Background: Nurse graduates (NGs) are ill prepared when faced with patient death and dying, despite receiving educational preparation on end-of-life (EOL) care in their prelicensure nursing programs. Method: This qualitative descriptive study included a convenience sample of NGs ( n = 20) who experienced a first adult patient death during their first 18 months of practice at a large teaching hospital with an extensive NG transition program, including preceptor-guided orientations, nurse internship programs, and nurse residency programs. Results: Six major themes described the NG experience: Navigating the Process, Not Prepared, Support, Missed Opportunities, Preparing NGs for Death and Dying, and Guiding NGs Through Practice. Critical gaps in preparation were evident across all themes. Conclusion: Results of this study suggest specific opportunities for improvement of NGs' readiness to effectively care for patients and families in EOL situations by increasing their exposure to death and dying experiences before graduation and during their first year of practice. [ J Contin Educ Nurs . 2020;50(6):267–273.]

Background Effective pedagogy that encourages high standards of excellence and commitment to lifelong learning is essential in health professions education to prepare students for real-life challenges such as health disparities and global health issues. Creative learning and innovative teaching strategies empower students with high-quality, practical, real-world knowledge and meaningful skills to reach their potential as future health care providers. Objective The aim of this study was to explore health profession students’ perceptions of whether their learning experiences were associated with good or bad pedagogy during asynchronous discussion forums. The further objective of the study was to identify how perceptions of the best and worst pedagogical practices reflected the students’ values, beliefs, and understanding about factors that made a pedagogy good during their learning history. Methods A netnographic qualitative design was employed in this study. The data were collected on February 3, 2020 by exporting archived data from multiple sessions of a graduate-level nursing course offered between the fall 2016 and spring 2020 semesters at a large private university in the southeast region of the United States. Each student was a data unit. As an immersive data operation, field notes were taken by all research members. Data management and analysis were performed with NVivo 12. Results A total of 634 posts were generated by 153 students identified in the dataset. Most of these students were female (88.9%). From the 97 categories identified, four themes emerged: (T) teacher presence built through relationship and communication, (E) environment conducive to affective and cognitive learning, (A) assessment and feedback processes that yield a growth mindset, and (M) mobilization of pedagogy through learner- and community-centeredness. Conclusions The themes that emerged from our analysis confirm findings from previous studies and provide new insights. Our study highlights the value of technology as a tool for effective pedagogy. A resourceful teacher can use various communication techniques to develop meaningful connections between the learner and teacher. Styles of communication will vary according to the unique expectations and needs of learners with different learning preferences; however, the aim is to fully engage each learner, establish a rapport between and among students, and nurture an environment characterized by freedom of expression in which ideas flow freely. We suggest that future research continue to explore the influence of differing course formats and pedagogical modalities on student learning experiences.

OBJECTIVE To identify factors associated with subsequent hospital-acquired pressure injury (HAPrI) formation among patients in surgical and cardiovascular surgical ICUs with an initial HAPrI. METHODS Patients admitted to a level 1 trauma center and academic medical center in the Western US between 2014 and 2018 were eligible for this retrospective cohort study. Inclusion criteria were development of an HAPrI stage 2 or above, age older than 18 years, the use of mechanical ventilation for at least 24 hours, and documentation of a risk-based HAPrI-prevention plan including repositioning at least every 2 hours. The primary outcome measure was development of a second, subsequent HAPrI stage 2 or higher. Potential predictor variables included demographic factors, shock, Charleston comorbidity score, blood gas and laboratory values, surgical factors, vasopressor infusions, levels of sedation or agitation, Braden Scale scores, and nursing skin assessment data. RESULTS The final sample consisted of 226 patients. Among those, 77 (34%) developed a second HAPrI. Independent risk factors for subsequent HAPrI formation were decreased hemoglobin (odds ratio, 0.71; 95% confidence interval [CI], 0.53–0.92; P < .000), vasopressin infusion (odds ratio, 2.20; 95% CI, 1.17–4.26; P = .02), and longer length of stay in the ICU (odds ratio, 1.01; 95% CI, 1.00–1.02; P = .009). CONCLUSIONS Patients with an HAPrI are at high risk of subsequent HAPrI development. Anemia, vasopressin infusion, and longer ICU stays are independent risk factors for repeat HAPrI formation.

AIM The purpose of this project was to connect nursing students from schools of nursing in China and the United States for colearning using virtual simulations. BACKGROUND With technology and international partnerships, nursing programs can offer global education without students traveling to other countries. METHOD Virtual simulations were produced by each school for the project. Students completed them in two synchronous 1.5-hour virtual sessions, one month apart. At the end of each session, students completed the Simulation Effectiveness Tool-Modified and the Nurses Clinical Reasoning Scale. RESULTS Scores on the Simulation Effectiveness Tool-Modified ranged from 75.0 percent to 100 percent on Simulation 1 (video vignettes focused on prioritization) and 88.9 percent to 100 percent on Simulation 2 (computer-based obstetrics case). Most students strongly agreed or agreed that the simulation improved their clinical reasoning skills. CONCLUSION Virtual simulations allowed students to learn together and develop an awareness of differences in nursing practices across countries.

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