Simulated Learning Experience in Advance Care Planning Conversations.

The Centers for Disease Control and Prevention reports that one-third of all Americans have not done any advance care planning, which is essential for maintaining autonomy when people are no longer able to communicate wishes directly at the end of life. The Institute of Medicine reports that providers have limited training in communication techniques and low confidence in holding advance care planning conversations. Forty-four family nurse practitioner students received classroom communication training using evidence-based end-of-life nursing education consortium materials and role-play opportunities. One month later, students participated in a palliative care simulation experience in a high-fidelity simulated medical office environment with standardized patient. The family practice nurse practitioner students were required to communicate bad news of a poor diagnosis to a family member and begin the advance care planning conversation using the SPIKES protocol. Findings include a significant increase in postintervention advance care planning communication knowledge scores and self-confidence in holding these conversations (mean, 30.55 [SD, 2.992]; 95% confidence interval, 29.64-31.46; median, 31; range, 11-35) and satisfaction with the learning experience (mean, 18.14 [SD, 2.11]; 95% confidence interval, 17.50-18.78; median, 19; with range between 13 and 20).

Nurses' Perceptions of Technology Used in Language Interpretation for Patients with Limited English Proficiency.

PURPOSE: This project examined nurses' positive and negative perceptions of the technology used in language interpretation for patients who have limited English proficiency (LEP). The intervention was guided by the technology acceptance model, a framework that addresses users' acceptance or rejection of computer-based technology. METHODS: A sample of 47 nurses participated. Nurses' perceptions of an existing telephone-based remote interpretation technology were compared with their perceptions of a video remote interpretation (VRI) system. Instruments included a structured questionnaire to collect nurses' demographic and other characteristics and to measure their perceptions of the technology used in language interpretation; open-ended questions were added on how technology affected nursing care and nurses' rapport and communication with patients. Questionnaires on the telephone-based interpretation technology were administered, and after an eight-week trial of the VRI technology, questionnaires on the VRI system were administered. RESULTS: Overall, positive perceptions of VRI were significantly higher and negative perceptions significantly lower compared with perceptions of telephone-based interpretation technology (P < 0.001 for both). Qualitative findings indicated that VRI technology improved communication and was less time consuming for nurses. CONCLUSIONS: Nurses preferred VRI technology because of its positive effects on time expenditure and communication. VRI technology is likely to be adopted successfully and ensures increased use of professional language interpretation for patients with LEP.

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.

Maternal goals for childbirth associated with planned vaginal and planned cesarean birth.

We describe maternal childbirth goals among women planning either cesarean or vaginal birth. Women in the third trimester planning cesarean or vaginal birth were asked to report up to five childbirth goals. Goal achievement was assessed postpartum. Based on free-text responses, discrete goal categories were identified. Goals and goal achievement were compared between the two groups. Satisfaction was rated on a visual analogue scale and was compared with goal achievement. The sample included 163 women planning vaginal birth and 69 women planning cesarean. Twelve goal categories were identified. Only women planning vaginal birth reported a desire to achieve fulfillment related to childbirth. Women planning cesarean were less likely to express a desire to maintain control over their own responses during childbirth and more likely to report a desire to avoid complications. The 72 women who achieved all stated goals reported significantly higher mean satisfaction scores than the 94 women reporting that at least one goal was not achieved (P = 0.001). Goal achievement was higher among women planning cesarean than among those planning vaginal birth (52.2% versus 23.1%, P < 0.001). This research furthers our understanding of women's attitudes regarding cesarean childbirth and definitions of a successful birth experience.

Mothers' satisfaction with planned vaginal and planned cesarean birth.

We sought to describe maternal satisfaction with childbirth among women planning either cesarean or vaginal birth. We enrolled primiparous women planning cesarean birth and a comparison group planning vaginal birth. After delivery, the maternal subjective experience was assessed with a visual analogue satisfaction scale and the Salmon questionnaire, with scale scores for these aspects of the maternal experience of birth: fulfillment, distress, and difficulty. The sample included 160 women planning vaginal birth and 44 women planning cesarean. Eight weeks postpartum, women planning cesarean reported higher satisfaction ratings ( P = 0.023), higher scores for fulfillment ( P = 0.017), lower scores for distress ( P = 0.010), and lower scores for difficulty ( P < 0.001). The least favorable scores were associated with unplanned cesarean ( N = 48). Women planning cesarean reported a more favorable birth experience than women planning vaginal birth, due in part to low satisfaction associated with unplanned cesarean. Maternal satisfaction with childbirth may be improved by efforts to reduce unplanned cesarean, but also by support for maternal-choice cesarean.