Browsing by Author "Pesut, Daniel J."
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Item Debriefing For Meaningful Learning: Fostering Development of Clinical Reasoning Through Simulation(2011-02-25) Dreifuerst, Kristina Thomas; Jeffries, Pamela R.; Horton-Deutsch, Sara L.; McNelis, Angela M.; Pesut, Daniel J.There is a critical need for faculty, a shortage of clinical sites, and an emphasis on quality and safety initiatives that drive increasing use of simulation in nursing education. Debriefing is an essential component of simulation, yet faculty are not consistently prepared to facilitate it such that meaningful learning, demonstrated through clinical reasoning, occurs from the experience. The purpose of this exploratory, quasi-experimental, pre-test-post-test study was to discover the effect of the use of a simulation teaching strategy, Debriefing for Meaningful Learning (DML), on the development of clinical reasoning in nursing students. Clinical reasoning was measured in 238 participant students from a Midwestern university school of nursing taking an adult health course that uses simulation. Participants were assigned to either the experimental or control group where the DML was compared to customary debriefing using the Health Sciences Reasoning Test (HSRT) before and after the debriefing experience, and the Debriefing Assessment for Simulation in Healthcare©–Student Version (DASH©–SV) with four supplemental questions about the DML (DMLSQ) process, during the post-debriefing assessment. This research sought to understand if the DML debriefing strategy positively influenced the development of clinical reasoning skills in undergraduate nursing students, as compared to usual and customary debriefing. The data revealed that there was a statistical difference between total mean test scores measured by the HSRT. There was, additionally, statistical significance in the change in scores between pre-test and post-test for those who used the DML as compared to the control. There was also a difference in the student’s perception of the quality of the debriefing measured by the DASH©–SV with the DML rated statistically higher than usual debriefing. Finally, there was a significant correlation, demonstrated through regression analysis, between the change in HSRT scores and students’ perception of quality debriefing and the use of the DML. This study contributes to the growing body of knowledge about simulation pedagogy, provides tools for use in debriefing, and informs faculty on best practices in debriefing.Item THE EFFECT OF CURRICULAR SEQUENCING OF HUMAN PATIENT SIMULATION LEARNING EXPERIENCES ON STUDENTS’ SELF-PERCEPTIONS OF CLINICAL REASONING ABILITIES(2011-11-18) Jensen, Rebecca Sue; Ebright, Patricia; Pesut, Daniel J.; Fisher, Mary L., Ph.D.; Welch, Janet L.It is unknown whether timing of human patient simulation (HPS) in a semester, demographic (age, gender, and ethnicity), and situational (type of program and previous baccalaureate degree and experience in healthcare) variables affects students’ perceptions of their clinical reasoning abilities. Nursing students were divided into two groups, mid and end of semester HPS experiences. Students’ perceptions of clinical reasoning abilities were measured at Baseline (beginning of semester) and Time 2 (end of semester), along with demographic and situational variables. Dependent variable was Difference scores where Baseline scores were subtracted from Time 2 scores to reveal changes in students’ perceptions of clinical reasoning. Students who were older and had previous healthcare experience had higher scores, as well as students in the AS program, indicating larger changes in students’ perceptions of clinical reasoning abilities from Baseline to Time 2. Timing of HPS, mid or end of semester, had no effect on Difference scores, and thus students’ perceptions of clinical reasoning abilities.Item Effective Teaching in Clinical Simulation: Development of the Student Perception of Effective Teaching in Clinical Simulation Scale(2009-06-23T21:51:22Z) Reese, Cynthia E.; Jeffries, Pamela; Pesut, Daniel J.; Halstead, Judith; Bakas, TamilynClinical simulation is an innovative teaching/learning strategy that supports the efforts of educators to prepare students for practice. Despite the positive implications of clinical simulations in nursing education, no empirical evidence exists to inform effective teaching in simulated learning environments. The purpose of this research is to create an instrument to measure effective teaching strategies in clinical simulation contexts. The conceptual framework for this study is the Nursing Education Simulation Framework. The Student Perception of Effective Teaching in Clinical Simulation (SPETCS) is a survey instrument scored on a 5-point Likert scale with two response scales: Extent and Importance. The Extent response scale measures participants’ perception of the extent to which the instructor used a particular teaching strategy during the simulation, and the Importance response scale measures perception of the degree of importance of the teaching strategy toward meeting simulation learning outcomes. A descriptive, quantitative, cross-sectional design was used. Evidence to support content validity was obtained via a panel of simulation experts (n = 7) which yielded a content validity index of .91. A convenience sample of undergraduate nursing students (n = 121) was used for psychometric analysis. Internal consistency reliability met hypothesized expectations for the Extent (α = .95) and Importance (α = .96) response scales. Temporal stability reliability results were mixed; correlations between administration times met expectations on the Importance scale (ICC = .67), but were lower than expected on the Extent scale (ICC = .52). Both response scales correlated within hypothesized parameters with two criterion instruments (p < .01). The Importance scale was selected for exploratory factor analysis (EFA). EFA revealed 2 factors: Learner Support and Real-World Application. The result of careful item and factor analysis was an easy to administer 33 item scale with 2 response scales. The SPETCS has evidence of reliability and validity and can serve as a tool for the assessment, evaluation, and feedback in the ongoing professional development of nurse educators who use clinical simulations in the teaching/learning process. In addition, results of this study can support the identification of best practices and teaching competencies in the clinical simulation environment.Item Evaluating local skin heating as an early detection method for small-fiber neuropathy in women with breast cancer receiving paclitaxel (Taxol®)(2018-04-18) Zanville, Noah Robert; Champion, Victoria L.; Vasko, Michael R.; Otte, Julie L.; Carter-Harris, Lisa; Pesut, Daniel J.The purpose of this prospective, observational study was to determine if a technique used to detect early signs of small-fiber neuropathy (local skin heating) could detect signs of small-fiber taxane-induced peripheral neuropathy (TIPN) in breast cancer survivors (BCS) during the first 6 weeks of Taxol®. Aims of the study were to compare the mean size of (1) axon reflexes and (2) axon flares (both markers of small fiber nerve function) in BCS receiving Taxol® to the size of reflexes/flares in healthy female controls (HCs). A third aim was to determine whether the size of axon reflexes/flares correlated with (a) overall TIPN severity and (b) severity of individual signs/symptoms of TIPN during early Taxol®. Data for the study was collected from nine BCS and 20 HCs (N = 29). All BCS had first-time, non-metastatic cancer and received weekly or bi-weekly Taxol®. Data was collected at 3 time-points: Time 1 (day 0, before Taxol®), Time 2 (day 14), and Time 3 (day 42). Axon reflexes and flares were generated using a validated 40-minute skin heating protocol. Axon reflexes were measured using laser Doppler Flowmetry. Axon flares were measured using full-field laser perfusion imaging. TIPN was measured using the 5-item Short Form of the Total Neuropathy Score (Reduced Version). Results identified potential signs of small-fiber TIPN in BCS after 6 weeks of Taxol®. Contrary to expectation, axon reflexes were larger for BCS at Time 3 than HCs, suggesting that Taxol® may be associated with an increase in small-fiber nerve function like that seen in pre-clinical studies. Clinical signs/symptoms of TIPN were not significantly correlated with axon reflexes or axon flares at the same time point. Analyses of axon flare size were confounded by issues with the data. These results add to the growing body of evidence showing that Taxol® affects small-diameter sensory nerves and provides the first evidence in humans that changes in small-fiber nerve function may be detectable after just 6 weeks of Taxol® therapy. Studies in larger samples are needed to validate these findings.Item An evaluation of the relationship between reflective judgment and critical thinking in senior associate degree nursing students(2011-06-14) Maskey, Cynthia L.; Boland, Donna L.; Pesut, Daniel J.; Halstead, Judith A.; Flessner, Ryan B.For nursing students to be successful in current and future practice they must be proficient critical thinkers and be able to use reflective judgment skills to manage the daily dilemmas of healthcare practice. Critical thinking and reflective judgment are not elements of nursing curricula unless faculty explicitly design learning activities to develop these skills. This study examined the relationship between reflective judgment and critical thinking by comparing a measure of reflective judgment, the Reasoning about Current Issues (RCI) test, with a measure of critical thinking in nursing (the HESI Exit Exam) in a sample population of senior associate degree nursing (ADN) students (N = 108). The descriptive variables of individual ADN student’s age, grade point average (GPA) in nursing courses and the number of completed college/university credit hours were also examined. A modest correlation (r = .370, p < .01) was found between critical thinking and reflective judgment indicating a positive relationship between these two variables. However, the results supported the hypothesis that these are separate concepts; while the students achieved an acceptable level on the measure of critical thinking, they did not exhibit the skill level of an effective reflective thinker. Positive correlations were found between reflective judgment and individual student age and nursing program GPA (p < .01). Critical thinking was also positively correlated with age (r = .351) and GPA (r = .426). There were no statistically significant correlations noted between the number of credits or previously earned baccalaureate degrees with either reflective judgment or critical thinking. An appreciation of the unique commonalities and differences between reflective judgment and critical thinking is essential for the development of innovative strategies and pedagogies meant to advance teaching/learning within schools of nursing with an explicit focus on both concepts and an ultimate goal of improving competence in newly graduated nurses. The implication for nurse educators is in changes and innovations that can lead to more effective thinkers. Careful pedagogical planning and a mindful inclusion of learning activities to develop both reflective judgment and critical thinking skills may lead to increased competence as nursing students and as new graduate nurses.Item Examining facilitators for men during nursing education: development and psychometric testing of the survey of facilitators for men (SFM)(2015) Clark-Ott, Dorothy G.; Bakas, Tamilyn; Ellett, Marsha; Horton-Deutsch, Sara L.; Pesut, Daniel J.Despite outstanding employment opportunities and high demand to address the global nursing shortage, men who consider becoming nurses are less likely to enroll in and to graduate from nursing programs. Many barriers that men commonly encounter during nursing education have been found in the literature; however, there is a lack of theoretically based research that examines factors that help men succeed as they study nursing. Based on a conceptual model derived from O’Lynn’s construct of male friendliness in nursing education and Frankl’s theory of will to meaning and purpose in life, this study examined facilitators for men during nursing education. This was accomplished through the development and psychometric testing of the Survey of Facilitators for Men (SFM) in a sample of 145 men in nursing. Strong evidence of reliability and validity was provided for the SFM consisting of three subscales (Internal facilitators, External Connections facilitators, and Institutional facilitators). Internal facilitators consist of intrapersonal strengths, experiences, and motivators. External Connections facilitators are interpersonal connections that emerge from relationships that men develop. Institutional facilitators involve structural or organizational aspects of institutions that ease barriers. Testing provided satisfactory evidence of internal consistency (α = .85) and test-retest reliability (intraclass coefficient = .72; confidence interval = 0.57–0.83). Dimensionality of three facilitator subscales was supported by Principle Axis Factoring with Varimax rotation and satisfactory factor loadings (.49–.72). Support for the conceptual model was provided using multiple regressions explaining 17% of the variance in purpose in life [F(4, 140) = 6.99, p < .001], 13% of the variance in GPA [F(6, 114) = 2.88, p < .01], and 49% of the variance in perception of nursing success [F(9, 128) = 13.42, p < .001]. Purpose in life was associated with Internal facilitators and comfortable income, GPA was associated with External Connections facilitators and age at BSN, while perception of nursing success was associated with purpose in life, holding an MSN, having a comfortable income, and having children. Future research is warranted to determine the usefulness of the SFM in designing strategies to recruit and retain men in nursing programs.Item Factors that Facilitate and Inhibit Engagement of Registered Nurses: An Analysis and Evaluation of Magnet versus Non-Magnet Designated Hospitals(2012-03-16) Wonder, Amy C.; Fisher, Mary L., Ph.D.; Pesut, Daniel J.; Ebright, Patricia; Halstead, Judith A.Work engagement of registered nurses (RNs) has gained attention in health care, as an organizational process that is requisite to promoting optimal patient outcomes. Improving patient outcomes has caused a movement to examine what can be done to bridge the disparity between good and excellent care. Standards that enhance RN engagement to promote professional care are seen as vital to excellence. Magnet designation, awarded by the American Nurses Credentialing Center, signifies an organization meets such standards. Therefore, the purpose of this study was to evaluate whether a correlation exists between RN engagement and the organizational structures common to Magnet designation. This study also evaluated the influence of social and institutional demographics on the relationship between engagement and Magnet designation. The variables in this study included: age (generation), gender, nursing degree, years of RN experience, years of unit longevity, shift, hours scheduled and worked per week, percentage of time in direct patient care, nursing unit, and shared governance council participation. Finally, this study evaluated the influence of RN perception related to organizational support for work on the relationship between engagement and Magnet designation. A total of 370 RNs in Magnet (n = 220) and non-Magnet (n = 150) designated hospitals completed a 17-item engagement survey and a 15-item demographic survey. Major findings of the study indicated no significant difference in RN engagement between nurses who work at Magnet versus non-Magnet designated hospitals. Within the Magnet sample, significant relationships were found between engagement and shift, years of RN experience in any clinical setting, and RN perceptions related to organizational support for work. Scatter plots for nursing experience showed positive slopes for total engagement, vigor, dedication, and absorption. Post-hoc results for RN perception related to organizational support for work identified the significant areas of engagement were total engagement, vigor, and absorption. No significant post-hoc results were noted for the variable of shift. Through significant and non-significant findings, several insights were gained about engagement. As a result of this study, leadership can better assess the needs of the RN workforce to provide what RNs perceive to be important to professional practice and RN engagement.Item Identification and Comparison of Academic Self Regulatory Strategy Use of Traditional and Accelerated Baccalaureate Nursing Students(2009-12-08T19:25:18Z) Mullen, Patricia A.; Billings, Diane M.; Pesut, Daniel J.; Beckstrand, Janis; Wlodkowski, RaymondObjective: To explore and compare the use of metacognitive, cognitive, and environmental resource management self regulatory learning (SRL) strategies used by a national sample of students enrolled in traditional and accelerated baccalaureate nursing programs. Background: Learner focused reforms in nursing education require students to assume more responsibility for learning. Nursing student responsibility for learning is reflected in their use of metacognitive, cognitive, and environmental resource SRL strategies. Learning strategy use promotes the development of clinical reasoning and lifelong learning skills requisite to meet the needs of complex patients in a dynamic healthcare environment. Method: Using Bandura’s social cognitive theory as a framework, the learning subscales of the Motivated Strategies for Learning Questionnaire were used to survey a national sample of 514 baccalaureate nursing students enrolled in their final semester of a traditional baccalaureate nursing program or a 12-month accelerated baccalaureate program. Delineation of student use of metacognitive, cognitive (rehearsal, organization, and elaboration), and environmental resource management (help seeking, peer learning, effort regulation, and time and study environment) SRL strategies was examined by program and in light of age, grade point average (GPA), weekly hours spent studying independently, and weekly hours spent in employment. Results: Differences in SRL strategy use were found between the program groups and between program groups divided by sample age. Older students in both the accelerated and traditional programs used more metacognition and elaboration SRL strategies than their younger traditional counterparts. Older traditional students used significantly more effort regulation SRL strategies than both groups of younger students. Both older groups of students studied significantly more, used significantly more time and study environment SRL strategies, and had significantly higher GPAs than the younger groups of students from both programs. Conclusions: This study provides a framework for learner focused nursing education by explicitly defining differences in SRL strategy use of students enrolled in traditional and accelerated baccalaureate nursing programs.Item Nurses' experiences of the practice of the PeerSpirit Circle model from a Gadamerian philosophical hermeneutic perspective(2013-10-07) Lombard, Kristen Cronk; Horton-Deutsch, Sara L.; Pesut, Daniel J.; Sims, Sharon L.; Spence, DeborahThe PeerSpirit Circle is a non-hierarchical, intentional, and relationship-centered practice of collaboration. There is a lack of scientific knowledge about the phenomenon of the PeerSpirit Circle in nursing or its potential impact on nursing practice, education, research, and the evolution of the profession and health care. The health care milieu is often entrenched in ways of being that do not support sustained change. For vitality to prosper and creativity to abound, paradigmatic shifts and new models of practice that emphasize collaboration are being called for. The purpose and aims of this phenomenological research study are to explore and give voice to the experiences of nurses who have participated in the PeerSpirit Circle model of practice with other nurses. The study includes interviews from five registered nurses from Canada and the United States conducted from 2009–2010 and interpreted from a Gadamerian philosophical hermeneutic perspective. The research findings reveal three themes: (1) experiencing the Circle container” where participants begin to understand the value of intentional preparation of the interpersonal space for safe human interaction and stronger collaboration—there are experiences of gathering, protecting, appreciating ritual, and sharing stories; (2) Experiencing space where protected space seems to be the essential element to inspire the presencing of participants with self and other, which in turn engenders genuine dialogue, a sense of sacred space, and freedom to be authentic; and (3) Experiencing our humanity, an unfolding theme, where participants experience reconnection with and understanding of their deeper humanity, stronger congruence with their core values, deeper experiences of caring and courage, personal and professional growth, and a profound appreciation for belonging to a lineage of nurses. The findings inspire a deeper understanding of barriers to congruence between values and action in nursing and nurses’ need to acknowledge, honor, support, and protect each other’s vulnerability. The implications for nursing practice, education, and research show that the PeerSpirit Circle model is a beneficial for use in all settings.Item Nursing students' perceptions of presence in online courses(2015-08-27) Van Schyndel, Jennie L.; Halstead, Judith Ann; Pesut, Daniel J.; Fisher, Mary L.; Bakas, TamilynLack of presence in online courses can result in perceived isolation leading to student dissatisfaction with the learning experience. The purpose of this study was to measure nursing students' perceived extent of teaching, social and cognitive presence and course satisfaction in an online undergraduate nursing course, and whether relationships and associations existed between the three presences, course satisfaction, student demographic, academic, and technology variables, and selected instructional strategies. The Community of Inquiry theory was the framework used in this descriptive correlational study of RN-BSN students (n= 76). Variables were measured using the Community of Inquiry Survey and the Perceived Student Satisfaction Scale instruments, and a researcher developed survey. Findings indicated students' perceived teaching and cognitive presence were present to a greater extent than social presence. Significant positive correlations (p < .01) were found between teaching and cognitive presence (r =.79), cognitive and social presence (r =.64), teaching and social presence (r =.52), satisfaction and the teaching (r =.77), social (r =.63), and cognitive (r =.52) presences. There were no significant findings associated with age, ethnicity, race, number of online courses taken, expected course grade or GPA and perceptions of the three presences and course satisfaction. There was a significant difference (p ≤ .05) with gender and perceived social presence with male students reporting stronger levels. Students experiencing course technology difficulties reported significantly (p ≤ .05) lower perceptions of teaching presence than those experiencing no difficulty. Significant differences (p ≤ .05) were found between specific course instructional strategies and each presence and course satisfaction. The findings provide faculty with an understanding of online course management and teaching/learning strategies that may increase students' perceptions of presence in online courses and improve student satisfaction with online learning.