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INTRODUCTION: Very little prospective, randomized, experimental research exists on the use of simulation as a teaching method, and no studies have compared the effects of 2 strategies of using the Human Patient Simulator (HPS) and a CD-ROM on the management of patients exposed to chemical agents. METHODS: A prospective, pretest-posttest experimental, mixed design (within and between) was used to determine if there were statistically significant differences between educational strategies using HPS, CD-ROM, and a control group in the care of patients exposed to chemical agents. Care was operationally defined as the score on the Management of Chemical Warfare Patients Performance (MCWPP) instrument. Participants included active duty and reserve military nurses (n=92). They were randomly assigned to one of 3 teaching groups: HPS (n=30), CD-ROM (n=31), or a control group (n=31). RESULTS: Analysis of variance and a Tukey post-hoc test were used to analyze the data. The means on MCWPP instrument were as follows: HPS (pretest: mean=65.13, SD ± 8.9; posttest mean=73.0, SD ± 8.6); CD-ROM (pretest: mean=67.74, SD ± 11.18, posttest mean=65.67, SD ± 10.82); control (pretest: mean=68.51 SD ± 8.5; posttest mean=62.6, SD ± 8.6). There were no significant differences between the groups on the pretest (P=.363), but there were significant differences on the posttest (P=.001). Post-hoc analyses indicated the HPS group performed better than the CD-ROM group (P=.017) and the control group (P=.000). There was no significant difference between the CD-ROM and control groups (P=.485). CONCLUSION: Based on the results of this study, the HPS is more effective than the CD-ROM in teaching nurses about the care of patients exposed to chemical agents.
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CD-ROM , Guerra Química , Educación en Enfermería/métodos , Medicina Militar/educación , Simulación de Paciente , Análisis de Varianza , Evaluación Educacional , Femenino , Humanos , Masculino , Estudios ProspectivosRESUMEN
Military medical personnel preparing for deployment to Iraq (N = 328) participated in a survey concerning predeployment risk and resilience factors. Participants reported exposure to an average of 2.5 potentially traumatic events before deployment and 76% (n = 229) reported at least two current concerns about predeployment stressors. Military personnel also endorsed a series of positive appraisals of the military, the mission, and their unit. Fairly low levels of post-traumatic stress disorder symptoms before deployment were reported and positive affect was significantly higher than reported negative affect. Post-traumatic stress disorder symptoms that were present before deployment were most strongly associated with risk factors, whereas positive affect was most strongly associated with resilience factors. Predeployment negative affect was associated with a combination of risk and resilience factors. These findings have implications for possible interventions and preparation of medical personnel before military deployment. A better understanding of the factors related to risk and resilience in military medical personnel will allow for improved screening, educational, training, and clinical programs aimed at increasing resilience before military deployments.
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Adaptación Psicológica , Personal Militar , Psiquiatría Militar , Trastornos por Estrés Postraumático/psicología , Adolescente , Adulto , Afecto , Femenino , Indicadores de Salud , Humanos , Irak , Masculino , Persona de Mediana Edad , Pruebas Psicológicas , Psicometría , Riesgo , Factores de Riesgo , Estados UnidosRESUMEN
BACKGROUND: Very little prospective randomized experimental research exists on the use of simulation as a teaching method, and no studies have compared the two strategies of using the HPS and a CD-ROM. In addition, no researchers have investigated the effects of simulation on various levels of cognition, specifically lower-level and higher-level cognition or critical thinking. OBJECTIVES: A prospective pretest-posttest experimental mixed design (within and between) was used to determine if there were statistically significant differences in HPS and CD-ROM educational strategies in lower-level, higher-level cognition and critical thinking. RESULTS: A repeated measures multivariate analysis of variance (RMANOVA) with LSD post-hoc tests were used to analyze the data. There were no significant differences between the HPS and CD-ROM groups on lower-level cognition scores. The HPS group did significantly better than the CD-ROM group on higher-level cognition and critical thinking scores. CONCLUSION: This study demonstrated that the choice of teaching strategies for lower-level cognition does not make a statistically significant difference in outcome. However, the HPS is superior to using CD-ROM and should be considered as the choice in teaching.
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Air Force (AF)-certified registered nurse anesthetists (CRNAs) play an important role in the support of the global war on terror. The purpose of the investigation was to use an AF CRNA-specific modification of the Readiness Estimate and Deployability Index Revised for AF Nurses to assess readiness for deployment. Dimensions included clinical competency, operational competency, soldier/survival skills, personal/psychosocial/physical readiness, leadership and administrative support, and group integration/identification. Readiness skills verification for AF CRNAs was used to develop clinical competency questions. Validity was assessed by two experts, and internal consistency reliability was evaluated by using Cronbach's alpha. Available stateside AF CRNAs (n=105) were surveyed, with a 60% response rate. Descriptive statistics were used to describe the sample, providing a mean score for each variable. Using a 5-point scale, participants rated themselves with an overall readiness score of 4.09, which suggests that AF CRNAs perceive themselves as ready to deploy.
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Competencia Clínica , Medicina Militar/educación , Personal Militar , Enfermeras Anestesistas/educación , Guerra , Adulto , Demografía , Femenino , Encuestas de Atención de la Salud , Humanos , Liderazgo , Masculino , Enfermeras Anestesistas/psicología , Proyectos Piloto , Factores Socioeconómicos , Estados UnidosRESUMEN
CONCEPTUAL FRAMEWORK: The Academic Center for Evidence-based Practice (ACE) Star Model was used to implement an evidence-based clinical practice guideline (CPG) in order to decrease ventilator-associated pneumonia (VAP) incidence rates and ventilator days. The goal was to interrupt person-to-person transmission of bacteria and bacterial colonization using low-cost, evidence-based strategies to prevent VAP. DISCOVERY: Two geographically proximate medical centers, inclusive of five intensive care units located in the southwestern region of the United States had significant variations in their VAP rates. EVIDENCE SUMMARY: Using the U.S. Preventive Services Task Force grading criteria, the results of 69 studies were used to establish a clinical practice guideline to prevent ventilator-associated pneumonia. TRANSLATION: A clinical practice guideline was developed for the prevention of VAP and included five nursing activities: (a) head-of-bed elevation; (b) oral care; (c) ventilator tubing condensate removal; (d) hand hygiene; and (e) glove use. The effect of the CPG, inclusive of an educational intervention, was measured using an observational, prospective, quasi-experimental design. INTEGRATION: A multidisciplinary education team developed a self-learning packet, educational materials, and storyboards for the staff as dissemination strategies. Strategies also included e-mail, one-on-one teaching with clinicians, and feedback on guideline adoption and VAP rate reports. EVALUATION: Observation data were collected to evaluate adoption of the CPG while caring for 106 ventilated patients. VAP rates changed at both hospitals although the change was not statistically significant. Additionally, the ICU length of stay declined at both facilities, causing cost savings. DISCUSSION: These results support the idea that adoption of evidence-based practices contributes to decreased VAP rates. For a successful program, ICU leaders should emphasize strategies that routinize adoption of evidence-based CPGs.
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Infección Hospitalaria/prevención & control , Medicina Basada en la Evidencia , Personal de Enfermería en Hospital/educación , Neumonía Asociada al Ventilador/prevención & control , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infección Hospitalaria/epidemiología , Difusión de Innovaciones , Educación Continua en Enfermería/organización & administración , Medicina Basada en la Evidencia/educación , Medicina Basada en la Evidencia/organización & administración , Femenino , Humanos , Incidencia , Control de Infecciones/organización & administración , Capacitación en Servicio/organización & administración , Masculino , Persona de Mediana Edad , Modelos Educacionales , Rol de la Enfermera , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/organización & administración , Neumonía Asociada al Ventilador/epidemiología , Guías de Práctica Clínica como Asunto/normas , Evaluación de Programas y Proyectos de Salud , Respiración Artificial/efectos adversos , Respiración Artificial/enfermería , Sudoeste de Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: The purpose of this study was to test the reliability and validity of the Readiness Estimate and Deployability Index Revised for Air Force Nurses Short Form, with a sample of 205 Air Force nurses. Participants were mostly female (70%), 36.31 +/- 9.3 years of age, with 11.52 +/- 7.17 years of nursing experience. METHODS: With structural equation modeling, the initial model did not fit the data (chi2/df = 5.45) and was revised. RESULTS: Revisions based on modification indices provided evidence of reliability (alpha coefficients of 0.70-0.94; the majority of R2 values were >0.50) and improved the fit of the model (chi2 difference, 35.54; df difference, 3.76; p < 0.05). Hypothesis testing provided evidence of construct validity. CONCLUSIONS: The 40-item Readiness Estimate and Deployability Index Revised for Air Force Nurses Short Form provides evidence of reliability and validity as a self-assessment measure of deployment preparedness.
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Adaptación Psicológica , Competencia Clínica , Enfermería Militar/educación , Personal Militar/psicología , Enfermeras y Enfermeros/psicología , Psicometría/instrumentación , Programas de Autoevaluación , Adulto , Recolección de Datos , Femenino , Humanos , Masculino , Enfermería Militar/normas , Enfermeras y Enfermeros/normas , Inventario de Personalidad , Autoeficacia , Factores de Tiempo , Estados UnidosRESUMEN
The Readiness Estimate and Deployability Index Revised for Air Force Nurses (READI-R-AFN) was derived from modifications of Reineck's Readiness Instrument. Reliability and validity of the READI-R-AFN was estimated on completed questionnaires of 181 active duty Air Force nurses. The READI-R-AFN was evaluated based on item analysis, internal consistency (alpha coefficient, >0.70), confirmatory factor analysis with structural equation modeling, and hypothesis testing. The findings were supported by Flannery's model of stress resistance. There was evidence of reliability and validity of the 83-item READI-R-AFN based on internal consistency (alpha, 0.80-0.96), structural equation modeling, and hypothesis testing. The original hypothesized six dimensions were retained.