Alicia Huckstadt

Promoting signing of advance directives in faith communities

AbstractOBJECTIVE: To develop a participatory educational program implemented in faith communities that would increase discussion and signing of two types of advance directives—living will and durable power of attorney for health care decisions. DESIGN: Longitudinal study with four annual cycles of program implementation, evaluation, and revision incorporating a program that fostered the discussion, signing, and/or revision of advance directives. The program involved an educational workbook and ongoing support by parish nurses. SETTING: Seventeen faith communities in Wichita, Kansas. Faith communities included several predominantly white congregations, as well as several primarily African-American and Hispanic congregations. PARTICIPANTS: Seventeen faith communities, their pastors, and 25 parish nurses worked with 361 self-selected residents, living in community settings, to participate in the program as members of their faith communities. Congregations were recruited by the executive director of a local interfaith ministries organization and parish nurses. MAIN RESULTS: Two hundred forty-eight (69%) of the congregants who started the program completed it. Of the program completers, 83 (33%) had a directive prior to the program and 140 (56%) had a directive after completion. One hundred eighty-six of the completers discussed directives with family members. Overall, 89 (36%) of the 248 program completers revised an existing directive or signed one for the first time. Age was positively related to having signed/revised a directive prior to the program. Fear that advance directives would be used to deny medical care was negatively related to signing both prior to the program and after program completion, and contributed to participants’ reluctance to sign directives. CONCLUSIONS: Educational programs implemented by parish nurses in faith communities can be effective in increasing rates of discussion, revision, and/or signing of advance directives.

Developing interactive continuing education on the Web.

BACKGROUND To meet the continuing education needs of advanced practice nurses, on-line continuing education modules were designed as part of a grant-funded nurse practitioner learning project. METHOD Three modules were planned from the results of a nurse practitioner (n=187) survey of computer availability and skills, topic preference, and their potential for taking on-line continuing education. RESULTS The development and implementation of two of the three modules demonstrates the interactive framework, extensive use of links, pre- and posttesting, and on-line registration. The two modules were designed to be interactive, realistic self-studies that closely resemble clinical practice. CONCLUSIONS Outcome data are currently being collected on-line and will be analyzed for efficacy of this delivery system for continuing education.

Acute Low Back Pain in the Emergency Department

Emergency departments across the nation are confronted multiple times a day with patients who present with complaints of acute low back pain. The role of the practitioner in the emergency department is to carefully evaluate the low back pain symptom as a potentially serious illness. The primary focus of this article is to discuss the historical and physical “red flags” that warrant a more detailed evaluation of this common chief complaint. Nonspecific low back pain is a diagnosis of exclusion. History is the key to differentiating mechanical acute low back pain from more serious etiologies. Age, duration of pain, history of trauma, location and radiation of pain, systemic complaints, history of cancer, neurologic deficits, psychological and social risks, and functional pain are important considerations during history taking. The physical examination of the patient with acute low back pain is based on the history and guides the practitioner to determine the extent of examination necessary to distinguish serious from more simple nonspecific low back pain. Abnormal vital signs are of particular concern and are “red flags.” The focused physical examination of the back includes inspection of the back, range of motion, and a thorough neurologic examination. An abdominal examination should be conducted to exclude intra-abdominal pathology such as aneurysm or masses. Rectal examinations are critical in anyone with complaints of saddle anesthesia or who may have cauda equina syndrome. Nonorganic are also causes for low back pain. Diagnostic studies include laboratories for infection, radiograph studies when the patient meets criteria, computerized axial tomography, and magnetic resonance imaging along with ultrasound aid in the differential diagnosis of patients with low back pain. Admission criteria of patients with nonspecific low back pain without evidence of neurologic findings is the inability to perform activities of daily living at home. The goal for patients with acute low back pain is the restoration of normal daily activities with medications, activity, patient education, and, at times, adjuvant therapy. Overall, the prognosis is good for patients with mechanical low back pain.

Evaluation of interactive online courses for advanced practice nurses

Purpose The purpose of this study was twofold: (a) to examine the effectiveness of two interactive online learning modules for advanced practice nurses (APNs) and (b) to examine the participants’ demographic characteristics and their perceptions of the strengths and weaknesses of online learning. Data sources A purposive sample of 73 registered nurses and APNs enrolled in graduate study or continuing education completed an online learning course. These participants were pretested and post-tested using a knowledge test developed by the authors. Participants were also surveyed for demographic characteristics and perceptions toward online learning. Conclusions The findings of this study support case-based online learning as a successful method in the education of APNs. The evaluation of the online modules and the enthusiasm from students indicated success of this teaching/learning method. The majority of learners responded positively toward the online method of learning and included comments that indicated they enjoyed learning using this method, would like to have the site available at their practice locations for reference, and would like to have other courses designed and delivered in this manner. Implications for practice and education The effectiveness and quality of the online instruction ultimately matter most to student satisfaction in online courses. The future of online education is dependent on well-structured, interactive, and substantive programs. Educators are challenged to continually assess and evaluate the changing learning needs of APNs.Purpose The purpose of this study was twofold: (a) to examine the effectiveness of two interactive online learning modules for advanced practice nurses (APNs) and (b) to examine the participants’ demographic characteristics and their perceptions of the strengths and weaknesses of online learning. Data sources A purposive sample of 73 registered nurses and APNs enrolled in graduate study or continuing education completed an online learning course. These participants were pretested and post‐tested using a knowledge test developed by the authors. Participants were also surveyed for demographic characteristics and perceptions toward online learning. Conclusions The findings of this study support case‐based online learning as a successful method in the education of APNs. The evaluation of the online modules and the enthusiasm from students indicated success of this teaching/learning method. The majority of learners responded positively toward the online method of learning and included comments that indicated they enjoyed learning using this method, would like to have the site available at their practice locations for reference, and would like to have other courses designed and delivered in this manner. Implications for practice and education The effectiveness and quality of the online instruction ultimately matter most to student satisfaction in online courses. The future of online education is dependent on well‐structured, interactive, and substantive programs. Educators are challenged to continually assess and evaluate the changing learning needs of APNs.

Database trial impact on graduate nursing comprehensive exams

While the authors were doing a test period of databases, the question of whether or not databases affect outcomes of graduate nursing comprehensive examinations came up. This study explored that question through using citation analysis of exams that were taken during a database trial and exams that were not. The findings showed no difference in examination pass/fail rates. While the pass/fail rates did not change, a great deal was learned in terms of citation accuracy and types of materials that students used, leading to discussions about changing how citation and plagiarism awareness were taught.