Lifelong learning--the key to competence in the intensive care unit?

The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes

This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross-sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of  Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses' lifelong learning level explained the three subdimensions of self-confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision-making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses' lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses' lifelong learning awareness.

Effective competency-based medical education requires learning environments that promote a mastery goal orientation: A narrative review

PURPOSE

Competency-based medical education (CBME) emphasizes the need for learners to be central to their own learning and to take an active role in learning. This approach has a dual aim: to encourage learners to actively engage in their own learning, and to push learners to develop learning strategies that will prepare them for lifelong learning. This review paper proposes a theoretical bridge between CBME and lifelong learning and puts forth the argument that in order for CBME programs to produce the physicians truly needed in our society now and in the future, learning environments must be intentionally designed to foster mastery goal orientations and to support the development of adaptive self-regulated learning skills and behaviours.

MATERIALS AND METHODS

This narrative literature review incorporated results of searches conducted by a subject librarian in PsycInfo and MedLine. Articles were also identified through reference lists of identified papers to capture older key citations. Analysis of the literature used a constructivist epistemological approach to develop an integrative description of the interaction of achievement goal orientation, self-regulated learning, learning environment, and lifelong learning.

RESULTS

Findings from achievement goal theory research support the assumption that adoption of a mastery goal orientation facilitates the use of adaptive learning behaviours, such as those described in self-regulated learning theory. Adaptive self-regulated learning strategies, in turn, facilitate effective lifelong learning. The authors offer evidence for how learning environments influence goal orientations and self-regulated learning, and propose that CBME programs intentionally plan for such learning environments. Finally, the authors offer specific suggestions and examples for how learning environments can be designed or adjusted to support adoption of a mastery goal orientation and use of self-regulated learning behaviours and strategies to help support development of adaptive lifelong learners.

Nurses' experiences of providing care during the COVID-19 pandemic in Taiwan: A qualitative study

In the event of a contagious disease outbreak that reaches the level of a pandemic, the responsibility of providing care for patients increases for front-line nurses. However, being in a nursing role exposes professionals to a range of risks, including but not limited to contagion and mental health impacts. This qualitative study aimed to explore in-depth nurses' experiences of providing care in the time of the COVID-19 global pandemic. The study followed the COREQ guidelines. Purposive sampling was applied to recruit participants. Semi-structured face-to-face interviews were used to collect the data from 16 nurses across five hospitals in Taiwan in 2020. Contents were analysed using Colaizzi's seven-step method. The essential structure that was identified was 'Providing care cautiously and being alert to the changing environment', which reflects the progress of Taiwanese nurses in providing care during the global COVID-19 pandemic. The essence of the phenomenon is presented through three themes: (i) facing the emerging challenge, (ii) struggling with uncertainty, fear, stigma, and workload, and (iii) adapting to changes in the environment: learning and innovation. The findings identified multi-dimensional impacts of nursing experiences during the COVID-19 pandemic, and the study yielded evidence and practices that can be used to guide and support adequate interventions to support nursing professionals. By understanding the various aspects of nurses' experiences, policymakers and administrators can better address nursing care providers' professional and mental health needs during a pandemic.

Nurses' Views on the Potential Use of Robots in the Pediatric Unit

PURPOSE

To describe nurses' views on the potential use of robots in the pediatric unit.

DESIGN AND METHODS

A qualitative descriptive design was employed. Semi-structured interviews were conducted with 23 nursing staff who worked in the pediatric unit. The interviews were audiotaped, transcribed, and analyzed using qualitative content analysis.

RESULTS

Three themes emerged related to the nurses' views on the potential use of robots in the pediatric unit (1) care impact - advantages, which included: (a) reducing healthcare providers' workload and (b) adequately meeting the needs of pediatric patients and their families; (2) care impact - shortcomings, which included: (a) deficiency of individualized care and (b) reduced employment opportunities for skilled nursing staff; and (3) attitude impact, including (a) lifelong learning and (b) integrating culture and technology to meet pediatric care needs.

CONCLUSIONS

Robots' application may ameliorate the overall quality of pediatric care, allowing for better apportioning of nurses' time and energies to focus on direct patient care and reducing nurses' workloads. However, some possible disadvantages need attention, including robots' inability to provide genuine human touch, demonstrate human emotions associated with pediatric care, and exhibit cultural sensitivity. It is desirable to embed nursing practice needs in the advanced functions of robots and thereby ensure safe, reliable robotics suitable for pediatric care usage.

PRACTICE IMPLICATIONS

The findings can be used as a reference for nurses encountering challenges in working with robots, and for lifelong learning needs for pediatric nurses.

Lifelong learning strategies in nursing: A systematic review

Background

Lifelong learning is an expectation in the professional performance of nurses, which is directly related to the success of students in nursing schools. In spite of the considerable attention paid to this issue, lifelong learning strategies are not fully understood.

Objective

The aim of this study was to clarify lifelong learning strategies of nursing students with respect to international experience.

Methods

In this systematic review, an extensive investigation was carried out using Persian and English studies in Pub Med, ProQuest, Cochrane, Ovid, Scopus, Web of Science, SID, and Iran Doc using the following keywords: lifelong learning, self-directed learning, lifelong learning model, continuing education, nursing education, and lifelong program. Finally, 22 articles published from 1994 to 2016 were selected for the final analysis. Data extracted from the selected articles was summarized and classified based on the research questions.

Results

In this study, 8 main themes, namely intellectual and practical independence, collaborative (cooperative) learning, researcher thinking, persistence in learning, need-based learning, learning management, suitable learning environment, and inclusive growth, were extracted from the article data.

Conclusion

Having identified and clarified lifelong learning strategies in nursing, it is recommended to use the research findings in the programs and teaching systems of nursing schools. Use of strategies of lifelong learning will led to increased quality of education, development of nursing competency and finally, increased quality of patient care.

Effects of technology on nursing care and caring attributes of a sample of Iranian critical care nurses

PURPOSE

To examine the association between attitudes of critical care nurses about influences of technology and their caring attributes.

STUDY DESIGN AND METHODOLOGY

In a cross-sectional study, firstly the psychometric properties of caring attributes questionnaire, which was developed to examine caring attributes of a sample of international nurses, was refined in a sample of 200 critical care nurses working in educational hospitals of a city in the southwest of Iran. Results of factor analysis with Varimax rotation decreased 60 items of caring attributes to 47 items which loaded under five subscales of caring negation, caring compassionate, caring advocacy, caring essence and caring communication. Secondly, attitudes of these nurses toward influences of technology on nursing care were assessed using a 22-item questionnaire, developed by the study researchers. Finally, the association between scores of caring attributes and attitudes toward influences of technology of this sample was determined.

RESULTS

There was a positive association between caring attributes and influences of technology among our study nurses. Caring attributes scores were higher in female single nurses. Although caring attributes' scores had decreased along with age and work experience, caring commitment was higher in older more experienced nurses. Furthermore, female nurses had a better attitude toward influences of technology on their care. In contrast, younger and less experienced nurses had negative views on the effects of technology on nursing care.

CONCLUSION

Continuing education and life-long learning on application of new technological equipment in nursing care and harmonising their use with caring values are necessary for nursing students and registered nurses to ensure delivering a patient-centred care, in a technologically driven environment.

Knowledge of pulse oximetry: comparison among intensive care, anesthesiology and emergency nurses

AIMS AND OBJECTIVES

To evaluate pulse oximetry knowledge of nurses employed in the Intensive Care Unit (ICU), Anesthesiology Department (AD) and Emergency Department (ED) and to compare knowledge among these departments/units.

BACKGROUND

Although pulse oximetry has been widely used in clinical practice, previous studies have reported knowledge deficits among nurses, which may adversely affect patient outcomes.

DESIGN

  Prospective, cross-sectional, multicentre study.

METHODS

All nurses employed in the ICU, AD and ED of six hospitals were asked to complete in private a 21-item, knowledge-evaluating questionnaire, which was evaluated for content-related validity and reliability.

RESULTS

Two hundred and seven questionnaires were completed (a response rate of 74·5%). Mean pulse oximetry knowledge score was 12·8 ± 3·2, with ICU nurses having significantly higher scores than ED nurses (p = 0·001) and those with more than 10 years of experience having significantly higher scores than less experienced ones (p = 0·015). Correct responses did not exceed 50% for six questionnaire items, five of which covered principles of pulse oximetry function. ICU nurses had significantly more correct responses in five items compared to ED nurses, and in two of them compared to AD nurses.

CONCLUSIONS

Longer professional experience and being employed in the ICU were associated with higher pulse oximetry knowledge of Greek nurses. Considering knowledge deficits and differences among nurses, pulse oximetry knowledge seems to mainly develop through clinical experience.

RELEVANCE TO CLINICAL PRACTICE

These findings highlight the need for pregraduate education to follow clinical advances, and especially for the implementation of high-quality, continuing education programmes to provide systematic learning and support professional development of nurses.

Measuring paediatric intensive care nursing knowledge in Australia and New Zealand: how the Basic Knowledge Assessment Tool for pediatric critical care nurses (PEDS-BKAT4) performs

Validated professional knowledge measures are limited in paediatric intensive care unit (PICU) nursing. The Basic Knowledge Assessment Tool for Pediatric Critical Care Nurses (PEDS-BKAT4) measures knowledge, however content and practice differences exist between various PICUs. The study aim was to evaluate the PEDS-BKAT4 in the Australian and New Zealand setting. A panel of 10 experts examined item and scale content validity. Items were evaluated for 31 evidence-based item writing flaws and for cognitive level, by a 4-person expert panel. Thirty-six PICU nurses completed the PEDS-BKAT4, with reliability and item analysis conducted. Mean item content validity was 0.70, and 43% of items had content validity less than 0.8. Overall (Scale) content validity was 0.71. Thirty-five percent of items were classified as flawed. Thirty-five percent of items were written at the 'knowledge' level, and 58% at 'understanding'. The mean PEDS-BKAT4 score was 60.8 (SD=9.6), KR-20 reliability 0.81. The mean item difficulty was 0.62, and the mean discrimination index was 0.23. The PEDS-BKAT4 was not a reliable and valid measure of basic PICU nursing knowledge in Australian and New Zealand. Further research into the types of knowledge and skills required of PICU nurses in this setting are needed to inform the development of a future tool.

Nurses new to intensive care: perceptions of their clinical learning environment

BACKGROUND

All nurses entering intensive care unit (ICU) for the first time are required to master many critical nursing skills. Providing a clinical learning environment that is, conducive to mastering these essential skills is a key component of ensuring clinical competence. Yet there are few publications worldwide that focus on clinical learning for qualified nurses entering ICU for the first time. Factors that affect clinical learning in ward environments have been clearly identified. It remains unclear if these factors are applicable to the ICU environment.

AIMS AND OBJECTIVES

(1) To describe how registered nurses new to ICU environment perceive their clinical learning environment; (2) to identify the factors that influence these perceptions.

DESIGN

Descriptive quantitative survey design.

METHOD

Sixty-four nurses were recruited from five Irish teaching hospitals. The participants completed a modified version of Dunn and Burnett's clinical learning environment scale, with five subscales, that measures perceived factors that influence clinical learning.

RESULTS AND CONCLUSIONS

Nurses new to ICU perceived the environment as conducive to clinical learning. Factors positively affecting clinical learning include: educational staff and clinical nurse managers' commitment to supporting learning and good interpersonal relationships. Non-European qualified nurses who did not do an induction course and those with longest experience on the unit were more satisfied with ICU as a clinical learning.

RELEVANCE TO CLINICAL PRACTICE

These findings will provide nurse educationalists with some further insight as to the factors that promote optimal learning in ICU.

The competencies of the shift leader in the intensive care unit setting, in a private hospital group in South Africa

Newly qualified intensive care nurses are forced into positions of authority and responsibility as shift leaders at an early stage and are not given a chance to consolidate their new knowledge with practice. They have to be responsible and accountable not only for their own actions, but also for those of their staff. The purpose of this study was to explore and describe the competencies of the shift leader in the intensive care unit setting to determine whether there is a gap between what is expected of the shift leader and what is happening in reality. A quantitative, descriptive design was used and cluster sampling was implemented.Questionnaires were used to gather data from three clusters, comprising 11 hospitals from a single private hospital group. Of the 251 questionnaires that were handed out to intensive care personnel (including trained and non-trained staff), 98 were returned, resulting in a response rate of 39%. An in-depth literature study and submission of questionnaires to experts before being administered to respondents ensured validity and reliability. Results were used to describe a typology of the competencies of the shift leader in the intensive care setting and indicated that respondents classified competencies related to the application of the nursing process in the intensive care unit in all its facets as essential competencies. None were classified as a critical competency and only four were classified as specific competencies. All respondents in the three clusters regarded their shift leaders as competent.OpsommingPas-gekwalifiseerde, intensiewesorg-verpleegkundiges word op ’n vroeë stadium as skofleiers in posisies van gesag en verantwoordelikheid geplaas en word nie die kans gegun om hul nuwe kennis met die praktyk te konsolideer nie. Tog moet hulle verantwoordelikheid en aanspreeklikheid aanvaar nie net vir hul eie aksies nie, maar ook vir dié van hul personeel. Die doel van hierdie studie was om die vaardighede van skofleiers in die opset van die intensiewesorg-eenheid te ondersoek en te beskryf om te bepaal of daar ’n gaping bestaan tussen wat van hulle verwag word en wat in werklikheid gebeur. ’n Kwantitatiewe, beskrywende ontwerp is gebruik en ’n trossteekproef is geïmplementeer. Vraelyste is gebruik om data in te samel van drie trosse bestaande uit 11 hospitale van ’n enkele privaathospitaalgroep. Van die 251 vraelyste wat uitgedeel is aan intensiewesorg-personeel (insluitend opgeleide en nie-opgeleide personeel), is 98 terugontvang, wat vertaal na ’n responskoers van 39%. ’n Diepgaande literatuurstudie en voorlegging van vraelyste aan deskundiges voordat dit aan respondente uitgedeel is, het bygedra tot geldigheid en betroubaarheid. Resultate is gebruik om ’n tipologie van die vaardighede van skofleiers in ’n intensiewesorg-eenheid te beskryf en dit het geblyk dat respondente die vaardighede wat verband hou met die verpleegproses in die intensiewesorg-eenheid in al sy fasette as noodsaaklike vaardighede klassifiseer. Geen vaardigheid is as kritiek geklassifiseer nie en slegs vier vaardighede is as spesifieke vaardighede geklassifiseer. Al die respondente in die drie trosse het hul skofleiers as vaardig beskou.

Critical care nurses' experiences of follow-up visits to an ICU

AIM

The aim of this study was to describe critical care nurses' experiences of follow-up visits for formerly critically ill people discharged from an intensive care unit and their close relatives.

BACKGROUND

The critical illness experience affects the ill person and their close relatives not only during the stay in an intensive care unit, but also for a long time afterwards. Follow-up visits were introduced to offer people the opportunity to talk about their experiences. This activity has not been studied earlier from the perspective of critical care nurses.

DESIGN

The design of this study was qualitative.

METHOD

Eight critical care nurses narrated their experiences of follow-up visits by formerly critically ill people and their close relatives to an intensive care unit. Data were collected during 2007-2008. Qualitative thematic content analysis was applied to the interview texts.

RESULTS

The findings show that to feel they were doing a good job it was vital for the critical care nurses to be well prepared for the follow-up visits. It was difficult, in a positive way, to recognise formerly critically ill people when they returned looking healthy. The critical care nurses were disappointed that their former patients remembered so few real events. The follow-up visits gave the critical care nurses a new picture of how the critically illness experience influenced the former patient's everyday life during and after their stay in the intensive care unit and how it affected the lives of their close relatives.

CONCLUSIONS

Through sharing the experiences of formerly critically ill peoples' and their close relatives' critical care nurses receive valuable feedback about their work.

RELEVANCE TO CLINICAL PRACTICE

Receiving feedback about one's work from follow-up visits gives critical care nurses the possibility for to evaluate given care. Follow-up visits to intensive care units can provide them with valuable knowledge that might lead to improved nursing care.

Planning and implementation framework for a hybrid e-learning model

E-learning and traditional classroom learning have been combined to deliver library and information science (LIS) education. However, the framework for planning and implementing a hybrid e-learning model is unclear in the literature. Using a routines-based perspective, e-learning opportunities were explored through identifying the internal difficulties of a part-time LIS postgraduate programme in Taiwan. External challenges were also examined. A practical implication of the findings is a planning and implementation framework for hybrid e-learning, namely ‘the Four Elements model’ and the ‘Structure-System-Process paradigm’, respectively. The former includes four core competencies: cost, service, quality and flexibility needed for LIS educators to formulate an action plan. The latter demonstrates how and what resources can be deployed to implement the action plan. With the framework, a part-time LIS postgraduate programme with limited e-learning courses is generally expected to develop a competitive advantage.

Quality of practice in an intensive care unit (ICU): a mini-ethnographic case study

BACKGROUND

Nurses' perspectives of maintaining quality practice is important in the context of today's safety and quality agenda. This study provides a snapshot of registered nurses' perspectives on practice quality in one Australian ICU.

METHODS

A mini-ethnographic case study examined how quality is embedded in the culture of ICU nursing. Semi-structured interviews of 10 informants were analysed using Spradley's (Spradley JP. The ethnographic interview. Sydney: Holt, Rinehart and Winston, Inc.;1979) ethnographic guidelines.

FINDINGS

Three major themes influenced nursing quality: maintaining cohesiveness in a complex and stressful environment; rapid, effective and respectful communication; and specialist knowledge gained through experience and formal learning.

CONCLUSION

The nurses reported satisfaction with the quality of their ICU practice, but revealed factors that could diminish quality and contribute to job dissatisfaction. Given current recruitment and retention issues and the link between satisfaction and retention, it is important to consider this these factors in advancing the knowledge base for workforce planning.

Use of technological equipment in critical care units: nurses' perceptions in Greece

AIMS AND OBJECTIVES

The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants.

BACKGROUND

Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole.

DESIGN

Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14-item questionnaire and a series of demographic characteristics. A five-point Likert scale was used for each of these 14 questions.

METHODS

The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview.

RESULTS

A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel.

CONCLUSIONS

The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care.

RELEVANCE TO CLINICAL PRACTICE

Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.