Integration of a Simulation Curriculum Across Semesters in an Acute Care Pediatric Nurse Practitioner Program.

INTRODUCTION: Simulation is a common strategy for health care education. Research regarding simulation for nurse practitioner education is sparse. This paper describes the integration of a nine simulation session curriculum into a nurse practitioner program, including motivating factors, process description, and lessons learned. RESULTS: Students report high satisfaction and improved perception of confidence and competence of knowledge, skills, and performance. DISCUSSION: Integrated learning experiences and outcomes that span an educational program are needed in thetransition to competency-based education. This description serves as a guide for other programs seeking to incorporate simulation-based education.

Effect of fatigue loading and rest on impact strength of rat ulna.

Stress fracture is a common injury among athletes and military personnel and is associated with fatigue-initiated damage and impact loading. The recovery of bending strength has been shown to be a function of the rest days allowed after fatigue loading in rodents and the aim of this study was to investigate if similar results would occur under impact conditions. In this study, cyclic axial compression load was applied in vivo on the right forelimbs while left forelimbs served as controls. Two rest groups were used: one day of rest and seven days of rest. Afterwards, all ulnae were scanned using micro-Computed Tomography followed by impact testing. The micro-CT scan confirmed the formation of woven bone on loaded ulnae after seven days rest. The peak impact force was 37.5% higher in the control (mean = 174.96 ± 33.25 N) specimens compared to the loaded bones (mean = 130.34 ± 22.37 N). Fourier-transformed infrared spectroscopy analyses suggested no significant change of chemical composition in the cortical region between the loaded and control ulnae, but woven bone region had lower carbonate and amide I content than contralateral controls (p < 0.05). We find that cyclic fatigue loading had a negative effect on bone's impact response. Bones that experienced fatigue loading became less stiff, weaker, and more prone to fracture when subjected to impact. The formation of woven bone after seven days of rest did not restore the stiffness upon impact and confirm that rest time is crucial to the recovery of fatigue damage.

Living the Manatt report: Advancing the future of nursing through joint academic appointments.

In 2016, the American Association of Colleges of Nursing published the Manatt Report which outlines recommendations to address the future of academic nursing. This report asserts that in order to influence the direction of healthcare, academic nursing needs to partner with academic health centers in leadership positions, embrace current clinical practice, and prioritize research. The following paper details the successful implementation of joint academic appointments between a college of nursing and a medical college. Joint appointments have formalized the role of clinician-educator, brought current clinical knowledge to academia, and allowed for protected academic time that is focused on enhancing the nursing curriculum. The development of joint appointments must be approached in a structured fashion ensuring a symbiotic relationship for all parties. This arrangement validates the commitment of both organizations to the education of future providers within the interdisciplinary team.

Pleural effusion in a child with a ventriculoperitoneal shunt and congenital heart disease.

We present the unique case of an 8 month old infant who required extracorporeal membrane oxygenation (ECMO) after neonatal repair of tetralogy of Fallot. While on ECMO, he developed grade 3 intraventricular hemorrhage resulting in hydrocephalus requiring ventriculoperitoneal (VP) shunt placement at 5 months of life. He presented to cardiology clinic with a 2-month history of poor weight gain, tachypnea, and grunting and was found to have a large right sided pleural effusion. This was proven to be cerebrospinal fluid (CSF) accumulation secondary to poor peritoneal absorption with subsequent extravasation of CSF into the thoracic cavity via a diaphragmatic defect. After diaphragm repair, worsening ascites from peritoneal malabsorption led to shunt externalization and ultimate conversion to a ventriculoatrial (VA) shunt. This is the second reported case of VA shunt placement in a child with congenital heart disease and highlights the need to consider CSF extravasation as the cause of pleural effusions in children with VP shunts.