High fidelity full sized human patient simulation manikins: Effects on decision making skills of nursing students

Background: The continued use of high fidelity full sized human patient simulation manikins (HF-HPSMs) for developing decision making skills of nursing students has led to growing research focusing its value on student learning and decision making skills. Methods: In October 2012, a cross-sectional survey using the 24-item Nurse Decision-Making Instrument was used to explore the decision making process of 232 pre-registration nursing students (age 22.0 + 5.4; 83.2% female) in Singapore. Results: The independent samples t-tests demonstrated three significant predictive indicators. These indicators include: prior experience in high fidelity simulation based on pre-enrolled nursing course (t = 70.6, p = .001), actual hands-on practice (t = 69.66, p < .005) and active participation in debrief (t = 70.11, p < .005). A complete experience based on role-playing followed by active discussion in debrief was a significant contributor to the decision making process (t = 73.6667, p < .005). However, the regression model indicated active participation in debrief as a significant variable which explained its development (t = 12.633, p < .005). Conclusions: This study demonstrated the usefulness of active participation in simulation learning for an analytic- intuitive approach to decision making, however active participation in debrief was a more important influencing element than role-playing. In situations where resources are limited for students to experience hands-on role-playing, peer reviewing and feedback on others’ experiences could benefit students, just as much. However, further study is warranted to determine the development of HF-HPSMs as a pedagogic tool for enhancing the decision making process of nursing students

Caring behaviours of student nurses: Effects of pre-registration nursing education

In an increasing technologised and cost-constrained healthcare environment, the role of pre-registration nursing education in nurturing and developing the professional caring disposition of students is becoming far more critical than before. In view of this growing demand, the aim of this study was to evaluate the impact of Singapore's pre-registration nursing programmes on students' concept of caring. A descriptive quantitative cross-sectional survey collected data using the Caring Behaviour Inventory from first and final year student nurses, nurse lecturers and nurses in practice. The findings based on student surveys indicated a statistically significant reduction in the overall level of caring behaviour in first to final year students. When compared with the findings of lecturers and nurses, less variance to lecturers than to nurses was found amongst the first years' score, and the lowest variance to nurses was demonstrated amongst the final year. A greater reduction was evidenced amongst Singaporean students, which was exaggerated with exposure to pre-enrolled nursing education and magnified with caring job experience. This study indicates more effort is necessary to harness student caring attributes in students' entire educational journey so that expressive caring is not subsumed in the teaching of students to meet demands of complicated contemporary care

Country and climate: Journeys toward the decolonial option among non-indigenous climate activists

Climate and environmental activism have long grappled with concerns of First Nations’ land, rights, and sovereignty in the Australian settler-colonial context.  However, analyses of environmental campaigns indicate that there are tensions with the realities of  decolonial praxis in the intersubjective exchange among Indigenous and non-Indigenous people. We aimed to respond to and work alongside First Nations’ agendas in this space in by making visible the role of coloniality, interrogating complicity and colonial narcissism, and exploring ways in which non-Indigenous climate activists understand and traverse the decolonial option in order to disrupt hegemonic systems of colonial violence. From the thematic analysis of interviews with five non-Indigenous climate activists from around Australia, four major themes emerged: development of positionality awareness, negotiation of positionality, decolonial imaginings, and a shared journey of (un)learning. These findings illustrate the shifts in subjectivities, the imaginings of decolonial futures, the dilemmas of navigating competing discourses, and the fundamental importance of ongoing learning and unlearning with one another in authentic dialogue.  Considerations for future research and decolonial climate activism actions are explored

Binary Decision Diagrams: from Tree Compaction to Sampling

Any Boolean function corresponds with a complete full binary decision tree. This tree can in turn be represented in a maximally compact form as a direct acyclic graph where common subtrees are factored and shared, keeping only one copy of each unique subtree. This yields the celebrated and widely used structure called reduced ordered binary decision diagram (ROBDD). We propose to revisit the classical compaction process to give a new way of enumerating ROBDDs of a given size without considering fully expanded trees and the compaction step. Our method also provides an unranking procedure for the set of ROBDDs. As a by-product we get a random uniform and exhaustive sampler for ROBDDs for a given number of variables and size

Effects of sugars on lipid bilayers during dehydration - SAXS/WAXS measurements and quantitative model

We present an X-ray scattering study of the effects of dehydration on the bilayer and chain-chain repeat spacings of dipalmitoylphosphatidylcholine bilayers in the presence of sugars. The presence of sugars has no effect on the average spacing between the phospholipid chains in either the fluid or gel phase. Using this finding, we establish that for low sugar concentrations only a small amount of sugar exclusion occurs. Under these conditions, the effects of sugars on the membrane transition temperatures can be explained quantitatively by the reduction in hydration repulsion between bilayers due to the presence of the sugars. Specific bonding of sugars to lipid headgroups is not required to explain this effect

Kinetics of the lamellar gel-fluid transition in phosphatidylcholine membranes in the presence of sugars

Phase diagrams are presented for dipalmitoylphosphatidylcholine (DPPC) in the presence of sugars (sucrose) over a wide range of relative humidities (RHs). The phase information presented here, determined by small angle X-ray scattering (SAXS), is shown to be consistent with previous results achieved by differential scanning calorimetry (DSC). Both techniques show a significant effect of sucrose concentration on the phase behaviour of this phospholipid bilayer. An experimental investigation into the effect of sugars on the kinetic behaviour of the gel to fluid transition is also presented showing that increasing the sugar content appears to slightly increase the rate at which the transition occurs

Equatorial and related non-equilibrium states in magnetization dynamics of ferromagnets: Generalization of Suhl's spin-wave instabilities

We investigate the nonlinear dynamics underlying the evolution of a 2-D nanoscale ferromagnetic film with uniaxial anisotropy in the presence of perpendicular pumping. Considering the associated Landau-Lifshitz spin evolution equation with Gilbert damping together with Maxwell equation for the demagnetization field, we study the dynamics in terms of the stereographic variable. We identify several new fixed points for suitable choice of external field in a rotating frame of reference. In particular, we identify explicit equatorial and related fixed points of the spin vector in the plane transverse to the anisotropy axis when the pumping frequency coincides with the amplitude of the static parallel field. We then study the linear stability of these novel fixed points under homogeneous and spin wave perturbations and obtain a generalized Suhl's instability criterion, giving the condition for exponential growth of P-modes under spin wave perturbations. Two parameter phase diagrams (in terms of amplitudes of static parallel and oscillatory perpendicular magnetic fields) for stability are obtained, which differ qualitatively from those for the conventional ferromagnetic resonance near thermal equilibrium and are amenable to experimental tests.Comment: 23 pages, 5 figures, To appear in Physica

A quasi-experiment to evaluate the effects of a blended approach of simulation learning and podcasting on caring behaviours

Background: The need for quality nursing personnel in clinical practice expected nurse teachers to be able to impart instrumental and expressive aspects of caring behaviours to nursing students. Operating in a resource-limited higher educational context, nurse teachers are required to do so in a cost effective way. This study as part of a larger study evaluated the effects of a blended approach to learning of caring behaviours based on ‘modified’ medium-fidelity simulation scenarios and podcasting to repeat debriefs. Methods: This study employed a quasi-experimental, two group pre-test-post-test design. The study included 146 second year nursing students. Participants were divided into ‘intervention’ and ‘control’ groups and were asked to complete a caring behaviour inventory scale at various stages of the research study. Results: Students in the intervention group scored statistically higher, post receiving medium-fidelity simulation learning and higher post podcasting. The exposure to high fidelity simulation learning has resulted in the lower scoring in control group. Conclusions: This study highlights the value of a blended approach based on medium-fidelity simulation learning and podcasting. Successful learning of caring behaviours lies in the heart of a care-oriented teaching approach rather than the use of sophisticated technologies. This study has implications for a better practice in nursing education for developing student caring behaviours, it also has a wider implication for all vocational and non-nursing healthcare education

Health Risk Behaviors in Insured and Uninsured Community Health Center Patients in the Rural US South

Introduction: The impact of health behaviors on the leading causes of death across the USA has been well demonstrated. However, limited focus has been placed on the leading health risk behaviors of rural Federally-Qualified Health Center (FQHC) patients, a particularly underserved group. The current study was undertaken to examine the most common risk-taking behaviors of rural FQHC patients and to examine if risk-taking behaviors vary between insured and uninsured patients. Methods: A convenience sample of 199 patients was recruited at an FQHC in the rural US South. Participants completed a battery of demographic and health risk behavior assessments. Results: The most common risk behaviors were eating fried foods, not eating five servings of vegetables per day, not eating three servings of fruit per day, drinking caloric beverages, not exercising regularly, not wearing a seatbelt, having sex without a condom and smoking. Uninsured patients were more likely to talk on their cell phones while driving (p Conclusions: Rural FQHC patients demonstrated high levels of behavioral and health risk-taking, including dietary-, exercise- and traffic-related risks, in a context where traditional prevention methods have failed to penetrate. Differences exist between insured and uninsured patients, indicating that the reasons behind behavioral risk-taking may be context-specific and need to be explored further to help identify intervention targets that are culturally and situationally appropriate for diverse rural groups

Phospholipid membrane protection by sugar molecules during dehydration - insights into molecular mechanisms using scattering techniques

Scattering techniques have played a key role in our understanding of the structure and function of phospholipid membranes. These techniques have been applied widely to study how different molecules (e.g., cholesterol) can affect phospholipid membrane structure. However, there has been much less attention paid to the effects of molecules that remain in the aqueous phase. One important example is the role played by small solutes, particularly sugars, in protecting phospholipid membranes during drying or slow freezing. In this paper, we present new results and a general methodology, which illustrate how contrast variation small angle neutron scattering (SANS) and synchrotron-based X-ray scattering (small angle (SAXS) and wide angle (WAXS)) can be used to quantitatively understand the interactions between solutes and phospholipids. Specifically, we show the assignment of lipid phases with synchrotron SAXS and explain how SANS reveals the exclusion of sugars from the aqueous region in the particular example of hexagonal II phases formed by phospholipids