Factors influencing evidence-based practice for community nurses.

Factors influencing the development of evidence-based nursing practice (EBNP) were examined in Prince Edward Island, Canada. An adapted electronic questionnaire was distributed to practicing registered nurses and nurse practitioners (n=68). An analysis of variance revealed a significant difference between nurses' clinical practice setting and the EBNP scale. Significant differences were also found between age and education level when compared with the EBNP subscales where novice nurses were less likely to rely on experience and intuition, and expert nurses with a higher level of education reported being more skilful at synthesising and applying information from research findings into their nursing practice.

Impact of outcome-based assessment on student learning and faculty instructional practices.

Increased accountability has been a catalyst for the reformation of curriculum and assessment practices in postsecondary schools throughout North America, including veterinary schools. There is a call for a shift in assessment practices in clinical rotations, from a focus on content to a focus on assessing student performance. Learning is subsequently articulated in terms of observable outcomes and indicators that describe what the learner can do after engaging in a learning experience. The purpose of this study was to examine the ways in which a competency-based program in an early phase of implementation impacted student learning and faculty instructional practices. Findings revealed that negative student perceptions of the assessment instrument's reliability had a detrimental effect on the face validity of the instrument and, subsequently, on students' engagement with competency-based assessment and promotion of student-centered learning. While the examination of faculty practices echoed findings from other studies that cited the need for faculty development to improve rater reliability and for a better data management system, our study found that faculty members' instructional practices improved through the alignment of instruction and curriculum. This snap-shot of the early stages of implementing a competency-based program has been instrumental in refining and advancing the program.

Developing numeracy skills using interactive technology in a play-based learning environment.

BACKGROUND: The purpose of this study was to measure the impact of interactive technology in the form of mathematical applications (apps) delivered using iPads on kindergarten children's learning of number sense in a play-based learning environment. Secondly, factors influencing the use of interactive technology in a play-based environment were examined. This technology was introduced to a small (n = 13) rural kindergarten classroom using an experimental design embedded in a mixed methods approach. RESULTS: The teacher was keen to introduce technology to her class but was self-described as a beginner in using iPads for personal or teaching tasks. Small gains were noted between the control and intervention groups but they were not significant. Further, children were observed collaborating which supported prior research. Another observation was related to attention span, when an app became too challenging children would abandon the app or use a trial and error method to move to the next level. Lastly, when given choice, children were drawn to creative and entertaining apps rather than apps that were more pedagogically accurate but less creative. Although there was not a large gain in achievement, using interactive technology promoted student collaboration and engagement in a play-based learning environment. CONCLUSIONS: Small gains in mathematics achievement and high levels of engagement suggest that using interactive technology in the kindergarten classroom enhances learning of mathematics. Factors influencing the use of interactive technology included the quality of the app such that creative and fun apps promoted children's engagement in learning mathematics. The level of difficulty of an app was a second factor influencing children's use of interactive technology. If the difficulty level was too challenging, children became disengaged with the app.

Developmental specialists in pediatric practices: perspectives of clinicians and staff.

OBJECTIVE: To investigate how introducing early child-development specialists (Healthy Steps Specialists) and enhanced developmental services into routine pediatric care affects perspectives of clinicians and staff. METHODS: Self-administered questionnaires were completed at baseline and at 30 months by clinicians, clinical staff, and nonclinical staff at pediatric sites participating in the evaluation of the Healthy Steps for Young Children Program. The evaluation included 6 randomization and 9 quasi-experimental sites. Barriers to providing well-child care, visit length, perceptions of care provided, and topics discussed with parents were assessed. RESULTS: Over time, despite persistent barriers to delivering high-quality services, clinicians were more likely to report being satisfied with their clinical staff's ability to meet developmental and behavioral needs of children. Moreover, clinicians were more likely to report discussing the importance of routines with control rather than with intervention families, suggesting a reliance on Healthy Steps Specialists. There was no effect on visit length. Thirty months after introducing Healthy Steps Specialists and enhanced services, nearly all clinicians agreed or strongly agreed that the Healthy Steps Specialists talked with parents about their child's development, showed them activities to do with their child, and provided emotional support. Involvement of the Healthy Steps Specialist in these activities was reported more by clinicians than by clinical staff and least by nonclinical staff. CONCLUSIONS: Clinicians acknowledged the activities performed by and contributions of the developmental specialists. Differences in perspectives of personnel may reflect different interactions among families, developmental specialists, and practice staff.

A practice-based intervention to enhance quality of care in the first 3 years of life: the Healthy Steps for Young Children Program.

CONTEXT: There is growing concern regarding the quality of health care available in the United States for young children, and specific limitations have been noted in developmental and behavioral services provided for children in the first 3 years of life. OBJECTIVE: To determine the impact of the Healthy Steps for Young Children Program on quality of early childhood health care and parenting practices. DESIGN, SETTING, AND PARTICIPANTS: Prospective controlled clinical trial enrolling participants between September 1996 and November 1998 at 6 randomization and 9 quasi-experimental sites across the United States. Participants were 5565 children enrolled at birth and followed up through age 3 years. INTERVENTION: Incorporation of developmental specialists and enhanced developmental services into pediatric care in participants' first 3 years of life. MAIN OUTCOME MEASURES: Quality of care was operationalized across 4 domains: effectiveness (eg, families received > or =4 Healthy Steps-related services or discussed >6 anticipatory guidance topics), patient-centeredness (eg, families were satisfied with care provided), timeliness (eg, children received timely well-child visits and vaccinations), and efficiency (eg, families remained at the practice for > or =20 months). Parenting outcomes included response to child misbehavior (eg, use of severe discipline) and practices to promote child development and safety (eg, mothers at risk for depression discussed their sadness with someone at the practice). RESULTS: Of the 5565 enrolled families, 3737 (67.2%) responded to an interview at 30 to 33 months (usual care, 1716 families; Healthy Steps, 2021 families). Families who participated in the Healthy Steps Program had greater odds of receiving 4 or more Healthy Steps-related services (for randomization and quasi-experimental sites, respectively: odds ratio [OR], 16.90 [95% confidence interval [CI], 12.78 to 22.34] and OR, 23.05 [95% CI, 17.38 to 30.58]), of discussing more than 6 anticipatory guidance topics (OR, 8.56 [95% CI, 6.47 to 11.32] and OR, 12.31 [95% CI, 9.35 to 16.19]), of being highly satisfied with care provided (eg, someone in the practice went out of the way for them) (OR, 2.06 [95% CI, 1.64 to 2.58] and OR, 2.11 [95% CI, 1.72 to 2.59]), of receiving timely well-child visits and vaccinations (eg, age-appropriate 1-month visit) (OR, 1.98 [95% CI, 1.08 to 3.62] and OR, 2.11 [95% CI, 1.16 to 3.85]), and of remaining at the practice for 20 months or longer (OR, 2.02 [95% CI, 1.61 to 2.55] and OR, 1.75 [95% CI, 1.43 to 2.15]). They also had reduced odds of using severe discipline (eg, slapping in face or spanking with object) (OR, 0.82 [95% CI, 0.54 to 1.26] and OR, 0.67 [95% CI, 0.46 to 0.97]). Among mothers considered at risk for depression, those who participated in the Healthy Steps Program had greater odds of discussing their sadness with someone at the practice (OR, 0.95 [95% CI, 0.56 to 1.63] and OR, 2.82 [95% CI, 1.57 to 5.08]). CONCLUSION: Universal, practice-based interventions can enhance quality of care for families of young children and can improve selected parenting practices.

Maternal depressive symptoms and children's receipt of health care in the first 3 years of life.

BACKGROUND: Maternal depression is widely recognized to negatively influence mother-child interactions and children's behavior and development, but little is known about its relation to children's receipt of health care. OBJECTIVE: To determine if maternal depressive symptoms reported at 2 to 4 and 30 to 33 months postpartum are associated with children's receipt of acute and preventive health care services in the first 30 months. DESIGN: Cohort study of data collected prospectively as part of the National Evaluation of Healthy Steps for Young Children (HS). Data sources included medical records abstracted for the first 32 months, enrollment questionnaires, and parent interviews when children were 2 to 4 and 30 to 33 months old. Acute care use included hospitalizations and emergency department visits. Preventive care included well-child visits and vaccinations. Maternal depressive symptoms were assessed by using the Center for Epidemiologic Studies-Depression Scale. Generalized linear models (logistic regression for dichotomous outcomes and Poisson regression for count outcomes) were used to estimate the effect of maternal depressive symptoms on children's receipt of care. The models were adjusted for baseline demographic characteristics, child health status, participation in HS, and site of enrollment. RESULTS: Of the 5565 families enrolled in HS, 88% completed 2- to 4-month parent interviews, 67% completed 30- to 33-month parent interviews, and 96% had medical records abstracted. The percentages of mothers reporting depressive symptoms were 17.8% at 2 to 4 months, 15.5% at 30 to 33 months, and 6.4% at both. Children whose mothers had depressive symptoms at 2 to 4 months had increased use of acute care reported at 30 to 33 months including emergency department visits in the past year (odds ratio [OR]: 1.44; confidence interval [CI]: 1.17, 1.76). These children also had decreased receipt of preventive services including age-appropriate well-child visits (eg, at 12 months [OR: 0.80; CI: 0.67, 0.95]) and up-to-date vaccinations at 24 months for 4 doses of diphtheria, tetanus, pertussis, 3 doses of polio vaccine, and 1 dose of measles-mumps-rubella (OR: 0.79; CI: 0.68, 0.93). There was no association of maternal depressive symptoms at 30 to 33 months with children's preceding use of care. CONCLUSIONS: Maternal depressive symptoms in early infancy contribute to unfavorable patterns of health care seeking for children. Increased provider training for recognizing maternal depressive symptoms in office settings, more effective systems of referral, and development of partnerships between adult and pediatric providers could contribute to enhanced receipt of care among young children.