- Email: [email protected]
Exploring the Lived Experience of Trauma Among Obstetric Registered Nurses
RESEARCH Proceedings of the 2014 AWHONN Convention
A Phenomenological Approach to Describe the Lived Experience of Ovarian Cancer Objective o explore and illuminate the lived experience of women diagnosed with ovarian cancer.
T
Joanna L. Guenther, PhD, RN, FNP-BC, CNE, Texas Tech University Health Sciences Center, Lubbock, TX Keywords ovarian cancer lived experience phenomenology women’s health
Paper Presentation
Design A phenomenological approach in which individuals tell their stories to make meaning of their truths, realities, and experiences. Phenomenology allows researchers to interpret the meaning of the experiences through hearing and observing the words and descriptions of participants. Setting The women were interviewed for an hour or more at their homes or workplaces. Each interview was audio-recorded and transcribed. Sample Eleven women aged 23 to 66 were interviewed beginning with the open-ended question “Tell me about events leading up to your diagnosis of ovarian cancer.” The women were diagnosed with stages II (n = 1), III (n = 8), and IV (n = 2) ovarian cancer within the past 5 years. Stages III and IV are advanced stages. Methods The narrative responses were analyzed for constitutive patterns and relational themes according to the hermeneutic phenomenological process. By illuminating the memories and recollections of the women, the meanings and particulars of the ovarian cancer experience were identified.
Results Prior to diagnosis, most women were not aware of the symptoms of ovarian cancer. Even though symptoms were present, they were often attributed to gastrointestinal and renal problems by the woman and provider. There was an average delay in diagnosis of at least 6 months. Six constitutive patterns evolved from the experiences of the 11 women: the revelation, jeopardy, on the lookout, becoming normal, and living every moment.
Conclusion/Implications for Nursing Practice The women participated in this study with the expectation that their experiences would be passed on to health care providers who care for women. They wanted the information to contribute to improvement in the care provided with hopes for earlier diagnosis. They wanted others to know about the difficulties they experienced when they sensed something was wrong with their bodies and the need to search for answers by going from provider to provider. Once they were correctly diagnosed, they faced complex physical, spiritual, and psychological needs associated with an incurable illness. The women’s symptoms are described to enable nurses to educate women about the symptoms of ovarian cancer and to evaluate their risk factors. In addition, the women provided key insights into approaches and strategies for facing death while embracing life.
JOGNN http://jognn.awhonn.org
C
2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
S81
RESEARCH Proceedings of the 2014 AWHONN Convention
Continuing Psychometric Evaluation of the Perinatal Grief Intensity Scale in the Subsequent Pregnancy After Perinatal Loss Objective o examine the relation of grief intensity, psychological wellbeing, and the quality of intimate partner relationships of women in the subsequent pregnancy after a miscarriage, stillbirth, or neonatal death.
T
Marianne Hopkins Hutti, PhD, WHNP-BC, University of Louisville, Louisville, KY Deborah S. Armstrong, PhD, RN, University of Louisville, Louisville, KY
Design Descriptive, cross-sectional, correlational research design. Based on the theoretical framework of perinatal grief intensity developed by the author, we examined the reliability and convergent validity of the Perinatal Grief Intensity Scale (PGIS) in the subsequent pregnancy after a perinatal loss.
John Myers, PhD, University of Setting Louisville, Louisville, KY Web-based study. Keywords Perinatal grief intensity subsequent pregnancy
Paper Presentation
Sample Currently pregnant women (N = 227) who had experienced a perinatal loss in their immediate past pregnancies. Analysis indicated the sample of 227 women who completed the instruments (48% of total) afforded sufficient power to test the hypotheses. Methods Instruments included the Pregnancy Outcome Questionnaire (POQ) for pregnancy-specific anxiety; Impact of Event Scale (IES) for posttraumatic stress; Center for Epidemiologic StudiesDepression Scale (CES-D) for depression symptoms; Autonomy and Relatedness Inventory (ARI) for quality of intimate primary relationship; and the PGIS for perinatal grief intensity. Data were analyzed using descriptive statistics.
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Results Cronbach’s alphas for all total scales and subscales used in the study were high and ranged from .75 (PGIS total) to .95 (ARI total). Increased grief intensity was associated with significantly increased pregnancy-specific anxiety; depression symptoms; posttraumatic stress; and poorer, primary, intimate relationships. Participants in all three groups (miscarriage, stillbirth, and neonatal death) reported significantly higher mean CES-D scores (range 25.2-29.6, p < .001) than the traditional cutoff score of 16 used for suggesting depression symptoms. Similarly, all mean loss group scores were significantly higher than 23 (range 34.4-35.5, p < .001), the IES cutoff score used to suggest posttraumatic stress. Conclusion/Implications for Nursing Practice The consequences associated with intense grieving may include significant couple relationship issues, depression, pregnancy-specific anxiety, and posttraumatic stress that may also extend into the subsequent healthy pregnancy. The PGIS demonstrated total and subscale internal consistency reliability when used with all types of perinatal loss within the context of subsequent pregnancy. It demonstrated convergent validity by establishing statistically significant and appropriate directional relationships with concepts thought to be associated with intense grief, including pregnancy-specific anxiety, depression symptoms, posttraumatic stress, and the quality of the primary intimate relationship. It may eventually be useful as a clinical instrument to help health care providers identify parents at risk for intense grief reactions and other clinically relevant symptoms.
JOGNN, 43, S81-S85; 2014. DOI: 10.1111/1552-6909.12438
http://jognn.awhonn.org
Baxter, J. M. S., Kavanaugh, K., and Vonderheid, S.
RESEARCH Proceedings of the 2014 AWHONN Convention
Response to the Call to Action: A National Picture of Breastfeeding Support Provided in Neonatal Intensive Care Professional Issues
Sunny G. Hallowell, PhD, PCPNP-BC, IBCLC, University of Pennsylvania, Philadelphia, PA
Objective o measure the frequency of breastfeeding support by nurses and receipt of human milk by very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU), which is not known and to determine if the numbers and qualifications of nurses, their professional practice environments, and the availability of lactation consultants increased the number of infants who received this care.
T
Design Diane L. Spatz, PhD, RN-BC, Cross-sectional, observational study. FAAN, University of Pennsylvania School of Nursing Setting and Children’s Hospital of Philadelphia, Philadelphia, PA One hundred four NICUs. Eileen Lake, RN, PhD, FAAN, University of Pennsylvania, Philadelphia, PA Alexandra L. Hanlon, PhD, University of Pennsylvania School of Nursing, Philadelphia, PA Keywords nurse work environment practice environment score breastfeeding support human milk NICU
Paper Presentation
Sample Participants included 6,060 nurse survey respondents, 15,233 infants who were card for by nurses on their last shifts worked, and 7,886 VLBW infants cared for in participating NICUs. Methods Secondary analysis was used to examine nurse survey data collected in 2008 from the parent study and infant hospitalization data from 104 NICUs in the Vermont Oxford Network (VON), an NICU quality collaborative. Analysis was conducted using bivariate and multiple general linear regression models.
Results The majority (54%) were discharged on formula only. Few infants (6%) were discharged on exclusive human milk. The remaining infants (42%) received human milk mixed with fortifier or formula. Nurses reported providing breastfeeding support to one in five infants whose parents were present. Sixty percent of infants had parents present for part or the entire shift. Only half of the NICUs had a lactation consultant (51%). Significantly greater numbers of infants received breastfeeding support and human milk (p < .05) in NICUs with supportive professional practice environments, baccalaureate-prepared nurses, and nurses with at least 5 years NICU experience. Conclusion/Implications for Nursing Practice National health care agencies including the U.S. Surgeon General and American Academy of Pediatrics have described breastfeeding and human milk as the normative standard for infant feeding and nutrition. However, the country is falling far short of the Surgeon General’s recommendation for this high-risk pediatric population. The findings suggest NICU nurses provide breastfeeding support around the clock, typically without a lactation consultant available. Our results demonstrate that nurses are essential to providing lactation care to NICU infants for whom the receipt of human milk is an issue of patient satisfaction, quality patient care, effectiveness, and survival.
Exploring the Lived Experience of Trauma Among Obstetric Registered Nurses Jennifer M. S. Baxter, PhD, Objective BSN, SUNY Downstate o describe and analyze the lived experiences Medical Center, New York, NY
T
of obstetric registered nurses (RNs) encountering trauma while providing direct care.
Karen Kavanaugh, PhD, RN, FAAN, Wayne State University, Design Detroit, MI
Hermeneutic phenomenology. Susan Vonderheid, PhD, RN, University of Illinois at Chicago, Chicago, IL
Setting New York City. Sample Ten eligible obstetric nurses were recruited in using convenient, purposive, and snowball sam-
JOGNN 2014; Vol. 43, Supplement 1
pling. We also collected other data, including etymological history of the words, idiomatic phrases related to the phenomenon, and experiential descriptions in literature, biographies, diaries, art, and phenomenological literature. Methods Institutional review board approval and a Certificate of Confidentiality from the National Institute of Nursing Research were obtained prior to collecting data. Interviews were recorded, transcribed, and analyzed based on van Manen’s stages of reflective analysis to arrive at the essential meaning of the phenomenon.
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RESEARCH Proceedings of the 2014 AWHONN Convention
Results Though experiences with trauma varied, the most common experiences included maternal death, intrauterine fetal demise (IUFDs), and emergency cesarean. Seven essential themes were uncovered as follows: (a) an internal process, (b) being faced with the unexpected, (c) going through the motions, (d) feeling helpless, (e) engaging others, (f) a visceral imprint, and (g) a damaged person. Conclusion/Implications for Nursing Practice Trauma is the emotional or psychological state of discomfort or stress resulting from an overwhelming event or series of events while providing direct care. Exposure to trauma has negative consequences for nurses, including mental,
physical, and/or emotional health issues leading to problems such as posttraumatic stress disorder (PTSD), burnout, poor nursing care, and patient safety risk. For participants, trauma was an unforgettable, deeply personal, and complex experience. It is important that obstetric RNs and outsiders recognize that trauma is ever present in the obstetric specialty. The critical insight gained from this study provides valuable information to enrich our awareness about the vulnerability of obstetric nurses to trauma, to begin a conversation about how to improve the work environment for nurses, and to enhance the care they provide to their patients. We provide recommendations for practice, education, and research.
Keywords birth trauma nursing experience
Professional Issues Paper Presentation
The Maternal-Newborn Assessment Study: Can Simulation Replicate the Clinical Learning Experience in Undergraduate Nursing Education? Objective o compare high-fidelity simulation and practice in the clinical laboratory to hospital-based clinical learning on the ability of undergraduate nursing students to assess, intervene, and critically think in the obstetric setting.
T
Design Quasi-experimental, nonequivalent comparison groups, post test only; power analysis for three variables, medium effect size required 76 in each comparison group for a total of 152 participants; alpha level .05 and power of .8. Setting Private university in the Pacific Northwest. Sample Undergraduate, senior nursing students (80) in the maternal-child course: 39 in an obstetric hospital rotation and 41 in a pediatric clinical rotation voluntarily participated and comprised the two comparison groups. Methods Each student demonstrated simulated postpartum and newborn assessments, whereas an obstetric faculty member trained as an observer evaluated performance using check-off forms. Following and prior to debriefing, students provided written responses to questions designed to assess critical thinking during the simulation. Questions and items on check-off forms were assigned points to obtain assessment, written, and total scores. Scores <92% required remediation.
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Check-off forms, developed by study researchers were tested for inter-rater reliability and content validity, and questions were pilot tested. t Tests were used to compare scores of students completing an obstetric hospital rotation versus those in a pediatric clinical rotation, and frequencies for passing assessments were calculated. Results No significant difference was detected between students in the pediatric clinical rotation who only practiced assessments in the laboratory setting and students completing a hospital-based obstetric rotation related to ability to assess, intervene, or critically think. The p-value for comparisons ranged from .41 to .93 (all nonsignificant); less than one third of students passed either assessment. Conclusion/Implications for Nursing Practice Simulation is a widely used teaching strategy. Researchers have found simulation increases undergraduate nursing students’ knowledge, skills, self-efficacy, and confidence. Our findings indicate that simulation was as effective as clinical practice in terms of students’ performance outcomes. Well-designed simulations can replace part of nursing students’ hands-on clinical time with positive learning outcomes. Evaluating individual student performance facilitates design of remediation activities targeting identified areas of weakness. Future researchers should combine simulation with hospital-based clinical experience to determine if student competency improves.
JOGNN, 43, S81-S85; 2014. DOI: 10.1111/1552-6909.12438
Linda M. Veltri, PhD, RN, Oregon Health and Science University, Ashland, OR Joanna M. Rowe, PhD, RN, Linfield College, Portland, OR Kathleen J. Bell, RN, MSN, CNM, AHN-BC, MS1-BC, Northern Light, Cannon Beach, OR Ellyn L. Arwood, EdD, University of Portland, Portland, OR Lindsay L. Kindler, PhD, RN, CNS, Kaiser Permanente Northwest, Portland, OR Keywords maternal-newborn undergraduate nursing students simulation
Professional Issues Paper Presentation
http://jognn.awhonn.org
RESEARCH
Veltri, L. M.
Proceedings of the 2014 AWHONN Convention
Experiences of Staff Nurses during Clinical Learning Linda M. Veltri, PhD, RN, Oregon Health and Science University, Ashland, OR Keywords clinical learning undergraduate nursing students staff nurses maternity nursing
Objective o understand the unstructured experiences of staff nurses in an obstetric unit with undergraduate nursing students present.
T
Design Naturalistic inquiry. Setting Family birth center in Pacific Northwest.
Professional Issues Paper Presentation
Sample Convenience sample, 12 English speaking, baccalaureate-prepared registered nurses (RNs) who worked in unstructured manner with nursing students. Methods Semistructured interviews were conducted and recorded. Participants shared their experiences of working with students. Data were analyzed using an interpretive continuous approach according to Lincoln and Guba’s elucidation of Glaser and Strauss’s constant-comparative method, and data were stored, organized, and coded. Data collection and analysis ceased when categories were saturated and no new information surfaced. Demographic data were analyzed using descriptive statistics. An experienced qualitative researcher provided oversight to ensure accuracy. Credibility, transferability, dependability, confirmability were used to ensure trustworthiness. Results Five themes emerged as follows: giving and receiving: working with students provided nurses
JOGNN 2014; Vol. 43, Supplement 1
opportunities to give back to their profession— nurses learned from students; advancing professionally and personally: many nurses took advantage of workplace incentives to gain additional compensation and opportunities; balancing act: nurses balanced their typical workloads with student learning needs and provision of safe, quality care—students slowed nurses down; getting to know and working with you: nurses worked to know student personally and tailored the learning experience—nurses desired students be prepared; past and present: clinical experiences exert long lasting impressions.
Conclusion/Implications for Nursing Practice Clinical learning is integral to nursing education and preparation for professional practice. Increased enrollments in baccalaureate nursing programs require more staff nurses to supervise students in the workplace. Researchers have found students’ learning, impressions of nursing, and perceptions of clinical learning are greatly influenced by nurses in the workplace, and working with students is a benefit for many nurses. Workplace learning may increase when students are prepared prior to entering clinical settings. Nurses working with students should be judiciously selected. Future research should be aimed at discovering tangible rewards and benefits that motivate nurses to work in an unstructured manner with students and determine how students in the workplace influence patient safety and quality of care.
S85
A Phenomenological Approach to Describe the Lived Experience of Ovarian Cancer Objective o explore and illuminate the lived experience of women diagnosed with ovarian cancer.
T
Joanna L. Guenther, PhD, RN, FNP-BC, CNE, Texas Tech University Health Sciences Center, Lubbock, TX Keywords ovarian cancer lived experience phenomenology women’s health
Paper Presentation
Design A phenomenological approach in which individuals tell their stories to make meaning of their truths, realities, and experiences. Phenomenology allows researchers to interpret the meaning of the experiences through hearing and observing the words and descriptions of participants. Setting The women were interviewed for an hour or more at their homes or workplaces. Each interview was audio-recorded and transcribed. Sample Eleven women aged 23 to 66 were interviewed beginning with the open-ended question “Tell me about events leading up to your diagnosis of ovarian cancer.” The women were diagnosed with stages II (n = 1), III (n = 8), and IV (n = 2) ovarian cancer within the past 5 years. Stages III and IV are advanced stages. Methods The narrative responses were analyzed for constitutive patterns and relational themes according to the hermeneutic phenomenological process. By illuminating the memories and recollections of the women, the meanings and particulars of the ovarian cancer experience were identified.
Results Prior to diagnosis, most women were not aware of the symptoms of ovarian cancer. Even though symptoms were present, they were often attributed to gastrointestinal and renal problems by the woman and provider. There was an average delay in diagnosis of at least 6 months. Six constitutive patterns evolved from the experiences of the 11 women: the revelation, jeopardy, on the lookout, becoming normal, and living every moment.
Conclusion/Implications for Nursing Practice The women participated in this study with the expectation that their experiences would be passed on to health care providers who care for women. They wanted the information to contribute to improvement in the care provided with hopes for earlier diagnosis. They wanted others to know about the difficulties they experienced when they sensed something was wrong with their bodies and the need to search for answers by going from provider to provider. Once they were correctly diagnosed, they faced complex physical, spiritual, and psychological needs associated with an incurable illness. The women’s symptoms are described to enable nurses to educate women about the symptoms of ovarian cancer and to evaluate their risk factors. In addition, the women provided key insights into approaches and strategies for facing death while embracing life.
JOGNN http://jognn.awhonn.org
C
2014 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
S81
RESEARCH Proceedings of the 2014 AWHONN Convention
Continuing Psychometric Evaluation of the Perinatal Grief Intensity Scale in the Subsequent Pregnancy After Perinatal Loss Objective o examine the relation of grief intensity, psychological wellbeing, and the quality of intimate partner relationships of women in the subsequent pregnancy after a miscarriage, stillbirth, or neonatal death.
T
Marianne Hopkins Hutti, PhD, WHNP-BC, University of Louisville, Louisville, KY Deborah S. Armstrong, PhD, RN, University of Louisville, Louisville, KY
Design Descriptive, cross-sectional, correlational research design. Based on the theoretical framework of perinatal grief intensity developed by the author, we examined the reliability and convergent validity of the Perinatal Grief Intensity Scale (PGIS) in the subsequent pregnancy after a perinatal loss.
John Myers, PhD, University of Setting Louisville, Louisville, KY Web-based study. Keywords Perinatal grief intensity subsequent pregnancy
Paper Presentation
Sample Currently pregnant women (N = 227) who had experienced a perinatal loss in their immediate past pregnancies. Analysis indicated the sample of 227 women who completed the instruments (48% of total) afforded sufficient power to test the hypotheses. Methods Instruments included the Pregnancy Outcome Questionnaire (POQ) for pregnancy-specific anxiety; Impact of Event Scale (IES) for posttraumatic stress; Center for Epidemiologic StudiesDepression Scale (CES-D) for depression symptoms; Autonomy and Relatedness Inventory (ARI) for quality of intimate primary relationship; and the PGIS for perinatal grief intensity. Data were analyzed using descriptive statistics.
S82
Results Cronbach’s alphas for all total scales and subscales used in the study were high and ranged from .75 (PGIS total) to .95 (ARI total). Increased grief intensity was associated with significantly increased pregnancy-specific anxiety; depression symptoms; posttraumatic stress; and poorer, primary, intimate relationships. Participants in all three groups (miscarriage, stillbirth, and neonatal death) reported significantly higher mean CES-D scores (range 25.2-29.6, p < .001) than the traditional cutoff score of 16 used for suggesting depression symptoms. Similarly, all mean loss group scores were significantly higher than 23 (range 34.4-35.5, p < .001), the IES cutoff score used to suggest posttraumatic stress. Conclusion/Implications for Nursing Practice The consequences associated with intense grieving may include significant couple relationship issues, depression, pregnancy-specific anxiety, and posttraumatic stress that may also extend into the subsequent healthy pregnancy. The PGIS demonstrated total and subscale internal consistency reliability when used with all types of perinatal loss within the context of subsequent pregnancy. It demonstrated convergent validity by establishing statistically significant and appropriate directional relationships with concepts thought to be associated with intense grief, including pregnancy-specific anxiety, depression symptoms, posttraumatic stress, and the quality of the primary intimate relationship. It may eventually be useful as a clinical instrument to help health care providers identify parents at risk for intense grief reactions and other clinically relevant symptoms.
JOGNN, 43, S81-S85; 2014. DOI: 10.1111/1552-6909.12438
http://jognn.awhonn.org
Baxter, J. M. S., Kavanaugh, K., and Vonderheid, S.
RESEARCH Proceedings of the 2014 AWHONN Convention
Response to the Call to Action: A National Picture of Breastfeeding Support Provided in Neonatal Intensive Care Professional Issues
Sunny G. Hallowell, PhD, PCPNP-BC, IBCLC, University of Pennsylvania, Philadelphia, PA
Objective o measure the frequency of breastfeeding support by nurses and receipt of human milk by very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU), which is not known and to determine if the numbers and qualifications of nurses, their professional practice environments, and the availability of lactation consultants increased the number of infants who received this care.
T
Design Diane L. Spatz, PhD, RN-BC, Cross-sectional, observational study. FAAN, University of Pennsylvania School of Nursing Setting and Children’s Hospital of Philadelphia, Philadelphia, PA One hundred four NICUs. Eileen Lake, RN, PhD, FAAN, University of Pennsylvania, Philadelphia, PA Alexandra L. Hanlon, PhD, University of Pennsylvania School of Nursing, Philadelphia, PA Keywords nurse work environment practice environment score breastfeeding support human milk NICU
Paper Presentation
Sample Participants included 6,060 nurse survey respondents, 15,233 infants who were card for by nurses on their last shifts worked, and 7,886 VLBW infants cared for in participating NICUs. Methods Secondary analysis was used to examine nurse survey data collected in 2008 from the parent study and infant hospitalization data from 104 NICUs in the Vermont Oxford Network (VON), an NICU quality collaborative. Analysis was conducted using bivariate and multiple general linear regression models.
Results The majority (54%) were discharged on formula only. Few infants (6%) were discharged on exclusive human milk. The remaining infants (42%) received human milk mixed with fortifier or formula. Nurses reported providing breastfeeding support to one in five infants whose parents were present. Sixty percent of infants had parents present for part or the entire shift. Only half of the NICUs had a lactation consultant (51%). Significantly greater numbers of infants received breastfeeding support and human milk (p < .05) in NICUs with supportive professional practice environments, baccalaureate-prepared nurses, and nurses with at least 5 years NICU experience. Conclusion/Implications for Nursing Practice National health care agencies including the U.S. Surgeon General and American Academy of Pediatrics have described breastfeeding and human milk as the normative standard for infant feeding and nutrition. However, the country is falling far short of the Surgeon General’s recommendation for this high-risk pediatric population. The findings suggest NICU nurses provide breastfeeding support around the clock, typically without a lactation consultant available. Our results demonstrate that nurses are essential to providing lactation care to NICU infants for whom the receipt of human milk is an issue of patient satisfaction, quality patient care, effectiveness, and survival.
Exploring the Lived Experience of Trauma Among Obstetric Registered Nurses Jennifer M. S. Baxter, PhD, Objective BSN, SUNY Downstate o describe and analyze the lived experiences Medical Center, New York, NY
T
of obstetric registered nurses (RNs) encountering trauma while providing direct care.
Karen Kavanaugh, PhD, RN, FAAN, Wayne State University, Design Detroit, MI
Hermeneutic phenomenology. Susan Vonderheid, PhD, RN, University of Illinois at Chicago, Chicago, IL
Setting New York City. Sample Ten eligible obstetric nurses were recruited in using convenient, purposive, and snowball sam-
JOGNN 2014; Vol. 43, Supplement 1
pling. We also collected other data, including etymological history of the words, idiomatic phrases related to the phenomenon, and experiential descriptions in literature, biographies, diaries, art, and phenomenological literature. Methods Institutional review board approval and a Certificate of Confidentiality from the National Institute of Nursing Research were obtained prior to collecting data. Interviews were recorded, transcribed, and analyzed based on van Manen’s stages of reflective analysis to arrive at the essential meaning of the phenomenon.
S83
RESEARCH Proceedings of the 2014 AWHONN Convention
Results Though experiences with trauma varied, the most common experiences included maternal death, intrauterine fetal demise (IUFDs), and emergency cesarean. Seven essential themes were uncovered as follows: (a) an internal process, (b) being faced with the unexpected, (c) going through the motions, (d) feeling helpless, (e) engaging others, (f) a visceral imprint, and (g) a damaged person. Conclusion/Implications for Nursing Practice Trauma is the emotional or psychological state of discomfort or stress resulting from an overwhelming event or series of events while providing direct care. Exposure to trauma has negative consequences for nurses, including mental,
physical, and/or emotional health issues leading to problems such as posttraumatic stress disorder (PTSD), burnout, poor nursing care, and patient safety risk. For participants, trauma was an unforgettable, deeply personal, and complex experience. It is important that obstetric RNs and outsiders recognize that trauma is ever present in the obstetric specialty. The critical insight gained from this study provides valuable information to enrich our awareness about the vulnerability of obstetric nurses to trauma, to begin a conversation about how to improve the work environment for nurses, and to enhance the care they provide to their patients. We provide recommendations for practice, education, and research.
Keywords birth trauma nursing experience
Professional Issues Paper Presentation
The Maternal-Newborn Assessment Study: Can Simulation Replicate the Clinical Learning Experience in Undergraduate Nursing Education? Objective o compare high-fidelity simulation and practice in the clinical laboratory to hospital-based clinical learning on the ability of undergraduate nursing students to assess, intervene, and critically think in the obstetric setting.
T
Design Quasi-experimental, nonequivalent comparison groups, post test only; power analysis for three variables, medium effect size required 76 in each comparison group for a total of 152 participants; alpha level .05 and power of .8. Setting Private university in the Pacific Northwest. Sample Undergraduate, senior nursing students (80) in the maternal-child course: 39 in an obstetric hospital rotation and 41 in a pediatric clinical rotation voluntarily participated and comprised the two comparison groups. Methods Each student demonstrated simulated postpartum and newborn assessments, whereas an obstetric faculty member trained as an observer evaluated performance using check-off forms. Following and prior to debriefing, students provided written responses to questions designed to assess critical thinking during the simulation. Questions and items on check-off forms were assigned points to obtain assessment, written, and total scores. Scores <92% required remediation.
S84
Check-off forms, developed by study researchers were tested for inter-rater reliability and content validity, and questions were pilot tested. t Tests were used to compare scores of students completing an obstetric hospital rotation versus those in a pediatric clinical rotation, and frequencies for passing assessments were calculated. Results No significant difference was detected between students in the pediatric clinical rotation who only practiced assessments in the laboratory setting and students completing a hospital-based obstetric rotation related to ability to assess, intervene, or critically think. The p-value for comparisons ranged from .41 to .93 (all nonsignificant); less than one third of students passed either assessment. Conclusion/Implications for Nursing Practice Simulation is a widely used teaching strategy. Researchers have found simulation increases undergraduate nursing students’ knowledge, skills, self-efficacy, and confidence. Our findings indicate that simulation was as effective as clinical practice in terms of students’ performance outcomes. Well-designed simulations can replace part of nursing students’ hands-on clinical time with positive learning outcomes. Evaluating individual student performance facilitates design of remediation activities targeting identified areas of weakness. Future researchers should combine simulation with hospital-based clinical experience to determine if student competency improves.
JOGNN, 43, S81-S85; 2014. DOI: 10.1111/1552-6909.12438
Linda M. Veltri, PhD, RN, Oregon Health and Science University, Ashland, OR Joanna M. Rowe, PhD, RN, Linfield College, Portland, OR Kathleen J. Bell, RN, MSN, CNM, AHN-BC, MS1-BC, Northern Light, Cannon Beach, OR Ellyn L. Arwood, EdD, University of Portland, Portland, OR Lindsay L. Kindler, PhD, RN, CNS, Kaiser Permanente Northwest, Portland, OR Keywords maternal-newborn undergraduate nursing students simulation
Professional Issues Paper Presentation
http://jognn.awhonn.org
RESEARCH
Veltri, L. M.
Proceedings of the 2014 AWHONN Convention
Experiences of Staff Nurses during Clinical Learning Linda M. Veltri, PhD, RN, Oregon Health and Science University, Ashland, OR Keywords clinical learning undergraduate nursing students staff nurses maternity nursing
Objective o understand the unstructured experiences of staff nurses in an obstetric unit with undergraduate nursing students present.
T
Design Naturalistic inquiry. Setting Family birth center in Pacific Northwest.
Professional Issues Paper Presentation
Sample Convenience sample, 12 English speaking, baccalaureate-prepared registered nurses (RNs) who worked in unstructured manner with nursing students. Methods Semistructured interviews were conducted and recorded. Participants shared their experiences of working with students. Data were analyzed using an interpretive continuous approach according to Lincoln and Guba’s elucidation of Glaser and Strauss’s constant-comparative method, and data were stored, organized, and coded. Data collection and analysis ceased when categories were saturated and no new information surfaced. Demographic data were analyzed using descriptive statistics. An experienced qualitative researcher provided oversight to ensure accuracy. Credibility, transferability, dependability, confirmability were used to ensure trustworthiness. Results Five themes emerged as follows: giving and receiving: working with students provided nurses
JOGNN 2014; Vol. 43, Supplement 1
opportunities to give back to their profession— nurses learned from students; advancing professionally and personally: many nurses took advantage of workplace incentives to gain additional compensation and opportunities; balancing act: nurses balanced their typical workloads with student learning needs and provision of safe, quality care—students slowed nurses down; getting to know and working with you: nurses worked to know student personally and tailored the learning experience—nurses desired students be prepared; past and present: clinical experiences exert long lasting impressions.
Conclusion/Implications for Nursing Practice Clinical learning is integral to nursing education and preparation for professional practice. Increased enrollments in baccalaureate nursing programs require more staff nurses to supervise students in the workplace. Researchers have found students’ learning, impressions of nursing, and perceptions of clinical learning are greatly influenced by nurses in the workplace, and working with students is a benefit for many nurses. Workplace learning may increase when students are prepared prior to entering clinical settings. Nurses working with students should be judiciously selected. Future research should be aimed at discovering tangible rewards and benefits that motivate nurses to work in an unstructured manner with students and determine how students in the workplace influence patient safety and quality of care.
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