Rural-Focused Nursing Education: A Summative Evaluation of RNs’ Experiences of the Rural Nursing Certificate Program

Nurses working in rural and remote communities perform multi-dimensional and complex roles. They require education opportunities that support them in providing the best healthcare possible to rural populations. However, the location and content of existing education programs often make them inaccessible and unsuitable to the context of rural nursing practice. In order to address this gap, the Rural Nursing Certificate Program (RNCP) was implemented and evaluated as a pilot project between 2007 and 2010. The RNCP is a provincial program that delivers practice-driven curriculum via e-learning modes and practical experiences to Registered Nurses (RNs) in rural communities throughout British Columbia, Canada. This paper reports on the summative evaluation of the program with respect to learning outcomes. It addresses the following research question: In what ways has the implementation of this practice-driven model of nursing education influenced nursing practice? Participants gave concrete and compelling examples of how RNs’ levels of confidence and competence rose as a result of their education, and evidence obtained from both nurses and their managers indicated that RNs improved their practice, increased their knowledge, and developed important skills around research and evidence, effective communication, and teamwork. In addition to raising their levels of competence and confidence, participants reported that their engagement in the RNCP expanded their opportunities and increased their overall job satisfaction. RNs also experienced some challenges while in the RNCP, the most significant being time-management and workload. We conclude that these learning outcomes bode well for supporting recruitment and retention efforts, and may contribute to improving patient outcomes. _ Résumé Les infirmières travaillant dans des communautés éloignées et rurales jouent des rôles complexes et multidimensionnels. Elles ont besoin d’offres de formation pour les aider à fournir les meilleurs soins de santé possible aux populations rurales. Or, le contenu des programmes de formation existants ainsi que les endroits où ils sont offerts les rendent difficiles d’accès et incompatibles avec la pratique infirmière en milieu rural. Afin de combler cette lacune, le programme de certificat en sciences infirmières en milieu rural (Rural Nursing Certificate Program [RNCP]) a été mis en œuvre et a servi de projet pilote de 2007 à 2010. Le RNCP est un programme provincial qui offre aux infirmières autorisées (IA) des communautés rurales de la Colombie-Britannique (Canada) un programme d’études axé sur la pratique grâce à des modes d’apprentissage en ligne et à des expériences pratiques. Le présent article fait état de l’évaluation sommative du programme en ce qui a trait aux résultats d’apprentissage. La question de recherche était la suivante : En quoi la mise en œuvre de ce modèle de formation en sciences infirmières axé sur la pratique a-t-il influé sur la pratique infirmière? Les participantes ont donné des exemples concrets et convaincants de la mesure dans laquelle se sont accrus les niveaux de compétence et de confiance des IA à la suite de leur formation. Les données obtenues, tant des infirmières que de leurs gestionnaires, ont indiqué que les IA avaient amélioré leur pratique, approfondi leurs connaissances et acquis d’importantes aptitudes en matière de recherche et de données probantes, de communication efficace et de travail en équipe. En plus de renforcer leurs niveaux de compétence et de confiance, les participantes ont indiqué que leur participation au RNCP leur avait permis d’élargir l’éventail de leurs possibilités et d’accroître leur satisfaction générale à l’égard de leur travail. Les IA ont également dû relever quelques défis dans le cadre du RNCP, le plus important étant la gestion du temps et la charge de travail. Nous pouvons conclure que ces résultats d’apprentissage sont très prometteurs pour appuyer les efforts de recrutement et de rétention dans ces milieux et que le programme peut contribuer à l’amélioration des résultats pour les patients

Processing of alcohol-related health threat in at-risk drinkers: an online study of gender-related self-affirmation effects

Aims: Defensiveness in response to threatening health information related to excessive alcohol consumption prevents appropriate behaviour change. Alternatively, self-affirmation may improve cognitive-affective processing of threatening information, thus contributing to successful self-regulation. Methods: Effects of an online self-affirmation procedure were examined in at-risk university student drinkers. Participants were randomly assigned to a self-affirmation (writing about personally relevant values) or control task (writing about values relevant to another person) prior to presentation of alcohol-related threatening information. Assessment of prosocial feelings (e.g. ‘love’) after the task served as a manipulation check. Generic and personalized information regarding the link between alcohol use and cancer was presented, followed by assessment of perceived threat, message avoidance and derogation. Page dwell-times served as indirect indices of message engagement. Alcohol consumption and intention to drink less were assessed during the first online session and at 1-week and 1-month follow-up. Results: Although self-affirmation resulted in higher levels of prosocial feelings immediately after the task, there was no effect on behaviour in the self-affirmation group. Effects on intention were moderated by gender, such that men showed lower intention immediately after self-affirmation, but this increased at 1-week follow-up. Women's intention to reduce consumption in the self-affirmation group reduced over time. Trend-level effects on indices of derogation and message acceptance were in the predicted direction only in men. Conclusion: It is feasible to perform self-affirmation procedures in an online environment with at-risk drinkers. However, use of internet-based procedures with this population may give rise to (gender-dependent) effects that are substantially diluted compared with lab-based experiments

Substitution of a single non-coding nucleotide upstream of TMEM216 causes non-syndromic retinitis pigmentosa and is associated with reduced TMEM216 expression

Genome analysis of individuals affected by retinitis pigmentosa (RP) identified two rare nucleotide substitutions at the same genomic location on chromosome 11 (g.61392563 [GRCh38]), 69 base pairs upstream of the start codon of the ciliopathy gene TMEM216 (c.-69G>A, c.-69G>T [GenBank: NM_001173991.3]), in individuals of South Asian and African ancestry, respectively. Genotypes included 71 homozygotes and 3 mixed heterozygotes in trans with a predicted loss-of-function allele. Haplotype analysis showed single-nucleotide variants (SNVs) common across families, suggesting ancestral alleles within the two distinct ethnic populations. Clinical phenotype analysis of 62 available individuals from 49 families indicated a similar clinical presentation with night blindness in the first decade and progressive peripheral field loss thereafter. No evident systemic ciliopathy features were noted. Functional characterization of these variants by luciferase reporter gene assay showed reduced promotor activity. Nanopore sequencing confirmed the lower transcription of the TMEM216 c.-69G>T allele in blood-derived RNA from a heterozygous carrier, and reduced expression was further recapitulated by qPCR, using both leukocytes-derived RNA of c.-69G>T homozygotes and total RNA from genome-edited hTERT-RPE1 cells carrying homozygous TMEM216 c.-69G>A. In conclusion, these variants explain a significant proportion of unsolved cases, specifically in individuals of African ancestry, suggesting that reduced TMEM216 expression might lead to abnormal ciliogenesis and photoreceptor degeneration

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Law, property and power: a critical legal geography of matrimonial real property on reserve

Until recently, spouses living on First Nation reserves in Canada did not have access to legal recourse when dealing with their family homes following the dissolution of their relationships. Federal law governing life on First Nation reserves did not address the division of matrimonial real property (MRP), and provincial/territorial law had limited application on reserve. In response to mounting concerns about this “legislative gap,” the federal government undertook a nation-wide “consultation” process (2006-2007) aimed at identifying a viable legislative solution to deal with MRP on reserve. The outcome of this process was a seemingly straightforward piece of property legislation that would apparently resolve the legislative gap while simultaneously addressing First Nation concerns around jurisdiction, culture/tradition, and consultation. However, despite being championed as a viable legislative solution, the Act was not widely supported. This research is broadly concerned with exploring theories of property to understand various ways in which property is conceptualized. I trace why these different and often competing conceptualizations of property matter in the context of matrimonial real property on reserve. The study is informed by critical legal geography literature and theories of property that argue spatial-legal categories are not fixed, apolitical and neutral. Rather, they are contested, enacted and inextricably linked to relations of power. I analyze discourses around “solving” the legislative gap in order to highlight the ways in which dominant conceptualizations of property serve to bracket matrimonial real property on reserve, and I consider the discursive “work” of property with respect to matrimonial real property on First Nation reserves in Canada. This research expands an understanding of the potential performativity of property with respect to matrimonial real property, and explores the applicability of property theory to questions concerning Indigenous people(s) and spaces in colonial contexts. Exploring the legal geographies of property on reserve is relevant to current Canadian political and social life, and this research contributes greater insight into and appreciation of this under-theorized topic

The Family Adaptability and Cohesion Evaluation Scale (FACES): An instrument worthy of rehabilitation?

Aims and method: There have been a variety of instruments developed for evaluating family functioning, but no specific measure has emerged as appropriate for routine clinical use. The Family Adaptability and Cohesion Evaluation Scale (FACES) was viewed as a useful tool for a period, but has been less popular of late. This paper looks at its use in families with two very different types of problem to assess its discriminatory ability. Results: Mothers with depression whose children were not showing mental health difficulties reported a very different pattern of family functioning from those whose children were showing chronic school refusal. Clinical implications: The FACES is capable of discriminating between different patterns of family functioning. Its ease of administration, and the information it provides, should recommend it for wider use in clinical settings

Validating the Ontario child health scale in a UK population

The Ontario Child Health Scale (OCHS) was one of the first scales to seek to assess a broad range of formally defined psychiatric disorders using a checklist format. The performance of the teacher version of this instrument is reported in a UK population of children attending a special educational provision for emotionally and behaviourally disordered (EBD) pupils. Against DSM-IV criteria the instrument proved to have retained its convergent and discriminant validity, although it was somewhat less effective in detecting internalising disorders and discriminating oppositional defiance from other behavioural disorders. Overall the results confirm the usefulness of this instrument as a screening tool in a UK population

Assessing the Factors Underlying Differences in Group Performance: Methodological Issues and Empirical Findings from the Highlands of Central Kenya

This paper examines the performance of rural groups in Kenya and addresses the methodological issues and challenges faced in doing this, and presents the empirical evidence regarding various hypothesized explanatory factors for relative performance levels. Eighty-seven groups and 442 households were surveyed using several approaches. Various performance measures were tested. Both descriptive analysis and regression models were used to gain a better understanding of the group-level and household-level factors that explain performance. Collective action is desired and practiced for a large number of tasks. The findings highlight the incredible number, diversity and dynamic nature of groups in the highlands of Kenya (and we suspect this finding is not terribly unique to this region). Assessing and comparing performance across a range of group activities is wrought with difficulties related to measurement and standardization. Focusing on groups undertaking similar activities makes it easier to delve more deeply into performance drivers. The empirical analysis focused on the effect of group structural variables (e.g. its size) on performance. We found that choice of performance measure and level at which it is measured (e.g. household, group) matters when it comes to trying to explain the variability in that measure. An analysis across different types of groups engaged in exactly the same activity (tree nurseries) found that predicted group performance was not linked to any easy-to-measure group characteristic, implying that for this task dissemination need not be targeted towards particular types of groups. Looking more broadly at a range of activities, we found that structural factors had varied results