Rapid Curricular Innovations During COVID-19 Clinical Suspension: Maintaining Student Engagement with Simulation Experiences.

Health care education programs were faced with the need to quickly adapt to a new reality during the coronavirus disease 2019 pandemic. Students were temporarily suspended from campus and clinical sites, requiring prompt changes in structure to their didactic and clinical learning. This article describes the rapid adjustments that one midwifery and women's health nurse practitioner education program created using both synchronous and asynchronous simulation experiences to promote student learning and ongoing engagement. Flexibility and reflexivity were needed by faculty and students alike in the face of the multiple changes wrought by the pandemic. Curricular changes were made simultaneously in many courses. Objective structured clinical examinations simulate telehealth experiences that assess knowledge, clinical reasoning, and professional behaviors via a scripted scenario and an actor patient. On-call simulations mimic telephone triage and provide students the opportunity to build listening, assessment, and management skills for prenatal and intrapartum scenarios. Students are provided equipment and virtual instruction in an intrauterine device insertion session, which promotes skill acquisition and self-confidence. Trigger films are used to visualize real-life or scripted clinical encounters, leading to discussion and decision-making, particularly in the affective domain. Bilateral learning tools, similar to case studies, provide students an opportunity to demonstrate their knowledge and critical thinking with a mechanism for faculty feedback. Web-based virtual clinical encounter learning tools using patient avatars prompt additional student learning. Suturing skills introduced in live remote group sessions are augmented with video-guided individual practice. This article describes each of these adapted and innovative simulation methods and shares lessons learned during their development and implementation.

Immediate Postpartum Contraception: Intrauterine Device Insertion.

Insertion of an intrauterine device (IUD) in the immediate postpartum period is a safe, evidence-based form of contraception appropriate for most women. Despite the higher risk of expulsion as compared with interval insertion, the benefits of insertion in the immediate postpartum period are significant and include improved rates of contraception continuance and reduced instances of short interval birth. Through shared decision making, midwives and other clinicians can assist women in clarifying their reproductive goals and understanding of contraceptive options, including this method. In response to identified gaps in knowledge and insertion technique among midwives, this article provides an overview of immediate postpartum IUD insertion, risks and benefits, and eligibility criteria and describes preinsertion, insertion, and postinsertion care.

Effect of differentiation of self on adolescent risk behavior: test of the theoretical model.

BACKGROUND: Innovative theoretical models are needed to explain the occurrence of high-risk sexual behaviors, alcohol and other-drug (AOD) use, and academic engagement among ethnically diverse, inner-city adolescents. OBJECTIVE: The aim of this study was to test the credibility of a theoretical model based on the Bowen family systems theory to explain adolescent risk behavior. Specifically tested was the relationship between the predictor variables of differentiation of self, chronic anxiety, and social problem solving and the dependent variables of high-risk sexual behaviors, AOD use, and academic engagement. METHODS: An ex post facto cross-sectional design was used to test the usefulness of the theoretical model. Data were collected from 161 racially/ethnically diverse, inner-city high school students, 14 to 19 years of age. Participants completed self-report written questionnaires, including the Differentiation of Self Inventory, State-Trait Anxiety Inventory, Social Problem Solving for Adolescents, Drug Involvement Scale for Adolescents, and the Sexual Behavior Questionnaire. RESULTS: Consistent with the model, higher levels of differentiation of self related to lower levels of chronic anxiety (p < .001) and higher levels of social problem solving (p < .01). Higher chronic anxiety was related to lower social problem solving (p < .001). A test of mediation showed that chronic anxiety mediates the relationship between differentiation of self and social problem solving (p < .001), indicating that differentiation influences social problem solving through chronic anxiety. Higher levels of social problem solving were related to less drug use (p < .05), less high-risk sexual behaviors (p < .01), and an increase in academic engagement (p < .01). CONCLUSIONS: Findings support the theoretical model's credibility and provide evidence that differentiation of self is an important cognitive factor that enables adolescents to manage chronic anxiety and motivates them to use effective problem solving, resulting in less involvement in health-comprising behaviors and increased academic engagement.