Literature Synthesis and Summary
PICO: In nursing programs, how does the implementation of a nursing student retention toolkit (I) by faculty (P) impact the retention of undergraduate nursing students (O) compared to no toolkit (C)?
Search terms:
Nursing and student and retention on ERIC with limiters 2019 to present in academic journals and peer-reviewed
nursing and student and success and research in CINAHL. Literature Synthesis and Summary
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| Author/Title/Journal/Year Published | Purpose/Problem/Objective/Aims | Data Collection Measures | Analysis/ Outcomes | Strengths/ Limitations | Level of Evidence |
| Irwin, P., Magee, D., Weiley, S., Teakel, S., & Linden, K. (2024). Improving student success and retention in first-year nursing through embedded tutor support. Nurse Education Today, 136, 106134. https://doi.org/10.1016/j.nedt.2024.106134
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To evaluate the impact of embedded tutor support on first-year nursing students’ success and retention in a foundational nursing subject. This study addresses the challenges faced by students from diverse backgrounds, who often struggle with academic literacy and self-efficacy. | Individual assessment grades, cumulative marks for the subject, and online anonymous surveys for feedback from students, tutors, and subject convenors. These measures were designed to provide both quantitative and qualitative insights into the effectiveness of the tutoring intervention. | Statistical analysis showed significant improvement in grades for students who met with embedded tutors (p < 0.05); students from equity backgrounds had a cumulative mark increase of 9-17%. Most at-risk students who received outreach support passed the course, indicating the positive impact of timely intervention on student success. | Strengths: Collaborative approach, timely intervention, and a positive impact on student self-efficacy and academic literacy.
Limitations: The study focused on a single discipline, which may limit generalizability, and constraints on tutor availability may have affected overall participation rates. |
Level 2 |
| Kruse, J. A., Litten, J. P., Kujawa, J., Chatman, N., & Didion, J. (2020). Project REACH: A multi-level, interdisciplinary approach to enhance student retention and success. Journal of Professional Nursing, 36(5), 364-371. https://doi.org/10.1016/j.profnurs.2020.02.005 | Aligns with tools for student success
To evaluate the REACH program’s effectiveness in supporting nursing students to increase the nursing progression and graduation rates and NCLEX exam ass rates for undergraduate nursing students from diverse or under-resourced backgrounds. A total of 35 REACH program students participated in the study. |
Survey and evaluation at program exit.
Program evaluation-feedback from students Graduation and NCLEX-RN pass rates tracking for REACH program participants |
The program demonstrated a high first-time NCLEX pass rate: 80% in year 1, 100% in year 2, and 83% in year 3.
A graduation rate of 100% REACH program students for the three years. The REACH program students also had a higher employment rate in underserved populations (97%) compared to the non-REACH students (25%), showing the program’s effectiveness in meeting the healthcare workforce/staffing needs. |
The program has a strong evidence-based framework and employed a well-tested social determinants model and CPGs. It also had comprehensive financial, academic, emotional, and mentorship support. Limitations included a short implementation period of 2 years and a limited opportunity for cultural bias and inclusion training. | Level III evidence- Quasi-experimental study design |
| Heinrich, D. & O’Connell, K. A. (2024). The effects of mindfulness meditation on nursing students’ stress and anxiety levels. Nursing Education Perspectives, 45(1), 31-36.
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This study aimed to evaluate the effectiveness of a virtual mindfulness meditation intervention in reducing stress and anxiety levels among nursing students. Given the unique challenges faced by nursing students, such as heavy workloads and clinical pressures, the research sought to determine whether mindfulness meditation could serve as a viable method for improving mental well-being in this population. | | Data were collected using a pretest-posttest randomized controlled design, with participants completing the Perceived Stress Scale (PSS) and the Generalized Anxiety Disorder-7 Scale (GAD-7) before and after the intervention. The study involved 145 nursing students, who were either assigned to receive meditation recordings or nursing-related information recordings. | Statistical analysis using a two-way mixed ANOVA revealed that participants in the experimental group who received mindfulness meditation recordings experienced significantly lower levels of stress and anxiety compared to the control group (p < 0.05). Specifically, the experimental group showed a greater decrease in both stress and anxiety levels, indicating the effectiveness of the mindfulness intervention in promoting mental health among nursing students. | Strengths of the study include its randomized controlled design and the use of validated measurement tools (PSS and GAD-7), which enhance the reliability of the findings. Additionally, the large sample size of 145 participants contributes to the generalizability of the results. Limitations include potential sampling bias, as participants were recruited via an email list, and a relatively high attrition rate of 26%, which may affect the study’s overall validity. Literature Synthesis and Summary | Level 1 RCT |
Thematic Literature Synthesis
The major themes discussed in the literature synthesis include stress and other psychological factors management, academic support and improvement in academic success/retention, other factors involved in retention, impacts beyond retention in the program to increases in nurses staying in the career, and financial impact for students/institutions.
Reducing Stress and Other Psychological Factors
The literature review aimed to find effective interventions to incorporate into a doctoral project to improve the retention of nursing students. Heinrich and O’Connell (2024) reported multiple sources that connected high stress levels in students with difficulty with academics (p. 31). The researchers used a mindfulness intervention to effectively reduce stress and anxiety in nursing students. Stress and anxiety were not measured by Kruse et al. (2020), but psychological supports were provided in their multimodal program called “Realizing Educational Attainment and Careers in Healthcare (Reach)” (p. 365). The REACH also included financial assistance and training to lessen financial concerns. In addition, Kruse et al. (2020) included referrals to social workers, supportive counseling, and success workshops. Irwin et al. (2024) did not mention stress or anxiety but did not ignore psychological impacts. They included qualitative research for their tutoring program and found students growing in confidence and demonstrating a positive attitude about getting academic help.
Academic Support
While Heinrich and O’Connell (2024) reduced student stress and anxiety and could potentially help them perform better on tests, no impact on academic success or retention was researched. The direct academic support provided by Irwin et al. (2024) with a tutoring intervention and Kruse et al. (2020) in REACH demonstrated academic effectiveness. Kruse et al. (2929) showed that the REACH program students graduated with 92%, and 91% of the graduates are employed as registered nurses- 62% in HRSA-designated professional shortage areas, compared to 24% of other students. Irwin et al. (2024) results showed that students had a 9-17% (p<0.05). However, the academic support varied. REACH provided mandatory monthly 45-minute tutoring sessions with nurse faculty, writing skills with English faculty, and individualized connections with the campus academic success center (Kruse et al.). Irwin et al. (2024) used online meetings with registered nurse (RN) teachers, online educational modules, and other supports “including Academic Skills, Library Services, Disability Services, and the [Australian] First Nations tutoring support program” (p. 5).
Other factors involved in retention
Students may become at-risk for reasons beyond academic or psychological issues. The REACH program was based on “The Nursing Undergraduate Retention and Success (NURS) Model by Jeffreys” (Kruse et al., 2020, p. 365). Based on this comprehensive model, REACH also included reducing financial strain with scholarships and stipends, training on economic management, explaining available campus resources, and providing a social worker to help find community resources (Kruse et al., 2020). Irwin et al. (2024) and Heinrich and O’Connell (2024) did not address the complexity of retaining nursing students. These factors have a vital impact on the intervention’s success.
Identifying at-risk Students
Adding to the complexity is deciding which nursing students should receive interventions. Kruse et al. (2020) put in a lot of time considering who would be recruited for the REACH interventions based on criteria including financial need and “member of a diverse population and underserved population” (p. 365). Irwin et al. (2024) chose students based on a failed assessment or failed class in the nursing program. Heinrich and O’Connell (2024) randomly provided mindfulness sessions, which resulted in a higher level of research but didn’t add to the evidence for the retention of at-risk students. The two studies showed the effectiveness of improving students’ pass rates and retention rates in the program. All students could benefit from resources provided by the REACH grant. Not all students require a tutoring resource. A systems change project for improving retention would be more practically targeted towards at-risk students to reduce costs to the institution and enhance sustainability.
Financial impact for students/institution
Before starting a program, it is vital to consider the financial impacts related to providing interventions. Kruse et al. (2020) covered two years of the multimodal REACH with a grant. Irwin et al. (2024) and Heinrich and O’Connell (2024) did not charge students for their interventions. But looking at sustainability, would tuition and fees be increased if REACH had been continued without the grant? If the cost of attending school increased, the financial burden of loans would increase unless a donor sought to cover scholarship funds. Irwin et al. (2024) note that tutoring interventions took extra faculty time, so it could potentially cost the institution more in salary. Heinrich and O’Connell (2024) did not mention costs related to their recorded mindfulness sessions.
Knowledge Application to the EBP Topic
The thematic analysis contributed vital knowledge for consideration in the EBP project. This knowledge can be applied to developing the overall design and implementation of a nursing student retention toolkit. For example, incorporating targeted support interventions such as tutoring programs, psychological interventions, and holistic student support models enhances the project’s success. Studies show academic, psychological, and financial support can improve student retention and success (Irwin et al., 2024; Kruse et al., 2020; Heinrich & 0’Connels, 2024).
The studies outcomes also suggest early identification of at-risk students based on academic performance and background, financial need, underrepresented groups, and personal challenges. In addition, the tutoring and academic support programs should be tailored to the needs of struggling students. Thus, a robust assessment should be made to identify students who need tutoring and academic support because not all at-risk students need these services. Besides tutoring and academic support, mental health and well-being initiatives such as mindfulness sessions and stress management workshops can be incorporated into the program for student mental health support. In addition, the study outcomes show that comprehensive support services are vital to help address various factors that affect student retention. The retention toolkit should also incorporate comprehensive support services to address vital factors identified in the study, such as financial strains, academic performance, social resources, and personal challenges (Kruse et al., 2020; Irwin et al., 2024). For example, the retention toolkit should include scholarships for financially needy students, peer and tutor support systems, and psychotherapists to help meet the diversified patient needs. Lastly, the literature shows the need to consider the financial implications of selected interventions. The financial impact varies significantly.
Impact of Individual Diversity Across Populations on EBP Recommendations from the Studies
Individual diversity, including socio-economic, cultural, or religious factors, comorbidities, contraindications, or baseline risks, can significantly influence the applicability and effectiveness of evidence-based recommendations derived from these findings. For example, Kruse et al. (2020) showed that financial aid and access to social resources helped improve retention rates among low-income students. The need for comprehensive support may vary in a socio-economical setting, necessitating solutions such as financial counseling or scholarships. More so, Heinrich and O’Connell’s (2024) findings on mindfulness effectiveness may not resonate with all students due to cultural or religious backgrounds related to mental health. Tailoring psychological interventions in the retention toolkit to ensure cultural sensitivity and inclusivity will be crucial. The geographical and population context may negatively impact the applicability of evidence-based recommendations. Socio-economic conditions may impact the affordability and accessibility of interventions, particularly those requiring additional resources such as tutors and scholarships. In addition, population characteristics differ in various factors, including culture, socio-cohesion, and religion, and problems that are common in a specific population may be different for another population, limiting the findings’ applicability. Irwin et al. (2024) conducted their study in Australia, and the diverse population presents a unique blend of student characteristics, limiting its application to nursing students in the US. For example, student loans in the US are easily accessible, which can help address many financial limitation factors in nurses’ student retention. Comorbidities, contraindications, and baseline risks introduce a unique set of problems and must be addressed promptly. Students with comorbidities or contraindications of specific interventions would require a change in interventions to meet their needs. Thus, individual diversity across populations may affect the applicability of research study findings.
References
Heinrich, D. & O’Connell, K. A. (2024). The effects of mindfulness meditation on nursing students’ stress and anxiety levels. Nursing Education Perspectives, 45(1), 31-36.
Irwin, P., Magee, D., Weiley, S., Teakel, S., & Linden, K. (2024). Improving student success and retention in first-year nursing through embedded tutor support. Nurse Education Today, 136, 106134. https://doi.org/10.1016/j.nedt.2024.106134
Kruse, J. A., Litten, J. P., Kujawa, J., Chatman, N., & Didion, J. (2020). Project REACH: A multi-level, interdisciplinary approach to enhance student retention and success. Journal of Professional Nursing, 36(5), 364-371. https://doi.org/10.1016/j.profnurs.2020.02.005
