James Whyte

Expert performance in nursing: reviewing research on expertise in nursing within the framework of the expert-performance approach.

Traditionally, studies on expertise have used social criteria to identify highly respected and experienced individuals and examined how these experts differ from less-experienced individuals. Our article reviews research on nursing expertise during the last decades from the perspective of the expert-performance approach, which focuses on reproducibly superior performance in everyday life. Our review proposes explanations for repeated failures to find reliably superior performance for nurses with longer professional experience. The article concludes with an outline of how the expert-performance approach can be applied to the study of nursing expertise where the focus is on measurement and analysis of superior nursing performance.

Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory.

Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients α for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed.

The relationship between knowledge and clinical performance in novice and experienced critical care nurses.

PURPOSE The purpose of this study was to measure directly the knowledge and performance of novice and experienced critical care nurses in a simulated task environment. METHODS Nurses were required to control the physiologic deterioration of patients with respiratory compromise in 4 scenarios and were also tested on their knowledge of the constructs present in the scenarios. RESULTS The results indicate that experienced nurses possessed highly superior knowledge when compared with novice nurses (P < .001). The results further demonstrated a lack of reliable differences in actual clinical performance when nurses were considered solely on the basis of their term of experience. Group differences in performance were demonstrated only when nurses who had achieved board certification in critical care nursing were compared with the remaining participants. CONCLUSION The results demonstrate the lack of linkage between knowledge and clinical performance, which calls into question the supposition by many in nursing that knowledge and performance are inextricably linked.

Sexual Assertiveness in Low-Income African American Women: Unwanted Sex, Survival, and HIV Risk

The objective of this study was to determine the relationship of social variables related to sexual relationships in African American women.1 The study used a quantitative descriptive design to gather data from a convenience sample of 524 African American women aged 18 to 49 who dwelled in the southeastern United States. The study utilized the HIV Risk Behavior Questionnaire to determine the participants level of HIV risk. Results indicated substantial levels of sex in the women due to violence or fear of violence, relationship loss, lost shelter, and high levels of unwanted sex. There was a positive correlation between level of survival sex and high-risk behavior (R = .651, p < .01). Multiple correlations indicated associations between history of forced sex and sex due to fear of violence (R = .604, p < .01). Further correlations indicated a pattern of association between poverty, age, and sex out of fear of relationship loss or shelter loss. The study indicates a need for a broader definition of HIV-related risk in high-risk populations.

A Theoretical Framework for Simulation in Nursing: Answering Schiavenato’s Call

The aim of this article was to provide a response that supports and extends Schiavenatos call for a theoretically guided approach to simulation use in nursing education.We propose that a theoretical framework for simulation In nursing must first include, as a basis, a theoretical understanding of human performance and how it is enhanced.This understanding will, in turn, allow theorists to provide a framework regarding the utility, application, and design of the training environment, including internal and external validity. The expert performance approach, a technique that recently has been termed Expert-Performance-based Training (ExPerT), is introduced as a guiding frame work for addressing these training needs. We also describe how the theory of deliberate practice within the framework of ExPerT can be useful for developing effective training methods in health care domains and highlight examples of how deliberate practice has been successfully applied to the training of psychomotor and cognitive skills.

Cognitions associated with nurse performance: a comparison of concurrent and retrospective verbal reports of nurse performance in a simulated task environment.

BACKGROUND Cognitions represent the computations associated with human thought processes. Verbal protocols offer a method by which to record these processes. While concurrent and retrospective verbal reporting of cognitions have been used extensively within nursing and other domains, the use of this methodology in nursing has been characterized by inconsistencies in its application. OBJECTIVES The primary objective of this study was to describe and compare the content of concurrent and retrospective verbal reports provided by nurses during and after administering care in a simulated task environment. DESIGN The study utilized a laboratory based quasi-experimental research design. SETTING The study was based in a simulation laboratory designed specifically for use in studies designed to measure nursing performance. The laboratory integrated extensive instrumentation that facilitated the comprehensive audio and video recording of participant actions. PARTICIPANTS The participants (N=15) were recruited from a College of Nursing at a large university in the Southeastern United States. METHODS Research participants were asked to admit a patient experiencing an acute exacerbation of congestive heart failure in a simulated task environment, during which they were required to prioritize and provide care. Participants were trained in the method for providing verbal reports of thoughts, and concurrent and retrospective report data were collected during and after the simulation exercise. The data were then coded for the purposes of descriptive analysis. RESULTS The results indicated that the concurrent verbal reports provide a more complete representation of the cognitions of research participants providing care in a simulated task environment. However, the results reflect that additional unique data is present in the retrospective reports, exclusive of the concurrent reports. CONCLUSIONS The findings support the utility of concurrent and retrospective verbal reports as a method of gathering data in studies that address nursing performance in a clinical context.

Down Low Sex, Older African American Women, and HIV Infection

&NA; The phenomenon of down low sex, wherein men involved in monogamous relationships with women seek extrarelationship sexual relations with men, has gained recognition in recent years. This study addressed the issue of down low sex in a group of African American women whose long‐term sexual partners had become infected with HIV during extramarital sexual encounters with men. A grounded theory methodology was used to explore the experiences of 11 women in individual interviews that were sensitive to the intimate nature of their experiences. Themes shown in the data focused on (a) being betrayed and losing trust; (b) reflecting upon the features of the past relationship; (c) seeking the positive aspects of the past relationship; (d) being ashamed before God, community, and family; and (e) assuming the caregiver role and sharing the burden of illness. The study identified the strong influence of positive long‐term relationships on life decisions of women following a diagnosis of HIV, despite the extrarelationship sexual activities of their partners.

Option Generation and Decision Making in Critical-Care Nursing

The recognition-primed decision (RPD) model and Take the First (TTF) heuristic assert that successful and experienced decision makers typically generate relatively few options, and generate a satisficing, or the best, option first. Moreover, the TTF heuristic suggests that as more options are generated the likelihood that the best option will be selected is reduced. An alternative proposal suggests that the ability to anticipate the outcome of a situation is actually positively related to the number of options generated. To test these opposing claims we compared high and low performing critical-care nurses on three simulated critical care scenarios and measured their option generation behaviors and the courses of action pursued. Consistent with RPD and TTF, the data suggest that high performers generate fewer options than low performers during situational assessment. However, counter to RPD and TTF, the current data suggest that the selection of options generated later in the process may actually facilitate better outcomes. Implications for the design of instruction and training materials are discussed.

A study of HIV positive undocumented African migrants' access to health services in the UK

Newly immigrated persons, whatever their origin, tend to fall in the lower socioeconomic levels. In fact, failure of an asylum application renders one destitute in a large proportion of cases, often resulting in a profound lack of access to basic necessities. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority. The purpose of the study was to determine the basic social processes that guide HIV positive undocumented migrants efforts to gain health services in the UK. The study used the Grounded Theory Approach. Theoretical saturation occurred after 16 participants were included in the study. The data included reflections of the prominent factors related to the establishment of a safe and productive life and the ability of individuals to remain within the UK. The data reflected heavily upon the ability of migrants to enter the medical care system during their asylum period, and on an emerging pattern of service denial after loss on immigration appeal. The findings of this study are notable in that they have demonstrated sequence of events along a timeline related to the interaction between the asylum process and access to health-related services. The results reflect that African migrants maintain a degree of formal access to health services during the period that they possess legal access to services and informal access after the failure of their asylum claim. The purpose of this paper is to examine the basic social processes that characterize efforts to gain access to health services among HIV positive undocumented African migrants to the UK. The most recent estimates indicate that there are a total of 618,000 migrants who lack legal status within the UK. Other studies have placed the number of undocumented migrants within the UK in the range of 525,000–950,000. More than 442,000 are thought to dwell in the London metropolitan area. Even in cases where African migrants enter the UK legally, they often face considerable difficulty in their quest to gain legal employment due to barriers inherent to the system that grants work permits. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority.

Identification and comparison of interventions performed by Korean school nurses and U.S. school nurses using the Nursing Interventions Classification (NIC).

The purpose of the study was to identify Nursing Interventions Classification (NIC) interventions performed by Korean school nurses. The Korean data were then compared to U.S. data from other studies in order to identify differences and similarities between Korean and U.S. school nurse practice. Of the 542 available NIC interventions, 180 were selected as the basis of a questionnaire designed to quantify key aspects of school nursing practice. The data were collected from 131 school nurses working in Korea. The results indicated that Korean school nurses focused on classifications from the Physiological Basic domain. Comparisons to previously reported U.S. data reflect that U.S. school nurses focus primarily on the Behavioral domain. The data reflect important differences between the practice characteristics of Korean and U.S. school nurses. Further, the data support the utility of NICs in quantifying the practice characteristics of school nurses in Korea.