Effects of two intervention strategies on the behavior of nurses and nurse students related to advance directives

Advance directives are one mechanism for preserving the rights of individuals to exercise some control over their health care when serious illness may prevent them from direct participation. Nurses, as the health care providers with the closest and most sustained contact with critically ill and dying patients, are positioned to assist patients to plan for future health care needs. Although a majority of nurses favor the concept of advance directives for their patients and for themselves, they have not played a significant role in facilitating advance health care planning with their patients nor implemented advance health care planning for themselves.^ Research has also shown that differing forms of education and counseling increase the completion rates for advance directives in selected populations, mostly the elderly and seriously ill. Not yet developed are effective educational strategies to assist nurses and nurse students to make optimal contributions in assisting their clients' plans for future health care decision-making. This study sought to determine whether specific learning strategies (a) increased the involvement of nurses and nurse students in facilitating advance care planning with patients and (b) increased the percentage of the nurses' and nurse students' own personal advance care planning activities.^ The study compared two learning interventions and two populations, nurses and nurse students. The participants were randomly assigned to one of the two learning interventions, L1 or L2. Participants in L1 received a lecture, discussion and exploration of the forces impacting on advance directive behavior. Participants in L2 received the same intervention components with the additional component of group practice completing advance directives.^ Analysis of the data by chi-square and logistic regression did not support the hypotheses that the practice component would make a difference in the participants' facilitation of advance care planning with patients or in their own personal advance care planning activities. There were significant differences in post-intervention behavior between the nurse and nurse student groups. The nurses in the study did significantly more facilitation of advance care planning with patients and completed significantly more advance care documents than the nurse students post-intervention. However, the nurse students held more post-intervention family discussions than did the nurses. ^

Beliefs and attitudes of nurses regarding visitation in the pediatric intensive care unit

The purpose of this study was to investigate the beliefs and attitudes of nurses regarding the effects of visitation in pediatric intensive care units (PICU).^ Questionnaires were used to gather data from nurses (n = 48) in four study sites. Data were analyzed according to the Theory of Reasoned Action.^ A predominant theme among the beliefs was that visitation should be individualized. It was found that PICU nurses have more positive attitudes regarding traditional visitation as opposed to open visitation (p $<$.01). Significant relationships were found between nurses' years of education and attitudes toward traditional (p $<$.01) and open (p $<$.05) visitation.^ In light of the literature suggesting the positive effects of open visitation, it appears that PICU nurses' attitudes may present a barrier when implementing open policies. Since years of education shows a positive correlation with nurses' attitudes, educational intervention may be helpful in overcoming this obstacle. ^

The development of an optimized system of narcotic and explosive contraband mimics for calibration and training of biological detectors

Current commercially available mimics contain varying amounts of either the actual explosive/drug or the chemical compound of suspected interest by biological detectors. As a result, there is significant interest in determining the dominant chemical odor signatures of the mimics, often referred to as pseudos, particularly when compared to the genuine contraband material. This dissertation discusses results obtained from the analysis of drug and explosive headspace related to the odor profiles as recognized by trained detection canines. Analysis was performed through the use of headspace solid phase microextraction in conjunction with gas chromatography mass spectrometry (HS-SPME-GC-MS). Upon determination of specific odors, field trials were held using a combination of the target odors with COMPS. Piperonal was shown to be a dominant odor compound in the headspace of some ecstasy samples and a recognizable odor mimic by trained detection canines. It was also shown that detection canines could be imprinted on piperonal COMPS and correctly identify ecstasy samples at a threshold level of approximately 100ng/s. Isosafrole and/or MDP-2-POH show potential as training aid mimics for non-piperonal based MDMA. Acetic acid was shown to be dominant in the headspace of heroin samples and verified as a dominant odor in commercial vinegar samples; however, no common, secondary compound was detected in the headspace of either. Because of the similarities detected within respective explosive classes, several compounds were chosen for explosive mimics. A single based smokeless powder with a detectable level of 2,4-dinitrotoluene, a double based smokeless powder with a detectable level of nitroglycerine, 2-ethyl-1-hexanol, DMNB, ethyl centralite and diphenylamine were shown to be accurate mimics for TNT-based explosives, NG-based explosives, plastic explosives, tagged explosives, and smokeless powders, respectively. The combination of these six odors represents a comprehensive explosive odor kit with positive results for imprint on detection canines. As a proof of concept, the chemical compound PFTBA showed promise as a possible universal, non-target odor compound for comparison and calibration of detection canines and instrumentation. In a comparison study of shape versus vibration odor theory, the detection of d-methyl benzoate and methyl benzoate was explored using canine detectors. While results did not overwhelmingly substantiate either theory, shape odor theory provides a better explanation of the canine and human subject responses.

The Development of an Optimized System of Narcotic and Explosive Contraband Mimics for Calibration and Training of Biological Detectors

Current commercially available mimics contain varying amounts of either the actual explosive/drug or the chemical compound of suspected interest by biological detectors. As a result, there is significant interest in determining the dominant chemical odor signatures of the mimics, often referred to as pseudos, particularly when compared to the genuine contraband material. This dissertation discusses results obtained from the analysis of drug and explosive headspace related to the odor profiles as recognized by trained detection canines. Analysis was performed through the use of headspace solid phase microextraction in conjunction with gas chromatography mass spectrometry (HS-SPME-GC-MS). Upon determination of specific odors, field trials were held using a combination of the target odors with COMPS. Piperonal was shown to be a dominant odor compound in the headspace of some ecstasy samples and a recognizable odor mimic by trained detection canines. It was also shown that detection canines could be imprinted on piperonal COMPS and correctly identify ecstasy samples at a threshold level of approximately 100ng/s. Isosafrole and/or MDP-2-POH show potential as training aid mimics for non-piperonal based MDMA. Acetic acid was shown to be dominant in the headspace of heroin samples and verified as a dominant odor in commercial vinegar samples; however, no common, secondary compound was detected in the headspace of either. Because of the similarities detected within respective explosive classes, several compounds were chosen for explosive mimics. A single based smokeless powder with a detectable level of 2,4-dinitrotoluene, a double based smokeless powder with a detectable level of nitroglycerine, 2-ethyl-1-hexanol, DMNB, ethyl centralite and diphenylamine were shown to be accurate mimics for TNT-based explosives, NG-based explosives, plastic explosives, tagged explosives, and smokeless powders, respectively. The combination of these six odors represents a comprehensive explosive odor kit with positive results for imprint on detection canines. As a proof of concept, the chemical compound PFTBA showed promise as a possible universal, non-target odor compound for comparison and calibration of detection canines and instrumentation. In a comparison study of shape versus vibration odor theory, the detection of d-methyl benzoate and methyl benzoate was explored using canine detectors. While results did not overwhelmingly substantiate either theory, shape odor theory provides a better explanation of the canine and human subject responses.

The impact of selected factors in nurses' attitudes toward bedside computers

The purpose of this study was to determine the impact of selected factors on nurses' attitudes toward bedside computers. Bedside computer systems, also referred to as point-of-care systems, are clinical information systems that allow documentation of patient care and retrieval of data at the patient's bedside, or in close proximity to where care is delivered. The adoption of bedside computer systems appears to be increasing among U.S. institutions. As healthcare institutions undertake automation projects, they face many challenges associated with implementing large-scale change. ^ The study explored four factors and their relationship to nurses' attitudes toward bedside computers. A pre-bedside implementation survey of 184 staff nurses did not demonstrate a relationship between previous computer experience and nurses' attitudes toward bedside computers (p > .05). The data did not indicate a relationship between nurses' formal education and their attitude toward bedside computers (p > .05). The data did support a relationship between nurses' previous computer experience and their comfort in the use of bedside computers (p < .0005). Using a quasi-experimental control group design, attitudes of nurses were studied over an 18 month period. The Pre versus Post Survey data indicated that nurses who used bedside computers, the experimental group, had more positive attitudes than the nurses who did not use bedside computers, the control group (p < .0005). ^ The findings are significant to institutions implementing bedside computers, to the human resource development staff overseeing bedside computer training, and to the practice of clinical nursing. ^

Nurses' spiritual well-being: Its influence on attitudes and level of practice in providing spiritual care

The purpose of this study was to examine the relationship between the spiritual well-being of nurses and its influence on their attitudes toward providing spiritual care to patients. Two research instruments and a demographic data form were used for the survey. Using a descriptive design, tbe Spiritual Well-Being Scale, the Health Professional's Spiritual Role Scale, and the demographic data form were administered to 100 registered nurses from a large South Florida teaching hospital. The findings indicated a significantly positive correlation between the overall Spiritual Well-Being Scale and the Health Professional's Spiritual Role Scale (r = 0.52; p =.005). Significant differences were found between correlation of nurses' levels of spiritual well-being and all sociodemographic factors except for the three Age Groups and for religious affiliations. Findings have implications for how nurses should be trained in meeting patients total needs. ^

Education and training in the use of physical agent modalities by occupational therapists practicing in the physical disabilities area

This study was conducted to examine how occupational therapists (OTs) practicing in the physical disabilities area received their training in the use of physical agent modalities (PAMs); to determine the frequency of PAMs usage by those therapists; and to obtain their opinions regarding the training of OTs and OT students in the administration of PAMs. Three hundred OTs practicing in physical diabilities (n = 194 returned) were surveyed. The most frequently used modalities were hot and cold packs, paraffin, and ultrasound. The least frequently used modalities were transcutaneous electrical stimulation (TENS) and whirlpool. On-the-job training was the most common educational method received by the respondents for PAMs usage. The respondents considered a combination of undergraduate education, fieldwork, continuing education and on-the-job training as the most appropriate educational setting for training in modalities. While few of the respondents received preparation in PAMs during entry-level academic programs, the majority felt that OT students should be trained in PAMs usage as part of their education curriculum. ^

Secondary school inclusion rates: The relationship between the training and beliefs of school site principals and the implementation of inclusion

Programs require strong support and guidance from those in leadership positions to ensure proper implementation (Fullen, 2001). Consequently, school site principals must rely on the training they have received to support them in making appropriate decisions. It is the school site principal’s leadership that is pivotal in the success of students with disabilities (DiPaola & Walther-Thomas, 2003; Monteith, 2000). In fact, the principal has a moral obligation to provide an environment that supports social justice in schools (Grogan & Andrews, 2002). The inclusion of students with disabilities does just that—it ensures that these students are not segregated to a “separate but equal” education. This study utilized a participant survey to collect data on principals’ beliefs and training in special education. This information was compared to the percentage of time students with disabilities spent with their non-disabled peers in the principals’ respective schools. An analysis was conducted to identify if a linear relationship exists between the selected variables and the inclusion percentages. Open-ended questions were included in the original survey which allowed for a thematic analysis of the responses. These responses were utilized to allow participants to further express their thoughts on the identified variables. Results indicated that there were no statistically significant relationships identified between the beliefs and training of secondary school site principals and the percentage of time that their students in special education spend with their non-disabled peers. Although the original research questions were not supported, further post hoc analysis indicated that the results obtained did support that the principals believed inclusion had a social benefit to students. Additional investigation into the academic benefits of inclusion is still needed. In addition, principals who indicated that they had some type of training in special education indicated a higher percentage that the individual student should be the focal point when making placement decisions. These results support the need for further research in the area of principal preparation programs and their relationships to the daily practice of school site principals.

A comparison of the impact of trained media specialists and untrained media personnel in junior colleges in the Republic of China

From educational, communications, psychological, and technical points of view, the renovation of pedagogy in media education is based upon the promotion of "educational technology." The promotion of educational technology relies upon the appropriate availability and knowledge of different educational media made available by the trained media personnel.^ In the past three decades most of the junior colleges in Taiwan set up educational media centers to help students learn through the use of media which enables them to obtain optimum benefits in a short time. What are the roles the media personnel play in the media center? What responsibilities have they to bear in the center? What differences are there when a trained and untrained media personnel are presented in junior colleges media center in Taiwan? What do the trained and untrained media personnel feel toward the importance of each media service in the area of media center's administration, media production, specialized media duties, and the training of staff in media use? These are the questions addressed in this study.^ Through the study of the related literature and a survey conducted in the junior colleges in Taiwan, recommendations are offered to provide improvement of the services and training of media specialists in Taiwan that are appropriate for a changing work and environment. These recommendations are for media specialists to be formally trained to effectively serve the changing needs of school library media so as to make optimal use of media in the junior colleges. ^

Profile of planning: A study of a three-year project on the implementation of collaborative library media programs

The implementation of collaborative planning and teaching models in ten flexibly scheduled elementary and middle school library media centers was studied to determine which factors facilitated the collaborative planning process and to learn what occurs when library media specialists (LMSs) and classroom teachers (CTs) plan together. In this qualitative study, 61 principals, CTs, and LMSs were interviewed on a range of topics including the principal's role, school climate, the value of team planning, the importance of information literacy instruction, and the ideal learning environment. Other data sources were observations, videotapes of planning sessions, and documents. This three-year school reform effort was funded by the Library Power Project to improve library programs, to encourage collaborative planning, and to increase curricular integration of information literacy skills instruction. ^ The findings included a description of typical planning sessions and the identification of several major factors which impacted the success of collaborative planning: the individuals involved, school climate, time for planning, the organization of the school, the facility and collection, and training. Of these factors, the characteristics and actions of the people involved were most critical to the implementation of the innovation. The LMS was the pivotal player and, in the views of CTs, principals, and LMSs themselves, must be knowledgeable about curriculum, the library collection, and instructional design and delivery; must be open and welcoming to CTs and use good interpersonal skills; and must be committed to information literacy instruction and willing to act as a change agent. The support of the principal was vital; in schools with successful programs, the principal served as an advocate for collaborative planning and information literacy instruction, provided financial support for the library program including clerical staff, and arranged for LMSs and CTs to have time during the school day to plan together. ^ CTs involved in positive planning partnerships with LMSs were flexible, were open to change, used a variety of instructional materials, expected students to be actively involved in their own learning, and were willing to team teach with LMSs. Most CTs planning with LMSs made lesson plans in advance and preferred to plan with others. Also, most CTs in this study planned with grade level or departmental groups, which expedited the delivery of information literacy instruction and the effective use of planning time. ^ Implications of the findings of this research project were discussed for individual schools, for school districts, and for colleges and universities training LMSs, CTs, and administrators. Suggestions for additional research were also included. ^

Analysis and comparison of the moral development of students required to graduate with an ethics course

Accounting students become practitioners facing ethical decision-making challenges that can be subject to various interpretations; hence, the profession is concerned with the appropriateness of their decisions. Moral development of these students has implications for a profession under legal challenges, negative publicity, and government scrutiny. Accounting students' moral development has been studied by examining their responses to moral questions in Rest's Defining Issues Test (DIT), their professional attitudes on Hall's Professionalism Scale Dimensions, and their ethical orientation-based professional commitment and ethical sensitivity. This study extended research in accounting ethics and moral development by examining students in a college where an ethics course is a requirement for graduation. ^ Knowledge of differences in the moral development of accounting students may alert practitioners and educators to potential problems resulting from a lack of ethical understanding as measured by moral development levels. If student moral development levels differ by major, and accounting majors have lower levels than other students, the conclusion may be that this difference is a causative factor for the alleged acts of malfeasance in the profession that may result in malpractice suits. ^ The current study compared 205 accounting, business, and nonbusiness students from a private university. In addition to academic major and completion of an ethics course, the other independent variable was academic level. Gender and age were tested as control variables and Rest's DIT score was the dependent variable. The primary analysis was a 2 x 3 x 3 ANOVA with post hoc tests for results with significant p-value of less than 0.05. ^ The results of this study reveal that students who take an ethics course appear to have a higher level of moral development (p = 0.013), as measured by the (DIT), than students at the same academic level who have not taken an ethics course. In addition, a statistically significant difference (p = 0.034) exists between freshmen who took an ethics class and juniors who did not take an ethics class. For every analysis except one, the lower class year with an ethics class had a higher level of moral development than the higher class year without an ethics class. These results appear to show that ethics education in particular has a greater effect on the level of moral development than education in general. Findings based on the gender specific analyses appear to show that males and females respond differently to the effects of taking an ethics class. The male students do not appear to increase their moral development level after taking an ethics course (p = 0.693) but male levels of moral development differ significantly (p = 0.003) by major. Female levels of moral development appear to increase after taking an ethics course (p = 0.002). However, they do not differ according to major (p = 0.097). ^ These findings indicate that accounting students should be required to have a class in ethics as part of their college curriculum. Students with an ethics class have a significantly higher level of moral development. The challenges facing the profession at the current time indicate that public confidence in the reports of client corporations has eroded and one way to restore this confidence could be to require ethics training of future accountants. ^

Reference Points: Hotel Management Training In The United States and Europe

Different cultures and historical precedents produce a broad range of influences on the training of hotel managers in Europe and the United States. The author isolates a certain number of facts the nature of which clarify an understanding of two attitudes which complement each other to the benefit of their common objective - efficient professional training.

Employee perceptions of workplace empowerment in relation to self -reported intent to stay on the job

As the nursing profession faces a shortage of nurses, workplace initiatives focused on retaining employees are critical to the United States healthcare industry (Sochalski, 2002). The purpose of this research was to determine whether self-reported intent to stay on the job was related to perceptions of workplace empowerment using Kanter's (1977) theory of organizational empowerment as a framework. ^ The sample consisted of 206 Florida registered nurses. Four self-report scales and a demographic questionnaire were administered by mail. The Conditions for Work Effectiveness Questionnaire (CWEQ; Chandler, 1987), Job Activity Scale (JAS; Laschinger, Kutzscher, & Sabiston, 1993), Organizational Relationships Scale (ORS; Laschinger, Sabiston, & Kutzscher, 1993) and an intent to stay instrument (Kim, Price, Mueller & Watson, 1996) were used to measure perceived access to empowerment structures, perceived formal power, perceived informal power, and intent to stay, respectively. The data were analyzed using descriptive statistics, correlational analysis, and hierarchical regression. ^ Twenty-eight percent of the variance of intent to stay was explained by perceived access to empowerment structures, perceived formal power, and perceived informal power when holding age, gender, education, overall nursing experience, and number of years on current job constant. Perceived access to empowerment structures (CWEQ total score) was the best predictor of self-reported intent to stay for this sample. Of the four components of perceived access to work empowerment structures, perceived access to opportunity and resources were the best predictors of nurses' intent to stay on the job. ^ This study was the first step in establishing the relationship between Kanter's full model and intent to remain on the job, which is a stepping stone for the development of effective retention strategies based on a workplace empowerment model. This knowledge is particularly important in today's healthcare industry where healthcare administrators and human resource development practitioners are ideally positioned to implement organizational strategies to enhance access to work empowerment structures and potentially reduce turnover and mitigate the effects of nursing shortage. ^

The relationship of instructor technical literacy to the academic performance of students in career academies

Career Academy instructors' technical literacy is vital to the academic success of students. This nonexperimental ex post facto study examined the relationships between the level of technical literacy of instructors in career academies and student academic performance. It was also undertaken to explore the relationship between the pedagogical training of instructors and the academic performance of students. ^ Out of a heterogeneous population of 564 teachers in six targeted schools, 136 teachers (26.0 %) responded to an online survey. The survey was designed to gather demographic and teaching experience data. Each demographic item was linked by researchers to teachers' technology use in the classroom. Student achievement was measured by student learning gains as assessed by the reading section of the FCAT from the previous to the present school year. ^ Linear and hierarchical regressions were conducted to examine the research questions. To clarify the possibility of teacher gender and teacher race/ethnic group differences by research variable, a series of one-way ANOVAs were conducted. As revealed by the ANOVA results, there were not statistically significant group differences in any of the research variables by teacher gender or teacher race/ethnicity. Greater student learning gains were associated with greater teacher technical expertise integrating computers and technology into the classroom, even after controlling for teacher attitude towards computers. Neither teacher attitude toward technology integration nor years of experience in integrating computers into the curriculum significantly predicted student learning gains in the regression models. ^ Implications for HRD theory, research, and practice suggest that identifying teacher levels of technical literacy may help improve student academic performance by facilitating professional development strategies and new parameters for defining highly qualified instructors with 21st century skills. District professional development programs can benefit by increasing their offerings to include more computer and information communication technology courses. Teacher preparation programs can benefit by including technical literacy as part of their curriculum. State certification requirements could be expanded to include formal surveys to assess teacher use of technology.^

Analysis and comparison of the moral development of students required to graduate with an ethics course

Accounting students become practitioners facing ethical decision-making challenges that can be subject to various interpretations; hence, the profession is concerned with the appropriateness of their decisions. Moral development of these students has implications for a profession under legal challenges, negative publicity, and government scrutiny. Accounting students moral development has been studied by examining their responses to moral questions in Rest's Defining Issues Test (DIT), their professional attitudes on Hall's Professionalism Scale Dimensions, and their ethical orientation-based professional commitment and ethical sensitivity. This study extended research in accounting ethics and moral development by examining students in a college where an ethics course is a requirement for graduation. Knowledge of differences in the moral development of accounting students may alert practitioners and educators to potential problems resulting from a lack of ethical understanding as measured by moral development levels. If student moral development levels differ by major, and accounting majors have lower levels than other students, the conclusion may be that this difference is a causative factor for the alleged acts of malfeasance in the profession that may result in malpractice suits. The current study compared 205 accounting, business, and nonbusiness students from a private university. In addition to academic major and completion of an ethics course, the other independent variable was academic level. Gender and age were tested as control variables and Rest's DIT score was the dependent variable. The primary analysis was a 2x3x3 ANOVA with post hoc tests for results with significant p-value of less than 0.05. The results of this study reveal that students who take an ethics course appear to have a higher level of moral development (p=0.013), as measured by the (DIT), than students at the same academic level who have not taken an ethics course. In addition, a statistically significant difference (p=0.034) exists between freshmen who took an ethics class and juniors who did not take an ethics class. For every analysis except one, the lower class year with an ethics class had a higher level of moral development than the higher class year without an ethics class. These results appear to show that ethics education in particular has a greater effect on the level of moral development than education in general. Findings based on the gender specific analyses appear to show that males and females respond differently to the effects of taking an ethics class. The male students do not appear to increase their moral development level after taking an ethics course (p=0.693) but male levels of moral development differ significantly (p=0.003) by major. Female levels of moral development appear to increase after taking an ethics course (p=0.002). However, they do not differ according to major (p=0.0 97). These findings indicate that accounting students should be required to have a class in ethics as part of their college curriculum. Students with an ethics class have a significantly higher level of moral development. The challenges facing the profession at the current time indicate that public confidence in the reports of client corporations has eroded and one way to restore this confidence could be to require ethics training of future accountants.