Enhancing Nurse Residency Programs with High Quality Simulation and Debriefing

Inadequate clinical judgment in newly graduated nurses has been positively linked to decreased patient outcomes and lower nursing job satisfaction, compelling staff nurse educators to employ innovative evidence-based methods to remedy this known clinical-practice gap. Use of quality simulation and theory-based debriefing has been shown in the evidence to positively contribute to clinical judgment formation in novice nurses. Incorporating quality simulation and theory-based debriefing into nurse residency programs has the potential to increase job satisfaction and decrease turnover, resulting in better outcomes and quality for patients and less cost for health care organizations. Methods: This was a quasi-experimental evidence-based change project with pretest/post-test design, aimed at increasing clinical judgment and learner satisfaction in novice nurses through evidence-based teaching measures. Debriefing for Meaningful learning, a theory-based debriefing pedagogy, and quality simulation scenarios were added to an existing nurse residency program. A pre and post learner satisfaction survey, the Debriefing Experience Scale was given to measure satisfaction with program changes. The scale is a two-part 5 point Likert scale which measures the participant experience as well as areas of perceived importance. Current evidence supported the validity and reliability of the scale with student nurses, although further testing had been encouraged with other participant types. Results: A paired samples T-test correlation was conducted in comparing the pre- and post-intervention experience and importance subsets completed by the program participants. The agreement portion of the scale measured a mean of 4.54 in June, 4.47 in July and 4.42 in August. The importance portion of the scale measured a mean of 4.39 in June, 4.25 in July and 4.23 in August revealing no statistical significance with program changes. Test-retest reliability was conducted to further validate the validity and reliability of the Debriefing Experience Scale with a post-graduate, post-licensure population. The Cronbach’s alpha coefficient remained consistently greater than .894 within each month of the program. These findings further validate that the DES is a valid and reliable tool to determine participant satisfaction following a simulation and debriefing experience. Conclusions: Simulation and Debriefing for Meaningful Learning are evidence-based teaching methodologies which have been shown in the literature to positively affect clinical judgment development in participants. The data which was collected looked at the satisfaction of participants involved in a simulation and theory-based debriefing pedagogy, as compared to simulation and informal debriefing measures. Although no statistically significant increase in participant satisfaction could be empirically determined, it can be surmised that learner experience was enhanced through implemented changes. Participants reported high satisfaction with the program both pre and post implementation. As participants remained satisfied despite program changes, use of simulation and DML within residency programs can be supported. In addition, the validity and reliability of the Debriefing Experience Scale were established with a postgraduate population. These findings further validate that the DES is a valid and reliable tool to determine participant satisfaction following a simulation and debriefing experience

‘‘Bursting’’ to Go and Other Experiences: Children’s Views on Using the Toilet in the First School Year

Children’s use of the toilet at school, although rarely explored, is an important facet of school experience with consequences for physical and psychological health. A mixed methods study investigated views of 25 children (4–5 years) regarding potential stressors in the first school year, including views of toileting, in Dublin, Ireland. Despite very positive responses to school, most responses to toileting (15 of 25) were mixed or negative. Although some liked to go, or noted the toilets were clean, most indicated delayed toilet use (‘‘bursting’’ to go) and ambivalent or negative experiences such as fear of not identifying the right toilet, fear of being alone, lack of privacy, and potential bullying. Many children did not expect to receive help from the teacher. As delaying toilet use can have lasting health consequences, teacher–nurse collaboration could be used to develop whole-school policies to support children’s early adjustment in this sensitive area of functioning

‘Look, I have my ears open’: Resilience and early school experiences among children in an economically deprived suburban area in Ireland

Children from economically disadvantaged communities frequently lack the socio- emotional, cognitive and behavioural skills needed for successful early school adjustment. Assessments of early school experience often rely on parent and teacher perspectives, yet children’s views are essential to design effective, resilience-promoting school ecologies. This mixed methods study explored children’s appraisals of potential stressors in the first school year with 25 children from a disadvantaged suburban community in Ireland. School scenarios were presented pictorially (Pictorial Measure of School Stress and Wellbeing, or PMSSW), to elicit children’s perspectives on social ecological factors that enable or constrain resilience. Salient positive factors included resource provision, such as food, toys and books; school activities and routines, including play; and relationships with teachers. Negative factors included bullying; difficulties engaging with peers; and using the toilet. Drawing on these factors, we indicate how school psychologists can develop resilience-fostering educational environments for children in vulnerable communitie

LEARNING UNDER THE DREAMING SPIRES – PERSONALISATION IN OXFORD TUTORIAL (46)

Traditionally, teaching in universities has been done in lectures, example classes, and tutorials. Knowledge transfer in these forms of teaching is mainly teacher-focused and unidirectional with attempts to activate students to initiate a dialogue between students and lecturers. Oxford University has always offered tutorials as well as lectures but these tutorials are less tutor-focused because of the low number of tutees (typically 1-4 per tutorial). Thus, Oxford tutorials seem to be an instance of a personalised form of teaching and learning. In this paper, we will discuss our qualitative research into personalisation in such tutorials. In particular, we will analyse the results of observations and discuss the implications of information systems for providing personalised learning environments in and beyond these tutorials

The First Scattered Light Image of the Debris Disk around the Sco-Cen target HD 129590

We present the first scattered light image of the debris disk around HD 129590, a ~1.3 M$_\odot$ G1V member of the Scorpius Centaurus association with age ~10-16 Myr. The debris disk is imaged with the high contrast imaging instrument SPHERE at the Very Large Telescope, and is revealed by both the IRDIS and IFS subsytems, operating in the H and YJ bands respectively. The disk has a high infrared luminosity of $L_{\textrm{IR}}/L_{\textrm{star}}$~5$\times$10$^{-3}$, and has been resolved in other studies using ALMA. We detect a nearly edge on ring, with evidence of an inner clearing. We fit the debris disk using a model characterized by a single bright ring, with radius ~60-70 AU, in broad agreement with previous analysis of the target SED. The disk is vertically thin, and has an inclination angle of ~75$^\circ$. Along with other previously imaged edge-on disks in the Sco-Cen association such as HD 110058, HD 115600, and HD 111520, this disk image will allow of the structure and morphology of very young debris disks, shortly after the epoch of planet formation has ceased.Comment: 8 pages, 4 figures. Accepted for publication in ApJ

Application of “omics” to Prion Biomarker Discovery

The advent of genomics and proteomics has been a catalyst for the discovery of biomarkers able to discriminate biological processes such as the pathogenesis of complex diseases. Prompt detection of prion diseases is particularly desirable given their transmissibility, which is responsible for a number of human health risks stemming from exogenous sources of prion protein. Diagnosis relies on the ability to detect the biomarker PrPSc, a pathological isoform of the host protein PrPC, which is an essential component of the infectious prion. Immunochemical detection of PrPSc is specific and sensitive enough for antemortem testing of brain tissue, however, this is not the case in accessible biological fluids or for the detection of recently identified novel prions with unique biochemical properties. A complementary approach to the detection of PrPSc itself is to identify alternative, “surrogate” gene or protein biomarkers indicative of disease. Biomarkers are also useful to track the progress of disease, especially important in the assessment of therapies, or to identify individuals “at risk”. In this review we provide perspective on current progress and pitfalls in the use of “omics” technologies to screen body fluids and tissues for biomarker discovery in prion diseases

Longitudinal Health Outcomes and Treatment Utilization Among Emerging, Early-Mid, and Older Rural Adults Using Stimulants

There is limited knowledge about age-related differences in health outcomes and treatment utilization among rural stimulant users. The current study examined physical health, mental health, and treatment utilization (hospital, mental health, and substance use care) among 710 stimulant users living in rural areas of the United States. Generalized estimating equations (GEE) were used to examine associations between age and physical health, mental health, and treatment utilization over a 3-year period. Analyses controlled for participants’ gender, race, and education. To capture age-related differences, participants were grouped into emerging adults (18–25 years old, n = 223), early-mid adults (26–44 years old; n = 384), and older adults (45–61 years old; n = 103). At baseline, older stimulant users were in significantly poorer health even though they had significantly fewer substance use problems than emerging adult users. GEE models indicated that substance use outcomes improved for all participants over the course of the study but other outcomes remained stable. Older stimulant users continued to have worse physical health and mental health, even though they had fewer substance use problems, than the other age groups. Older adults also used more hospital and mental health services than the other age groups. White participants tended to be at higher risk for negative outcomes than nonwhite participants. We conclude that rural older adults who use stimulants have poor health despite having milder substance use problems and using more health care resources, and need targeted intervention to improve health outcomes

Video guide to design flexible DNA.mp4

Model file name: Video guide to design flexible DNA.mp4 Authors: Michelle E Howell, Karin van Dijk, Christine S Booth, Tomas Helikar, Brian A Couch, Rebecca L Roston This 30-minute video includes step-by-step instructions to design and 3-D print a long flexible DNA model that mimics the structure and function of DNA. The instructions are applicable for designing the model using open-source 3-D computer graphics software Blender 2.79 which is available for download at https://www.blender.org/download/. .mp4 file download (70 MB) below