Research on the Reform and Practice of “Basic Nursing Skills Practice” Course Assessment

Objective: “Basic Nursing Skills Practice” is a key course connecting classroom and clinical teaching in nursing specialty teaching. Nursing practice ability is one of the core abilities of nurse practitioners. Therefore, the teaching quality of this course is directly related to the quality of nursing work. To improve the teaching quality of practical course, the assessment reform of the “Basic Nursing Skills Practice” course was carried out among the nursing undergraduates to explore a reasonable and fair assessment mechanism. Method: In the assessment of “Basic Nursing Skills Practice” course, the assessment included individual skill operation assessment, virtual simulation assessment and team comprehensive skill assessment. The assessment proportion was adjusted from 100% for the final examination to 50% for the middle and final examinations respectively. The assessment method was changed from individual skills assessment at the end of the term to a combination of individual skills assessment at the midterm and virtual simulation assessment and team skills assessment at the end of the term. The method has changed from summative evaluation to a combination of formative evaluation and summative evaluation, and self-made questionnaire was used to investigate the effect. Results: After implementing the assessment reform, 86.84% of the students were satisfied with the assessment reform, and the percentage of students with scores above 80 reached 100%. The highest score is 93.0, while the lowest score is 83.0, and the average score was 88.0. Conclusions: High satisfaction of students with basic nursing skills examination reform promoted the learning effectiveness and professional emotions, cultivated comprehensive quality and ability, promoted the realization of talent training objectives.

Improvement in Patient Mobility Following Short-Term Rehabilitation in Skilled Nursing Facilities

Background: Mobility in older adults can be impaired after acute illness or hospitalization, and the level of severity can be used as a predictor of one’s ability to return to independent living. Patients are often referred to skilled nursing facilities in hopes of improving their mobility. We wanted to prove that rehabilitative services at Skilled Nursing Facilities improve overall outcomes. Methods: We conducted a retrospective analysis of data from 4612 patients admitted for short-term rehabilitation in a large nursing home chain in California. Our aim was to determine whether patients’ mobility scores, as measured by rehabilitative staff, significantly improved by time of discharge compared to their scores at admission. Mobility scores were rated from 1 to 6, with 1 being the most dependent on aid and 6 being the most independent, over a variety of tasks at admission and compared to scores at discharge. Pearson’s correlations were performed to determine if there were significant relationships in the data: the Pearson’s correlation coefficient was used to describe the relationships between patient admission to a skilled nursing facility and medical improvement upon discharge. Results: The study demonstrated a statistically significant improvement in patients’ mobility scores upon discharge, with Medicare insured patients showing on average 57% improvement and Managed Care insured patients showing on average 59% improvement. Additionally, admission scores appeared to be predictive of the patient’s outcome at discharge. Conclusions: The values and consistency of improvement support the use of acute rehabilitative services in skilled nursing facilities. An equation can be formulated that evaluates patients’ estimated mobility statuses upon discharge from facilities based on their conditions on their arrivals. With this, new interventions can be studied and compared to the current standard of care by using these measurements. They can determine if further improvements can be made to increase patient outcomes.

Improvement of Activities of Daily Living (ADL) for Patients Treated in Skilled Nursing Facilities (SNFs)

Background: Self-care tasks or activities of daily living (ADL)’s performance are often disrupted after an older adult sustains an injury or illness, which can be a determining factor for discharge placement after hospitalization, or it can determine the level of assistance required after discharge from a skilled nursing facility (SNF). We believe that comprehensive rehabilitation can improve a patient’s overall functioning during their short term stay in SNFs. The purpose of this study is to determine if an individual’s level of independence improved after admission to a skilled nursing facility and procurement of rehabilitation services. Methods: This study retrospectively reviewed 4612 nursing home patients in California who underwent rehabilitative services at skilled nursing facilities to determine how the patients responded to their environments, therapy interventions, and any other additional supportive measures. The records of patients who were admitted for short-term rehabilitation were reviewed in a blinded fashion, looking specifically at Section GG of the Minimum Data Set (MDS). Self-Care Section GG scores recorded by rehabilitative staff provide objective data and measure patients’ levels of assistance that were required. Each activity is scored from 1, being completely dependent, to 6, being entirely independent, with varying levels of assistance with scores in between. The admission scores versus the discharge scores can be compared to determine if a patient improved their level of functioning upon discharge. Results: Utilizing the Pearson’s correlation coefficient, a strong correlation of improvement in ADL performance on Section GG between the admission and discharge scores was identified, implying significant improvement in functional independence upon discharge. The average percent improvement for Managed Care patients was ~35.4% and ~39.4% for Medicare patients. Conclusions: The results support the benefits of rehabilitation services in skilled nursing facilities, and the data suggests that admission scores can be used as a predictive tool for functional outcomes.

Health personnel's experience with resident-centered care in nursing homes in Korea: A qualitative study

Objectives: Changing the culture in nursing homes in South Korea comes with challenges,and the key issues of resident-centered care have been described.This study aims to describe health personnel's experience in providing resident-centered care in nursing homes.Methods: Qualitative data were collected through individual and focus group interviews consisting of registered nurses (n =4),certified nurse assistants (n =2),and long-term caregivers (n =12) working at nursing homes in South Korea.The participants (n-18) completed the interviews from May to June 2018,and all interviews were recorded,transcribed,and analyzed by employing the content analysis method.Results: Five main categories are conceptualized: (1) residents' participation in decision making,(2) the sharing of the history and story of residents,(3) the recognition of facility-or task-based attitudes,(4) the guarantee of private time and space for residents,and (5) the need for standardized guidelines.Conclusions: Results corroborate that health personnel regard resident-centered care as a desirable nursing paradigm.However,facility-or task-centered care is the most effective in hectic situations.A standardized protocol on the application of resident-centered care based on the facility-tailored specification is unavailable.Therefore,health personnel's perception and practice of resident-centered care can differ.Efficient nursing intervention programs should be developed after clarifying facility culture.

Attitudes of Nursing Faculty Members and Graduates towards the Objective Structured Clinical Examination (OSCE)

The aim of this study was to evaluate the attitudes of faculty and graduates of college of nursing towards Objective Structured Clinical Examination (OSCE) as a valid and reliable method of clinical competency assessment in nursing ten years after its inception. Core nursing courses are based on instructional teaching methods and “hands-on” approach to impact cognitive, psychomotor skills and clinical judgments. Different clinical competency assessment methods are used globally;however, most of them are subjective. A descriptive survey using 16-item five-point likert scale questionnaire was conducted. The study sample consisted of 140 participants: 20 faculty members, 27 graduates of the Bachelor of Science in Nursing (BSN) Degree and 93 graduates of the Associate Degree of Nursing (ADN) programs with OSCE experience during their training. Data collection was carried out between October and November 2015. Eighty percent of faculty members, 74% of BSN and 62.3% of ADN graduates agreed that OSCE represented an objective evaluation method for psychomotor skills. Majority of the graduates perceived their OSCE experience positively although stressful. However, they have suggested the introduction of trial/mock OSCE prior to each exam to minimize the stress associated with it. In conclusion, there appears to be no single “gold-standard” assessment tool for clinical competency. OSCE assesses student nurses’ psychomotor skills in a non-clinical environment, therefore without risks to real patients. In combination with other assessment methods in the clinical settings, OSCE will provide a more comprehensive student psychomotor skill evaluation. OSCE experiences gave new nursing graduates confidence to work as registered nurses in health care settings.