Development and Testing of an Instrument for Summative Assessment of Practical Skill Performance: A Generalizability Theory Approach.

BACKGROUND AND PURPOSE: Many newly graduated nurses lack proficiency in practical skill performance. Presently, nursing students' practical skill is assessed by summative instruments with overarching items. The purpose of this study was to develop a more detailed instrument to use in summative assessment of nursing students' practical skill performance and to assess its psychometric properties. METHODS: A 50-item instrument was developed. Video-recorded performances were rated by experienced clinical supervisors. A multifacet measurement design was developed. Relevant parameters were estimated by generalizability analysis. RESULTS: Findings indicated that error of measurement were mainly caused by raters far more than by items. CONCLUSIONS: The present study suggested that summative assessment in realistic settings may not apply one rater only. Two to three/four raters appear necessary to dependably measure most skills.

Improving Clinical Nurses' Development of Supervision Skills through an Action Learning Approach.

The aim of this study was to investigate action learning as an implementation method in a large-scale project with many participants in several autonomous and geographically spread groups. The focus of the implementation was the Model of Practical Skill Performance as a learning and supervision tool in the clinical education of nursing students. Nineteen action learning groups were established, and a total of 129 clinical supervisors and 13 facilitators were involved. To evaluate the implementation process, qualitative data were generated through three focus group interviews, questionnaires, and notes. Data illuminate clinical supervisors' perceptions of value, impact, and sustainability when they participate in an action learning group to become familiar with the Model of Practical Skill Performance. The deductive data analysis was guided by central concepts from action learning. Action learning proved to be an engaging and effective tool in the implementation where the main strength seemed to be the autonomous local group supporting collective reflections on actions. Clinical supervisors had the right competences to adopt a reflective process-oriented approach, which is the hallmark of action learning. This study shows the necessity of collaboration between stakeholders in practice, education, and management to implement large-scale projects in clinical practice. The findings imply that managers should choose participants on the basis of their motivation and their voluntary wish to participate and that nurses' immersion in the project over time aids implementation.

The art of preceptorship. A qualitative study.

In the clinical nursing practice preceptorship is a widespread method to improve patient care by assisting nurses in developing the right clinical skills. However, little is known about how preceptorship should be practiced to achieve a positive learning outcome. The aim of the study was to investigate how preceptorship can be used in clinical practice to create learning and facilitate competence development. A qualitative study guided by a hermeneutic phenomenological approach and inspired by ethnographic fieldwork included 28 participant observations and 58 interviews. Data were analysed according to Steinar Kvale's three interpretation contexts. The findings showed three themes: Being together: Preceptee and preceptor were physically present in the same room optimising the learning situation with focus on complexity, use of senses and patient safety. Doing together: Preceptee and preceptor performed nursing together to obtain skills focusing on independence, practical skills and communication. Getting along together: Preceptee and preceptor together focused on the patient, relation, comfort and managing how to keep the balance between a professional and a personal relation. Precepetorship is situated learning where knowledge and skills are generated through participation in clinical practice. In this way, nurses develop clinical judgement and independence.

Experiences and management of fatigue in everyday life among adult patients living with heart failure: a systematic review of qualitative evidence.

BACKGROUND: Fatigue, a common and distressing symptom of heart failure, is a non-specific, invisible and subjective experience, which is difficult to describe and for which there are no effective interventions. Fatigue negatively impacts on patients' everyday life, prognosis and quality of life, therefore it is important that patients can manage, monitor and respond to changes in fatigue. To cope with fatigue patients may need or seek advice on self-management strategies. OBJECTIVES: To synthesize the best available evidence on the experiences and management of fatigue in everyday life among adult patients with stable heart failure. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adults with confirmed and stable heart failure. PHENOMENA OF INTEREST: Studies exploring the experiences and management of fatigue in everyday life among adults with heart failure. TYPES OF STUDIES: Qualitative studies focusing on qualitative data, including, but not limited to, designs within phenomenology, grounded theory or ethnography. SEARCH STRATEGY: A three-step search strategy was used to identify published and unpublished qualitative studies from 1995 to 2014. METHODOLOGICAL QUALITY: Studies that met the inclusion criteria were assessed by two independent reviewers for methodological validity using the standardized critical appraisal tools of the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION: Data was extracted from the five included studies using JBI-QARI. DATA SYNTHESIS: Findings were identified and arranged according to the three research questions: patients' experiences of fatigue, impact of fatigue on everyday life and how patients' managed fatigue and its consequences in everyday life. Findings were pooled using JBI-QARI. RESULTS: From the five included studies, 108 findings were derived and subsequently aggregated into 24 categories, which were finally meta-synthesized into five syntheses: "A pervasive and unignorable bodily experience" captured the patients' descriptions of fatigue experiences; "Limited performance of daily living and social activities" and "Loss of self-esteem, identity and intellectual function" aggregated the impact of fatigue on patients' everyday life; "Using protecting and restoring strategies according to the body barometer" and "A dynamic balance between accepting and struggling against fatigue" captured how patients managed fatigue and its consequences. CONCLUSION: Three different types of bodily fatigue challenge patients with heart failure. Decreased physical capacity, unpredictability and fluctuating intensity are dominant features of fatigue experiences, which cause limitations in performing daily and social activities, increased dependency of others, and loss of self-esteem, identity and intellectual function. Patients' management of fatigue and its consequences is an ongoing process involving use of protective and restorative activities to handle the specific bodily fatigue. However it also relates to living constructively with fatigue by striking a balance between adjusting to and struggling against fatigue. IMPLICATIONS FOR PRACTICE: Healthcare providers should be accountable to their patients, recognizing and taking into consideration patients' fatigue experiences and the meaning of fatigue, in order to provide optimal and individual care to their patients. IMPLICATIONS FOR RESEARCH: Further qualitative research is needed to consider cultural factors of importance for managing fatigue in everyday life among patients with heart failure. Furthermore research should explore and test different kinds of physical and mind-body activities on the patients' functional capacity and wellbeing.

From theoretical model to practical use: an example of knowledge translation.

AIM: To present a case of knowledge translation in nursing education and practice and discusses mechanisms relevant to bringing knowledge into action. BACKGROUND: The process of knowledge translation aspires to close the gap between theory and practice. Knowledge translation is a cyclic process involving both the creation and application of knowledge in several phases. The case presented in this paper is the translation of the Model of Practical Skill Performance into education and practice. Advantages and problems with the use of this model and its adaptation and tailoring to local contexts illustrate the cyclic and iterative process of knowledge translation. DISCUSSION: The cultivation of a three-sided relationship between researchers, educators, and clinical nurses was a major asset in driving the process of knowledge translation. The knowledge translation process gained momentum by replacing passive diffusion strategies with interaction and teamwork between stakeholders. The use of knowledge creates feedback that might have consequences for the refinement and tailoring of that same knowledge itself. With end-users in mind, several heuristics were used by the research group to increase clarity of the model and to tailor the implementation of knowledge to the users. IMPLICATIONS FOR NURSING: This article illustrates the need for enduring collaboration between stakeholders to promote the process of knowledge translation. Translation of research knowledge into practice is a time-consuming process that is enhanced when appropriate support is given by leaders in the involved facilities. CONCLUSION: Knowledge translation is a time-consuming and collaborative endeavour. On the basis of our experience we advocate the implementation and use of a conceptual framework for the entire process of knowledge translation. More descriptions of knowledge translation in the nursing discipline are needed to inspire and advise in this process.

Model of practical skill performance as an instrument for supervision and formative assessment.

There are still weaknesses in the practical skills of newly graduated nurses. There is also an escalating pressure on existing clinical placements due to increasing student numbers and structural changes in health services. Innovative educational practices and the use of tools that might support learning are sparsely researched in the field of clinical education for nursing students. This paper reports on an action research study that promoted and investigated use of The Model of Practical Skill Performance as a learning tool during nursing students' clinical placement. Clinical supervisors and two cohorts of nursing students placed in a hospital setting shared their experiences on the use of the model in six focus group interviews. Data was also generated through the supervisors' reflective logs. The model was viewed as highly applicable in the planning of learning situations as well as during practice, performance and formative assessment of practical skills learning. It provided a common language about practical skills and enhanced the participants' understanding of professionalism in practical nursing skill. In conclusion, the model helped to highlight the complexity in mastering practical skills, afforded help in sequencing a learning process that supported the novice, and contributed to a more nuanced feedback by supervisors.

Metal uptake in a peri-urban Lactuca sativa cultivated area.

In this study, two Lactuca sativa crops grown in a net-protected site and an unprotected site were compared. The results showed metals were accumulated by Lactuca sativa. Higher metal accumulation in lettuce grown in the unprotected parcel was established, and the only significant differences in their physicochemical properties were cation exchange capacity and exposure to sunlight. Exposure to the sun may translate into higher soil-plant flux of water and/or higher decomposition rate of organic matter, which may augment the mobilization of metals into the plant, and therefore lead to higher noxious metal accumulation on the crops. Also, EDTA was explored as a possible extractant that could predict the bioavailablity of metals to the lettuce. Our results did not show a good agreement between the metal transferred from soil to leaves and the EDTA extracted metals, although some tendencies were found for the metal transfer from soil to roots. It is predicted that many developing countries will continue and/or increase the use of waste water for the irrigation of crops despite the health risks. Different solutions have been explored to diminish the availability of the metals in the soils. Our study shows that an action as simple as placing a net over the parcel could help diminish the accumulation of metals into the crops of a rapidly expanding peri-urban agricultural system.

Metal distribution in coral reef complex Cayo Arcas in the Gulf of Mexico.

This study evaluated the spatial and temporal distribution of metals in the coral reef system Cayos Arcas and Triangulos in the Campeche Bank region, off the Yucatan peninsula in Mexico. No information has been generated before for the incorporation of natural and non-natural occurring metals, some of which are possibly endowed by the oil marine station Cayo Arcas. The multivariate exploratory study of the metals on the coral skeletons, showed the formation of two distinct groups. The metals that have the highest influence on the differentiation of the groups are the metals that are natural constituents of the coral skeletons, in particular Sr can explain much of the differences between the groups, and to a much lesser extent are the metals that could be indicators of pollution. This differentiation suggests that, in our case, the environment around the corals has a higher impact than the non-naturally occurring metals (and possible indicators of pollution). The two groups formed corresponded to: the coral cores influenced by open sea variables and the coral cores in the inner part of the keys which is less exposed to open sea variables. A chronological study was made to two samples that had the longest coral section and were situated in two clearly distinctive zones: an exposed surface subjected to high wave forces and another that was less exposed. Ni and Zn show an accumulation trend in both coral samples, while Ba showed an increase in incorporation around 1980 when the Cayo Arcas oil marine station was constructed.

Assesment of trace elements and organic pollutants from a marine oil complex into the coral reef system of Cayo Arcas, Mexico.

Possible contaminants produced by the Petroleos Mexicanos (PEMEX) marine oil complex in the vicinity of the Cayo Arcas (Mexico) coral reef ecosystem were evaluated by analyzing sediments and sea water for hydrocarbons and metal elements. We found that the concentrations of aliphatic hydrocarbons in the sea water were generally low, with the highest values detected near the oil station; the concentration of polycyclic aromatic hydrocarbons (PAHs) was generally below the detection limit. The hydrocarbons found in the sediments seem to have a pyrogenic origin, and were probably produced by marine traffic in the study area. The total PAH concentration did not exceed the NOAA criteria, although levels of some individual PAHs did. The only metal detected in the sea water at high concentrations was nickel. The Ni/V ratio in the sediments indicates the contribution of crude oil to the system. The high content of Ni and Zn was attributed to the ballast waters from the oil tankers that load at the station's monobuoys. The presence of fine sediments that commonly originate from terrestrial ecosystems supported this assumption.

Suitability of the vegetation types in Mexico's Tamaulipas state for the siting of hazardous waste treatment plants.

A land suitability study was carried out by applying a multiple-criteria technique to 12 different vegetation types in Mexico's Tamaulipas state to help select potentially suitable sites for hazardous waste treatment plants. Species richness, spatial distribution, and uniqueness were selected as the criteria for estimating a vegetation type's suitability. Using the analytical hierarchy process, we ranked and mapped vegetation types, then compared the results with rankings of the same vegetation types based only on their number of endemic species. The suitabilities of the various vegetation types were ordered in more or less the same way by both methods, except in two cases for which the results were very different. The method proved to be a useful tool despite the availability of only partial (mostly qualitative) information; under such circumstances, expert experience can be incorporated in the evaluation process to a limited degree. The technique described in this paper has a high potential to aid decisions when many opinions and options must be considered simultaneously.

The influence of water-soluble As(III) and As(V) on dehydrogenase activity in soils affected by mine tailings.

Dehydrogenase activity (DHA) in soils contaminated by arsenic-bearing tailings was correlated with total arsenic and total water-soluble arsenic (As(III)+As(V)) to evaluate the impact of tailings dispersion on the oxidative capacity of soil microorganisms. Georeferenced surface soil samples (0-10 cm depth) were collected at different distances from a tailings dam. In the samples farthest from the dam, all water-soluble arsenic (avg. 0.6+/-0.1 mg kg(-1)) was As(V). The highest concentration of water-soluble As(III)+As(V) (>1.9 mg kg(-1)) was found where As(III) was present. DHA averaged 438.9+/-79.3 microg INTF g(-1) h(-1) at the greatest distance from the dam and decreased to 92.3+/-27.1 microg INTF g(-1) h(-1) with decreasing distance from the dam. Pearson correlation coefficient between DHA and samples containing water-soluble As(V) (r=-0.87) was greater than that between DHA and total water-soluble arsenic (r=-0.57). The correlation between DHA and soluble arsenic containing both As(V) and As(III) was not significant (r=0.24). In soils with detectable As(III) concentrations where wet conditions prevail (i.e., reducing conditions), there is an abiotic response in addition to a biotic one. The correlation between DHA and total water-soluble As(III)+ As(V) was higher (r=-0.79) when the abiotic response was excluded. Our study demonstrated the importance of distinguishing between total and available fraction and its species and the need to evaluate biological functions in addition to purely geochemical analyses. DHA bioassay combined with other microbial properties offers a good tool for evaluating soil microbial activity and status and is a suitable indicator of the oxidative capacity of soil microorganisms affected by tailings in an oxidizing environment; however, under reducing conditions, abiotic responses must also be studied.