding procedure was developed. Articles were reviewed, categorized and coded. Expert interviews were conducted and categorized into themes. Spiral data analysis was utilized to determine themes within the research. Results: Simulation, case studies and reflections were found as valid tools to increase student clinical judgment skills. Faculty evaluation and feedback is needed to determine the level of clinical judgment and to address areas of clinical judgment that need improvement. Faculty can use evaluations to address gaps in clinical judgment. Conclusions: Through this review, it was determined that simulation, case study, and reflection are valid alternatives to traditional clinical time to increase student’s clinical judgment. Educators need to implement clinical judgment into curriculum to prepare students for the Next Generation NCLEX exam. Future recommendations include development for a standardized evaluation tool with governing body support and an implementation plan for faculty.
- ItemEvaluating Components of Nurse Residency Programs That May Impact Nurse Retention Rates Beyond the Initial Year of Hire(Bryan College of Health Sciences, 2021-12)Purpose: To create a framework of components for successful nurse residency programs (NRP) where the key goal is for improving nurse retention rates in the second year of hire. PICO: Among new graduate nurses who participate in a nurse residency program, what components of the NRP can increase an organization’s second year retention rate? Literature Review: Research studies have shown that participation in a NRP leads to an increase in retention in the first year of hire. While NRPs offer a way to improve first year retention rates, further research is needed to assess the effectiveness of content, structure, and to assess retention rates past the initial year of hire. Theoretical Framework: Benner’s Nursing Theory, From Novice to Expert provides a framework for use as a consistent guide for the key elements of NRP’s and this project. Methods: IRB approval was granted for an evidence based project to proficiently analyze relevant and current evidence, and conduct expert interviews with Human Resources (HR) and NRP experts. Data were collected through guided NRP and expert HR interviews to determine possible components of NRP programs that could impact second year retention rates. Results: This evidence based project has created an opportunity to disseminate knowledge for best practice, as well as recommending revisions for NRP’s to meet the contemporary needs of healthcare systems. An NRP’s utilization of the Framework of Successful Components may optimize retention among second year nurses. Recommendations: Next steps needed are to begin building relationships between HRs and NRPs beyond the initial year of hire, supporting an assessment of current technological capabilities, and lastly, to consider potential benefits of rural communities participating in an NRP program and the support needed for this to occur.
- ItemYears of Nursing Experience and Resiliency During a Pandemic(Bryan College of Health Sciences, 2020-12-09)Purpose: This quality improvement project was conducted to understand resiliency of new nurses during the COVID19 pandemic. What is the self-reported resiliency of newly graduated nurses with 0-3 years of experience during the COVID19 pandemic? Literature Review: Nursing is a rewarding, often challenging, and at times emotionally draining profession. Stress in nursing can lead to burnout, nurse turnover, and potentially contribute to poor patient outcomes. Providing care within a pandemic can increase the stress. Literature shows the first year of practice is the most stressful in a nurse’s career, and nurse residency programs (NRP) are beneficial with the transition. Resiliency, defined as the “ability to thrive in the face of adversity”, is teachable and can provide nurses with emotional adaptability. Patricia Benner’s Novice to Expert Theory provides a theoretical framework which can be utilized to understand the nurse’s growth and development. Methods: NRP co-coordinators, as the stakeholders, provided permission to conduct this project within the NRP. The Connor-Davidson Resilience Scale (CD-RISC) was used. The CD-RISC assessed resiliency differences of nurses with less than one-year experience and nurses with 1-3 years of experience. After IRB review, data were collected and analyzed for 62 valid responses. Results: Nurses completed the survey with n=23 reporting having less than one-year experience and 39 reporting having 1-3 years of experience. The mean resiliency scores for nurses with less than one-year experience was 26.83 and nurses with 1-3 years of experience was 28.31. The results did not show a statistically significant difference. Conclusion: This data suggests that utilizing a resiliency scale and providing training to all nurses in the organization would be beneficial. This allows the individual the opportunity to see how they score regarding resiliency to identify areas of strength and potential areas for improvement.
- ItemTroubleshooting Vascular Access Device Selection(Bryan College of Health Sciences, 2020-12-09)Purpose: To educate registered nurses (RN) regarding the necessity for pre-assessment of risk factors, and importance of vascular access device (VAD) selection. Will providing this education to RNs, improve understanding of appropriate VAD selection? Literature Review: Identified knowledge gaps and patients presenting with co-morbidities and associated risk factors are affecting VAD selection, leading to inappropriate prescriptions from providers. Central lines (CL) are associated with central line associated bloodstream infections (CLABSI), leading to increased morbidity/mortality rates. Even with national initiatives created to improve safety and education regarding VAD selection, CLABSIs are still occurring. Three factors leading to complications with VADs (host factors, device factors, and provider factors) have been identified. Mandatory annual training on maintenance of VAD improves confidence and competence. The Plan, Do, Study, Act (PDSA) cycle provides a framework for developing, testing, implementing change and improvement in VAD selection. Methods: The setting for the QI project was general/progressive/critical care areas in an urban hospital. Project stakeholders were a Clinical Educator, and a Clinical Nurse Specialist. The RNs on selected units were given comprehensive VAD education on pre-assessment of risk factors, and importance of appropriate VAD selection. The participants completed a pre-test, and then completed a post-test following education, to determine understanding. The data were reviewed and analyzed. IRB reviewed the project and deemed it a quality improvement project. Results: The project question was supported by the outcomes, as evidence by, improved post education scores. It was determined that the location of the education session can be detrimental to the learning outcomes. Future testing considerations would include review of test question verbiage to be more succinct and unit directed. Conclusion: VAD selection education improved the knowledge of the RNs regarding appropriate VAD selection. Plan to disseminate education to all units, and commit to implementing annual education.
- ItemWorkplace Attributes Leading to Job Satisfaction of the Bedside Nurse(Bryan College of Health Sciences, 2020-12-09)Purpose: The purpose of this quality improvement project is to better understand workplace attributes of selected units within an acute care hospital to provide recommended strategies for improving the workplace attributes as a way to promote nurses’ job satisfaction. The guiding question was “What are the attributes that promote nurses’ job satisfaction within the workplace?” Literature Review: Communication, relationships with physicians, and nursing involvement in decision making are workplace attributes discussed in the literature leading to job satisfaction. Nurses having autonomy and control over their work environment are also strong factors for satisfaction with the work environment. Methods: The project took place on both intensive care and progressive care units. The stakeholders were the nurse managers and directors of these units and the CNO of the organization. A Google Form was developed to administer the questionnaire and participants were invited via email. SMART objectives were created, partially met, with one being delayed. The PDSA framework relates to change theory in planning, implementing, and evaluating the project. Data were collected via the NWI-R as the instrument. The capstone project was reviewed by the IRB and deemed as a quality improvement project. Results: The outcome of this quality improvement project was to identify strategies as recommendations, which included implementing task forces for nurse's involvement in controlling costs, employee forums increased to bi-monthly, twice monthly informal CNO rounding, maintaining a culture of safety, and professional/career development opportunities with improved marketing. Recommendations were given via a flyer and presentation. Conclusion: The project's outcomes supported the guiding question, in that we learned work attributes that scored higher on job satisfaction, which were also supported in the literature. Initially, stakeholders should focus on the most influential recommendations provided and create SMART goals as a framework to implement strategies going forward.