Formative online multiple-choice tests in nurse education: An integrative review.

AIM: The aim of this integrative review is to explore how formative online multiple-choice tests used in nurse education promote self-regulated learning and report on pedagogies that support their design. BACKGROUND: Online multiple-choice tests are widely used as learning and formative assessment tools in a range of educational contexts. However, little is known about how these tools are used to promote patterns of learner self-regulation. It is important that nurses and nursing students develop the capability to self-regulate learning to be effective lifelong learners and navigate complex and unfamiliar practice environments. DESIGN: A five-stage approach guided this integrative review: problem identification, literature search, data evaluation, data analysis and presentation. METHOD: A systematic search of ERIC, Web of Science, Ovid Medline, Scopus, PubMed, Embase and CINAHL was conducted in February 2021. Seventeen peer-reviewed papers were identified that discussed formative online multiple-choice tests in nurse education. Purposive sampling and ancestry searching identified an additional paper. Articles were analysed and sorted into themes of outcomes (presented as components of self-regulated learning theory) and pedagogy. RESULTS: Formative online multiple-choice tests are used with good effect in nurse education as measured by knowledge gain and exam performance, increased confidence and learner satisfaction. There was no literature that explored metacognitive outcomes and minimal literature considered behavioural outcomes. Pedagogy supporting the implementation of multiple-choice tests was lacking in most articles. CONCLUSIONS: Formative online multiple-choice tests are widely used with good effect in nurse education. However, opportunities for further research on how these tools can encourage metacognition and self-regulatory behaviours is warranted.

The Impact of Nurse-Led Innovations and Tactics During a Pandemic.

The COVID-19 pandemic hit southeast Michigan hard and a rapid influx of patients forced Beaumont Health to shift rapidly into an emergency management model with a laser focus on transforming clinical care and administrative processes to meet complex patient care needs. Navigating this landscape required agility, surge planning, strong interprofessional teams, transformational leadership, nurse-led innovations, support, and transparency to manage the ever-changing environment. This article explains nursing's response and nurse-led innovations that were implemented to meet the needs of the community, patients, and staff, as well as lessons learned to ensure preparedness for any potential future surge.

Women in the midluteal phase of the menstrual cycle have difficulty suppressing the processing of negative emotional stimuli: An event-related potential study.

Emotion regulation deficits have been implicated in anxiety and depressive disorders, and these internalising disorders are more prevalent in women than men. Few electrophysiological studies have investigated sex differences in emotional reactivity and emotion regulation controlling for menstrual phase. Event-related potentials (ERPs) were recorded from 28 early follicular women, 29 midluteal women, and 27 men who completed an emotion regulation task. A novel finding of increased N2 amplitude during suppression was found for midluteal women compared with men. These findings suggest midluteal women may be significantly less able to suppress cortical processing of negative stimuli compared to men. This ERP finding was complemented by behavioral ratings data which revealed that while both early follicular and midluteal women reported more distress than men, midluteal women also reported greater effort when suppressing their responses than men. P1 and N1 components were increased in midluteal women compared to men regardless of instructional set, suggesting greater early attentional processing. No sex or menstrual phase differences were apparent in P3 or LPP. This study underscores the importance of considering menstrual phase when examining sex differences in the cortical processing of emotion regulation and demonstrates that midluteal women may have deficits in down-regulating their neural and behavioural responses.

The impact of high trait social anxiety on neural processing of facial emotion expressions in females.

A cognitive model of social anxiety predicts that an early attentional bias leads to greater cognitive processing of social threat signals, whereas the vigilance-avoidance model predicts there will be subsequent reduction in cognitive processing. This study tests these models by examining neural responses to social threat stimuli using Event-related potentials (ERP). 19 women with high trait social anxiety and 19 women with low trait social anxiety viewed emotional expressions (angry, disgusted, happy and neutral) in a passive viewing task whilst ERP responses were recorded. The HSA group revealed greater automatic attention, or hypervigilance, to all facial expressions, as indexed by greater N1 amplitude compared to the LSA group. They also showed greater sustained attention and elaborative processing of all facial expressions, indexed by significantly increased P2 and P3 amplitudes compared to the LSA group. These results support cognitive models of social anxiety, but are not consistent with predictions of the vigilance-avoidance model.

Gender differences in salivary alpha-amylase and attentional bias towards negative facial expressions following acute stress induction.

This study investigated gender differences in two key processes involved in anxiety, arousal and attentional bias towards threat. Arousal was assessed using salivary alpha-amylase (sAA), a biomarker of noradrenergic arousal and attention bias using a dot-probe task. Twenty-nine women and 27 men completed the dot-probe task and provided saliva samples before and after a stress induction [cold pressor stress (CPS) test]. Women displayed a significant increase in arousal (sAA) following the stressor compared to men, who displayed a significant reduction in arousal. Reaction time data revealed a significant avoidance of threat in women at baseline, but a significant change to an attention bias towards threat following the stressor. Men did not significantly respond to the stressor in terms of attentional bias. These findings suggest that women are more reactive to a stressor than men, and display an initial avoidance response to threat, but an attentional bias towards threat following stress.

Early visual processing is enhanced in the midluteal phase of the menstrual cycle.

Event-related potential (ERP) studies have revealed an early attentional bias in processing unpleasant emotional images in women. Recent neuroimaging data suggests there are significant differences in cortical emotional processing according to menstrual phase. This study examined the impact of menstrual phase on visual emotional processing in women compared to men. ERPs were recorded from 28 early follicular women, 29 midluteal women, and 27 men while they completed a passive viewing task of neutral and low- and high- arousing pleasant and unpleasant images. There was a significant effect of menstrual phase in early visual processing, as midluteal women displayed significantly greater P1 amplitude at occipital regions to all visual images compared to men. Both midluteal and early follicular women displayed larger N1 amplitudes than men (although this only reached significance for the midluteal group) to the visual images. No sex or menstrual phase differences were apparent in later N2, P3, or LPP. A condition effect demonstrated greater P3 and LPP amplitude to highly-arousing unpleasant images relative to all other stimuli conditions. These results indicate that women have greater early automatic visual processing compared to men, and suggests that this effect is particularly strong in women in the midluteal phase at the earliest stage of visual attention processing. Our findings highlight the importance of considering menstrual phase when examining sex differences in the cortical processing of visual stimuli.

Leisure Time Activities and Mental Health in Informal Dementia Caregivers.

OBJECTIVES: Dementia prevalence and the demand for dementia care are increasing. Informal caregiving accounts for a large proportion of dementia care, but can come at high cost for caregivers. Informal dementia caregivers are at higher risk for mental health problems than the general population. This study examines whether perceived change in leisure activities is one working mechanism linking stress and burden experience in dementia caregiving to lower mental health (depressive symptoms, anxiety symptoms, and reduced satisfaction with life), and whether there are group-based leisure activities that can buffer this detrimental effect. METHODS: A total of 346 informal Australian dementia caregivers (88.15% female, age 18-82 years) participated in an online study. RESULTS: Mediation and moderation analyses using multiple regression demonstrated that perceived changes in leisure activities linked caregiving stress and burden to lower mental health, and that membership in groups engaging in affiliation or social activities attenuates negative effects of caregiving. CONCLUSION: Informal dementia caregivers benefit from satisfying leisure activities. In particular, engaging in social activities and self-help groups buffered the negative impact of caregiving.

Self-reported physiological and psychological side-effects of an acute alcohol and energy drink dose.

OBJECTIVE: There have been repeated calls from health professionals and policy-makers to clarify the side-effects of the increasingly popular consumption trend of alcohol mixed with energy drinks (AmED). There is a dearth of research assessing the differential effects of AmED relative to alcohol by comparing self-reported psychological and physiological outcomes whilst under the influence of these substances. The aim of the present study was to examine the acute effects of a moderate alcohol and energy drink (ED) dose on self-reported psychological and physiological outcomes. METHOD: Using a single-blind, placebo-controlled, crossover design, 28 adults completed four sessions where they were administered: (i) 0.50g/kg alcohol, (ii) 3.57mL/kg ED, (iii) AmED, and (iv) placebo. Participants independently completed the Profile of Mood States and a Somatic Symptom Scale at baseline and at 30 and 125min after beverage administration. RESULTS: Breath alcohol concentration peaked at .068% and .067% in the alcohol and AmED conditions, respectively. There were no interactive alcohol and ED effects on self-reported psychological outcomes. Treatment effects for physiological outcomes generally only related to alcohol or ED administration, with the exception of a moderate magnitude decrease in heart palpitation ratings following alcohol relative to AmED. Decreased muscular tension ratings were evident when the two constituents were consumed separately relative to placebo. CONCLUSIONS: The results provide evidence of few subjective changes in physiological and psychological state after consuming AmED relative to alcohol. The majority of treatment-based changes arose from the independent effects of alcohol or ED, rather than being modified by their interaction. However, research extending into higher dosage domains is required to increase outcome generalisability for consumers in the night-time economy.

Sex differences and emotion regulation: an event-related potential study.

Difficulties in emotion regulation have been implicated as a potential mechanism underlying anxiety and mood disorders. It is possible that sex differences in emotion regulation may contribute towards the heightened female prevalence for these disorders. Previous fMRI studies of sex differences in emotion regulation have shown mixed results, possibly due to difficulties in discriminating the component processes of early emotional reactivity and emotion regulation. The present study used event-related potentials (ERPs) to examine sex differences in N1 and N2 components (reflecting early emotional reactivity) and P3 and LPP components (reflecting emotion regulation). N1, N2, P3, and LPP were recorded from 20 men and 23 women who were instructed to "increase," "decrease," and "maintain" their emotional response during passive viewing of negative images. Results indicated that women had significantly greater N1 and N2 amplitudes (reflecting early emotional reactivity) to negative stimuli than men, supporting a female negativity bias. LPP amplitudes increased to the "increase" instruction, and women displayed greater LPP amplitudes than men to the "increase" instruction. There were no differences to the "decrease" instruction in women or men. These findings confirm predictions of the female negativity bias hypothesis and suggest that women have greater up-regulation of emotional responses to negative stimuli. This finding is highly significant in light of the female vulnerability for developing anxiety disorders.

The impact of alcohol and energy drink consumption on intoxication and risk-taking behavior.

BACKGROUND: It has been argued that consuming alcohol mixed with energy drinks (AmED) causes a subjective underestimation of intoxication and an increased level of risk-taking behavior. To date, however, there is mixed support for AmED-induced reductions in perceived intoxication, and no objective assessment of risk-taking following AmED consumption. Consequently, the present study aimed to determine the effect of alcohol and energy drink (ED) consumption on subjective measures of intoxication and objective measures of risk-taking. METHODS: Using a placebo-controlled, single-blind, cross-over design, participants (n = 28) attended 4 sessions in which they were administered, in counterbalanced order: 0.5 g/kg alcohol, 3.57 ml/kg ED, AmED, and a placebo beverage. Participants completed the Biphasic Alcohol Effects Scale and a Subjective Effects Scale at baseline and 30 and 125 minutes postbeverage administration; risk-taking was measured using the Balloon Analogue Risk Task (BART). RESULTS: Participants reported greater subjective intoxication, impairment, and sedation after active relative to placebo alcohol consumption, with no interactive AmED effects. However, a significant moderate magnitude increase in stimulation ratings was observed in the AmED relative to alcohol, ED, and placebo conditions. There was no independent effect of alcohol, or interactive effect with ED, on the BART. A significant, yet small magnitude, increase in risk-taking was evident in active relative to placebo ED conditions. CONCLUSIONS: The interactive effect of AmED appears restricted to perceived stimulation, with alcohol-induced increases in subjective intoxication occurring regardless of presence or absence of ED. Engagement in risk-taking behavior was only increased by ED consumption; however, this effect was only of small magnitude; at these doses, alcohol consumption, with or without EDs, did not affect risk-taking. Further research assessing the dose-dependent effects of AmED on objectively measured risk-taking behavior could clarify whether the ED effect increases with higher doses and whether an interactive effect is observed with higher alcohol doses.

Energy drink ingredients. Contribution of caffeine and taurine to performance outcomes.

While the performance-enhancing effects of energy drinks are commonly attributed to caffeine, recent research has shown greater facilitation of performance post-consumption than typically expected from caffeine content alone. Consequently, the aim of the present study was to investigate the independent and combined effect of taurine and caffeine on behavioural performance, specifically reaction time. Using a double-blind, placebo-controlled, crossover, within-subjects design, female undergraduates (N=19) completed a visual oddball task and a stimulus degradation task 45min post-ingestion of capsules containing: (i) 80mg caffeine, (ii) 1000mg taurine, (iii) caffeine and taurine combined, and (iv) matched placebo. Participants completed each treatment condition, with sessions separated by a minimum 2-day washout period. Whereas no significant treatment effects were recorded for reaction time in the visual oddball task, facilitative caffeine effects were evident in the stimulus degradation task, with significantly faster reaction time in active relative to placebo caffeine conditions. Furthermore, there was a trend towards faster mean reaction time in the caffeine condition relative to the taurine condition and combined caffeine and taurine condition. Thus, treatment effects were task-dependent, in that independent caffeine administration exerted a positive effect on performance, and co-administration with taurine tended to attenuate the facilitative effects of caffeine in the stimulus degradation task only.