Examining the Impact of Double Time Written Tests in Nursing Education: A Mixed Methods Study

Background: Nursing education is stressful for students: an inherent quality of a competitive professional degree program leading to a career where client safety and quality healthcare are dependent on graduates with high levels of intellectual and emotional capacities. In the interest of student health and well-being, it is worthwhile taking a moment to pause and consider what, if any, stressors can be minimized or eliminated. This study resulted from such a moment of pause to consider norms related to in-person timed written tests and how the factor of time might be contributing to modifiable student stress. Purpose: The purpose of this study was two-fold: 1) to explore nursing students’ experience of double time on all major in-person written tests, and 2) to examine the relationship between the time it takes a student to write a test and their grade on that evaluation measure when double time is provided. Methods: The study involved a mixed methods descriptive correlational design. Convenience sampling was used to recruit undergraduate nursing students across three pathways within one collaborative Bachelor of Nursing program over the 2018-2019 academic year. Qualitative data were collected through an online survey to capture the students’ experience of double time on in-person written tests. Quantitative data included the length of time each student took to complete a test in minutes as well as the student’s grade on the test. Results: Thematic analysis of data from completed surveys (N=457) revealed students’ experience of the calming and enabling impact of having double time for all in-person written tests. Analysis of quantitative data demonstrated lack of a consistent overall difference or relationship between the time a nursing student takes to complete a written test and their grade on that test. Conclusion: Teaching norms related to timed written tests were questioned in the interest of enhancing the quality of the student experience. The findings of this study provide preliminary evidence that offering a double time option for in-person written tests may help create the learning environment needed to mitigate an important element of nursing student stress and enhance the quality of their academic experience. Résumé Contexte : La formation en sciences infirmières génère beaucoup de stress chez les étudiantes : une qualité inhérente à un programme professionnel de grade, compétitif et menant à une carrière où la sécurité des clients et la qualité des soins de santé dépendent de diplômées dotées de capacités intellectuelles et émotionnelles élevées. Dans l’intérêt de la santé et du bien-être des étudiantes, il vaut la peine de prendre un moment de recul pour identifier les facteurs de stress, le cas échéant, qui peuvent être minimisés ou éliminés. Cette étude découle d’un tel moment de pause pour examiner les normes liées aux tests écrits en personne, dans un temps déterminé, et la manière dont le facteur temps pourrait contribuer à modifier le stress des étudiantes. Objectif : Cette étude avait deux objectifs, soit : 1) explorer l’expérience des étudiantes en sciences infirmières d’avoir le double du temps pour tous les principaux tests écrits en personne, et 2) examiner la relation entre le temps qu’il faut aux étudiantes pour passer leur test et leur note obtenue à cette évaluation lorsque le double du temps est fourni. Méthode : L’étude descriptive corrélationnelle a été réalisée grâce à un devis mixte. Un échantillonnage de convenance a été utilisé pour recruter des étudiantes de premier cycle en sciences infirmières de trois parcours au sein d’un programme collaboratif de baccalauréat en sciences infirmières au cours de l’année universitaire 2018-2019. Des données qualitatives ont été recueillies par le biais d’un sondage en ligne pour saisir l’expérience des étudiantes d’avoir le double du temps pour réaliser les tests écrits en personne. Les données quantitatives comprenaient le temps en minutes que chaque étudiante a mis pour terminer un test ainsi que la note de l’étudiante au test. Résultats : L’analyse thématique des données des sondages remplis (N=457) a révélé l’expérience des étudiantes de l’impact apaisant et facilitant d’avoir le double du temps pour tous les tests écrits en personne. L’analyse des données quantitatives a démontré l’absence d’une différence ou d’une relation globale cohérente entre le temps que les étudiantes en sciences infirmières prennent pour terminer un test écrit et leur note à ce test. Conclusion : Les normes d’enseignement liées au temps limité pour les épreuves écrites ont été remises en question dans l’optique d’améliorer la qualité de l’expérience étudiante. Les résultats de cette étude fournissent des preuves préliminaires que l’offre d’une option de temps double pour les tests écrits en personne peut aider à créer l’environnement d’apprentissage nécessaire pour atténuer un élément important du stress des étudiantes en sciences infirmières et améliorer la qualité de leur expérience universitaire

Person-centredness - The ‘state’ of the art

Background: Person-centred practice is now firmly embedded in the nursing and healthcare discourse. While there is a growing body of development and research activity in the field, there is increased recognition of the need for further advances in the body of existing knowledge. This is reflected in the different approaches to person-centredness being adopted by healthcare systems internationally. Aims: To provide an overview of person-centredness and ways in which person-centred practice has been adopted in healthcare systems internationally. Methods: A summary review of the evidence underpinning the concepts and theory of person-centredness, incorporating an overview of national strategic frameworks that influence the development of person-centred practice in different countries. Findings: While there have been considerable advances in the development of person-centredness, there is a lot of work to be done in the adoption of more consistent approaches to its development and evaluation. In particular, a shared discourse and measurement tools are needed. Internationally, person-centredness is gaining momentum and many countries have strategic frameworks in place to direct its development and implementation

Unlocking the doors: introducing practice development to Canadian healthcare

From my early days as a nursing assistant in complex continuing care, I recognised that all was not well in healthcare. I was particularly troubled with practices that I perceived to be antithetical to ‘caring’ and I struggled to facilitate change within my very limited circle of influence. I remember well the day I asked for the key to open the balcony doors on the unit so I could take patients out for a breath of fresh air. Being told by the registered nurse that ‘those doors haven’t been opened in 15 years and that isn’t going to change’, was what I now appreciate as the start of my practice development journey. Although I have had the privilege of observing and contributing to more quality healthcare practices in my subsequent roles as a registered nurse, advanced practice nurse and, most recently, Director of Interprofessional Practice, I am also keen to know how far we have yet to go in bringing that ‘fresh air’ I sought decades ago to our patients through more person centred means. I think our lack of progress can be attributed in part to evolving technologies in healthcare that pull our attention away from the human-to-human exchange that has the most impact on patients’ experience of care. Practice development holds the promise of keeping us focused on our caring practices, in balance with the seductive lure of high tech solutions, to address gaps in our quality care. Canada is not alone in its need of healthcare improvement; media and scholarly literature across the globe abound with examples of poor quality care and calls to action across healthcare sectors, settings and specialties. Canada is, however, distinct because of the absence of practice development as a systematically adopted methodology for meeting quality improvement priorities at provincial, national or even local levels. This is despite how embedded practice development has become at local and national levels in both practice and academic settings beyond North America, with examples including the Older Persons Services National Practice Development Programme in the Republic of Ireland, the New South Wales-based Essentials of Care programme in Australia and the England Centre for Practice Development hosted by Canterbury Christ Church University. These success stories, as well as the breadth of related theoretical and empirical literature that has evolved over the past 20 years, have not influenced Canadian healthcare practices much beyond the level of individual academics and practitioners – a relatively small group of converts

Revealing and acting on patient care experiences: exploring the use of Photovoice in practice development work through case study methodology

Traditional efforts in healthcare to evaluate patient satisfaction with care, an outcome expected from effective person-centered practices, rely heavily on survey methodology. At West Park Healthcare Centre, a rehabilitation and complex continuing care facility in Ontario, Canada, data from patient satisfaction surveys were proving insufficient on their own to inform and ultimately motivate those in a position to bring about improvement in person-centered practices. Additional and more effective strategies were therefore sought as part of a larger practice development initiative to evaluate our progress in accomplishing person-centered outcomes for our patients and to guide the planning of continuous improvement strategies. Photovoice was selected and evaluated through qualitative within-site, multiple case study design as a method to reveal the care experiences of patients living in complex continuing care and facilitate change based on expressed needs and concerns. The findings suggest Photovoice improves understanding of: The factors that influence patient satisfaction with care The practice changes required to enhance the person-centeredness of that care However, Photovoice did not result in consistent shifts in care practices based on the improved understanding. Going forward, these findings suggest more work is needed to help the organisation move beyond an understanding of what matters to patients to acting on that knowing

Person-centredness - the \u27state\u27 of the art

Background: Person-centred practice is now firmly embedded in the nursing and healthcare discourse. While there is a growing body of development and research activity in the field, there is increased recognition of the need for further advances in the body of existing knowledge. This is reflected in the different approaches to person-centredness being adopted by healthcare systems internationally. Aims: To provide an overview of person-centredness and ways in which person-centred practice has been adopted in healthcare systems internationally. Methods: A summary review of the evidence underpinning the concepts and theory of person-centredness, incorporating an overview of national strategic frameworks that influence the development of person-centred practice in different countries. Findings: While there have been considerable advances in the development of person-centredness, there is a lot of work to be done in the adoption of more consistent approaches to its development and evaluation. In particular, a shared discourse and measurement tools are needed. Internationally, person-centredness is gaining momentum and many countries have strategic frameworks in place to direct its development and implementation. Conclusions: Significant developments in the theory and practice of person-centredness in nursing and healthcare have taken place. However, as evidenced by the accounts of in-country developments, internationally there is a need to develop more strategic multiprofessional approaches to the development/implementation and evaluation of person-centred practices. Implications for practice: -National developments in person-centred healthcare need to reflect the diversity of strategicapproaches internationally -While a common language of person-centredness is emerging, there is a need for clarity overhow this is operationalised in everyday practice situation

Recent geological and hydrological activity on Mars: The Tharsis/Elysium corridor

The paradigm of an ancient warm, wet, and dynamically active Mars, which transitioned into a cold, dry, and internally dead planet, has persisted up until recently despite published Viking-based geologic maps that indicate geologic and hydrologic activity extending into the Late Amazonian epoch. This paradigm is shifting to a water-enriched planet, which may still exhibit internal activity, based on a collection of geologic, hydrologic, topographic, chemical, and elemental evidences obtained by the Viking, Mars Global Surveyor (MGS), Mars Odyssey (MO), Mars Exploration Rovers (MER), and Mars Express (MEx) missions. The evidence includes: (1) stratigraphically young rock materials such as pristine lava flows with few, if any, superposed impact craters; (2) tectonic features that cut stratigraphically young materials; (3) features with possible aqueous origin such as structurally controlled channels that dissect stratigraphically young materials and anastomosing-patterned slope streaks on hillslopes; (4) spatially varying elemental abundances for such elements as hydrogen (H) and chlorine (Cl) recorded in rock materials up to 0.33 m depth; and (5) regions of elevated atmospheric methane. This evidence is pronounced in parts of Tharsis, Elysium, and the region that straddles the two volcanic provinces, collectively referred to here as the Tharsis/Elysium corridor. Based in part on field investigations of Solfatara Crater, Italy, recommended as a suitable terrestrial analog, the Tharsis/Elysium corridor should be considered a prime target for Mars Reconnaissance Orbiter (MRO) investigations and future science-driven exploration to investigate whether Mars is internally and hydrologically active at the present time, and whether the persistence of this activity has resulted in biologic activity. © 2008 Elsevier Ltd. All rights reserved

Landscapes of binding antibody and T-cell responses to pox-protein HIV vaccines in Thais and South Africans.

BackgroundHIV vaccine trials routinely measure multiple vaccine-elicited immune responses to compare regimens and study their potential associations with protection. Here we employ unsupervised learning tools facilitated by a bidirectional power transformation to explore the multivariate binding antibody and T-cell response patterns of immune responses elicited by two pox-protein HIV vaccine regimens. Both regimens utilized a recombinant canarypox vector (ALVAC-HIV) prime and a bivalent recombinant HIV-1 Envelope glycoprotein 120 subunit boost. We hypothesized that within each trial, there were participant subgroups sharing similar immune responses and that their frequencies differed across trials.Methods and findingsWe analyzed data from three trials-RV144 (NCT00223080), HVTN 097 (NCT02109354), and HVTN 100 (NCT02404311), the latter of which was pivotal in advancing the tested pox-protein HIV vaccine regimen to the HVTN 702 Phase 2b/3 efficacy trial. We found that bivariate CD4+ T-cell and anti-V1V2 IgG/IgG3 antibody response patterns were similar by age, sex-at-birth, and body mass index, but differed for the pox-protein clade AE/B alum-adjuvanted regimen studied in RV144 and HVTN 097 (PAE/B/alum) compared to the pox-protein clade C/C MF59-adjuvanted regimen studied in HVTN 100 (PC/MF59). Specifically, more PAE/B/alum recipients had low CD4+ T-cell and high anti-V1V2 IgG/IgG3 responses, and more PC/MF59 recipients had broad responses of both types. Analyses limited to "vaccine-matched" antigens suggested that some of the differences in responses between the regimens could have been due to antigens in the assays that did not match the vaccine immunogens. Our approach was also useful in identifying subgroups with unusually absent or high co-responses across assay types, flagging individuals for further characterization by functional assays. We also found that co-responses of anti-V1V2 IgG/IgG3 and CD4+ T cells had broad variability. As additional immune response assays are standardized and validated, we anticipate our framework will be increasingly valuable for multivariate analysis.ConclusionsOur approach can be used to advance vaccine development objectives, including the characterization and comparison of candidate vaccine multivariate immune responses and improved design of studies to identify correlates of protection. For instance, results suggested that HVTN 702 will have adequate power to interrogate immune correlates involving anti-V1V2 IgG/IgG3 and CD4+ T-cell co-readouts, but will have lower power to study anti-gp120/gp140 IgG/IgG3 due to their lower dynamic ranges. The findings also generate hypotheses for future testing in experimental and computational analyses aimed at achieving a mechanistic understanding of vaccine-elicited immune response heterogeneity