John M. Clochesy

The Impact of High Fidelity Human Simulation on Self-Efficacy of Communication Skills

Communication is a critical component of nursing education as well as a necessity in maintaining patient safety. Psychiatric nursing is a specialty that emphasizes utilization of communication skills to develop therapeutic relationships. Nursing students are frequently concerned and anxious about entering the mental health setting for their first clinical placement. High fidelity human simulation (HFHS) is one method that can be used to allow students to practice and become proficient with communication skills. The purpose of this study was to compare the effectiveness of two educational delivery methods, traditional lecture and HFHS, on senior level nursing students self-efficacy with respect to communicating with patients experiencing mental illness. The results of this study support the use of HFHS to assist in enhancing undergraduate students’ self-efficacy in communicating with patients who are experiencing mental illness.

Communication and Human Patient Simulation in Psychiatric Nursing

Communication is an integral component of nursing education and has been shown to improve health outcomes, patient compliance, and patient satisfaction. Psychiatric nursing emphasizes knowledge and utilization of communication skills. Nursing students often express anxiety and lack of confidence regarding communicating with patients diagnosed with psychiatric illnesses. Human patient simulation is one method that may be used for students to practice and become proficient with communication skills in a simulated environment. The authors of this article provide an overview of communication and psychiatric nursing as well as review of the current research related to the use of human patient simulation in nursing education.

Psychometric evaluation of the Chinese version of the Minnesota living with heart failure questionnaire

Background: Health-related quality of life has emerged as an important outcome in treating and managing patients with heart failure (HF). However, there is no existing instrument for use in Chinese populations. Objectives: To translate the Minnesota Living With Heart Failure Questionnaire (MLHFQ) into a Chinese version and to validate it in the clinical setting. Methods: This was a cross-sectional study. A convenience sample of 247 participants with New York Heart Association Class II to III chronic HF were recruited from a cardiovascular outpatient department in Taiwan. Results: The content validity index was 0.98. Construct validity was supported by exploratory factor analysis, which showed three factors with 20 of 21 items loading above .50, explaining 71% of the variance. Total scale and subscale scores were correlated highly with the reference instruments, indicating satisfactory concurrent and convergent validity. The mean scores of the Chinese version of the MLHFQ were significantly higher among participants with HF than those from a non-HF comparison group. The instrument demonstrated high internal consistency (Cronbachs α of .95 for the scale and .93 to .95 for the subscales). Conclusion: The psychometric properties indicate that the Chinese version of the MLHFQ is a valid and reliable instrument for future research. This instrument provides a holistic approach for measuring health-related quality of life in New York Heart Association Class II and III HF patients.

Atrial fibrillation : Prevalence after minimally invasive direct and standard coronary artery bypass

BACKGROUND This study identified and compared the prevalence of new-onset atrial fibrillation (AFIB) following standard coronary artery bypass grafting (SCABG) with cardiopulmonary bypass (CPB) and minimally invasive direct vision coronary artery bypass grafting (MIDCAB) without CPB. A further comparison was made between AFIB prevalence in SCABG and MIDCAB subjects with two or fewer bypasses. METHODS This is a retrospective, comparative survey. Patients with new-onset AFIB who underwent SCABG or MIDCAB alone were identified electronically using a triangulated method (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9 CM] code; clinical database word search; and pharmacy database drug search). RESULTS The total sample (n = 814; 94 MIDCAB, 720 SCABG) exhibited a trend toward lower AFIB prevalence in MIDCAB (23.4%) versus SCABG (33.1%) subjects (p = 0.059). AFIB prevalence in the SCABG subset with two or less vessel bypasses (n = 98; n = 18 single vessel, n = 80 double vessels) and MIDCAB subjects (n = 94; n = 90 single vessels, n = 4 double vessels) was almost identical (SCABG subset 24.5% versus MIDCAB 23.4%, p = 0.860). Slightly more than half (56.9%) of new-onset AFIB subjects were identified by ICD-9 CM codes, with the remainder by word search (37.7%) or procainamide query (5.4%). CONCLUSIONS In this sample, the number of vessels bypassed seemed to have a greater influence on AFIB prevalence than the application of CPB or the surgical approach. Retrospective identification of AFIB cases by ICD-9 CM code grossly underestimated AFIB prevalence.

Avatar-based depression self-management technology: promising approach to improve depressive symptoms among young adults.

Major depressive disorder is prevalent among American young adults and predisposes young adults to serious impairments in psychosocial functioning. Without intervention, young adults with depressive symptoms are at high risk for worsening of depressive symptoms and developing major depressive disorder. Young adults are not routinely taught effective depression self management skills to reduce depressive symptoms and preempt future illness. This study reports initial results of a randomized controlled trial among young adults (18-25 years of age) with depressive symptoms who were exposed to an avatar-based depression self-management intervention, eSMART-MH. Participants completed self-report measures of depressive symptoms at baseline and at 4, 8, and 12 weeks follow-up. Participants who received eSMART-MH had a significant reduction in depressive symptoms over 3 months, while individuals in the attention-control condition had no change in symptoms. In this study, eSMART-MH demonstrated initial efficacy and is a promising developmentally appropriate depression self-management intervention for young adults.

Urinary bladder and rectal temperature monitoring during clinical hypothermia.

Three methods of temperature monitoring were studied in 55 adult hypothermic postcardiac surgery patients using the pulmonary artery, rectum, and urinary bladder as measurement sites. Pulmonary artery temperature served as the standard for core body temperature. Measurements in the rectum were recorded with a disposable plastic temperature probe and in the urinary bladder with a thermistor-tipped Foley catheter. Patients were studied within one hour of admission to the cardiac surgical intensive care unit and on an hourly basis until they reached normothermia (37 °C). Although mean temperatures did not vary greatly for any group, there was a significant difference between measures over time. Correlations of pulmonary artery and urinary bladder temperatures ranged from .78 to .94, pulmonary artery and rectal temperature from .49 to .82, and urinary bladder and rectal temperature from .46 to .85. The results of this study indicate that the urinary bladder is a reliable indicator of core temperature during rewarming following cardiac surgery.

Safety in numbers 3: Authenticity, Building knowledge & skills and Competency development & assessment: The ABC of safe medication dosage calculation problem-solving pedagogy

When designing learning and assessment environments it is essential to articulate the underpinning education philosophy, theory, model and learning style support mechanisms that inform their structure and content. We elaborate on original PhD research that articulates the design rationale of authentic medication dosage calculation problem-solving (MDC-PS) learning and diagnostic assessment environments. These environments embody the principles of authenticity, building knowledge and skills and competency assessment and are designed to support development of competence and bridging of the theory-practice gap. Authentic learning and diagnostic assessment environments capture the features and expert practices that are located in real world practice cultures and recreate them in authentic virtual clinical environments. We explore how this provides students with a safe virtual authentic environment to actively experience, practice and undertake MDC-PS learning and assessment activities. We argue that this is integral to the construction and diagnostic assessment of schemata validity (mental constructions and frameworks that are an individuals internal representation of their world), bridging of the theory-practice gap and cognitive and functional competence development. We illustrate these principles through the underpinning pedagogical design of two online virtual authentic learning and diagnostic assessment environments (safeMedicate and eDose™).

Mechanical Ventilation Antioxidant Trial

BACKGROUND Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation. OBJECTIVE To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation. METHODS A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours. RESULTS Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital. CONCLUSIONS Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults.

Validation of an Interaction Model of Health Behavior Among Adults With Hypertension.

The purpose of this study was to test the Interaction Model of Client Health Behavior among adults with hypertension. The predictive associations among health literacy, quality of the provider interaction, perceived communication skills, and behavioral activation on blood pressure control were examined. Participants were 109 adults with hypertension recruited from community settings. A path analysis using maximum likelihood estimation was conducted in Analysis of Moment Structures for Windows (AMOS). The model fit to these data was excellent (χ2 = 1.1, p = .76, Tucker–Lewis index [TLI] = 1.1, comparative fit index [CFI] = 1.0, root mean square error of approximation [RMSEA] = .00, standardized root mean residual [SRMR] = .03). As hypothesized, health literacy, quality of the provider interaction, and perceived communication skills directly affected behavioral action. The quality of the provider interaction, perceived communication skills, and behavioral activation had direct effects on systolic blood pressure control. The study results support health literacy screening and communication skill building, and improving the quality of provider interactions to enhance blood pressure control among adults with hypertension.

From scientific discovery to health outcomes: A synergistic model of doctoral nursing education

Across the globe, health system leaders and stakeholder are calling for system-level reforms in education, research, and practice to accelerate the uptake and application of new knowledge in practice and to improve health care delivery and health outcomes. An evolving bi-dimensional research-practice focused model of doctoral nursing education in the U.S. is creating unprecedented opportunities for collaborative translational and investigative efforts for nurse researchers and practitioners. The nursing academy must commit to a shared goal of preparing future generations of nurse scientists and practitioners with the capacity and motivation to work together to accelerate the translation of evidence into practice in order to place nursing at the forefront of health system improvement efforts and advance the profession.