Ensuring clinical competency and judgment in nursing students is critical. Developing ways for students to obtain this goal in a second-degree bachelor of science in nursing (BSN) program is challenging. One method described here is the early immersion clinical (EIC). Occurring concurrently with health assessment and fundamentals courses, EIC allowed for quick application of skills in the context of clinical care. Weekly clinical objectives were aligned with objectives for both courses. This article describes how EIC was implemented in a 12-month second-degree accelerated BSN program.
Young adults, 18-35 years of age, account for nearly half of all inflammatory bowel disease emergency department visits annually, costing millions of healthcare dollars and signifying undue pain and suffering. To mitigate this sequela, the study aimed to characterize the relationships between transition readiness (self-management ability), stress, and patient-centered outcomes. Outcomes were defined as disease activity and inflammatory bowel disease-related healthcare utilization (emergency department visits and inpatient hospitalization). This was a descriptive, correlational design via online survey of young adults with inflammatory bowel disease. Participants (n = 284) utilized an estimated 2.77 million healthcare dollars in 12 months. Transition readiness decreased the odds of having consistently active disease and healthcare utilization, with adjusted odds ratio ranging from 6.4 to 10.9 (p < .05). Higher stress levels increased the odds of having consistently active disease and healthcare utilization, with adjusted odds ratio ranging from 9.5 to 10.5 (p < .0001). Twenty-five percent (24.7%) of the variation in transition readiness was explained by changes in stress (p < .0001). Transition readiness and stress impacted all patient-centered outcomes. Stress negatively impacted transition readiness. These results are powerful reminders for healthcare providers to assess and treat stress and support transition readiness in young adults with inflammatory bowel disease. The potential to decrease pain, suffering, and healthcare cost is enormous.
Background: Undergraduate health assessment courses aim to prepare nursing students to conduct systematic physical assessment of patients. Competency in the undergraduate health assessment course is traditionally validated by student demonstration of a memorized, comprehensive physical examination.Problem: Often, this validation requires performance of an exhaustive list of physical examination skills rather than the typical physical assessment performed by the generalist nurse in the hospital setting. This precedent to "do it all" does not align with competency-based education and may cause students to be ill-prepared for clinical practice.Approach: Faculty in a 12-month second-degree accelerated BSN program adapted the comprehensive physical assessment validation to better reflect a clinically relevant bedside assessment. The process, results, challenges, and recommendations are described. Here, the redefined comprehensive physical assessment included evaluation of the patient's general appearance, activity, vital sign measurements, pain, and key assessment of the neurologic, respiratory, cardiovascular, integumentary, gastrointestinal, and genitourinary systems. In alignment with the AACN recommendations, students were also validated on focused assessments.
Conclusion:This change improved the students' transition to clinical practice. We challenge faculty to prepare students for real-world nursing assessment by adapting validations to closely mirror bedside practice.
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