Dissertations / Theses on the topic 'Nursing and Health Curriculum and Pedagogy'

Pressure ulcers (PUs) remain a relatively common and potentially serious health issue among the elderly in any healthcare setting and have been associated with high mortality and morbidity rate. A low incidence of PUs is highly desirable and is considered as an indication of quality care by patients, caregivers, and regulatory authorities on both the state and federal levels.

Nursing assistants play an integral role in the direct patient care; ongoing training and educational opportunities about pressure ulcer prevention are very important in maintaining their skill, motivation and knowledge. Research findings showed that staff education with reinforcement is the key in decreasing prevalence and incidence of pressure ulcer. This educational curriculum was designed to increase nursing assistants' knowledge about pressure ulcer prevention among elderly in long-term care.

As the number of older adults with dementia in nursing facilities grows, so does the need for holistic dementia training for nursing home staff. This curriculum was designed as a training tool for all nursing facility staff in order to provide practical education on how to develop individualized, psychosocial interventions for residents that have dementia. The curriculum is presented in two parts. Part I is a simulation activity and discussion to create empathy among staff members by demonstrating the perspective of an older adult with dementia. Part II is a guided practice activity on how to identify important interests and characteristics of an individual resident and apply this knowledge to create effective interventions. The training is a total of approximately 4 hours and focuses on teaching staff skills that will allow them to continue to target dementia symptoms with psychosocial interventions. The curriculum also includes a trainer’s guide, handouts, and a survey tool for evaluation.

This thesis presents findings from a narrative and phenomenological case study that examined the inspirations and motivations that led to an adolescent student’s engagement in a self-initiated experiential education project (SEEP) and the subsequent effects on the adolescent’s sense of self. The student’s SEEP was a month-long challenge to eat only wild foods. SEEPs and self-designed experiential learning projects are examples of self-directed learning, which is becoming more common in adult, elementary, secondary, and post-secondary education. Six theoretical areas are addressed in the literature review, including adolescent sense of self, benefits of exposure to nature, mentoring, experiential education, eclectic homeschooling, and rites of passage. The investigator interviewed the SEEP initiator, who was a student at a school employing the deep nature connection mentoring model of education, and seven of the student’s mentors. Artifacts produced by the student and mentors related to the student’s self-initiated experiential education project were examined. Data analysis included crafting researcher profiles, writing a chronological story of the case, and an open-coded thematic analysis of the interview transcripts. Findings indicate the influences and motivations inspiring the creation of the SEEP in this case included elements of the initiators’ identity, self-esteem, education, resilience and self-efficacy; an adolescent need to test oneself; and a desire for a deeper connection with nature. The outcomes in terms of sense of self include impacts on identity and self-esteem, increased resilience and self-efficacy and an increasing appreciation for nature, family, and the student’s interdependence with other people. These impacts indicate that SEEPs could be a desired aspect of curriculum design. Educator, family, peer, and community support appear to be important influences encouraging students to create and engage in SEEPs.

This qualitative study critically examined nurses' perception of nursing qua nursing in an American Nurses Credentialing Center Magnet^® re-designated healthcare system in Albany NY. Watson's Theory of Human Caring is used by many Magnet^® hospitals, including the site for this study, to inform and guide nursing practice. Watson's Theory supports concepts and practices of integral health, holism, caring, healing, and the education and integration of complementary health care modalities as independent therapeutic nursing interventions. This study aimed to understand the nurse's emancipatory experience, comportment and self-agency as she/he participated in a theory guided practice; and illuminate the nurses' acquisition, understanding and utilization of knowledge and power as required for engaging independent therapeutic nursing interventions in the unitary-transformative health paradigm.

Eight nurses from the Oncology Unit self-selected to participate without recidivism from August to October 2012. The study was conducted in two parts: 1) A questionnaire was developed by the researcher to collect demographic and educational data from participants including: age, ethnicity, level of academic education, years of experience in nursing and in specialty, education to nursing theory, including education specifically to Watson's Theory of Human Caring and to holistic nursing and Complementary and Alternative Modalities (CAM), and CAM use in practice and self-care; and 2) Kim's (1999, 2007, 2010) Critical Narrative Inquiry Method was used to collect and analyze narrative data in three phases: 1) descriptive 2) reflective; and 3) critical-emancipatory. Written and audio data from in-person interviews were transcribed and analyzed by the researcher. Data was validated by participants and used to answer four research questions: 1) What are the emancipatory experiences of nurses in a Magnet^® re-designated healthcare system that promotes Human Caring Theory; 2) What are the patterns that facilitate nurses' comportment and self-agency to fully embody and practice integral nursing qua nursing in a Magnet^® re-designated healthcare system; 3) What are the patterns that create barriers to nurses' comportment and self-agency to fully embody and practice integral nursing qua nursing in a Magnet ^® re-designated healthcare system; and 4) How does the organization support nurses control over their nursing practice within this one ANCC Magnet ^® re-designated healthcare system? Findings gleaned from the patterns that occurred most frequently in the narrative data included: 1) Nurses used Human Caring and Integral Nursing theoretical concepts to inform and conduct their practice; even though they reported limited education to the theories. Elements of the theories that manifested in their practice and self-care included: advocating, educating, counseling, creating a caring-healing environment by honoring the patient and family's space and wishes, approaching patients and families non-judgmentally with an open mind and loving kindness, using complementary modalities of humor, prayer, intention, authentic presence, music, imagery, touch, and obtaining complementary therapy, palliative and spiritual care consults for patients; 2) Facilitators to practice included: the support of their manager, colleagues and team members, optimal staffing patterns, resource nurses and competent, self-motivated care technicians and support staff; and 3) Nurses in the study confirmed their Magnet^® healthcare system values: a) Supportive and participative nursing management; b) Advanced education by providing tuition reimbursement and flexible scheduling; c) Participation in and use of the most current nursing research in their practice; and d) A strong nursing mentoring culture, where nurses empower each other to provide ethical care and advocate for patients' and nurses' rights. Opportunities for nursing education and leadership include: 1) The need to revise academic and continuing education curricula to adopt integral theory guided practice at all levels; 2) The need for advanced practice nurses to translate conceptual models into practice and help nurses to articulate the value and power of nursing to impact integral health and healing.

Suggested Keywords: nursing, holistic, integral, human caring, theory guided practice, emancipatory praxis, critical narrative inquiry, ANCC Magnet^®.

The purpose of this basic qualitative study was to explore the experiences of nursing faculty members who taught in associate degree nursing programs and how they implemented the hidden curriculum. The hidden curriculum is referred to as the subtle messages relayed to students either verbally or nonverbally. In higher education, it is understood that the hidden curriculum is used to socialize students into professional roles, but, the process of how to socialize individuals varies. The sample consisted of 12 nursing faculty members who taught in associate degree programs in the Pacific region of the United States. Research on the hidden curriculum in nursing education has focused on the student’s perspective. Upon reviewing the literature, a gap existed in regards to the experiences of nursing faculty with the hidden curriculum. Information was gathered through semistructured interviews to learn how these faculty members implemented the hidden curriculum. Data analysis revealed four reoccurring themes on how nursing educators implement the hidden curriculum in their practice. The first two themes uncovered how nursing faculty members described themselves as mentors and role models to their students to help students become successful in school and later in the workforce. Another theme revealed how nursing faculty members saw themselves as experts who could demonstrate skills and explain procedures. Lastly, nursing faculty members saw themselves as implementing the hidden curriculum by being advocates who could help students troubleshoot problems, as well as assisting them to navigate the nursing program. After interviewing the nursing faculty members, it became apparent that they used the hidden curriculum to provide a pathway for success for their students. The findings also highlight the need for the hidden curriculum to be included in faculty professional development workshops and seminars, and perhaps, the need to bring the hidden curriculum out from hiding.

This study took place at a Wake Technical Community College, a multi-campus institution in Raleigh, North Carolina. An evaluation of the return on investment in high fidelity simulation used by an associate degree of nursing program was conducted with valid and reliable instruments. The study demonstrated that comparable student outcomes are attainable when traditional clinical study is replaced with high fidelity simulation curriculum. Limited clinical practice space justifies the spread of simulation in college health science programs. North Carolina Administrative Code permits community colleges to replace 25% of traditional clinical with simulation. The lack of research on the cost effectiveness of high fidelity simulation has been cited as a barrier to its diffusion. Sound research demonstrating performance-based and patient-centric outcomes can provide governing bodies with evidence supporting the diffusion of high fidelity education.

One way to mitigate health disparities in the provision of nursing care and impact social justice with vulnerable populations is the development of cultural competence. Although addressed in nursing curricula, gaps in how to best address cultural competence remain. A study was undertaken to determine whether participation in a researcher-designed intervention, entitled Transcultural Humility Simulation development, based on components of Campinha-Bacote’s model with an emphasis on “becoming” culturally competent, improved cultural competence in graduating baccalaureate nursing students. A longitudinal, descriptive, quasi-experimental, pretest-posttest comparison group design using embedded mixed methods was used. A total of 57 student participants from one baccalaureate nursing school in the western US were randomly assigned to the intervention group (n = 22) or the comparison group (n = 35). All participants completed the Inventory for Assessing the Process of Cultural Competence-Student Version before and after the intervention. Intervention participants also completed three written reflection exercises the day of the workshop. A subgroup of participants in the intervention group (n = 12) and the comparison group (n = 8) were interviewed two to three months after graduation. No statistically significant differences were obtained between groups while treating the pretest as a covariate. Participants who identified as more than one race on the demographic survey perceived they were more culturally competent than those who identified as one race, F ratio of F(10, 3) = 15.13, p = .02. Analysis of participant reflections during the intervention indicated they anticipated incorporating cultural competence into their practice by shattering preconceived perceptions, constructing innovative insights, improving effective communication, and emerging personal development. Once in practice, they incorporated cultural competence through cultivating nursing-person relationships, providing quality nursing care, serving the patient and family, establishing extraordinary communication and approaching care with humility. This study suggests that bringing attention to cultural competence through participation in Transcultural Humility Simulation Development could raise awareness and foster developmental growth among student participants through transformative learning, epistemic belief change, and double-loop learning.

Recent changes in the ethnic composition of the population of the United States pose great challenges for healthcare institutions and healthcare providers. In recent years, policy statements on nursing education indicated that nursing educators recognized the need to increase the cultural caring of the nursing workforce (Swanson, 2012). Salimbene (2014) discussed the importance of considering clients’ culture as an integral part of assessing their healthcare needs and planning culturally appropriate nursing care to meet those needs. Currently, there is a paucity of information regarding patients’ perceptions of culturally competent care. The purpose of this qualitative study was to identify culturally sensitive caring behaviors of professional nurses from the perspective of Hispanic American maternity patients two to four weeks post-discharge in a WIC program in rural Georgia. Utilization of a phenomenological research design included interviews with 15 Hispanic American women. Data analysis was conducted using phenomenological analysis methods with the aid of the software program Nvivo 11. Themes that were identified were: Better Future, Better Medical Care, Treatment of Patients, Customs and Practices, and Meaning of Care. This information may aid in creating a culturally competent maternity care curriculum.

Behavioral complications, such as Inappropriate Sexual Behavior (ISB), are developed in many cases of dementia. Sex, even for those with dementia, is a primary need, but supporting this need in an appropriate manner may overwhelm caregivers. The purpose of this project was to create a curriculum for Dementia Friendly Community (DFC) residential caregivers on the topic of sexual expression among older adults with dementia. By offering training on sexuality and dementia it is expected that caregivers can increase the DFC's provision of quality of life. This project presented an assessment tool and plan on how to manage ISB, activities relevant to the discussed topics, and curriculum evaluation forms. Expert reviewers offered recommendations to further improve the curriculum's quality.

Intercultural competence through study abroad is widely recognized as a preferred teaching approach for the development of globally competent health care practitioners. Colleges and universities are looking for multiple ways to encourage students to study abroad because of the noteworthy effects that these experiential opportunities have on students. Sparse research has been conducted to determine if short-term study abroad trips of less than two weeks are achieving these same outcomes.

The purpose of this basic interpretative qualitative study was to describe the nature and meanings of a short-term international cultural experience for nursing students, and whether or how their understanding of the role of the professional nurse was changed. A group of baccalaureate nursing students traveled to Tanzania and took part in professional and social opportunities over an 8-day period. All participants were required to complete a nursing course with global objectives prior to the trip and pre-immersion seminars. Data were collected from reflective journals during the study abroad experience, focus group discussions one month after returning home, and personal interviews 6 months later. The results indicated that the participants experienced culture shock, but they also gained in self-awareness, cultural empathy, leadership skills, a desire to learn more, and a new perspective of the role of the professional nurse. Langer's theory of Mindfulness, Bennett's Developmental Model of Sensitivity and Campinha-Bacote's Process of Cultural Competence provided the theoretical framework for this study.

Researchers have developed strategies used in nursing programs to promote cultural awareness (Hunter & Krantz, 2010). Minimal research has focused on the graduating associate degree-nursing students to determine if a relationship existed between the use of an integrated cultural curriculum and the nursing student’s level of cultural awareness (Kardong-Edgren & Campinha-Bacote, 2008, Sealey, Burnett, & Johnson, 2006). The associate degree-nursing program accreditation, statistical, and benchmark reports mandated the integration of diversity content, local, national, and worldwide perspectives in the curricula (NLN, 2008). Additionally societal and cultural patterns must be integrated across the entire nursing school curricula (Board of Registered Nursing, 2012, section 1426-e7). A correlational approach was implemented to determine if relationships existed between the integrated cultural curriculum and level of cultural awareness in graduating associate degree nursing students in a large metropolitan area, such as in Los Angeles (Sealey et al., 2006). The Cultural Awareness Scale (CAS) was used to survey the participants. Based on the findings of the 51 participants surveyed in this study, the cultural awareness level may be attributed to several factors, including the integrated cultural curricula. The nursing student’s learning style, perception of faculty, personal experiences, and cultural encounters may also contribute to the cultural awareness level. Analysis of variance results revealed no statistically significant difference on the CAS total or subscale scores based on gender, age, and ethnicity. The outcome of this study may encourage academic affairs leaders to emphasize cultural awareness as a significant student-learning outcome for nursing educational programs.

Attitudes toward patient safety are the foundation of patient safety culture. Nursing students begin to formulate their attitudes toward patient safety while in educational programs. Nursing faculty have been challenged in their efforts to enhance the patient safety culture of students because there is a lack of empirical evidence as to which teaching strategies positively affect student attitudes toward patient safety. The purpose of this study was to examine the relationship between a 50-minute teaching module based upon the concept of medical error recovery and 9 dimensions of patient safety culture as measured by the Attitudes to Patient Safety Questionnaire. The guiding framework for the study was the reciprocal interactive theory of patient safety culture in nursing. The conceptual model used to illuminate the role of nurses in recovering medical errors in the educational intervention was the modified Eindhoven model of near-miss events. The sample comprised 4 student cohorts (N = 142) enrolled in an accelerated bachelor of science in nursing (ABSN) program at one university, with 4 participants lost to follow-up (n = 138). A quasi-experimental, nonequivalent control group, pretest/posttest design was used to compare mean attitude scores between the control (n = 75) group and the intervention group (n = 63) after statistically controlling for the pretest. ANCOVA revealed statistically higher mean attitude scores for the intervention group in 5 of 9 dimensions of patient safety culture with a small-medium effect size associated with the intervention: patient safety training, error inevitability, professional incompetence as error cause, patient's role in error, and importance of patient safety culture in curriculum. The results supported the use of a short-duration educational session on medical error recovery to enhance a subset of patient safety culture dimensions among ABSN students.

This study explores the role of instructional design in the development of shared epistemic agency (SEA) when RN to BSN nursing students collaborate to complete a team project in an online course. Paavola & Hakkarainen's (2005) trialogical model of learning is used to design a learning activity where teams create a shared knowledge object, a co-authored patient interprofessional care plan to support group knowledge creation. The study addresses the following research questions: 1. What patterns of SEA are evident at the team level as manifest through epistemic and regulative actions in online student discourse? 2a. How did each team's epistemic and regulative decisions contribute to their shared knowledge object? 2b. How did the instructor's online interaction enhance or constrain each team's epistemic and regulative decisions? 2c. How did each team's use of project technology tools affect the development of their shared knowledge object? 3. What contributed to supporting or suppressing SEA in each team? These questions examine SEA in relationship to research in shared knowledge construction pedagogies and instructional design within nursing education.

This study uses a convergent parallel mixed methods design, in which both quantitative and qualitative data are collected, analyzed separately, and then merged (Creswell & Plano Clark, 2011). Quantitative content analysis is used to examine student discourse for evidence of student epistemic and regulative actions. This is combined with two forms of qualitative analysis. Thematic analysis is used to examine student artifacts and interviews with team members and their instructor to gain deeper insight into the meanings of their epistemic and regulative experiences within this six week collaborative activity. Case analysis is used to describe and synthesize differences among teams that supported or constrained the development of SEA.

The quantitative strand of research found higher levels of regulative actions compared to epistemic actions in both teams. The qualitative strand of research identified two areas which constrained each team's development of SEA overall. The first related to a series of uncertainties related to apprehensions about working with team members for the first time, concerns about the project and the instructor's expectations, and doubts about using technology for collaboration. The second related to a series of disjunctures associated with students' discordent beliefs about collaboration; contradictory views of conflict; and, discrepent views of leadership.

Synthesis of these results resulted in six factors that contributed to supporting or suppressing SEA in each team: team contracts, the team wiki, propensity for regulative over epistemic actions, narrow views of conflict, misconceptions about collaborative learning, and the instructor's role. In light of these findings, theoretical and practical implications and recommendations are detailed.

Embodied practices are central to the cultivation of nursing presence, but are rarely taught in nursing programs. This study proposed the use of brief embodied learning practices embedded in a nursing course. It quantitatively and qualitatively examined the impact of such a program experienced by 22 first-semester students in a registered nursing program. Embodied meditation (e.g., sensing and shifting attention to the body) and inquiry exercises (e.g., interacting with others while remaining fully present in oneself) were introduced in theory and skill lab classes during an 8-week Foundations of Nursing course taught in the spring semester of 2017. Fourteen students completed the embodied learning program as well as pretest and posttest questionnaires. Eighty-six percent of participants reported increased scores on embodied presence as measured by the Five Facet Mindfulness Questionnaire (FFMQ). Their posttest score on the FFMQ was greater than their pretest score with a moderate to high effect size (p < .05, d = .75). A majority of participants reported positive changes in their wellbeing, learning ability, learning outcomes, relationships with patients, and satisfaction with the instruction of embodied learning, as measured by an Impact Questionnaire. Participants’ satisfaction with embodied learning was greater than their satisfaction with conventional instruction (p < .05). The study found a positive correlation between increases in participants’ FFMQ scores and their overall exam scores in the course (p < .01). Qualitative data from a focus group aligned with the quantitative findings. The results suggest practice guidelines for teaching embodiment within the context of content learning in nursing courses.

The health outcomes of men are significantly worse, when compared to their female counterpart, for the top 15 leading causes of death nationwide. At this time, men are not actively engaged in the healthcare system and didactic and clinical education does not adequately prepare providers to care for men or understand the psychology of masculinity. As of 2016 there were no primary care programs or medical schools that incorporated a specific course in men’s health promotion or the psychology of masculinity within their curriculum. This research study implemented one curricular module on the content of men’s health promotion and the psychology of masculinity. The researcher sought to understand what aspects of men’s primary healthcare and masculinity were taught within Primary Care Providers (PCP) didactic and clinical studies, what PCPs state was lacking from their curriculum, and how that translates to their ability to practice clinically. The research took place at six separate universities throughout the United States. Using a five-point Likert scaled survey, quantitative data was collected from students in six universities after they participated in a single module on men’s health promotion and masculinity. One month after students at the six universities went through the intervention, a second quantitative, five-point Likert Scale survey was collected that sought to determine what information from the module was applicable in their clinical education and settings after going through the intervention. The researcher then conducted six, qualitative, semi-structured, open-ended interviews with students who responded favorably to such an interview in quantitative evaluations through Qualtrics. Data analysis was completed through Wilcoxon Signed Rank Testing. Cohen’s d effect size was utilized to understand the significance of effect size within the data. Students in primary care agree that lack of timely healthcare, on behalf of men, is a stressor on the healthcare system and 100% of students agree they would welcome more content in their didactic education on men’s health promotion and the psychology of masculinity. Similarly, 94.5% of respondent’s state there is a need for primary care students to learn how to engage men in primary preventive care with 77% of respondents requesting more gender specific training. Students that went through the educational endeavor found value in the content delivered with 83.4% of participants stating they planned to make changes in their practice as a result of going through the educational module. Quantitative findings revealed that less than 20% of those surveyed are consistently utilizing evidence based interventions noted in literature to recruit and retain men into primary preventive care. Qualitative interviews noted that participants found themselves unconsciously unaware of their limitations in caring for men in the primary care setting, but fully aware that diverse and holistic care improves patient outcomes. Qualitative respondents also expressed a desire to grow professionally and a willingness to engage in pioneering practices that would equip them to deliver excellence in care.

Sexuality education in public schools in the United States excludes a large population of students. These exclusions are due to a long history of legal and economic battles, as well as the politicized nature of adolescent sexuality. This critical interpretive inquiry explored the long history of sexuality education through the lens of economics, law, and psychological paradigms and examined the way in which each of these lenses furthered the exclusion of nonheterosexual males in curricula. Using a framework comprised of critical feminist theory, critical pedagogy, and queer theory, this manuscript provides an understanding of the social structures of sexuality education and how they continue to marginalize students labeled as “other.” Using critical discourse analysis, this study reviewed legal and political documents, state and private curricula, and works in the sociology and psychology fields.

The outcomes of interpretive research do not lend themselves to specific answers, but to a greater understanding of the experience of marginalized individuals and the structures in place that keep this experience intact. Through a critical review of current programming initiatives, recommendations are made to continue moving toward a more gender- and identity-inclusive sexuality education curriculum. These recommendations, which are grounded in current legal and economic requirements, include teacher certification requirements, implementation of the Advocates for Youth 3Rs curriculum, utilization of a rights-based approach to program design, and adoption of national sexuality education by the Department of Health and Human Services, rather than by the Department of Education.

An important goal of nursing education is to produce graduates who are problem solvers and competent clinical practitioners able to practice in a very complicated health care environment; reflection and inquiry are two ways to accomplish this goal. This qualitative study explored how eight senior baccalaureate nursing students developed in their ability to utilize reflection and inquiry at higher stages over time through the use of the online clinical post-conference conducted as an asynchronous discussion board. Transcripts of participant postings were examined weekly to determine the stage of reflection and inquiry displayed and a comparison was done to determine if the stages increased over time. Boud's model of the reflective process and the practical inquiry model of Garrison, Anderson, and Archer provided the theoretical framework for this study.

Findings from this study demonstrated that participants developed in their ability to utilize reflection and inquiry at higher stages over time by engaging in the online clinical post-conference and that the online clinical post-conference was an effective venue that encouraged the use of reflection and inquiry. The social aspect of the online clinical post-conference (reading others' posts, having others read and comment on their posts, and asking each other questions) was seen as promoting learning from peers.

Findings of this study could be used by nurse educators to change their pedagogy to produce nurses who learn from experiences and are lifelong learners. Nurse faculty should consider incorporating the use of reflection, inquiry, and the online clinical post-conference in all clinical courses.