Julie K. Waterhouse

PREDICTING NCLEX-RN SUCCESS: Can It Be Simplified?

The purpose of this study was to compare a simple, easily calculated method for predicting student success on the nursing licensure exam (NCLEX-RN) with more statistically complex methods of prediction. The Risk Appraisal Instrument (RAI), designed by Barkley, Rhodes, and Dufour (1), does not require sophisticated statistical methods, and the authors suggest it may be adapted for use in other nursing programs. We modified the RAI to suit the University of Delaware nursing program, and retroactively applied the Delaware RAI (DRAI) formula to the records of 538 students who graduated from our undergraduate baccalaureate nursing program between 1995 and 1998. Nearly 61 percent of NCLEX-RN failures were correctly classified, and 72 percent were accurately classified overall. While this more simple prediction might be helpful as a predictor of risk, it does not approach the 76 percent to 92 percent correct prediction of failure in recently published studies using statistically more complex methods.

Correlation between the Sedation-Agitation Scale and the Bispectral Index in ventilated patients in the intensive care unit

BACKGROUND Oversedation masks neurologic changes and increases mortality/morbidity, whereas undersedation risks prolonged stress mobilization and patient injury. In situations such as deep sedation/analgesia, the Bispectral Index (BIS) has potential use as an adjunct to clinical assessment of sedation to help determine depth of sedation. Determining the correlation between clinical and BIS measures of sedation will help to determine the correct role of BIS in intensive care unit (ICU) practice settings. OBJECTIVE To evaluate the correlation between the clinical assessment of sedation using the Sedation-Agitation Scale (SAS) and the assessment using BIS in ventilated and sedated ICU patients. METHODS ICU patients requiring mechanical ventilation and sedation were monitored using the SAS and BIS. Nurses initiated event markers with BIS at the time of SAS assessment but were blinded to BIS scores. RESULTS Data were collected on 40 subjects generating 209 paired readings. Moderate positive correlation between BIS and SAS values was shown with a Spearman Rank coefficient r value of .502 and an r(2) of .252 (P < .0001). Wide ranges of BIS scores were observed, especially in very sedated patients. Strong positive correlation was noted between BIS and electromyography with an r value of .749 (P < .0001). Age and gender significantly influenced BIS/SAS correlations. CONCLUSION In situations in which the clinical assessment is equivocal, BIS monitoring may have an adjunctive role in sedation assessment. BIS values should be interpreted with caution, however, because electromyography activity and other factors seem to confound BIS scores. More research is necessary to determine the role of BIS monitoring in ICU practice.

Predicting NCLEX-RN performance: Cross-validating an identified classification procedure

This study was an attempt to cross-validate a procedure from an earlier study for predicting NCLEX-RN performance. In the original study, a discriminant function was developed on 313 baccalaureate nursing graduates (1988 through 1990), which used 15 variables to correctly categorize more than 91 per cent of them on NCLEX-RN performance. This study used 142 subjects who graduated in 1991 and 1992 to evaluate the adequacy of the classification procedure. Subjects in this more recent sample differed significantly from those in the first on several variables, including SAT scores, physiology grades, and nursing grades. Eight-four per cent of the subjects in the cross-validation sample were correctly classified using the original discriminant function. More than 62 per cent of failures and 87 per cent of passes were correctly categorized. These results suggest that it is statistically and ethically sound to use this discriminant function to identify future students in danger of NCLEX-RN failure.

Post-graduation factors predicting NCLEX-RN success.

The academic and nonacademic factors that influence nursing students’ success on the licensure exam have been widely reported. However, many questions remain as to why certain candidates fail the exam. This pilot study explores postgraduation influences on the NCLEX-RN.® Factors such as length and type of study, work hours, review course participation, sleep, and stress were recorded using the newly developed NCLEX Preparation Survey. Results suggest both expected and unexpected relationships between these factors and NCLEX-RN mastery.

Discussing sexual concerns with health care professionals: positive attitudes in healthy subjects.

Sexuality is an important part of human health and should be addressed in numerous aspects of nursing care. Many nurses have difficulty providing patients with care in the area of sexuality, however, and usually do not address sexual concerns unless the patient asks specific questions. This study explored the attitudes of healthy individuals toward physicians and nurses discussing sexual concerns with clients. Most subjects thought discussing sexual concerns with nurses was appropriate, and all subjects thought that physicians should discuss sexual concerns with clients. Regression analyses indicated that attitudes were not influenced by variables such as age, gender, or marital status. These findings suggest that nurses can feel comfortable addressing sexuality with many more of their clients and that when unsure about discussing sexuality with clients, nurses should refer clients to their physicians.

What Do Adolescents Think About Teen Parenting

Unexpected increases in the teen birth rates have stimulated a renewed focus on the prevention of teen pregnancy. Although many adults believe there are certain costs associated with teen parenting, the attitudes of teens toward the parenting experience are not known. The purpose of this descriptive study was to determine teens’ thoughts on how their lives would change if they experienced a teen birth in the areas of relationships, vocation, and life impacts. The Thoughts on Teen Parenting Survey (TTPS), designed to measure demographic variables and perspectives on the costs and rewards of teen parenting, was administered to 695 high school students. The survey yielded a composite score, subscale scores, and aggregate data measuring teen thoughts on the consequences of the teen parenting experience. Findings may be used to identify teens at risk for pregnancy, develop interventions, and evaluate prevention strategies based on the insights of teens.

Forearm and Upper-Arm Oscillometric Blood Pressure Comparison in Acutely III Adults

When patients’ upper arms are not accessible and/or when cuffs do not fit large upper arms, the forearm site is often used for blood pressure (BP) measurement. The purpose of this study is to compare forearm and upper-arm BPs in 70 acutely ill adults, admitted to a community hospital’s 14-bed ICU. Using Philips© oscillometric monitors, three repeated measures of forearm and upper-arm BPs are obtained with head of bed flat and with head of bed elevated at 30°. Arms are resting on the bed. Paired t tests show statistically significant differences in systolic BPs, diastolic BPs, and mean arterial pressures in the supine and head-elevated positions. Bland—Altman analyses indicate that forearm and upper-arm oscillometric BPs are not interchangeable in acutely ill adults.

A pilot program to address healthy sexual behaviors among girls in juvenile detention.

PURPOSE This pilot study was designed to determine the effectiveness of an intervention on sexual behavior among girls in juvenile detention. METHODS The pre/posttest model assessed for changes in knowledge, attitudes, and reported behaviors. This program merged three curricula to create the unique Young Women Get Real Program with nursing student program facilitators. FINDINGS Despite high levels of satisfaction with the program, the data related to the final sample (n = 35) failed to reveal significant changes in measured variables. CONCLUSIONS The results may inform nurses as they pursue interventions to promote responsible sexual behavior in selected populations.

Benefits of using undergraduate teaching assistants throughout a baccalaureate nursing curriculum.

The Residency Model of Nursing Education was put into practice at our institution to provide more active teaching-learning strategies, make use of innovative clinical approaches, and accommodate more students. A unique aspect of this creative curricular change is the use of undergraduate teaching assistants (UTAs) to provide mentor and mentee opportunities for nursing students and assist faculty with course logistics. This article describes the development, challenges, and benefits of implementing a UTA program in a baccalaureate school of nursing.

A Feasibility Study to Assess the Effectiveness of Safe Dates for Teen Mothers

OBJECTIVE To determine the effectiveness of the adapted Safe Dates curriculum as an intervention for pregnant and/or parenting teens to prevent teen dating violence (TDV). DESIGN This pre-/posttest, single-sample study provided a means to assess the effectiveness of an adapted Safe Dates curriculum for teen mothers. SETTING The adapted Safe Dates curriculum was implemented in three schools designed for the unique needs of teens who are pregnant and/or parenting. PARTICIPANTS The final sample of 41 teen participants, with a mean age of 16.27, completed 80% of the curriculum and two of the three assessments. Most of the teens were pregnant during participation in the curriculum, and six had infants between age 1 and 3 months. METHODS The teen mothers completed the pretest, participated in the 10-session adapted Safe Dates curriculum, and completed the posttest at the end of the program and 1 month after program completion. The pre/posttest was adapted from the Safe Dates curriculum-specific evaluation instrument. Senior, undergraduate nursing students were trained in and implemented the curriculum. RESULTS Participation in the adapted Safe Dates program yielded significant differences in the areas of responses to anger, gender stereotyping, awareness of resources for perpetrators and victims, and psychological violence perpetration. CONCLUSIONS This adapted program may be effective in changing selected outcomes. The implementation of a larger scale, experimental/control group study may demonstrate the programs efficacy at reducing the incidence of TDV among teen mothers.