Resident training in nursing home care: survey of successful educational strategies

OBJECTIVE: To identify educational strategies for resident training in nursing home care deemed successful by a large number of programs. DESIGN: A mail survey with three follow-up mailings. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs. MEASUREMENTS: Open- and closed-ended questionnaire eliciting curricular content, instructional strategies, and evaluation techniques from programs offering a nursing home experience. Identification of barriers to implementation of a nursing home curriculum and recommendations for success were requested. MAIN RESULTS: Of the 814 surveys mailed, 537 were returned for a response rate of 66%. Nursing home experiences were required in 86% of family practice residency programs but in only 25% of internal medicine programs. Most geriatric medicine curricular content areas were taught in the nursing home; however, relatively little emphasis was given to rehabilitation, organization, and financing of health care, and coordination of care between acute and chronic settings. Direct patient care, bedside rounds, and lectures were the most common instructional strategies reported. Evaluation approaches included faculty observations, resident attendance, and chart reviews with written and skill-based examinations infrequent. Availability of faculty and conflict with other rotations were identified as the principal barriers to implementation of nursing home rotations. An organized nursing home curriculum supervised by enthusiastic faculty using a longitudinal rotation format with resident involvement in an interdisciplinary team was recommended. CONCLUSIONS: Educational strategies exist for successful implementation of a residency nursing home curriculum. Greater priority must be given to training residents in nursing home care and developing nursing home faculty to substantially increase the number and quality of physicians who practice in this setting.     

Interview with: Donna Vidam, CPM. Interview by Ina May Gaskin

The application of Leininger's Theory of Culture Care Diversity and Universality to the dialogue between students and faculty regarding nursing education and practice provides the theoretical framework for evaluating a transcultural nursing curriculum in a transcultural, transnational setting on the Texas-Mexico border. In evaluating the first semester of this cultural encounter between the nurse-patient-community system and baccalaureate nursing education, faculty and students at Texas A&M International University School of Nursing in Laredo identified some particular challenges and assessed the effectiveness of approaches to meeting these challenges within the context of Leininger's Culture Care Theory and its three modes of action: culture care preservation, accommodation, and repatterning.     

Facilitators and barriers for minority students in master's nursing programs

The purpose of this exploratory qualitative study was to identify facilitators and barriers to admission to and successful completion of a master's of science in nursing program as perceived by minority students in that program. Students currently registered in the master's of science in nursing program of a large midwestern private university who were classified as minority according to federal classification were interviewed using an interview guide of 10 open-ended questions. Data analysis identified emergent themes in the transcribed interviews. Major areas drawn from the data included personal factors, undergraduate education, support systems/family and friends, support systems/employment, graduate program/university, and graduate faculty. In each area, respondents identified both facilitators and barriers to their success in graduate education. In addition, respondents suggested several specific strategies for recruitment and retention of minority students in graduate nursing programs.     

The effects and perceived consequences of testing accommodations on math and science performance assessments.

The present study examined the effect accommodations have on test results of students with and without disabilities and documented experts’ judgments about the appropriateness of testing accommodations. Test score data were collected from 218 fourth-grade students with and without disabilities on mathematics and science performance tasks and from eight testing experts who evaluated the fairness and validity of a sample of testing accommodations used with these students. Results indicated that, for most students with disabilities and some students without disabilities, packages of testing accommodations had a moderate to large effect on performance task scores. Expert reviewers rated most accommodations for a student with disabilities as being both valid and fair, and they gave accommodations listed on a student’s individualized education program (IEP) significantly higher validity and fairness ratings than accommodations that were not listed on the student’s IEP. Interpretations of these data are provided and implications for practice and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Score comparability of a state mathematics assessment across students with and without reading accommodations.

This study investigated the factorial invariance of a fourth-grade state mathematics assessment across groups of general education students and students with learning disabilities with and without reading accommodations. Confirmatory factor analysis was used to assess the fit of a 2-factor model to each of the 3 groups. In addition to the overall fit of this model, several levels of constraint were investigated. Invariance across the 3 groups was supported for factor loadings and intercepts. However, invariance of the factor covariances across the general education group and the groups of students with learning disabilities was not supported. Because of the implications for aggregating reported scores, further research is needed into the relationship between the factors in the different groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and testing of the Clinical Post-Conference Learning Environment Survey

Clinical postconference is an integral component of the required laboratory hours in undergraduate baccalaureate nursing education. Empirical evidence supporting the educational benefits of this activity are nearly nonexistent. This article describes the development and psychometric testing of a self-report instrument designed to measure clinical postconference learning environments as perceived by undergraduate nursing students and faculty. The Clinical Post-Conference Learning Environment Survey (CPCLES) consists of 54 items and has been tested with more than 500 participants in three schools of nursing in the Midwest. Based on theoretical support and comprehensive review of the literature, six components of the learning environment are measured in two forms of the instrument; an actual scale and an importance scale. Content validity, internal consistency, and test-retest reliability are discussed. Using the CPCLES, perceptions of undergraduate nursing students and faculty were measured. Significant differences between the actual components of the learning environment and the correlated ratings of the importance of these components were found. Faculty perceived a significantly greater amount of teacher support, task orientation, and innovation in the postconference learning environment than did undergraduate students. No differences were noted between faculty and students regarding the importance of the learning environment components. This study presents findings with the use of the first instrument developed to measure clinical postconference learning environments. The congruence and discrepancy among and between learning groups' perceptions carry implications for educational practices in this setting. Subseqent investigations using this tool may be able to link the perceived learning environment to valued cognitive, affective, and behavioral learning outcomes.     

Characterization and evolution of mariner elements from closely related species of fruit flies (Diptera: Tephritidae)

The authors reviewed the literature published from 1966 to 1996 to identify enrichment programs for underrepresented minority precollege students sponsored by medical schools and affiliated programs, finding 19 articles describing 27 programs. The authors categorized the reported programs according to the components they contained. Most programs contained more than one component type. Twenty-four programs had an academic enhancement component. Two thirds had a motivational component to encourage students to consider medical and other health careers. Two programs set up mentoring relationship between students and health professionals. There were four research apprenticeships and three academic partnerships between medical schools and local school districts. Twelve of the 27 programs were evaluated in the literature. Eight evaluations focused on identifying the numbers of students who continued their education into college and professional schools. Five programs reported participant satisfaction or identified other short-term outcomes such as gains on standardized tests. While the percentage of participants completing college and entering health care careers is impressive, the authors do not believe that the educational success of participants can be attributed to involvement in these programs. The authors recommend ways to improve the quality and interpretability of enrichment program evaluations. Evaluators should adopt common terminology for activities and outcomes. Participants' economic and educational disadvantages should be described. Programs' theoretical underpinnings should be identified and related to evaluation. Measures should include immediate effects as well as long-term outcomes. Where possible, data from comparison groups should be reported to support conclusions. Adequate funding needs to be available to design and complete reasonable evaluations.     

Managing clinical experiences for minority students with physical disabilities and impairments

According to the Americans with Disabilities Act of 1990, clinical training programs cannot refuse admission to individuals with certain physical limitations. That is, an otherwise qualified person who meets program requirements in spite of a handicap must not be discriminated against. Since hypertension and renal disease affect a disproportionately higher number of African Americans than others, the numbers of students with physical disabilities as well as students of color who are also adult learners are likely to increase in clinical nursing programs. This article discusses a planning model developed and implemented by nursing faculty in a baccalaureate degree nursing program at a historically Black university which was used as a guide for the inclusion in clinical practice of students experiencing physical disabilities. A case study is presented to illustrate how the model was implemented with an immunosupressed student secondary to a renal transplantation.     

Concealed lung abscess in critically ill, mechanically ventilated patients

This article reports on phenomenological research designed to discover how caring was taught in a nursing education program. The basic questions were: 1) What is the meaning of caring to the faculty and students; 2) How do the faculty communicate this meaning to the students; and 3) How does this meaning shape the experience of the students? Data were collected from a small associate degree nursing program using: a) semi-structured interviews with all faculty and a selected group of students, b) classroom observations, and c) review of documents. Data were analyzed for and found to have content explaining the meaning of caring, how caring was being taught, and what students were learning about caring as the essence of nursing. Implications derived speak to the need for faculty and administrators to have caring as a way of being if they wish to communicate caring as the essence of nursing to students.     

The new paradigm: concepts and application in community health nursing

The central role of community health nursing in future health care delivery systems is undisputed. The abilities and characteristics of nurses who will practice in those systems depends to a large extent on their learning experiences in basic nursing programs. Educators are being asked to prepare skilled, compassionate scholar-clinicians to provide care for the complex needs of clients, despite already packed curricula. The curricular changes cannot be additive; learning must be designed to empower students to become nurses who are both skilled and compassionate. Certain faculty attitudes and behaviors are essential to this new educational paradigm and student activities and assignments must foster confident effective practice.     

The effects of testing accommodations on students' performances and reactions to testing.

This study examined the effects of testing accommodations on students' test performances and reactions to the use of testing accommodations. Participants (N = 170) were fourth- and eighth-grade students, with and without disabilities. All students were administered, with and without accommodations, equivalent forms of widely used math and reading tests. Students completed a questionnaire to summarize their reactions to the use of accommodations. The findings indicated testing accommodations overall had a positive impact on students' individual reading and math scores. Furthermore, testing accommodations had a differential positive effect on reading scores for students with disabilities compared to students without disabilities. The relationship between students' perceptions of testing accommodations and the effects of testing accommodations on their test performances was not significant, although most students had positive perceptions of testing accommodations. Students perceived the provision of accommodations as fair for students without disabilities and more fair for students with disabilities. These findings are interpreted within a validity framework and contribute to a greater understanding of testing accommodations by integrating information concerning effects on scores and consequential effects on test-takers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promotion of Academic Careers in School Psychology: A Conceptual Framework of Impact Points, Recommended Strategies, and Hopeful Outcomes.

School psychology is facing a major shortage of faculty in graduate training and education programs. To deal with this shortage and the issues that surround it, we propose a conceptual framework that incorporates a number of impact points that graduate training programs can use to educate and sustain individuals in academic careers. The impact points include: selection of students, program-related training variables, post-program transition variables, and sustainability of academic careers. Each of these impact points is discussed within the context of the role that current faculty and practitioners in the profession can play in graduate education and training of academic scholars. Among the variety of potential solutions to the shortage, we introduce the concept of the "virtual university" to promote future education and sustainability of faculty within our graduate training programs. A case scenario from graduate students at the University of Wisconsin-Madison is presented as a context for the impact points raised in the article. We argue that those of us in the profession think systemically and lead the way into a new era of collaborative work across our graduate programs and among our colleagues in clinical, counseling, and related areas of applied and professional psychology graduate training. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A review of programs that promote higher education access for underrepresented students.

This review of the research on college access programs between 1997 and 2007 examines: (a) target populations of students served; (b) assumptions and value judgments of researchers and program staff about participants in connection with participants' diverse backgrounds; and (c) views of access held by college access programs, based on analysis of program practices. Very few research studies were published on college access programs, of which the majority focused on racial and ethnic minority students, and only a few focused on students with disabilities. No programs targeted students from diverse racial/ethnic backgrounds with disabilities, nor did any studies question college access programs' neglect to target or measure outcomes for minority students with disabilities. In addition to these findings, implications are provided for future policies, practices, and research around college access, as well as for higher educational institutions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring organizational readiness for nursing research programs

Nursing research programs are important innovations for health services organizations (HSOs). Evidence supports the positive impact that successful programs have on both clinical practice and patient outcomes. In the current era of scarce health care resources, decision makers must be able to accurately judge HSO readiness for nursing research programs to facilitate their success. Judging innovation readiness is an important and complex process for decision makers. An Innovation Readiness Scale (IRS) was developed from research-based HSO contextual cues identified by nurse researchers as supportive of successful hospital-based nursing research programs. The IRS provides decision makers with a measure by which to judge HSO readiness for nursing research programs. Psychometric results are reported from a pilot and actual test of the IRS in two urban acute care settings involved in nursing research program innovation.     

Bridge to the future: nontraditional clinical settings, concepts and issues

Healthcare restructuring in the wake of healthcare reform places greater emphasis on primary healthcare. Clinical education in acute care settings and existing community health agencies are not compatible with teaching basic concepts, principles and skills fundamental to nursing. Problems of clients in acute care settings are too complex and clients in the community are often too dispersed for necessary faculty support and supervision of beginning nursing students. Nontraditional learning settings offer the baccalaureate student the opportunity to practice fundamental skills of care and address professional skills of negotiation, assertiveness, organization, collaboration and leadership. An overview of faculty designed clinical learning experiences in nontraditional sites such as McDonald's restaurants, inner city churches, YWCA's, the campus community and homes are presented. The legal, ethical and academic issues associated with nontraditional learning settings are discussed in relation to individual empowerment, decision making and evaluation. Implications for the future address the role of the students and faculty as they interact with the community in which they live and practice.     

Computerized NCLEX-RN and NCLEX-PN preparation programs. Comparative review, 1997

The computerized test taking market continues to expand to meet the needs of nursing students studying to prepare for the NCLEX-RN and the NCLEX-PN. In addition, currently registered nurses may choose to use these software programs to review clinical knowledge in areas in which they are not currently practicing. This article reviewed software designed for personal use, review books with complete disks, on-site institutional testing and consultation, and school of nursing LANs. The costs of software for personal use is priced reasonably and provides flexibility for students to use as their schedule permits. The cost of institutional licenses is moderate and most programs provide multiple on-site use rights. The marketplace has responded to the computerized NCLEX testing now in place nationally. As new formats are developed and new uses identified, nursing faculty and students can expect to see an expanded use of computerized testing.     

Perceptions of control of students with and without cognitive disabilities

Research in the educational and psychological literature has linked adaptive perceptions of control to positive adult outcomes like better employment, higher quality of life, and increased independence. In recent years these findings have been extended to people with mental retardation. Research with this population has suggested that they tend to be more externally oriented than peers without disabilities or peers with other types of disabilities. This research, however, has not provided direct comparisons between people with mental retardation and other populations. The present study compared the perceptions of control of 431 students (227 boys, 204 girls) ages 10-20 years (M = 14.3) with mental retardation (n = 94), learning disabilities (n = 159), or no disabilities (n = 178). Analysis confirmed that students with mental retardation scored significantly more externally on measures of locus of control and attributions of academic success and failure than their peers with learning disabilities or without disabilities. The discussion focuses on implications for these students.     

Mathematics education and students with learning disabilities: introduction to the special series

The prevalence of students with mathematics learning disabilities has triggered an interest among special education researchers and practitioners in developing an understanding of the needs of this group of students, and in identifying effective instructional programming to foster their mathematical performance during the school years and into adulthood. Research into the characteristics of students with mathematics learning disabilities is being approached from different perspectives, including developmental, neurological and neuropsychological, and educational. This diversity helps us develop a broader understanding of students' learning needs and difficulties. Special education assessment practices encompass a variety of approaches, including norm-referenced, criterion-referenced, and nonstandardized procedures, depending on the specific assessment questions professionals seek to answer. Students' mathematical knowledge and conceptual understanding must be examined to determine their strengths and weaknesses, curriculum-based progress, and use of cognitive strategies to arrive at mathematical solutions. Research findings have identified empirically validated interventions for teaching mathematics curricula to students with mathematics learning disabilities. Research studies have been grounded in behavioral theory and cognitive psychology, with an emergent interest in the constructivist approach. Although research studies have focused primarily on computational performance, more work is being conducted in the areas of story-problem solving and technology. These areas as well as other math curricular skills require further study. Additionally, the needs of adults with math LD have spurred educators to examine the elementary and secondary math curricula and determine ways to infuse them with life skills instruction accordingly. As the field of mathematics special education continues to evolve, special educators must remain cognizant of the developments in and influences on the field of mathematics education. Reform efforts have shaped the field significantly since the 1950s, contributing to the curriculum offered in mathematics textbooks and the pedagogical practices taught in higher education courses. Mathematics educators continue to search for a better understanding of how children learn mathematics; this process is shaped by the prevailing theoretical orientations and research methodologies. This special series in mathematics special education provides readers with information about the characteristics of students with mathematics learning disabilities, assessment procedures, mathematics programming, teacher preparation, and future directions for the field. The series originated as a result of discussions with Dr. Lee Wiederholt and Dr. Judith K. Voress, who saw a need for the compilation of recent research and best practices in mathematics special education. I thank them for their support of and thoughtful insights about the development of this series. I also appreciate the support of Dr. George Hynd and his editorial assistant, Kathryn Black, in finalizing the details for publication. Finally, I am most appreciative of the authors' contributions to this series; their work continues to significantly influence the development of the field of mathematics special education and programming for students with mathematics learning disabilities.     

Palliative care in undergraduate medical education. Status report and future directions

OBJECTIVE: To describe the status of palliative care education in the undergraduate medical curriculum and to offer recommendations for improvement. DATA SOURCES: Review of literature on palliative care and of recently submitted grants on medical education for end-of-life care. STUDY SELECTION: English-language reports of educational programs targeted toward medical students were examined, as well as surveys of medical schools. DATA EXTRACTION: Studies were reviewed by the authors to assess the quality of the educational program, evaluation methodology, and conclusions. From over 9000 citations on palliative care and related topics that were retrieved from MEDLINE searches from 1980 through 1995, and from reviewing 14 palliative care journals published from 1985 through 1996, 310 articles were identified that addressed medical education for end-of-life care, and 180 were carefully examined. DATA SYNTHESIS: While nearly all medical schools offer some formal teaching about end-of-life care, there is considerable evidence that current training is inadequate, most strikingly in the clinical years. Teaching about palliative care is received favorably by students, positively influences student attitudes, and enhances communication skills. However, curricular offerings are not well integrated; the major teaching format is the lecture; formal teaching is predominantly preclinical; clinical experiences are mostly elective; there is little attention to home care, hospice, and nursing home care; role models are few; and students are not encouraged to examine their personal reactions to these clinical experiences. CONCLUSIONS: The increasing attention to palliative care education has created major opportunities for improving education about care at the end of life. Educational programs should be rigorously evaluated to identify best educational practices.     

Training Faculty to Teach Civil Engineering

Adoption of ASCE’s Policy Statement 465 and subsequent discussion of the what, how, and who of teaching the body of knowledge (BOK) that will be required for professional civil engineering practice has heightened the need for continued improvement in civil engineering education. ASCE has explicitly said the role of educators and practitioners in teaching the body of knowledge is critical and has listed faculty-related success factors for teaching the BOK. A key success factor is statement 465’s call for faculty and practitioners to properly prepare to “effectively engage students in the learning process.” This paper considers this challenge and discusses an instructor training program that effectively prepares faculty and practitioners to actively engage students in the learning process as envisioned by Policy Statement 465. We will show quantifiable evidence of the positive results gained by using this instructor training program through student and instructor feedback. Additionally, alternative shorter courses based on this program of preparation are highlighted that may be attended by the faculty of multiple engineering programs and by practitioners.