Effect of Sequence of Simulated and Clinical Practicum Learning Experiences on Clinical Competency of Nursing Students

Two different sequences of blocks of simulated and clinical practicum learning experiences compared the clinical competency development of nursing students using a randomized crossover design. Competency was measured 3 times: after each block of simulated and clinical experiences and after a final simulated experience. No significant differences in competency scores between the 2 groups across the 3 time points were found. Using alternative models of clinical and simulation learning may help address barriers to the delivery of clinical education faced by schools of nursin

Effect of Sequence of Simulated and Clinical Practicum Learning Experiences on Clinical Competency

Delivery of clinical education using the traditional model involving faculty supervision of students in a hospital setting has become increasingly difficult for schools of nursing due to factors such as increased student enrollment and decreased clinical site availability. Simulated learning experiences (SLE) have increasingly been used as a supplement or replacement for a portion of nursing students’ traditional clinical learning experiences (CLE). There has been a call for research to ensure that new models for delivery of clinical education are built on a foundation of research. Although SLE have been increasingly used as a supplement to CLE, it is unknown if the sequence in which these learning experiences occur affects nursing students’ clinical competency development. This study was guided by the NLN/Jeffries’ Simulation Framework and employed a crossover design to explore the effects of age and sequence of blocks of SLE and CLE on clinical competency development. Forty-eight nursing students in their first medical surgical practicum rotation participated. Participants were randomly assigned to one of two group sequences of simulated and clinical practicum learning experiences over the course of one semester. Clinical competency assessment using the Creighton Competency Evaluation Instrument (CCEI) occurred at three time periods: (1) During a designated simulation vignette at the end of participants’ SLE rotation; (2) During a preselected clinical day/single patient encounter occurring in the final week of participants’ CLE rotation; and (3) After completion of the semester during a follow up simulation vignette. Repeated measures analysis of variance was used to determine if CCEI total scores or subscale scores differed over the three measurement time points within or between the two groups. Results demonstrated no significant differences in CCEI total or subscale scores between the two groups across the three data collection points. There was also no significant effect of age and group on CCEI total scores or subscales. The use of sequences of blocks of SLE and CLE may help address barriers in delivery of traditional clinical education faced by schools of nursing such as increased student enrollment and lack of clinical site availability, but further study is needed

Assessing the Mechanics of Two Earthquake Clusters in the Basin and Range Province

The seismicity in the Basin and Range Province of the western United States often manifests as clusters of earthquakes occurring over brief windows of time, lasting from months to years. Two different earthquake clusters occurring between 2014 and 2018, near Challis, Idaho and northwestern Nevada, were assessed in this study. The seismic activity in the southeastern section of the Challis cluster began with a M5.2 earthquake that was likely the main-shock earthquake in an aftershock sequence. The northwestern section of the Challis cluster does have several potential candidates for a main-shock earthquake, but none have been identified as a start to a true aftershock sequence, and there is no distinct spatial progression noted. Similarly, the Sheldon cluster also does not have a distinct spatial progression or main-shock earthquake. Using the classification method described by Vidale and Shearer in their 2006 paper, I analyzed the statistical, temporal, and spatial characteristics of both clusters to see how these two clusters compare. For the Challis region, the two sections of the cluster appear to have different driving mechanisms. While the northwest cluster falls under the “average” classification, the southeast cluster is categorized as “aftershock-like” sequence, suggesting that the southeast cluster is related to the Lost River Fault System. The northwest cluster’s seismicity may be due to hydrothermal activity, as there are several hot springs in the area. The Sheldon cluster, whose hypocentral distribution resembles a tube or a ball when mapped in 3D, falls under the classification of “swarm-like.” The driving mechanism for this cluster is more difficult to determine, as there is no history of seismicity in this area, though there is some history of relatively recent magmatism and some currently active hot springs

Commodity definition and content validity in stated preference valuation: a meta-analysis of water quality welfare estimates

Thesis (M.S.) University of Alaska Fairbanks, 2013This paper applies a meta-analysis to investigate variation in willingness to pay estimates that arise from the use of different commodity descriptions in stated preference valuation surveys. To maintain commodity consistency, the data set for this meta-analysis is composed of willingness to pay estimates from contingent valuation, conjoint analysis, and choice experiment studies valuing water quality change in surface water bodies in the United States. The analysis uses an ordinary least squares regression with a cluster command to correct for potential correlation between observations drawn from the same study. The primary contribution of this study is the identification of systematic variation across stated preference studies resulting from changes in how the environmental commodity is presented and defined. By identifying the directional effect of these differences, this analysis provides insight into interpreting stated preference estimates and guidance for producing well-designed stated preference studies capable of eliminating bias and context effects

The Impact of Simulation Sequencing on Perceived Clinical Decision Making

An emerging nursing education trend is to utilize simulated learning experiences as a means to optimize competency and decision making skills. The purpose of this study was to examine differences in students\u27 perception of clinical decision making and clinical decision making-related self-confidence and anxiety based on the sequence (order) in which they participated in a block of simulated versus hospital-based learning experiences. A quasi-experimental crossover design was used. Between and within group differences were found relative to self-confidence with the decision making process. When comparing groups, at baseline the simulation followed by hospital group had significantly higher self-confidence scores, however, at 14-weeks both groups were not significantly different. Significant within group differences were found in the simulation followed by hospital group only, demonstrating a significant decrease in clinical decision making related anxiety across the semester. Finally, there were no significant difference in; perceived clinical decision making within or between the groups at the two measurement points. Preliminary findings suggest that simulated learning experiences can be offered with alternating sequences without impacting the process, anxiety or confidence with clinical decision making. This study provides beginning evidence to guide curriculum development and allow flexibility based on student needs and available resources

Origin of anomalous breakdown of Bloch's rule in the Mott-Hubbard insulator MnTe2_2

We reinvestigate the pressure dependence of the crystal structure and antiferromagnetic phase transition in MnTe$_2$ by the rigorous and reliable tool of high pressure neutron powder diffraction. First-principles density functional theory calculations are carried out in order to gain microscopic insight. The measured N\'eel temperature of MnTe$_2$ is found to show unusually large pressure dependence of $12$ K GPa$^{-1}$. This gives rise to large violation of Bloch's rule given by $\alpha=\frac{d\log T_N}{d\log V}=-\frac{10}{3} \approx -3.3$, to a $\alpha$ value of -6.0 $\pm$ 0.1 for MnTe$_2$. The ab-initio calculation of the electronic structure and the magnetic exchange interactions in MnTe$_2$, for the measured crystal structures at different pressures, gives the pressure dependence of the Ne\'el temperature, $\alpha$ to be -5.61, in close agreement with experimental finding. The microscopic origin of this behavior turns to be dictated by the distance dependence of the cation-anion hopping interaction strength

Nursing Student Perceptions Regarding Simulation Experience Sequencing

BACKGROUND: The use of simulated learning experiences (SLEs) have increased within nursing curricula with positive learning outcomes for nursing students. The purpose of this study is to explore nursing students\u27 perceptions of their clinical decision making (CDM) related to the block sequencing of different patient care experiences, SLEs versus hospital-based learning experiences (HLEs). METHOD: A qualitative descriptive design used open-ended survey questions to generate information about the block sequencing of SLEs and its impact on nursing students\u27 perceived CDM. RESULTS: Three themes emerged from the data: Preexperience Anxiety, Real-Time Decision Making, and Increased Patient Care Experiences. CONCLUSION: Nursing students identified that having SLEs prior to HLEs provided several benefits. Even when students preferred SLEs prior to HLEs, the sequence did not impact their CDM. This suggests that alternating block sequencing can be used without impacting the students\u27 perceptions of their ability to make decisions

Recent Developments: The Uniform Arbitration Act

Since 1983, this annual Article 2 has been prepared to provide a survey of recent developments in the case law interpreting and applying the various state versions of the Uniform Arbitration Act3. The purpose is to promote uniformity in the interpretation of the U.A.A. by developing and explaining the underlying principles and rationales courts have applied in recent cases.

The Impact of Simulation on Knowledge and Performance Gain Regarding Diabetic Patient Care

Background It is essential that nurses be prepared to provide quality care for patients with diabetes, a common condition today. The purpose of this study was to evaluate the impact of a high-fidelity simulation on traditional prelicensure nursing students\u27 knowledge and performance related to care of the diabetic patient. Methods This multisite, multimeasure study used a purposive, quasiexperimental pretest-posttest design. Results Simulation positively impacted performance change scores. Pretest scores were positively associated with simulation scores and posttest scores. Conclusions The findings from this study support the use of high-fidelity simulation to improve care of the diabetic patient