Darrell Spurlock

A systematic review of the effectiveness of remediation interventions to improve NCLEX-RN pass rates.

First-time NCLEX-RN pass rates are important measures of educational quality in prelicensure nursing education programs. Licensure pass rate problems has been the subject of countless nursing education articles and studies over the past several decades. To improve NCLEX-RN pass rates, remediation is often prescribed for students who have academic performance deficits. This article presents a systematic review of studies on remediation interventions and their effects on NCLEX-RN pass rates. Most studies of remediation and its effects on licensure pass rates are descriptive program evaluation reports. The overall quality of studies included in this review is uneven but generally low. Nursing education researchers should focus on conducting higher quality intervention studies in which the fidelity of remediation interventions can be examined. Viewing licensure pass rates from a process improvement perspective and accounting for pass rate variations could also change the nature of scholarship on this topic.

A Study of the Usefulness of the HESI Exit Exam in Predicting NCLEX-RN Failure

Schools of nursing across the country are implementing progression policies that prohibit students from graduating or from taking the nursing licensure examination, sometimes based solely on a single predictive test score. In addition, little empirical evidence exists that supports progression policies as effective in increasing a schools NCLEX-RN pass rates. This article reports on a study conducted when one school did not achieve the results they expected after implementing a progression policy. With use of logistic regression, diagnostic indexes, and other methods, reasons for the disparity between expected and observed NCLEX-RN pass rates were examined. Results revealed that the Health Education Systems, Inc. (HESI) Exit Exam was not able to accurately predict NCLEX-RN outcomes for graduates and, further, that progression policies that allow retest after retest so as to achieve a minimum score on the HESI Exit Exam are not supported empirically. Conclusions and suggestions for schools using or considering progression policies are provided.

Capnography (ETCO2), Respiratory Depression, and Nursing Interventions in Moderately Sedated Adults Undergoing Transesophageal Echocardiography (TEE)

PURPOSE Little attention has been paid to the safety of moderate sedation given to adult patients undergoing transesophageal echocardiography (TEE). Although capnography has been found to indicate respiratory depression earlier than pulse oximetry in other sedation scenarios, its usefulness during TEE has not been clearly documented. DESIGN A prospective, single-group, observational design was used. METHODS A total of 200 adult patients undergoing TEE with moderate sedation were studied. Patient demographic and procedural physiologic variables, types and doses of sedating medications administered, incidence of respiratory depression, and types and effectiveness of nursing interventions delivered when subjects experienced respiratory depression were examined. FINDING Respiratory depression identified by capnography occurred in 45% of the subjects. Capnography provided earlier identification of respiratory depression than pulse oximetry. Hydromorphone was associated with respiratory depression more so than other agents; whereas nursing interventions were effective in preventing more serious cardiorespiratory compromise. CONCLUSIONS Capnography, as a tool to provide early warning of respiratory depression or airway compromise, has the potential to further decrease the incidence of serious adverse events due to inadvertent oversedation.

Validity and Reliability Evidence for a New Measure: The Evidence-Based Practice Knowledge Assessment in Nursing.

BACKGROUND Studies of evidence-based practice (EBP) among nurses often focus on attitudes and beliefs about EBP and self-reported EBP knowledge. Because knowledge self-assessments can be highly inaccurate, the authors developed and tested a new objective measure of EBP knowledge--the Evidence-Based Practice Knowledge Assessment in Nursing (EKAN). METHOD Seven subject matter experts reviewed candidate items, resulting in a scale content validity index of 0.94. Rasch modeling was used to evaluate item-person performance on the proposed unidimensional trait of EBP knowledge. The candidate item pool was then tested among 200 undergraduate nursing students. RESULTS Strong evidence of unidimensionality was confirmed by narrow item infit statistics centering on 1.0. The item separation index was 7.05, and the person separation index was 1.66. Item reliability was 0.98, and person reliability was 0.66. CONCLUSION The 20-item EKAN showed strong psychometric properties for an instrument developed under the Rasch model and is available for use in research and educational contexts.

What's in a Name? Revisiting Pilot Studies in Nursing Education Research

Pilot studies are a commonly described type of study in the nursing education literature. Although nursing education researchers continue to label small, single-site, hypothesis-driven studies as pilot studies, the consensus in other fields as to what constitutes a pilot study has changed over time to focus more narrowly on issues of feasibility and acceptability of study interventions and interactions. Nursing education researchers are encouraged to adopt more modern definitions of pilot studies that substantially reduce (or eliminate) the focus on inferential statistical testing while increasing the focus on practical and procedural aspects of study design and implementation. This article highlights the historical evolution of the term pilot study and provides researchers with suggestions about the purpose and focus of pilot studies that support development of the science of nursing education. [J Nurs Educ. 2018;57(8):457-459.].

Statistical Power in Nursing Education Research

Nursing researchers have been encouraged for decades to address the validity of their statistical conclusions in part by accumulating evidence from studies that are capable of correctly identifying relationships between variables when those relationships are truly present. However, it has been noted that only a fraction of nursing studies appear to have undertaken power analyses to help mitigate the risk of Type II statistical conclusion errors. This Methodology Corner article reviews some of the major aspects of power analysis procedures and reiterates recommendations that researchers who plan to use inferential statistical analyses also conduct a power analysis to guide decision making about target sample sizes to increase the validity of study findings. [J Nurs Educ. 2018;57(5):262-264.].

Measurement Matters: Improving Measurement Practices in Nursing Education Research

Measurement is a fundamental but often overlooked component of research design and scientific inquiry. In quantitative study designs, the data that are collected, the statistical analyses conducted, and the conclusions drawn from those analyses all hinge on the validity, reliability, and appropriateness of measurements taken during the investigation. Missteps in the measurement process can undermine the validity of a studys findings and in doing so, efforts to advance the science of nursing education will fall short. This months Methodology Corner article highlights several important measurement-related considerations for nursing education researchers seeking to build the evidence base-the body of knowledge about nursing education-on which instructional, curricular, policy, and planning decisions are made. [J Nurs Educ. 2017;56(5):257-259.].

The Purpose and Power of Reporting Effect Sizes in Nursing Education Research

Like many other fields and subfields within the social sciences, education, and medicine, nursing education research has a long history of giving p-values associated with common statistical tests a position of primary importance in interpreting study findings. Global, transdisciplinary efforts are underway to diminish the role p-values play in making judgements about the significance of study findings by changing the threshold p-value used to pronounce statistical significance, through the use of Bayesian statistics, and through efforts to report effect sizes alongside p-values. In this months Methodology Corner installment, the focus is on effect sizes and their role in enhancing the value and utility of nursing education research studies. [J Nurs Educ. 2017;56(11):645-647.].