BACKGROUND & AIMS: The health care industry is in the throes of remarkably penetrating and destabilizing change, the effects of which have been felt earliest by perinatal service directors. In anticipation of future trends marked by rampant change, a survey of perinatal service directors and vice presidents was conducted to elicit their opinions about the current and future states of perinatal health care. Findings supported the notions that change is a constant, that clinical and service excellence is a mandate, and that collaboration is key. Future success will require many old behaviors and systems to be replaced. Leadership to guide us to the future has never been more important.

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BACKGROUND & AIMS: :A pilot study was conducted to determine changes in Native American high school students' knowledge and opinions about nursing after attending a 6-day residential summer nursing institute. To date, Native American high school students, particularly those interested in nursing, have not been well researched. Seventeen high school students affiliated with nine Northwest tribes participated in this study. A 66-item, investigator-constructed, pretest-posttest survey included 38 scaled (4-point Likert type) and 20 dichotomous items. Reliability estimates (Cronbach's alpha) were 0.72 and 0.85 for the pretest and posttest, respectively. This pilot study showed an increase in students' knowledge and opinions of professionalism, autonomy, and role importance in nursing after attending the summer nursing institute. A salient and culturally related reason for choosing nursing was to be important to one's tribe. Although the sample was small, the findings provide initial evidence supporting the effectiveness of a nursing education intervention with Native American high school students and an instrument that can measure its success.

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BACKGROUND & AIMS: PURPOSE:There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. METHODS AND MATERIALS:The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. RESULTS:Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. CONCLUSION:An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.

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BACKGROUND & AIMS: Importance:Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. Objective:To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. Design, Setting, and Participants:This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. Exposures:Periods with and without ADHD medication use. Main Outcomes and Measures:Scores from the higher education entrance examination (score range, 1-200 points). Results:Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. Conclusions and Relevance:Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.

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BACKGROUND & AIMS: BACKGROUND:A growing body of literature shows that many universities and colleges are making educational portfolios part of their faculty assessment and student's learning plan for both undergraduate and graduate programs. We provide an outline for the development of a medical educator's portfolio, including an electronic version. DESCRIPTION:Guidelines for the development of an educational portfolio focusing on medical education are provided, including design, format, and content. An electronic version of the portfolio, which combines flexibility and ease of revision, is also described, including formats for publication and distribution. Student reflections on the e-portfolio are presented, and potential applications of the e-portfolio in medical education are described. CONCLUSION:We believe that portfolio development is a valuable application that provides rich documentation of participants' educational history, accomplishments, and intellectual property as related to their professional learning and growth.

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BACKGROUND & AIMS: :This paper examines factors that have lead to increasing internationalisation in nursing workforce and nursing education and contends that education and support for nurse managers and nurse academics is required in order to better prepare them for the challenges they will face. There are many benefits to be gained from internationalisation of nursing, the most significant being greater cross-cultural understanding and improved practices in workplaces across countries. However, the way in which nursing and nurses contribute to the international agenda is crucial to maintaining standards of education and nursing care in Australia and in countries with whom Australians collaborate. Internationalisation poses numerous challenges that need to be carefully thought through. This paper seeks to unravel and scrutinize some of the issues central to internationalisation in nursing, particularly in the Australian context.

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BACKGROUND & AIMS: OBJECTIVES:To evaluate an intervention to improve care transitions at the time of skilled nursing facility (SNF) discharge. DESIGN:Natural experiment using a pre-post design. SETTING:Veterans Affairs hospital, community SNF, and outpatient clinic. PARTICIPANTS:The pre-intervention group comprised 134 individuals discharged to the community from posthospitalization SNF care, and the intervention group was 217 individuals who received a postdischarge clinic (PDC) intervention at SNF discharge after receiving posthospitalization care at the SNF. INTERVENTION:This study is a natural experiment using a pre-post design. The intervention was a one-time visit to a PDC before SNF discharge, where an advanced nurse practitioner conducted medication reconciliation, ordered medical supplies and equipment and home health services if needed, provided individual and caregiver education, and communicated the information to the individual's primary outpatient care provider through electronic medical records. MEASUREMENTS:The pre-PDC and PDC intervention groups were compared on various measures of hospital utilization within 30 days of the SNF discharge (number of rehospitalizations, acute care inpatient days, and emergency department (ED) visits). RESULTS:Although there was a 23% rehospitalization rate in the pre-PDC group, participants in the PDC intervention group had a 14% rehospitalization rate within 30 days of SNF discharge (P = .02). Those who received the PDC intervention had significantly fewer acute care inpatient days during the 30-day follow-up (P < .001). Although the difference in the number of ED visits between the two groups was not statistically significant, the number of ED visits per 1,000 patient follow-up days during the 30-day interval was significantly lower in the PDC intervention group (P = .03). CONCLUSION:Comprehensive care coordination at the time of SNF discharge can reduce postdischarge hospital use in settings with shared electronic records.

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BACKGROUND & AIMS: :In May 1988, the English National Board (ENB, Statutory Body for Nursing Education for England) issued draft proposals for development of continuous assessment of theory and practice in basic nursing courses. As an integral part of a new curriculum the staff at Wolverhampton School of Nursing have developed a strategy for continuous assessment of theory and practice which now has formal ENB approval. In order to qualify as a person who can apply to be registered on one or more parts of the register students must have demonstrated their ability to acquire the competencies which are specified in Rule 18(1) of the Nurses, Midwives and Health Visitors Rules Approval Order (UKCC 1983). The strategy demonstrates the development and achievement of competencies of Rule 18(1) as they increase in complexity. We do not claim that the strategy is the only framework which could be developed for implementing continuous assessment, nor do we claim that it is flawless. The strategy is intended as a framework which may contribute in assisting other nurse teachers who are in the present position of developing such schemes of assessment.

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BACKGROUND & AIMS: AIM:To explore nursing students' experiences of patient safety and peer reporting using hypothetical medication administration scenarios. BACKGROUND:Pre-registration nurse training is tasked with the preparation of students able to provide safe, high quality nursing care. How students' contextualise teaching related to patient safety, risk recognition and management in the clinical setting is less clear. METHOD:A total of 321 third year students enrolled in the final semester of an adult branch pre-registration nursing programme in 2011 in a UK university were surveyed. Using free texts, the questionnaire contained hypothetical medication administration scenarios where patient safety could potentially be at risk. Students' qualitative responses were analysed using thematic analysis. FINDINGS:The response rate was 58% (n = 186). Four themes were identified from the scenarios: (1) Protecting patient safety (2) Willingness to compromise; (3) Avoiding responsibility; (4) Consequences from my actions. CONCLUSION:The findings underscore the importance of contextual teaching about risk management, practical techniques for error management and leadership for optimal patient safety in nursing curricula. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers are role models for nursing students in the clinical setting. Nursing management must lead, by example, the patient safety agenda in the clinical setting.

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BACKGROUND & AIMS: OBJECTIVE:To determine the availability of early defibrillation and automated external defibrillators in nursing homes in selected cities. DESIGN:A standardized telephone survey was conducted of all skilled nursing facilities to characterize early defibrillation capabilities. SETTING:The study involved nursing homes in Philadelphia, Omaha, Seattle, and Boston. PARTICIPANTS:All skilled nursing facilities not physically attached to hospitals in the selected cities based on listings from the Centers for Medicare and Medicaid Services as of January 2004. MEASUREMENTS:Each site was queried as to whether or not they had an automated external defibrillator (AED), if they were physically freestanding facilities, if a manual defibrillator was present, and if staff were present 24 hours a day to use the defibrillator. Early defibrillation was defined as the presence of either a manual defibrillator or AED in addition to 24-hour trained staff availability. RESULTS:There were 126 nursing homes identified from the Medicare listing and 81% (102) responded to our phone survey. After exclusion of non-freestanding facilities, 90 nursing homes (71.4%) were available for analysis. Overall, 16.7% (95% CI 8.8-24.5) of nursing homes reported early defibrillation capabilities via manual defibrillator or AEDs; 6.7% (95% CI 1.4-11.9) of nursing homes reported AEDs; 10.0% (95% CI 3.7-16.3) of nursing homes reported manual defibrillators. Nursing homes in Seattle had a higher rate of early defibrillation capability than the other 3 cities. CONCLUSION:Despite the fact that nursing homes have been identified as locations with multiple cardiac arrests, the early defibrillation capabilities and prevalence of AEDs in this setting remains low. AEDs may play a role in improving survival from cardiac arrest in nursing homes. The placement of AEDs in nursing homes needs further consideration and study.

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BACKGROUND & AIMS: :Autopsy rates remain disturbingly low in nursing homes despite the fact that 1 of 5 deaths occurs in this setting. To determine the autopsy rate for nursing homes, we analyzed all deaths occurring in New York State nursing homes from 1980 to 1984. Of 58,985 nursing home deaths, autopsies were performed in only 499 cases (0.8%). In comparison to the general nursing home population, autopsied residents were more likely to be male and never married and less likely to be widowed. Of 110 practicing nursing home physicians surveyed, 19% believed autopsies had little if any value in the nursing home population, whereas 71% saw autopsy as a valuable tool but rarely requested one. Fewer than 1 in 10 physicians routinely discussed autopsies with patients and/or families before death. Perceived obstacles included the emotional lability of patients and families and a lack of financial reimbursement. Concerns over religious objections, funeral delays, and unnecessary mutilation were cited by fewer than one third of respondents. Facilitation of consent, physician education, and cost sharing may all contribute to enhanced rates of autopsies in the future.

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BACKGROUND & AIMS: AIMS:The aim of the present study was to compare the levels of stress, depression, and intention to leave among clinical nurses employed in different medical units in relation to their demographic characteristics under the National Health Insurance (NHI) System in Taiwan. METHODS:Cross-sectional Spearman's correlation, one-way ANOVA with Scheffe post hoc analysis tests, and multiple regression analyses were conducted. Several self-report questionnaires, such as the Center for Epidemiological Studies Depression Scale, the Perceived Stress Scale and Intention to Leave Scale, were administered. A total of 314 research participants were surveyed, all of whom came from regional hospitals in Northern Taiwan. RESULTS:Marital status and working tenure were significant predictors to the levels of stress, depression, and intention to leave among nurses before taking the medical units into consideration. However, with adding medical units as predictors, the effect of marital status and working tenure were insignificant except for the stress model, indicating medical units were showing dominant effect over other variables. In particular, internal medical ward (IMW) nurses experienced a higher prevalence of depression than emergency room (ER) nurses and professional nursing practitioners. External medical ward (EMW) nurses also experienced greater depression than emergency room (ER) nurses. Both IMW and EMW nurses perceived significantly greater stress than ER and dialysis center. Moreover, IMW nurses also perceived greater stress than operating room (OR) nurses and showed stronger intention to leave than their counterparts in the outpatient service departments. CONCLUSIONS:The results indicated that significant differences existed among various medical units with regards to nurses' stress, depression, and intention to leave. Nurses working in internal and external medical wards, especially the inexperienced and married ones, experienced greater depression and stress, thereby developing stronger intention to leave their job.

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BACKGROUND & AIMS: :At present Chinese nurses could not get the up-to-date and high-quality evidences efficiently and conveniently due to language barrier and other practical difficulties. This program built a Chinese website of integrated evidence-based network information resources for EBN studies. Researchers hope to provide practical guidance and advice for nurses in non-English-speaking countries..

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BACKGROUND & AIMS: :In 1998 the Society for Academic Emergency Medicine's (SAEM's) Board of Directors asked the SAEM Public Health and Education Task Force to develop recommendations for prevention, screening, and counseling activities to be conducted in emergency departments (EDs). The Task Force's work was divided into two phases: 1) a discussion of the rationale for preventive services in the ED, along with generation of a preliminary list of prevention activities that could be studied for ED implementation; and 2) a formal evidence-based review of topics chosen from the preliminary list, along with recommendations for ED implementation and further study. This paper represents Phase I of the project. Phase II, the formal evidence-based review and recommendations, is published separately in this issue.

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BACKGROUND & AIMS: OBJECTIVE:Nurse educators need an enhanced understanding of factors contributing to nursing student success to decrease attrition and increase retention. Improved understanding of factors related to successful nurse preparation could improve educational processes and facilitate student success, thereby addressing the worldwide nursing shortage as well as increasing the competence and expertise of new graduates. Student-faculty trust and related characteristics have been identified as factors associated with student success (Applebaum, 1995). Research investigating trust in communications and education has been conducted with students in other disciplines but not with nursing students. This research investigated the complex relationships between students' trust in faculty, the students' mood states, and students' educational performance and outcomes. METHOD:The study utilized a quantitative, cross-sectional, descriptive, and correlational design. Student volunteers were recruited from a baccalaureate nursing education program located in the southwest United States. Participants completed three instruments: the Health Sciences Reasoning Test (HSRT), Profile of Mood States (POMS), and Interpersonal Trust Scale (ITS). The resulting scores were compared and contrasted along with selected demographic variables. RESULTS:The study identified a significant relationship between total mood disturbance and interpersonal trust. The trends in the POMS subscales of Anger and Confusion are of particular interest, as the two factors strongly influenced shifts in Total Mood Disturbance. As students progressed through the nursing program, experiences of Anger and Confusion increased with each progressive semester and were accompanied by corresponding decreases in trust. CONCLUSIONS:The results complement established findings relating mood and cognitive function. Alterations in the student's level of trust potentially could share relationships with cognition and critical thinking, although perhaps not in a direct and linear fashion.

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