Louise S. Jenkins

Testing the reliability and validity of the Self-Efficacy for Exercise scale.

BACKGROUND The measure for self-efficacy barriers to exercise was developed for adults and revised on the basis of quantitative and qualitative research with older adults so it would be more appropriate for that age group. OBJECTIVES To test the reliability and validity of the Self-Efficacy for Exercise (SEE) Scale. METHODS Initial reliability and validity testing was performed using a sample of 187 older adults living in a continuing care retirement community. The average age of the participants was 85 +/- 6.2 years, and most were White (98%), female (82%), and unmarried (80%). Face-to-face interviews were completed and included the SEE, the 12-item Short Form Health Survey (SF-12), and the Expected Outcomes and Barriers for Habitual Exercise scale. Exercise activity was based on verbal report of participation in aerobic exercise (walking, swimming, biking, or jogging). RESULTS There was sufficient evidence of internal consistency (alpha = 0.92), and a squared multiple correlation coefficient using structural equation modeling provided further evidence of reliability (R2 ranged from 0.38 to 0.76). There was evidence of validity of the measure based on hypothesis testing: Mental and physical health scores on the SF-12 predicted efficacy expectations, and efficacy expectations predicted exercise activity. Lambda X estimates (all estimates > or = 0.81) provided further evidence of validity. CONCLUSION Preliminary testing provided evidence for the reliability and validity of the SEE scale. Future testing of the scale needs to be done with young old adults and subjects from different socioeconomic and cultural groups.

Tachycardia-Related Cardiomyopathy: A Common Cause of Ventricular Dysfunction in Patients With Atrial Fibrillation Referred for Atrioventricular Ablation

OBJECTIVE To determine the frequency of tachycardia-related cardiomyopathy in patients with atrial fibrillation and systolic dysfunction referred for atrioventricular node ablation. PATIENTS AND METHODS This prospective multicenter cohort study was conducted at 16 tertiary care centers. The ejection fraction was measured before and 3 and 12 months after atrioventricular node ablation. Patients with reduced systolic function (ejection fraction < or = 45%) before atrioventricular ablation were included in this study. Patients whose ejection fraction increased by at least 15 percentage points and to higher than 45% were considered to have tachycardia-related cardiomyopathy. RESULTS Of 63 patients with systolic dysfunction, 48 had at least 1 adequate follow-up echocardiographic study. Sixteen (25%) of the 63 had marked improvement in the ejection fraction (mean +/- SD change, 27 +/- 8 percentage points) to a value higher than 45% after ablation. CONCLUSIONS Tachycardia-related cardiomyopathy is common in patients with atrial fibrillation and systolic dysfunction referred for atrioventricular node ablation. This diagnosis should be considered in all patients in whom systolic dysfunction occurs subsequent to or concomitant with onset of atrial fibrillation.

Correlates of self-efficacy expectation and prediction of walking behavior in cardiac surgery elders,

As the number of elderly patients undergoing cardiac surgery (coronary artery bypass and valve replacement) continues to increase, evidence is growing that they can do so with improved health status, functional status, longevity, and life quality. In this article, we used self-efficacy theory to explore one of the most common recovery behaviors—walking various distances. In preoperative data collected in-hospital through data collection at one, two, three, six, and twelve months postoperatively, we explored: (a) the trajectories of self-efficacy expectation (SEE) and self-reported (SR) behavior performance over the first postoperative year; (b) the relationships between SEE and SR behavior; (c) predictors of SEE; and (d) using hierarchical multiple regression, identified predictors of SR behavior at each point of time. The sample (N=199) was primarily male (76%) with a mean age of 75.8 years. SEE and SR behavior increased over time though with different trajectories; at all points in time, females had lower scores. Correlations between SEE and SR behavior were statistically significant (r values ranging from 0.67 to 0.89; p<.01) for both males and females. Predictors of SEE and SR identified were a mix of physiologic and psychologic constructs. The amount of explained variance in SR behavior scores ranged from a low of 23% at one month to a high of 64.7% at six months. The gender differences sustained one year after cardiac surgery are striking; elder females may need targeted interventions to enhance recovery.

Mood disturbance in patients with recurrent ventricular dysrhythmia before insertion of implantable cardioverter defibrillator

OBJECTIVE To examine the relationships among personal factors (demographic variables and trait optimism); situational factors (ejection fraction, functional status, history of sudden cardiac arrest); coping and appraisal processes; and mood disturbance in patients hospitalized for recurrent ventricular dysrhythmia before the insertion of an implantable cardioverter defibrillator (ICD). DESIGN Descriptive and correlational. SETTING Five community and tertiary care hospitals in the southeast and midwest. PATIENTS Eighty-four men and 17 women (aged 24 through 79) scheduled to receive an initial implant of an ICD. VARIABLES AND MEASURES: Trait optimism measured by the Life Orientation Tool; coping measured by the Jalowiec Coping Scale; threat-and-challenge appraisal measured by the Meaning in Illness Questionnaire; functional status measured by the Heart Failure Functional Status Inventory; and total mood disturbance measured by the Profile of Mood States. RESULTS Hierarchical regression analysis revealed that factors of age, sex, optimism, functional status, and history of sudden cardiac arrest accounted for 47% of the variance in the total mood disturbance score (F = 7.44, df = 11.68, p = 0.00) with female sex, and less trait optimism, higher threat appraisal, and more use of evasive coping behavior as significant predictors. CONCLUSIONS These findings can be used to identify patients with recurrent ventricular dysrhythmia who are potentially at risk for mood disturbance in the acute care setting before ICD insertion. Nursing interventions to address these factors can be developed and tested. Longitudinal studies on the response to ICDs should include assessment of preinsertion affective state.

The Use and Effectiveness of Active Learning Methods in Nursing and Health Professions Education: A Literature Review

AIM The aim of the study was to find evidence of the use and effectiveness of active learning methods in nursing and the health professions, as well as major knowledge gaps. BACKGROUND National research priorities include research on best practices for teaching and learning and use of rigorous research designs. METHOD A literature review was conducted to evaluate research (2000–2012) on the effectiveness of active learning methods in nursing and the health professions. RESULTS Of 22 studies reviewed, only one used a randomized design. Most subjects (89.5 percent) were baccalaureate nursing students. Studies typically lacked definition of active learning and few reported reliability and validity estimates for measures. Results were mixed, though 15 reported positive results. CONCLUSION Results suggest insufficient evidence regarding the use and effectiveness of active learning in nursing and the health professions. High quality research is essential to build an evidence base supporting use of these methods.

Designing, delivering and evaluating a distance learning nursing course responsive to students needs

BACKGROUND AND PURPOSE The majority of available studies in distance learning in nursing and health lack the sufficient details of course design and delivery processes which greatly affect the learning outcomes. Also, little is available about the fairness of this method of education to students with limited access to course resources. We describe the design and delivery processes and experience, in terms of satisfaction and achievement, of undergraduate nursing students in a distance course. The difference in achievement between the distance students and a comparable cohort of hybrid students is also examined. We also demonstrate the possibility of providing accessible education to students with limited technological resources. METHODS Participants included all undergraduate nursing students who were enrolled in a distance and a hybrid section of a communication skills course offered at a School of Nursing in Jordan. The distance course was created using Blackboard and Tegrity learning management systems. The design and delivery processes of the distance course incorporated three pedagogical principles that enhance: (a) course access and navigation; (b) communication and interaction; and (c) active and collaborative learning experiences. After course completion, distance students completed a 27-item satisfaction questionnaire. Achievement in the course and correlates of satisfaction were measured. RESULTS The final sample included 25 students in the distance section and 35 in the hybrid section (N=60). The mean score of overall satisfaction in the distance section was 4.14 (0.32) out of a 5-point scale, indicating a high satisfaction. Results revealed significant associations between total satisfaction score and achievement in the distance course, grade expected in the course, and frequency of accessing the course materials (p<.05). All distance students, including students with limited technological resources available at home, managed to successfully complete the course. Major concerns reported by distance students were related to lack of time management skills and negative attitudes toward group assignments. The mean final course grade of the distance section (80±8.2) was significantly higher than the hybrid section (72.2±9.5), (t=3.5, p<.05). CONCLUSIONS The use of effective instructional strategies resulted in delivering successful distance learning, even for students with limited resources. Institutions have to make strategic decisions on how to optimize the use of technology to fit their individualized learning environments. Instructors need to become familiar with the characteristics of students cohort served by the course and design the course accordingly. In addition, students should be guided on how to manage their time in distance learning environments and work effectively in group assignments.

Quality of Life at Baseline: Is Assessment After Randomization Valid?

OBJECTIVES The purpose of this report is to examine whether differences existed between patients who completed a baseline quality of life (QoL) form before being informed about their randomized assignments versus those who completed it after knowing their randomization assignments. METHODS In the pilot phase of the Antiarrhythmics Versus Implantable Defibrillators (AVID) study (n = 200), 113 patients completed a baseline QoL battery prior to randomization (drug versus defibrillator), 49 additional patients completed this battery after randomization, and 38 patients did not complete this battery. Baseline demographic, clinical and QoL data were compared for these groups. RESULTS Although the two groups with QoL data were not significantly different regarding various clinical and demographic characteristics, they did have significantly different QoL profiles. Patients with QoL collected before randomization had better overall QoL scores and mental health scores. CONCLUSIONS These data suggest that patients with worse QoL may be less willing to complete a baseline QoL form in a timely manner or that knowledge of the randomization assignment may have an effect on QoL.

Debriefing Practices in Nursing Education Programs: Results from a National Study

AIM The purpose of the study was to describe debriefing practices in nursing education programs in the United States. BACKGROUND Despite the acknowledged importance of debriefing, little is known about debriefing practices. It is imperative that debriefing practices be examined in order to establish a baseline understanding of current practice. METHOD The study design was a cross‐sectional Internet‐based survey. Surveys were sent to every accredited prelicensure nursing program in the United States. Regression analysis determined variables that were associated with the use of theory‐based debriefing. RESULTS Data analysis determined that most debriefers do not have training in debriefing and that their competence was not assessed. Factors associated with the use of theory‐based debriefing included the presence of a designated simulation administrator, training for debriefers, and competence assessment of debriefers. CONCLUSION These results establish a baseline from which to prioritize faculty development in simulation‐based education.

Psychological Reactions among Family Members of Patients with Implantable Defibrillators

Objective: To describe psychological reactions among family members of patients receiving an implantable cardioverter/defibrillator (ICD) during the first 9 months after implantation. Methods: Eighty-two family members (age 56 ± 12 years, 74 percent female, 79 percent married, 88 percent Caucasian) of ICD patients completed questionnaires regarding their mood (Profile of Mood State), cognitive illness appraisals (Meaning of Illness Questionnaire) and coping strategies (Jalowiec Coping Scale) prior to ICD implantation, and as well as 1 and 9 months postoperatively. Results: Total mood disturbance score (TMD), threat appraisal, and emotion- and problem-focused coping were highest prior to ICD implantation, and decreased during the first postoperative month showing stable values thereafter. There was no change in challenge appraisal. Multiple regression analysis found that the use of psychotropic drugs (anxiolytics, sedatives; Beta = .25), emotion-focused coping (Beta = .37), and challenge appraisal (Beta = .21) at 1 month accounted for 26 percent of variance in TMD at 9 months. Conclusion: A spouses ICD implantation is a major stressful event for family members leading to a diminished mood state prior ICD implantation. Reduction in emotion-focused coping and the use of challenge appraisal may improve mood state in family members of ICD patients during early follow-up.

Communication education for pre-licensure nursing students: Literature review 2002–2013

OBJECTIVES Effective communication skills are fundamental to good nursing care and required by certification bodies for nursing education. The purpose of this literature review was to update one done in 2002 of communication education to pre-licensure registered nursing students. That review concluded that it was unclear which interventions were most effective due to methodological and other quality issues. The goal of this review was to identify recent educational methods, frameworks, and evaluation tools and to assess the quality of this recent evidence. DESIGN Literature review. DATA SOURCES PubMed, CINAHL, and PsychINFO. REVIEW METHODS Inclusion criteria were articles in English, 2002 to 2013, full text available, addressing nurse:patient communication, and educational interventions. Exclusion criteria were inter-professional interventions as they are not yet as widely available. Studies were evaluated using the Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scale. This scale categorizes the levels of evidence and methodological quality. RESULTS The search yielded 457 titles, 115 abstracts, and 38 articles. Twenty studies met inclusion and exclusion search criteria. They included a range of research designs, samples, and outcomes. In line with recent communication educational trends, the interventions all involved active learning. Using the JHNEBP scale, the quality of the 20 studies was low due to both research design and methodological issues. CONCLUSION Despite the importance of communication in nursing education, the quality of evidence to support specific communication interventions continues to be low. Recommendations for future communication education research are to (1) explore the highest quality designs available and use randomization where possible; (2) more consistently use theoretical frameworks and their accompanying outcome measures; and (3) that tools be tested for evidence of reliability and validity.