Bernard Mark Garrett

No abstract available.

Background: The ongoing difficulty that nursing educators face is managing finite class time and limited instructor-student interactions to achieve balance between discourse and active learning. To complicate this predicament, technology has infiltrated all aspects of daily life demanding that education must also meet the growing expectation of students to incorporate technology into curriculum. One approach that addresses this need is the flipped classroom (FC) format, which remains operationally ill-defined and the understanding of its effects on higher-level thinking are still nascent.Aim: The purpose of this study is to explore the differences in learning between the FC format compared to the traditional classroom lecture (TL) in the context of an undergraduate nursing course.Methods: A content analysis was performed on a previous study conducted in 2015. Concept maps were used to evaluate data from transcripts of undergraduate nursing students discussing a case scenario in either a TL or FC format. Results: When comparing FC and TL groups, FC groups had a more complex concept map morphology and greater amount of identified subcategories and links. The FC groups exhibited more higher order thinking concepts compared to the TL cohort. An unexpected finding was the emergence of discussion tangents across both the FC groups and the TL cohort.Conclusion: Flipped classrooms have a place in the gamut of pedagogical approaches and this study demonstrates that the FC approach enhances student learning and aids in the development of higher-level thinking.Keywords: flipped classroom, concept maps, traditional lecture, flexible learning, content analysis

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The experience of the clinical nursing instructor (CNI) in teaching nursing students deemed at risk of failure has not been well explored in nursing literature. It may be difficult for the CNI to support as well as evaluate a student when that student’s performance is judged to be unsatisfactory or unsuccessful. The purpose of this study was to explore CNIs’ experiences in teaching undergraduate nursing students deemed at risk of failure, to discover how CNIs identify potentially unsuccessful students and to describe what supports and resources CNIs utilize to help them manage such students. A pilot study using a qualitative phenomenological approach was used to interview CNIs who had at least one experience teaching an undergraduate nursing student deemed at risk of failure at the University of British Columbia (UBC) and the British Columbia Institute of Technology (BCIT) schools of nursing. The study found that CNIs identified students at risk of failure using “red flags” that included a range of actions, behaviours, and attitudes. These red flags included deficits in the demonstrated thinking, knowledge, and skills; deficits in the social and cultural aspects of nursing practice; disorganization and tardiness; and lack of integrity. CNIs felt that early and clear communication of their concerns with faculty and students deemed at risk of failure was beneficial for both the student and CNI. CNIs made decisions to fail students by considering patient safety and objective evidence while at the same time supporting and nurturing these students by providing opportunities for success.

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This study aimed to describe the current use of competency-based assessment frameworks and tools in nursing programs in British Columbia (BC) who utilize HFS. High-Fidelity Simulation (HFS) is being adopted and used by nursing programs at an increasing rate. Competency-based assessment frameworks or tools offer an effective way to assess student learning and competence when utilizing HFS as part of teaching. However, current assessment methods used by nurse educators when utilizing HFS mostly involve assessing student’s self-reported competence measures, confidence, or satisfaction with the learning process. These instruments are typically designed within their institution and many have not been tested for validity or reliability. A survey study was designed to explore the frameworks and instruments currently used by nurse educators, trends related to specialized training in using HFS as a teaching tool for nurse educators, HFS utilization in nursing programs, and challenges experienced when using HFS. An online survey was used to collect data from nurse educators in British Columbia. Findings indicated inconsistent use of competency-based assessment frameworks and tools in various nursing programs in BC. Participants reported completing formative assessments after each HFS scenario, but a large majority of participants did not complete any summative assessments when utilizing HFS activities as part of their teaching. Lower range values were reported with regards to the number of specially trained nurse educators using HFS, as well as hours students were exposed to HFS in their programs. Challenges related to students’ attitudes towards realism of HFS scenarios, as well as nurse educators’ resistance to implementing best practices related to HFS use in education were also reported. Further research on developing validated and reliable competency-based assessment frameworks and tools, and implementation of consistent use of these tools in nursing programs is recommended.

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New graduate registered nurses (RNs) experience many challenges as they transition from the role of student nurse to professional nurse. Mentoring can support new nurses with the development of clinical nursing skills and competencies, and is linked to professionalism, nursing quality improvement, self-confidence, retention, and job satisfaction. This rapid evidence assessment (REA) addresses how new graduate mentorship programs can be effective in improving performance, satisfaction, retention, and confidence in novice nurses’ practice. It also reports the key elements of effective new graduate mentorship programs and reported problems in implementing new graduate RN mentorship programs.Seventeen research studies were selected for inclusion and examined using Bandura’s social learning theory. The data from each research study was extracted using the EPPI-Centre Data Extraction and Coding Tool for Education Studies to allow for mapping and analysis. Each research study was then scored from highest level of evidence to lowest level of evidence. The findings were then synthesized to suggest that mentorship programs can be effective in improving performance, satisfaction, retention, and confidence in novice nurses’ practice under the right conditions. The reported key elements of effective new graduate RN mentorship programs include mentor-mentee matching, availability of mentors, adequate training and preparation of mentors, commitment and support, and length of the mentoring relationship. The reported problems in implementing new graduate RN mentorship programs include lack of training and preparation of mentors and mentees, availability of mentors, and mentor-mentee mismatch.

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With the continual advances in medical technology and specialized procedures, surgical patients have increasingly complex and specific needs. The questions that surfaces are: 1) Do surgical nurses now require advanced knowledge and skills to meet the needs of the thoracic surgery patient population? 2) And if so, do nurses and surgeons perceive value in recognizing thoracic surgery as a specialty for nurses? In this study, the perceptions of senior thoracic nurses and surgeons regarding nursing specialization were examined. Nurses’ and surgeons’ perceptions of what characterize a nursing specialty, if and why they consider thoracic surgery a nursing specialty, and what they identify as the outcomes and value of nursing specialization and related outcomes were also explored. An inductive approach was used, with data collected through a quantitative web-based questionnaire, using the 18-item Perceived Value of Certification Tool © (PVCT) as well as specific additional Likert scale and multiple-choice questions related to thoracic surgery. Study findings revealed that thoracic nurses and surgeons value nurse certification for similar intrinsic and extrinsic reasons as nurses in other specialties and in other countries, identifying several intrinsic rewards, such as “enhances feelings of personal accomplishment,” “provided a professional challenge,” and “validates specialized knowledge,” as motivators for certification. Findings from this study also suggest that nurses and surgeons perceive that additional nursing education related to knowledge and skills is required to meet the care needs of the thoracic surgery patient population, and improve the overall nursing care provided. Additionally, study results also suggested that nurses and surgeons believe that nursing specialty recognition may promote better patient outcomes. Finally, study findings demonstrated that thoracic nurses and surgeons believe that thoracic surgery should be formally recognized as a certified nursing specialty.

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Graduate-prepared nurses play an important role in fulfilling leadership, administration, education, and advanced practice positions within academic and clinical practice settings. With only a slim majority of Canadian nurses holding a graduate degree as their highest level of education, concerns exist about how vacancies in advanced roles will be filled. Many research studies have focussed on the motivators and barriers to pursing higher education in adult learners in general and on those learners who have already made the decision to seek higher education.This research question addressed the gap between both types of learners by examining the attitudes and perceptions of registered nurses who have never enrolled in graduate studies and their perceived motivators and barriers.The problem was examined from the perspective of adult nursing education and specifically used Cross’s (1981) chain-of-response’ model. Cross’s model conceptualizes the intrinsic and the extrinsic factors that motivate adult participation in learning activities.A qualitative phenomenological study design was conducted and transcribed. For increased homogeneity, a convenience sample of eight registered nurses was divided into two focus groups based on their years of nursing experience. The major themes that emerged were categorized as: motivators, barriers, perceptions and attitudes. The motivators included having a professional goal, being personally and professionally challenged, and having a role model in the form of peer support and mentorship.The barriers are divided into three categories drawn from Cross’s (1981) work, which includes situational barriers of work-life balance and financial impact with a subtheme of ageiiiand personal and family commitments, institutional barriers related to the application process, and dispositional concerns around returning to study.The other general themes were perceptions and attitudes in respect to pursuing graduate education, and these included alternative educational opportunities, non-graduate careers, supporting resources, theory–practice gap, value of graduate education, and misconceptions of graduate level roles.The findings highlighted that more work needs to be done to promote the different opportunities and roles available for graduate-prepared nurses and to promote the resources available within both the academic and healthcare employment settings.

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Whole genome sequencing/exome sequencing (WGS/ES) technology is becoming more affordable and accessible, and will become more frequently used in various clinical settings, including for diagnosing rare childhood diseases. However, its use means that parents face decisions that could uncover life-altering information, unrelated to their child’s illness that may also have personal and ethical implications for their families. The purpose of this study is to explore and describe parents’ perceptions of their decisional needs when deciding on WGS/ES for their child. The qualitative methodological approach known as Interpretive Description, the concept of shared decision-making and the Ottawa Decision Support Framework were used to inform and guide this study. Parents of children who had previously undergone WGS/ES informed consent were invited to participate in a focus group or individual in-person or telephone interviews. Parents had children with a range of undiagnosed conditions suspected to be genetic in origin. 15 parents were interviewed and transcriptions were analyzed concurrently and iteratively. Repeat interviews were conducted with 5 of the parents to confirm, challenge or expand on the developing conceptualizations.Participants felt that their decision to proceed with WGS/ES for their child was easy. However, they expressed many unresolved decisional needs including: a lack of knowledge about certain topics that became relevant and important to them later, unmet expectations, and a need for more support and resources. Participants also acknowledged that the high volume of information and urgency of their circumstances may have caused them to be less receptive (or even unreceptive) to information during their WGS/ES decision-making (DM) process. Additionally, participants had ongoing informational and psychosocial needs beyond the single clinical encounter where their WGS/ES DM occurred. The content and amount of information that participants considered to be important varied. Prior to the widespread use of clinical WGS/ES, parents’ perspectives about their decisional needs should be considered in order to implement parent-tailored education, counselling, decision support and informed consent processes.

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Vertical violence is the term used to describe abusive and bullying behaviours among a group of people with unequal power. Vertical violence is used in this study because the recipients of abusive behaviours are students. The goal of this phenomenological study was to elicit a description of the lived experience of nursing students with vertical violence during their clinical placements in three major hospitals in Palestine. Findings suggest that nursing students are experiencing and witnessing bullying behaviours in different forms, most notably by staff nurses and head nurses. Students reported that their experiences with vertical violence lessen as they advance in their clinical education and gain more skills. The majority of the students told someone about their experiences. Experiencing vertical violence was found to impact the students' learning, socialization and clinical practice. The students reported using different coping strategies to deal with vertical violence. Implications for practice include ensuring that if the issue of vertical violence is not dealt with, it will have a detrimental effect on the student nurses and on their practice. Recommendations include providing policies to address this issue and provide reporting guidelines for student nurses. Also teaching nursing students and nurses about vertical violence is to be a top priority for the schools of nursing and hospital managements.

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There is a growing need for undergraduate students to acquire quality placements for clinical practice. However with the current state in healthcare, quality placements have been very hard to attain (Traynor, et al., 2010). Therefore HPS are become the latest trend in many nursing schools in attempt to address this issue (Traynor, et al., 2010). In this study, HPS has been seen to help with confidence levels for clinical practice. However, the benefits that students’ take away from the simulation based learning activities is very dependent on how the simulation is organized, structured and conducted. This notion is supported by the findings of this study. A qualitative phenomenological study design using two focus groups was used. A convenience sample of students from one educational institution, University of British Columbia (UBC) in the term 3, of their undergraduate nursing degree was emailed an invitation to attend a focus group session.There were six major themes and multiple sub- themes that came about during this study that impacted how students perceived their experience with HPS in relation to clinical confidence. The major themes that were evident from the participants’ experiences were classified as: Realism, building on knowledge, safe environment, critical thinking and confidence and anxiety. From this study several conclusions can be drawn about how HPS effects undergraduate student nurses confidence for clinical practice. Findings indicate it is crucial for participants to feel that the whole simulation experience depicts reality. Realism was the major theme related to clinical confidence. If the scenario was not simulating enough participants felt they did not learn much from them; however, during times when simulations were at the optimal level participants felt that they acquired many things, such as confidence, clinical techniques, linking theory to practice, identifying their own knowledge gaps, critical thinking, background knowledge to help in similar cases in the actual clinical environment. It is very important that HPS is well integrated into the nursing programs so students achieve great results from the simulations, which can be done if the simulations being conducted and organized at the right times in the programs.

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