Dr. Rebecca D Toothaker

Transition to practice from a nursing student to registered nurse comes with challenges. Just culture is taught in nursing education, yet not easily translated into practice.
BACKGROUND - Transition to practice from a nursing student to registered nurse comes with challenges. Just culture is taught in nursing education, yet not easily translated into practice.The purpose of this study was to the understand NGN's perception of just culture from transition to practice.
PURPOSE - The purpose of this study was to the understand NGN's perception of just culture from transition to practice.A secondary data analysis was conducted from a mixed-methods longitudinal study. Just culture perceptions were assessed at 2 time points, while in school and 6 months after graduation.
METHODS - A secondary data analysis was conducted from a mixed-methods longitudinal study. Just culture perceptions were assessed at 2 time points, while in school and 6 months after graduation.Data converged around the beliefs of just culture and willingness to report safety events. Other aspects of just culture, such as continuous improvement and fear of reporting, not only change across time as NGN transition to practice but are divergent.
RESULTS - Data converged around the beliefs of just culture and willingness to report safety events. Other aspects of just culture, such as continuous improvement and fear of reporting, not only change across time as NGN transition to practice but are divergent.Students and NGN participants reported understanding the concept of just culture; however, challenges remain with institutional and societal norms.
CONCLUSION - Students and NGN participants reported understanding the concept of just culture; however, challenges remain with institutional and societal norms.

Background: The nurse’s transition into practice is challenging. The need to facilitate a safe transition into practice and retain nurses is crucial in today’s healthcare. Objective and Design: The qualitative study aim was to describe the lived experiences of new nurses’ safe transition into practice and their perceptions of functioning as safe practitioners. Method: This descriptive, phenomenological arm of a larger, mixed methods study (Safety Transition Education to Practice study) interviewed 11 nurses with varied clinical backgrounds regarding their first six months as licensed nurses. Semistructured, one-to-one interviews with nurses representing geographical locations across the nation were conducted. Colaizzi’s method of analysis was used to extract themes. Results: The data revealed five themes with subthemes. The most universal theme was lack of practical knowledge (skills dexterity, real-world knowledge), followed by impostor syndrome, safety culture (unsafe environment, lack of supplies, lack of mentoring/management), internalized fear, and seeking the sage. Conclusion: The experiences support the understanding that transition to practice is overwhelming and uncertain. Academic faculty and practice nurses’ cooperative efforts can aid novice nurses in safe transition to practice through academic curriculum enhancement, preceptors, and nurse residency programs working toward narrowing the academic practice gap.

High anxiety levels are prevalent among graduate nurses transitioning from student nurses to professional nurses. Along with higher anxiety levels, low levels of self-confidence in clinical decision-making skills are also reported among new graduate nurses. Nurse externship programs provide senior-level nursing students the opportunity to increase self-confidence, decrease anxiety, and improve clinical decision-making skills by practicing in the graduate nurse role under a supervising Registered Nurse. Following a comprehensive literature search, there is limited research on nurse externships in the critical care clinical environment and the positive benefits externship programs provide nursing students. The aim of this qualitative descriptive case study is to describe one senior nursing students' perception on providing care for critically ill patients during a summer nurse externship. The student nurse journaled a week prior to the externship, each day following the experience and upon the completion of the experience. The method of journaling allowed for accurate self-reflection and acknowledgment of changes in confidence, anxiety and critical decision-making skills. Following the completion of a ten-week externship program, the nursing student reflected on personal and professional growth which included increase in self-confidence, decreased anxiety, and improved clinical decision-making in providing care for critically ill patients. Externships can provide senior-level nursing students a successful transition to professional clinical practice and promote safer practice at the bedside.

Background: Nurses are frequently present during the dying process as a support for the dying person and the family. Experiencing death in this capacity can cause emotional and psychological stress to the nursing staff as they work to help others. Nursing students as the upcoming generation of nurses, need the knowledge and selfawareness to support others through these often traumatic events. Many students may not have experience with death or dying and when combined with lack of knowledge will be a great barrier once students graduate.
Objectives: The purpose of this study is to determine how sophomore, junior, and senior undergraduate nursing students enrolled in one University setting perceive the concept of death and dying.
Design: A descriptive quantitative study was designed to explore the various perceptions that sophomore, junior, and senior nursing students have about death and dying. Results: The Frommelt Attitudes Toward Care of the Dying scale showed students have a positive attitude toward caring for dying patients. The Death Attitudes Profile-Revised scale indicated the presence of all profiles, though most students identified with Neutral Acceptance profile.
Conclusions: Nursing students often fear caring for clients with death or dying. Additional targeted education along with end of life care simulations can improve students improve their attitudes and beliefs to better care for patients.

Background: Just culture has been identified as a vital component of safety culture by national and international organisations. In a just culture, emphasis is not placed on blaming individuals for errors but rather on examining personal and system processes that can best support safety and prevent reoccurrence. Although those in the practice arena have worked to implement the concepts of just culture, the same is not true in nursing education, leaving nursing students lacking the pre-requisite knowledge, skills and attitudes to implement just culture in practice on graduation. Aims Assessment of this phenomena is the essential first step to align nursing education with practice in promoting just culture as a mechanism for patient safety. The purpose of this paper is to further refine the Just Culture Assessment Tool-Nursing Education through exploratory factor analysis.
Methods: The Just Culture Assessment Tool-Nursing Education was adapted from the Just Culture Assessment Tool, an instrument created for the practice setting. Validity and reliability were established for the Just Culture Assessment Tool-Nursing Education in a study of 800 nursing students to assess their perceptions and understanding of just culture with their nursing programmes. Using the previously conducted data, an exploratory factor analysis was conducted.
Results: Factor analysis supports six subscales, similar to that of the Just Culture Assessment Tool. However, individual items were loaded into different subscales. All subscales demonstrated good reliability. Factor analysis supported further refinement of two items to improve the instrument's ability to capture data.
Conclusions: Perceptions of just culture differ between experienced providers and nursing students; nursing students have less experience with reporting errors. Factor analysis of Just Culture Assessment Tool-Nursing Education items demonstrated these differences, supporting modification of items by the instrument developers. An 'if' statement for students to consider their possible actions rather than experience was added to two items to better capture data from nursing students when completing the assessment.

Background: While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education.
Purpose: The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia.
Methods: Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs.
Results: The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (chi(2)[2] = 25.09, P < .001).
Conclusions: The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.

Patient safety efforts in practice have focused on creating a just culture where errors can be identified and reported, and system remedies created to prevent reoccurrence. The same is not true of nursing education where student experiences with error and the sequelae that follow focus on individual performance.
The purpose of this study was to adapt the Just Culture Assessment Tool (JCAT) used in practice settings into a valid and reliable instrument to evaluate just culture in academic settings.
A 27-item instrument was adapted for academia. Content validity was established. Reliability was determined in a pilot study with 133 prelicensure nursing students.
The scale content validity index (CVI) was calculated at 1. The reliability of the instrument is strong (α = .75).
The CVI and pilot study findings support the use of the JCAT for Nursing Education as a valid and reliable instrument to evaluate student perception of just culture in academia.

The American Association of Colleges of Nursing’s (AACN) (2017) report shows that there are 17,725 nursing students enrolled in baccalaureate programs in the United States. One in three college students have reported that stress has had a negative impact on their school performance (ACHA). The purpose of the review article is to study and synthesize the sources of stressors among baccalaureate nursing students in relation to the clinical practicum, and effective ways to manage those stressors. A literature review was conducted using the following key words: “undergraduate,” “baccalaureate nursing students,” “stress,” and “clinical”. The databases used to search for relevant literature included: EBSCOhost, CINAHLhost, Academic Search Complete, and Science Direct. All articles were selected from peer-reviewed journals. Using the following eligibility criteria--articles that addressed the unique experiences of baccalaureate nursing students and stress in the clinical environment, ten articles were selected from 2015-2017 for use in this literature review. The findings indicated that the most common generators of student nurse stress included: inexperience and insufficient knowledge, risk for patient harm, risk of patient death and the lack of support from faculty/nurses. Meditation, adequate sleep, exercise, music listening and utilizing faculty for help are all creative strategies to combat nursing student stress. In conclusion, the literature revealed that baccalaureate nursing students are experiencing varying degrees of stress in response to clinical situations. Strategies for assisting nursing students experiencing clinical stress warrants further exploration to identify effective prevention and coping strategies and modification of the clinical context in ways that minimize stress.

This article, the second in a two-part series, reviews and examines the components of clinical nutrition. In Part 2, the authors discuss nutritional components of fats, proteins, vitamins, minerals, and water. A resource guide is provided for the occupational health nurse to assist in the implementation of employee education in the area of healthy nutrition. The intent of the articles is to acquaint and inform the occupational health nurse on the current guidelines for healthy eating so she or he can better appraise their employee population, thus creating a healthier workforce. The information provided is not all-inclusive on the topics discussed but it provides a foundation for a better understanding of the requirements for healthy eating.