Medicine and Health Sciences Commons^™

Cultural Norms Of Clinical Simulation In Undergraduate Nursing Education, Susan G. Mcniesh

Susan McNiesh

Simulated practice of clinical skills has occurred in skills laboratories for generations, and there is strong evidence to support high-fidelity clinical simulation as an effective tool for learning performance-based skills. What are less known are the processes within clinical simulation environments that facilitate the learning of socially bound and integrated components of nursing practice. Our purpose in this study was to ethnographically describe the situated learning within a simulation laboratory for baccalaureate nursing students within the western United States. We gathered and analyzed data from observations of simulation sessions as well as interviews with students and faculty to produce a …

Exploring Barriers To Organ Donation In The African American Communities Of California, D. R. Law, Susan Mcniesh

Susan McNiesh

There are a disproportionate number of African-Americans on transplant waiting lists across the country. The outcomes of a transplant are greatly improved when the donor and the recipient are from the same ethnic group. Sadly, the demand for cadaver organs in the African-American community exceeds the supply. Researchers in the past have sought to identify barriers to organ and tissue donation. To date, the studies have been conducted in the eastern and southern regions of the United States. This study examines whether the previously identified barriers are applicable in the African-American communities of California. A revised version of the Bone …

The Lived Experience Of Students In An Accelerated Nursing Program: Intersecting Factors That Influence Experiential Learning, Susan Mcniesh

Susan McNiesh

The goal of this interpretive research study was to articulate the lived experience of students in an accelerated master’s of nursing entry program learning the practice of nursing within a clinical setting. Specific questions included: How did previous life experiences, education, and career choices influence the experience of second-degree students? What were the potential effects on learning of condensing and accelerating the curriculum as is requisite in second-degree programs? Data from small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Akin to the experience of tourists or new immigrants, students were confronted with new physical demands, …

The Composite First Person Narrative: Texture, Structure, And Meaning In Writing Phenomenological Descriptions, M. S. Wertz, M. Nosek, Susan Mcniesh, E. Marlow

Susan McNiesh

This paper illustrates the use of composite first person narrative interpretive methods, as described by Todres, across a range of phenomena. This methodology introduces texture into the presently understood structures of phenomena and thereby creates new understandings of the phenomenon, bringing about a form of understanding that is relationally alive that contributes to improved caring practices. The method is influenced by the work of Gendlin, Heidegger, van Manen, Gadamer, and Merleau-Ponty. The method’s applicability to different research topics is demonstrated through the composite narratives of nursing students learning nursing practice in an accelerated and condensed program, obese female adolescents attempting …

Changes In Temperature Of Heel Skin Under Pressure In Hip Surgery Patients, Vivian K. Wong, N. A. Stotts, H. W. Hopf, G. A. Dowling, E. S. Froelicher

Vivian K. Wong

OBJECTIVE: The aim of the study was to examine the effect of external pressure of the bed surface on heel skin temperature in adults in the first 3 days after hip surgery.

DESIGN: A quasi-experimental study in a prospective, within-subjects, repeated-measures design.

SETTING: This study was performed at 2 acute-care hospitals.

PARTICIPANTS: Eighteen subjects (9 men and 9 women) with a mean age of 58.3 (±16.1) years were recruited after hip surgery at the 2 hospitals.

METHODS: Temperature sensors were placed on the plantar surface of each foot, close to the heels. Measures were taken when the heels were (1) …

Skin Blood Flow Response To 2-Hour Repositioning In The Long-Term Care Residents: A Pilot Study, Vivian K. Wong

Vivian K. Wong

PURPOSE: The purpose of this noninvasive pilot study was to examine the changes in transcutaneous oxygen (tcO2), skin temperature, and hyperemic response in the heels, sacrum, and trochanters in a 2-hour loading-unloading condition in nursing home residents who are positioned in supine and lateral positions.

DESIGN: A 1-group, prospective, repeated-measures design was used.

SUBJECTS AND SETTING: Nine subjects (5 males, 4 females) with a mean age of 85.3 ± 10.86 years (mean ± SD) who required help in turning and positioning at a skilled nursing facility participated in the study.

METHODS: Oxygen and temperature sensors were placed on the heels, …

Integrating A Professional Apprenticeship Model With Clinical Simulation For Psychiatric Nursing Students, M. C. Crider, Susan Mcniesh

Susan McNiesh

In this article, we present a theory-based application of clinical simulation in psychiatric-mental health nursing education. As described by Benner, Sutphen, Leonard, and Day, a three-pronged apprenticeship that integrates intellectual, practical, and ethical aspects of the professional role is critical in the development of practical reasoning in nursing education and training. Clinical encounters are often fraught with ambiguity and uncertainty. Therefore, educating for a practice discipline requires experiential and situated learning. Using the three-pronged experiential model in simulated psychiatric-mental health nursing practice supports the development of critical nursing skills, ethics, and theoretical concepts. A clinical scenario is presented that demonstrates …

Learning Formative Skills Of Nursing Practice In An Accelerated Program, Susan Mcniesh, P. Benner, C. Chesla

Susan McNiesh

The purpose of this qualitative research study was to describe how students in an accelerated master’s degree entry program experientially learned the practice of nursing. One research question examined in this study was: What formative experiences did students identify as helping them develop and differentiate their clinical practice? Data from clinical observations and a combination of small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Students identified formative skills learned through the independent care of a patient as pivotal in their identity and agency development. By experiencing the responsibility and action from within the body and …

How Heel Oxygenation Changes Under Pressure, Vivian K. Wong, N. A. Stotts, H. W. Hopf, E. S. Froelicher, G. A. Dowling

Vivian K. Wong

The mechanism of heel pressure ulcers after hip surgery is not entirely understood. The purpose of this one-group, prospective, repeated-measures design study was to examine how the external pressure of the bed surface affects heel skin oxygen tension in adults on the first 3 days after hip surgery. Transcutaneous oxygen sensors were placed on the plantar surface of each foot, close to the heels. Measures were taken on room air and with an oxygen challenge with the heels (1) suspended above the bed surface (preload), (2) on the bed surface for 15 minutes (loading), and (3) again suspended above the …

Physiology And Prevention Of Heel Ulcers: The State Of Science, Vivian K. Wong, N. A. Stotts

Vivian K. Wong

The prevalence of heel ulcers across settings is high and is increasing. Prevention of ulcers requires knowledge of their etiology and the scientific basis for preventive care. The interaction between external pressure and the heel vasculature is central to the prevention of heel ulcers. This article focuses on the prevention of heel pressure ulcers. The physiology of heel tissue perfusion, the effect of external pressure on heel perfusion, as well as what is known about strategies to reduce external pressure and approaches to improve heel skin blood flow will be discussed. It is only through understanding of the physiology of …