The Impact of a Simulated Clinical Experience on CEGEP Nursing Students’ Perceptions of Self-Efficacy and Achievement

Abstract : Providing high-quality clinical experiences to prepare students for the complexities of the current health-care system has become a challenge for nurse educators. Additionally, there are concerns that the current model of clinical practice is suboptimal. Consequently, nursing programs have explored the partial replacement of traditional in-hospital clinical experiences with a simulated clinical experience. Despite research demonstrating numerous benefits to students following participation in simulation activities, insufficient research conducted within Québec exists to convince the governing bodies (Ordre des infirmières et des infirmiers du Québec, OIIQ; Ministère de L’Éducation supérieur, de la Recherche, de la Science et de la Technologie) to fully embrace simulation as part of nurse training. The purpose of this study was to examine the use of a simulated clinical experience (SCE) as a viable, partial pedagogical substitute for traditional clinical experience by examining the effects of a SCE on CEGEP nursing students’ perceptions of self-efficacy (confidence), and their ability to achieve course objectives. The findings will contribute new information to the current body of research in simulation. The specific case of obstetrical practice was examined. Based on two sections of the Nursing III-Health and Illness (180-30K-AB) course, the sample was comprised of 65 students (thirty-one students from section 0001 and thirty-four students from section 0002) whose mean age was 24.8 years. With two sections of the course available, the opportunity for comparison was possible. A triangulation mixed method design was used. An adapted version of Ravert’s (2004) Nursing Skills for Evaluation tool was utilized to collect data regarding students’ perceptions of confidence related to the nursing skills required for care of mothers and their newborns. Students’ performance and achievement of course objectives was measured through an Objective Structured Clinical Examination (OSCE) consisting of three marked stations designed to test the theoretical and clinical aspects of course content. The OSCE was administered at the end of the semester following completion of the traditional clinical experience. Students’ qualitative comments on the post -test survey, along with journal entries served to support the quantitative scale evaluation. Two of the twelve days (15 hours) allocated for obstetrical clinical experience were replaced by a SCE (17%) over the course of the semester. Students participated in various simulation activities developed to address a range of cognitive, psychomotor and critical thinking skills. Scenarios incorporating the use of human patient simulators, and designed using the Jeffries Framework (2005), exposed students to the care of families and infants during the perinatal period to both reflect and build upon class and course content in achievement of course objectives and program competencies. Active participation in all simulation activities exposed students to Bandura’s four main sources of experience (mastery experiences, vicarious experiences, social persuasion, and physiologic/emotional responses) to enhance the development of students’ self-efficacy. Results of the pre-test and post-test summative scores revealed a statistically significant increase in student confidence in performing skills related to maternal and newborn care (p < .0001) following participation in the SCE. Confidence pre-test and post-test scores were not affected by the students’ section. Skills related to the care of the post-partum mother following vaginal or Caesarean section delivery showed the greatest change in confidence ratings. OSCE results showed a mean total class score (both sections) of 57.4 (70.0 %) with normal distribution. Mean scores were 56.5 (68.9%) for section 0001 and 58.3 (71.1%) for section 0002. Total scores were similar between sections (p =0.342) based on pairwise comparison. Analysis of OSCE scores as compared to students’ final course grade revealed similar distributions. Finally, qualitative analysis identified how students’ perceived the SCE. Students cited gains in knowledge, development of psychomotor skills and improved clinical judgement following participation in simulation activities. These were attributed to the « hands on » practice obtained from working in small groups, a safe and authentic learning environment and one in which students could make mistakes and correct errors as having the greatest impact on learning through simulation.

Reading Performance in Children with Visual Function Anomalies

Aims: To compare reading performance in children with and without visual function anomalies and identify the influence of abnormal visual function and other variables in reading ability. Methods: A cross-sectional study was carried in 110 children of school age (6-11 years) with Abnormal Visual Function (AVF) and 562 children with Normal Visual Function (NVF). An orthoptic assessment (visual acuity, ocular alignment, near point of convergence and accommodation, stereopsis and vergences) and autorefraction was carried out. Oral reading was analyzed (list of 34 words). Number of errors, accuracy (percentage of success) and reading speed (words per minute - wpm) were used as reading indicators. Sociodemographic information from parents (n=670) and teachers (n=34) was obtained. Results: Children with AVF had a higher number of errors (AVF=3.00 errors; NVF=1.00 errors; p<0.001), a lower accuracy (AVF=91.18%; NVF=97.06%; p<0.001) and reading speed (AVF=24.71 wpm; NVF=27.39 wpm; p=0.007). Reading speed in the 3rd school grade was not statistically different between the two groups (AVF=31.41 wpm; NVF=32.54 wpm; p=0.113). Children with uncorrected hyperopia (p=0.003) and astigmatism (p=0.019) had worst reading performance. Children in 2nd, 3rd, or 4th grades presented a lower risk of having reading impairment when compared with the 1st grade. Conclusion: Children with AVF had reading impairment in the first school grade. It seems that reading abilities have a wide variation and this disparity lessens in older children. The slow reading characteristics of the children with AVF are similar to dyslexic children, which suggest the need for an eye evaluation before classifying the children as dyslexic.

Le cognitive enhancement en milieu universitaire : entre souffrance psychique individuelle, culture de performance et insécurités sociales

Ce projet de mémoire s’intéresse à la mise en relation du cognitive enhancement observé dans les universités occidentales contemporaines et de la société dans laquelle il s’insère. Nous avons voulu détacher la perspective du phénomène des analyses principalement orientées vers les programmes de sciences de la santé et de droit, ainsi que de l’approche quantitative, clinique, athéorique et somme toute moralisatrice qui lui est usuellement accordée afin d’explorer la nature des pratiques d’usages de psychotropes des étudiants universitaires en sciences humaines et sociales en vue d’augmenter leurs performances cognitives, d’approfondir la compréhension des raisonnements sous-jacents à ces pratiques, puis de resituer ces derniers dans leur contexte élargi. Nous avons interrogé treize étudiants de divers programmes de sciences humaines et sociales consommant, ou ayant déjà consommé, des psychotropes en vue de rehausser leurs performances cognitives en contexte académique. Les résultats suggèrent un écart dans la nature de leurs pratiques d’usage par rapport aux domaines d’études habituellement préconisés en ce sens qu’une grande variété de substances sont considérées comme supports cognitifs ; ensuite, que le recours aux psychotropes dans une visée de performance cognitive s’éloigne des logiques de la nécessité médicale et de la toxicomanie. En premier lieu, le cognitive enhancement est associé par plusieurs à une souffrance psychique liée à une perte de repères existentiels et les étudiants y ont recours dans une optique de compréhension de soi et de quête de repères dans un monde qu’ils ressentent comme instable. En second lieu, la consommation de psychotropes s’apparente davantage à un désir de satisfaire aux conditions incertaines et menaçantes des demandes externes de performance telles qu’ils les appréhendent qu’à un souci de soigner quelque condition médicale de la cognition. Nous pensons que le rapport au psychotrope qu’entretiennent les étudiants universitaires en sciences humaines et sociales s’insère en toute cohérence dans les discours et injonctions contemporaines de performance, en ce sens que leur souffrance psychique individuelle expose les limites de ce que la société attend d’eux.

Implementation of an enhanced planar processing protocol in clinical practice

Introdução: A cintigrafia óssea é um dos exames mais frequentes em Medicina Nuclear. Esta modalidade de imagem médica requere um balanço apropriado entre a qualidade de imagem e a dose de radiação, ou seja, as imagens obtidas devem conter o número mínimo de contagem necessárias, para que apresentem qualidade considerada suficiente para fins diagnósticos. Objetivo: Este estudo tem como principal objetivo, a aplicação do software Enhanced Planar Processing (EPP), nos exames de cintigrafia óssea em doentes com carcinoma da mama e próstata que apresentam metástases ósseas. Desta forma, pretende-se avaliar a performance do algoritmo EPP na prática clínica em termos de qualidade e confiança diagnóstica quando o tempo de aquisição é reduzido em 50%. Material e Métodos: Esta investigação teve lugar no departamento de Radiologia e Medicina Nuclear do Radboud University Nijmegen Medical Centre. Cinquenta e um doentes com suspeita de metástases ósseas foram administrados com 500MBq de metilenodifosfonato marcado com tecnécio-99m. Cada doente foi submetido a duas aquisições de imagem, sendo que na primeira foi seguido o protocolo standard do departamento (scan speed=8 cm/min) e na segunda, o tempo de aquisição foi reduzido para metade (scan speed=16 cm/min). As imagens adquiridas com o segundo protocolo foram processadas com o algoritmo EPP. Todas as imagens foram submetidas a uma avaliação objetiva e subjetiva. Relativamente à análise subjetiva, três médicos especialistas em Medicina Nuclear avaliaram as imagens em termos da detetabilidade das lesões, qualidade de imagem, aceitabilidade diagnóstica, localização das lesões e confiança diagnóstica. No que respeita à avaliação objetiva, foram selecionadas duas regiões de interesse, uma localizada no terço médio do fémur e outra localizada nos tecidos moles adjacentes, de modo a obter os valores de relação sinal-ruído, relação contraste-ruído e coeficiente de variação. Resultados: Os resultados obtidos evidenciam que as imagens processadas com o software EPP oferecem aos médicos suficiente informação diagnóstica na deteção de metástases, uma vez que não foram encontradas diferenças estatisticamente significativas (p>0.05). Para além disso, a concordância entre os observadores, comparando essas imagens e as imagens adquiridas com o protocolo standard foi de 95% (k=0.88). Por outro lado, no que respeita à qualidade de imagem, foram encontradas diferenças estatisticamente significativas quando se compararam as modalidades de imagem entre si (p≤0.05). Relativamente à aceitabilidade diagnóstica, não foram encontradas diferenças estatisticamente significativas entre as imagens adquiridas com o protocolo standard e as imagens processadas com o EPP software (p>0.05), verificando-se uma concordância entre os observadores de 70.6%. Todavia, foram encontradas diferenças estatisticamente significativas entre as imagens adquiridas com o protocolo standard e as imagens adquiridas com o segundo protocolo e não processadas com o software EPP (p≤0.05). Para além disso, não foram encontradas diferenças estatisticamente significativas (p>0.05) em termos de relação sinal-ruído, relação contraste-ruído e coeficiente de variação entre as imagens adquiridas com o protocolo standard e as imagens processadas com o EPP. Conclusão: Com os resultados obtidos através deste estudo, é possível concluir que o algoritmo EPP, desenvolvido pela Siemens, oferece a possibilidade de reduzir o tempo de aquisição em 50%, mantendo ao mesmo tempo uma qualidade de imagem considerada suficiente para fins de diagnóstico. A utilização desta tecnologia, para além de aumentar a satisfação por parte dos doentes, é bastante vantajosa no que respeita ao workflow do departamento.

Objective Structured Clinical Examinations (OSCE) improved communication skills of student of Pharmacology in Medicine and Podiatry degree.

Objective Structured Clinical Examinations (OSCE) improved communication skills of student of Pharmacology in Medicine and Podiatry degree. Bellido I, Blanco E, Gomez-Luque A. D. Pharmacology and Clinical Therapeutic. Medicine School. University of Malaga. IBIMA. Malaga, Spain. Objective Structured Clinical Examinations (OSCEs) are versatile multipurpose evaluative tools that can be utilized to assess health care professionals in a clinical setting including communication skills and ability to handle unpredictable patient behavior, which usually are not included in the traditional clinical exam. To designee and perform OSCEs by student is a novelty that really like to the students and may improve their arguing and planning capacities and their communication skills. Aim: To evaluate the impact of designing, developing and presenting Objective Structured Clinical Examinations (OSCE) by student in the communication skills development and in the learning of medicines in Medicine and Podiatry undergraduate students. Methods: A one-year study in which students were invited to voluntarily form groups (4 students maximum). Each group has to design and perform an OSCE (10 min maximum) showing a clinical situation/problem in which medicines’ use was needed. A clinical history, camera, a mobile-phone's video editor, photos, actors, dolls, simulators or whatever they may use was allowed. The job of each group was supervised and helped by a teacher. The students were invited to present their work to the rest of the class. After each OSCE performance the students were encouraged to ask questions if they wanted to do it. After all the OSCEs performances the students voluntarily answered a satisfaction survey. Results: Students of Pharmacology of Medicine degree and Podiatry degree, N=80, 53.75% female, 21±2.3 years old were enrolled. 26 OSCEs showing a clinical situation or clinical problem were made. The average time spent by students in making the OSCE was 21.5±9 h. The percentage of students which were satisfied with this way of presentation of the OSCE was 89.7%. Conclusion: Objective Structured Clinical Examinations (OSCE) designed and performed by student of Pharmacology of the Medicine and Podiatry Degree improved their communication skills.

Hematology and productive performance of nile tilapia (Oreochromis niloticus) naturally infected with Flavobacterium columnare

Columnaris disease is one of the main causes of mortality in tilapia rearing and is responsible for large economic losses worldwide. Hematology is a tool that makes it possible to study organisms' physiological responses to pathogens. It may assist in making diagnoses and prognoses on diseases in fish populations. The hematological variables of nile tilapia were studied in specimens with a clinical diagnosis of columnaris disease and in specimens that were disease-free. The total erythrocyte count, hemoglobin rate, hematocrit percentage, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), organic defense blood cell percentages (leukocytes and thrombocytes) and hepatosomatic and splenosomatic index were determined. The results showed that there were changes in the erythrocytic series and in organic defense blood cells, in the fish infected with the bacterium, with reductions in erythrocytic variables and significant increases in the numbers of circulating lymphocytes and neutrophils.

Clinical efficacy of paclitaxel in the treatment of mid-stage and advanced malignant gastric cancer, and effect of nursing interventions

Purpose: To investigate the clinical efficacy of paclitaxel combined with additional chemotherapy for mid-stage and advanced malignant tumors, and the benefits afforded by scientific nursing. Methods: Patients with mid-stage and advanced gastric cancer were randomly divided into test and control groups. Control group was given intravenous chemotherapy (400 mg/m2 fluorouracil and 2500 mg/m2 cisplatin) and nursed conventionally, while the test group was additionally treated with 80 mg/m2 paclitaxel and underwent special scientific nursing. Clinical effects and changes in the rates of apoptosis and cell proliferation were recorded. The effect of applying scientific nursing on therapeutic outcomes was also evaluated. Results: The overall rate of treatment effectiveness, clinical control rate, mean apoptosis and proliferation rates in the test group were 56.40, 92.30, (7.10 ± 3.17 and 28.70 ± 3.22 %, respectively, while, in the control group, the values were 38.50, 64.10, 25.40 ± 2.67 and 32.60 ± 2.93 %, respectively. The differences were all statistically significant (p < 0.05). In terms of nursing efficacy, the test group had a lower pain score and higher quality-of-life scores (Karnofsky performance status score) than control group. There was no significant difference in the incidence of adverse reactions between the two groups (p > 0.05). Conclusion: Paclitaxel has a significant effect when used to treat mid-stage and advanced gastric cancer. Moreover, additional nursing not only enhances the therapeutic effect but also improves prognosis and quality-of-life.

Análise da força e amplitude articular de rotação do ombro e avaliação da performance do remate em atletas de andebol masculino

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Clinical Accuracy of the MedGem Indirect Calorimeter for Measuring Resting Energy Expenditure in Cancer Patients

OBJECTIVE: To compare, in patients with cancer and in healthy subjects, measured resting energy expenditure (REE) from traditional indirect calorimetry to a new portable device (MedGem) and predicted REE. DESIGN: Cross-sectional clinical validation study. SETTING: Private radiation oncology centre, Brisbane, Australia. SUBJECTS: Cancer patients (n = 18) and healthy subjects (n = 17) aged 37-86 y, with body mass indices ranging from 18 to 42 kg/m(2). INTERVENTIONS: Oxygen consumption (VO(2)) and REE were measured by VMax229 (VM) and MedGem (MG) indirect calorimeters in random order after a 12-h fast and 30-min rest. REE was also calculated from the MG without adjustment for nitrogen excretion (MGN) and estimated from Harris-Benedict prediction equations. Data were analysed using the Bland and Altman approach, based on a clinically acceptable difference between methods of 5%. RESULTS: The mean bias (MGN-VM) was 10% and limits of agreement were -42 to 21% for cancer patients; mean bias -5% with limits of -45 to 35% for healthy subjects. Less than half of the cancer patients (n = 7, 46.7%) and only a third (n = 5, 33.3%) of healthy subjects had measured REE by MGN within clinically acceptable limits of VM. Predicted REE showed a mean bias (HB-VM) of -5% for cancer patients and 4% for healthy subjects, with limits of agreement of -30 to 20% and -27 to 34%, respectively. CONCLUSIONS: Limits of agreement for the MG and Harris Benedict equations compared to traditional indirect calorimetry were similar but wide, indicating poor clinical accuracy for determining the REE of individual cancer patients and healthy subjects.