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. ^

Mindmapping as an adult learning notetaking strategy to increase the encoding of information in a corporate training course

A study was conducted to investigate the effectiveness, as measured by performance on course posttests, of mindmapping versus traditional notetaking in a corporate training class. The purpose of this study was to increase knowledge concerning the effectiveness of mindmapping as an information encoding tool to enhance the effectiveness of learning. Corporations invest billions of dollars, annually, in training programs. Given this increased demand for effective and efficient workplace learning, continual reliance on traditional notetaking is questionable for the high-speed and continual learning required on workers.^ An experimental, posttest-only control group design was used to test the following hypotheses: (1) there is no significant difference in posttest scores on an achievement test, administered immediately after the course, between adult learners using mindmapping versus traditional notetaking methods in a training lecture, and (2) there is no significant difference in posttest scores on an achievement test, administered 30 days after the course, between adult learners using mindmapping versus traditional notetaking methods in a training lecture. After a 1.5 hour instruction on mindmapping, the treatment group used mindmapping throughout the course. The control group used traditional notetaking. T-tests were used to determine if there were significant differences between mean posttest scores between the two groups. In addition, an attitudinal survey, brain hemisphere dominance survey, course dynamics observations, and course evaluations were used to investigate preference for mindmapping, its perceived effect on test performance, and the effectiveness of mindmapping instruction.^ This study's principal finding was that although the mindmapping group did not perform significantly higher on posttests administered immediately and 30 days after the course, than the traditional notetaking group, the mindmapping group did score higher on both posttests and reported higher ratings of the course on every evaluation criteria. Lower educated, right brain dominant learners reported a significantly positive learning experience. These results suggest that mindmapping enhances and reinforces the preconditions of learning. Recommendations for future study are provided. ^

A study of state and trait anxiety and perceived causes of anxiety identified by licensed practical nurses returning to an associate degree nursing program

The purpose of this study was to identify the state and trait anxiety and the perceived causes of anxiety in licensed practical nurses (LPNs) returning to an associate degree nursing program in order to become registered nurses (RNs). The subjects for this study were 98 students enrolled in a transitional LPN/RN associate degree nursing program in two community colleges in the state of Florida. The State-Trait Anxiety Inventory (STAI) developed by Spielberger (1983), was used as the measuring instrument for this study.^ In addition, a Q-sort technique was used to obtain information from the subjects regarding perceived causes of anxiety. Anxiety causes for the Q-sort cards used in the study were developed from the themes identified by a sample of LPN/RN students in a pilot study. The state and trait anxiety levels were obtained using the STAI for college students scoring key and scales. Descriptive statistics were used to determine the state and trait anxiety of the students. Correlational statistics were used to determine if relationships existed between the state and trait anxiety levels and perceived causes of anxiety identified by LPN students returning to an associate degree nursing program.^ The analysis of the Q-sort was performed by computing the means, standard deviations, and frequencies of each cause. The mean trait anxiety level of the students was 57.56, $SD=29.69.$ The mean state anxiety level of the students was 68.21, $SD=25.78.$ Higher percentile scores of trait anxiety were associated with higher ranks of the Q-sort category, "failing out of the program," $\rm r\sb{s}=.27,\ p=.008.$ Implications for future nursing research and application of the findings to nursing education are presented. ^

A qualitative study of the impact of an educational intervention on older parents of adults with disabilities engaged in the phenomenon of future-care planning

This phenomenological study describes the impact of an educational intervention on the day-to-day experiences of older parent caregivers of adults with developmental disabilities who were engaged in the process of future-care planning. Qualitative strategies of individual and focus group interviewing were used with a purposive sample of older caregivers. Participants were members of an existing parent support group. Twenty-three caregivers representing 18 families were queried before and after the education program. The disabilities represented were mental retardation, cerebral palsy and autism. Parents whose children live at or away from home were included. The intervention was conducted on five Saturdays over a two month period; the duration of the study was five months. Findings used typical words of the respondents from their individual and focus group interviews to describe feelings, attitudes and experiences in making future-care plans. Data from verbatim transcriptions and researcher's field notes were coded, analyzed, sorted into themes, and subjected to interpretive analysis. Respondents showed a positive change in attitudes and actions after participating in the education program, regardless of their initial stage in care planning. Fears were replaced by hope and determination; hesitation and ineptitude by feelings of competence and confidence; and procrastination and delay by purposeful actions. Other key findings: use of a planning document greatly aided caregivers; barriers to planning were often intrinsic and amenable to education; residential plans were the most difficult aspect of planning; listening to the experiences of other parent caregivers was helpful; and making burial plans for their offspring was one aspect of planning parents wished to do themselves. ^

Effects of using manipulative materials to teach remedial algebra to community college students on achievement and attitudes towards mathematics

This dissertation derived hypotheses from the theories of Piaget, Bruner and Dienes regarding the effects of using Algebra Tiles and other manipulative materials to teach remedial algebra to community college students. The dependent variables measured were achievement and attitude towards mathematics. The Piagetian cognitive level of the students in the study was measured and used as a concomitant factor in the study.^ The population for the study was comprised of remedial algebra students at a large urban community college. The sample for the study consisted of 253 students enrolled in 10 sections of remedial algebra at three of the six campuses of the college. Pretests included administration of an achievement pre-measure, Aiken's Mathematics Attitude Inventory (MAI), and the Group Assessment of Logical Thinking (GALT). Posttest measures included a course final exam and a second administration of the MAI.^ The results of the GALT test revealed that 161 students (63.6%) were concrete operational, 65 (25.7%) were transitional, and 27 (10.7%) were formal operational. For the purpose of analyzing the data, the transitional and formal operational students were grouped together.^ Univariate factorial analyses of covariance ($\alpha$ =.05) were performed on the posttest of achievement (covariate = achievement pretest) and the MAI posttest (covariate = MAI pretest). The factors used in the analysis were method of teaching (manipulative vs. traditional) and cognitive level (concrete operational vs. transitional/formal operational).^ The analyses for achievement revealed a significant difference in favor of the manipulatives groups in the computations by campus. Significant differences were not noted in the analysis by individual instructors.^ The results for attitude towards mathematics showed a significant difference in favor of the manipulatives groups for the college-wide analysis and for one campus. The analysis by individual instructor was not significant. In addition, the college-wide analysis was significant in favor of the transitional/formal operational stage of cognitive development. However, support for this conclusion was not obtained in the analyses by campus or individual instructor. ^

A case study of adults in college who developed an experiential learning portfolio

This single-case study provides a description and explanation of selected adult students' perspectives on the impact that the development of an experiential learning portfolio had on their understanding of their professional and personal lives. The conceptual framework that undergirded the study included theoretical and empirical studies on adult learning, experiential learning, and the academic quality of nontraditional degree programs with a portfolio component. The study employed qualitative data collection techniques of individual interviews, document review, field notes, and researcher journal. A purposive sample of 8 adult students who completed portfolios as a component of their undergraduate degrees participated in the study. The 4 male and 4 female students who were interviewed represented 4 ethnic/racial groups and ranged in age from 32 to 55 years. Each student's portfolio was read prior to the interview to frame the semi-structured interview questions in light of written portfolio documents. ^ Students were interviewed twice over a 3-month period. The study lasted 8 months from data collection to final presentation of the findings. The data from interview transcriptions and student portfolios were analyzed, categorized, coded, and sorted into 4 major themes and 2 additional themes and submitted to interpretive analysis. ^ Participants' attitudes, perceptions, and opinions of their learning from the portfolio development experience were presented in the findings, which were illustrated through the use of excerpts from interview responses and individual portfolios. The participants displayed a positive reaction to the learning they acquired from the portfolio development process, regardless of their initial concerns about the challenges of creating a portfolio. Concerns were replaced by a greater recognition and understanding of their previous professional and personal accomplishments and their ability to reach future goals. Other key findings included (a) a better understanding of the role work played in their learning and development, (b) a deeper recognition of the impact of mentors and role models throughout their lives, (c) an increase in writing and organizational competencies, and (d) a sense of self-discovery and personal empowerment. ^

A study of dual cultures in dyadic relations

Elderly caregiving, a fact of life for millions of Americans, has gained significance with the increase in the elderly population. Over 25 million family caregivers in the US, most of whom are women rearing their own children, care for severely ill or disabled family members. The increased flow of women into the labor force has caused this traditional role to be entrusted to hired caregivers, mainly home health aides. ^ This case study describes and explains the dyadic experiences of elderly Jewish clients and their Jamaican home health aides in a mixed-culture environment. The inquiry was conducted with a purposive sample of four dyads, their case manager, and the placement officer, all of whom were selected through a home care agency in Fort Lauderdale, Florida. Strategies of data collection including non-participant observation, interviews, document analysis, and researcher's journals. Data from verbatim transcription of interviews and field notes were coded, sorted into emic categories, and reduced as linkages were identified via cross-case comparison. Three major themes—mixed-culture experiences, relationship building and maintenance, and agency role perceptions—emerged from the interpretative analysis of the data. ^ Assertions from these findings include that dyads have established a range of relationships to meet their personal needs, expectations, and desires in these goal-driven relationships. Relationally, they have reached interactional synchrony with some achieving the ideal family-type bond. Cultural difference is but one of the many contextual variables in the home care environment, which has its own cultural norms and expectations. Conflicts transcend cultural difference and seemed more a factor of individual relational disposition. ^

Selected psychosocial and demographic factors affecting levels of pre-retirement planning

In September 2002, the State of Florida implemented a new retirement structure for those employed in the Florida Public School System. Teachers were given the option to maintain their existing defined benefit plan or choose the newly offered defined contribution plan. The variables that affect planning for retirement are innumerable. Identifying the most significant variables is essential to understanding how one plans for retirement. ^ This study examined the relationship between hypothesized psychosocial and demographic factors and an individual's level of pre-retirement planning. The criterion variable, the level of pre-retirement planning, comprised two concepts. First, the time spent thinking about retirement was determined by the score an individual received on a pre-retirement planning scale. This scale included the concepts of information gathering, goals, anticipated resources, and long-range planning. Second, implementation of retirement plan procedures was determined by the percentage an individual annually deferred to retirement. ^ The survey used for data collection contained 50 close-ended items. It was distributed to all full-time teachers in nine randomly selected elementary, middle, and senior high schools throughout Miami-Dade County Public Schools. Multiple regression and crosstabulation indicated that math anxiety, general risk, years of service, and total family income were significant predictors of the level of pre-retirement planning, as measured by the pre-retirement planning scale. In addition, the statistical analysis indicated that math anxiety, internal locus of control, years of service, and total family income were significant predictors of the level pre-retirement planning, as measured by the amount deferred to retirement. An individual's level of math anxiety and family income were the two factors that were the most significant predictors for both concepts on the level of pre-retirement planning. ^ Based on the findings of the study, recommendations focused on assessing an individual's level of math anxiety and educating teachers, particularly pre-service candidates, about the factors that affect pre-retirement planning. Further research should investigate the benefit of such educational programs. ^

The theory of margin as a predictor of success on the National Council Licensure Examination for Registered Nurses

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the examination that all graduates of nursing education programs must pass to attain the title of registered nurse. Currently the NCLEX-RN passing rate is at an all-time low (81%) for first-time test takers (NCSBN, 2004); amidst a nationwide shortage of registered nurses (Glabman, 2001). Because of the critical need to supply greater numbers of professional nurses, and the potential accreditation ramifications that low NCLEX-RN passing rates can have on schools of nursing and graduates, this research study tests the effectiveness of a predictor model. This model is based upon the theoretical framework of McClusky's (1959) theory of margin (ToM), with the hope that students found to be at-risk for NCLEX-RN failure can be identified and remediated prior to taking the actual licensure examination. To date no theory based predictor model has been identified that predicts success on the NCLEX-RN. ^ The model was tested using prerequisite course grades, nursing course grades and scores on standardized examinations for the 2003 associate degree nursing graduates at a urban community college (N = 235). Success was determined through the reporting of pass on the NCLEX-RN examination by the Florida Board of Nursing. Point biserial correlations tested model assumptions regarding variable relationships, while logistic regression was used to test the model's predictive power. ^ Correlations among variables were significant and the model accounted for 66% of variance in graduates' success on the NCLEX-RN with 98% prediction accuracy. Although certain prerequisite course grades and nursing course grades were found to be significant to NCLEX-RN success, the overall model was found to be most predictive at the conclusion of the academic program of study. The inclusion of the RN Assessment Examination, taken during the final semester of course work, was the most significant predictor of NCLEX-RN success. Success on the NCLEX-RN allows graduates to work as registered nurses, reflects positively on a school's academic performance record, and supports the appropriateness of the educational program's goals and objectives. The study's findings support potential other uses of McClusky's theory of margin as a predictor of program outcome in other venues of adult education. ^

Effects of cooperative and individual integrated learning system on attitudes and achievement in mathematics

This study compares the effects of cooperative delivery (CD) and individual delivery (ID) of integrated learning system (ILS) instruction in mathematics on achievement, attitudes and behaviors in adult (16-21 yrs.) high school students (grades 9-13). The study was conducted in an urban adult high school in Miami-Dade County Public Schools using a pre-test/post-test design. Achievement was measured using the Test of Adult Basic Education (TABE) by CTB MC-Graw-Hill and Compass Learning. An attitudinal survey measured attitudes towards mathematics, the computer-related lessons, and attitudes toward group activities. Behavior was assessed using computer lab observations. ^ Two-way analyses of variance (ANOVA) were conducted on achievement (TABE and Compass) by group and time (pre and post). A one-way ANOVA was conducted on the overall attitude by group on the five components (i.e., content mathematics, delivery/computers, cooperative, partners, and self efficacy) and a one-way ANOVA was conducted on the on-task behavior by group. ^ The results of the study revealed that CD and ID students working on mathematics activities delivered by the ILS performed similarly on achievement tests of the TABE. The CD-ILS students had significantly better overall mathematics attitudes than the ID-ILS students and the ID-ILS group was on-task significantly more than the CD-ILS group. This study concludes that regularity and period of time over which the ILS is used may prove to be important variables although there were insufficient data to fully investigate the impact of models of use. Additionally, a minimum amount of time-on-system is necessary before gains can become apparent in innumeracy and increasing exposure to the system may have beneficial effects on learning. ^

An analysis of student and instructor perceptions of students' writing skills at the university level

This study examined university students' writing skills as perceived by university students and their English instructors. The goal of the study was to provide English instructors with objective, quantified information about writing perceptions from both the students' and instructors' viewpoints. ^ A survey instrument was developed based on a survey instrument created by Newkirk, Cameron, and Selfe (1977) to identify instructors' perceived knowledge of student writing skills. The present study used a descriptive statistical design. It examined five writing skill areas: attitude, content, grammar and mechanics, literary considerations, and the writing process through a questionnaire completed by a convenience sample of summer and fall admitted freshmen who were enrolled in Essay Writing and Freshman Composition courses and English Department instructors at a large South Florida public university. ^ The study consisted of five phases. The first phase was modifying of the Newkirk, Cameron, and Selfe (1977) questionnaire. Two versions of the revised survey were developed - one for instructors and one for students. The second phase was pilot testing the questionnaire for evaluation of administration and scoring. The third phase was administering the questionnaire to 1,280 students and 48 instructors. The fourth phase was analyzing the data. The study found a significant difference in the perceptions of students and instructors in all areas of writing skills examined by the survey. Responses to 29 of 30 questions showed that students felt they had better attitudes toward writing and better writing skills than instructors thought. ^ The final phase was developing recommendations for practice. Based on findings and theory and empirical evidence drawn from the fields of adult education and composition research, learner-centered, self-directed curriculum guidelines are offered. ^ By objectively quantifying student and instructor perceptions of students' writing skills, this study contributes to a growing body of literature that: (a) encourages instructors to acknowledge the perception disparities between instructors and students; (b) gives instructors a better understanding of how to communicate with students; and (c) recommends the development of new curriculum, placement tests, and courses that meet the needs of students and enables English instructors to provide meaningful instruction. ^

Team Primacy Concept-based employee evaluation and job performance

This qualitative case study explored how employees learn from Team Primacy Concept (TPC)-based employee evaluation and how they apply the knowledge in their job performance. Kolb's experiential learning model (1974) served as a conceptual framework for the study to reveal the process of how employees learn from TPC evaluation, namely, how they experience, reflect, conceptualize and act on performance feedback. TPC based evaluation is a form of multirater evaluation that consists of three components: self-feedback, supervisor's feedback, and peer feedback. The distinctive characteristic of TPC based evaluation is the team evaluation component during which the employee's professional performance is discussed by one's peers in a face-to-face team setting, while other forms of multirater evaluation are usually conducted in a confidential and anonymous manner.^ Case study formed the methodological framework. The case was the Southeastern Virginia (SEVA) region of the Institute for Family Centered Services, and the participants were eight employees of the SEVA region. Findings showed that the evaluation process was anxiety producing for employees, especially the process of peer evaluation in a team setting. Preparation was found to be an important phase of TPC evaluation. Overall, the positive feedback delivered in a team setting made team members feel acknowledged. The study participants felt that honesty in providing feedback and openness to hearing challenges were significant prerequisites to the TPC evaluation process. Further, in the planning phase, employees strove to develop goals for themselves that were meaningful. Also, the catalyst for feedback implementation appeared to stem from one's accountability to self and to the client or community. Generally, the participants identified a number of performance improvement goals that they attained during their employment with IFCS, which were supported by their developmental plans.^ In conclusion, the study identified the process by which employees learned from TPC-based employee evaluation and the ways in which they used the knowledge to improve their job performance. Specifically, the study examined how participants felt and what they thought about TPC-based feedback, in what ways they reflected and made meaning of the feedback, and how they used the feedback to improve their job performance.^

An evaluation of an intervention strategy for retention and determination of predictors of success for high -risk students in an associate degree nursing program

The purpose of this study was twofold: (1) to evaluate the effect of a specific instructional Intervention, a Nursing Theory Laboratory, on increasing the retention of high risk students in the associate degree nursing program at Miami-Dade Community College in Miami, Florida; and (2) to identify predictors of success of high risk nursing students in this associate degree nursing program.^ Data were collected from the 195 nursing students enrolled in Nursing Fundamentals during the 1985-1987 academic years, and identified as high risk students. Control and experimental groups were selected based on enrollment in the Nursing Theory Laboratory.^ Results were determined by analyzing several cross-tabulations of selected variables and yielding chi square values, t-tests, and two discriminant analyses. There was no significant relationship between age or ethnic background and enrollment in the Nursing Theory Laboratory. There was no significant relationship between enrollment in the Nursing Theory Laboratory and success in Nursing 1 (Nursing Fundamentals). There was a significant relationship between enrollment in the Nursing Theory Laboratory and success in Nursing 3 (Medical-Surgical Nursing). Writing assessment test scores in two entrance tests and high risk categories, based on the number of enrollments in required science courses, were identified as predictors of success in this program.^ The conclusion was that the Nursing Theory Laboratory does not significantly improve retention of high risk associate degree nursing students if they are enrolled in this intervention at the same time they are enrolled in Nursing Fundamentals. Since those students who were enrolled in the Nursing Theory Laboratory had a significantly higher success rate in Nursing 3, than those students who were not enrolled in the Nursing Theory Laboratory, a recommendation of this study was to offer the Nursing Theory Laboratory to high risk students prior to the beginning of nursing courses. Another recommendation was that students deficient in reading and writing skills should be required to enroll in developmental courses prior to enrollment in the nursing course. ^

*Postsecondary access for individuals with psychological disabilities: An analysis of federal rulings and institutional philosophies, *policies, and practices

This study was a qualitative investigation, with demographic quantitative features, of post-secondary educational access and legal guidelines for individuals with psychological disabilities. Although disability laws have positively influenced post-secondary educational attitudes and practices relative to accommodating many individuals with disabilities, prevailing stigmas regarding mental illness have discouraged the equal access to higher education for individuals with psychological disabilities. Little research concentrating on this area was found.^ Thirty-six relevant legal case decisions, focusing on a variety of realms of higher education, were scrutinized. The policies, procedures, and practices of six Southeastern United States universities were analyzed through official documents and participant responses from disability service providers and other university employees. Comparisons were made between legal cases, and within and between universities. Case findings also provided standards through which participating university practices could be studied.^ The legal analysis revealed that most institutions did not discriminate against individuals with psychological disabilities. Practices of a few of these institutions, however, suggested non-compliance despite favorable decisions on their behalf. Institutions found to have discriminatory practices were cited for inadequate procedures, or for presumptive assessments of the educational functioning levels of individuals with psychological disabilities.^ Participant university practices generally suggested disability law compliance; however, certain campus interventions were determined to be ineffective in identifying, addressing, and communicating about the educational needs of individuals with psychological disabilities. The most effective services for these individuals, who were described as rapidly increasing in number but lagging in self-advocacy and acceptance by others, went beyond legal requirements.^ Recommendations were made for institutional practices concerning disability-related documentation, written standards and operations, and student identification and referral. Directions for future research focused on study skills training for students; exposure of mental health professionals to client educational needs; and expansion of the current research, on a nationwide collegiate level, and a parallel analysis focusing on business and industry. ^

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. ^