Pamela Baxter

Nurse faculty perceptions of simulation use in nursing education.

In this study nursing faculty perceptions of the implementation of simulation in schools of nursing across Ontario, Canada, were explored using the Q-methodology technique. Following Q-methodology guidelines, 104 statements were collected from faculty and students with exposure to simulation to determine the concourse (what people say about the issue). The statements were classified into six domains, including teaching and learning, access/reach, communication, technical features, technology set-up and training, and comfort/ease of use with technology. They were then refined into 43 final statements for the Q-sample. Next, 28 faculty from 17 nursing schools participated in the Q-sorting process. A by-person factor analysis of the Q-sort was conducted to identify groups of participants with similar viewpoints. Results revealed four major viewpoints held by faculty including: (a) Positive Enthusiasts, (b) Traditionalists, (c) Help Seekers, and (d) Supporters. In conclusion, simulation was perceived to be an important element in nursing education. Overall, there was a belief that clinical simulation requires (a) additional support in terms of the time required to engage in teaching using this modality, (b) additional human resources to support its use, and (c) other types of support such as a repository of clinical simulations to reduce the time from development of a scenario to implementation. Few negative voices were heard. It was evident that with correct support (human resources) and training, many faculty members would embrace clinical simulation because it could support and enhance nursing education.

An integrative review of the factors influencing new graduate nurse engagement in interprofessional collaboration

AIM To analyse critically the barriers and facilitators to new graduate nurse engagement in interprofessional collaboration. BACKGROUND The acculturation of new graduate nurses must be considered in strategies that address the global nursing shortage. Interprofessional collaboration may support the transition and retention of new graduate nurses. DESIGN Whittemore and Knafls revised framework for integrative reviews guided the analysis. DATA SOURCES A comprehensive multi-step search (published 2000-2012) of the North American interprofessional collaboration and new graduate literature indexed in the CINAHL, Proquest, Pubmed, PsychINFO and Cochrane databases was performed. A sample of 26 research and non-research reports met the inclusion criteria. REVIEW METHODS All 26 articles were included in the review. A systematic and iterative approach was used to extract and reduce the data to draw conclusions. RESULTS The analysis revealed several barriers and facilitators to new graduate engagement in interprofessional collaboration. These factors exist at the individual, team and organizational levels and are largely consistent with conceptual and empirical analyses of interprofessional collaboration conducted in other populations. However, knowledge and critical thinking emerged as factors not identified in previous analyses. CONCLUSION Despite a weak-to-moderate literature sample, this review suggests implications for team and organizational development, education and research that may support new graduate nurse engagement in IPC.

Exploring new graduate nurse confidence in interprofessional collaboration: A mixed methods study

BACKGROUND Confidence is required for effective engagement in interprofessional collaboration. New graduate nurses often lack confidence in interprofessional interactions, and this may compromise the delivery of safe and effective healthcare. OBJECTIVES The overall objective of this study was to explore new graduate nurse confidence in interprofessional collaboration. DESIGN An explanatory sequential mixed methods design was used. METHODS New graduate nurses from Ontario, Canada (N=514) completed a cross-sectional descriptive survey in 2012. The survey measured perceived confidence in interprofessional collaboration, and it included items that were proposed to have a relationship with new graduate nurse confidence in interprofessional collaboration. Follow-up qualitative telephone interviews were conducted with 16 new graduate nurses. RESULTS The quantitative findings suggested that several factors have a positive relationship with new graduate nurse confidence in interprofessional collaboration: availability and accessibility of manager, availability and accessibility of educator, number of different disciplines worked with daily, number of team strategies, and satisfaction with team. The qualitative phase supported the quantitative findings and also provided new information about factors that facilitated and challenged new graduate nurse confidence when engaging in interprofessional collaboration. The facilitators were: experience, knowledge, respect, supportive relationships, and opportunities to collaborate. Challenges included: lack of experience, lack of knowledge, communication challenges, and balancing practice expectations. The overall findings relate to team and organizational support, and new graduate nurse development. CONCLUSION Interventions that provide support for interprofessional collaboration at the team and organizational levels, and develop new graduate nurse knowledge and experiences regarding collaborative practice, are essential for enhancing new graduate nurse confidence in interprofessional collaboration.

A systematic review of the cost-effectiveness of nurse practitioners and clinical nurse specialists: what is the quality of the evidence?

Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n = 11), NP-transition (n = 5), NP-inpatient (n = 2), CNS-outpatient (n = 11), CNS-transition (n = 13), and CNS-inpatient (n = 1). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.

Continuing education for primary health care nurse practitioners in Ontario, Canada

The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated.

Factors that facilitate registered nurses in their first-line nurse manager role.

AIM To determine the factors that attract and retain Registered Nurses in the first-line nurse manager role. BACKGROUND The first-line nurse manger role is pivotal in health-care organisations. National demographics suggest that Canada will face a first-line nurse manager shortage because of retirement in the next decade. Determination of factors that attract and retain Registered Nurses will assist organisations and policy makers to employ strategies to address this shortage. METHODS The study used an exploratory, descriptive qualitative approach, consisting of semi-structured individual interviews with 11 Registered Nurses in first-line nurse manager roles. RESULTS The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role and confirmed the challenges encountered by first-line nurse managers practicing in the current health-care environment. CONCLUSIONS The first-line nurse manager role has been under studied. Further research is warranted to understand which strategies are most effective in supporting first-line nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT Strategies to support nurses in the first-line nurse manager role are discussed for the individual, programme, organisation and health-care system/policy levels.

Teaching Critical Management Skills to Senior Nursing Students: Videotaped or Interactive Hands-On Instruction?

ABSTRACT This study examined and compared the effectiveness of videotape training versus hands‐on instruction in preparing senior nursing students to respond to emergency clinical situations. Fourth year nursing students (n = 27) were randomly assigned to one of three groups; one group received videotaped instruction, one group engaged in a hands‐on experience, and one group, a control, received no instruction. Students were evaluated using a three‐station objective structured clinical examination that involved high‐fidelity simulations. Differences between the control and the two instructional groups were significant (p = .007); however, there was no significant difference between the two types of instruction. It was concluded that instruction on crisis management with a high‐fidelity simulator, using either video or hands‐on instruction, can result in a significant improvement in performance.

Exploring Student and Faculty Perceptions of Clinical Simulation: A Q-Sort Study

BACKGROUND Simulation learning has become a widely accepted and valuable methodology within nursing education. This study assessed whether student and faculty perceptions regarding simulation learning have changed since curricular integration of simulation activities within an undergraduate nursing program. METHOD Q-methodology was used to identify unique and similar perspectives of 12 faculty and 21 students. Participants completed a brief demographic questionnaire and sorted statements related to beliefs about simulation-based learning. RESULTS Faculty perceptions were captured within one viewpoint-positive enthusiasts. Three student viewpoints were identified: challenge seekers, realistic embracers, and support seekers. Both students and faculty believed that simulation improved critical thinking. CONCLUSION The findings suggest that faculty should be aware of the range of student perceptions and tailor their teaching approaches accordingly to maximize student learning.

Leaders’ experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review

INTRODUCTION Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. PURPOSE The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. METHODS We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. RESULTS Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. CONCLUSIONS Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care.

A mixed methods exploration of the team and organizational factors that may predict new graduate nurse engagement in collaborative practice

Abstract Although engagement in collaborative practice is reported to support the role transition and retention of new graduate (NG) nurses, it is not known how to promote collaborative practice among these nurses. This mixed methods study explored the team and organizational factors that may predict NG nurse engagement in collaborative practice. A total of 514 NG nurses from Ontario, Canada completed the Collaborative Practice Assessment Tool. Sixteen NG nurses participated in follow-up interviews. The team and organizational predictors of NG engagement in collaborative practice were as follows: satisfaction with the team (β = 0.278; p = 0.000), number of team strategies (β = 0.338; p = 0.000), participation in a mentorship or preceptorship experience (β = 0.137; p = 0.000), accessibility of manager (β = 0.123; p = 0.001), and accessibility and proximity of educator or professional practice leader (β = 0.126; p = 0.001 and β = 0.121; p = 0.002, respectively). Qualitative analysis revealed the team facilitators to be respect, team support and face-to-face interprofessional interactions. Organizational facilitators included supportive leadership, participation in a preceptorship or mentorship experience and time. Interventions designed to facilitate NG engagement in collaborative practice should consider these factors.