Enhancing Clinical Judgment in Nursing Students

Background/Objectives: Nurses need to be able to think critically and to use clinical judgment in order to competently do their work required of them in the clinical environment. The National Council of State Boards of Nursing (NCSBN) recognized this and developed the NCSBN Clinical Judgment Measurement Model (CJMM) in order to assess and measure clinical judgment on the NCLEX exams. This model was designed to give guidance to faculty so that they can help students develop the desired skills in critical thinking and clinical judgment. The faculty in a senior-level Adult Medical-Surgical Nursing used the CJMM to redesign the clinical paperwork for students with the objective to better evaluate clinical judgment in real-life clinical situations and to improve the student experience. Methods: In order to be able to get a better understanding of students’ thinking with their clinical assignments, the former clinical paperwork was altered to follow the CJMM. Senior-level undergraduate nursing students completing their third adult health clinical were asked to complete the clinical worksheet for the first half of the semester. 90 students were in the course and completing their clinical hours at both academic and community hospitals. At the end of the semester, all course students were asked to complete a brief three question survey via a google form which was presented to them via a QR code during a didactic class session. The three questions were as follows: Do you feel the clinical day worksheet enhanced or improved your bedside critical thinking? Please elaborate on how it did or did not.Do you feel the clinical worksheet enhanced your readiness to enter the profession? Why or why not? Do you have any suggestions for how the clinical day worksheet could be improved for future students? Results: 23 total responses were received with apparent themes emerging. Overwhelmingly, students reported that the clinical worksheet did improve their bedside critical thinking (21/23 students). One student stated “Yes, it really helped with understanding why I was performing certain nursing interventions, how they related to the patient’s disease process, as well as how to evaluate the effectiveness of my interventions. It also helped me better understand what medications would be used for each disease process, and why.” Responses to question two were similarly positive, with responses such as “Yes. The part of the worksheet where we addressed pathophysiology and medications was especially helpful for me. Nursing interventions make a lot more sense when I know the pathophysiology behind the patient’s admitting diagnosis, so getting the chance to review a disease process in depth each week was very beneficial for preparing me to enter the profession. The review of medications was also very helpful. I liked the opportunity to research the patient’s medications, as well as write about why they were being used, how they work, and any side effects or other considerations. I will be responsible for knowing this as a nurse, so I thought this part of the worksheet was very useful in helping me prepare to enter the nursing profession.” Conclusions: The clinical worksheet is an effective tool in evaluating students’ critical thinking and clinical judgment from the student perspective. Feedback indicated that students did not feel that all clinical faculty had the same expectations for how the clinical worksheet should be completed. From these responses, lessons learned for future implementation would be to provide more detailed and standardized training amongst clinical faculty regarding the assignment expectations. Further exploration of faculty perception of student performance would also be useful to see if faculty feel that this new approach is producing better clinical judgment

The Effects of Computer-assisted Pronunciation Readings on ESL Learners’ Use of Pausing, Stress, Intonation, and Overall Comprehensibility

With research showing the benefits of pronunciation instruction aimed at suprasegmentals (Derwing, Munro, & Wiebe, 1997, 1998; Derwing & Rossiter, 2003; Hahn, 2004; McNerney and Mendelsohn, 1992), more materials are needed to provide learners opportunities for self-directed practice. A 13-week experimental study was performed with 75 ESL learners divided into control and treatment groups. The treatment group was exposed to 11 weeks of self-directed computer-assisted practice using Cued Pronunciation Readings (CPRs). In the quasi-experimental pre-test/post-test design, speech perception and production samples were collected at Time 1 (week one of the study) and Time 2 (week 13). Researchers analyzed the treatment’s effect on the learners’ perception and production of key suprasegmental features (pausing, word stress, and sentence-final intonation), and the learners’ level of perceived comprehensibility. Results from the statistical tests revealed that the treatment had a significant effect on learners’ perception of pausing and word stress and controlled production of stress, even with limited time spent practicing CPRs in a self-directed environment

Culture-Based Environmental Microbiology Monitoring of Crop-Based Space Food Systems (veggie Monitoring)

Crewmembers live and work in a closed environment that is monitored to ensure their health and safety. Quarterly monitoring of the microorganisms in the International Space Station (ISS) environment supports crew safety and contributes to a large set of microbial concentration and diversity data from air, surfaces and water samples. This study leverages quarterly operational Environmental Health System (EHS) sampling by collecting additional microbial samples from the surface of the stations Veggie plant production system. Longer exploration missions may require spaceflight-based systems for growth of plants, and this investigation is expected to provide additional data to help establish requirements to protect these systems, plants, and crew, mitigating adverse microbial exposure

Effect of plyometric training on swimming block start performance in adolescents

This study aimed to identify the effect of plyometric training (PT), when added to habitual training (HT) regimes, on swim start performance. After the completion of a baseline competitive swim start, 22 adolescent swimmers were randomly assigned to either a PT (n = 11, age: 13.1 ± 1.4 yr, mass: 50.6 ± 12.3 kg, stature: 162.9 ± 11.9 cm) or an HT group (n = 11, age: 12.6 ± 1.9 yr, mass: 43.3 ± 11.6 kg, stature: 157.6 ± 11.9 cm). Over an 8-week preseason period, the HT group continued with their normal training program, whereas the PT group added 2 additional 1-hour plyometric-specific sessions, incorporating prescribed exercises relating to the swimming block start (SBS). After completion of the training intervention, post-training swim start performance was reassessed. For both baseline and post-trials, swim performance was recorded using videography (50Hz Canon MVX460) in the sagital plane of motion. Through the use of Silicon Coach Pro analysis package, data revealed significantly greater change between baseline and post-trials for PT when compared with the HT group for swim performance time to 5.5 m (−0.59 s vs. −0.21 s; p < 0.01) and velocity of take-off to contact (0.19 ms−1 vs. −0.07 ms−1; p < 0.01). Considering the practical importance of a successful swim start to overall performance outcome, the current study has found that inclusion of suitable and safely implemented PT to adolescent performers, in addition to HT routines, can have a positive impact on swim start performance

English Language Literacy Development in Deaf Individuals: The Role of Environmental Factors

Learning to read and write plays a significant role in children\u27s linguistic and cognitive development. However, prelingually deaf children born into hearing families face immense linguistic, social, and emotional obstacles in the acquisition of reading and writing skills (Swisher,1989). This research was carried out to gain first hand information on the nature of literacy acquisition by deaf individuals. A case study approach was employed in order to investigate factors contributing to two prelingually deaf adults\u27 acquisition of literacy in English. Findings from this study showed the significance of the home and school settings as learning environments which either enhanced or hindered the development of reading and writing skills. Suggestions based these findings are discussed for caregivers and educators of deaf students

Testing Transparency

In modern democracies, governmental transparency is thought to have great value. When it comes to addressing administrative corruption and mismanagement, many would agree with Justice Brandeis’s observation that sunlight is the best disinfectant. Beyond this, many credit transparency with enabling meaningful citizen participation. But even though transparency appears highly correlated with successful governance in developed democracies, assumptions about administrative transparency have remained empirically untested. Testing effects of transparency would prove particularly helpful in developing democracies where transparency norms have not taken hold or only have done so slowly. In these contexts, does administrative transparency really create the sorts of benefits attributed to it? Transparency might grease the gears of developed democracies, but what good is grease when many of the gears seem to be broken or missing entirely? This Article presents empirical results from a first-of-its-kind field study that tested two major promises of administrative transparency in a developing democracy: that transparency increases public participation in government affairs and that it increases government accountability. To test these hypotheses, we used two randomized controlled trials. Surprisingly, we found transparency had no significant effect in almost any of our quantitative measurements, although our qualitative results suggested that when transparency interventions exposed corruption, some limited oversight could result. Our findings are particularly significant for developing democracies and show, at least in this context, that Justice Brandeis may have oversold the cleansing effects of transparency. A few rays of transparency shining light on government action do not disinfect the system and cure government corruption and mismanagement. Once corruption and mismanagement are identified, it takes effective government institutions and action from civil society to successfully act as a disinfectant