<p> Clinical nursing practice requires intensive education, yet anxiety can interfere with student learning. A gap exists in the nursing literature on how nursing students can manage anxiety during clinical practice. Since the clinical portion of nursing education may be especially anxiety provoking for nursing students, a new teaching strategy has been developed to help reduce anxiety during clinical practice. In this quasi-experimental research study, a new teaching strategy known as mindfulness meditation intermixed with humor was used for four weeks with nursing students to examine whether there was a reduction in anxiety during clinical practice. A sample of 73 male and female junior and senior nursing students from a nursing program at a university in the southern region of the United States completed pretest and posttest questionnaires, which included the Spielberger's State-Trait Anxiety Inventory (STAI), the Mindful Attention Awareness Scale (MAAS), and the Multidimensional Sense of Humor Scale (MSHS). One-way ANOVA and correlation analysis were conducted to assess whether gender, race, and age were significantly related to the measures of STAI, MSHS, and MAAS scores. The findings indicated there was a significant reduction in STAI scores when participants were exposed to the new teaching strategy, which indicated a reduction in anxiety levels of junior and senior clinical nursing students. The results also signified a significant increase in the MAAS and MSHS scores, which revealed that participants became more mindful and humorous when exposed to the new teaching strategy. Implications include the use of mindfulness meditation intermixed with humor being implemented by nurse educators as a teaching strategy in clinical nursing courses to help reduce anxiety levels.</p>

<p> Toastmasters International (TI) is a well-known worldwide association focused on communication skills and leadership development. TI clubs are designed to build confidence in public speaking. Despite the benefits that members gain from joining Toastmasters clubs, the organization is concerned with the factors that affect members' retention in TI. </p><p> This mixed-methods study of TI clubs in Southern California included member surveys completed at club meetings, interviews with club leaders, and the researcher's extensive field notes. A stratified purposeful sampling method was used to ensure that the sample size included each club category and quota of the target population of TI club members and leaders. One hundred twelve members completed the members' survey, representing a 56% response rate of the paid members in the clubs surveyed. Twelve club leaders participated in long semi-structured interviews. </p><p> The findings revealed that members join TI for self-improvement and development in speaking: the purpose of the TI curriculum. The surveys revealed that 45% of the members join TI to improve communication skills and advance their career. Fifty-six percent indicated that constant participation and attendance at TI meetings helped them to overcome their fear of public speaking. Fifty-seven percent of the members stated that they continue their membership with TI to alleviate their fear of public speaking, improve their communication, and participate in speech contests. </p><p> The survey indicated that 64% of the members enjoyed activities that allowed them to speak during the club meetings. Thirty-nine percent of the members surveyed were able to achieve their competent communicator (CC) and competent leader (CL) awards. Another 39% of the members were also in progress of completing these awards. </p><p> The convenience and location of the club was important for members in terms of their attendance. Members attended meetings when there were enough parking spaces, the club was centrally located and accessible to public transportation, and the club was comfortable as well as conducive for club meetings. It is recommended that TI develop facilities requirements to meet the needs of members and encourage them to remain in the club.</p>

<p> The purpose of this quantitative ex-post facto study was to determine if the level of satisfaction is increased over hospitals that do not incorporate PCC services. The study involved the use of archival data from HCAHPS (n.d.) satisfaction surveys analyzed during the first quarter of 2013. The respondents of the study included using archival patient satisfaction survey data from 113 hospitals within the State of Michigan. Fifty-two of these hospitals were identified as providing some level of PCC services to patients, and 61 of the hospitals were identified as not providing PCC services to patients. For each of the research questions, a two-sample t-test was used to compare the mean percentages between hospitals that have implemented PCC services and hospitals that have not implemented PCC services. The use of a two-sample test with all of the research variables did not reject any of the hypotheses for this study. This outcome could indicate that HCAHPS (n.d.) patient satisfactions scores may not be directly linked to PCC services. Although the results for this study did not demonstrate a favorable outcome regarding HCAHPS (n.d.) satisfaction scores and PCC services, the literature review for this study validates the importance for leaders within the health care community who have established PCC services to find other measurements to assess the effectiveness of PCC services, and those who do not to consider the implementation of Patient-Centered Care (PCC) services within their hospitals.</p>

<p> The purpose of this project is to create fun and educational lesson plans for before and after school childcare providers of children in kindergarten through fifth grade. The lesson plan will incorporate aspects of physical activity and nutrition into the basic curriculum for this age group. The nutrition and physical activity curriculum contains four themed weekly lessons. Each lesson incorporates a nutrition discussion, an activity related to the discussion, and one group game. The lessons and activities were designed to incorporate minimal materials so that any facility could easily incorporate them. A committee of nutrition professionals and educators reviewed the curriculum and improvements were made based on their recommendations.</p>

<p> Childhood obesity is a disease that affects 17% of children aged 2-19. This disease, best described by a social ecological perspective, is multifactorial in nature and includes individual, familial, community, and societal contributors. As the causes are multifactorial, so too should be prevention and treatment. Healthcare providers, specifically physicians, can play an important role in the diagnosis, prevention, and treatment of childhood obesity, especially if they appropriately utilize nutrition behavior change counseling to facilitate lifestyle changes. Behavior change falls within the realm of the social and behavioral sciences, disciplines that will receive greater emphasis on the newly designed MCAT 2015^&reg;; therefore, premedical and medical programs may need to alter their approaches to disseminating this discipline-specific knowledge. Nutrition education is currently limited in medical education; and thus, just as premedical programs seek to increase the social and behavioral sciences, so too should they increase nutrition education. In light of these recommended curricular changes, researchers sought to investigate the current state of premedical and medical students. views of childhood obesity. This dissertation describes three studies conducted for that purpose. In study 1, researchers investigated 30 pre-healthcare undergraduate seniors. views of childhood obesity and their sources of knowledge through in-depth qualitative interviews. Investigators found that students with specialized coursework and significant volunteer and/or internship experience had a deeper understanding of childhood obesity; however, as a whole, students failed to see the role of healthcare providers in prevention and treatment. These findings provide justification for premedical programs to guide students to see their role in prevention and treatment through educating them on the social ecological model and providing them with relevant service-learning opportunities and guided reflection. In study 2, researchers conducted a similar nationwide qualitative investigation in 78 third and fourth year medical students. These students described student-, patient- and healthcare system-centered barriers, including their lack of knowledge, patients. lack of access, and their lack of time in practice. Students also requested more applicable information and counseling training in order to equip them to prevent and treat childhood obesity. Much like the pre-healthcare seniors, these medical students failed to discuss their role in prevention and treatment. Therefore, medical schools need to help their students overcome barriers by providing them knowledge and skills and helping them understand their role in prevention and treatment. In study 3, researchers built on the knowledge gained from study 1 and study 2 and developed a valid and reliable computerized tool, the Childhood Obesity Prevention Self-efficacy (COP-SE) survey. Factor analysis of 444 completed surveys from students at 53 medical schools revealed a two factor structure with a correlation of 0.637 between factors. Factor 1 assesses self-efficacy in nutrition counseling while Factor 2 measures self-efficacy to assess readiness to change and initiate nutrition lifestyle changes. There was high reliability within factors (Factor 1 = 0.946; Factor 2 = 0.927), and the correlation (0.648) between the COP-SE survey and a general self-efficacy survey confirmed that the COP-SE measures domain-specific self-efficacy. This valid and reliable survey can be used by medical schools as a formative or summative assessment of students. self-efficacy in childhood obesity prevention and treatment. Further research should include confirming the factor structure and exploring the significance of response trends seen in this sample. The findings of all three studies can be used by premedical and medical programs to maximize the effectiveness of their preparatory programs to provide students with the necessary skills for prevention and treatment of childhood obesity. With the appropriate preparation, future healthcare providers can build their self-efficacy in disease prevention and treatment, hopefully resulting in improved patient outcomes.</p>

<p> Low health literacy impacts an individual's ability to comprehend communication from healthcare providers, reduces access to healthcare, and contributes to increased mortality. The purpose of this study was to evaluate the impact of learning style on adult health literacy education. The health belief model, protection motivation theory, the transtheoretical model, and social cognitive theory were used to analyze the data in this study, and to further develop effective health literacy education. The research questions addressed the effectiveness of educational intervention adjusted to their appropriate learning style in comparison to a standardized health literacy intervention and potential difference, according to type of learning style, in the amount of changed performance between pretest and posttest. A sample of 80 adults in an urban community was recruited through organizations serving low-income individuals. The participants were assessed for baseline health literacy level, followed by identification of learning style, educational intervention, and posttest assessment, which led to determination by <i>t</i> test that changes between pretest and posttest scores were statistically significant between the control group and the study groups. This finding suggests that health education should be delivered to patients according to individual learning style in order for patients to comprehend and retain information provided. Social change implications include healthcare professionals appropriately addressing health literacy so that patients may participate more actively in their personal healthcare decisions to improve healthcare quality outcomes, decrease long-term costs of delivering healthcare services, and improve the general health of the community.</p>

<p> An important goal of nursing education is to produce graduates who are problem solvers and competent clinical practitioners able to practice in a very complicated health care environment; reflection and inquiry are two ways to accomplish this goal. This qualitative study explored how eight senior baccalaureate nursing students developed in their ability to utilize reflection and inquiry at higher stages over time through the use of the online clinical post-conference conducted as an asynchronous discussion board. Transcripts of participant postings were examined weekly to determine the stage of reflection and inquiry displayed and a comparison was done to determine if the stages increased over time. Boud's model of the reflective process and the practical inquiry model of Garrison, Anderson, and Archer provided the theoretical framework for this study. </p><p> Findings from this study demonstrated that participants developed in their ability to utilize reflection and inquiry at higher stages over time by engaging in the online clinical post-conference and that the online clinical post-conference was an effective venue that encouraged the use of reflection and inquiry. The social aspect of the online clinical post-conference (reading others' posts, having others read and comment on their posts, and asking each other questions) was seen as promoting learning from peers. </p><p> Findings of this study could be used by nurse educators to change their pedagogy to produce nurses who learn from experiences and are lifelong learners. Nurse faculty should consider incorporating the use of reflection, inquiry, and the online clinical post-conference in all clinical courses.</p>

<p> Intercultural competence through study abroad is widely recognized as a preferred teaching approach for the development of globally competent health care practitioners. Colleges and universities are looking for multiple ways to encourage students to study abroad because of the noteworthy effects that these experiential opportunities have on students. Sparse research has been conducted to determine if short-term study abroad trips of less than two weeks are achieving these same outcomes. </p><p> The purpose of this basic interpretative qualitative study was to describe the nature and meanings of a short-term international cultural experience for nursing students, and whether or how their understanding of the role of the professional nurse was changed. A group of baccalaureate nursing students traveled to Tanzania and took part in professional and social opportunities over an 8-day period. All participants were required to complete a nursing course with global objectives prior to the trip and pre-immersion seminars. Data were collected from reflective journals during the study abroad experience, focus group discussions one month after returning home, and personal interviews 6 months later. The results indicated that the participants experienced culture shock, but they also gained in self-awareness, cultural empathy, leadership skills, a desire to learn more, and a new perspective of the role of the professional nurse. Langer's theory of Mindfulness, Bennett's Developmental Model of Sensitivity and Campinha-Bacote's Process of Cultural Competence provided the theoretical framework for this study.</p>

<p> <b><u>Background and Objective:</u></b> Lead exposure effects on IQ are well known, and detrimental impact of lead exposure on reading, math and school progress have been described. We evaluated the relationship between blood lead levels (BLLs) and kindergarten reading readiness in a diverse urban school population.</p><p> <b><u>Methods:</u></b> School administrative data and Phonological Awareness and Literacy Screening Kindergarten (PALS-K) test scores, measures of kindergarten reading readiness, for children attending public school kindergarten in Providence, Rhode Island were linked to Department of Health BLLs. Children with at least one BLL and reading readiness scores in both the fall and spring were included in the study (N=3,406). Fifty-nine percent (59%) were Hispanic. Data were analyzed using multiple linear and logistic regression with progressive levels of adjustment.</p><p> <b><u>Results:</u></b> The median geometric mean (GM) BLL was 4.2 (IQR 2.9-6.0)&mu;g/dL. In the fall, children whose BLLs were 5-9 and &ge;10&mu;g/dL were 1.44 and 2.51 times more likely to fail to achieve fall benchmark for reading readiness [OR 1.44 (95%CI 1.23, 1.69) and OR 2.51 (95%CI 1.86, 3.40)] compared to children whose BLLs were 0-4&mu;g/dL. Fall reading readiness scores were decreased by 4.5 and 10 points for children with BLLs in the 5-9 and 10+&mu;g/dL categories, respectively, compared to children with BLLs 0-4&mu;g/dL [-4.5 points (95%CI -6.2, -2.9) and -10.1 points (95%CI -13.3, -7.0)]. In the spring, children who had scored below the fall benchmark and who had GM BLLs &ge;5&mu;g/dL were approximately 1.5 times more likely to fail to achieve the benchmark compared to children with BLLs &lt;5&mu;g/dL. For children who achieved the fall benchmark, BLLs were not associated with an increased risk of failure in the spring.</p><p> <b><u>Conclusions:</u></b> Children who enter kindergarten with low levels of reading readiness and GM BLLs of >5&mu;g/dL are at increased risk for failure to make adequate progress.</p>

<p> The backcountry skiing population has increased significantly over the past ten years. Current sales of backcountry ski and rescue gear outpace more traditional alpine, telemark, and snowboarding equipment. As higher numbers of people head into avalanche terrain more fatal accidents are occurring, human triggered avalanches being the primary cause of death. In the late 1980s there were an average of 11 avalanche related deaths per year in the United States. That number has risen to an average of 30 over the past five years. Over that time avalanche specific rescue gear has been quick to adapt to the changing needs of backcountry skiers. However, over that same period of time theoretical approaches to risk management have been slow to adjust to the community's changing needs. Consequently, this study examined the preemptive decisions and the risk perceptions skiers held as they prepared to enter Tuckerman Ravine. Results show that 69% of the survey population did not have formal avalanche training. Despite significant technological advances 56% of the survey population did not have everyone in their group carry a beacon, shovel and probe. Fifty-one percent of the survey population strongly disagreed with frequent beacon practice. However, a skier was more likely to practice with their beacon if they had taken a formal avalanche course. Women were less likely to feel as though the trip were a failure if goals were not met. Additionally, the underrepresentation of women in this study (<i>n</i>=4) required an assessment of broader gender disparities within the backcountry skiing community. Quantitative and qualitative results show a lack of female leadership among recreational backcountry skiers. This leadership gap limits mentoring opportunities and decreases accessibility to the community for novice female backcountry skiers. The lack of gender diversification has significant affects on the decision-making process. This study concludes that dual-process cognitive methods and multilayered risk management protocols can increase margins of safety and encourage diverse perspectives within the larger backcountry skiing community. This paper suggests that because backcountry skiing involves the interconnection between complex adaptive systems and complex physical systems skiers should adopt a systems thinking approach to their decision-making processes.</p><p> <i>Keywords:</i> Systems thinking, avalanches, dual-process cognition, complexity, preemptive decision making, risk management, female backcountry leadership, risk perception, human triggered avalanches.</p>