• Exploring Voluntary Turnover of Nurse Practitioners in the United States

      Strobehn, Patricia K; Georgia Baptist College of Nursing
      Access to care has been hindered by turnover in the NP workforce. The purpose was to describe the voluntary turnover behaviors of NPs to inform a contemporary model of NP voluntary turnover. A cross-sectional, descriptive, and exploratory secondary analysis of participants who self-identified as nurses with active certification, licensure, or other legal recognition to practice as an NP from a state board of nursing in the United States from the 2018 National Sample Survey of Registered Nurses (NSSRN) was used. Participants were excluded if they didn’t provide patient care or indicated involuntary reasons for leaving. Descriptive statistics were used to analyze four NP voluntary turnover groups informed by Herzberg’s Dual-Factor Theory of Job Satisfaction (i.e., dynamic leavers, static leavers, dynamic stayers, and static stayers). Two-step cluster analyses were used to distinguish subgroups of NP dynamic leavers reporting similar NP differences, reasons for leaving, working conditions, and training topic needs. Dynamic leavers (those who changed jobs but stayed in nursing) reported the highest percentages (35.2%) of job dissatisfaction. The study culminated in two cross-validated models best distinguishing dynamic leavers (i.e., Model 1: Burnout and Model 2: Job Satisfaction). The findings highlight job satisfaction, lack of good management, burnout, and other working conditions as contributors of NP voluntary turnover for dynamic leavers and support a wide variety of literature emphasizing job satisfaction as a predictor of NP turnover intention. Both models demonstrated strong validity evidence. The population estimates from the 2018 NSSRN parent study revealed findings related to race should be cautiously considered. Further refinement of Model 1: Burnout and Model 2: Job Satisfaction could maximize retention strategies, promote workforce development, shape healthcare policy, and project the future supply and distribution of NPs in the U.S. health care system. Future NP training initiatives should focus on working in underserved communities, social determinants of health, and evidence-based care. Accurate workforce projections related to scope of practice and the estimated costs of NP turnover would be beneficial. Instrumentation measuring burnout, stress, organizational climate, and satisfaction should be validated in the NP population. This study should be replicated using accurate race and ethnicity variables.
    • Factors Associated with Cardiovascular Disease Risks in Black Women Undergoing Percutaneous Coronary Intervention (PCI) or Coronary Bypass Graft (CABG) Procedures: A Retrospective Correlational Study

      Sutton, Paula Renee; Georgia Baptist College of Nursing
      Cardiovascular disease (CVD) remains the leading cause of death among adults in the United States (US) with a high prevalence among Black women. Black women have higher incidences of known CVD risks and higher CVD-related mortality than women of other races. To reduce CVD risks, factors associated with CVD risks should be investigated. Although some sociodemographic, biophysiological or physical, and psychological factors have been found to be associated with CVD risks, the associations of these factors with each CVD risk have been rarely examined in Black women. The purpose of this study was to examine the prevalence of CVD risks (smoking, obesity, HTN, diabetes, hyperlipidemia, and alcohol use) and the associations of sociodemographic (i.e., age and health insurance payor), biophysiological/physical (i.e., metabolic/infectious/autoimmune [MIAs] conditions [kidney disease, thyroid disease, hepatitis, and systemic lupus erythematous] and antihypertensive/antidiabetic/lipid-lowering medication use), and psychological (i.e., depression) factors with each of the CVD risks in Black women who had percutaneous coronary intervention or coronary artery bypass graft procedures. In this retrospective, correlational study, variable data were collected from a convenience sample of 137 Black women (mean age: 64 years) based on electronic health records (EHRs) of a large healthcare system. Descriptive statistics and binary logistic regression using the Enter method were used to analyze the data and address the purpose of the study. Participants had a mean of 3.6 total CVD risks. There was high prevalence of hypertension (95.6%), hyperlipidemia (95.6%), and obesity (59.1%). Those with MIAs (p = .010) or on lipid-lowering medications (p = .020) were less likely to smoke. Participants on antidiabetic medication were more likely to be obese (p = .013). Older age was associated with hypertension (p = .024). Antidiabetic medication use was associated with diabetes (p <.001) and lipid-lowering medication was associated with hyperlipidemia (p = .029). No factors were associated with alcohol use. Further studies are needed to examine the relationships of those factors used in this study in larger sample studies with prospective, longitudinal study designs. Then, development and delivery of interventions targeting those factors affecting CVD risks are needed for Black women with multiple CVD risks.
    • Factors Associated with Transition to Student-Centered Pedagogy in Nursing Educators: A Cross-Sectional, Correlational Study

      Slocumb, Rhonda Harrison; Georgia Baptist College of Nursing
      Student-centered pedagogy (SCP) has positively affected student performance, but transition to SCP in nursing education has not been fully progressed. To facilitate transition to SCP, factors affecting transition to SCP should be examined from nursing educators’ perspectives because of their important roles in the transition. Multidimensional factors that may be associated with transition to SCP have not been frequently examined from educators’ perspectives. Therefore, the purpose of this study was to examine factors associated with transition to SCP in the total sample and in the subgroups based on age, program, and teaching experience. In this cross-sectional, correlational study, a convenience sample of 108 nursing educators were enrolled using social media, online forum, and emails with study information. Data on demographic characteristics, earned degree, knowledge of SCP, belief in effectiveness of SCP, support, situation, strategy, and transition to SCP were collected through an online survey. Multiple regression analyses with the Enter method were used to address the study purpose. The majority of the sample were > 50 years old (52.8%) and female (96.3%). The level of transition to SCP was low (2.76 out of 4), and the levels of knowledge of SCP and belief in effectiveness of SCP were moderate (30.27 and 31.42 out of 40, respectively). Knowledge of SCP was consistently, significantly associated with transition to SCP in the total sample (p < .001) and in all the subgroups: age ≤ 50 years old (p = .001), age > 50 years old (p = .007), teaching associate program (p < .001), teaching baccalaureate and graduate programs (p = .012), teaching experience ≤ 10 years (p = 001), and teaching experience > 10 years (p = .030). In addition, belief in effectiveness of SCP (p = .017) and degree earned (p = .046) were significantly associated with transition to SCP only in the age > 50 years group. Thus, interventions need to be developed and delivered to nursing educators to increase their knowledge of SCP and belief in effectiveness of SCP, and, in turn, to facilitate transition to SCP, especially for nursing educators > 50 years old with higher earned degree.
    • Measurement of Intrinsic Cognitive Load and Mental Effort in Pre-Licensure Baccalaureate Nursing Students: A Focus on Instructional Design in the Synchronous Online Classroom

      Smith, Nicole Elena; Georgia Baptist College of Nursing
      One of the most significant challenges in nursing education is identifying effective approaches to teach the foundational knowledge of nursing. Students are often overwhelmed by instruction. It is important for educators to explore how instructional design strategies and student characteristics impact learning. Based on the cognitive load theory, all instructional designs should be analyzed from a cognitive load perspective. The purpose of this study was to examine how instructional design strategies, influenced by the principles of the cognitive load theory, affect the cognitive load and mental effort of pre-licensure baccalaureate nursing (BSN) students in the United States. This study used a two-within repeated-measures design examining students' perceived mental effort and intrinsic cognitive load while controlling for prior knowledge (N = 39). There were two within-factors with two levels [complexity: simple and complex; and instructional strategy: cooperative learning (CPL) and cooperative learning with a problem-based component (CPL + PBL)]. All participants experienced a short lecture, then completed the Paas scale and Cognitive Load Rating Scale (CLRS) subscale for intrinsic load after engaging in a simple CPL or CPL + PBL activity followed by a complex CPL or CPL + PBL activity. In both cases, the simple activities required slightly more mental effort and intrinsic cognitive load when compared to the complex activities. The CPL + PBL instructional strategy required slightly less mental effort (Paas) and intrinsic load (CLRS) when compared to CPL. As content became more complex, the CPL + PBL strategy resulted in lower perceived mental effort and intrinsic cognitive load. However, differences were practically and statistically insignificant. Preliminary evidence suggests that when tasks are complex, the CPL + PBL strategy may be more impactful in its effect on mental effort and cognitive load. Further research is warranted to examine the potential of the novelty effect and total cognitive load while including student characteristics such as prior knowledge as a control variable. Building support for effective instructional design strategies that consider students’ cognitive load has the potential to improve pedagogical practices in nursing education leading to a better-prepared nurse graduate and improved patient outcomes.
    • Nursing Student Perceptions of Presence in a Virtual Learning Environment: A Qualitative Description Study

      Thrift, Jason R; Georgia Baptist College of Nursing
      Multifaceted approaches to learning are used for educating student nurses. One common teaching modality in nursing education, simulation, provides hands-on experiences in a safe environment to prepare student nurses for professional roles. High quality simulation standards recommend an engaging immersive experience, with physical, emotional, and conceptual fidelity to clinical practice. Presence is the perception of being there in a simulation as if it were real. Studies have reported improved learning outcomes with increased sense of presence. A simulation modality seldom used in nursing education is virtual reality simulation (VR-Sim) a three dimensional, immersive experience. VR-Sim with head mounted visual and haptic enhancements has the potential to increase presence and improve learning. Student perceptions of presence in VR-Sim is unknown. The purpose of this study was to explore student nurses’ perceptions of presence during simulation. A qualitative description design included a VR-Sim of a patient needing cardiopulmonary resuscitation (CPR). Each participant (N=11) performed two repetitions in the VR-Sim followed by debriefing and a guided interview. The conceptual framework for the study was informed by extant literature including theoretical frameworks. Two research questions guided the study to 1) explore student perceptions of presence in VR-Sim and 2) align findings with current theories of simulation and presence. Braun and Clarke’s (2006) steps for theme development and Saldaña’s (2016) coding informed the data analysis. For Research Question 1, three themes and eight subthemes described participants perceptions of being there in the VR-Sim environment. Findings showed all participants reported experiencing presence during the simulation (Theme: What Brought Me In, What Brought Me Out), but glitches, feel of compressions, and sensing the real physical environment outside the simulation interrupted the experience of presence (Theme: Issues in VR-Sim). Additionally, participants described the experience of learning CPR with the VR-Sim (Theme: Higher Level of Learning). For Research Question 2, the main constructs from the extant theories aligned with the perceptions of participants including ideas about presence, fidelity, individual factors, learning outcomes, and collaboration. The study conceptual model provided a sound framework for continued research of the efficacy of VR-Sim in nursing education.
    • Satisfaction and Work-Life Balance in Undergraduate Nursing Faculty: A Mixed-Methods Study

      Crawford, Ryan Patricia; Georgia Baptist College of Nursing
      The current nursing and nursing faculty shortages are related, multifactorial problems. The nursing faculty shortage impedes the current demands to increase the number of baccalaureate prepared nurses. Important concepts, which could impair recruitment and retention of nursing faculty, include job satisfaction, life satisfaction, and work-life balance. These concepts could be impacted by certain demographics. The purpose of this study was to better understand the gender, generational, and racial differences of job satisfaction, life satisfaction, and work-life balance in baccalaureate nursing faculty. This study incorporated a convergent parallel mixed-methods study design to assess job, satisfaction, life satisfaction, and work-life balance of baccalaureate nursing faculty of differing genders, generational cohorts, and races. A total of 370 full-time, baccalaureate nursing faculty members participated in one web-based survey. Quantitative data were collected using four instruments: a demographic questionnaire, the Work-Life Balance Self-Assessment, the Job Satisfaction Survey, and the Satisfaction with Life Survey. Qualitative data were collected using open-ended questions. Within the quantitative findings, significant differences were identified with minority faculty reporting less job and life satisfaction. Gender differences were also identified in satisfaction levels. Both findings have practical significance as there are increased calls to diversify the nursing workforce and faculty. Qualitative data analysis revealed the themes Relationship with Administration, Nursing Faculty Workload, and Boundary-setting. These themes presented a dichotomy in subthemes relating to the concerns of the nursing faculty members. Generational differences were seen among the qualitative findings, which included one theme for Generation X and Millennial cohorts Family Life, with varying subthemes for the generations. The findings of the quantitative and qualitative strands were similar for work-life balance regarding the bimodality noted in the quantitative strand and the dichotomy of subthemes within the qualitative strand. The findings from this study have the potential to provide a better understanding of work-life balance among full-time, baccalaureate nursing faculty members. Recommendations for nursing based on these findings include thoughtful workload calculations, mentoring, faculty development, and administrator development. The findings from this study could guide further research, which is needed to identify the unique experiences of faculty who identify as male or from a minority race.
    • The Essence of Caring™: Exploring Six Steps for Effective Spiritual Conversations at Mayo Clinic

      Valino, Estrella L; McAfee School of Theology
      Under the direction of Denise Massey, Ph.D. Spiritual care has important implications for an individual’s health and wellbeing. This study explored the effectiveness of the process of CARING™: Six Steps for Effective [Spiritual] Conversations, as the methodology was taught to a nurse and then evaluated. Over seven weeks, the CARING™ process was to be found effective, reliable, and beneficial in her role as a nurse. This mixed-method approach of research demonstrated the effectiveness of the educational tool. This participant was able to rate her beliefs based on her own experiences as a nurse working with patients who go through life-changing events. This participant developed her competence, shared her experiences, and articulated a clear understanding of the CARING™ methodology through her responses in pre-test and post-test questionnaires, personal reflection, and the post-focused interview process. This participant experienced spiritual growth and acquired skills and knowledge of the CARING™ process by participating in this study. Learning the six steps of CARING™ increased her knowledge. She developed a new set of skills for her daily routine to continuously use this tool for effective [spiritual] conversations. This nurse greatly benefited by the CARING™ model. She described feeling empowered to work collaboratively with hospital chaplains as they might seek to implement spiritual care interventions in a healthcare setting. Further development of this work might include sharing this material with healthcare providers, allied health workers, chaplains, and other ministers. Doing so might build rapport and trust, not only in multi-disciplinary healthcare settings, but more importantly in every person’s home, community, and parish settings.