The Politics of the Biosphere: Lessons from the Niagara Escarpment and Maya Reserve

Biosphere reserves are generally conceived of as an important part of the current global conservation strategy. Yet how does a particular region receive such a designation and such protection? How does scientific knowledge and the interests and desires of specific groups affect these designations? In what ways do the main actors involved in these processes exercise power in order to shape the policies and protocols that govern biosphere reserves

The Comparative Growth of Goods and Services Prices

For several decades, the prices of services have been rising more rapidly than the prices of goods in Canada and the other major industrialized countries. In 2002, this gap between the growth rates of these two components of the consumer price index (CPI) widened considerably, leading researchers to ask if this was the beginning of a trend. Analysis reveals, however, that the gap is based on short-term dynamics and that it appears to be independent of the trend in the development of the overall price level. Evidence also shows that the gap is eventually reabsorbed. The authors examine a number of potential causes for the prices of services to rise faster than those of goods. These include the more rapid pace of productivity growth in the goods sector, the greater openness of goods to foreign trade, and stronger growth in the demand for services.

Simulation in nursing education

Part of becoming a working professional always involves applying knowledge and trying out skills in carefully controlled and monitored settings to get feedback on our first attempts at practice. For many years, nurses have practiced taking BP readings on each other, learned to provide certain kinds of physical care on manikins, and rehearsed giving injections with oranges. With advances in technology, learning labs in nursing schools now include standardized patients (actors), various kinds of lifelike models, and full-scale simulators (manikins that manifest symptoms and respond to treatment decisions and other actions). The use of simulation in nursing education has grown to the point where it's now a common element in the preparation for practice. We review what should you know about simulation and how it's shaping the education of nursing students and graduate nurses coming to your units and settings

Contribution of a reflective debriefing to nursing students' clinical judgment in patient deterioration simulations : a mixed-methods study

Background While reflection is a hallmark of debriefing, there is little understanding of how it contributes to nursing students' clinical judgment. Objectives The aim of this study was to describe how nursing students perceived that the Reflective dEbriefing after a PatieNt Deterioration simulation (REsPoND) fostered learning and how it contributed to their clinical judgment in patient deterioration simulations. Design A sequential explanatory mixed-methods study. Participants Nineteen students who showed the greatest clinical judgment score variation in a randomized controlled trial of the effectiveness of REsPoND. Methods Students participated in interviews on their learning experience in REsPoND. Data were subjected to thematic analysis and themes were contrasted according to students' score variations. Results Through guided exchanges with their peers, students configured a causes–observations–interventions framework that embodied their understanding of the patient's situation. They evaluated their own simulation performance based on that framework. The contribution of REsPoND to students' clinical judgment differed depending on (1) the value placed on the review of the simulation through a systematic assessment approach; (2) their focus on anticipating the situation or on performing in the simulation; and (3) their preference for who participated more in debriefing. Conclusion Clinical judgment might be improved when a systematic assessment approach is used to structure debriefing. The relationship between reflection and self-assessment during debriefing remains to be disentangled

Translation, adaptation, and content validation of a French version of the Nurse Competence Scale in Canada.

Background: While everyone agrees that it is important for nurses to be competent practitioners, no validated French questionnaire measuring nurse competence is available to date. Internationally, one of the most frequently used questionnaires used to measure the competence level of nurses working in a clinical setting is the Nurse Competence Scale (NCS). Objective: The objective of this study was to translate and culturally adapt a French version of the NCS (NCS-Fr) with nurses working in the province of Quebec (Canada). Methods: It had a multi-method design, inspired by guidelines for translation, adaptation, and validation of scales in health research. The scale instructions and items were translated from English to French by two translators knowledgeable in nursing/healthcare and then back-translated to English by two other translators. Versions were compared; ambiguities and discrepancies were resolved during a synthesis discussion. A convenience sample of registered nurses (n=8) and experts in nursing education (n=10) assessed instructions and items for comprehensibility. Results: Content validity index (CVI) for items (I-CVI) of the preliminary version ranged from 0.56 to 1, with most items (n=64) meeting the threshold of 0.78. The scale CVI (S-CVI) was 0.89. Conclusion: This study used a rigorous method to translate and adapt a French version of the NCS. The next step will be to evaluate the psychometric properties and items performance of the NCSFr

Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients

To provide optimal care, nurses need to be prepared to recognize signs and symptoms of patient deterioration so they can obtain assistance from appropriate respondents and initiate rescue interventions when needed. In this paper, we describe the development of a post-simulation educational intervention aimed at improving nurses' and nursing students' recognition and response to patient deterioration. This intervention takes the form of a debriefing after a simulated patient deterioration experience. Following the Medical Research Council's guidance on complex interventions, we reviewed empirical studies of existing educational interventions for content, teaching strategies, and outcomes, as well as for frameworks, theoretical underpinnings, and rationale. Based on those results, we reviewed theoretical literature (Tanner's clinical judgment model and Dewey's theory of experiential learning) that might inform our understanding of our intervention's intended effect (learning outcomes) and of the mechanisms by which the intervention could lead to it. Integrating results from the empirical and theoretical phases helped us define the new intervention's rationale and develop its components according to relevant standards of best practices. The resulting educational intervention, REsPoND, consists in a reflective debriefing after a patient deterioration simulation. It will be tested in an upcoming mixed methods study

Defining patient deterioration through acute care and intensive care nurses' perspectives

Aim: To explore variations between acute care and intensive care nurses’ understanding of patient deterioration according to their use of this term in published literature. Background: Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses’ help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains. Design: Dimensional analysis was used as a framework to analyze papers retrieved in a nursing focused database. Method: A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses’ perspectives on patient deterioration was conducted. Findings: No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses’ accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored. Conclusions: From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology toward critical illness. Contextual factors relating to acute care units appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modeling the concept of patient deterioration, which could be specific to acute care units. Relevance to Clinical Practice: The findings suggest it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issu

Testing nursing students’ clinical judgment in a patient deterioration simulation scenario : development of a situation awareness instrument

Background: Situation awareness may be used to operationalize nursing students' clinical judgment of patient deterioration simulation scenarios. Objectives: To develop and test an instrument to measure bachelor-level nursing students' situation awareness in a patient deterioration simulation scenario, using the Situation Awareness Global Assessment Technique (SAGAT). Design: Instrument development and validation. Settings: A faculty of nursing of a French-Canadian university. Participants: 15 critical care experts and 234 bachelor-level nursing students from a critical care course. Methods: The queries were developed from evidence and guidelines regarding nurses' assessment and response to patient deterioration and an inventory of nursing diagnosis. After expert content validation, the instrument was administered to three cohorts of nursing students in a high-fidelity simulation with a scenario of hypovolemic hemorrhagic shock. Difficulty, discrimination, and fidelity indices were computed. The impact of the instrument on student's performance was assessed with a post-simulation survey. Results: The instrument comprised 31 queries, which obtained high content validity indices. Most showed satisfying difficulty, discrimination, and fidelity properties. Inadequate properties of the queries may be explained by the content of the simulation scenario, the assessment practices of nursing students, and their reliance on medical assistance. Students perceived that completing the instrument helped them realize what they forgot to assess in the simulation. Conclusions: This instrument appears as a promising research tool, although it still needs to be tested with other populations and in other patient deterioration simulation scenarios