Efficacy of African American Grandmothers Regarding the Education of Custodial Grandchildren

The roles of grandparents, from occasional helpers to custodial adults in their grandchildren\u27s lives, often raise levels of social discomfort among those involved,; especially when the children are still in elementary school. A disproportionate number of custodial grandparents are African American women. This phenomenological study explored the lived experiences of 8 custodial African American grandmothers in Delaware regarding the education of their school-aged grandchildren. The theoretical foundation was Carter and McGoldrick\u27s theory of families as interconnected systems, and Sands, Goldberg-Glen, Shin, and Robin\u27s theory that life event changes often lead to stress and coping strategies. Data were collected through in-depth interviews and analyzed using open and axial coding to reveal common themes. The grandmothers saw themselves as surrogate parents to their grandchildren and depended on support programs to help with their grandchildren\u27s education. A recommendation is for school districts to build relationships with these African American grandmothers to help facilitate the education of their grandchildren and provide effective and affordable services. Disseminating the findings to educational leaders could lead to the development of more programs to assist custodial African American grandmother families, thus promoting social change

Clinical Nursing Reasoning in Nursing Practice: A Cognitive Learning Model based on a Think Aloud Methodology

Background. The current context of increasingly complex nursing care requires a high level of clinical reasoning in nursing practice. Still, teaching clinical reasoning in nursing remains a challenge for educators in the field. Although several studies have been conducted to try to understand clinical reasoning in nursing, neither its developmental stages nor the corresponding critical milestones have been uncovered. Therefore, nursing educators cannot rely on a cognitive learning model (a description of how people learn and develop a specific competency) to facilitate the learning of this crucial competency. Objectives. This study was conducted to develop a cognitive learning model of clinical reasoning in nursing, from the beginning of education to the development of expertise, highlighting the critical milestones corresponding to each stage. Design. A descriptive design based on the think aloud method was used. Settings and participants. The study was held in one university and two associated hospitals. Individual interviews were conducted with 45 undergraduate nursing students and 21 registered nurses (RN). Participants were asked to think aloud, using five clinical scenarios that were validated in a previous study. Analysis. Interviews were transcribed verbatim and subsequently analyzed using the protocol analysis method recommended for think aloud studies. Results. Five developmental stages and their related critical milestones were identified and used in the elaboration of a cognitive learning model for clinical reasoning in nursing: (1) internalization of the idea that nursing is a scientific profession; (2) learning to read and use scientific literature in care planning and nursing interventions; (3) learning to move from data collection to hypothesis generation to nursing interventions; (4) integrating wards’ routines and protocols; (5a) towards professional expertise or (5b) towards task-oriented practice. Conclusion. Recommendations for teaching and learning clinical reasoning in nursing during initial and continuing education in nursing are suggested. _________________ Contexte. Le contexte actuel de soins infirmiers de plus en plus complexes exige un niveau élevé de raisonnement clinique. L’enseignement et l’apprentissage du raisonnement clinique représentent un défi pour la formation infirmière. L’utilisation d’une approche par compétences (APC) de deuxième génération pour la formation en sciences infirmières (initiale et continue) demande un modèle cognitif d’apprentissage (MCA) conçu avec rigueur pour chacune des compétences. Le raisonnement clinique en sciences infirmières constitue une compétence essentielle de la pratique infirmière; il est donc urgent d’élaborer un MCA pour cette compétence. Même si plusieurs études ont été menées pour comprendre le raisonnement clinique infirmier, aucune n’a porté sur ses étapes de développement ni sur les apprentissages critiques de ces étapes. Objectifs. Une étude a été menée pour élaborer un MCA du raisonnement clinique infirmier, du début de l’apprentissage à l’expertise, tout en faisant ressortir les apprentissages critiques qui correspondent à chaque étape de développement. Conception. Un devis descriptif fondé sur la méthode de réflexion à voix haute a été utilisé. Méthodologie. L’étude a été réalisée dans une université et deux centres hospitaliers affiliés. Des étudiantes (n=41) et des infirmières soignantes (n=25) ont été invitées à réfléchir à voix haute pendant des entrevues individuelles, sur 5 vignettes cliniques validées dans une étude antérieure. Résultats. La méthode d’analyse de protocole a été utilisée afin de définir les apprentissages critiques et les étapes de développement correspondantes. D’abord, les étudiantes doivent s’approprier l’idée que les sciences infirmières sont une profession scientifique et apprendre à lire des écrits scientifiques. Ensuite, les étudiantes et les infirmières doivent procéder à un processus itératif entre la collecte de données et l’élaboration d’hypothèses, au lieu de se reposer sur les routines et les protocoles des services. Conclusion. Des recommandations ont été formulées pour l’enseignement et l’apprentissage du raisonnement clinique infirmier pendant la formation initiale et continue des infirmières

Coconstruction d'un modèle cognitif et l'apprentissage d'une compétence en vue d'assurer la validité et l'équité de son évaluation : le cas de la compétence "Exercer un jugement clinique infirmier

L'évaluation des compétences comporte des enjeux éthiques reliés à la validité et l'équité des inférences évaluatives. Ces valeurs édumétriques sont fortement compromises lorsque l'objet et les critères d'évaluation ainsi que les pratiques évaluatives des évaluateurs ne tiennent pas compte des caractéristiques du concept de compétence, notamment son caractère développemental. Un système d'évaluation des compétences fondé sur le modèle cognitif de l'apprentissage, congruent avec le concept de compétence, est plus susceptible d'assurer la validité et l'équité des inférences évaluatives. La compétence "Exercer un jugement clinique infirmier" fut choisie pour élaborer un modèle cognitif de l'apprentissage pour les trois années de formation au baccalauréat en sciences infirmières. De plus, des indicateurs de développement ont été identifiés pour les trois niveaux de développement de cette même compétence. Une approche collaborative a été privilégiée pour atteindre ces objectifs. Le groupe collaboratif, composé de trois tutrices, de trois infirmières-monitrices et de la chercheuse, a analysé six récits d'expérience d'évaluation de cette compétence chez des étudiants de ce programme. L'analyse des données a conduit à une première version du modèle cognitif de l'apprentissage de la compétence "Exercer un jugement clinique infirmier" qui fut validée et améliorée par les partenaires de recherche. La logique de progression des apprentissages critiques et la concrétisation de ceux-ci par les indicateurs de développement ont été confirmées par des experts académiques. Les résultats montrent également des interinfluences entre les paramètres de cette compétence qui appuient la nécessité de réaliser tous les apprentissages critiques d'un même niveau pour l'atteindre. Les retombées de cette étude concernent les programmes de formation en sciences infirmières ainsi que ceux destinés à l'intégration des nouvelles infirmières dans les milieux cliniques. Les résultats de l'étude incitent aussi à poursuivre des recherches ultérieures pour compléter ce modèle cognitif de l'apprentissage et également à en construire pour d'autres compétences professionnelles

Bronze Age and Early Saxon activity at Dagenham Heathway, London Borough of Barking and Dagenham

Excavations by Pre-Construct Archaeology Ltd in advance of development of a former school playing field at Dagenham Heathway, in the London Borough of Barking and Dagenham, revealed prehistoric archaeology, dominated by two phases of Late Bronze Age activity. This comprised a series of ditched fields with possible stock management elements, which was superseded by an enclosed settlement containing three roundhouses. The site was not reoccupied again until the Early Saxon period, when a different type of agrarian settlement was established. During either the Middle or Late Saxon period the site was abandoned and another series of field ditches was laid out

A conceptual framework of student professionalization for health professional education and research

Objectives To present a conceptual framework of student professionalization for health professional education and research. Methods Synthesis and discussion of a program of research on competency-based education. Results Competency-based education relies on active, situation-based group learning strategies to prepare students to become health professionals who are connected to patient and population needs. Professionalization is understood as a dynamic process of imagining, becoming, and being a member of a health profession. It rests on the evolution of three interrelated dimensions: professional competencies, professional culture, and professional identity. Professionalization occurs throughout students’ encounters with meaningful learning experiences that involve three core components: the roles students experience in situations bounded within specific contexts. Educational practices conducive to professionalization include active learning, reflection, and feedback. Conclusions This conceptual framework drives a research agenda aimed at understanding how students become health professional and how learning experiences involving action, reflection, and feedback foster that process and the advancement of professional practices

Multicentre implementation of a nursing competency framework at a provincial scale : a qualitative description of facilitators and barriers

Rationale : Nurses are responsible for engaging in continuing professional development throughout their careers. This implies that they use tools such as competency frameworks to assess their level of development, identify their learning needs, and plan actions to achieve their learning goals. Although multiple competency frameworks and guidelines for their development have been proposed, the literature on their implementation in clinical settings is sparser. If the complexity of practice creates a need for context-sensitive competency frameworks, their implementation may also be subject to various facilitators and barriers. Aims and Objectives : To document the facilitators and barriers to implementing a nursing competency framework on a provincial scale. Methods : This multicentre study was part of a provincial project to implement a nursing competency framework in Quebec, Canada, using a three-step process based on evidence from implementation science. Nurses’ participation consisted in the self-assessment of their competencies using the framework. For this qualitative descriptive study, 58 stakeholders from 12 organizations involved in the first wave of implementation participated in group interviews to discuss their experience with the implementation process and their perceptions of facilitators and barriers. Data were subjected to thematic analysis. Results : Analysis of the data yielded five themes: finding the ‘right unit’ despite an unfavourable context; taking and protecting time for self-assessment; creating value around competency assessment; bringing the project as close to the nurses as possible; making the framework accessible. Conclusion : This study was one of the first to document the large-scale, multi-site implementation of a nursing competency framework in clinical settings. This project represented a unique challenge because it involved two crucial changes: adopting a competency-based approach focused on educational outcomes and accountability to the public and valorizing a learning culture where nurses become active stakeholders in their continuing professional development

Évaluation objective structurée de l’animation du débriefing (ÉOSAD) : traduction, adaptation et validation d’une rubrique

Contexte : Le débriefing en simulation clinique requiert des habiletés d’animation de la part des formateurs. Bien que des outils d’évaluation validés existent et pourraient servir à leur formation, ils sont uniquement disponibles en anglais et ne sont pas adaptés à la réalité québécoise. But : (1) Traduire une rubrique d’évaluation de la qualité de l’animation du débriefing (Objective Structured Assessment of Debriefing) en français et l’adapter au contexte québécois ; et (2) en tester la validité et la fidélité dans un contexte de formation en sciences infirmières. Méthodes : La rubrique a été traduite et adaptée par trois traducteurs indépendants. Des experts en simulation (n = 11) en ont validé le contenu selon une méthode Delphi modifiée. La rubrique traduite a été mise à l’essai auprès d’animateurs en simulation (n = 10) qui ont évalué la qualité de débriefings filmés (n = 16). Résultats : La rubrique présente une forte validité de contenu selon les experts et une forte validité concomitante en comparaison avec un score d’évaluation générale du débriefing. Les résultats pour les fidélités interjuges et test-retest montrent une variabilité dans l’attribution des scores par les animateurs de débriefing. Conclusion : La rubrique fournit un langage et des critères communs pour évaluer la qualité d’animation des débriefings. Elle pourrait servir de base à la formation des formateurs en précisant des critères de performance et des descripteurs reflétant différents niveaux de performance. Les qualités psychométriques observées suggèrent toutefois qu’une formation plus exhaustive et des modifications dans les descripteurs seraient nécessaires avant que la rubrique ne soit utilisée en contexte de recherche.Context: Educators must be skilled to facilitate debriefing after healthcare simulations. While tools to assess the quality of debriefing exist and could guide educators’ training, they are only available in English and are not adapted to the reality of Quebec. Purpose: (1) To translate a rubric to assess the quality of debriefing (Objective Structured Assessment of Debriefing) in French and adapt it to the context of Quebec; and (2) to test the validity and fidelity of the translated and adapted rubric. Methods: Three independent translators translated and adapted the rubric. Simulation experts (n = 11) validated the rubric’s content through a modified Delphi process. The translated rubric was piloted with a sample of simulation educators (n = 10) whom assessed the quality of recorded debriefings (n = 16). Results: The rubric presented strong content validity according to simulation experts and strong concurrent validity when compared to a general debriefing assessment score. Results for interrater and test-retest reliability showed some variability among educators. Conclusion: The rubric offers a common language and a set of criteria to assess the quality of debriefing. The rubric could guide educators’ training by specifying performance criteria and descriptors reflecting various levels of performance. However, results regarding psychometric properties of the rubric suggest that extensive training and some modification to descriptors are required prior to its use as a research instrument

Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial

Background: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes.Methods/design: A cluster-randomised trial in 34 (2 × 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 × 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/μL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters.Discussion: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. © 2013 Iwuji et al.; licensee BioMed Central Ltd