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Pitt, V., Powis, D., Levett-Jones, T., & Hunter, S. (2012). Factors infl uencing nursing students’ academic and clinical perfor- mance and attrition: An integrative litera- ture review. Nursing Education Today, 32, 903–913.
Rouse, S., & Rooda, L. (2010). Factors for attri- tion in an accelerated baccalaureate nurs- ing program. Journal of Nursing Education, 49(6), 359–362.
Rudel, R. (2006). Nontraditional nursing students: The social infl uences on reten- tion. Teaching and Learning in Nursing, 1, 47–54.
Williams, M. (2010). Attrition and retention in the nursing major: Understanding persistence in beginning nursing stu- dents. Nursing Education Perspectives, 31(6), 362–367.
Emerson E. Ea
A
UDIENCER
ESPONSES
YSTEMDEFINITION
The Audience Response System (ARS) is an active learning and teaching strategy that utilizes computer software and a handheld remote control device also termed a clicker to wirelessly communicate with a receiver connected to a universal serial bus (USB) port on the computer (Vana, Silva, Muzyka,
& Hirani, 2011). The ARS transmits question responses for display using graphics and fre- quency distributions to provide instant feed- back for both the lecturer and students (Vana et al., 2011).
APPLICATION
Traditional lecture is widely used in nursing education, although it has been identifi ed as passive, with student learning often discon- nected from knowledge application (Johnson
& Mighten, 2005). Nursing lectures often include a great deal of information covering specifi cally address the needs of those stu-
dents who are struggling in the program, (g) offering assistance to students how to access possible sources of fi nancial aid and scholarships, and (h) creating a system to support faculty to address issues that relate to attrition and retention.
Addressing attrition in nursing educa- tion has a signifi cant relevance to our future as a profession. A review of the literature on student attrition and retention reveals that although there are many extenuating cir- cumstances that could infl uence attrition, schools of nursing have a primary responsi- bility to ensure that students accepted into a nursing program are provided with support and resource in order to succeed.
The literature search also reveals that there is limited information on this topic especially among nontraditional or accel- erated-degree students. There is a need to explore the pattern and nature of attri- tion among this growing cohort of nursing students.
California Postsecondary Education Commission. (2003). Admission policies and attrition rates in California community college nursing programs. Commission report 03–2.
Retrieved March 19, 2014, from http://
www.cpec.ca.gov./completereports/2003r eports/03–02.pdf
Higgins, B. (2005). Strategies for lowering attrition rates and raising NCLEX-RN pass rates. Journal of Nursing Education, 44(12), 541–547.
Jeffreys, M. (2007). Nontraditional students:
Perceptions of variables infl uencing reten- tion: A multisite study. Nurse Educator, 32(4), 161–167.
McLaughlin, K., Moutray, M., & Muldoon, O.
(2007). The role of personality and self- effi cacy in the selection and retention of successful nursing students: A longitu- dinal study. Journal of Advanced Nursing, 61(2), 211–221.
O’Donnell, H. (2010). Expectations and volun- tary attrition in nursing students. Nursing Education in Practice, 11, 54–63.
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34 ■ AUDIENCE RESPONSE SYSTEM
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support, correct, and clarify misconceptions.
At the conclusion of each lecture the educa- tor can save all student responses for further review and analysis.
SYNOPSIS
The practice of nursing education requires students to bring together content learned in the classroom for application in clinical prac- tice. The ability to think critically and make accurate and appropriate decisions aimed at providing safe patient care is imperative.
When using the ARS in the classroom set- ting the lecturer can present questions and case studies to students using the ARS to bridge the gap between classroom and clini- cal practice. This teaching strategy has been found to be effective in both small and large classes (Stein et al., 2006; Thomas, Monturo,
& Conroy, 2011; Vana et al., 2011).
There are several benefi ts to utilizing the ARS in nursing education, which includes the ability to reinforce student learning, increase student participation, improve stu- dent engagement and active learning, and identify misconceptions for clarifi cation (Efstathiou & Bailey, 2012; Stein et al., 2006).
These benefi ts are increasingly valuable as nursing-class sizes steadily increase making it diffi cult to discern whether students under- stand information taught (Russell et al., 2011).
In addition to the increased benefi t of active student learning, research fi nding demon- strates that student satisfaction with the ARS system combined with lecture is higher than that with lecture alone (Lee & Dapremont, 2012; Stein et al., 2006).
RECOMMENDATIONS
Nurse educators are challenged to teach students how to provide patient care in an increasingly complex health care system.
Although, the impact of ARS usage on exam- ination scores is inconclusive (Vana et al., 2011), overall student satisfaction is high. The ARS system provides prompt feedback for both students and faculty to improve student learning.
new and often complex topics. The ARS allows the instructor to present a question to students. Then students use their handheld device clickers to select the correct answers and the instructor can display the aggregate student responses anonymously in real time (Clauson, Alkhateeb, & Singh-Franco, 2012).
The utilization of the ARS in the nursing classroom can transform a traditional pas- sive lecture into a multidimensional active learning environment.
ARS questions can be embedded into PowerPoint presentations to assess student learning. When used in this format, the educator must prepare ARS questions prior to class; however, preconstructed questions may be readily available from the textbook publisher. It is benefi cial to space the ques- tions in the lecture, about 1 question every 15 to 20 minutes or 3 to 4 questions per hour to prevent overloading. When the ques- tion appears on the slide students are given a specifi ed time to provide an answer. One minute is usually suffi cient for the length of the question. During this time, students read the question and provide an answer using their clicker devices. At the conclusion of the specifi ed time, polling is closed. The instruc- tor can then view results, which are instantly tabulated and displayed. Next, students are queried to share which answer they chose, the rationale, and how other choices were eliminated. This usually leads to a discus- sion among students who either respectfully agree or disagree with peers. During this time, students discover and learn from peers.
After discussion of the question, the educa- tor can: display the correct answer, identify correct decisions by students, clarify any misconceptions, and reteach any content that was not fully understood. Therefore, when ARS responses are polled the educator must be fl exible, prepared, and feel comfortable engaging in open discussion with students.
The discussion that follows an ARS question can help students think like a nurse (Russell, McWilliams, Chasen, & Farley, 2011) and to improve test-taking skills (Stein, Challman,
& Brueckner, 2006). The educator can serve as the moderator during discussions and
AUDIENCE RESPONSE SYSTEM ■ 35
A
notes combined with structured group discussion versus lecture only. Journal of Nursing Education, 44(7), 319–322.
Lee, S. T., & Dapremont, J. A. (2012). Engaging nursing students through integration of the audience response system. Nursing Education Perspectives, 33(1), 55–57.
Russell, J. S., McWilliams, M., Chasen, L.,
& Farley, J. (2011). Using clickers for clinical reasoning and problem solv- ing. Nurse Educator, 36(1), 13–15. doi:
10.1097/NNE.0b013e3182001e18; 10.1097/
NNE.0b013e3182001e18
Stein, P. S., Challman, S. D., & Brueckner, J. K.
(2006). Using audience response technol- ogy for pretest reviews in an undergrad- uate nursing course. Journal of Nursing Education, 45(11), 469–473.
Thomas, C. M., Monturo, C., & Conroy, K.
(2011). Experiences of faculty and stu- dents using an audience response system in the classroom. Computers, Informatics, Nursing: CIN, 29(7), 396–400. doi:
10.1097/NCN.0b013e3181fc405b; 10.1097/
NCN.0b013e3181fc405b
Vana, K. D., Silva, G. E., Muzyka, D., &
Hirani, L. M. (2011). Effectiveness of an audience response system in teaching pharmacology to baccalaureate nurs- ing students. Computers, Informatics, Nursing: CIN, 29(6 Suppl), TC105–113. doi:
10.1097/NCN.0b013e3182285d71; 10.1097/
NCN.0b013e3182285d71.
Shirleatha T. Lee The educator must be prepared to integrate
ARS questions into lecture and plan ahead accordingly. Time must be allowed to present and discuss the question and reteach content if necessary (Vana et al., 2011). Although, time must be allotted to prepare the ARS questions (Stein et al., 2006; Vana et al., 2011), many text- book publishers have begun to provide pre- constructed ARS questions with resources that are readily available for faculty use.
The ARS system increases student par- ticipation, interaction, and engagement in the classroom (Stein et al., 2006). The anonym- ity of ARS responses also decreases student apprehension about answering questions in class. Although, preparation time for educa- tors can be a slight drawback, the technology is easy to use, and requires minimal training (Efstathiou & Bailey, 2012). The pedagogical benefi ts support the use of this active learn- ing technology (Thomas et al., 2011).
Clauson, K. A., Alkhateeb, F. M., & Singh- Franco, D. (2012). Concurrent use of an audience response system at a multi- campus college of pharmacy. American Journal of Pharmaceutical Education, 76(1), 6.
doi: 10.5688/ajpe7616; 10.5688/ajpe7616 Efstathiou, N., & Bailey, C. (2012). Promoting
active learning using audience response system in large bioscience classes. Nurse Education Today, 32(1), 91–95. doi: 10.1016/j.
nedt.2011.01.017; 10.1016/j.nedt.2011.01.017 Johnson, J. P., & Mighten, A. (2005). A com-
parison of teaching strategies: Lecture
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B
B
ESTP
RACTICEG
UIDELINESDEFINITION
Evidence-based practice (EBP) is the consci- entious use of current best evidence for clini- cal decisions about patient care. Best practice guidelines or evidence-based guidelines are defi ned as outcomes from systematic reviews that are synthesized and appraised to deter- mine the current best knowledge in an area of specifi c interest. These outcomes provide nurses and/or other clinicians with up-to- date information to formulate guidelines for practice such as clinical guidelines, pro- tocols, policies, and procedures. Evidence- based guidelines support optimal clinical decisions and standardized best practice to enhance effi ciency and better patient out- comes (Cajulis, Beam, & Davis, 2010). These guidelines uphold the American Nurses Association (ANA) practice standard for pro- fessional nurses to integrate evidence and research fi ndings into practice (ANA, 2010).
Utilization of these guidelines can reduce inappropriate variations in patient care, pro- vide optimal timely clinical intervention, and promote autonomy in clinical practice.
Understanding the impact of EBP on patient outcomes and cost of services is essential for every nurse.
APPLICATION
Education of nurses at all levels from theo- retical and/or practical experiences is req- uisite for best practice. The need to be educated and updated about practice begins as a nursing student moves forward with the career as a graduate nurse. Every nurse
has the professional responsibility to attain knowledge and skills to improve practice (Fitzpatrick, 2013). Likewise, every nurse has a responsibility to use best evidence in the delivery of patient care.
Creating a work environment of EBP for nurses is a fundamental component in the education of nurses. A paradigm shift is occurring from traditional practice to EBP.
Undergraduate- and graduate-level students are educated in formal courses on research and EBP in the curriculum. Students review, discuss, and critique research articles, and report on evidence-based interventions for a specifi c clinical population. Students in clinical practice experience real-time patient care delivery. Most clinical sites provide stu- dents with access to evidence-based clinical guidelines, policies, and procedures. Clinical instructors and nurse mentors are expected to be knowledgeable about evidence-based guidelines, as well as be readily available to guide students to solve clinical issues using best practice guidelines.
Education is a continuous process of knowledge and skill acquisition obtained from formal education programs, continu- ing education, or self-learning (Fitzpatrick, 2013). Continuing education is essential for the delivery of the current best avail- able evidence for patient care interventions.
With a considerable body of information and advanced technology, many evidence-based guidelines are available for nurses at all lev- els to guide clinical decisions for best pos- sible patient care.
SYNOPSIS
Understanding the concept of EBP is essen- tial for staff nurses and advanced practice
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38 ■ BEST PRACTICE GUIDELINES
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nurses translate research into practice guide- lines. Nursing rounds can promote education and practice improvement strategies by helping staff nurses apply evidence-based knowledge to clinical situations (Mahanes et al., 2013).
Shulman (2008) suggested that staff nurses should have access to EBP databases 24 hours/day. Promoting use of databases by providing support to nurses on how to access the databases through continuing educa- tion programs and mentorship can increase access and use of the guidelines.
Promotion of EBP skills by staff nurses and APN can translate into improved patient care and professional satisfaction. These best practices can facilitate the use of practice guidelines in patient care. Research on imple- mentation of these guidelines is needed in order to promote nurses’ understanding and utilization of EBP.
American Nurses Association (ANA).
(2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD:
Author.
Cable-Williams, B., Rush, J., Mowry, A., MacLeod, A., Gilmer, C., Graham, C., &
White, S. (2014). An educational innova- tion to foster evidence-informed practice.
Journal of Nursing Education, 53(X), 1–4.
doi:10.3928/0148434–20140217-06
Cajulis, C. B., Beam, P. S., & Davis, S. B. (2010).
Making evidence-based decisions in nurs- ing. In F. Chiappelli, M. H. Ramchandani, N. Neagos, O. O. Oluwadara, & X. M.
Caldeira Brant (Eds.), Evidence-based prac- tice: Toward optimizing clinical outcomes. New York, NY: Springer. Science and Media Cullen, L., & Adams, S. L. (2012). Planning
for implementation of evidence- based practice. The Journal of Nursing Administration, 42(4), 222–230. doi:10.1097/
NNA.0b013e31824ccd0a
Fitzpatrick, J. J. (2013). Professional standards for nurses. In M. M. Glembocki & J. J.
Fitzpatrick (Eds.), Advancing professional nursing practice (pp. 51–74). Minneapolis, MN: Creative Health Care Management.
Mahanes, D., Quatrara, B. D., & Shaw, K. D.
(2013). APN-led nursing grand rounds:
nurses (APN) in order to deliver high-quality and cost-effective care. Improving knowl- edge about EBP improves implementation of best practice guidelines. Several steps in implementing EBP include assessing the need for EBP, reviewing the current litera- ture, implementing EBP at all organizational levels, and evaluating the implementation.
Increased understanding of EBP facilitates implementation of EBP in clinical settings.
Cullen and Adams (2012) presented an EBP model consisting of four phases: organiza- tional interest, education, implementation, and evaluation.
Shulman (2008) emphasized the impor- tance of organizational leadership in pro- moting an environment of clinical inquiry and constant learning. Access to clinical information, education of staff members on how to evaluate the literature, strategies to ensure implementation of practice changes, and promotion of EBP projects are factors that support EBP. Cable-Williams et al.
(2014) described a program using best prac- tice guidelines for curricula development in a baccalaureate nursing program. They emphasized several key points for project management and sustainability including shared governance, ongoing communica- tion among members, identifying outcomes, promoting new opportunities for students and faculty, and disseminating project information.
Mahanes, Quatrara, and Shaw (2013) described implementation of APN rounds in which identifi cation of evidence-based patient issues are discussed by staff nurses.
They found that a proactive approach improves implementation of evidence-based guidelines. In addition, evidence-based guidelines are frequently not implemented because they are not disseminated to the staff nurses.
RECOMMENDATIONS
APNs are at the forefront in developing and implementing EBP guidelines in the clinical setting. Their clinical expertise and ability to interpret research fi ndings can help staff
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