An integrative review of simulation,senior practicum and readiness for practice

Readiness for practice (RFP) is essential as new nurses will practice in a nursing shortage climate, with high acuity patients and complex technology. Nurse educators are challenged to foster readiness for practice.AimThe aim of this integrative review was to explore the impact of simulation and senior practicum on graduating senior nursing students' readiness for practice.BackgroundReadiness for practice has been a point of concern for healthcare for quite some time. This has led to a need for better understanding for what RFP means including their perceptions of various stakeholders. Further, it is important to address what teaching and learning strategies can be implemented to assist in ensuring the graduating senior nursing student is ready for practice on graduation and for their first professional practice. Readiness for practice is defined as the ability to safely and competently care for patients by synthesizing theory, skills, attitudes and values in applying clinical reasoning in practice settings.MethodAn integrative review identified 48 published papers on simulation and senior practicum that met the inclusion criteria.ResultsThemes identified from the senior practicum/preceptor literature included clinical reasoning, skills, barriers to the senior practicum and transition. Themes identified regarding simulation as a strategy included preparation, competence development, clinical reasoning and the number of human patient simulators used.ConclusionAlthough the evidence is not conclusive, simulation and senior practicums have the promise of preparing graduating nursing students for their first professional practice. However, nurse educators must ensure simulations are well-organized with clear objectives and that preceptors are supported in teaching and assessing students.     

WHO's Service Availability and Readiness Assessment of primary health care services of commune health centers in a rural district of Northern Vietnam

The objective of this study was to assess the availability and readiness of the primary health care (PHC) services of commune health centers (CHCs) in Quoc Oai, a rural district of Northern Vietnam based on the World Health Organization's Service Availability and Readiness Assessment (SARA) tool. The study was done in 2 steps. First, the heads of the 21 CHCs of Quoc Oai district were interviewed using SARA, a quantitative survey, and the responses were then validated by direct observations of each facility. The results showed that although the average number of health staffs in each CHC met the national standards (at least 5 staffs per CHC), its allocation within each CHC was not properly met because some CHCs had only 2 health staffs. Several health equipment and facilities were not fully available in many CHCs, and although the majority of the PHC services were available at the CHCs, their readiness remained limited. Several significant correlates between the availability of health care workers and the availability of the facilities and the PHC services were observed, suggesting that they depend upon and affect one another in the health system. Using the SARA‐based inventory, the study helps health managers and policy makers to prioritize efforts and allocate resources more appropriately. To be effective, attention should be given to how to make facilities, services, and human resources for health ready for PHC activities—more investment and support from the system (from higher to lower level) and the government.     

Differential recovery rates of fitness following U.S. Army Ranger training

ObjectivesTo investigate tactically-related physical performance and body composition recovery following U.S. Army Ranger training.DesignProspective cohort.MethodsPhysical performance was comprehensively assessed using a tactically-related performance battery (i.e., Ranger Athlete Warrior assessment) in 10 male Soldiers at baseline (BL) two-weeks (P1), and six-weeks (P2) post-Ranger School. Body composition was determined using DXA. A one-way repeated measures ANOVA was used followed by Bonferroni-adjusted pairwise comparisons when group differences existed (p ≤ 0.05). Pearson correlation coefficients were used to establish associations between changes in fitness and body composition.ResultsAll performance domains except the bench press and deadlift worsened following training. Speed/mobility (Illinois agility test, seconds – BL: 16.20 ± 0.86 vs. P2: 18.66 ± 2.09), anaerobic capacity (300-yard shuttle run, seconds – BL: 62.95 ± 6.17 vs. P2: 67.23 ± 5.91), core strength (heel clap, repetitions – BL: 15.80 ± 4.08 vs. P2: 11.50 ± 4.95), and aerobic endurance (beep test, stage – BL: 9.95 ± 2.18 vs. P2: 7.55 ± 1.07) had not recovered by P2. Only upper body muscular endurance and strength (metronome push-up and pull-up, respectively) were similar to BL by P2. Percent body fat increased from 15.62 ± 3.94 (BL) to 19.33 ± 2.99 (P2) (p < 0.001). There were no significant associations between changes in body composition and performance.ConclusionsA comprehensive characterization of physical performance and body composition revealed Rangers did not experience full recovery of fitness six weeks after training. Optimal recovery strategies are needed to return Soldiers to a state of readiness following arduous training.     

Pilot for Learning Interprofessional Physical Assessment Skills

A 6-week pilot study of graduate nursing students and School of Medicine students integrated into the same learning laboratory with the same testing and passing standards in a physical assessment course showed no negative impact on learning outcomes when compared with a concurrently run traditional course. Focus group comments revealed a positive attitude toward continued interprofessional experiences and the development of mutual respect between students, despite some disruptive impact on their personal lives. Scoring on the Readiness for Interprofessional Learning survey had a ceiling effect. A full integration of both school cohorts is planned.     

Acquisition of typical EEG waveforms during fMRI: SSVEP, LRP, and frontal theta

Recent work has demonstrated the feasibility of simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Virtually no systematic comparisons between EEG recorded inside and outside the MR scanner have been conducted, and it is unknown if different kinds of frequency mix, topography, and domain-specific processing are uniformly recordable within the scanner environment. The aim of the study was to investigate several typical EEG waveforms in the same subjects inside the magnet during fMRI and outside the MR examination room. We examined whether uniform artifact subtraction allows the extraction of these different EEG waveforms inside the scanner during EPI scanning to the same extent as outside the scanner. Three well-established experiments were conducted, eliciting steady state visual evoked potentials (SSVEP), lateralized readiness potentials (LRP), and frontal theta enhancement induced by mental addition. All waveforms could be extracted from the EEG recorded during fMRI. Substantially no differences in these waveforms of interest were found between gradient-switching and intermediate epochs during fMRI (only the SSVEP-experiment was designed for a comparison of gradient-with intermediate epochs), or between waveforms recorded inside the scanner during EPI scanning and outside the MR examination room (all experiments). However, non-specific amplitude differences were found between inside and outside recorded EEG at lateral electrodes, which were not in any interaction with the effects of interest. The source of these differences requires further exploration. The high concordance of activation patterns with published results demonstrates that EPI-images could be acquired during EEG recording without significant distortion.     

早产儿准备经口喂养评估量表对早产儿喂养不耐受的影响

目的探讨早产儿准备经口喂养评估量表对早产儿喂养不耐受的影响。方法将2016年6月至2017年9月入住中山市博爱医院新生儿科的60例早产儿,采用随机数字信封法分为对照组和观察组各30例。对照组给予常规早产儿治疗和护理及非营养性吸吮、口腔按摩及运动等干预措施,同时按照《早产儿低出生体重儿喂养建议》实施经口喂养;观察组给予常规护理及干预,并采用早产儿准备经口喂养评估量表对患儿经口喂养能力进行评估后经口喂养。观察比较两组患儿经口喂养不耐受的发生情况。结果观察组奶量不增或减少、呕吐、腹胀、胃潴留等喂养不耐受发生率低于对照组,两组比较差异有统计学意义(P<0.01)。结论早产儿准备经口喂养评估量表可以指导医护人员正确评估并帮助早产儿尽早安全的经口喂养,降低早产儿经口喂养不耐受的发生率。