The effect of a structured internship on the clinical performance of novice nurses?

Objective: The study examined the clinical performance differences of novices before and after a critical care internship and compare their performance attributes to a reference group comprised of experienced critical care nurses. The extant research regarding clinical internship programs has focused on retention in practice, workforce issues and competence. While studies have shown a pattern of improved retention in practice settings, they have failed to objectively measure actual clinical performance. Methods: The study design was based on pre-post comparisons of novice nurses and a reference group comprised of experienced nurses who served as a benchmark. The novice group was required to respond to patient needs in high-fidelity clinical scenarios before and after an internship. The experienced nurses attended a single testing session. Results: Findings revealed statistically significant improvement in the performance of the novice group; however, they failed to perform at the level of the experienced nurses. Conclusions: The study is the first to detail the degree to which a structured internship can facilitate changes in selected aspects of clinical performance. The study establishes the effect associated with engagement in a structured internship. While novices improve significantly, they fail to achieve the level of clinical performance seen in experienced nurses. The paper will present background information related to the established effects of internship programs, and will then present the data related to the current study. The paper will then present similarities and differences between the results of the current study, and the literatur

The legal and human rights basis of HIV positive undocumented African migrants’ access to healthcare services in the UK and US: a non-governmental organization based study

This thesis established the relationship between actual practices, law and human rights in HIV positive undocumented African migrants’ quest to gain health related services in the United Kingdom and the United States. The thesis establishes this through an examination of extant law and literature and an empirical exploration of actual practices. The empirical component of the thesis is based methodologically upon the Grounded Theory Method. Data was collected from various Non-Governmental Organizations within each of the respective countries. The arguments and conclusions of the thesis hinge on the interaction between laws that facilitate or prevent access to health services under humanitarian grounds in the respective nations. The major theoretical concern identified in the study centers upon the moment at which the individual migrant loses their legal status. In the case of the UK, this generally occurs after the application and appeal for asylum have failed. In the US, the majority of persons experience this loss of legal status far earlier, since few Africans enter the country incident to asylum applications. The results of the thesis considerable inconsistencies in the implementation of law in the case of both countries, and establishes the governmental and nongovernmental factors that influence the provision of such services. While services continue to be available in life threatening circumstances, there is currently no legally mandated point prior to this that care is mandated. Thus, the initially degradation of health in the case of people living with HIV/AIDS is inevitable. The domestic laws of the UK and US are equivalent in that both guarantee care only in cases where life is acutely threatened. The functional aspects of the two systems are significantly different. In the case of the US, there are few programs that offer government funded care to even legal citizens, thus care for even legal migrants is difficult to obtain. The UK conversely is characterized by near universal access to general practitioners with patchy access to consultants who provide HIV related care. In the cases of both countries, there is a likelihood that an individual may receive HIV related care and later be denied care resulting in the eventual deterioration of there health. The thesis concludes that there is need for reconsideration of the current approach to law in both the UK and US, given existing international human iv rights declarations. In the context of HIV/AIDS, this is particularly profound given the chronic nature of the disease, its amenability to treatment, and the inevitability of death in cases where treatment is withheld

Option generation and decision making in critical-care nursing

The recognition-primed decision (RPD) model and Take the First (TTF) heuristic assert that successful and experienced decision makers typically generate relatively few options, and generate a satisficing, or the best, option first. Moreover, the TTF heuristic suggests that as more options are generated the likelihood that the best option will be selected is reduced. An alternative proposal suggests that the ability to anticipate the outcome of a situation is actually positively related to the number of options generated. To test these opposing claims we compared high and low performing critical-care nurses on three simulated critical care scenarios and measured their option generation behaviors and the courses of action pursued. Consistent with RPD and TTF, the data suggest that high performers generate fewer options than low performers during situational assessment. However, counter to RPD and TTF, the current data suggest that the selection of options generated later in the process may actually facilitate better outcomes. Implications for the design of instruction and training materials are discussed. Copyright 2010 by Human Factors and Ergonomics Society, Inc. All rights reserved

Learning at the edge: The role of mentors, coaches, and their surrogates in developing expertise

Mentoring and coaching are effective and sometimes necessary strategies to foster the development of expertise. However, these learning enhancement methods are multifactorial and often ambiguously characterized. The goal of this chapter is to unpack this complex interactional relationship to more fully describe what it means to be an effective coach/mentor, and to better understand their role in developing expertise. Specifically, this chapter provides: (1) a detailed description of the different components and functions of mentoring, coaching, and preceptorship; (2) a summary of the meta-analytic evidence supporting the effectiveness of developmental support roles on a range of outcome measures (e.g., job performance); (3) a review of the empirical evidence supporting the development of expertise in mentoring-type roles; and (4) concluding remarks summarizing some of the major issues, and suggestions for how to advance this area of research