Financing nurse anesthesia education

Health care spending in the United States outpaces all other nations or 14% of the gross domestic product. Although the escalating increases in health care costs which have characterized the industry over the past quarter century have begun to slow down, if changes in the current health care policy are not implemented, spending is expected to increase at a rate of 11.5% during each of the next 5 years. Health care spending will reach $1.1 trillion or 15% of the gross domestic product in the near future. Both hospitals and universities are facing mounting pressures to reduce their costs and improve their services. In this environment, it becomes increasingly important for directors of nurse anesthesia programs to financially justify their existence. This discussion begins with a brief overview of nurse anesthesia education in the United States. The value of and need for nurse anesthetists in the US health care system is addressed. Advantages and disadvantages of hospital versus university-based programs are highlighted and funding sources identified. Future needs and challenges in nurse anesthesia education conclude this discussion.     

Using conflict to improve effectiveness of nurse teams

As nurses increasingly turn to teamwork as a viable option for accomplishing a myriad of duties and responsibilities, they are discovering that teamwork can also be a source of conflict. This article suggests that conflict is both inevitable and necessary within a team. A model is presented that aims not at reducing conflict but at making it more effective. The author traces the influence of preconflict conditions and perspective-taking on conflict and ultimately team effectiveness. Finally, to aid in applying the model to practice, two examples are presented, demonstrating both an ineffective and an effective use of conflict.     

Academic gaming in nurse education

This paper describes a study of the usefulness of academic gaming in nurse education. The research has been carried out over the course of 3 years and represents an attempt by a nurse tutor to carry out a study on research lines, during the course of normal working and with a minimum of interference to the normal working of a nurse education department. The study involved psychiatric nurse learners at Winterton Hospital, Sedgefield, Durham and attempted to assess the usefulness of academic gaming by evaluating one academic game which has been designed for nurse learners. This game aims to teach various aspects of the digestive system and digestive processes. The questions which required answers were, can nurse learners learn from academic games? Do they like this method of learning? How does this method compare with other learning methods? Eighty-six learners participated in a test/game/test situation and completed a questionnaire after playing the game. Results suggest that learners can increase their knowledge of the subject by playing the game but it may be most useful as a consolidation method. Learners most often stated that they enjoyed the game and when ranked according to preference, gaming was preferred to film, reading and discussion methods but equally preferred to the lecture method.     

Preceptorship and post-registration nurse education

The Report of the Post-Registration Education and Practice Project (UKCC 1990) and the Framework for Continuing Professional Education for Nurses, Midwives and Health Visitors (ENB 1991) have led to an unprecedented period of formalised supervision and support for registered practitioners in the UK. The preceptor has been identified as having a pivotal part to play in providing this support. There is however, a need for further clarification regarding the exact nature of the preceptor's role in post-registration education and practice, and the full extent of the responsibilities involved. This paper explores the issues involved in preceptorship for qualified nurses and some of the related literature. The following key questions are addressed: Who will be designated as preceptors? How will they be selected? What preparation and support will such preceptors be offered? What is the role of the preceptor and what is the conceptual and empirical difference between the preceptor and the mentor? It is proposed that strategies must be identified for clarification of the preceptor's role and responsibilities, identification of selection criteria, and the establishment of preceptor preparation programmes and support networks.     

Using the stepladder technique to facilitate the performance of audioconferencing.

Organizational workforces are becoming increasingly dispersed. To facilitate communications among individuals or groups of people located in a number of different locations, teleconferencing technologies, such as audioconferencing, have been developed. The authors examined whether a structural group intervention, the stepladder technique, can facilitate the task performance of 4-person groups (n=52) when using audioconferencing. Consistent with research conducted on face-to-face groups, the stepladder technique was found to facilitate the decision-making performance of groups interacting via audioconference. The authors postulated that certain structural elements of the stepladder technique compensate for obstacles inherent in nonvisual communications. Supplementary analyses examined best member influence and the existence of order of entry effects into the stepladder process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The commodification of specialty nurse education

The nexus between tertiary nursing education and employment was strengthened during the 1990s when universities became involved in delivering a plethora of specialty graduate certificates and diplomas which largely replaced hospital-based post-registration courses. These university-based courses can be seen as contributing to the commodification of education as well as the legitimisation of a stratification of nursing knowledge through which biological sciences and experiential knowledge remain privileged. In the development of specialist nurse education courses, it is vital there is an accompanying examination of whose interests are being served by the models adopted. In particular, there is a need to contest the dominance of service needs in shaping nurse education. Rather than continuing to respond with uncritical acceptance of courses that are characteristically highly technical and vocational in nature, nursing needs to explore curriculum models that enable students to choose their course pathways to develop their practice. It is argued that nurse academics are complicit in reproducing power relations which continue to subjugate nurses within medical and economic discourses.     

Humanist ideology and nurse education. 2. Limitations of humanist educational theory in nurse education

This article questions the viability of humanist educational theory in nurse education and raises the issue of which interests are served by humanist ideology. The limitations of the humanist approach are traced. Self-directed learning is shown to be problematic in nurse education, leading to tensions between independent learning and required course content, and the appropriateness of student-centred learning to the professional education of nurses is queried. The need to produce safe practitioners compromises the humanist model. Lifelong learning, for example, becomes institutionalized, and its self-directed character transformed into a mandatory process of lifelong professional education. The humanist model has become the new orthodoxy in nurse education and operates as a form of social control. Through its individualism the approach supports a competency model, which in turn restricts the potential diversity of 'product'. This individualistic bias denies the social reality of nursing and fails to empower the nurse by emphasizing individual growth at the expense of social learning. The article concludes that humanist ideology serves the needs of a free-market philosophy. If nurse education is to be challenging it must break with individualism and seek to develop a different rationale, that of a collectivist ideology.     

Using action research to facilitate organisational change in mental health service delivery

OBJECTIVE: To evaluate human immunodeficiency virus (HIV)-1 RNA burden in paired plasma and cervicovaginal lavage specimens and to assess the relation of plasma HIV-1 RNA level, CD4 cell count, and antiretroviral therapy with cervicovaginal HIV-1 viral load. METHODS: Paired blood and cervicovaginal lavage specimens were collected from 72 HIV-infected women. Quantitation of HIV-1 RNA from plasma and cervicovaginal lavage specimens was performed by using the nucleic acid sequence-based amplification assay. Analyses examined relations between cervicovaginal HIV-1 RNA and plasma HIV-1 RNA level, CD4 count, and antiretroviral therapy. RESULTS: Plasma HIV-1 RNA was detectable in 61 of 72 women (85%), with copy numbers ranging from 330 to 1,600,000 copies/mL. Twenty-eight of 72 (39%) had detectable HIV-1 RNA in cervicovaginal lavage specimens, ranging from 320 to 440,000 copies/mL. The cervicovaginal lavage HIV-1 RNA level was detectable in 9%, 29%, 52%, and 53% of the women with plasma HIV-1 RNA of less than 400, 400-9999, 10,000-100,000, and more than 100,000 copies, respectively (P = .043). Among women with CD4 counts of less than 200, 200-500, and greater than 500/mm3, cervicovaginal lavage HIV-1 RNA was detected in 67%, 32%, and 25% of subjects, respectively (P = .018). Among women receiving antiretroviral therapy, cervicovaginal lavage revealed HIV-1 RNA in 67%, 31%, and 25% with CD4 cell counts of less than 200, 200-500, and more than 500/mm3, respectively (P = .042). CONCLUSION: The presence of HIV-1 RNA in cervicovaginal lavage correlates significantly with the level of HIV-1 RNA in plasma and negatively with CD4 cell count.     

Client-centred approach to student nurse education in mental health practicum: an inquiry

This project utilized constructive feedback from clients of mental health facilities as a means of facilitating student nurse learning in three clinical environments. Three questionnaires were utilized to elicit and evaluate the impact of this feedback with a sample of 43 students and 74 client participants. The inquiry demonstrated that clients are willing to participate in students learning and believe that they can contribute towards it. Students also believed that clients have a valuable role to play in their learning, although they note caution in regards to client selection.     

A framework to identify learning needs for continuing nurse education using information technology

This paper concerns one of the main problems facing continuing nurse education, that of matching the learning needs of the individual nurse with the needs of the care setting. This endeavour is inescapable because of the necessity for giving high quality care within financial restraint. Modern information technology, it is suggested, can be helpful in fulfilling the task more easily. A theoretical framework is introduced as a possible solution for developing a computer program which, it is the hope of the author, will be available in the not so far future.     

Exploring the potential of problem-based learning in nurse education

Despite the increased attention that problem-based learning has received as an appropriate pedagogical technique for educating adults for professional practice, reports that evaluate the process are rare and usually relate to professions other than nursing. A study was undertaken in order to discover the graduates' own perceptions of a problem-based learning programme and its effectiveness in preparing them for the reality of their chosen profession. Twelve practising graduate nurses who had completed the programme were interviewed according to the ethnographic method. Three categories were identified from the data: 'and all of a sudden...', which describes the transition from PBL student to staff nurse; 'not an unthinking assistant', where the characteristics that the PBL graduates believe make them different from traditionally trained nurses are described; and 'the buck stops here', which describes the sense of personal responsibility that the graduates experience in terms of their learning and actions.     

Engineering proteins to facilitate bioprocessing

Genetic engineering is now being applied to aid the purification of recombinant proteins. The addition of specifically designed tags or the modification of sequences within the target-gene product has enabled the development of novel strategies for downstream processing that can be employed for efficient recovery of both native or modified proteins. This article discusses novel trends in genetic engineering that aid the bioprocessing of recombinant proteins.     

The purpose of flexible learning in post-registration nurse education

Post-registration nurse education in England has changed significantly in recent years. One of the most significant changes has been the emergence of flexible learning which is characterized by adaptations in the way programmes are planned, the nature of provision, the ways of enhancing access, the process of teaching and learning, the nature of assessment and the way in which programmes are evaluated. This paper reviews the influences on nurse education at post-registration level which have brought about flexible learning. It analyses the purposes of flexible learning by integrating theoretical considerations and the outcomes of the case study of programmes and modules deemed by providers to be flexible. The over-arching purpose of flexible learning is the improvement of educational quality, specifically in relation to improving access, availability, relevance, and the way in which individual practitioners' needs and importantly the needs of other stakeholders (for example, providers, employers and validating bodies) are met. Flexible learning is also concerned with encouraging self-direction in professional learning. The different purposes and the way in which they interrelate, together with the range of different stakeholders and their potentially conflicting needs, significantly complicates the management of flexible learning.     

Future education: what do nurse executives need?

A small number of trauma patients with penetrating thoracic trauma will require formal pulmonary resections to repair severe injuries or control massive haemorrhage. Although previous reports on this subject have addressed the management of these injuries in battle conditions, civilian experience with this type of chest injury is limited. In a 3-year period, 259 patients underwent urgent thoracotomies for penetrating thoracic trauma. We retrospectively reviewed 43 patients who underwent lobectomies or pneumonectomies to control bleeding (93%) or bronchial injuries (7%). Handguns were the aetiologic agent in 41 patients (95%). The most common complication, pneumonia, was seen in 21 patients (87%). Fifteen patients (62%) developed respiratory failure. The complications of wound infection, post-operative haemorrhage and empyema were seen in equal frequency in four patients (16%). Two patients (8%) developed bronchopleural fistulas. Nine pneumonectomies and 34 lobectomies were performed with mortality rates of 66% and 38%, respectively (overall mortality, 44%). Ten (53%) deaths occurred in the operating room, late deaths (2-15 days) were secondary to sepsis and multiple organ dysfunction syndrome (MODS). Currently, the management of patients with devastating thoracic injuries to the thoracic cavity is divided into two stages. First, initial resuscitation with rapid surgery to control major bleeding, cardiac tamponade, tracheal disruptions and potentially lethal air embolism is indicated. Once the life-threatening conditions have been resolved, definitive surgical procedures are performed to repair injuries to any of the thoracic structures.     

我国应加快推出钢材期货

在全球钢材需求旺盛，钢材价格剧烈波动的形势下，中国作为全球最大的钢材生产国和消费国，迫切需要加快推出钢材期货，以规避钢材价格波动的风险、促进我国钢铁产业结构调整。当前，我国已充分具备推出钢材期货的条件，为早日推出钢材期货，需要妥善处理各方面的关系和解决面临的障碍，充分做好准备钢材期货上市前期的准备工作。     

A missed opportunity: master's education for certified nurse practitioners

Many nurse practitioners were prepared in nondegree certificate programs and lack academic credentials desired in today's marketplace. The history of nurse practitioner education is reviewed, and a master's completion program for certified nurse practitioners is presented.     

An economic analysis of the investment in nurse anesthesia education

The purpose of this research was to study the prevalence of ectopic eruption of the first permanent molars and possible etiologic factors. A group of 4,232 Thai students, from 6 to 9 years old, was examined. The prevalence of ectopic eruption of the first permanent molars in the subjects was 0.75%. Both the severity of the ectopic eruption and the amount of root resorption on the second primary molars were more pronounced in the maxilla than in the mandible. The important etiologic factors were the eruption path of the first permanent molars relative to reference lines and the size of the mandibular second primary molars. The amount of proximal caries did not seem to affect the prevalence of ectopic eruption.