Integrative simulation: a novel approach to educating culturally competent nurses

Nursing education faces many challenges as a result of the population's increased cultural diversification. Of primary importance is the need to prepare culturally competent nurses to provide care in both urban and remote rural areas. This paper presents a HRSA funded program that utilises simulations to provide culturally diverse learning opportunities for both university-based and distance learning students. Cases are developed using focus groups and individual interviews. The information is used with standardised patients to develop vignettes that are loaded into a web-based virtual hospital where students conduct interviews with culturally diverse patients. The information obtained during the interview is then used to provide hands-on care to a high performance simulator (simulated mannequin). The encounters are videotaped for use in debriefing sessions with the students, for educational programs in the classroom, and for video-streaming to web-based distance students. Students in the debriefing sessions and classroom participate in a review of the videotape using the Personal Response System to respond to question. Through the culturally enhanced integrated simulation, students have an opportunity to address clinical situations and the impact of culture in a relatively safe non-threatening environment where the impact of their biases can be explored.     

Gender differences in cardiac remodeling secondary to chronic volume overload

BACKGROUND: Gender differences in the prevalence of cardiovascular disease, both clinical and experimental, led us to evaluate the influence of gender on ventricular remodeling induced by chronic volume overload. METHODS AND RESULTS: Chronic volume overload was induced in male and female rats via infrarenal aortocaval fistula. Ventricular function was assessed 8 weeks after fistula surgery in surviving rats. Left ventricular, right ventricular, and lung weights were measured. Mortality in female rats was 10-fold less than in male rats after 8 weeks of volume overload. Both sexes had significant increases in left ventricular weights relative to controls (77% increase for female v 114% for male rats; P <.05). Corresponding increases were also observed in right ventricular weight (134% for female v 161% for male rats; P <.05). However, lung weight was significantly increased only in males. In contrast to males, female rats had no indications of congestive heart failure. Male rats had marked dilatation and increased compliance, whereas female rats had no significant change in left ventricular dilatation or compliance. CONCLUSIONS: There are clear gender-specific differences in ventricular function, structural remodeling, and mortality induced by chronic volume overload in this model of heart failure.     

Design, feasibility, and acceptability of an intervention using personal digital assistant-based self-monitoring in managing type 2 diabetes

BackgroundThe information processing demands associated with behavioral self-management of diabetes are extensive. Pairing personal digital assistant (PDA)-based self-monitoring with a behavioral self-management intervention may improve adherence and patient outcomes.MethodsENHANCE is a randomized controlled trial to test an intervention designed to improve regimen adherence in adults with type 2 diabetes. The intervention, based on Social Cognitive Theory (SCT), is paired with PDA-based self-monitoring. In this paper we describe the: (a) manner in which PDA-based self-monitoring is integrated within the SCT-based intervention, (b) feasibility and acceptability of PDA-based dietary self-monitoring, and (c) issues encountered in teaching participants to self-monitor using a PDA.ResultsDuring the first 30 months of this 5-year study, 232 participants were screened and 151 were randomized. To date, 6 cohorts have completed the study. The retention rate is 85% (n = 129). Of those randomized to the intervention (n = 74) and completing the study (n = 61), 88% reported understanding the usefulness of PDA-monitoring, 85% reported ease in entering foods into the device, 70% reported ease in interpreting feedback graphs, and 82% indicated that they would continue to use the PDA for self-monitoring after the study concluded. Assuming 3 meals per day, participants entered an average of 58% of their meals in their PDA, and 43% were entered assuming 4 meals per day. If we eliminate from the analysis those individuals who entered less than 10% of their expected meals (n = 12), the average rate of self-monitoring was 69% assuming 3 meals per day, and 52% assuming 4 meals per day.ConclusionsPDA-based dietary monitoring is perceived by participants to be useful and acceptable. The approach used to instruct participants in use of the PDA and lessons learned are discussed. PDA technology shows promise as a tool for assisting those with type 2 diabetes in their efforts to manage their disease.     

THE EFFECT OF POTASSIUM DEFICIENCY ON THE REABSORPTION OF PROTEIN IN THE RENAL TUBULE OF THE RAT

Male Wistar rats were made potassium-deficient by feeding a diet low in potassium, while controls were pair-fed the same diet supplemented with potassium. Four weeks later 10 mg of T-1824 was injected into each rat. It was found that the characteristic granules which accumulate in the renal collecting tubule cells as a result of potassium deficiency were colored blue and that a diminished coloration of the convoluted tubule cells of the kidney was present. Quantitative measurements of the renal T-1824 content showed that it was decreased as a result of potassium deficiency. The daily rate of protein excretion was increased by the potassium deficiency. It is concluded that potassium deficiency decreases reabsorption of protein in the convoluted tubules of the kidney and that increased proteinuria thus results. Also, the granules which appear in renal collecting tubule cells as a result of potassium deficiency contain serum protein, which probably enters the cells from the tubular lumen.     

Gastric emptying and secretion in Zollinger-Ellison syndrome.

Gastric emptying and secretion, as well as intragastric volume and composition, were determined simultaneously in three patients with Zollinger-Ellison syndrome and in seven normal subjects. Gastric hypersecretion was observed in patients with Zollinger-Ellison syndrome and in normal subjects receiving pentagastrin. In contrast, the fraction of gastric contents emptied per minute (fractional rate of emptying) was increased in Zollinger-Ellison patients and unchanged or decreased in normal subjects receiving pentagastrin. The increased fractional rate of gastric emptying in patients with Zollinger-Ellison syndrome persisted despite abolition of gastric hypersecretion by metiamide. Thus, the increased fractional gastric emptying seen in patients with Zollinger-Ellison syndrome is not attributable to hypergastrinemia, or to gastric hypersecretion per se. Instead, it appears to be caused by an undefined nervous or humoral factor.     

When and how to initiate discussion about prognosis and end-of-life issues with terminally ill patients

The aim of this study was to explore by whom, how, and when discussions about prognosis and end-of-life issues should be initiated with terminally ill patients, and the context in which these issues can be optimally discussed. Focus groups and individual interviews were conducted with 19 palliative care (PC) patients, 24 carers, and 22 PC health professionals (HPs). Participants had disparate views regarding by whom and when such discussions should be initiated, although a similar range of perspectives was expressed by all participant groups. Four main approaches were identified: wait for the patient/carer to raise the topic; HPs to offer all PC patients and their carers the opportunity to discuss the future (preferred by the majority of participants); HPs to initiate the discussion when the patient/family need to know; or HPs to initiate the discussion when the patient/family seem ready. Four themes emerged regarding the optimal context of the discussion: importance of the relationship with HP, clarifying the patient/carers' understanding and how much detail they want to know, negotiating who should be present during the discussion, and who should deliver the information. Initiating prognostic discussions with terminally ill patients requires considerable skill and sensitivity. Communication skills training for HPs may be required to optimize such discussions.     

Interdisciplinary and distance education in the Delta: the Delta Health Education Partnership

The purpose of this article is to describe the activities and outcomes of the Delta Health Education Partnership (DHEP), an interdisciplinary and distance education program developed to promote 'anytime, anywhere' education. The goal of the project is to recruit, educate, and retain interdisciplinary groups of primary care health practitioners to increase access to health care in medically underserved and health professional shortage areas of the lower Mississippi Delta. The targeted health providers are certified nurse midwives, physician assistants, and family nurse practitioners. The DHEP program spans six universities across four primarily rural states. Primary health care students in the lower Mississippi Delta region are taught using asynchronous technology strategies including Internet-based coursework. Opportunities to expand educational options for distance learners and geographically bound students are explained. In addition, methods of building community partnerships in an effort to recruit and retain primary care providers are also explained. The advantages and limitations of the asynchronous Internet-based courses are explored as part of the program evaluation.