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The perceptions of students and teachers regarding the introductory module of an enrolled nurse conversion course.

This study sets out to explore the perceptions of students' and their teachers' regarding the Introductory Module of a course to convert Enrolled Nurses to Registered General Nurses. The course has been developed as a joint venture with two local Schools of Nursing as an experiment in joint course management. An illuminative evaluation approach has been adopted utilising the techniques of observation, questionnaires and interviews, in order to provide information by a variety of means upon which the course management team can base their future decisions regarding the course. The findings suggest that the introductory module was perceived by the students and teachers as a valuable learning experience. Issues specific to the course which were highlighted included the need for the involvement of the course teachers from each School of Nursing in the teaching programme, the introduction of negotiated student learning, a joint approach to the assessment of theory and practice and a modification of the maternity and community care experience. General issues related to the students as mature learners included the need for pre-course preparation for the students, the assessment of individual learning needs, the inclusion in the content of essay writing skills and stress management and the need for a comprehensive staff development programme for the teaching staff. The study highlighted the need for evaluation of nurse education programmes and teaching methods in order to provide professional accountability and to ensure nurse education practice is research-based.

Curriculum↗

Nurse socialization: issues and problems.

A comparative study was conducted of the professional socialization process of student nurses in three nurse education centres in South Wales. Patterns and problem areas can be identified of relevance to issues in role theory and with practical implications for the more effective implementation of Project 2000. Three cohorts of students were interviewed using a semi-structured interview schedule whilst in the introductory block and at the end of the first year. The teaching and ward staff directly involved in the socialization process were also interviewed so that their views could be compared with those of the students. There were differences between the types of ward in the opportunities they offered for role modelling. It was doubtful whether the three categories of students, teaching staff and ward staff were all employing a single conception of 'the good nurse'. The student has to find her own pathway through the divergent and often conflicting values and philosophies of the teaching staff and those in authority on the wards. It is recommended that a more unified approach be adopted to reduce the conflict which learners experience. In accordance with Project 2000, the teaching staff should act as practitioners and thereby be perceived as a professional role model with clinical credibility.

Attitude of Health Personnel↗

An interactive, web-based tool for learning anatomic landmarks.

PURPOSE: To evaluate the effectiveness of a Web-based interactive teaching tool that uses self-assessment exercises with real-time feedback to aid students' learning in a gross anatomy class. METHOD: A total of 107 of 124 first-year medical students at one school were enrolled in the study. Students were divided into three groups: Group 1 (n = 63) received introductory material and activated their Web-based accounts; Group 2 (n = 44) received introductory material but did not activate their Web-based accounts; and Group 3 (n = 17) were not enrolled in the study and received no introductory material. Students in Group 1 had access to a graphic showing the locations of anatomic landmarks, a drill exercise, and a self-evaluation exercise. Students' ability to identify the anatomic landmarks on a 30-question midterm and a 30-question final exam were compared among the groups. RESULTS: The mean scores of students in Group 1 (midterm = 28.5, final = 28.1) were significantly higher than were the mean scores of students in Group 2 (midterm = 26.8, p <.001; final = 26.9, p <.017) and Group 3 (midterm = 24.8, p <.001; final = 26.4, p <.007). CONCLUSIONS: The Web-based tool was effective in improving students' scores on anatomic landmark exams. Future studies will determine whether the tool aids students in identifying structures located in three-dimensional space within regions such as the cranium and the abdominal cavity.

Adult↗

A strategy to increase the palliative care capacity of rural primary health care providers.

OBJECTIVE: To pilot and evaluate an intervention aimed at increasing the palliative care capacity of primary health care providers in rural and remote communities. DESIGN: Pre- and post-workshop, and three months follow-up questionnaires. SETTING: Four locations in Far North Queensland. SUBJECTS: One hundred and forty-nine primary health care providers ranging from personal care workers to general practitioners (GPs). INTERVENTIONS: Fourteen workshops were conducted. These were tailored to local palliative case loads facilitated by a specialist palliative care team from the Mt Olivet Hospice Service. Workshop content consisted of introductory didactic teaching based on participant-nominated topics, small group case management discussions and a session devoted to psychosocial and counselling inputs. MAIN OUTCOME MEASURES: Cost, GP reach, evaluation of educational and clinical objectives. RESULTS: Average cost per participant--excluding wages--was 271 dollars. Thirty-two per cent of local GPs attended the workshops and 93.2% of participants reported that the workshops had satisfied their educational learning objectives. Evaluation of GP clinical performance revealed significant improvements in confidence regarding palliative care knowledge and skill levels as well as the management of common palliative symptoms. Evaluation of other primary health care providers' clinical performance showed significant improvements in skills, management and rated knowledge. CONCLUSIONS: This intervention is relatively inexpensive, has reasonable reach and is effective as measured by educational and clinical outcomes.

Attitude of Health Personnel↗

Effectiveness of skills-based training using the Drink-less package to increase family practitioner confidence in intervening for alcohol use disorders.

BACKGROUND: Misuse of alcohol is second only to tobacco as a leading cause of preventable death in Australia. There is an opportunity in family practice to detect problems and intervene with people at risk of alcohol-related harm before complications occur. However, family practitioners (FPs) report low levels of confidence in managing patients with drinking problems. The aim of this study was to determine whether the interactive training session using the 'Drink-less' package led to improvement in FPs' self-reported level of confidence in detecting and providing interventions for risky alcohol consumption. METHOD: FPs in urban and rural New South Wales were invited to training sessions in their local area. An introductory overview preceded a practical skills- based session, using the Drink-less package. Participants completed before and after evaluation forms. RESULTS: While 49% (CI 43-55) of the attending FPs indicated at baseline that they felt confident in identifying at-risk drinkers, this proportion rose to 90% (95% CI: 87-93) post-session, and they also reported increases in confidence from 36% (95% CI: 31-41) to 90% in their ability to advise patients. Urban FPs reported lower levels of confidence than rural FPs, both pre- and post-session. CONCLUSION: Training sessions in the Drink-less intervention resulted in increased self-reported confidence in detection and brief intervention for alcohol problems. Further research is needed to determine the duration of this effect and its influence on practice behaviour.

Accidents, Traffic↗

Influences on the selection of dietetics as a career.

OBJECTIVE: To gather information on the factors that influence students' decisions to choose dietetics as a career. DESIGN: Self-administered questionnaires regarding the point at which career decisions were made were completed by 1,695 students in Plan IV/V dietetics programs throughout the United States. SUBJECTS: All Plan IV/V dietetics programs that reported greater than five graduates in the academic year 1989 to 1990 were selected from the 1990-1991 Directory of Dietetic Programs for the sample population. Of the 156 schools that were mailed questionnaires, responses were received from 84 schools (54%). Almost 90% of the students were women, 10.6% were men. STATISTICAL ANALYSES: Data were analyzed using the Statistical Package for the Social Sciences. A chi 2 analysis was used to examine the relationship between point of decision and factors that influenced career choice, including people who influence career choice. RESULTS: The majority of students (55%) questioned reported making their career decision in college. Students rated interest in nutrition (96.3%) and job enjoyment (93.8%) as factors that were important in their decision to pursue a career in dietetics. College catalogs were rated by 48.3% of the students as being either useful or very useful in helping them make their career selection. With respect to gender differences, women rated a diverse work environment as being very important to their career decision more frequently than men (chi 2 = 15.44, P < .01). Women were more likely than men to rate part-time work opportunities as being very important (chi 2 = 26.75, P < .001); and selected working with people as being very important to their career decision (chi 2 = 17.59, P < .01). CONCLUSIONS: Findings identified that recruitment strategies need to be audience specific. Because career decision making appears to occur during one of three time frames (high school, college, or work experience), recruitment activities should be developed to specifically target students at these times. One way to increase the exposure of students to the profession of dietetics is for registered dietitians to give guest lectures in introductory college courses and high school upper-class courses in health, home economics, and biology. The use of university/college catalogs as effective marketing tools should also not be underestimated. Data suggest that gender differences exist in factors that influence persons to choose dietetics as a career. To increase the number of men who pursue careers in dietetics, future research should be designed to more fully explore gender differences, so that strategies to recruit more men into the profession can be developed.

Adolescent↗

Bleeding patterns and acceptability among Norplant users in two Asian countries.

Changes in menstrual bleeding patterns are the most frequent reason for discontinuing NORPLANT during the first year of use. Although NORPLANT is used by more women in Asia than in any other region, the changes that occur among these women are not well documented. In pre-introductory clinical trials of NORPLANT in the Philippines and Sri Lanka, 175 women were enrolled with greater than 95% continuing the method after one year. Daily menstrual bleeding calendars were kept by 94% of subjects for nine months and by 66% for one year. In contrast to findings in previous studies which showed that approximately 60% of NORPLANT users had bleeding disruptions in the first year of use, almost all of these women experienced bleeding disruptions. In a one-year study of menstrual pattern changes, increased bleeding was found to occur with the same frequency as reduced bleeding. However, the changes experienced by the Asian women tended to be decreases, rather than increases, in menstrual bleeding.

Adult↗

Student assessment of the educational benefits of using a CD-ROM for instruction of basic surgical skills.

RATIONALE FOR STUDY: At Texas A&M University, introductory-level surgical lecture and laboratory notes were converted to a CD-ROM format that included illustrative photographs as well as instructional videos demonstrating the basic surgical skills that all students were required to master. The CD-ROM was distributed to all students in place of traditional paper notes in the second-year surgical class in the professional veterinary curriculum. The study reported here was designed to evaluate the educational benefits of the use of the CD-ROM in place of traditional paper notes by examining the attitudes and practices of students before and after exposure to the CD-ROM format. METHODOLOGY: An anonymous survey was distributed to students in the second-year introductory surgery course on the first day of class and again on the last day of class. Responses to questions were tabulated, response frequencies determined, and Chi-square analysis performed to determine differences between initial and final responses. RESULTS: On the final survey, 89 per cent of students responded that the instructional videos definitely helped them prepare for the laboratory, and 77 per cent responded that they were more likely to practice techniques learned from the CD-ROM videos than those learned from traditional study materials. The majority of students believed that the CD-ROM improved both the course (60 per cent) and their learning experience (62 per cent) as compared to traditional paper notes. CONCLUSIONS: Including instructional videos on the CD-ROM enhanced the educational experience of the students by promoting preparedness for laboratories and promoting practice of techniques learned from the videos outside of the laboratory.

Attitude to Computers↗

How to develop a group curriculum: developing an exercise programme for overweight adults.

This paper reports on work to develop introductory exercise courses for sedentary, moderately overweight adults. The aim is to offer a safe and motivating programme of physical exercise and, through experiential learning, to encourage and facilitate increased physical activity. The core of the programme is a course of 10-20 weekly exercise classes. The classes include a variety of physical exercises adapted to the special needs of overweight adults (BMI 28-34 kg/m2) and a number of health-related fitness tests. We outline the underlying principles of the exercise courses, their structure and contents, the guidelines of instruction, and the use of formative evaluation. In addition, we report on the implementation of five weight-reduction courses and six exercise courses involving a total of 209 participants. A fairly high level of programme acceptability (in terms of attendance rates and personal commitment) and programme feasibility (in terms of acceptability, changes in personal orientation towards health and weight reduction, and satisfaction among participants) was achieved.

Adolescent↗

[The introduction of antiretroviral therapy in Malawi].

The prevalence of HIV infection in Malawi is high. Until mid 2004, antiretroviral therapy (ART) was only available for a fee; later, a programme for free distribution was started. When ART was started, no laboratory tests other than an HIV test were felt to be necessary. After an introductory period in which hospitals were assessed for the presence of sufficient infrastructure and health workers were trained in ART, the number of public and private clinics where ART was distributed rose to 60. By end 2005, the number of patients on ART was 37,840, which is 45% of the target in the so-called '3-by-5' initiative of the WHO/Joint United Nations Programme on HIV/ AIDS (UNAIDS). The goal of this initiative was to have half (85,000) ofthe estimated 170,000 HIV-infected individuals in Malawi for whom ART is indicated on treatment by end 2005. After 12 months of follow-up, 81% of the patients treated were still alive and on treatment, while the mortality was 10%, 8% no longer visited the outpatient clinic, and 1% had stopped ART. Despite facing various challenges, intensive collaboration with all stakeholders involved, under strong leadership of the Ministry of Health, has laid the foundation for this thus far successful programme.

Anti-HIV Agents↗

A practical approach to creative teaching: an experiment.

The purpose of this experiment was to see if creative teaching methods would prove effective when included in a school of nursing teaching programme. This would be demonstrated by significant differences in levels of achievement in assessments and a demonstration that the knowledge gained was applied to the clinical situation. Didactic teaching methods were exchanged for a more creative approach without alteration of the course structure. The quasi experimental method was used, with four introductory courses of 20 nursing students at two separate district schools as the sample, two groups acting as the control groups and two as the experimental groups. The teaching sessions introduced medical problems associated with poor oxygenation, particularly those consequent to heart disease. The teaching was supported by appropriate care planning within the Roper et al. (1981) theoretical framework. Three distinct areas were identified; fact learning, e.g. anatomy and physiology, problem identifications and planning for nursing, intervention and skill learning. Students in the experimental groups were given work sheets and facilities for self learning whilst those in the control groups continued with a traditional lecture/demonstration format. The results of the experiment were evaluated by testing all four groups using multiple choice objective tests, essays, problem solving and nursing intervention exercises and practical assessments. The findings showed that the experimental groups did no better in the multiple choice objective tests or in the essays than the control groups but they did do significantly better in the problem identification and planning for nursing intervention exercise. In the assessment of practical skills there was no difference between the groups in skill performance but the experimental groups were able to apply the theory significantly better than the control groups.

Creativity↗

Expanding safer sex options: introducing the female condom into national programmes.

Although the female condom has been introduced into over 90 countries since 1997, it has only been accepted in sexual and reproductive health programmes as a mainstream method in a few. This paper describes introductory strategies developed by Ministries of Health and non-governmental organisations in Brazil, Ghana, Zimbabwe and South Africa, supported by UNAIDS, and the manufacturers of the female condom, which have significantly expanded the number of female condoms being used. These projects have several key similarities: a focus on training for providers and peer educators, face-to-face communication with potential users to equip them with information and skills, an identified target audience, a consistent supply, a long assessment period to gauge actual use beyond the initial novelty phase, and a mix of public and private sector distribution. Female condom programmes require the sanction, leadership and funding of governments and donors. However, the non-governmental and private sectors have also played a major role in programme implementation. To ensure successful introduction of the female condom, it is crucial to involve a range of decision-makers, programme managers, service providers, community leaders and women's and youth groups. The rising cost of inaction and unprotected sex in the spread of HIV and AIDS force us to recognise the high cost of not providing female condoms alongside male condoms in family planning and AIDS prevention programmes.

Brazil↗

An introductory orientation to clinical pathology core and on-call responsibilities.

An introductory 4-week orientation for clinical pathology is described. There were 76 hours of lectures, 74 hours of conferences, and 68 hours of laboratories for a total of 221 hours. During the orientation, all calls handled by the residents were evaluated as to resolution, patient outcome, and interaction required. Eighty calls were received during the orientation from 57 technologists (71%), 16 physicians (20%), and seven nurses (9%). The calls originated concerning the following: blood banking, 37 (46%); hematology, 21 (27%); chemistry, 14 (18%); microbiology, five (6%); and administration, three (4%). Sixty percent of the calls were consultative and 40% were supervisory. Ninety-nine percent were handled appropriately by the residents. Patient outcome was moderately or significantly affected in 44% of all calls, divided between 67% of all consultative calls and 9% of all supervisory calls. Significant pathologist interaction was required in 49% of all calls, divided between 71% of the consultative calls and 16% of the supervisory calls. Using this integrated, dynamic system of resident instruction, on-call experience, and evaluation, residents quickly gain confidence in handling call, didactic clinical consultation, and patient management. The orientation and on-call system described provides for a relevant and dynamic system for resident education.

Curriculum↗

Self-regulation training enhances dietary self-efficacy and dietary fiber consumption.

OBJECTIVE: To evaluate the effectiveness of incorporating two self-regulation strategies (goal setting and self-monitoring) into a nutrition education class to enhance dietary fiber self-efficacy and foster a positive change in dietary fiber consumption. DESIGN: College students in an introductory nutrition class (n = 113) were randomly assigned to one of four treatment conditions: goal setting, self-monitoring, goal setting and self-monitoring, and no goal setting and no self-monitoring. Twenty-six college students from an introductory health class served as the control group. STATISTICAL ANALYSES: The main and interaction effects of goal setting and self-monitoring on postintervention variables were analyzed using analysis of covariance with baseline intake levels as the covariate. Analysis of variance was used to examine differences in the mean changes between the groups. Path analysis was conducted to analyze the causal linkage among the pretest and intervening variables to predict postintervention knowledge, self-efficacy, and fiber consumption. RESULTS: Goal setting had a significant main effect on dietary fiber self-efficacy and on dietary fiber consumption Subjects who set goals scored 15% higher on the dietary fiber self-efficacy scale and consumed 91% more fiber than subjects who did not set goals. Self-monitoring had no significant main effect on either dietary fiber self-efficacy or dietary fiber consumption. There was no significant interaction between goal setting and self-monitoring. Changes in dietary fiber scores differed between the groups. Increases in dietary fiber for the goal setting and self-monitoring group were significantly higher than the goal-setting, self-monitoring, no goal setting and no self-monitoring, and control groups. In addition, the goal setting only group had significantly greater increases in fiber intake than the self-monitoring, no goal setting and no self-monitoring, and control groups. Changes in self-efficacy scores were significantly different between the groups. The goal setting and goal setting and self-monitoring groups had significantly higher self-efficacy scores than the control group. Path analysis revealed that both goal setting and self-monitoring affected dietary fiber consumption through knowledge and dietary fiber self-efficacy, goal setting had a strong direct effect on fiber consumption, and postintervention knowledge affected fiber consumption only through self-efficacy. APPLICATIONS/CONCLUSIONS: Our findings suggest that dietary change requires active self-regulation of food intake. Combining goal setting and self-monitoring significantly enhances dietary behavior change. This strategy can easily be incorporated into nutrition education or counseling programs to enhance dietary behavior change.

Adolescent↗

Multidisciplinary team interaction: summary and Action Plan.

INTRODUCTION: Multidisciplinary team interaction has become a commonplace phrase in the discussion of disaster response. Theme 6 explored multidisciplinary team interactions and attempted to identify some of the key issues and possible solutions to the seemingly intractable problems inherent in this endeavour. METHODS: Details of the methods used are provided in the introductory paper. The Cochairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The Cochairs then presided over a workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) promotion of multidisciplinary collaboration, (2) standardization, (3) the Incident Command System, (4) professionalism, (5) regional disparities, and (6) psychosocial impact. DISCUSSION: Action plans recommended: (1) a standardized template for Needs Assessment be developed, implemented, and applied using collaboration with international organizations, focusing on needs and criteria appropriate to each type of event, and (2) team needs assessments be recognized for local responses and for determination of when international assistance may be required, for planning a command system, and for evaluating the psychosocial impact. CONCLUSIONS: There is a clear need for the development of standardized methods for the assessment of needs, development and implementation of a command structure, and for appreciation of regional differences and the psychosocial impact of all interventions.

Attitude of Health Personnel↗

Experiential learning in the animal sciences: development of a multispecies large-animal management and production practicum.

Students enrolled in an introductory animal science course (ASG 3003) at the University of Florida were surveyed (n = 788) over a 3-yr period to ascertain their current experience and career goals in animal agriculture. Sixty-one percent of the students indicated that they were from an urban background. Only 4% were raised on a farm or ranch where the majority of family income was attributed to production agriculture. Eighty-six percent of the students had minimal or no experience working with large domestic farm animals, but nearly 64% of the students wanted to pursue a career in veterinary medicine. Disciplinary and species interests of the students were highly associated with previous background experiences. Students from nonagricultural backgrounds, who were most likely to indicate a career interest involving veterinary medicine, were most interested (P < 0.05) in animal behavior, whereas the students of rural background were more interested (P < 0.05) in animal management. Thirty-three percent of students were primarily interested in small companion animals; 22% in horses; 20% in domestic farm animals, including beef, dairy, swine, or sheep; and 24% in undomesticated zoo animals or wildlife. The career goals indicated by most students necessitate practical application of animal husbandry skills that are often assumed as general knowledge. Thus, a multispecies large animal management and production practicum (ANS 3206) was developed to provide students with hands-on experience. It was an elective course, and students were encouraged to enroll for two consecutive semesters. Teams of students rotated responsibilities among four livestock species (beef, dairy, equine, and swine). Daily responsibilities at each of the units included feeding and monitoring growth of feedlot cattle and finishing swine, farrowing assistance and baby pig processing, and equine training and foaling assistance. Students were also involved with all facets of a working dairy. Additionally, students completed written assignments specific to their individual species responsibilities that included daily journals, worksheets, or calculation of performance measures. Weekly class meetings allowed for instruction and were used to manage the varied course activities. Using a 5-point scale (1 = poor, 5 = excellent), students indicated that the course further stimulated their interest (4.73) and facilitated their learning (4.63) of animal science concepts. Overall course evaluations ranged from 4.54 +/- 0.55 to 4.85 +/- 0.38 over a 4-yr period. As more students enter animal science programs with nonagricultural backgrounds, it will become necessary to reemphasize basic animal-handling skills and practical applications through experiential learning activities.

Agriculture↗

Evaluation of safety, efficacy, and acceptability of NORPLANT implants in Sri Lanka.

This paper presents findings based on a one-year pre-introductory clinical investigation concerning safety, efficacy, and acceptability of the new contraceptive NORPLANT implants in Sri Lanka. The study is based on 400 acceptors of the implants at two clinics in Sri Lanka. Acceptors' mean age was 27 years, mean number of children was about two, and average educational attainment was eight years. Nearly half of the acceptors did not want to have another child. Follow-up was conducted at one, three, six, and twelve months. The one-year termination rate due to medical problems was very low, and the one-year life-table pregnancy rate was 0.5. Menstrual pattern disruption was the most frequently reported complaint with the implants. Amenorrhea increased in the first three months of use, and intermenstrual bleeding was common among those menstruating. In spite of these changes and some significant variations between the acceptors in the two study center, the overall degree of satisfaction with the implants was very high. The features most important to the acceptability of the implants were low risk of pregnancy, the long duration of action, and the convenience of use. The results of the study suggest that NORPLANT implants are safe, effective, and highly acceptable to Sri Lankan women.

Adolescent↗

[Quality and quantitative comparison of health status during nursing care before and after basic kinesthesis training in a nuclear and radiotherapy clinic].

UNLABELLED: Immediately before and half a year after an introductory course into the principles of kinesthetic nursing the nursing team of the Clinic for Nuclear Medicine and Radiotherapy, City Hospital Triemli (Zurich, Switzerland), was asked to attend a semi-structured interview and nonverbal rating of a selection of important aspects of their physical and mental state during nursing. Eighteen persons had two interviews. The main differences in the second interview compared to the first one are the following: With respect to personal aims at work caring for the patients' well-being had fewer mentions; instead nursing was more often considered a process to which both sides do contribute significantly. Considerable improvements were found regarding to the physical contact to patients while caring, the team, and the nurses' general mental well-being. Physical benefits from the new nursing method were experienced only by part of the team, probably due to unplanned cancelling of kinesthetic supervision. Pressure due to the nurses' compassion for their patients' suffering and dying also was much less mentioned in the second interview, when pressure from outside, and lack of interdisciplinary communication and cooperation weighted more heavily. INTERPRETATION: Competence was already high in the team at the time of the first interview, but even improved by the time of the second interview. This is expressed by the resource-oriented patient-nurse partnership in the process of nursing, by team communication, as well as the heavily weighing discrepancy between knowledge and limited authorisation.

Attitude of Health Personnel↗