Benjamin A. Smallheer

Bee and Wasp Stings Reactions and Anaphylaxis

This article provides a brief introduction to the history of anaphylaxis and the order Hymenoptera, which is responsible for most reported sting-induced allergic reactions. The anatomic similarities and differences as well as inhabited similarities and differences between bees and wasps are discussed. The various types of allergic reactions and their manifestations are described. Treatment regimens ranging from home therapies and over-the-counter medications to prescription medications and emergency treatments are introduced. Education, avoidance, and venom-specific immunotherapy are discussed.

Evaluation and Treatment of Restless Legs Syndrome in the Primary Care Environment

Restless legs syndrome/Willis-Ekbon disease (RLS/WED) is a common sensorimotor disorder characterized by an irresistible urge to move and is associated with an uncomfortable sensation typically in the lower extremities. Dopaminergic neurotransmission abnormalities, genetics, sleep deprivation, and iron deficiency all play key roles in the pathogenesis of primary RLS. Secondary RLS has been associated with other medical conditions and medication usage. A thorough subjective evaluation and complete neurologic examination are key in the diagnosis of RLS/WED. Treatment includes pharmacologic and nonpharmacologic approaches. Referral to a neurologist or sleep specialist should be considered if initial treatment plans are ineffective.

Immunosuppressive/Autoimmune Disorders

Autoimmune disorders are a category of diseases in which the immune system attacks healthy cells as a result of a dysfunction of the acquired immune system. Clinical presentation and diagnosis are disease specific and often correspond with the degree of inflammation, as well as the systems involved. Treatment varies based on the specific disease, its stage of presentation, and patient symptoms. The primary goal of treatment is to decrease inflammation, minimize symptoms, and lessen the potential for relapse. Graves disease, Hashimoto thyroiditis, rheumatoid arthritis, Crohn disease, ulcerative colitis, systemic lupus erythematosus, and multiple sclerosis are discussed in this article.

Learned Helplessness and Depressive Symptoms Following Myocardial Infarction

Psychosocial factors are known to impact depressive symptoms across clinical populations. Learned helplessness has the potential of affecting depressive symptoms following acute myocardial infarction (AMI), though little is known about this relationship. The purpose of this study was to examine the relationship between learned helplessness and depressive symptoms in patients following an AMI. Using a descriptive cross-sectional design, participants with a diagnosed AMI within the past 12 months were recruited. Standardized instruments and measures were used to evaluate learned helplessness and depressive symptoms. A statistically significant direct relationship was found between learned helplessness and depressive symptoms, suggesting that individuals with higher self-reported levels of learned helplessness also reported more depressive symptoms. These results indicate learned helplessness is associated with depressive symptoms in individuals following an AMI. In developing post-AMI treatment plans, health care staff should focus on psychologic points of intervention to the same extent as physiologic interventions.

Use of a Virtual Learning Platform for Distance-Based Simulation in an Acute Care Nurse Practitioner Curriculum

Background: Acute care nurse practitioner (ACNP) programs that use high-fidelity simulation as a teaching tool need to consider innovative strategies to provide distance-based students with learning experiences that are comparable to those in a simulation laboratory. Objective: The purpose of this article is to describe the use of virtual simulations in a distance-based ACNP program and student performance in the simulations. Method: Virtual simulations using iSimulate were integrated into the ACNP course to promote the translation of content into a clinical context and enable students to develop their knowledge and decision-making skills. With these simulations, students worked as a team, even though they were at different sites from each other and from the faculty, to manage care of an acutely ill patient. Results: The students were assigned to simulation groups of 4 students each. One week before the simulation, they reviewed past medical records. The virtual simulation sessions were recorded and then evaluated. The evaluation tools assessed 8 areas of performance and included key behaviors in each of these areas to be performed by students in the simulation. More than 80% of the student groups performed the key behaviors. Discussion: Virtual simulations provide a learning platform that allows live interaction between students and faculty, at a distance, and application of content to clinical situations. With simulation, learners have an opportunity to practice assessment and decision-making in emergency and high-risk situations. Simulations not only are valuable for student learning but also provide a nonthreatening environment for staff to practice, receive feedback on their skills, and improve their confidence.

Reverse Case Study: A New Perspective on an Existing Teaching Strategy.

F ostering students’ learning through new and creative methods of teaching is a continual charge to educators. A significant challenge is the structure of an educational system that assumes everyone can learn the same material in the same way. Instructional methods such as a flipped classroom, high-fidelity simulation, and use of case studies are examples of teaching strategies being incorporated into nursing education to create a more diverse learning environment. These varied teaching methods allow educators to be less dependent on traditional methods of lecture, reading, and examinations. A case study presents a realistic situation involving a problem or conflict of variable complexity. Case studies are highly adaptive and have been used in a variety of disciplines. To further facilitate integration of knowledge across nursing courses, an unfolding case study can be used. An unfolding case evolves over time in a manner that is intentionally unpredictable to the learner. In doing so, it simulates real-world events and helps develop clinical reasoning and independent thinking skills. As a classroom activity, these case studies enable nursing faculty to emphasize the importance of both quality and safety of patientcentered care. Traditional case studies are often limited by an innate design of engaging the lower domains of Bloom’s Taxonomy (eg, remembering, understanding, and applying) as students demonstrate recall and understanding of content and apply it to apresented scenario. Topromote learningat thehigher levels of analyzing, evaluating, and creating, the reverse case study has gained recognition. Different from the traditional unfolding case study, in which a single scenario is presented, the reverse case study incorporates students into the development of a scenario, thus requiring them to demonstrate analysis and evaluation of the material, culminating in creating the necessary details of the case study. The purpose of this article is to present a method of using the reverse case study that engages small groups into an interactive and collaborative activity, requiring negotiation and kinesthetic learning.

Meta-Evaluation: Experiences in an Accelerated Graduate Nurse Education Program

Most schools of nursing are engaged in some form of program evaluation and recognize the potential benefits in using program evaluation outcomes to influence continuous improvement in program quality. A number of factors exist that may negatively influence program evaluation quality and adversely affect the ability to make sound decisions based on program evaluation outcomes. The potential limitations that threaten program evaluation quality underscore the importance of evaluating the evaluation process itself, also known as meta-evaluation. However, there is an absence of discussion in the nursing literature of the importance of program meta-evaluation. This article seeks to address this gap in the nursing literature and illuminate the need for more schools of nursing to engage in the meta-evaluation process. By introducing 1 model of program meta-evaluation and describing our own endeavors in the program meta-evaluation process, we hope to inspire other schools of nursing to consider using a systematic and formalized process to evaluate their own program evaluation processes to ensure that data obtained from program evaluation are of optimal quality to influence sound, data-driven decisions to promote continued quality and excellence in nursing education programs.