Teaching cultural care to students with variations in life experiences prior to formal nursing education is complex. Nursing research provides evidence of changes in measurement scores that are not always statistically significant because of the small sample sizes correlated to selected outcomes. Data translation strategies exploring curricular program outcomes may contribute to the preparation of nursing student for NCLEX© (National Council Licensure Examination for Registered Nurses) success and future practice in diverse health care environments (NCLEX-RN© Examination, 2015). Critical thinking has been a significant predictor of first-time NCLEX© success in a study by Romeo (2013).
Purpose and Significance
The purpose of this research is to explore student changes in Self-Efficacy Strength (SES) measured with the 83-Item Transcultural Self-Efficacy Tool (Jeffreys, 2010) and the relationship of successful NCLEX© achievement in a Nursing Education program that has implemented a Concept Based Curriculum (CBC). According to the Robert Woods Johnson Foundation (RWJ, 2011), NCLEX© serves as the benchmark for achievement of safe patient centered care. The focus of a CBC is commonality of assessments and plans for nursing interventions in the care of diverse clients and settings (Giddens, Caputi, & Rodgers, 2014). CBC uses a conceptual approach to reduce content saturation in the application of nursing process along the health-illness continuum (Hendricks & Wangerin, 2017). The Transcultural Self-Efficacy Tool (TSET) provides a measure of students’ perceptions of cultural awareness caring for diverse groups (Fisher, 2014). Exploring TSET scores and NCLEX© success contributes to knowledge about the complex contributions for nursing education.
Methods
A cross-sectional descriptive correlational design with logistic regression was used, TSET scores were used as the independent variable (IV) and first time success in NCLEX© licensure was used as the dichotomous dependent variable (DV). The data was collected in two cohorts of pre-licensure students participating in a Concept Based Curriculum (CBC) in the Mid-west.
The TSET scores relate normal progression of perceived self-efficacy beliefs reflecting Self-Efficacy Strength (SES) measured over time. The TSET was developed by Jeffreys (2010) and is an 83 item measure with three subscales reflecting knowledge development and confidence in the cognitive, practical, and affective domains. The TSET has supported reliability with reported Cronbach’s alpha 0.92-0.98 (Jeffreys & Dogan, 2010). Criterion related validity suggests that SES is influenced by cultural care experiences and changes over time. Nursing students more often score higher in the affective dimensions of competence and lower in the cognitive dimensions. Students as novice learners generally score lower as compared to advanced learners or professional nurses in practice with years of experience.
The NCLEX© is administered using Computerized Adaptive Testing (CAT) with a controlled percentage of questions. The category of Human Functioning assesses respondents’ knowledge about alterations along the wellness continuum (NCLEX© Examination, 2015). The NCLEX© dimensions of Human Functioning assess cognitive, practical, and affective domains and provide a good match to items on the TSET to provide a score about perceptions of Self-Efficacy Strength in cultural care. Specific items on the TSET measure efficacy beliefs about growth and development, self-concept, communication, sleep, rest, spiritual care, grieving, ethical concerns, and cultural beliefs (Jeffreys, 2010).
Results
TSET subscale scores were evaluated with paired t-tests and all three revealed statistically significant increases in scores in the sample (all two tailed t-tests). A paired-sample t-test was calculated to compare the mean pretest TSET-Cognitive score to the mean final TSET-Cognitive score. The mean on the pretest was 6.93 (sd = 1.57) and the mean on the final TSET-Cognitive was 8.32 (sd = 1.30). A significant increase from pretest to final TSET-Cognitive was found (t(57.31) = 80, p <.000). A paired-sample t-test was calculated to compare the mean pretest TSET-Practical score to the mean final TSET-Practical score. The mean on the pretest was 6.81 (sd = 1.65) and the mean on the final TSET-Practical was 7.99 (sd = 1.65. A significant increase from the pretest to final TSET-Practical score was found (t(43.43) = 80, p<.000). A paired-sample t-test was calculated to compare the mean pretest TSET-Affective score to the mean final TSET-Affective score. The mean on the pretest was 8.62 (sd = 1.04) and the mean on the final TSET-Affective was 8.91 (sd = .98). A significant increase from pretest to final TSET-Affective score was found (t(81.20) = 80, p<.000).
Logistic regression was conducted to explore the relationship of changes in each TSET subscale score to NCLEX© success passing score. Growth in TSET subscale scores were analyzed. After controlling for cohort, gender, and racial/ethnic status, there was no significant contribution of TSET-Cognitive or TSET-Practical score to predicting the likelihood of passing the NCLEX©. The change in the TSET-Affective subscale is marginally significant (p < .08) on the pass rate (β = 0.818). As noted, nursing students more often score higher in the TSET-Affective subscale throughout the times of testing and there is less increase in this score over time (Jeffreys, 2010), yet the small changes that do occur contribute strongly to increasing the likelihood to pass the NCLEX©. The preliminary results of analysis have potential implications in teaching professional nursing and translation into educational practice or policy.
Impact on Learner Preparation and Translation to Education
This research contributes to knowledge about education of professional nurses and shares findings that explore the relationship of cultural Self-Efficacy Strength (SES) to success with NCLEX© within a Concept Based Curriculum (CBC). Changes in TSET scores assessing SES impact learner preparation and provide evidence of the cognitive, practical, and affective domains of learning. Discussion and exploration of data with faculty in CBC is in progress to determine a theoretical model to guide curricular initiatives that will include measurement of quality outcomes in educational processes.
Future research is in process with standardized testing to further explore program outcome data to continue to generate evidence about teaching and learning. Suggestions for translation of evidence into teaching practices with enhanced integration of clinical components, simulation, and practical experiences in the community is indicated. Reflective narratives with journaling may provide data about student perceptions supporting assessment of the affective domain of learning and abstract concepts of significance to providing health services (Decker, Hensel, Kuhn, &Priest, 2017). Bernard (2015) suggests exploration of the attributes of student engagement, motivation, and resilience may provide insight for the development of learner-centered strategies in the academic environment. Additional research about student learning through the use of reflective narratives expands understanding of the student nurse perceptions of cultural competence, human functioning, care planning in diverse populations, critical thinking processes, and the affective domain – all significant components that impact learner preparation.