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Listening and responding to the voices of Latina prenursing students.

Abstract

AIM To describe how successful Latina prenursing students experience and respond to academic challenges. BACKGROUND Nursing schools are challenged to enhance persistence and graduation rates of Hispanic students to meet the health care needs of the Hispanic population in the United States.

METHOD The researcher used private semistructured interviews to explore the lived experiences of six successful Latina students when they encountered academic challenges in prerequisite nursing courses.

RESULTS Seven superordinate themes emerged through interpretative phenomenological analysis: a) facing academic challenges, b) recognizing emotional response, c) seeking help, d) transcending academic challenges, e) owning knowledge, f) persevering, and g) living out values and beliefs.

CONCLUSION Faculty need to recognize and respond to the importance of family, relationships, values, and beliefs to academic success among Latinas. Promoting academic success of Latina prenursing students helps prepare a health care workforce that reflects the population of the United States.

KEY WORDS

Latina Prenursing Students--Academic Challenges--Nursing Student Success

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The shortage of Hispanic nurses in the United States is well documented (American Association of Colleges of Nursing, 2009; US Department of Health and Human Services [DI-IHS], 2013), and the body of research regarding the needs of Hispanic nursing students is growing. Bond and colleagues (2008) emphasized the need for educators to understand Hispanics' "perspectives on nursing and nursing education" (p. 136). Williams (2010) studied persistence in beginning nursing students, but little has been published about Hispanics in prenursing courses, particularly how students who flourish differ from those who do not.

Although more than 100 freshmen at a Hispanic-serving liberal arts university designated their major as prenursing in 2008, many did not successfully complete the prerequisites. Therefore, the author qualitatively explored the experiences of six successful Latina students as they encountered academic challenges in prerequisite nursing courses to learn about the perceptions and responses that foster academic success in this population.

BACKGROUND

A shortage of minority nurses exists in the United States, and a significant deficit is found in the number of Hispanic nurses. According to the US Census Bureau's American Communities Survey 2008 to 2010, Hispanics comprised 14.2 percent of the working-age population in the country, but only 4.8 percent of the registered nurse workforce (DHHS, 2013). The Sullivan Commission on Diversity in the Healthcare Workforce (2004) reported an association between the shortage of minority health care professionals and health disparities in minority populations and recommended studying the educational environments in which health care professionals develop.

METHOD

Interpretative phenomenological analysis (IPA) was used as described by Smith, Flowers, and Larkin (2009) to study the experiences of successful Latina students as they encountered academic challenges in prerequisite nursing courses. Following institutional review board approval, students were purposively recruited using the following criteria: a) Latina, b) successful completion of at least two semesters of prerequisites with a grade point average (GPA) of 3.0 or higher, and c) no course withdrawals. Recruitment flyers were distributed in prerequisite chemistry and microbiology classes, and nursing faculty advisers were asked to electronically forward flyers to their advisees in an effort to reach all prenursing students.

Each prospective participant consented and then completed a preinterview to verify suitability and willingness to participate. Two private, semistructured recorded interviews with each participant followed during April and May 2010. The 12 interviews lasted between 40 and 93 minutes each, for a total recorded time of 13.7 hours. Participants were interviewed for a total of 106 to 178 minutes each, divided between their first and second audiorecorded interviews.

Analyzing multiple interviews with a small number of participants followed the recommendations of Smith et al. (2009) for the IPA. Each participant initially responded to the following during her first recorded interview: "I am interested in learning about how successful students experience academic challenges in prenursing courses. Think of times when you encountered academic challenges and tell me everything you can about those experiences, about what feelings you had, what you thought, what you said, what you did, and anything else that is important to you about the experiences." Additional structural and probing questions followed based on the students' responses.

Each audiorecorded interview was personally transcribed verbatim; the author listened to each interview two or three times during transcription and proofread each transcribed interview a final time against the recording to ensure accuracy. This process, which took 10 to 12 hours per interview, allowed the author to engage with the data while hearing the voice of each participant. No one other than the author had access to the recordings of the participants' voices.

Data Analysis

Data analysis followed an inductive and iterative cycle and included: a) reading and rereading, b) initial noting, c) developing emergent themes, d) searching for connections across emergent themes, e) moving to the next case, and f) looking for patterns across cases (Smith et al., 2009). Intense processing of transcripts, coding with gerunds (Charmaz, 2006, p. 49), language deconstruction, graphic representations (Smith et al., 2009, p. 99), and a Microsoft Access form (QR_Database. mdb) developed by Hahn (2008) enhanced data consideration.

Postinterview

Following analysis of the data, the researcher offered each participant the opportunity to complete a private member-checking interview; two accepted the invitation. Each interview lasted approximately 45 minutes and included review of the codes, themes, and superordinate themes. The two participants confirmed that the findings accurately reflected their experiences.

RESULTS

Participants were American citizens who were 19 or 20 years of age. They self-identified as being of Mexican or Puerto Rican heritage, all listed English as their primary language, and three were bilingual. Their college GPAs ranged from 3.13 to 3.76; Scholastic Assessment Test (SAT) scores ranged from 850 to 1070 (sum of critical reading and math only).

Despite their success, all of the participants described academic challenges. Stories of their experiences went beyond academic course work. They shared poignant stories of parents who did not have the opportunity to pursue higher education, stories of life-threatening illnesses of family members that influenced their decisions to become nurses, and stories of traumatic life events. All described how life experiences affected their responses to challenges. Seven superordinate themes common to all participants emerged: a) facing academic challenges, b) recognizing emotional response, c) seeking help, d) transcending academic challenges, e) owning knowledge, f) persevering, and g) living out values and beliefs. Multiple connections among superordinate themes were evident.

Facing Academic Challenges

Participants identified science courses, especially biological chemistry, as the most challenging. They described not understanding content and encountering new learning environments. They recounted volumes of material to be learned, the need to understand complex foundational concepts, encountering instructors who answered their questions by asking them more questions, and facing academic issues while separated from their families and friends from high school.

All participants recalled difficulties taking tests. They recognized personal strengths and weaknesses, ineffective learning strategies, and conflicting obligations. They then questioned their abilities and choice of major. One student described her doubts: "I felt like he [the professor] had given up on me.... I'm this dumb that he's gonna give up, 'cuz he doesn't think I'm gonna make it."

The participants also perceived differences between their desired and actual levels of achievement. With a growing academic awareness, they adapted to meet expectations. One student reported that she had to completely change her study habits in college because she felt she was on her own.

Recognizing Emotional Response

All of the participants described an intense emotional response, describing "anxiety," "anxiousness," a feeling that "drove me crazy," "fear" or "freaking out," nervousness, intenseness, and a feeling of being "scared." Three students remembered crying, and three described visceral responses such as "being on a roller coaster," breaking out in hives and throwing up, and feeling like "your throat [was] in your stomach." One student recalled a nerve-wracking semester during which she thought she was "gonna break." In addition, all described feeling discouraged, feeling disappointed, or experiencing frustration in response to academic challenges. One participant expressed disappointment after doing poorly in a class, stating, "I felt like my heart was being taken out of me." Another who recalled crying reflected: "There's also ... some sadness with it ... when you feel like you've done as much work as you've done and, and you still can't ... achieve the level that you think you should be at."

Two students felt discouraged as a result of interactions with a professor. One student reported: "One time I actually did go up to that professor...I told him, 'This is what I'm doing.... I'm still not making the grades that I would like to. What do you recommend I do?' And he told me that I had poor study habits ...I just felt like he ridiculed me." The other student recalled a professor telling her that if she paid better attention she would understand. Although each reported continuing to attend the class in which she felt discouraged, they tried not to ask questions or be noticed.

Despite the intensity of their emotional responses, participants recognized and managed emotions in ways that allowed them to respond effectively. One participant offered a salient example: "I had to put all of that behind me. I couldn't let my feeling toward the teacher keep me from actually doing well in the class."

Seeking Help

Participants sought help from a variety of sources, and the source about which they spoke the most was professors. The classroom teacher and environment significantly impacted their responses to academic challenges. Although all initially avoided seeking help, this behavior persisted in classrooms in which participants feared being embarrassed by a professor in front of their peers.

One student wondered, "Should I ask or shouldn't I ask, and if I ask is he gonna be ... upset?" while another student recalled, "I was intimidated by the teacher, you could say, so I never really asked questions. I just stayed quiet, and I think that's what made it even harder--was not feeling like I could ask questions."

Participants cited being encouraged by parents and professors to ask for help, letting go of pride, and realizing they should have asked for help sooner as keys to their transition to help seeking. One participant remembered a professor saying, "You're paying me. You're ... my boss. You should ...come into my office hours." Participants who felt welcomed by professors engaged in more help seeking, while those who felt uncomfortable when seeking help rarely returned. One student shared that she was "too scared to go up to that professor...he was just too intimidating and I was like, 'No I'm gonna feel stupid if I go up to him.' Because he would make us feel stupid."

All participants emphasized the importance of professors who welcomed, encouraged, and responded without judgment to their questions. "I didn't feel ... dumb for asking a question," one student recalled, while another said, "I was afraid she was gonna get upset, 'cuz I didn't know what I was doing. But ... she was understanding." Participants who did not receive the requested help from professors reached out to other sources such as peers or previous teachers.

Transcending Academic Challenges

Participants described a variety of ways by which they transcended academic challenges. All reported studying early, consistently, and often. They balanced family, work, and social commitments to allow adequate time for studying, employed strategies that maximized learning during class, and worked to improve their test-taking abilities.

Parental support was invaluable, but participants noted that support from professors and peers best helped them address academic challenges. A supportive college environment enhanced their learning and decreased their stress. In one student's words: "And that's one thing that settles my heart ... if I ... do have trouble ... I can find someone to help me.... The professors here ... actually take the time to know you, take the time to learn your learning style."

The superordinate themes of seeking help and transcending academic challenges overlapped, as all participants reached out to trusted peers for help. Selectively choosing peers and planning effective study sessions also connected with the processes by which participants became the owners of new knowledge.

Owning Knowledge

All participants recognized the difference between superficial recognition and a deeper understanding of concepts. They responded by striving to internalize new academic content and make it their own. One student described this process as, helping information to "actually get into my head." Another, who referred to recognition as "I know it but I don't," contrasted superficial knowledge with knowing information well enough that she would be able to consider it "in another way."

Participants worked to understand foundational information and described breaking complex content into manageable parts. Several reviewed new information daily to make it their own, with one participant stating, "I study a little bit, like every day, every day, every day." Two participants noted that they reviewed content shortly after its introduction, while a third said she built upon prior knowledge, likening it to climbing a ladder "one step at a time." Another student described "going outside of" a complex concept to learn everything about it with her study group, and another explained that she had to "understand how it worked inside of, you know, the material."

Several said that memorization was necessary, but they distinguished pure memorization from true comprehension. For one student, "memorizing is what happens when you study the night before a test.... [It] is ... equivalent to procrastination." Another said, "I memorized the formulas, but memorizing does not help if you do not know how to use them."

Participants praised instructors who connected theoretical concepts to life. One student shared, "The good thing with that professor ... she brought, um, real life situations into her lecture.... That helped me understand more." When taking biological chemistry II from a teacher who "was all about group work," that same student realized she learned best when working with others: "I'm more of a self-learner...like someone else teaching me or me teaching that person... when I was teaching somebody else...it helped me more understand what I was talking about."

Persevering

After initially becoming discouraged, all participants persevered in response to academic challenges. Although five recalled coming to college with a sense of personal strength or determination, all reported that encountering academic challenges increased their personal determination or helped them recognize personal strength. Four felt a sense of accomplishment, describing "seeing things through" and not giving up ("I did want to give up a lot, but I just had to keep reminding myself that I have to stick through it"). One student said, "I don't like to give up very easily. I'm very, like, persistent," and another emphasized, "I know that if I really try...I will excel with anything I do." In addition, three students described refocusing through prayer, yoga, reading, or music to enhance their perseverance.

All received parental encouragement long before entering college. Each participant sensed that her parents believed in her; this unwavering belief was coupled with high academic expectations and aggressive encouragement. Participants described parents as "driving," "pushing," "hard on me," "on my back," having "high standards," stating that "failure is not an option," and saying "you need to be a leader." Three described a change from being pushed or driven by parents to pushing or driving themselves. One student explained, "A large part of it is my parents, always driving me to do better and to work hard.... They haven't as much now ... now it's just me on my own."

Parental encouragement offset the discouragement that all but one had received at some point from other relatives, friends, professors, and, in one case, high school teachers and administrators. One participant remembered, "Every time she would tell me I couldn't do it, it made me feel stronger.... It'd like, strengthen me," and another emphasized, "It just made me more determined." When coupled with encouragement, challenges and even discouragement increased their persevering.

Living Out Values and Beliefs

The most powerful stories clustered within living out values and beliefs. This superordinate theme was tightly interwoven with persevering, and the two influenced every aspect of participants' experiences of academic challenges. Responses to academic challenges, especially with regard to persevering, arose from deeply ingrained values and beliefs about who they were, who they needed to become, the purposes they were to fulfill, and what was important to them in life.

The high value that participants placed on relationships influenced their expectations of the academic environment and how they learned. Participants expected and appreciated relationships with professors and peers, and all shared stories of learning situated within relationships, demonstrating connections between the superordinate themes of owning knowledge and living out values and beliefs. In addition, participants expressed bitter disappointment when the expected relationships with faculty failed to materialize.

The high value placed on family by every participant significantly impacted their experiences of and responses to academic challenges. Each talked about her family during the first interview without being asked. Expecting to be the first in their immediate families to earn a college degree, four participants arrived at college determined not to squander this opportunity; three appreciated that their parents offered educational support that they had not received; two recognized the generosity of parents who missed them, yet allowed them to leave home to reach their academic potential; two described the desire to fulfill parents' dreams; and three voiced a desire to reap the benefits of the economic investment in their education.

In summary, participants' abilities to face academic challenges, recognize and manage emotions, seek help, transcend academic challenges, make new knowledge their own, persevere, and live out their values and beliefs captured their experiences of and responses to academic challenges. Notably, values and beliefs were closely connected to persevering, and together they were highly significant to academic experiences and responses as described by participants.

DISCUSSION

Connections to theoretical literature and previous studies of Hispanic students emerged from the data. Bandura (1986) described self-efficacy as a "judgment of one's capability to accomplish a certain level of performance" (p. 391) and noted that self-efficacy affects how long and how hard individuals will persist to reach their goals. Cerna, Perez, and Sfienz (2009) documented the importance of self-efficacy to Latino success in a large study of college students. As theorized by Bandura (1977), participants' stories in this study illustrated close connections between self-efficacy and persevering. Having been aggressively encouraged by parents who believed in them, their stories also exemplified Bandura's (1986) assertion that verbal persuasion can affect self-efficacy.

As in previous studies of Hispanic nursing students (Bond et al., 2008; Cason et al., 2008; Rivera-Goba & Campinha-Bacote, 2008; Rivera-Goba & Nieto, 2007), the importance of personal determination and persevering to academic success emerged. All participants independently described persevering characterized by personal determination or recognizing personal strength.

Many spontaneous participant remarks in the current study are similar to those shared by students in a study by Williams (2010). When questioned about what helped them stay in nursing during their first two years in a BSN program, participants in Williams' study reported that "keeping up," "not giving up," "doing it," and "connecting" were inherent to their persistence. The participants in the current study also emphasized the importance of faculty availability, as did participants in the Williams study.

The intense emotional response and anxiety about test-taking among students who were academically successful and, hence, flying under the radar of teachers and faculty advisers was surprising. These findings echoed those of Zalaquett (2006), who discovered that even successful Hispanic college students experience barriers and that highly valuing education enhances academic success. Despite perceived challenges and fears, the students in the current study highly valued the experience, and they persevered and succeeded.

As in studies by Cason et al. (2008) and Zalaquett (2006), participants credited family and peer support as their keys to success. Although two reported that relatives doubted them, they said this made them more determined to succeed.

Although not generalizable, the findings regarding perseverance in the face of academic challenges in these prenursing students echoed the findings of similar studies of Hispanic students in various majors, as well as those of Hispanic nursing students. Significantly, similarities arose with regard to personal perseverance and the importance of faculty availability between successful Latina prenursing students at a Hispanic-serving institution in Texas and beginning nursing students at a BSN program in the Midwest (Williams, 2010). Although many have written about success in students already admitted to nursing programs, few have focused on the prenursing student population.

Recommendations

Benner, Sutphen, Leonard, and Day (2010) challenged nursing programs to recruit diverse students to meet the needs of the United States population. Increased admissions of Hispanic prenursing students should be accompanied by a willingness to understand and respond to the experiences of this population. Institutions may consider the findings of this study as they admit more Latina students to prenursing programs and strive to enhance academic success.

FACULTY AND INSTITUTIONAL APPROACHES

Despite their academic success, the participants in this study described an extremely intense experience during their transition to college. Although faculty members and advisers often focus on students who are visibly struggling, it is important to realize that outwardly successful students may also need help.

Participants learned within relationships and highly valued them. They expressed gratitude for faculty and members of the campus community who cared. Therefore, faculty should reach out frequently to all students, including those who are ostensibly achieving in the classroom and who hold great promise when they receive effective support. Faculty development that prepares educators to meet the needs of this student population is essential.

Faculty may need guidance in providing opportunities for participatory group learning during class. First-year students should be encouraged to form study groups with classmates and to plan study sessions to maximize effectiveness. Using class time or office hours to engage with and learn more about the students is worth the investment for this student population. It is also important to orient students to the college classroom where faculty may answer questions with more questions to encourage critical thinking.

Participants in this study described a variety of responses to challenges; some were intuitive, such as owning knowledge, and others, such as seeking help, required encouragement. Although these students independently transcended many of their challenges, less successful students may require guidance in their transition, particularly with the processes involved in owning knowledge. All students should be invited to ask questions and to request help. The provision of learning communities, tutoring, and formal, peer-assisted study opportunities is essential, and students should be actively encouraged to take advantage of such programs. Pairing prenursing students with Latinas who have completed the prerequisites may provide additional support within a peer-mentor relationship.

Amaro, Abriam-Yago, and Yoder (2006) found faculty support to be more important to the success of minority students than family support, and Williams (2010) found faculty availability to be significant in beginning BSN students. Similarly, participants in this study identified professors as the people who imparted the best help in the courses in which they struggled. Being encouraged to ask questions and feeling welcomed when reaching out built confidence and increased future help seeking. Therefore, additional academic support services should be viewed as supplementary, rather than as substitutions, for faculty support. Ideally, nursing faculty should serve as academic advisers for prenursing students and work with faculty members who teach prerequisites to provide optimal support. Admitting promising students directly into the nursing program while taking prerequisites as recommended by Williams (2010) may also enhance academic success.

Prenursing students should be encouraged to attend meetings of student nursing associations as such meetings may provide them opportunities to connect with students already in the program. In addition, it may be helpful to invite members from local chapters of organizations such as the National Association of Hispanic Nurses and Sigma Theta Tau to campus events to foster relationships between Hispanic prenursing students and Hispanic nurses in practice.

FAMILY INVOLVEMENT AND COMMUNITY OUTREACH Many students do not have the same family support as acknowledged by the study participants. Family orientation to the college environment as recommended by Alexander, Garcia, Gonzalez, Grimes, and O'Brien (2007) and by Cason et al. (2008) is essential. Advisers should inform families of the need to encourage students to persevere and to ask for help. Working with the families of this student population within the guidelines of the Family Educational Rights and Privacy Act throughout the college transition is necessary.

All participants credited long-term parental encouragement as inherent to their success. They also mentioned challenging high school courses, teachers, and counselors who fostered their success. Two reported that secondary school experiences impeded them. Nursing programs should reach out to high schools to collaborate on optimal preparatory experiences. Developing relationships with prospective students and their families may enhance academic success and encourage promising students to apply to programs of nursing.

Limitations

This study assumed that participants accurately perceived and verbalized their life experiences. It is impossible to capture a truly "pure" experience, as qualitative findings are shared and perceived through the personal lenses of participants, along with the author and readers. In addition, students who agreed to participate in time-consuming educational research may not represent those who would not.

The findings of the current study are not generalizable, but Smith et al. (2009) noted that such findings can have theoretical transferability, in which "the reader makes links between the analysis in an IPA study, their own personal and professional experience, and the claims in the extant literature" (p. 51). Member checking with two participants, spending prolonged time immersed in the data, and peer debriefing enhanced credibility of findings.

CONCLUSION

This study may help educators identify and support successful students, especially Latinas. Faculty can also use the findings to assist less successful students. Awareness of the emotional intensity of the experience and provision of faculty development to address it may improve the support provided to all students. Institutions that have not historically served Hispanic students may find the recommendations helpful as they reach out to this population. Promoting the academic success of Latina students in prerequisite courses may enhance their ability to succeed in nursing programs. Additional studies of prenursing students are needed to explore the experiences of other ethnic groups and to foster the success of the most promising prenursing students. Research that quantitatively examines relationships between self-efficacy, persevering, and success in prerequisite nursing courses may also be beneficial.

doi: 10.5480/11-594.1

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ABOUT THE AUTHOR

Julie Nadeau, EdD, RN, CNE, is assistant professor and BSN program chair, University of the Incarnate Word, Ila Faye Miller School of Nursing and Health Professions, San Antonio, Texas. Contact her at nadeau@uiwtx.edu.
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