Category: Nursing

Introduction

The Person-Centered Nursing (PCN) Framework was developed by McCance and McCormack (2017b). Currently, it is one of the theories that can be used in nursing practice. This paper will offer an overview of PCN and its approach to the nursing metaparadigm, justify PCN as a nursing theoretical framework, and apply it to a particular nursing role. Based on this information, the paper will argue that PCN is a strong nursing framework that is capable of guiding advanced nursing practice (ANP).

Model Overview. The Nursing Metaparadigms

PCN was first introduced by McCance and McCormack (2017b) in 2006, but since then, it was expanded. McCance and McCormack (2017a) proceed to update and enhance PCN: a recent development involved adding particular macro-context elements to it. Therefore, the framework is still developing and improving to suit the needs of the nursing practice, and the present paper will offer the most recent version of the framework.

PCN includes several key systems which constitute person-centered care. First, it describes prerequisites, which involve professional and interpersonal skills, beliefs, a good understanding of oneself, and commitment to the job that a nurse can show. Then, the model acknowledges the significance of the context of care (care environment), which includes multiple factors from staff relationships to decision-making and organizational systems, as well as the potential for innovation and physical environment. Then, PCN describes care processes, which incorporate holistic care, as well as sympathetic presence, work with the patients beliefs and values, and shared decision-making (McCance & McCormack, 2017b, p. 38-39).

The final element consists of outcomes, which must be patient-centered for PCN. Such outcomes include a personal assessment of well-being, patient satisfaction, and the development of a therapeutic or healthful culture in which the circumstances for care are optimal (McCance & McCormack, 2017b, p. 38-39). Thus, the model covers a number of important elements that can be of interest to APN.

The way PCN incorporates the nursing metaparadigm can help to understand how the model would guide practice. The metaparadigm consist of four concepts: person, health, environment, and nursing practice (Reed, 2017, p. 13). The person is central in PCN; the patient is viewed as a subject that is capable of making choices and should be involved in care. Health is shown to be a complex phenomenon that is not limited to physical well-being. PCN favors holistic care, and another important role of patients in PCN consists of determining the outcomes of care, which are linked to the definition of health.

In connection to that, nursing practice is also characterized by the patient; all the care processes and outcomes are centered on the patient and aimed at inviting him or her to participate in care. PCN highlights the importance of a nurses qualities and skills for care processes. Finally, the environments impact is acknowledged in PCN, and it singles out several important environmental factors to consider when providing care. To summarize, PCNs focus on the patient determines how it incorporates the metaparadigm.

PCN as a Theoretical Framework in Nursing

McCance and McCormack (2017b) point out that their PCN can be defined as a middle-range nursing theory. Here, PCN is characterized as relatively specific (as compared to conceptual models) and rather narrow (as compared to grand theories) since it focuses on patient-centered care. PCN also introduces specific concepts while explaining the relationships between them, and, according to McCance and McCormack (2017b), it was derived from broader conceptual frameworks (particularly that by McCormack). This understanding of middle-range nursing theories is in line with modern ideas about nursing knowledge and its hierarchies (Reed, 2017).

Furthermore, McCance and McCormack (2017b) note that PCN was acknowledged as a nursing model and is of interest to interdisciplinary teams. The authors suggest that its primary use consists of explaining the concept of person-centered nursing along with the related constructs within the context of modern nursing practices. In summary, PCN qualifies as a useful theoretical framework for nurses in theory and practice.

Applying the Theory

APN roles are numerous, but the present paper will focus on family nurse practitioners. There is not much research on the topic, but it is still apparent that person-centered care is applicable to APN practice (Enzman-Hines & Gaughan, 2017). PCN can provide working definitions for the metaparadigm concepts, which makes it a useful tool that should help to determine personal or environmental factors which affect care, the content of care, and the means of its assessment.

However, family nurses are especially likely to apply PCN effectively. They are typically involved in caring for particular individuals throughout their life span (Enzman-Hines & Gaughan, 2017). Consequently, they should be able to form meaningful connections with patients, which would facilitate the nursing care processes described by PCN, including holistic care, improvement of patients beliefs, and their effective engagement in care and decision-making.

Furthermore, the focus on patient-centered outcomes can be beneficial for nurses, quality of care, and patients, especially when patient satisfaction is concerned. Thus, PCN is applicable to family nurse practitioners practice because it can provide structure for care while having potential benefits for both patients and nurses.

Conclusion

In summary, PCN is a valid nursing theoretical framework that can be of use in guiding and informing nursing practice, especially that of a family nurse practitioner. PCNs primary feature is its focus on the patient, which determined the way it incorporates all the elements of the nursing paradigm. This focus makes PCN particularly useful for nurses who treat patients for prolonged periods of time, and because of its attention to patient-centered outcomes, PCN may be especially beneficial for patients and helpful for nurses.

References

Enzman-Hines, M., & Gaughan, J. (2017). Advanced holistic nursing practice narratives: A view of caring praxis. Journal of Holistic Nursing, 35(4), 328-341. Web.

McCance, T., & McCormack, B. (2017a). A considered reflection and re-presenting the Person-Centred Practice Framework. In B. McCormack & T. McCance (Eds.), Person-centred practice in nursing and health care (pp. 259-264). Oxford, UK: John Wiley & Sons.

McCance, T., & McCormack, B. (2017b). The Person-Centred Practice Framework. In B. McCormack & T. McCance (Eds.), Person-centred practice in nursing and health care (pp. 36-66). Oxford, UK: John Wiley & Sons.

Reed, P. (2017). The spiral path of nursing knowledge. In P. Reed & N. Shearer (Eds.), Nursing knowledge and theory innovation (pp. 1-20). New York, NY: Springer.

Facility Type: This facility is needed for blood transfusion and allows to save lives and improve health. Meanwhile, the mission of San Diego Blood Bank is to unite different communities of people to save others (San Diego Blood Bank, n.d.). In addition, the value statement is to provide the best possible service and the vision is to continuously develop for the health of patients.

Organizational Chart: The center has 26 employees who are divided into three departments. The governing body is the board of directors, which includes 16 employees. Moreover, there is a leadership team of 6 employees who are responsible for legal and financial issues (San Diego Blood Bank, n.d.). Moreover, one employee is elected from them to supervise the medical staff. The next department is the executive team, that is, persons with medical education, who are responsible for the gathering and preservation of blood.

Corrective Action Plan: The challenge that exists at San Diego Blood Bank is not the lack of donors, but in the event of an emergency, the lack of nurses to receive blood (San Diego Blood Bank, n.d.). The root cause of this problem is the lack of information among the population about the importance of blood transfusion not only in critical periods such as Covid 19, but also in normal times. In order to eliminate this issue, 3 months are needed, because this period is enough to develop and launch advertising about the center in the media. This will attract more doctors to the executive team and encourage residents to donate blood. Accordingly, it is necessary to involve the media as a third party to promote the profession and explain the importance of blood donation among the residents of the United States. After three months, it is possible to evaluate how much the number of visitors and nursing staff has increased. The survey should ask employees if their workload is adequate to meet the number of tasks.

Employee Resistance to Change: Employees may not be supportive of change because more blood donors will come first and then staff will be hired. Therefore, at first the executive team will work in several shifts, but gradually the executive team will be increased.

Reference

San Diego Blood Bank (n.d.). San Diego Blood Bank about us. Web.

Discussion

The research topic will be nursing and physician shortage across the globe. Generally, in order to have quality care services, there must be professionals that ensure the needs of patients are met. Healthcare is critical and every nation has prioritized ways of making the services universal to allow citizens receive better treatment to lower the mortality rate. The topic is interesting because it covers the critical area that determines the outcome of care delivery. When there is a shortage of practitioners, the likelihood of incurring fatal errors that can lead to the death of patients is high. This is because there will be a limited number of experienced nurses to guide the novice providers on how to perform some critical health processes (Spurlock, 2020). Similarly, sick individuals will be less satisfied with the care services as a result of reduced patient-nurse interaction. By traversing deeply into the causes and impacts of the topic, it will be easier to formulate effective approaches to curb nursing turnover.

Background

The nursing profession is currently expressing an increase in nurse turnover that is causing the healthcare to lack the required human resource to facilitate effective care delivery. Several factors including aging workforce and reduced experienced nurse educators contribute massively to the issue. These aspects are vital and universal in most cases making them be encountered in different regions. They significantly impact the outcome of care services and the overall satisfaction of patients. To lower the increasing nurse shortage, measures such as empowering providers and proper staffing ratios will be the vital framework for solving the issue.

The topic is interesting because it covers the critical area that determines the outcome of care delivery. When there is a shortage of practitioners, the likelihood of incurring fatal errors that can lead to the death of patients is high. This is because there will be a limited number of experienced nurses to guide the novice providers on how to perform some critical health processes (Spurlock, 2020). Similarly, sick individuals will be less satisfied with the care services as a result of reduced patient-nurse interaction. By traversing deeply into the causes and impacts of the topic, it will be easier to formulate effective approaches to curb nursing turnover.

Problem Statement

The shortage of nursing practitioners is critical to the healthcare sector because it facilitates poor care delivery which can result in high mortality rate and patient dissatisfaction.

Reference

Spurlock Jr, D. (2020). The nursing shortage and the future of nursing education is in our hands. Journal of Nursing Education, 59(6), 303-304. Web.

Introduction

The work of Rosemarie Parse has affected the modern perception of patient-nurse relations and expanded the role that nurses play in the healthcare system. She developed the theory of human becoming  a depiction of an ideal dynamic that nurses were to upkeep with their patients. The chosen video (Rosemarie Parse  Theory of Human Becoming, 2018) highlighted not only her nursing theories and practice but also touched upon her personal and family life.

Why Choose Parse?

Rosemarie Parse exists in the category of renowned nurse theorists whose proposals remain unverifiable and untestable, despite staying established in nursing practice. Alligood (2018) quotes Parse, who states that the [humanbecoing] theory does not lend itself to testing since it is not a predictive theory and is not based on a cause-effect view of [humanuniverse] (p. 381). This makes her theory of human nature at the same time practical and philosophical, creating an interesting combination of different factors.

Personal Philosophy

A possible point of disagreement with Parse would be on the matter that nurses should be responsible for keeping the patients quality of life as described by the patients themselves. While this sounds desirable in cases where the patient upkeeps a comfortable lifestyle, it may not remain so in the less likely instances in which they aspire to health deterioration. Even so, Parses theory focuses less on such issues more on the environment that a patient lives in, and the relation between the patient, their surroundings, and nurses as the mediators between them.

Surprising Moments

One of the intriguing parts of the interview was the discussion of theory growth as opposed to theory writing, with Parse reminiscing about the creation of her human becoming idea (Rosemarie Parse  Theory of Human Becoming, 2018). It is understandable that creating a work that could transform the role and dynamic of nurses and nursing is not a feasible day-task; the process of its formation is something that remains wholly private. Together with the philosophical language that Parse uses to illustrate her thought process, her theory is highlighted in an exceptionally human approach.

Basis for Recommendation

The value of the video lies in the personal aspect of it, with Parse herself answering questions in the form of an interview. This format provides additional insight into the process of theory creation and allows for in-the-moment queries and reactions, making the theorist accessible to a broad public. Thus, students studying the topic would benefit significantly from watching such a video, especially because it is a first-hand source.

Received Value

While written books and papers allow for a more in-depth study of theorists and their works, such videos help accustom students through in a more personal manner. Such videos play a knowledge-fastening note when studying nursing theories and their creators, with information on approaches accompanied by the additional clarification of arguable moments by the creator themselves. Thus, the video conveys a complex of ideas, as well as allows for a judgment of what information was relevant at the time of video creation through an analysis of the asked questions.

Conclusion

The assigned video viewing holds a lot of potential for students not only because of the knowledge obtained through it but also because it allows students to personify and familiarize themselves with certain nurse theorists. Interview videos, in particular, prevent students from feeling a sense of disunity and historical distance between personalities that affect nursing in the modern-day. In the case of Rosemarie Parse, her interview allows students not only to acquaint themselves with her theories but also with her life and personal philosophy.

References

Alligood, M. (2018). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier.

Rosemarie Parse  Theory of Human Becoming. (2018). Web.

Introduction

The U.S consists of the state boards and the national nursing board (NCSBN). The State Boards of Nursing (BON), develop and enforce nursing practice laws. Professional Nurse Associations (PNA) advocate for nurses during the development of these laws. The law development process allows nursing organizations to influence the outcome. PNAs ensure nurses and patients needs and interests are protected.

The Board of Nursing

• Performs criminal background checks;
• Imposes disciplinary actions;
• Setting licensure fees;
• Oversees the nursing licensure training procedure;
• PNAs are committed to their members and the nursing professions advancement;
• Guides the legal nursing practice scope;
• Upholds nursing education standards;
• Oversees advanced nursing practice;
• Accredits nursing education program;
• Contrarily, PNAs set the quality standards of practice and ethical guidelines;
• BON is public-based while PNAs are privatized.

Description of the Ohio Board of Nursing

It consists of ten board members appointed by the states governor. Members: 8 RNs, 2 LPNs, 1 advanced practice nurse, and 1 consumer member. The president and vice-president lead the board (About the board, n.d.). The board implements and enforces Chapter 4723 of the Ohio Revised Code (About the board, n.d.). The board reviews the code at least once every five years. The code delineates the basic practice standards for all nurses.

How to Become a Board Member

• Be a U.S citizen;
• Graduate from an approved education program;
• Have an active license to practice in Ohio;
• Being an active practicing nurse in the last five years

State Regulation of General Nurse Scope of Practice

RNs in Ohio have independent authority to engage in all licensed practice aspects with minor exceptions (Scope of practice, 2018). RNs can delegate, supervise, and evaluate LPNs nursing practice.

Influence on Nurses Role

This particular restriction limits their capacity to work to the full extent of their education. Their supervisory role facilitates the delivery of quality care (MacKinnon et al., 2018). APRNs can diagnose, treat, and prescribe medications for their patients (4-19y/o) (Scope of practice, 2018). However, they can only perform these roles in collaboration with a physician. Care delivery under physicians supervision exacerbates perceptions of APRNs incompetency. This, in turn, promotes role ambiguity and incongruence.

Influence on Delivery, Cost, and Access to Healthcare

Restricting RNs practice scope limit primary care services access. RNs full practice can help address the shortage of primary care services (MacKinnon et al., 2018). When allowed to practice to their educations full extent, RNs can create and implement affordable care plans. This approach will help reduce healthcare costs. A newly-introduced house bill in Ohio expanded Aprns practice scope in Ohio.

Supervisory approaches during care delivery can fragmented care, inadequate access, and high healthcare costs (Bosse et al., 2017). Cooperative practice agreement: Each party operates within the defined legal boundaries. APRNs cannot perform a physicians role despite their qualifications. Consequently, this treatment approach encourages fragmentation. Fragmentation, in turn, increases healthcare costs.

State Regulations for APRNs

Several reimbursement programs do not compensate APRNs for their services. APRNs authorized to perform to their practices full extent are denied reimbursements (Bosse et al., 2017). This may increase out-of-pocket expenses and deter patients from accessing healthcare. The limited practice also increases commuter time (Neff et al., 2018). It also reduces the number of available primary care providers (Neff et al., 2018).

References

About the board/contact: What we do. (n.d.). Ohio Board of Nursing. Web.

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761765. 

MacKinnon, K., Butcher, D. L., & Bruce, A. (2018). Working to full scope: The reorganization of nursing work in two Canadian Community hospitals. Global Qualitative Nursing Research, 5, 114. 

Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379385. Web.

Scope of practice. (n.d.). American Nurses Association. Web.

Scopes of practice: Registered nurses (RNs) and licensed practical nurses (LPNs). (2018). State of Ohio Board of Nursing. 

The world leader in nursing regulatory knowledge. (n.d.). National Council of State Boards of Nursing. Web.

Introduction

In spite of efforts of health care professionals to improve the situation in the United States regarding the access to healthcare services, the quality of services provided for minority groups in the country is often lower in comparison with the numbers for the Whites. In this context, it is important to examine the situation regarding the health profiles of such large US minority groups as African Americans and Hispanics. The reason is that Hispanics represent 17% of the total US population with the largest proportion of persons aged 15-35 years, and African Americans represent 13% of the population with the largest number of persons aged 20-45 years (Figure 1; The Office of Minority Health, 2015). Although African American and Hispanic minority populations are similar regarding the low access to the healthcare, the low insurance coverage, and common medical conditions, these groups are characterized by differences in relation to cultural norms and beliefs influencing their health.

Similarities and Differences in Accessing the Health Care

The access to the health care is a problem for African Americans and Hispanics because only the low percentage of these minority populations regularly see doctors and receive the professional medical assistance. The reasons for this problem are similar, and they include poverty, the low percentage of insurance coverage and low education levels associated with income and cultural perceptions. Thus, many African Americans and Hispanics regularly reject visiting doctors in spite of the increased participation in social and insurance programs, including Medicare and Medicaid; and prevention and management of certain conditions is complicated in these minority groups.

Although the reasons for the low access to the health care are similar, the actual numbers are different for African Americans and Hispanics. Thus, 30% of Hispanics do not have the source of care and visit a doctor regularly in comparison with 20% of African Americans. Besides, 26% of Hispanics have no insurance in contrast to 17% of African Americans, who has no health insurance (Figure 1; US Census Bureau, 2015). These factors influence medical conditions in these minority populations directly because the absence of insurance associated with the low-income status affects the persons opportunities to access the high-quality care. From this point, the situation for the Hispanic population is more critical than for African Americans.

Ways to Address Identified Factors to Increase the Trust in Populations

Health care professionals have necessary means in order to contribute to changing the situation to positive and increase the trust in minority groups. First, it is necessary to address cultural norms and beliefs regarding the health. Such typical medical conditions in African Americans as heart diseases (24%) and cancer (22%) are often associated with the absence of preventive measures, and such prevalent conditions as obesity and diabetes often result from negative lifestyle and eating habits, including the sedentary lifestyle and eating a lot of fast food and sugar. When African Americans need the medical assistance, they prefer using alternative medicine and herbal drugs. These individuals often resist visiting doctors because of noticing disrespect and prejudice. The level of satisfaction with healthcare services is rather low in African Americans (Centers for Disease Control and Prevention, 2015). The similar situation is typical for Hispanics who often suffer from cancer (22%), heart diseases (18%), and unintentional injuries (16%) (Figure 2). The levels of obesity and diabetes are also high because of eating the traditional food like tacos or burritos. Still, Hispanics often reject opportunities to see a doctor not because of financial issues, but because of language problems. They prefer to treat family members at home, using traditional methods, like distinguishing between hot and cold diseases.

From this point, the main approach addressing identified factors is to decrease the language barrier and use the help of interpreters in facilities, if it is necessary. Health care professionals also need to focus on the literacy levels and cultural visions of these populations and consider this fact while explaining treatment options depending on the peoples linguistic competency. It is important to for healthcare professionals to understand causes of typical diseases in minority groups and attract more people to visit doctors regularly while demonstrating the cultural awareness and respect for these persons values.

The Role of Cultural Proficiency

The cultural competence of health care professionals is as important for improving the health status of minorities as the increased funding and expanded insurance coverage. Many African Americans and Hispanics with such chronic conditions as high blood pressure, heart disease, and cancer do not visit doctors regularly because they feel uncomfortable while communicating with professionals (Disparities in healthcare quality, 2011). The problem is often in the low level of cultural awareness and competence in medical workers. In this case, it is necessary to improve the health care professionals knowledge of cultural values, religious beliefs, and language of minorities to avoid problems when a patient feels that the attitude is biased, and the provided care is worse than proposed to other ethnicities.

Conclusion

Thus, health care professionals need to develop their cultural competence in order to address the needs of the diverse American population and improve the persons medical experiences. This approach is important because cultural proficiency leads to increasing the access to the health care and rising rates of minority representatives who use the advantages of preventive care regularly.

References

Centers for Disease Control and Prevention. (2015). Racial and ethnic minorities. Web.

Disparities in healthcare quality among racial and ethnic groups. (2011). Web.

The Office of Minority Health. (2015). Minority populations. Web.

US Census Bureau. (2015). Quick facts. Web.

Exploratory research is a specific type of inquiry intended to define a phenomenon. It is used in cases when the problem at hand has not been studied sufficiently, lacks clarity, or is not supported by systematized operational definitions (De Chesnay, 2015). Exploratory research can be based on primary data, such as the opinions and perceptions of the involved stakeholders gathered via surveys and interviews. Alternatively, secondary data can be used for the research purposes, such as the information from the academic literature. Exploratory research is primarily used at the early stages of inquiry.

Qualitative research is a broad category that usually includes studies aiming at the in-depth inquiry into the decision-making process of groups of individuals. This type of research is often performed by evaluating the perceptions of the representatives of the studied group (Holloway & Galvin, 2016). It is usually exploratory and open-ended in nature and does not employ statistical analysis. The findings may be presented in a narrational form and are meant to provide insights rather than conclusively prove a point.

Quantitative research is aimed at establishing a statistical significance of a specific phenomenon. It requires the formulation of precise research hypotheses that are falsifiable and employs mathematically measurable variables (LoBiondo-Wood & Haber, 2014). Quantitative research uses well-defined data with fixed response options and utilizes numerous statistical tools intended for ensuring the reliability of the results. Since it is used to conclusively confirm or disprove a hypothesis, it relies on much larger samples than qualitative research.

The high quality of evidence is a cornerstone of evidence-based practice. For this reason, the credibility of the source is crucial for determining whether the source can be safely incorporated into the planned intervention. The credibility of the source can be established by checking the compliance with academic standards (e.g., the articles structure and the presence of peer review) and scientific standards (e.g., the use of appropriate sampling and analysis procedures).

One of the most prominent examples of change in the clinical setting as a result of EBP implementation was the introduction of a systematic multimodal intervention aimed at increasing compliance with hand hygiene practices in a local hospital. The intervention included the education of the nursing staff on the outcomes of the poor compliance, briefing on the decreased transmission of healthcare-associated infections and pathogens resulting from the change in order to increase motivation, and the change of equipment used for hand hygiene to alcohol-based solutions. The latter was based on the evidence from the academic literature suggesting that alcohol-based rubs are less time-consuming and have an overall positive effect on hand hygiene compliance (Smiddy, OConnell, & Creedon, 2015).

In addition, workshops were introduced that allowed the nurses to share relevant observations on the effectiveness of the strategy and provide useful feedback that could be used to adjust the process and further improve the results, thus further enhancing the evidence-based nature of the change. The facts that the initiative was directly aimed at nursing personnel and incorporated the feedback and observations of the nursing practitioners point to the fact that it was within the scope of nursing practice. While there is currently no data available to evaluate the clinical significance of the change, the results of the survey administered as a part of the initiative revealed that the nurses had perceived it as successful. Nevertheless, I would introduce a minor change by addressing the issue of irritated skin as one of the negative side effects. In this way, we would be able to improve employee satisfaction and, by extension, commitment in the workplace.

References

De Chesnay, M. (Ed.) (2015). Nursing research using data analysis: Qualitative designs and methods in nursing. New York, NY: Springer.

Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare (4th ed.). Ames, IA: John Wiley & Sons.

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence-based practice (8th ed.). St. Louis, MO: Elsevier.

Smiddy, M. P., OConnell, R., & Creedon, S. A. (2015). Systematic qualitative literature review of health care workers compliance with hand hygiene guidelines. American Journal of Infection Control, 43(3), 269-274.

This is a critique of the paper titled Sources of stress in nursing students: a systematic review of quantitative studies by three University of Jaen scholars. All components of the article were evaluated for strengths and weaknesses. It was concluded that the paper was not well written and that it should not inform any clinical practice process.

The title of the paper summarizes the scope of coverage of the document. However, the reader cannot immediately tell whether the studies in the review were conducted by one or more researchers. The gaps left in the title could lead the reader to believe that the articles being studied all focussed on identifying the sources of stress for nursing students.

In the introduction, the authors describe stress as a dynamic interaction between the individual and environment (Pulido, Augusto & Lopez, 2012, p.15). Although they expound on this in subsequent paragraphs, they do not convincingly describe the word stress. The reader is forced to read through layers of jargon to get the meaning of the definition.

The objectives of this study are also not properly linked with the title, which according to Schmidt and Brown (2009) creates gaps. The authors say their main objective is to identify the sources of stress among nursing students (Pulido, Augusto & Lopez, 2012). This is different from the titles prompting that the paper would only review studies by other scholars. By reading the objectives it is not clear if the authors want to use the work of other scholars to help them come up with their own conclusion, or if they plan to do their own independent data collection.

The methodology section explains that a number of journals will be perused and documents with titles corresponding to the topic picked (Pulido, Augusto & Lopez, 2012). The authors of the paper describe this as a quantitative method. However, based on their explanation, this methodology involves both qualitative and quantitative approaches.

The results section proves that the methodology chosen was not in tandem with the topic of discussion. Most of the results focus on the tally of articles identified and how they were filtered to yield a specific research sample. The qualitative element of the task has been given adequate prominence and it helped highlight the authors plan.

Because the entire project was designed to study scholarly literature by other people, there was no apparent need to introduce a literature review. The discussion part of the paper describes the kind of research that was done by the authors of each article. However, the scholars have a difficult time trying to group the data from the different sources together because the researchers behind them employed varied methodologies.

The implications for the practice section is also short for this paper. The papers under review had different findings, all of which had unique implications for practice. The tone in which this section is written is also not indicative of the fact that the research was a study of works by other writers. The section gives the reader the impression that the writers did the tests on subjects to come up with the findings that informed the implications.

In the conclusion, the authors confirm that the approach they took was difficult to implement because of the different methodologies in the papers under study. As part of the conclusion, the authors say that they have identified the stressors that affect nursing students and have come up with recommendations of how they can be tackled. This, however, is not true because Pulido, Augusto and Lopez did not do any original research. They should have written the conclusion in a way that clearly shows that the findings and recommendations were made by other people and all they did was aggregate it. Based on these shortcomings, the paper should not be used to either change or maintain any clinical practice activity.

Reference List

Schmidt, N. and Brown, J. (2009). Evidence Based Practice for Nurses. California: Jones and Bartlett Publishers

Pulido, M.M., Augusto, L.J., & Lopez, Z. (2012). Sources of stress in nursing students: a systematic review of quantitative studies. International nursing review, 59, 15-25.

Background

The research study was undertaken by Gale Robinson-Smith, Patricia K. Bradley, and Colleen Meakim, of Villanova University College of Nursing. The authors contribution to the paper stems from several years of experience in the nursing profession, hence, the information contained in the paper is credible for use as an academic source. The credibility of the paper is furthered by the authors reference to peer-reviewed articles. The paper is published in a nursing journal, Clinical Simulation in Nursing, and is therefore aimed at the nursing community, both novices and professionals.

Research Problem, Variables, & Concepts

The objective of this research was to develop a framework that could simplify the process of assessing psychiatric patients. Previous methods of assessing psychiatric patients have been difficult because student expectation of the interaction with persons who have psychiatric problems is normally filled with anxiety and uncertainty. Therefore, the study makes use us standardized patients (SPs) to prepare students for their interaction with actual patients. SPs are individuals who have been coached to simulate, in a precise and regular manner, patients with medical conditions, in this study, the SPs have been trained to simulate patients with psychiatric conditions.

SPs are independent variables, student response and experience during the study is dependent as it varies among the students, while the significant intervening variables are the different perceptions and expectations of the students before their interaction with the SPs.

Importance to Nursing Profession

This study is very important to the nursing practice since it prepares students for the actual nursing practice and enables them to have some knowledge of what to expect during their interaction with psychiatric patients.

Theoretical Framework

In this paper, the authors use adult development theory and problem-based development as a theoretical structure to assess student satisfaction, confidence, and vital thinking after taking part in a psychiatric nursing replication with a standardized patient (SP). At the end of the study, a nursing student is expected to have the ability to carry out psychiatric nursing evaluation, for example, suicide risk and sanity levels.

Research Question

The authors do not give any research questions, however, from the description of the research framework, we can deduce that the aim of the study is to assess student confidence and interactions with SPs. Besides, the study teaches and evaluates the students use of effective communication skills towards their participation in the nursing practice. Possible research questions include: what is the student response towards SP scenarios? What are students expectations towards an interaction with psychiatric patients before and after their exposure to SPs? Can student interaction with patients with psychiatric conditions be improved through exposure to SPs?

Sampling Procedure

The study used 112 young undergraduate nursing students, the paper does not give the criteria used to select the sample. Had they given the criteria, an evaluation of the neutrality or biasness of the method would have been possible. To get the students ready for the interview with SPs, they were required to use textbooks and other literature to enable them come up with questions that might elicit discussion, such discussions create a friendly atmosphere and eases the tension between student and patient in actual nursing practice (Robinson-Smith et al, 2009).

SPs were recruited from the universitys Communication Department and their training designed by a faculty member from the department. The training involved reviewing particular psychiatric conditions, simulating patient conditions, and how to present nursing students with useful verbal and written feedback on the psychiatric condition being simulated. Since this exercise was mainly designed to train students, the training of SPs was not elaborate. After having a theoretical perspective of the psychiatric nursing theory, students participated in practical SP interviews using the questionnaire designed earlier.

Ethical issues

Ethical issues arising from the study include enactment of psychiatric condition by the SPs as this could be a mockery or lack or respects for those genuine patients. To handle these issues, SPs were trained adequately on the psychiatric conditions and the clinical expectations of the nursing students, and their role in making the project a success. Therefore, ethical issues were handled by the training team.

Design and Data Collection

Formative evaluation was used for the simulation procedure, this type of evaluation provides feedback to students through oral and written information relating to clinical performance. The main mode of data collecting was through student interviewing of the SPs. Since the exercise was meant to be a learning exercise, the authors did not design any system to evaluate the students performance, instead, the students were given written and oral feedback through a yes-no answer based on whether they had achieved the desired goals of the study. Student satisfaction and self-confidence were assessed using a process from the National League of Nursing. The 112 students were not divided into samples as the authors were only interested in assessing the use of SP scenarios.

Students experience in SP scenarios were evaluated using a Student Satisfaction Survey tool. Satisfaction with this method of teaching was evaluated using 5 items, with a maximum score of 25 for Satisfaction with Learning, a maximum score of 15 for Self Confidence in the procedure (3 items), and a maximum score of 5 on the Effect of SP interview on critical thinking.

Findings

Means of the three parameters used in the survey were calculated and are presented below:

Table 1: Student Satisfaction Survey results (Sample, N, =112).

For most parts of the SP interview exercise, students levels of agreement with the experience were very high. For instance, in the category of Satisfaction with Learning through Standardized Patients, students highly agreed with three out five questions on their satisfaction with the exercise. The question that received the lowest rating under the self-confidence category was The use of standardized patient care scenario will prepare me for exams (Robinson-Smith et al, 2009).

At the end of the questionnaire, students were asked to give their overall experience of the SP interaction, again, the students indicated their positivity about the procedure, this section also showed the students anxiety prior to meeting the SPs for the interview, and the relation of these emotions to the responses given under the three categories. In summary, students were satisfied with the SP experience and mentioned that SP situations gave them an opportunity to practice and improve their communication skills, besides helping them design evaluation questions. The university faculty said that the exercise improved students confidence and reduced nervousness and uncertainty towards the interviewing of actual patients with psychiatric conditions.

Data obtained from students experience with SPs indicates that the whole experience was successful. These results show that SP encounters enhance the general self-confidence of the learners and improved their critical thinking.

Implications to the Nursing Practice

The use of SP in this study has given students a chance to practice and improve their communication skills, besides helping them design evaluation questions. The study offered a better understanding of simulation procedure and how it can be used in other investigations in the nursing practice. Save for a few modifications, the study was successful and the researchers aims were achieved. The findings from the study can assist in training of students to prepare them for the nursing practice. Besides, curriculum and books used during training can incorporate the use of SPs to prepare students adequately.

Personal Evaluation of the Study

Despite these positive ratings, some aspects of the study could be altered to improve the outcome. First, Robinson-Smith et al did not define any research questions, the research question should be the first step in a scientific research since it guides the investigator in undertaking both quantitative and qualitative research. The research question also indicates what the investigator desires to uncover.

Conclusions from the study were based on the means of the three student satisfaction surveys from a sample of 112 students. This lone measure was not sufficient for the study, other statistical measures of spread and centrality such as standard deviation, variance, covariance and correlation values could have improved the accuracy of the findings. Besides, these measures would indicate outliers in the data and hence would be eliminated. Increasing the size of the sample would also give better results, drawing this sample from a wider geographical area would also increase the statistical reliability and replicability of the results.

Another weakness of this study is its failure to use a control population since all 112 students used an SP. Besides, the authors did not conduct any constancy tests to test the uniformity of all SPs, non-uniformity of SPs could easily have affected their responses and hence the findings. The SPs were trained by different personnel from the universitys Communication Department, a factor that could have led to non-uniformity of responses. Such anomalies could have been corrected by using the statistical measures mentioned above.

Future studies into the use of SPs for psychiatry studies should use a larger sample size and use more statistical measures.

Reference

Robinson-Smith, G., Bradley P. K., and Meakim C. Evaluating the Use of StandardizedPatients in Undergraduate Psychiatric Nursing Experiences. Clinical Simulation in Nursing, 5(6), e203-211.

The nursing profession is characterized by various expectations and norms. For instance, the National Culturally and Linguistically Appropriate Services Standards (CLAS) overlap with some criteria that are distinct to nursing practice. In particular, CLASs core principle mandates that care should be responsive to all cultural backgrounds (U.S. Department of Health & Human Services [HHS], n.d.). Accordingly, the principle corresponds with the nursing standards of advocacy and respectful and equitable practice suggesting that registered nurses (RNs) should embrace patient uniqueness and strive to understand diverse clients (American Nurses Association [ANA], 2021). Moreover, CLAS proposes that healthcare professionals must establish relevant goals and policies and conduct assessments to examine that people receive high-quality care (HHS, n.d.). Such requirements correlate with the nursing benchmarks of quality practice and practice evaluation, which account for recommending strategies for improvement and engaging in reflection and appraisal of ones work (ANA, 2021). Consequently, my peers and I use the discussed standards by continuously obtaining information about cultures that we encounter in our areas of practice, learning to be open-minded, and reminiscing on our choices and behavior.

Furthermore, to promote cultural competence, one can address issues that hinder respectful attitudes toward different cultures. One action I might incorporate into my medical facility is resolving power imbalances to prevent them from negatively affecting care (ANA, 2021). For example, I could concentrate on QSENs (Quality and Safety Education for Nurses) competency of teamwork and collaboration (Stalter & Mota, 2018). QSEN suggests that effective cooperation between professionals must be based on mutual trust and communication (Stalter & Mota, 2018). Moreover, while being advocates for patients preferences, nurses must act as team coordinators (Porter-OGrady, 2018). Accordingly, to facilitate cultural competence, I could ensure that my colleagues collaborate properly to meet patient needs rather than exhibiting biases and prejudices.

References

American Nurses Association. (2021). Nursing: Scope and standards of practice (4^th ed.). Author.

Porter-OGrady, T. (2018). Leadership advocacy: Bringing nursing to the homeless and underserved. Nursing Administration Quarterly, 42, 115-122.

Stalter, A. M., & Mota, A. (2018). Using systems thinking to envision quality and safety in healthcare. Nursing Management, 49(2), 32-39.

U.S. Department of Health & Human Services. (n.d.). CLAS standards. HHS.