The Journal of Continuing Education in Nursing

Original Article 

Experience of Novice Clinical Adjunct Faculty: A Qualitative Study

Carol Mann, PhD, RN, CRNA, CNE; Jennie C. De Gagne, PhD, DNP, RN-BC, CNE, ANEF

Abstract

Background:

Despite the adjunct instructor's central role in the clinical training of nursing students, little research exists on the perspective of the clinical experts assuming this role. This qualitative study aimed to better understand how novice clinical adjunct faculty described their lived experiences in their significant role transition.

Method:

The sample consisted of nine novice adjunct clinical nursing faculty who provided direct clinical supervision of prelicensure students in the United States (i.e., Texas). The interview narratives were collected using an in-depth semi-structured approach. Conventional content analysis was used.

Results:

Four key themes emerged from the data: Unpreparedness; Facilitators and Barriers in the Transition; New Learning Needs and Processes; and Salient Recommendations to Pass On.

Conclusion:

Nursing programs that use adjunct faculty to sustain clinical education must support their vital contribution and fresh perspective. Targeted, organized, and consistent efforts will optimally integrate this group into the academe.

J Contin Nurs Educ. 2017;48(4):167–174.

Abstract

Background:

Despite the adjunct instructor's central role in the clinical training of nursing students, little research exists on the perspective of the clinical experts assuming this role. This qualitative study aimed to better understand how novice clinical adjunct faculty described their lived experiences in their significant role transition.

Method:

The sample consisted of nine novice adjunct clinical nursing faculty who provided direct clinical supervision of prelicensure students in the United States (i.e., Texas). The interview narratives were collected using an in-depth semi-structured approach. Conventional content analysis was used.

Results:

Four key themes emerged from the data: Unpreparedness; Facilitators and Barriers in the Transition; New Learning Needs and Processes; and Salient Recommendations to Pass On.

Conclusion:

Nursing programs that use adjunct faculty to sustain clinical education must support their vital contribution and fresh perspective. Targeted, organized, and consistent efforts will optimally integrate this group into the academe.

J Contin Nurs Educ. 2017;48(4):167–174.

A shortage of qualified nursing faculty has compelled nursing schools to use adjunct and part-time faculty in the classroom, clinical, and online settings (Crocetti, 2014; Schaar, Titzer, & Beckham, 2015). One of the solutions to accommodate increased enrollment has been to fill these faculty positions with experts in clinical practice. However, nursing pedagogy is not a natural by-product of clinical expertise, but rather requires the faculty's orientation, socialization, and development (Crocetti, 2014; Davidson & Rourke, 2012; Poindexter, 2013). Therefore, nurses who assume the role of adjunct nursing clinical instructors face challenges in their transition to academia, as they may be lacking in the academic preparation and skills necessary to maintain efficacy in their educator role (Cangelosi, Croker, & Sorrell, 2009; Crocetti, 2014; Davidson & Rourke, 2012; Poindexter, 2013; Zakari, Hamadi, & Salem, 2014).

Despite the adjunct instructor's central role in the clinical education of nursing students, few studies have explored teaching prelicensure nursing students in the clinical area from the novice clinical adjunct instructor's point of view. In addition, little literature exists that seeks to identify issues associated with developing adjunct faculty as educators from their perspective (Santisteban & Egues, 2014). Thus, an examination of the experience of this faculty group may yield findings that would positively influence their faculty development and the learning experiences and success of students enrolled in schools of nursing.

Method

The purpose of this qualitative study was to explicate the perceptions of new adjunct faculty and the underlying themes that would shed light on what was done and what needed to be done to help these nurses and future new adjuncts as they transition to their new role. The primary research question for this study was: “How do novice adjunct clinical nurse educators (NACNEs) describe their experiences in their professional role?”

NACNEs were purposively selected from three schools of nursing that provided the e-mail addresses of faculty who met the study criteria for interviews. The sample consisted of (a) nursing faculty members who provide direct supervision of prelicensure nursing students within the clinical setting; (b) those who held employment of 3 years or less in a prelicensure nursing program or considered themselves to be novices in this setting; (c) clinical faculty representing different types of nursing programs throughout the state of Texas; and (d) availability and willingness to participate in at least one in-depth interview. All participants were clinically expert nurses, as defined by Benner (2001, 2004). The expert nurse develops an intuition that guides them through many settings. The nurse who has attained the role of expert can revert back to another level in different situations or when entering a new role. All participants were currently working in their area of expertise and were employed as a clinical adjunct instructor by an academic institution. Potential participants were contacted individually by e-mail.

On verbal agreement, a formal invitation e-mail was sent to each participant. A time convenient for a telephone interview was also arranged. Data saturation was used to determine the number of interviews. Before participation, all interviewees signed an informed consent after reviewing the form and asking questions. The university's institutional review board approved the study protocol.

Data Collection and Procedures

Before the interview, participants responded to three researcher-developed, Web-based, field-tested, and pilot-tested data collection tools. No changes were made subsequent to the pilot test. First, a demographic inquiry was used to collect profile information that described their education, work history, age, and gender, as well as one open-ended survey question inquiring their reasons for teaching as an adjunct clinical nursing instructor. Second, participants responded to critical incident tool prompts (Table 1), which served as a validation check on some aspects of the data obtained in the interviews. The critical incidents allowed the voice of the participants to be heard, as they wrote about their experiences while constructing the versions of their objectivity rather than relying wholly on the expected biased interpretive skills of the researcher.


Critical Incident Form

Table 1:

Critical Incident Form

Third, participants completed a time line tool. The narrative style tailoring the time line method was constructed to enhance the motivation, engagement, and interest of the participant. Time lines are simple and easy ways to organize information and analyze the influence of context on current life (Stafford, 2009). Based on the literature review (Deacon, 2000), the time line tool was developed and presented as a query to which participants provided a brief written journal entry (Table 2). One time line described learning throughout their clinical career developing expertise in their specialty area. The second time line described their learning journey throughout their adjunct clinical teaching career phase (Ajjawi & Higgs, 2007).


Time Line Development Tool

Table 2:

Time Line Development Tool

Consistent with the study's design of gaining a comprehensive understanding and interpretation of the experience under investigation, an in-depth semi-structured approach guided the data collection. An interview guide was assembled for this study. It consisted of a general set of questions and format to follow that was used on all participants, and that differed from the data collected on the critical incident tool. Although the general structure was the same for all individuals being interviewed, the researcher was able to vary the questions as the situation demanded (Lichtman, 2006). Each audiotaped interview lasted approximately 1 hour via telephone.

Data Analysis

Conventional content analysis, in which coding categories were informed by the context of text data, was used (Hsieh & Shannon, 2005). All individual data were compiled in an organized, easily retrievable order. All audiorecorded telephone interviews were transcribed verbatim. Information was edited, redundant material collated, and parts of the interviews were put together. The demographic inquiry and journal entry responses to the critical incident tool and time line tool were downloaded, sorted, and ordered on notecards. The data were read multiple times to facilitate immersion in the data.

The compiled data were further broken down into smaller fragments or pieces and assigned to codes. The coded data were sorted into conceptual categories that reflected commonalities among the codes. These categories became the organizing framework that generated the interconnections among the concepts and categories. Data interpretation yielded narratives that led the reader to a thorough comprehension of each participant's description. Finally, statements regarding the study findings within the broad framework and setting of each respondent were formulated and interpreted in natural language text.

Respondent validation strategy that involved the review of transcripts and data analysis by participants was conducted to confirm or challenge the validity of the data. To address subjectivity and strengthen the credibility of the study, various procedural safeguards were followed, including (a) triangulation of data sources, (b) triangulation of methods, (c) interrater reliability checks with professional colleagues, and (d) member checks throughout the phases of the study to share data and interpretations with participants to validate themes, interpretations, and findings.

Triangulation was made in several ways: (a) analytical triangulation, (b) space triangulation, (c) data triangulation, and (d) person triangulation. Triangulation of sources compares the consistency of different data sources. Analytical triangulation was provided by a review of the findings by the co-participants and by another researcher experienced in qualitative methods. The transcripts and narrative interpretations were returned to the co-participants for judgment of the accuracy and truthfulness of the findings (Creswell, 2008). Another qualitative researcher that had no involvement with this project reviewed the findings, interpretations, and conclusions of the research to assess for the presence of valid support from the collected data. Space triangulation involves collecting data on the same phenomenon in multiple sites to test for cross site consistency. The data were collected from individuals in different schools throughout the state of Texas. Data triangulation involved using multiple data collection methods by analyzing oral interview and written survey and journal narrative data. A data process analysis identified the key themes from the findings.

Results

This study sought new perspectives that would be valuable in understanding experiences and facilitating faculty development of this group of adjunct nursing instructors. Nine NACNEs who met the study criteria were interviewed in this study. All participants were women and had current experience as an adjunct in one or more institutions or one or more nursing programs. Participants' ages ranged from 25 to 75 years, with an average of 43.8 years. Participants came from a variety of clinical specialties and educational and employment backgrounds (Table 3).


Demographics and Participant Characteristics (N = 9)

Table 3:

Demographics and Participant Characteristics (N = 9)

All participants were employed by state universities or colleges. Eight of nine participants were affiliated with associate degree programs, and only one participant represented a baccalaureate program. Although differences among the participants existed along the type of nursing program and academic institution, age, education, and work history, reasons for becoming an adjunct clinical faculty appeared to be similar, as described in Table 4.


Reasons for Becoming an Adjunct (N = 9)

Table 4:

Reasons for Becoming an Adjunct (N = 9)

The following four key theme patterns emerged from the data analysis of the interviews and written journal entries: (a) Unpreparedness; (b) Facilitators and Barriers in the Transition; (c) New Learning Needs and Processes; and (d) Salient Recommendations to Pass On.

Unpreparedness

None of the participants felt adequately prepared as they relied heavily on prior experiences to fulfill their new role in the clinical setting. In addition, all participants agreed that teaching in a clinical setting required an enormous amount of preparation before the course begins, as well as before each clinical day. Participant responses describing their level of preparation on assuming the clinical teaching role included:

  • I did not realize what it was like being on the other side from being a student…how much preparation it involved with the students and what it was like. It was kind of an eye-opener from being a student. (Roberta; all names changed for anonymity purposes)
  • It took [2] years before I felt like I wasn't an impostor. It helped a great deal to have others encourage me that I should do what I needed to with my students. My department head and undergraduate coordinators frequently did encourage me that I did know what I was doing. (Tina)

All participants identified the importance of a strong orientation program by the university for new employees. Only one participant (Tina) had been exposed to an adequate orientation program and mentoring experience and found it to be invaluable, although most participants (i.e., Pat, Joan, Linda, Paula, Sandra, and Roberta) described orientation programs as abbreviated due to lack of faculty or lack of experienced faculty. As a result, the novice clinical adjunct was left struggling. One participant stated:

The experience was probably the most important thing preparing me for teaching. From the beginning, though, it was trial and error. Moreover, when you try something, it either works, or it doesn't. You try to get to know your group a little better, and you can kind of mold what you need to do around them. Trial and error and experience prepared me for teaching. Just doing it.

Facilitators and Barriers in the Transition

Participants cited facilitators that contributed to their teaching experiences:

  • Graduate school programs that included courses in adult education and teaching and learning theories.
  • Prior employment or work experience.
  • Precepting students.
  • Help from coworkers, other faculty, mentors, and supervisors.
  • Residency education or orientation program.
  • Familiarity with the clinical facility they are teaching in.
  • Continuing education conferences.

Significant comments from the participants that highlight these facilitators included the following:

  • I often think back to when I was in nursing school and what was most helpful to me as a student. I find conferences geared toward teaching [to be] very helpful and informative and think keeping up with skills at the bedside is also important to give credibility to my teaching. I also find it helpful to observe other instructors to see different styles in action. (Mary)
  • I completed a rigorous residency program that extended my knowledge and prepared me to provide safe and effective care to ICU [intensive care unit] patients. I am currently enrolled in the MSN Leadership in Education program in a university. This program has helped prepare me for the challenge of teacher and the future of nursing education. (Suzy)

Barriers in the transition were also identified. Threaded throughout the data, such challenges were:

  • Unfamiliarity with the assigned clinical facility.
  • Underdevelopment of relationships with the staff in the clinical facilities.
  • Increase of workload.
  • Pressure to perform.
  • Fear of student failure and negative student evaluation.
  • Low pay and compensation.

Participants noted:

  • I believe that instructors that aren't employed in their clinical facility don't have the advantages of “opening doors” for some great experiences. I would like to see nursing instructors paid more, at least at the level of those working in the patient care settings. I feel the pay scale is a deterrent for many who would be great in the instructor role. (Mary)
  • This position is very awkward; one must act as a clinical nurse to keep patients safe, an educator to facilitate student learning and an employee. The title of “nursing instructor” means that some viewed me as someone who knew everything—some considered me as management and, therefore, intimidating. (Tina)

New Learning Needs and Processes

Most of the participants did not realize how much effort goes into the process of clinical teaching. Major challenges consistently identified by all of the participants were in managing adult learners. Significant participant descriptions of how they developed their teaching skills after assuming their instructor role included trial and error, on-the-job training, reading and continuing education, and taking academic courses in nursing education. Some of the participants recognized “learning from the students.” Representative comments from the participants that highlight new learning needs and processes were:

  • I think that my biggest challenge was how to deal with an adult learner who was not getting the job done, either for the didactic piece as well as the clinical component. Most adult learners are high achievers. It took me a while to understand that I was not a “Reader's Digest” for others. (Sandra)
  • It is more difficult than imagined to prepare the students for NCLEX and clinical application. It is necessary that the theoretical knowledge required to pass the NCLEX be bridged with clinical application, but the gap is very wide and at times students still fall short. As a novice clinical educator, it is a constant challenge trying to connect the two. (Suzy)

On assuming their adjunct teaching position, all participants described their experience in the field of adult education as “minimal” and “I came in here cold” (Roberta). Responses congregated from all nine participants were consistent regarding new learning processes: (a) going to clinicals, working with the students, and learning from my own experiences; (b) orienting and mentoring; (c) working with coworkers; (d) taking examples from others; and (e) reading and studying on your own. The majority of the participants indicated that they learned what they needed to know by asking questions, reaching out to informally confer with colleagues and others rather than through formal means. All mentioned reliance on the teaching skills developed in teaching patients and their employment settings.

Salient Recommendations to Pass On

Participant responses highlighted the advice they felt necessary to pass on. Pat stated, “All your nursing knowledge will be used. Don't be afraid to ask questions. Be there for the students.” The importance of being prepared for the unexpected was also described. In addition, many of the respondents emphasized the understanding of the adult learner, interaction with students as adults, and the importance of a professional relationship with the students. Pertinent statements on this last theme were:

  • I think that it is important to let the students know that I don't have all the information and will also learn from them. If I can't answer their question, I will find the answer. In saying that, I won't be the book. Go into it gradually. Still continue to work in the clinical setting and transition. Do not throw yourself into it. (Sandra)
  • Consider a Master's in Education before coming into it…. I would say to make sure the people you are working with can help you and are willing to help you in all areas…. Number one: have a good mentor…learn about the adult learner. (Suzy)

Other significant points to pass on to fellow adjunct clinical faculty were:

  • Not everyone will be successful.
  • A wide gap exists between theoretical knowledge and clinical application that must be bridged.
  • One must be flexible, willing to change, and figure out what works.
  • It is important to cultivate and maintain strong working relationships with the students, clinic facility staff, and faculty.

Participants added some advice, for example: “It takes lots of patience” (Paula); “Be strong and don't let the students rule you” (Linda); “Be sure and self-confident with students” (Pat); and “Be willing to accept constructive criticism” (Joan). Participant responses to these themes elicited a wide range of the replies characterized by rich, thick description and were deeply reflective and thoughtful.

Discussion

This qualitative study sought to describe the experience of NACNEs. These findings revealed some commonalities with previous studies, as well as some new information. The first theme, Unpreparedness, showed that the perceptions of participants in this study included ill-preparedness in assuming the new role and responsibilities. All participants indicated that they reached out through formal and informal means to learn what they needed to know. They also drew on their backgrounds in clinical nursing, academic training, and employment settings. As discussed by McDonald (2010), lack of socialization to the academe may result in being unprepared and left to engage in “trial-and-error” approaches, relying on the teaching skills that were used by faculty in their basic nursing program that may not work with their current students. These findings are consistent with other studies citing that most often, new teachers lacked adequate orientation and mentoring to guide them through the essentials of the teaching–learning process (Cangelosi, 2014; Gardner, 2014; Schoening, 2013).

The second theme, Facilitators and Barriers to the Transition, showed that the participants identified mentoring as integral to the role transition process. Group mentoring, formal and informal one-on-one mentoring programs, and outside mentoring were all suggested as alternatives to meet individual and faculty department needs. Gaberson and Oermann (2007) emphasized the combination of academic preparation and professional work experience that would support the educator's credibility and confidence. The current study suggests that adjunct instructors who maintained a practice or clinical affiliation with the instructional agency were able to maintain their clinical competence, especially if they taught in the same clinical agency and specialty area. One significant finding highlighted by the participants was that working in familiar environments that included the clinical facility and staff, community, clients, program director and faculty, and institutional administration was pivotal to teaching success and a smoother role transition, especially in situations where orientation and mentoring were inadequate or lacking. It may be optimal to hire adjunct clinical faculty from the educational institution's clinical affiliations. Benner (2001) posited that the transition from clinical expert to clinical educator requires experience, in addition to formal preparation. It connects personal learning to professional learning.

The third theme, New Learning Needs and Processes, showcased that teaching and management of the adult learner in the clinical setting is a major challenge. Participants in this sample represented a variety of clinical backgrounds and educational preparation. Learning is the process by which novices become experts (Daley, 1999). Experts understand how they learn, as well as how they create and use knowledge for themselves in the context of their practice (Benner, 2001, 2004). Joel (2013) also noted that Benner's model is experiential and does not consider education as a variable in distinguishing these skill levels. However, one cannot apply what one does not know. Situated in a context where these clinical experts perceived themselves as novices, they easily identified what they needed to learn and how to garner the information and move forward, fully integrating their platform of prior experience and education.

Clinical proficiency and expertise underpinned the framework for teaching success (Dahlke, Baumbusch, Affleck, & Kwon, 2012). The findings of the current study identified clinical skills as the most important factor in establishing credibility and a foundation from which to build teaching expertise. Clinical competence is necessary to give credibility to the program and faculty. Nurses who have been at an expert or proficient level are more aware of how it feels to operate on a deep understanding of the clinical practice, and although it feels like they have returned to a novice level, they can quickly accommodate higher levels of performance (Evans & Donnelly, 2006). According to Joel (2013), the pattern of moving from novice to expert is not unexpected and may be coupled with a loss of confidence and anxiety. Anticipatory socialization should be a planned goal during the orientation period and not left to chance. Provide this novice group ample support with experienced faculty centered on their practice and role development.

The fourth theme, Salient Recommendations to Pass On, uncovered commentary on how they navigated through their new role transition. This study revealed that facilitating students in an unfamiliar environment was not an option for this group. Participants asserted that employment at the clinical site in the area of the adjunct's expertise was crucial for their success. The literature stresses the value of a formal orientation development program and mentoring in the transition of this faculty group (Gardner, 2014; Suplee, Gardner, & Jerome-D'Emilia, 2014; Weidman, 2013). Despite the significant importance of clinical experts in the training of nursing students, a focused faculty development was lacking for eight of nine participants in this group.

The fostering of the development of skill sets in other areas, such as leadership, assertiveness, and self-confidence, was also highlighted as an important factor in the success of the clinical adjunct in the role of clinical educator. The findings of the current study are consistent with the existing literature (Davidson & Rourke, 2012; Hewitt & Lewallen, 2010). Davidson and Rourke (2012) also emphasized the importance of the ongoing inclusion and socialization of clinical nurse instructors into the faculty to key personnel during orientation. According to Joel (2013), socialization deficits are guaranteed to inhibit role performance, introducing additional stress. In addition, certification as a nurse educator is a vehicle that promotes role acquisition and role progression with its expectation of additional education and investment in practice.

The current study has some limitations that should be addressed in future research. First, the presence of the researcher may affect the participants' responses in unknown ways. Second, the interview data may be influenced by personal bias, emotional response, cultural sensitivity, or lack thereof. Finally, although the sample size of nine participants was appropriate for the research design, it may not be considered a true representation of all adjunct novice clinical nurse faculty.

Conclusion and Recommendations

Teaching in a clinical setting presents nurse educators with challenges and demands different from those encountered in the classroom. Unlike classroom teaching, clinical educators are faced with two distinct requirements: competence in nursing and competence in teaching. The current study results highlighted the match between the clinical and educational requirements and the clinical expertise of the adjunct set in a familiar clinical facility, which translates to success for educator and student. The workload demands, responsibilities, accountabilities, and skill sets required in job accomplishment and situated in the context of the acute nursing setting must be acknowledged to optimize the cultivation of this main faculty group. Targeted, organized, and consistent efforts that will optimize adjunct faculty into the academe are essentially characterized by the relationship of the hiring institution, nursing faculty, and the novice clinical adjunct instructor. This site-based management concept allows these novice clinical adjunct instructors the opportunity to use their skills, abilities, and years of experience to arrive at the best solutions to maximize success for all stakeholders. The adjunct clinical instructor position is not a “one size fits all” job and really should be tailored to the program and setting that create the best fit. The investigation of different models of mentoring may help individual departments that lack the faculty to initiate and sustain a successful mentoring program. Replicating this study with other populations of this faculty group and finding similar results would offer additional recommendations.

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Critical Incident Form

In reflecting on the time that you have been teaching as a clinical adjunct nurse educator, please respond to the following prompts in a paragraph or two as journal entries.

Is there an incident that stands out in your mind that reflects the essence of what it means to teach as a novice adjunct clinical nurse educator?

Describe the challenges of being a novice adjunct clinical nurse educator that most never realize.

What are lessons learned from being in the role of a novice adjunct clinical nurse educator?

Provide a direct account of two personal experiences that resulted in a change or influenced you as an adjunct clinical nurse educator.

Thank you very much. Your perceptions are very important and helpful in trying to understand the adjunct novice clinical nurse educator experience.

Time Line Development Tool

In reflecting on the time that you have been in clinical nursing, and then teaching as a clinical adjunct nurse educator, please respond to the following prompts in a paragraph or two as journal entries. Time line 1

Please describe some significant events, mentors, colleagues, friends, courses, or training which you have experienced during your clinical career that facilitated your development of clinical expertise.

Time line 2

Please describe some significant events, mentors, colleagues, friends, courses, or training you have experienced during the course of your teaching.

What was the high point of your teaching career as clinical adjunct?

What was the low point of your teaching career as clinical adjunct?

What surprised you most about teaching as an adjunct novice clinical instructor?

Thank you very much. Your journal notes are very important and helpful in trying to understand your experience as an adjunct novice clinical nurse educator.

Demographics and Participant Characteristics (N = 9)

PseudonymaAgeEducation LevelCurrent Working Status as an RNPrevious Employment in AcademiaType of RN ProgramClinical SpecialtyNo. of Years Teaching as Adjunct
Pat75BSNYes PT educator, LVNYes ADNFundamentals2
Joan35MSNYes Nurse educatorNoADNCC4
Sandra55MSNYes NNP-FT PNP/PTYesADNPediatric neonatal3
Linda38MSNYes Nurse educatorNoADNOR/CC6
Mary55MSNYes Clinical nurse specialist Director of EducationNoADNCNS/adult health11
Roberta37ADNVN instructorNoADNM–S correctional.5
Suzy25Pursuing MSNClinical educatorNoADNICU2
Paula32MSNInstructorNoADNSurgery5
Tina43MSNClinical educatorYesBSNAdult health/M S/hospice/geriatrics5.5

Reasons for Becoming an Adjunct (N = 9)

PseudonymReason
PatI enjoy teaching students and I think I can make a difference.
JoanChange of pace from the OR and being on call/recruited to teach clinical.
SandraI have always enjoyed teaching. After I had obtained my graduate study, I was encouraged by my thesis chair to fill an adjunct clinical position. Prior to that, I really had not thought about teaching at the college level.
LindaChange of pace from hospital setting (OR/on call), better part time schedule.
MaryI enjoy teaching and working with students at the bedside.
RobertaI enjoy teaching very much. I realized the value of education and how important it is, and being able to help others.
SuzyI enjoy working with students.
PaulaRecruited, easier part-time job for family and being on call.
TinaI enjoy teaching and prior experience as lead teacher in didactic program.
Authors

Dr. Mann is Professor, Department of Nursing, Howard College, Big Spring, Texas; and Dr. De Gagne is Associate Professor, School of Nursing, Duke University, Durham, North Carolina.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Carol Mann, PhD, RN, CRNA, CNE, Professor, Department of Nursing, Howard College, 1001 Birdwell Lane, Big Spring, TX 797920; e-mail: cmann@howardcollege.edu.

Received: May 04, 2016
Accepted: October 26, 2016

10.3928/00220124-20170321-07

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