What impact do specialist and advanced-level nurses have on people living with heart failure compared to physician-led care? A literature review

BACKGROUND: The inclusion of specialist nurses in multi-disciplinary teams is the current gold standard for care of people with heart failure (HF) in the UK; however, they remain underutilised in practice. Though existing systematic reviews favourably compare advanced nursing roles to physician-led care, none has focused solely on HF. AIM: To investigate the impact of specialist and advanced nurse-led care on the clinical outcomes, quality of life and satisfaction of people with HF compared to physician-led care. METHODS: Literature review and narrative synthesis. RESULTS: This review included 12 studies and categorised their measured outcomes into five domains: mortality; hospital admissions and length of stay; HF diagnosis and management; quality of life and patient satisfaction; and finally, self-assessment and self-care. Five studies appraised as medium or low risk of bias suggest the impact of specialist and advanced-level nurses on people with HF to be broadly equivalent to physicians regarding mortality, hospital admissions and length of stay, while superior in terms of self-assessment and self-care behaviours. CONCLUSIONS: There were too few studies of sufficient methodological quality to draw definitive conclusions. However, no evidence was found to suggest that nurse-led services are any less effective or safe than physician-led services

Trunk motion visual feedback during walking improves dynamic balance in older adults: Assessor blinded randomized controlled trial.

BACKGROUND: Virtual reality and augmented feedback have become more prevalent as training methods to improve balance. Few reports exist on the benefits of providing trunk motion visual feedback (VFB) during treadmill walking, and most of those reports only describe within session changes. RESEARCH QUESTION: To determine whether trunk motion VFB treadmill walking would improve over-ground balance for older adults with self-reported balance problems. METHODS: 40 adults (75.8 years (SD 6.5)) with self-reported balance difficulties or a history of falling were randomized to a control or experimental group. Everyone walked on a treadmill at a comfortable speed 3×/week for 4 weeks in 2 min bouts separated by a seated rest. The control group was instructed to look at a stationary bulls-eye target while the experimental group also saw a moving cursor superimposed on the stationary bulls-eye that represented VFB of their walking trunk motion. The experimental group was instructed to keep the cursor in the center of the bulls-eye. Somatosensory (monofilaments and joint position testing) and vestibular function (canal specific clinical head impulses) was evaluated prior to intervention. Balance and mobility were tested before and after the intervention using Berg Balance Test, BESTest, mini-BESTest, and Six Minute Walk. RESULTS: There were no significant differences between groups before the intervention. The experimental group significantly improved on the BESTest (p = 0.031) and the mini-BEST (p = 0.019). The control group did not improve significantly on any measure. Individuals with more profound sensory impairments had a larger improvement on dynamic balance subtests of the BESTest. SIGNIFICANCE: Older adults with self-reported balance problems improve their dynamic balance after training using trunk motion VFB treadmill walking. Individuals with worse sensory function may benefit more from trunk motion VFB during walking than individuals with intact sensory function

CARDS: A Collaborative Community Model for Faculty Development or an Institutional Case Study of Writing Program Administration

The structure of writing programs evolves to account for the transformation of composition studies. Online and dual credit programs necessitate a need to adjust prior practices initially geared towards face-to-face pedagogy; however, several challenges surface in online and dual credit writing programs. The most prevalent is that these online courses are primarily staffed by non-tenured faculty, including adjuncts who do not have a physical presence on campus. The faculty dynamic presents many challenges when attempting to garner participation in collaborations. In recent years, the Writing Program Administrator (WPA) at a regional public university noticed a need to improve faculty morale, satisfaction, and participation, especially with the emergence of online programs. Through a national survey and selective interviews of current faculty at the university, we determined that the answer lies in the structure of the program. The Writing Program Administrator has several models to choose from, but we will argue that the collaborative community model is most conducive to addressing and enhancing faculty morale, satisfaction, and participation in first-year writing programs

“I’m a Facilitator of Learning!” Understanding What Teachers and Students Do Within Student-Centered Physical Education Models

The role of the facilitator has become almost synonymously associated with student-centered approaches. However, how a teacher functions as a facilitator is less well defined. This article begins to define teacher action in student-centered learning environments. Through an exploration of teacher behavior, teacher–student interactions, and discussions around teacher-as-activator, the article argues that the teacher must play an active role in the classroom and should be considered much more than a “guide on the side.” Teachers should use a range of direct and indirect behaviors and dialogical exchanges to support and extend learning. These actions and interactions should be contextually relevant and aligned with the learning aims of the student-centered approach. In suggesting that facilitation provides a narrow perspective on teacher action, the article calls for further consideration around teacher-as-activator to consider the teacher as someone who activates new learning possibilities.16 page(s