The effectiveness of a staff education program on the use of continuous EEG with patients in neuroscience intensive care units

Approximately a third of patients in neuroscience intensive care units (ICUs) experience subclinical seizures and, as a result, are at higher risk for poor outcomes. The use of continuous electroencephalography (cEEG) monitoring can help nurses detect seizure activity and initiate early prevention. Nurse competency in the use of cEEG is important to facilitate effective bedside monitoring. The objective of this study was to evaluate the effectiveness of a staff educational program aimed at improving the knowledge of nurses in the use of cEEG monitoring in adults. A quasi-experimental pretest/posttest 1-group design was utilized. Neuroscience ICU registered nurses, whose experience ranged from 2 months to 24 years, participated in the study. Participants completed a pretest on seizure knowledge and the use of cEEG monitoring. Participants received a 4-hour educational session on the use of cEEG monitoring. Immediately after the program and again 1 month later, they completed a posttest. Test scores improved significantly from pretest to the first posttest (t = -15.093, p < .001). Although there was a slight decline in the mean score from the posttest to the 1-month follow-up, posttest scores were significantly better than the pretest score (t = -12.42, df = 44, p < .001). Whereas years of experience correlated positively to the pretest score, after the intervention, no such correlation was evident. The results demonstrated that an educational program improved the competency of nurses in the use of cEEG with adult patients in a neuroscience ICU and that this knowledge was sustained over time. Further research is needed to demonstrate the effectiveness of this intervention in other settings.     

Effects of an educational bereavement program on health care professionals' perceptions of perinatal loss

BACKGROUND: The purpose of this study was to examine the differences in health care professionals' perceptions of perinatal loss situations before and after an educational program on perinatal bereavement. METHOD: A quasi-experimental design was used in a pretest and posttest format. RESULTS: Scores were significantly higher (p = .000) on each of the posttest vignettes. Overall scores were lowest for the miscarriage pretest, whereas scores for the pretest vignettes for the stillbirth and neonatal loss were similar. A similar pattern occurred in the posttest vignette scores. CONCLUSION: Health care professionals' perceptions of the emotional care needs of families experiencing perinatal loss were significantly increased after an educational program. The miscarriage vignette had the largest change score and the lowest mean scores on the pretest and posttest, which indicates professionals do not view miscarriage as significant a loss as stillbirth and neonatal loss.     

Efficacy of an Educational Web Site for Educating Physicians about Bioterrorism

OBJECTIVES: To determine whether a Web-based educational intervention improves emergency physicians' knowledge about bioterrorism and to survey physicians' knowledge and sources of information on bioterrorism. METHODS: Prospective randomized controlled trial using pre- and postintervention testing in hospitals. Participants were general and pediatric emergency medicine attending physicians, fellows, and fourth-year emergency medicine residents. All participants completed a pretest and attended a lecture on bioterrorism. Participants were then randomized to the Web intervention group that received continuous access to a bioterrorism educational Web site with weekly exposure to case scenarios of diseases due to biological agents, or the control group. Participants were retested after one and six months and surveyed to identify their sources of information and assess their knowledge. RESULTS: Sixty-three physicians completed the pretest. There was no difference in mean +/- standard deviation (SD) pretest scores between Web intervention (45% +/- 10%) and control (44% +/- 10%) groups (mean difference: 1.9%; 95% confidence interval [CI] = -6.7% to 2.9%). There was no significant difference between pre- and posttest scores among groups at one month (Web intervention 48% +/- 10% vs. control 45% +/- 10%; mean difference: 3.3%; 95% CI = -8.5% to 2.0%) and six months (Web intervention 51% +/- 8% vs. control 47% +/- 9%; mean difference: 3.8%; 95% CI = -8.8% to 1.2%). More than 60% of physicians cited media reports as their primary source of information on bioterrorism and believed that their knowledge of bioterrorism was limited after one month. CONCLUSIONS: Providing physicians information on bioterrorism through simulated cases and continuous access to an educational Web site does not increase knowledge of bioterrorism. Physicians are more likely to use media reports for their primary source of information.     

Evaluation of a simulation-based workshop on clinical performance for emergency physicians and nurses

BACKGROUND: Simulation-based medical education has been growing rapidly and becomes one of the most popular teaching methods for improving patient safety and patient care. The Simulation Subcommittee of the Hong Kong College of Emergency Medicine organized an educational program emphasizing the team training, clinical decision-making and communication skills. This study aimed to evaluate the attitude of the participants toward a new training program and the change in the knowledge on clinical performance in emergency physicians and nurses after attending the educational program.METHODS: A course evaluation form was filled in by the participants at the end of the workshop. An assessment of 20 multiple-choice questions with 5 options was administered to the participants before and after the 2-day simulation-based training workshop.RESULTS: A total of 72 doctors and nurses working in the Accident and Emergency Department were enrolled. The average pretest and posttest scores were 12 and 14.3 respectively. The percentage improvement in the mean score of the pretest and posttest was 11.5%. The Chi-square test showed signifi cant improvement in the pretest and posttest score grading(P=0.00). Paired t-test revealed signifi cant difference between the mean scores of the pretest and posttest(P=0.00).CONCLUSIONS: Participants had positive attitude toward this new training program. Significant improvement of the knowledge on clinical performance in healthcare professionals in the Accident and Emergency Department was observed after the participation in this simulation-based educational program.     

Partnering for injury prevention: evaluation of a curriculum-based intervention program among elementary school children

A randomized pretest and posttest comparative design was used to evaluate the outcome of implementing Think First for Kids (TFFK), an injury prevention program for children grades 1, 2, and 3, among intervention and controls schools. The study showed that children often lack basic knowledge regarding safety and do not recognize behaviors considered high risk for injury. By using multivariate analysis, the intervention children had a significantly greater increase in knowledge about the brain and spinal cord and safe behaviors to prevent traumatic injury, and a decrease in self-reported, high-risk behaviors (p < .001) when compared with control subjects, adjusting for the covariates gender, socioeconomic status, and race/ethnicity. African American and Hispanic children, although displaying the lowest test scores at baseline, had the largest absolute improvement in posttest scores. The TFKK prevention program addresses the leading causes of trauma among children including sports, motor vehicle crashes, falls, drowning, and pedestrian injuries.     

Tracking the development of professional values in undergraduate nursing students

In the current nursing shortage, nurses are frequently making significant patient care decisions concerning value-laden clinical issues. A program evaluation study was conducted to track professional values over time from entry into a baccalaureate program to graduation. Nursing students completed a survey measuring professional values upon entry into and exit from the program. Comparative analysis of pretest and posttest group means demonstrated statistically significant increases in total scores. The highest pretest value items were also the highest on the posttest, with the addition of patient advocacy. Patient advocacy jumped 16 places from pretest to posttest to become the highest-ranked statement upon exit from the program. All of the values rated as least valued at pretest remained least valued at posttest; however, the means of all but two (participating in nursing research and providing consumer education about products/services) increased significantly. The value statements with mean scores that increased significantly centered on aspects of nursing practice less visible to the lay public and involving interaction with other health care providers.     

Outcomes associated with a summer handwriting course for elementary students.

OBJECTIVE: The purpose of this study was to examine the benefits of a summer handwriting instruction course offered to community elementary-age students. METHODS: Twenty-six students participated in the study and attended instruction for 1 hour per day for 2 weeks. Pre- and posttesting with the Evaluation Tool of Children's Handwriting (ETCH) were conducted. Parents were also asked to rate their child's handwriting at pretest, posttest, and 3 months posttest. RESULTS: Participants made significant improvement in two subtests of the ETCH and in parent ratings between pretest and posttest. Parent ratings remained significantly improved 3 months posttesting. Additional results suggest that children who received special education during the previous school year improved their handwriting scores on the ETCH to a greater degree than those who did not receive special education. CONCLUSION: A new service delivery model for handwriting instruction has the potential to benefit students. Occupational therapists should consider offering handwriting training to students in the summer especially if deterioration of performance is anticipated.     

Effect of field experiences on music therapy students' perceptions of choral music for geriatric wellness programs

The purpose of the study was to examine the effect of field experiences on music therapy students' perceptions of choral music for geriatric wellness programs. Specifically, the study investigated music therapy students': a) personal comfort working with senior adult singers; b) perceptions of preparation in their educational training to work with senior adults in a choral music wellness program; c) perceptions of senior adults' functioning levels as singers in choral ensembles; d) perceptions of senior adults' functioning levels as learners; and e) willingness to seek additional opportunities to lead senior adults in choral music wellness programs. Comparative analysis using pretest and posttest scores for each grouping was completed. Significant mean score differences were found in the categories of student comfort, preparation, perceptions of singing, and willingness, with gains from pre- to posttest in all categories. The general demographics and perceptions of learning groupings increased and decreased, respectively, though not significantly, following the field experience. Analysis combining all groups, creating an overall pretest and posttest score, was also completed. Results revealed that students felt significantly more positive about choral music being used in wellness programs for senior adults after the field experience.     

Clinical experience and cognition of a physical therapy procedure

This investigation was designed to determine if clinical experience influences cognition of a physical therapy procedure. We hypothesized that experience in the application of a physical therapy procedure on patients would increase the student's cognition of that procedure. Twenty-two junior students in a physical therapy baccalaureate program were study subjects. A multiple-choice test pertaining to gait training was administered to all subjects as a pretest and posttest. The pretest was given after classroom instruction and laboratory practice in gait training; posttest was administered eight weeks later. During the interim eight weeks, 11 subjects completed 32 hours of clinical experience and 11 subjects had no clinical experience. Analysis of the results of posttest compared with pretest indicated that for these subjects, clinical experience did not increase cognition of gait training.     

Immunization update: a community-based nursing education program

BACKGROUND: Nurses play key roles as advocates, educators, and researchers to eliminate barriers to access as well as educate the public on the importance of vaccines for children in the United States. METHOD: Fifty-four nurses attending a community-based immunization program completed a pretest questionnaire which included identification of related practice behaviors and general knowledge questions. Twenty-four responded to a similar posttest survey 6 months later. The investigators compared knowledge pretest and posttest scores with a t test. Behavioral changes were compared between the pretest and posttest group by analyzing the percentage of change between the time period. RESULTS: The mean score in the knowledge section increased significantly from a pretest mean of 52% to 75% during the posttest period (p < 005). Behavior change was not statistically significant because of the low number of posttest responses indicating actual immunization practices in the clinical setting. The investigators analyzed trends in practice by comparing percentages of responses. CONCLUSION: These findings suggest that a multifaceted, community-based nursing continuing education program including both local, ethnic community perspectives and information related to the latest standards of practice can impact knowledge levels and some practice behaviors.     

Psychiatric-mental health education with integrated role-play and real-world contact can reduce the stigma of nursing students towards people with mental illness

Stigma and negative attitudes towards people with mental illness are frequently found among nursing students. Interventions targeting mental illness stigma are the critical elements in altering the status. The aim of the present study was to examine the effects of the psychiatric-mental health education with role-play and real-world contact on stigma of nursing students towards people with mental illness in China. A single group pretest and posttest study design was adopted and total 373 students were recruited whilst 343 completed the course. We integrated the role-play and contact with patients in the routine psychiatric-mental health education. After the education was completed, the students' stigma towards people with mental illness were positively changed (pretest mean score of stigma: 53.77, posttest mean score of stigma: 49.01, 95% CI: 2.63–6.87) and their willingness to care for the people with mental illness was also significantly increased (pretest mean score of willingness: 5.45, posttest mean score of willingness: 7.38, 95% CI: −2.22–−1.65). The psychiatric-mental health education especially with integrated role-play and real-world contact is an effective way to reduce nursing students’ stigma and negative attitudes towards people with mental illness and increases their willingness to care for people with mental illness.     

Decrease of hypertonia after continuous passive motion treatment in individuals with spinal cord injury

OBJECTIVE: To examine the effect of ankle continuous passive motion on the reflex excitability and overall hypertonia of calf muscles in individuals with chronic spinal cord injury and without physical disabilities. DESIGN: Two-way repeated measure experimental design. SETTING: Inpatient rehabilitation department in general hospital. SUBJECTS: The spinal cord injury group comprised eight individuals with chronic complete spinal cord injury and the control group comprised eight healthy people without physical disabilities. An additional eight healthy people were recruited as the sham group. INTERVENTIONS: Each subject received 60 min of continuous passive motion on the ankle joint. MAIN MEASURES: The H-reflex of the soleus muscle was elicited by tibia nerve stimulation just before, immediately after, and 10 min after continuous passive motion. The Modified Ashworth Scale (MAS) score at the ankle joint was recorded for the spinal cord injury group just before and 10 min after continuous passive motion therapy. RESULTS. After 60 min of continuous passive motion of the ankle joint, the H-reflex amplitude at the soleus muscle was depressed in individuals with and without spinal cord injury (77.46 +/- 32.64%, P = 0.047 and 51.76 +/- 26.74% of initial, P<0.0001, respectively). This depression persisted up to 10 min after continuous passive motion only in individuals without spinal cord injury. In individuals with spinal cord injury, the median of MAS scores decreased from 2 to 1.25 after continuous passive motion. CONCLUSION: Sixty minutes of continuous passive motion of the ankle joint decreased reflex excitability and overall hypertonia in people with or without spinal cord injury. The depression of overall hypertonia persisted longer than the reflex excitability in people with spinal cord injury.     

Graduate nursing students' precourse and postcourse perceptions and preferences concerning completely web-based courses

Web-based nursing courses have proliferated rapidly in recent years, but few data are available about course outcomes. A pretest/posttest survey design of student perceptions and preferences was used to evaluate two graduate-level on-line nursing courses (required research and elective aging issues courses; N = 31 and N = 29, respectively) on the basis of Billings' outcomes evaluation framework for nursing Web-based courses. Students in both courses were favorable or at least neutral in their perceptions of outcomes at both pretest and posttest, but favorable shifts in perceptions also occurred from pretest to posttest. Most students remained stable in their preferences for format of instruction (on-line or classroom), and most favored an on-line format. Almost all students indicated they would take the course they took if they had the decision to make over again. Students who took the elective aging issues course had somewhat more favorable perceptions overall at posttest, compared to the required research course, but some differences were accounted for by pretest score differences between the groups. While outcomes were positive for both courses, the results also highlight specific needs for adequate socialization and support of students, particularly for first-year graduate students who are taking Web-based courses.     

Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation

OBJECTIVE: To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects' mean age +/- standard deviation (SD) was 59+/-18.3 years. INTERVENTION: Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5+/-1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay. MAIN OUTCOME MEASURES: Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined. RESULTS: There were no adverse incidents. The control group's mean percentage score +/- SD increased from 60.1%+/-14.4% to 64.9%+/-13.3%, an 8% improvement of the posttest relative to the pretest (P=.01). The WSTP group's mean score increased from 64.9%+/-9.4% to 80.9%+/-5.6%, a 25% improvement of the posttest relative to the pretest (P<.000). The WSTP group showed significantly greater improvements than the control group (P<.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills (P<.001). CONCLUSIONS: The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.     

Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses.

BACKGROUND: Hand-carried ultrasound (HCU) devices used by cardiologists as extensions of the physical examination have been shown to improve the accuracy of bedside diagnoses. We tested the feasibility of teaching medical students to use HCU devices to make bedside cardiac diagnoses and compared the accuracy of their HCU and physical examinations. METHODS: In all, 10 fourth-year medical students enrolled in a 4-week medical school course on the cardiac examination. Students examined 12 standardized patients at 3 different time intervals: (1) on day 1 of the course; (2) on day 10 after review of cardiac physical examination using traditional teaching methods; and (3) after instruction on the use of HCU devices. Students were scored at each time interval for primary findings (most salient) and all findings, accounting for both errors of commission and omission. Scores could range from +12 to -12 for primary findings and from +22 to -22 for all findings. A perfect score was +12 for primary findings and +22 for all findings. RESULTS: The average score for all students at baseline was -3.2 +/- 3.1 and -5.7 +/- 4.8 for primary and all findings, respectively. A significant improvement in the scores was noted with use of the HCU device (2.6 +/- 3.1 and 5.2 +/- 6.6 for primary and all findings, respectively) compared with the baseline and two subsequent physical examinations. CONCLUSION: Instruction of fourth-year medical students on the use of HCU device is feasible and results in significantly more accurate bedside diagnoses.     

Implementing a multidisciplinary disaster simulation for undergraduate nursing students

A liberal-arts-based undergraduate nursing program engaged in curriculum enhancement activities that led to the implementation of a disaster simulation for 81 multidisciplinary undergraduate students. A pretest/posttest design was used to determine the effectiveness of preparation for the simulation. Nursing students in three levels of the program received didactic preparation in disaster preparedness and were assigned to five different simulation response teams. One-way ANOVA revealed statistically significant differences for pretest and posttest scores, p = 0.05. An evaluation of student performance indicated that five of the eight nursing students assigned to the disaster site correctly triaged 81.2 percent of the victims; all eight nursing students assigned to the emergency department correctly reassessed the victims. Classroom didactic content, followed by a simulated learning experience, was found to be an effective teaching strategy for preparing undergraduate nursing students in disaster preparedness.     

Évaluation de l''attitude vis-à-vis des personnes handicapées des étudiants en médecine de 3 et 4 année par le questionnaire « Attitude towards disabled persons ». Effets de l''enseignement théorique et de stages dans les services de médecine physique et réadaptation

Modifications of the medical curriculum have included a compulsory course on disability. OBJECTIVE: To determine whether attendance in a course on disability and/or rotations in physical medicine and rehabilitation departments modify the attitude of medical students towards disabled people. METHODS: All third- and fourth-year students completed a translated version of the ATDPb. This questionnaire rates items evaluating attitude towards disabled people on a 6-point scale (minimum 0; maximum 180). Retro-translation was performed to control the translation. During the second year, all students had attended a general course in ethics. Fourth-year students had attended a 17 hours course on disability, and 21 of 78 had spent 9 weeks in the physical medicine and rehabilitation department. The study compares fourth-year students to third-year students, considered as controls, and students having spent a rotation in the physical medicine and rehabilitation department to others. RESULTS: The mean score of all students was 108.86+/-15.84 (73-160) on the ATDP scale. Males and females did not differ significantly, and the score did not change from that before the course on disability (109.95+/-14.98 vs 107.6+/-16.65, P=0.23) nor after a rotation in the physical medicine and rehabilitation department (113.52+/-11.42 vs 108.54+/-16.03, P=0.14). CONCLUSION: Development and validation of scores that would fit better to the European cultural context would be useful. The present method of theoretical courses and rotations do not improve the attitude of students towards disabled people and should be modified if this objective is to be achieved.     

Human patient simulation versus case study: Which teaching strategy is more effective in teaching nursing care for the hypoglycemic patient?

With the ever-increasing safety concerns presented in a health care setting, it is imperative that nursing students are prepared for the demand of utilizing the skill of critical thinking while providing care to patients experiencing hypoglycemia. Nurse educators strive to implement different teaching strategies to promote critical thinking skills. The purpose of the study was to evaluate the effectiveness of two teaching strategies: human patient simulation (HPS) and a single case study during diabetes education. In addition, the study was used to validate the inclusion of HPS in the authors' nursing program curriculum. A quasi-experimental, two-group pretest and posttest design was utilized to evaluate these teaching strategies. Faculty also completed an objective clinical evaluation, which evaluated students' clinical reasoning, and all students completed a postsurvey evaluating the teaching strategies. Study results indicated the pretest average scores for both groups were identical. The posttest results for the case study group were slightly higher than the simulation group results. On the clinical evaluation tool, the simulation group scored much greater than the case study group. Both results were statistically significant. The postlesson survey results were greater overall for the simulation group on all statements. All students agreed or strongly agreed that simulation was effective. According to the student test results and clinical evaluations, both teaching strategies are beneficial in nursing education; moreover, the student surveys and comments validated the addition of simulation as a valuable teaching strategy. As a result of this research, HPS was formally implemented into the nursing curriculum.     

The effect of an interprofessional simulation-based education program on perceptions and stereotypes of nursing and medical students: A quasi-experimental study

BackgroundInterprofessional education is intended to train practitioners to collaboratively address challenges in healthcare delivery, and interprofessional simulation-based education (IPSE) provides realistic, contextual learning experiences in which roles, responsibilities, and professional identity can be learned, developed, and assessed. Reducing negative stereotypes within interprofessional relationships is a prime target for IPSE.ObjectivesWe sought to understand whether perceptions of interprofessional education and provider stereotypes change among nursing and medical students after participating in IPSE. We also sought to determine whether changes differed based on the student's discipline.DesignThis was a quasi-experimental pretest-posttest study.SettingThe study took place at a large mid-Atlantic public university with a comprehensive health science campus.Participants147 senior Bachelors of Science in Nursing students and 163 fourth-year medical students participated.MethodsStudents were grouped into interprofessional teams for a two-week period and participated in three two-hour simulations focused on collaboration around acutely ill patients. At the beginning of the first session, they completed a pretest survey with demographic items and measures of their perceptions of interprofessional clinical education, stereotypes about doctors, and stereotypes about nurses. They completed a posttest with the same measures after the third session.Results251 students completed both the pretest and posttest surveys. On all three measures, students showed an overall increase in scores after the IPSE experience. In comparing the change by student discipline, medical students showed little change from pretest to posttest on stereotypes of doctors, while nursing students had a significant increase in positive perceptions about doctors. No differences were noted between disciplines on changes in stereotypes of nurses.ConclusionsThis study demonstrated that a short series of IPSE experiences resulted in improved perceptions of interprofessional practice and changes in stereotypical views of each profession even when the experience was not directly designed to address these issues. Differences observed between nursing and medical students should be explored further.