• Implementation of a Pilot Nurse Residency Program for Army Public Health Nurses

      Jackson, Kyndra A. (2016)
      Graduates of the Principles of Military Preventive Medicine course do not have access to a formal residency/orientation program upon graduation and transition into the role of an Army Public Health Nurse (APHN). There is consensus in the literature that additional competencies and knowledge beyond those attained in an entry level educational program are needed to transition effectively into a new professional role. Based on formative assessment data, current APHN residency/orientation programs are informal, sporadically located, vary in length, and training opportunities. The large degree of program variance and lack of standardization negatively impacts the development of competent and confident APHNs prepared for independent practice. The purpose of this scholarly project is to determine if a formal one-year nurse residency program (NRP) for APHNs improves competence and confidence in practice. A convenience sample of June 2015 nurse graduates of the Principles of Military Preventive Medicine Course (N=2) was recruited to participate in the pilot NRP. Outcomes of perceived confidence and competence in professional practice are measured at four points in the program using the APHN Readiness Assessment Tool. Phase One results are reported in this paper. Overall program satisfaction will be evaluated at program completion. At completion of Phase One, four month re-assessment mean scores improved in six of the ten essential public health services assessed. Improvement in mean scores was also seen in two of the fourteen confidence specific questions. Differences between baseline and four month re-assessment mean scores were not statistically significant. This project is the first attempt to formalize and standardize processes related to the professional transition of new nurse graduates of the Principles of Military Preventive Medicine course into public health nursing practice. It also provides an opportunity to evaluate tools designed to track competency assessment/validation and evaluate evidence-based NRP processes with a public health nurse population.
    • Using Simulation to Train Nurse Residents on Bedside Legal Ethical Dilemmas

      Salas, Elisa C. (2017)
      Problem: Nurse residents at a medium-size urban medical center reported a gap in knowledge on how to handle legal-ethical issues at the bedside. Objective: To develop a sustainable approach to integrate legal-ethical simulations into a nurse residency curriculum. Methods: In this quality improvement project, classroom content on ethics was replaced by a ten-minute presentation followed by two simulations depicting legal-ethical dilemmas at the bedside. The project leader designed the two legal-ethical simulations using a format consistent with the NLN/Jeffries simulation design. The topics of the simulations were cancer and pneumonia. The simulations for the first nurse resident cohort (N=9) were directed by the project leader; after training, the nursing residency coordinator directed the second cohort (N=19). Targeted training for nurse educators was also developed. Prior to and after the simulation, students completed a ten-item test to measure legal-ethical knowledge. Immediately after the simulation, students also completed the Student Satisfaction and Self-Confidence in Learning questionnaire, a 13 item Likert scale, 1= strongly disagree to 5 =strongly agree. Results: Comparison of pre and post legal-ethical knowledge scores showed a statistically significant increase in scores (Wilcoxon Signed-Rank Test p < .001, effect size medium to strong, r = .48). Scores for the Student Satisfaction and Self-Confidence in Learning showed consistency. There were no significant differences in scores between cohorts (Mann-Whitney U =256, z= 1.39, p= .1, two tailed) or between simulations (Mann-Whitney U= 371, z= 0.11, p= .9 two tailed). Implications: Providing nurse residents with a ten-minute presentation and two simulations appears sufficient to refresh knowledge of basic legal-ethical concepts. Satisfaction and self-confidence scores were high after each of the two simulations, suggesting that their implementation in the residency program could assist in filling the reported knowledge gap.