Medical residency is a time of high stress, long hours, high case loads, fatigue, and lack of free time. Burnout rates among residents have been reported to be between 25-76%. Scant literature exists in regard to resident stress and its impact on learning and attrition during residency. The theory of margin posits that a healthy margin is necessary for adults to learn. Healthy margin exists when a person’s ratio of burdens over resources creates a surplus of energy. This study sought to determine if there was a difference between emergency medicine (EM) residents’ margin in life scores and remediation, at risk for remediation, and those considering leaving their emergency medicine residency training. Volunteer EM residents (n = 279) completed the Margin in Life Scale for Emergency Medicine (MILS EM) questionnaire, which measures six life areas: Health/Body, Religion/Spirituality, Self-Confidence, Interdependence, Parenting, and EM Work. Residents self-reported if they were considering leaving EM training and program directors provided remediation, at risk for remediation, and attrition rates. The mean MILS EM score among the 273 included EM residents was .64, which is within the recommended healthy range of .30 to .80. Additionally, all mean subscale scores fell within the healthy range. Only 13% of residents were reported as being on remediation, MILS EM (M=.63) with no statistically significant differences between those on remediation versus those not. Only 6% of residents were reported as being in jeopardy of remediation, MILS EM (M=.63) versus those not at risk (M=.64). Finally, only 5% of EM residents self-reported considering leaving EM training and no residents left their training program. Women scored lower on the MILS EM, and the life areas Health/Body (p Results of this study suggest that EM residents appear to have sufficient margin overall and in each of the life areas. Few were on or at risk for remediation and even fewer reported they were considering leaving EM residency training. As females scored lower in some of the life areas, further investigation is needed to determine if there are characteristics in the work environment that affect women differently than men.

The purpose of this study was to determine which factors and the degree to which these factors influenced the Joint Committee when deciding how much money should be allocated to the different services funded by the Ryan White CARE Act. This study focused on the possible explicit and implicit factors influencing the decision-making process and interactions of the members of the HIV/AIDS Joint Prioritization & Allocation Committee in the decisions that were being made on behalf of the people who are infected and affected by this disease. The methodology included a combination of quantitative and qualitative data, utilizing surveys, coding of communicative behavior, one-on-one interviews and researcher observations. The surveys and interviews were the primary sources of data. The findings indicated that both explicit and implicit factors influenced decisions. A significant difference was found to exist between clients and committee members for the priority ranking of services. A significant difference also existed between the committee's perception and staffs perception of which factors were most important. The influence that the committee members may have had with one another during discussions was not enough to cause any significant changes in the way they weighed the importance of the factors. The majority of the committee members reported that they relied on recorded data sources such as the needs assessment, epidemiological data, and client utilization of services, rather than their personal experience or HIV status, however this was not totally substantiated by the interviews. Persons living with HIV admitted that their HIV status was a strong factor influencing their decisions. Most participants reported feeling respected and empowered in the surveys, however during the interviews some felt that they were not being listened to adequately. This finding was supported by the interaction analysis. The results indicated that there is a need for more training and mentoring, particularly for those who are new to the process. Some participants reported there is a need to conduct more business on a joint basis to reduce redundancy and duplication of effort. There is also a need to recognize the importance of the influence of the staff members who provide the committee with the information that is used to make the decisions.

The subject of religion in public schools has always been controversial. America is a religiously diverse society, and one of the fundamental documents of this country, the Constitution of the United States, prohibits the establishment of a single religion which may seek to influence or control the ―free exercise‖ of all religions. Indeed the discussion of religion in school is very extensive. The subject includes, but is not limited to the discussion of students‘ religious expression, prayer in school, students‘ religious accommodations, the right of the student to distribute religious literature, as well as the rights of students to form religious clubs. The objective of this research study was to refine the very broad discussion of religion and religious liberties in public schools to the narrow subject of how teaching about religion is viewed in the public schools. Furthermore, given the current world‘s conflict with members of the Islamic faith and the increasing Muslim population in the United States, the study about Islam is a fundamental subject of inquiry for today‘s students who require a more global outlook. Primary to the study of whether teaching about religion is constitutional, which it is, an examination of how teachers, administrators, and school board members approach the subject, implement the policy, and prepare teachers for the task, was the focus of this research. Using a mixed methods methodology, I collected and analyzed quantitative and qualitative data from a sample total of 1,054 Florida social studies teachers. Overall, the results of the findings were that the surveyed teachers were open to teaching about all religions. However, their training and level of understanding of the content material required to accomplish the tasks were deficient. Recommendations included the designing of appropriate pre-service and in-service training programs for teachers who have responsibilities for teaching about various religions.

Recent studies show that more than one-third of U.S. adults (over 72 million people) were obese in 2005–2006. This includes 33.3% of men and 35.3% of women. Obesity is a primary factor in the development of metabolic syndrome, a condition that places individuals at high absolute risk of mortality and morbidity. The use of a nutritionally balanced diet aimed at weight reduction has the potential to decrease the prevalence of obesity, therefore reducing the incidence of metabolic syndrome and its consequences. The purpose of this project was to investigate whether individual nutrition counseling would improve the outcomes of patients with metabolic syndrome. A transdisciplinary team of faculty and graduate students from nutrition and nursing served as consultants and educators at a clinic for the uninsured in a southeastern city in the United States. This study was a one-group before-and-after design, with baseline data obtained on patients prior to the practice change. The study ran for six months. The intervention was an evidence-based practice change incorporating intensive dietary program for 19 patients with metabolic syndrome and an evaluation of the effect of that change on lipoproteins, glucose, blood pressure, weight, and waist circumference. Although there were no positive changes in weight or waist circumference, the participants did enjoy a significant decrease in blood pressure, fasting glucose and plasma lipids. None of these changes were significantly associated with the dietary intervention. Based on the most current evidence, the most effective way to reduce risks associated with metabolic syndrome is weight reduction, adequate nutrition, and exercise.

Attrition from schools of nursing continues to affect almost one third of students enrolled. Attrition is costly financially and personally to the student, to the educational institution, the health care consumer and the profession. The purpose of this study was to identify variables measurable at time of admission which might alone or together be predictive of successful persistence until graduation from a nursing program. The variables included cognitive and noncognitive characteristics measured by the Nurse Entrance Test (NET) as well as demographic and other academic achievement measurements. A convenience sample of associate degree nursing students admitted into two successive classes of a large, urban community college was used. Two hundred sixty seven students participated, with successful students defined as those who succeeded in each course of the program and continued in enrollment in an uninterrupted fashion until graduation. Cognitive factors included preadmission grade point average (GPA), California Achievement Test score, and measurements on the Nurse Entrance Test (NET) for Math Skills, Reading Comprehension and Rate, Testtaking Skill and Preferred Learning Style. Noncognitive factors were NET self-perceived scores on five areas of Life Stress and a Social Interaction Profile of passive and aggressive styles. Demographics were age, gender and race. Using univariate analysis of variance and discriminant analysis, the same six characteristics were found to be significantly different between the groups of successful and nonsuccessful students and predictive of success or nonsuccess: Reading Comprehension, preadmission GPA, age and stress in three areas -academic, family and social. When a discriminant analysis using a stepwise inclusion procedure was performed, these six were included among the ten variables found together to be useful in a prediction equation. Added to these six were Testtaking Skill, Money Stress, Social Interaction Profile and gender. By measurements in all types of analyses used, Academic Stress and Reading Comprehension were consistently the strongest of the predictors of group membership. Group membership was successfully predicted in 74.33% of the cases when the reduced set of ten variables was used. Findings from this research could be used as a basis for developing a risk profile for students either for use in making admission decisions or for identifying students at risk for nonsuccess. Nursing educators should become alert to the finding that the students in this study were at risk for failure because of noncognitive as well as because of cognitive characteristics. Future research could focus on the multifactorial influences in a student's life which affect success. Research could focus also on the examination, implementation and evaluation of intervention strategies designed to increase retention and improve academic performance.

Members of the school community should work collaboratively in the educating of students. Teachers and principals must understand that their traditional roles have changed and improved organizational teamwork will be fostered by all members of the learning community assuming decision making roles. Toward this end, the purpose of this correlational study was to explore the relationship between teachers' perceptions of the leadership behaviors of Duval County secondary school principals and their perceptions of the level of shared decision making practiced in their schools. This study provides insight into principal behaviors which nurture participation. Leadership behavior was operationalized by the responses to each of the five practices on the Leadership Practices Inventory [LPI] (Kouzes & Posner, (1997). These behaviors were (a) challenging the process, (b) inspiring a shared vision, (c) enabling others to act, (d) modeling the way, and (e) encouraging the heart. The level of shared decision making was measured by responses to the Shared Educational Decisions Survey-Revised (Ferrara, 1994) in the areas of (a) planning, (b) policy development, (c) curriculum and instruction, (d) student achievement, (e) pupil personnel services, (f) staff development, and (g) budget management. The population for the study was a sample selected from all secondary schools in the Duval County Public School System. Schools with principals who had served in their schools two or more years were selected for the study. The sample consisted of 646 participants from 26 schools. Pearson product-moment correlations were generated for each of seven questions. A total of 34 significant relationships between the leadership behaviors of the principal and the level of shared decision making were identified. The significant correlations ranged between .096 and .191. These weak correlations demonstrate that the principals' leadership practices only explained between one percent and four percent of the variance in the level of shared decision making. Therefore, there was very little relationship between the leadership behaviors of the principal and the level of shared decision making in schools. A possible explanation of the weak relationships discovered for each of the seven research questions may relate to the construct of the principals' leadership behaviors used in the study. From a more speculative perspective, individual leadership behaviors of school principals may have less influence on the decision making culture than the organizational structure and culture of the schools and school district. The findings of this study provide implications for the leadership of school principals as they implement shared decision making in their schools. Principal training programs must provide prospective principals with experiences which will nurture the skills necessary to promote dynamic learning communities. Furthermore, in order to encourage their involvement, teachers must also be trained in this area. Tomorrow's principals must develop collaborative, professional cultures characterized by shared governance. Educational leaders should continue to construct deeper understandings of these professional learning communities.

Proper handwashing is one of the simplest, most affordable and effective means of stopping the spread of infection. Due to the close proximity of children in schools and child care settings, there is a high risk for the spread of infectious disease. The purpose of this project was to improve handwashing behaviors of three to six year old children in a community school setting by implementing an evidence based multi-activity handwashing education program. The objective was to increase understanding of the relationship between germs and handwashing, as well as increase the frequency and correct technique procedure of handwashing behavior in children in the community. The evidence based handwashing education program was implemented over several weeks and included multiple activities that were found in the literature to be effective. These activities included a lecture and presentation, a return demonstration, a Glo Germ™ training device, and a video and story on handwashing. The results of the statistical analysis found that the program was effective in increasing both the frequency and correct technique procedure of the children. Most parents (80%) reported that they noticed an increase in how often their child washes his/her hands. A majority of parents (83%) noticed an increase in the duration of how long their child washes his/her hands; a larger majority (90%) noticed a decrease in how often they needed to prompt their child to wash his/her hands. Nurses working collaboratively with other disciplines in the community can implement evidence based practice handwashing education programs in a variety of public child care settings. The effects of the handwashing programs may significantly decrease child healthcare costs associated with prescriptions, visits to the provider, hospital admissions and emergency room visits and influence positive health promotion behaviors in children. Implementing affordable and effective handwashing education programs can lead to a reduction in infectious diseases, absenteeism, antibiotic resistance and health care costs. By fostering positive health promotion practices, such as proper handwashing behaviors in children, habits may be instilled that carry into adulthood. These habits can increase the health of a child and the community.

The purpose of this study was to explore the experiences of new professionals in college student affairs as protégés in mentoring relationships. This study was designed as an exploratory study into the types of mentoring relationships that exist among college student affairs professionals, using Q methodology. The profession of college student affairs can use mentoring relationships to help recruit, train, develop, and retain high-quality individuals. Although mentoring relationships are frequently used to develop college student affairs professions, little is known about these relationships. Fifty-five new professionals in college student affairs from 29 different states sorted 39 statements describing mentoring relationships on a continuum from “least like my mentoring relationship” (-4) to “most like my mentoring relationship” (+4). These 55 sorts were factor analyzed and rotated. Following these procedures, four factors emerged that represented different perspectives on mentoring relationships in college student affairs. Interpretation of these factors yielded distinct themes within them. These factors were named: (a) Mentor as Ideal, (b) Mentor as Cheerleader, (c) Mentor as Friend, and (d) Mentor as Teacher. The results of the study, which intended to elicit the subjectivity of new college student affairs professionals regarding their mentoring relationships, suggest that college student affairs professionals value, in different ways, the interaction with their mentor. The results from this study suggest the personal interaction between a protégé and a mentor is a valuable part of a protégé's career. Additionally, the results from this study seem to indicate that mentoring relationships in college student affairs are, on balance, positive. The results also suggest that mentoring relationships in college student affairs are highly developmental. The perspectives described and the interpretation provided in this study can greatly assist student affairs professionals in the development of new professionals.

Proper collection of blood cultures is needed to identify pathogens causing serious infections and direct appropriate antibiotic therapy. Blood culture contamination can lead to longer hospital stays, incorrect antibiotic treatment, additional testing, and overall increased costs for the patient and hospital. Blood culture collection technique is the most important factor affecting contamination rates. The purpose of this project was to determine the effect of simulation reinforcement of blood culture collection processes on the rate of contamination of blood cultures drawn by nurses in a community medical center emergency department. This one-group before-and-after cohort study utilized a convenience sample of 50 nurses who collect blood cultures on adult clients. Each participant completed a pretest, attended a simulation in-service class, and completed a posttest immediately after the simulation and again one-month later. There was significant knowledge gained from pretest to immediate posttest, with no significant decrease in knowledge at I-month post-intervention. The 3-month blood culture contamination rate was 3.26% prior to the intervention, 4% during the intervention period, 3.7% after the intervention, and 2% in months 4 aI1d 5 postintervention. The use of simulation in the professional development of practicing nurses has the potential to improve clinical practice performance and patient outcomes.

Education researchers suggest that, since belief systems influence practicing teachers' behavior, it is important for teachers to examine their educational beliefs to determine whether those beliefs are consistent with current knowledge about teaching and learning. If the same relationship between beliefs and practices of inservice teachers holds true for preservice teachers, since beliefs are extremely resistant to change, reflection upon educational beliefs should be cultivated during the preservice stage of teacher development. To discover whether such a parallel exists, 12 preservice teachers, during their internships, were selected for study. First, they responded to a series of vignettes to ascertain beliefs about five instructional strategies. Second, a content analysis of the the interns' lesson plans was conducted to determine their instructional practices. Finally, 7 of the 12 interns were interviewed to explore consistencies and discrepancies. The study's results indicate that the findings of research studies documenting a connection between educational beliefs and instructional practices of inservice teachers also hold true with regard to preservice teachers. The study suggests that teacher education programs embrace and operationalize the proposition that encouraging reflective thought in teacher candidates is critical to enhancing their professional preparation.