COVID-19 Pandemic: Effects of Replacing Clinical Hours With Virtual Simulation in BSN Prelicensure Nursing Education.

ABSTRACT: At the onset of the COVID-19 pandemic, many academic institutions suspended in-person instruction and clinical experiences. Virtual simulation played an essential role in providing alternatives. The current study used faculty and student surveys, along with standardized exit exams and NCLEX-RN® pass rates, to determine the effect of using virtual simulation instead of traditional hospital clinical experiences during the final semester of a prelicensure BSN program. Results indicated a small decrease in exit exam scores compared to those who completed the traditional clinical experience and no significant relationship between NCLEX-RN pass/fail rates.

Creating a Periop 202 Course and Orientation Program for Open-Heart Procedures to Increase Cardiovascular OR Nurse Recruitment and Retention.

As the global population ages, hospital administrators will need to employ a sufficient number of OR nurses to meet the demands of increasing surgical volumes. However, ORs can be intimidating working environments and undergraduate nursing programs lack formal didactic courses in perioperative nursing, leaving little to entice newly graduated nurses to the perioperative specialty. It is important for nurse leaders to employ interventions for recruiting and retaining OR nurses, particularly in specialty service lines, including cardiovascular surgery. A Periop 202 course for open-heart procedures was developed and woven into a cardiovascular OR (CVOR) orientation program for newly graduated nurses and experienced nurses who were new to the CVOR. The program aimed to increase new CVOR nurses' competencies and knowledge of protocols and guidelines for open-heart procedures and their self-efficacy to function on the CVOR team. Knowledge questionnaire and learning scale results showed increased postintervention knowledge and self-efficacy among program participants.

Academic and Nonacademic Predictors of BSN Student Success on the HESI Exit Exam.

First-time success rate on the NCLEX-RN examination has significant implications for BSN students, faculty, and schools of nursing. Many nursing programs utilize standardized examinations such as the HESI Exit Exam to quantify student success on knowledge of nursing concepts and to prepare students for success on the NCLEX-RN. Nursing faculty must be able to identify predictors of student success early in the nursing program in order to offer appropriate support and remediation. The purpose of this retrospective, correlational study was to determine predictive variables of BSN student success on the HESI Exit Exam in a southeastern university. Students who reported higher test anxiety scored significantly lower on the HESI Exit Exam. Higher medical-surgical I HESI examination scores, higher medical-surgical II HESI examination scores, higher obstetrics HESI examination scores, and higher final grade point average were significant predictors of students' HESI Exit Exam scores and accounted for 39% of the variance in the scores. Results from this study suggest implementing remediation based on HESI Specialty Exam scores and interventions aimed at reducing test anxiety.

Perceptions of Black Children's Narrative Language: A Mixed-Methods Study.

Purpose In this mixed-methods study, we address two aims. First, we examine the impact of language variation on the ratings of children's narrative language. Second, we identify participants' ideologies related to narrative language and language variation. Method Forty adults listened to and rated six Black second-grade children on the quality of 12 narratives (six fictional, six personal). Adults then completed a quantitative survey and participated in a qualitative interview. Results Findings indicated that adults rated students with less variation from mainstream American English (MAE) more highly than students with greater variation from MAE for fictional narratives, but not for personal narratives. Personal narratives tended to be evaluated more favorably by parents than teachers. Black raters tended to assign higher ratings of narrative quality than did White raters. Thematic analysis and conversation analysis of qualitative interviews supported quantitative findings and provided pertinent information about participants' beliefs. Conclusion Taken together, quantitative and qualitative results point to a shared language ideology among adult raters of variation from MAE being more acceptable in informal contexts, such as telling a story of personal experience, and less acceptable in more formal contexts, such as narrating a fictional story prompted by a picture sequence.

Impact of a modified early warning score on nurses' recognition and response to clinical deterioration.

AIMS: (a) Improve nurse knowledge of and confidence in responding to clinical deterioration through implementation of the Modified Early Warning Score tool and (b) improve nurse ability to react to patient deterioration in a timely manner. BACKGROUND: Recognition of clinical deterioration in hospitalized inpatients often occurs far after those signs initially present. The Modified Early Warning Score has been shown to assist with recognition earlier in the deterioration process. METHODS: Eighty-five nurses participated in a simulation-based intervention to implement the Modified Early Warning Score into their rural hospital. Group classroom sessions and individual high-fidelity simulation experiences were provided for participants. Twenty-nine nurses also participated in self-confidence and knowledge assessment testing. RESULTS: The simulation-based intervention significantly improved nurse knowledge (t = 4.029, p < .01) and self-confidence (t = 3.698, p = <.01). Chart reviews found a 34.1% increase in nurse action taken in response to signs of clinical deterioration. CONCLUSION: Current study found that the Modified Early Warning Score tool as taught through a simulated patient experience is useful to prevent unrecognized deterioration. IMPLICATIONS FOR NURSING MANAGEMENT: Suggests that a simulation-based intervention is effective for teaching and evaluating post-licensure nurses on acute clinical deterioration in inpatients.

BMI, physical activity, and breast cancer subtype in white, black, and Sea Island breast cancer survivors.

Higher BMI, lower rates of physical activity (PA), and hormone receptor-negative breast cancer (BC) subtype are associated with poorer BC treatment outcomes. We evaluated the prevalence of high BMI, low PA level, and BC subtype among survivors with white/European American (EA) and African American (AA) ancestry, as well as a distinct subset of AAs with Sea Island/Gullah ancestry (SI). We used the South Carolina Central Cancer Registry to identify 137 (42 EAs, 66 AAs, and 29 SIs) women diagnosed with BC and who were within 6-21 months of diagnosis. We employed linear and logistic regression to investigate associations between BMI, PA, and age at diagnosis by racial/ethnic group. Most participants (82%) were overweight/obese (P=0.46). BMI was highest in younger AAs (P=0.02). CDC PA guidelines (≥150min/week) were met by only 28% of participants. The frequency of estrogen receptor (ER)-negative BC subtype was lower in EAs and SIs than in AAs (P<0.05). This is the first study to identify differences in obesity and PA rates, and BC subtype in EAs, AAs, and SIs. BMI was higher, PA rates were lower, and frequency of ER-negative BC was higher in AAs as compared to EAs and SIs. This study highlights the need to promote lifestyle interventions among BC survivors, with the goal of reducing the likelihood of a BC recurrence. Integrating dietary and PA interventions into ongoing survivorship care is essential. Future research could evaluate potential differential immune responses linked to the frequency of triple negative BC in AAs.

Positive Impact of Technician-Driven MTM Program on Performance Measures.

OBJECTIVE: To determine the effect of using a technician-driven medication therapy management (MTM) program on quality performance measures for a community pharmacy chain. METHODS: A technician-driven MTM program was incorporated in 35 stores of a regional supermarket pharmacy chain. The overall chain percentage score for the 4 quality measures used in Medicare Part D Star Ratings-proportion of days covered (PDC) for cholesterol, diabetes, renin-angiotensin system antagonists (RASA), and high-risk medication use-was compared pre- and postimplementation of the technician-driven MTM program. Data were collected from Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) platform and t tests were used to analyze 1 year pre- and postimplementation. RESULTS: The PDC for RASA, high cholesterol medications, and diabetes medications significantly increased pre- to postimplementation for each drug class (P < .001, P = .011, P = .001, respectively). The combined overall mean PDC score for RASA, cholesterol medications, and diabetes medication classes significantly increased by 5.6% from 2015 to 2016 (74.2% vs 79.8%, P < .001); there was also a nonsignificant decrease in high-risk medication use for the entire chain. CONCLUSIONS: This technician-driven MTM program can positively affect pharmacy quality performance and potentially improve patient outcomes.

Comparing Outcomes of Active Student and Observer Roles in Nursing Simulation.

BACKGROUND: Because of large class sizes and limited resources, students participating in high-fidelity simulation experiences may be assigned to an observer role as opposed to an active nursing role. PURPOSE: Educators need to determine if anxiety levels and student learning outcomes are comparable for students in active and observer roles. METHODS: A quasi-experimental study was conducted with 132 prelicensure baccalaureate students. Active nursing roles consisted of primary care, documentation, and medication nurse roles. Observer role students were provided with resources to guide them with developing their observational skills and achieving the simulation objectives. RESULTS: There were no significant differences between simulation roles for anxiety levels, satisfaction with learning, self-confidence in learning, clinical ability, problem solving, confidence in clinical practice, and collaboration. CONCLUSIONS: These findings suggest that either role is an appropriate assignment during simulation. Educators should identify ways to be supportive and reduce anxiety in students during simulation experiences.

Improving discharge planning using the re-engineered discharge programme.

AIMS: (a) Assess nurses' readiness to learn (RTL) before receiving education on the re-engineered discharge (RED) programme and (b) measure utilization of the RED discharge process from patient chart reviews following an educational intervention. BACKGROUND: Preventable readmissions are of great concern. Rural areas are at a disadvantage, due to decreased access to health care and other disparities. METHODS: Sixty-nine participants completed the Self-Directed Learning Readiness Scale prior to the RED education intervention. Thirty-minute education interventions were provided addressing various learning preferences. RESULTS: Participants scored high M = 219.8 (SD 23.7) on the SDLR, indicating nurses' high RTL prior to educational intervention. Chart reviews found usage of the RED 12 actionable item pre-intervention, (n = 60) M = 6.55 (SD 1.478) compared to post-intervention (n = 60) M = 10.08 (SD 1.544) indicated statistically significant improvement in pre-discharge patient education and planning (t = 17.730, p = 0.000 [CI 3.13-3.93]). CONCLUSION: Current study found that nurses with higher levels of RTL who underwent RED educational sessions significantly improved delivery of the RED process documented in the medical record. IMPLICATIONS FOR NURSING MANAGEMENT: Those responsible for education initiatives must make understanding nurses' learning preferences a priority to improve the quality of bedside practice.

Transanal minimally invasive surgery for resection of retrorectal cyst.

Tailgut cysts are benign retrorectal embryological remnants, often found incidentally or when evaluating a patient for pelvic symptoms. Transanal minimally invasive surgery (TAMIS) offers patients a low morbidity surgical approach for resection of a variety of low rectal lesions. This is a case report of resection of a tailgut cyst using TAMIS, including images and description of the steps of the procedure.

Dr. Buzby's ToeGrips® Application Results in Minimal Changes in Kinetic Gait Parameters in Normal Dogs.

Poor traction on slick surfaces is difficult for dogs with neurologic deficits, osteoarthritis, or recovering from injury or surgery. Many dogs respond inappropriately to slick surfaces by decreasing digital pad-floor contact and extending their toenails. A device marketed to increase paw-floor friction in dogs was evaluated. Fifteen normal dogs underwent kinetic gait analysis before and after application of Dr. Buzby's ToeGrips®. Ground reaction forces, including vertical peak force (VPF) and impulse for each limb, were measured and compared between pre- and post-application values. Stance time was significantly increased in all limbs after toe grip application. Stride velocity was slower in all limbs but significantly slower only in the left forelimb. VPF was significantly deceased in both hindlimbs after toe grip application, but the decrease was within the group SDs. Vertical impulse was significantly increased in both forelimbs and in the right hindlimb. Dr. Buzby's ToeGrips® result in a slower gait, with slightly decreased VPF in the hindlimbs and increased effort for propulsion kinetic changes were of minor magnitude and unlikely to be clinically relevant.

Recruiting colorectal cancer survivors to a surveillance study: Barriers and successful strategies.

BACKGROUND: Colorectal cancer (CRC) survival rates are increasing. Effective strategies to recruit CRC survivors to surveillance studies are needed. OBJECTIVE: We analyzed the barriers encountered while recruiting CRC survivors to a study assessing their surveillance care experiences. METHODS: The study included three phases: (I) focus groups/key informant interviews; (II) cognitive interviews; and (III) a statewide population-based telephone survey. PARTICIPANTS: In Phases I-II, clinic-based data and cancer center registries were used to identify CRC survivors who had received CRC resection within the past 18 months. In Phase III, survivors who had received CRC resection within the past two years were identified via a statewide, population-based cancer registry. RESULTS: In Phase I, 16 survivors participated in focus groups at two National Cancer Center-affiliated sites (response rate=29.6%). Eighteen additional survivors participated in individual interviews (response rate=50%). In Phase II, 11 survivors participated in cognitive interviews (response rate=81.8%). In Phase III, 150 survivors participated in the statewide survey (response rate=62.2%). CONCLUSIONS: Group-based/in-person recruitment efforts were unsuccessful due to scheduling barriers, lack of transportation, and remaining discomfort from previous resection surgery. Telephone-based data collection strategies produced higher response rates. PRACTICE IMPLICATIONS: To enhance CRC surveillance research, future studies could incorporate CRC survivor-centered recruitment strategies.

Factors Influencing Female Caregivers' Appraisals of Their Preschoolers' Behaviors.

INTRODUCTION: This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to explore family factors associated with primary female caregivers' appraisals of children's behaviors, distortion of their appraisals, and children's risk of having behavioral problems. METHOD: A cross-sectional, correlational design was used. Data were collected from female caregivers of preschoolers. Instruments measured demographic characteristics, comfort in parenting, appraisal of behaviors, daily and parenting stress, depressive symptoms, social support, ratings of children's behaviors, and distortion in ratings. Analyses included χ2 and simultaneous linear regression. RESULTS: Greater parenting discomfort and daily stress were associated with lower appraisals of children's behaviors. Caucasian race and higher distortion in behavioral ratings were associated with higher risk of behavioral problems. Caregiver's appraisal was associated with daily stress level and parenting comfort. DISCUSSION: Additional research is needed regarding how these factors affect children's behavior and causes of distorted parental views of children's behaviors.

Assessing the effects of a sexually transmitted disease educational intervention on fraternity and sorority members' knowledge and attitudes toward safe sex behaviors.

BACKGROUND AND PURPOSE: College years are a time young adults examine high-risk sexual behaviors, increasing their risk for sexually transmitted diseases (STDs). Fraternity/sorority membership has been identified as one factor contributing to increased risky sexual behavior in college students. This study measured the effectiveness of an educational intervention targeting STD prevention in fraternity and sorority members, and examined relationships between STD knowledge, attitudes, and demographics. METHODS: A descriptive, correlational design was used. Pre- and posttest data were collected from fraternity and sorority members (N = 132). Instruments measured demographic characteristics, STD knowledge, and attitudes toward safe sex behaviors. CONCLUSIONS: There was a significant increase in STD knowledge from baseline (M = 13.03, SD = 6.5) to 1 week (M = 20.27, SD = 4.9) t (131) = -13.53, p = .000. Males were more likely to report attitudes toward risky sexual behavior rs(132) = .323, p = .000, and as knowledge increased, attitudes became more favorable to safe sex behaviors (pre-STD knowledge and preintervention attitudes, r(132) = -.249, p = .004; post-STD knowledge and postintervention attitudes, rs(132) = -.307, p = .000). IMPLICATIONS FOR PRACTICE: Results support that brief STD educational interventions can increase STD knowledge. College health centers must aim to provide sexual health education to all students at every visit.

Family Typology and Appraisal of Preschoolers' Behavior by Female Caregivers.

BACKGROUND: Children with vulnerable caregivers may be at risk for being labeled as having behavior problems when typical behaviors are viewed by their caregivers as problematic, and therefore, research examining the accuracy of the caregivers' perceptions of children's behaviors is needed. OBJECTIVE: The purpose of this study was to use the resiliency model of family stress, adjustment, and adaptation as the theoretical foundation to explore family factors associated with the primary female caregiver's appraisal of her child's behavior, the extent to which the primary female caregiver's appraisal of her child's behavior may be distorted, and the child's level of risk of having a behavioral problem. METHODS: A cross-sectional, correlational design was used. Data were collected from female caregivers of preschoolers (N = 117). Family factors, demographic characteristics, comfort in parenting, appraisal of behaviors, daily stress, parenting stress, depressive symptoms, social support, ratings of children's behaviors, and distortion in the ratings were measured. Associations were studied using ANOVA, ANCOVA, and chi-squared tests. RESULTS: Family typology was not associated with the female caregiver's appraisals of her child's behavior (p = .31). Distortion of the caregiver's rating of her child's behavior was not associated with family hardiness (high or low; p = .20.) but was associated with having a child with an elevated risk for behavioral problems (p < .01). Families classified as vulnerable were significantly more likely to have a child with elevated risks of having behavioral problems than families classified as secure or regenerative. DISCUSSION: Findings emphasized the association between family factors (hardiness and coherence) and young children's behaviors. Additional research is needed into how these factors affect the young child's behavior and what causes a caregiver to have a distorted view of her child's behavior.

Evaluating the reliability of the Attitudes to Randomized Trial Questionnaire (ARTQ) in a predominantly African American sample.

PURPOSE: To evaluate the reliability of the Attitudes to Randomized Trial Questionnaire (ARTQ) in measuring perceptions of cancer clinical trials in a predominantly African American (AA) sample in South Carolina (SC). METHODS: Principal Component Analysis (PCA) and Cronbach's alpha estimates were used to assess the reliability of the ARTQ in a convenience sample of 315 participants (81.4 % AA) who were recruited from 2008 to 2013, and who live in eleven different counties in South Carolina with high rates of racial disparities in cancer mortality rates. RESULTS: Slightly more than half of the 315 participants had at least a college education (77.9 %), 84.8 % were female, and 53.1 % had an annual income of $40,000 or more. In this study, PCA confirmed that the ARTQ is unidimensional. Cronbach's alpha for the ARTQ was 0.86. CONCLUSION: The ARTQ displayed strong evidence of high statistical reliability. This analysis has great implications for future research because it represents the first test of reliability of the ARTQ in a predominantly African American sample and lays the groundwork for use of the ARTQ in future studies in diverse populations.

Constructing rigorous and broad biosurveillance networks for detecting emerging zoonotic outbreaks.

Determining optimal surveillance networks for an emerging pathogen is difficult since it is not known beforehand what the characteristics of a pathogen will be or where it will emerge. The resources for surveillance of infectious diseases in animals and wildlife are often limited and mathematical modeling can play a supporting role in examining a wide range of scenarios of pathogen spread. We demonstrate how a hierarchy of mathematical and statistical tools can be used in surveillance planning help guide successful surveillance and mitigation policies for a wide range of zoonotic pathogens. The model forecasts can help clarify the complexities of potential scenarios, and optimize biosurveillance programs for rapidly detecting infectious diseases. Using the highly pathogenic zoonotic H5N1 avian influenza 2006-2007 epidemic in Nigeria as an example, we determined the risk for infection for localized areas in an outbreak and designed biosurveillance stations that are effective for different pathogen strains and a range of possible outbreak locations. We created a general multi-scale, multi-host stochastic SEIR epidemiological network model, with both short and long-range movement, to simulate the spread of an infectious disease through Nigerian human, poultry, backyard duck, and wild bird populations. We chose parameter ranges specific to avian influenza (but not to a particular strain) and used a Latin hypercube sample experimental design to investigate epidemic predictions in a thousand simulations. We ranked the risk of local regions by the number of times they became infected in the ensemble of simulations. These spatial statistics were then complied into a potential risk map of infection. Finally, we validated the results with a known outbreak, using spatial analysis of all the simulation runs to show the progression matched closely with the observed location of the farms infected in the 2006-2007 epidemic.

Screening tests for the rapid detection of diarrhetic shellfish toxins in Washington State.

The illness of three people due to diarrhetic shellfish poisoning (DSP) following their ingestion of recreationally harvested mussels from Sequim Bay State Park in the summer of 2011, resulted in intensified monitoring for diarrhetic shellfish toxins (DSTs) in Washington State. Rapid testing at remote sites was proposed as a means to provide early warning of DST events in order to protect human health and allow growers to test "pre-harvest" shellfish samples, thereby preventing harvest of toxic product that would later be destroyed or recalled. Tissue homogenates from several shellfish species collected from two sites in Sequim Bay, WA in the summer 2012, as well as other sites throughout Puget Sound, were analyzed using three rapid screening methods: a lateral flow antibody-based test strip (Jellett Rapid Test), an enzyme-linked immunosorbent assay (ELISA) and a protein phosphatase 2A inhibition assay (PP2A). The results were compared to the standard regulatory method of liquid chromatography coupled with tandem mass spectroscopy (LC-MS/MS). The Jellett Rapid Test for DSP gave an unacceptable number of false negatives due to incomplete extraction of DSTs using the manufacturer's recommended method while the ELISA antibody had low cross-reactivity with dinophysistoxin-1, the major toxin isomer in shellfish from the region. The PP2A test showed the greatest promise as a screening tool for Washington State shellfish harvesters.