Factors surgical team members perceive influence choices of wearing or not wearing personal protective equipment during operative /invasive procedures

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

Regional diversification and performance: Conceptualization and competing strategic objectives

This dissertation comprised of three essays provides justification for the need to pursue research on multinationality and performance with a more fine-grained approach. Essay one is a conceptual response to an article written by Jean-Francois Hennart in 2011 which questions the need and approach toward future research in this domain. I argue that internalization theory does not render multinationality and performance research meaningless and identify key areas where methodological enhancements can be made to strengthen our research findings with regard to Hennart's call for more content validity. Essay two responds to the need for more-fine grained research on the consequences of multinationality by introducing non-traditional measures of performance such as social and environmental performance and adopting a more theoretically relevant construct of regionalization to capture international diversification levels of the firm. Using data from the world's largest 600 firms (based on sales) derived from Bloomberg and the Directory of Corporate Affiliates; I employ general estimating equation analysis to account for the auto-correlated nature of the panel data alongside multivariate regression techniques. Results indicate that regionalization has a positive relationship with economic performance while it has a negative relationship with environmental and social performance outcomes, often referred to as the "Triple Bottom-Line" performance. Essay three builds upon the work in the previous essays by linking the aforementioned performance variables and sample to corporate reputation which has been shown to be a beneficial strategic asset. Using Structural Equation Modeling I explore economic, environmental and social signals as mediators on relationship between regionalization and firm reputation. Results indicate that these variables partially mediate a positive relationship between regionalization and firm reputation. While regionalization positively affects the reputation building signal of economic performance, it aids in reputation building by reducing environmental and social disclosure effects which interestingly impact reputation negatively. In conclusion, the dissertation submits opportunities for future research and contributes to research by demonstrating that regionalization affects performance, but the effect varies in accordance with the performance criterion and context. In some cases, regional diversification may produce competing or conflicting outcomes among the potential strategic objectives of the firm.

The survival and stock performance of emerging country firms in the United States

Many firms from emerging markets flocked to developed countries at high cost with hopes of acquiring strategic assets that are difficult to obtain in home countries. Adequate research has focused on the motivations and strategies of emerging country firms' (ECFs') internationalization, while limited studies have explored their survival in advanced economies years after their venturing abroad. Due to the imprinting effect of home country institutions that inhibit their development outside their home market, ECFs are inclined to hire executives with international background and affiliate to world-wide organizations for the purpose of linking up with the global market, embracing multiple perspectives for strategic decisions, and absorbing the knowledge of foreign markets. However, the effects of such orientation on survival are under limited exploration. Motivated by the discussion above, I explore ECFs' survival and stock performance in a developed country (U.S.). Applying population ecology, signaling theory and institutional theory, the dissertation investigates the characteristics of ECFs that survived in the developed country (U.S.), tests the impacts of global orientation on their survival, and examines how global-oriented activities (i.e. joining United Nations Global Compact) affect their stock performance. The dissertation is structured in the form of three empirical essays. The first essay explores and compares different characteristics of ECFs and developed country firms (DCFs) that managed to survive in the U.S. The second essay proposes the concept of global orientation, and tests its influences on ECFs' survival. Employing signaling theory and institutional theory, the third essay investigates stock market reactions to announcements of United Nation Global Compact (UNGC) participation. The dissertation serves to explore the survival of ECFs in the developed country (U.S.) by comparison with DCFs, enriching traditional theories by testing non-traditional arguments in the context of ECFs' foreign operation, and better informing practitioners operating ECFs about ways of surviving in developed countries and improving stockholders' confidence in their future growth.

The antecedents to participation in learning activities among support staff at a college in Ontario

Les tendances de la participation à la formation des adultes au Canada n’ont pas évolué depuis des décennies, malgré les nouvelles influences économiques qui ont stimulé l’augmentation et la diversification permanente de la formation des employés et malgré les initiatives plus nombreuses en faveur de l’apprentissage des employés en milieu de travail. Il est donc nécessaire de ne plus se contenter d’étudier les prédicteurs de la formation déjà connus dans les profils des employés et des employeurs. Il est, en revanche, indispensable d’étudier les antécédents de la participation des employés à la formation, y compris les aspects et les étapes du processus qui la précède. Cette étude porte sur les antécédents de la participation des employés aux formations dans un important collège communautaire urbain en Ontario. Afin de préparer le recueil des données, un cadre théorique a été élaboré à partir du concept d’expression de la demande. Ce cadre implique l’existence d’un processus qui comporte plusieurs étapes, au cours desquelles plusieurs intervenants interagissent et dont la formation est susceptible d’être le résultat. Les résultats de l’enquête sur le profil d’apprentissage ont permis de conclure que le comportement des employés et de l’employeur est conforme aux modèles de prédicteurs existants et que les taux et les types de participation étaient similaires aux tendances nationales et internationales. L’analyse des entrevues d’un groupe d’employés atypiques, de leurs superviseurs, ainsi que de représentants du collège et du syndicat, a révélé d’importants thèmes clés : l’expression de la demande n’est pas structurée et elle est communiquée par plusieurs canaux, en excluant parfois les superviseurs. De plus, la place de l’auto évaluation est importante, ainsi que la phase de prise de décision. Ces thèmes ont souligné l’interaction de plusieurs intervenants dans le processus d’expression de la demande d’apprentissage et pendant la prise de décision. L’examen des attentes de chacun de ces intervenants au cours de ce processus nous a permis de découvrir un désir tacite chez les superviseurs et les employés, à savoir que la conversation soit à l’initiative de « l’autre ». Ces thèmes clés ont été ensuite abordés dans une discussion qui a révélé une discordance entre le profil de l’employeur et les profils des employés. Celle-ci se prête à la correction par l’employeur de son profil institutionnel pour l’harmoniser avec le profil dispositionnel des employés et optimiser ainsi vraisemblablement son offre de formation. Ils doivent, pour cela, appliquer un processus plus systématique et plus structuré, doté de meilleurs outils. La discussion a porté finalement sur les effets des motivations économiques sur la participation des employés et a permis de conclure que, bien que les employés ne semblent pas se méfier de l’offre de formation de l’employeur et que celle ci ne semble pas non plus les décourager, des questions de pouvoir sont bel et bien en jeu. Elles se sont principalement manifestées pendant le processus de prise de décision et, à cet égard, les superviseurs comme les employés reconnaissent qu’un processus plus structuré serait bénéfique, puisqu’il atténuerait les problèmes d’asymétrie et d’ambiguïté. Les constatations de cette étude sont pertinentes pour le secteur de la formation des adultes et de la formation en milieu de travail et, plus particulièrement, pour la méthodologie de recherche. Nous avons constaté l’avantage d’une méthodologie à deux volets, à l’écoute de l’employeur et des employés, afin de mieux comprendre la relation entre l’offre de formation et la participation à la formation. La définition des antécédents de la participation sous la forme d’un processus dans lequel plusieurs intervenants remplissent plusieurs rôles a permis de créer un modèle plus détaillé qui servira à la recherche future. Ce dernier a démontré qu’il est indispensable de reconnaître que la prise de décision constitue une étape à part entière, située entre l’expression de la demande et la participation à la formation. Ces constatations ont également révélé qu’il est véritablement indispensable que le secteur de la formation des adultes continue à traiter les questions reliées à la reconnaissance de la formation informelle. Ces conclusions et la discussion sur les constatations clés nous ont inspiré des recommandations à appliquer pour modifier les retombées du processus précédant la participation des employés à la formation. La majorité de ces recommandations ont trait à l’infrastructure de ce processus et ciblent donc principalement l’employeur. Certaines recommandations sont cependant destinées aux syndicats, aux superviseurs et aux employés qui peuvent aider l’employeur à remplir son rôle et favoriser la participation efficace de tous à ce processus. Les recommandations qui précédent impliquent que ce sont les antécédents de la formation qui gagneraient à être plus structurés et non la formation elle même. La structuration de l’infrastructure de l’apprentissage présente cependant des risques à elle seule. En liaison avec ce phénomène, une étude spécifique des effets de la nature, de la qualité et de l’asymétrie de la relation superviseur employé sur la participation des employés à la formation serait bénéfique. Mots clés : formation en entreprise, formation professionnelle continue, antécédents à la participation, employés de soutien

Spirituality of Thai Buddhists with chronic cardiovascular disease

Background. Advances in medical technology contribute to the survival rate of a growing number of persons with chronic illnesses. Individuals with chronic cardiovascular disease (chronic CVD) are among other chronically ill persons who add to the need for healthcare services. They need to cope and live with the chronic conditions and find a new balance to make sense of their lives. Thai Buddhists with chronic CVD may use their religious resources to cope with their illnesses because religious beliefs are reflected in patterns of living. The aims of the study were to: (a) explore how Thai Buddhists with chronic CVD construct the spiritual aspects of the illness experience, (b) explore how Thai Buddhists with chronic CVD may use their spiritual/religious resources as a means of coping with the illness, and (c) explore the impacts of spiritual/religious beliefs and/or practices on the daily lives of Thai Buddhists with chronic CVD. ^ Methods. Ethnography was employed and data were collected from December 1, 2007 to May 31, 2008 using in-depth interviews with 20 participants. Field notes were also recorded. ^ Findings. Three categories emerged from the study data: set of spiritual and biomedical beliefs and practices, integrated meanings, and positive consequences of the integration of spiritual and biomedical beliefs and practices. ^ Conclusions. The findings of the study suggest the importance of understanding and integrating spiritual needs into care of patients with chronic CVD. The findings revealed that the participants constructed ideas of their illness and meanings for living and coping with the illness, and integrated spiritual and biomedical beliefs and practices, resulting in positive outcomes. Further research could test interventions which facilitate such coping; for example, using reflective thinking and group support. Other studies might explore how age affects Buddhist views of the illness. ^

Fourth generation evaluation revisited: Testing a revised pause model

This research provides data which investigates the feasibility of using fourth generation evaluation during the process of instruction. A semester length course entitled "Multicultural Communications", (PUR 5406/4934) was designed and used in this study, in response to the need for the communications profession to produce well-trained culturally sensitive practitioners for the work force and the market place. A revised pause model consisting of three one-on-one indepth interviews conducted outside of the class, three reflections periods during the class and a self-reflective essay prepared one week before the end of the course was analyzed. Narrative and graphic summaries of participant responses produced significant results. The revised pause model was found to be an effective evaluation method for use in multicultural education under certain conditions as perceived by the participants in the study. participant self-perceived behavior change and knowledge acquisition was identified through use of the revised pause model. Study results suggest that by using the revised pause model of evaluation, instructors teaching multicultural education in schools of journalism and mass communication is yet another way of enhancing their ability to become both the researcher and the research subject. In addition, the introduction of a qualitative model has been found to be a more useful way of generating participant involvement and introspection. Finally, the instructional design of the course used in the study provides communication educators with a practical way of preparing their students be effective communicators in a multicultural world.

A study of the effects of a service-learning experience on student success at an urban community college

The purpose of this study was to explore the effects of a service-learning experience on student success as measured by class attendance, course completion, final course grades, and end-of-term evaluation data.^ Though many outcomes of service-learning experiences have been studied, including ethical values, self-esteem, student personal development, and career preparation, relatively few studies have been conducted on the effects of such experiences on academic achievement, and the studies that have been done have primarily studied students at traditional, four-year, residential universities.^ The study consisted of 286 students enrolled in six paired courses taught by five instructors at a community college in the Fall term 1996. One section of each pair (the control group) was taught using traditional subject matter and course materials and the other section of each pair (the treatment group) participated in a 20-hour required service-learning activity in addition to the regular course curriculum. The courses in the study included American History, Sociology, College Preparatory English, and Introduction to English Composition.^ The results of this study indicate that, overall, students who participated in a class in which service-learning was a requirement, achieved higher final course grades and reported greater satisfaction with the course, the instructor, the reading assignments, and the grading system, and the treatment section of one course pair had fewer absences. In addition, the faculty members reported that, in the treatment sections, class discussions were more stimulating, the sections seemed more vital in terms of student involvement, the students seemed more challenged academically, more motivated to learn, and seemed to exert more effort in the course. ^

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. ^

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 qualitative study of the clinical practice of graduates of a problem-based physical therapy program

The purpose of this study was to examine the perspectives of three graduates of a problem-based leaning (PBL) physical therapy (PT) program about their clinical practice. The study used the qualitative methods of observations, interviews, and journaling to gather the data. Three sessions of audiotaped interviews and two observation sessions were conducted with three exemplars from Nova Southeastern University PBL PT program. Each participant also maintained a reflective journal. The data were analyzed using content analysis. A systematic filing system was used by employing a mechanical means of maintaining and indexing coded data and sorting data into coded classifications of subtopics or themes. All interview transcripts, field notes from observations, and journal accounts were read, and index sheets were appropriately annotated. From the findings of the study, it was noted that, from the participants' perspectives, they were practicing at typically expected levels as clinicians. The attributes that governed the perspectives of the participants about their physical therapy clinical practice included flexibility, reflection, analysis, decision-making, self-reliance, problem-solving, independent thinking, and critical thinking. Further, the findings indicated that the factors that influenced those attributes included the PBL process, parents' value system, self-reliant personality, innate personality traits, and deliberate choice. Finally, the findings indicated that the participants' perspectives, for the most part, appeared to support the espoused efficacy of the PBL educational approach. In conclusion, there is evidence that the physical therapy clinical practice of the participants were positively impacted by the PBL curriculum. Among the many attributes they noted which governed these perspectives, problem-solving, as postulated by Barrows, was one of the most frequently mentioned benefits gained from their PBL PT training. With more schools adopting the PBL approach, this research will hopefully add to the knowledge base regarding the efficacy of embracing a problem-based learning instructional approach in physical therapy programs. ^

Facing a paradigm shift in professional credentialing: Preparedness of registered dietitians for Professional Development 2001

In the year 2001, the Commission on Dietetic Registration (CDR) will begin a new process of recertifying Registered Dietitians (RD) using a self-directed lifelong learning portfolio model. The model, entitled Professional Development 2001 (PD 2001), is designed to increase competency through targeted learning. This portfolio consists of five steps: reflection, learning needs assessment, formulation of a learning plan, maintenance of a learning log, and evaluation of the learning plan. By targeting learning, PD 2001 is predicted to foster more up-to-date practitioners than the current method that requires only a quantity of continuing education hours. This is the first major change in the credentialing system since 1975. The success or failure of the new system will impact the future of approximately 60,000 practitioners. The purpose of this study was to determine the readiness of RDs to change to the new system. Since the model is dependent on setting goals and developing learning plans, this study examined the methods dietitians use to determine their five-year goals and direction in practice. It also determined RD's attitudes towards PD 2001 and identified some of the factors that influenced their beliefs. A dual methodological design using focus groups and questionnaires was utilized. Sixteen focus groups were held during state dietetic association meetings. Demographic data was collected on the 132 registered dietitians who participated in the focus groups using a self-administered questionnaire. The audiotaped sessions were transcribed into 643 pages of text and analyzed using Non-numerical Unstructured Data - Indexing Searching and Theorizing (NUD*IST version 4). Thirty-four of the 132 participants (26%) had formal five-year goals. Fifty-four participants (41%) performed annual self-assessments. In general, dietitians did not currently have professional goals nor conduct self-assessments and they claimed they did not have the skills or confidence to perform these tasks. Major barriers to successful implementation of PD 2001 are uncertainty, misinterpretation, and misinformation about the process and purpose, which in turn contribute to negative impressions. Renewed vigor to provide a positive, accurate message along with presenting goal-setting strategies will be necessary for better acceptance of this professional development process. ^

Profile of Florida: Services in transitional housing programs for homeless women with children

Family homelessness is a disturbing social problem in the United States. This study was conducted to determine the scope of components that included services and programs available for homeless women with children in transitional housing programs in Florida and the effectiveness of these components in helping these women move towards independence. Primary data for this study were obtained through questionnaires sent to directors of homeless centers in Florida. Supportive services offered by these centers were evaluated to determine if they enabled homeless women with children to become self-sufficient. The findings of this research indicated that regardless of the size, length of participation, and scope of services provided by the centers, these women showed gains in their ability to move toward self-sufficiency. The results support the hypothesis that transitional housing programs have a positive effect on homeless women with children. ^

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. ^

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. ^

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. ^