Patricia L. Hart

Resilience in Nurses: An Integrative Review

AIM To describe nursing research that has been conducted to understand the phenomenon of resilience in nurses. BACKGROUND Resilience is the ability to bounce back or cope successfully despite adverse circumstances. Nurses deal with modern-day problems that affect their abilities to remain resilient. Nursing administrators/managers need to look for solutions not only to recruit nurses, but to become knowledgeable about how to support and retain nurses. EVALUATION A comprehensive search was undertaken for nursing research conducted between 1990 and 2011. Key search terms were nurse, resilience, resiliency and resilient. Whittemore and Knafls integrative approach was used to conduct the methodological review. KEY ISSUES Challenging workplaces, psychological emptiness, diminishing inner balance and a sense of dissonance are contributing factors for resilience. Examples of intrapersonal characteristics include hope, self-efficacy and coping. Cognitive reframing, toughening up, grounding connections, work-life balance and reconciliation are resilience building strategies. CONCLUSION This review provides information about the concept of resilience. Becoming aware of contributing factors to the need for resilience and successful strategies to build resilience can help in recruiting and retaining nurses. IMPLICATIONS FOR NURSING MANAGEMENT Understanding the concept of resilience can assist in providing support and developing programmes to help nurses become and stay resilient.

Cultural Competency among Nurses with Undergraduate and Graduate Degrees: Implications for Nursing Education

AIM To compare the level of cultural awareness, knowledge, skills, and comfort of nurses with undergraduate and graduate degrees when encountering patients from diverse populations. BACKGROUND Cultural competency is a core curriculum standard in undergraduate and graduate nursing programs. Assessing cultural awareness, knowledge, skills, and comfort among nurses can help identify areas to strengthen in nursing curricula. METHOD A prospective, cross‐sectional, descriptive study design was used. Two thousand surveys were sent to nurses in a southeastern state; 365 nurses participated. RESULTS Undergraduate‐degree nurses scored lower than graduate‐degree nurses on cultural knowledge. Scores on cultural awareness, skills, and comfort with patient encounters did not vary between groups. Both groups of nurses reported little cultural diversity training in the workplace or in professional continuing education. CONCLUSION The findings of this study indicate areas of need for undergraduate and graduate nursing education.

The culture of an emergency department: An ethnographic study

In an environment of change and social interaction, hospital emergency departments create a unique sub-culture within healthcare. Patient-centered care, stressful situations, social gaps within the department, pressure to perform, teamwork, and maintaining a work-life balance were examined as influences that have developed this culture into its current state. The study aim was to examine the culture in an emergency department. The sample consisted of 34 employees working in an emergency department, level II trauma center, located in the Southeastern United States. An ethnographic approach was used to gather data from the perspective of the cultural insider. Data revealed identification of four categories that included cognitive, environmental, linguistic, and social attributes that described the culture. Promoting a culture that values the staff is essential in building an environment that fosters the satisfaction and retention of staff. Findings suggest that efforts be directed at improving workflow and processes. Development and training opportunities are needed to improve relationships to promote safer, more efficient patient care. Removing barriers and improving processes will impact patient safety, efficiency, and cost-effectiveness. Findings show that culture is influenced and created by multiple elements.

Hearing the voices of Newly Licensed RNs: The Transition to Practice

OBJECTIVE The future of nursing depends on newly licensed RNs (NLRNs), who often need help in transitioning from an academic to a clinical setting. This study sought to describe the NLRNs orientation experience and to identify ways of enhancing it. METHODS Using qualitative methods, a convenience sample of NLRNs was recruited and 21 were interviewed; audio recordings of the interviews were transcribed and validated for accuracy. Interpretative analysis of the transcripts sought to identify major patterns and themes. RESULTS Four patterns and 10 themes emerged from the data analysis: preceptor variability (with themes of satisfactory and unsatisfactory preceptorship), professional growth and confidence changing with time (with themes of learning through experience, learning to manage time, and learning to communicate), a sense of being nurtured (with themes of support through the program, the preceptor, and peers), and enhancing the transition (with themes of orientation enhancements and human resource enhancements). CONCLUSIONS These qualitative findings provide insight into the NLRNs transition from student to professional and suggest ways institutions might enhance orientation. Further study is warranted.ObjectiveThe future of nursing depends on newly licensed RNs (NLRNs), who often need help in transitioning from an academic to a clinical setting. This study sought to describe the NLRNs orientation experience and to identify ways of enhancing it. MethodsUsing qualitative methods, a convenience sample of NLRNs was recruited and 21 were interviewed; audio recordings of the interviews were transcribed and validated for accuracy. Interpretative analysis of the transcripts sought to identify major patterns and themes. ResultsFour patterns and 10 themes emerged from the data analysis: preceptor variability (with themes of satisfactory and unsatisfactory preceptorship), professional growth and confidence changing with time (with themes of learning through experience, learning to manage time, and learning to communicate), a sense of being nurtured (with themes of support through the program, the preceptor, and peers), and enhancing the transition (with themes of orientation enhancements and human resource enhancements). ConclusionsThese qualitative findings provide insight into the NLRNs transition from student to professional and suggest ways institutions might enhance orientation. Further study is warranted.

Effectiveness of a structured curriculum focused on recognition and response to acute patient deterioration in an undergraduate BSN program

The study purpose was to evaluate the effectiveness of a structured education curriculum with simulation training in educating undergraduate Baccalaureate of Science in Nursing (BSN) students to recognize and respond to patients experiencing acute deterioration as first responders. Researchers have demonstrated a lack of adequate clinical reasoning skills in new graduate nurses is a factor in critical patient incidents. A mixed methods design using a quasi-experimental, repeated measures and a descriptive, qualitative approach was used. A convenience sample of 48 BSN students was recruited. Statistically significant increases were shown in knowledge, self-confidence, and perceptions of teamwork. Six categories emerged from the qualitative data analysis: sources of knowledge, knowledge as a person, knowledge as a group, reasoning under pressure, feelings, real person versus simulation, and values. Nursing educators need to use innovative teaching strategies to ameliorate or even eliminate the theory-practice gap in nursing.

Discovering Ways That Influence the Older Nurse to Continue Bedside Practice

A descriptive qualitative approach was used to investigate older nurses practicing bedside nursing and to identify ways to influence older nurses to continue bedside practice. A purposive sample of 18 older nurses was recruited from a healthcare system located in the Southeastern United States. Interpretative analysis of interviews resulted in the identification of three constitutive patterns and eight themes. The first constitutive pattern identified was attributes of the older nurse. The themes comprising this pattern were (a) professional growth in confidence and skills through experience and (b) passion and love for nursing. The second constitutive pattern was enduring stress and frustration. The themes comprising this pattern were (a) physical and mental changes associated with aging, (b) increased patient acuity and patient load, (c) constant change, and (d) time constraints. The third constitutive pattern was enhancements needed for older nurses to continue bedside nursing. The themes comprising this pattern were (a) work environment enhancements and (b) organizational relationship enhancements. Findings may provide a better understanding of the older nurses role in bedside nursing.

The Effects of Guided Imagery on Patients Being Weaned from Mechanical Ventilation

The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials.

Psychometric Validation of the Revised Clinical Cultural Competency Questionnaire

Background and Purpose: Growing diversity in health care requires culturally competent care. Assessing nurses’ cultural competence is the first step in designing cultural competency education. The Clinical Cultural Competency Questionnaire (CCCQ) is one instrument to assess nurses’ cultural competence. Methods: The psychometric properties and factor structure of the revised CCCQ-PRE (CCCQ-PRE-R) for nurses was examined. Results: A 1-factor solution was noted for the knowledge and skills subscales. A 2-factor solution was discovered for the comfort and awareness subscales: differentiating between comfort in dealing with positive and negative cross-cultural encounters/situations, and differentiating between importance awareness and self-awareness. Cronbach’s alpha coefficients were high for all subscales. Conclusions: The findings support the use of the revised CCCQ-PRE-R with nurses. Further testing in larger, more diverse nursing populations is warranted.

Psychometric properties of the Clinical Decision-Making Self-Confidence Scale.

Background and Purpose: Nurses’ self-confidence in handling acute patient deterioration events may influence decision-making capabilities and implementation of lifesaving interventions during such events. The study purpose is to provide further psychometric testing of the Clinical Decision-Making Self-Confidence Scale (CDMSCS). Methods: The psychometric properties and factor structure of the CDMSCS was examined. Results: A two-factor solution was discovered for the CDMSCS. Construct validity was further supported by statistically significant differences between registered nurses and nursing students’ self-confidence level in handling deterioration events. Cronbach’s alpha coefficients were acceptable for the subscales and instrument. Conclusion: The CDMSCS is a valid and reliable instrument. Future studies should focus on establishing test–retest reliability and to determine factor loadings of subscale items to retain or delete cross-loading items.

Effectiveness of an Evidence‐Based Practice Nurse Mentor Training Program

Background Multiple reasons are cited for why nurses do not incorporate evidence into clinical practice, including lack of knowledge and skills, training, time, and organizational support. Aims To investigate the effectiveness of a mentor training program on mentors’ perceptions of knowledge, attitude, skill, and confidence levels, and organizational readiness related to evidence-based practice (EBP) and research utilization; and to investigate the effectiveness of creating a formalized structure to enculturate EBP in order to prepare nurses to incorporate EBP into clinical practice on nurses’ perceptions of knowledge, attitude, skill levels, barriers, nursing leadership, and organizational support related to EBP and research utilization. Methods A two-group pretest–posttest quasi-experimental, interventional design was used. A convenience sample of 66 mentors and 367 nurses working at a five hospital integrated healthcare system located in the Southeastern United States participated. Findings Nurse mentors’ knowledge, attitude, skill level, and organizational readiness related to EBP, t = −8.64, p < .001, and confidence, t = −6.36, p < .001, improved after training. Nurses’ knowledge, attitude, and skill level related to EBP, t = −19.12, p < .001, and barriers to research utilization, t = 20.86, p < .001, EBP work environment t = −20.18, p < .001, and EBP nurse leadership, t = −16.50, p < .001, improved after a formalized structure was implemented. Linking Evidence to Action EBP mentors are effective in educating and supporting nurses in evidence-based care. Leaders should use a multifaceted approach to build and sustain EBP, including developing a critical mass of EBP mentors to work with point of care staff.