Cardiovascular disease remains the leading cause of mortality in the United States, and a primary educational objective is to develop professional competency among nurses to ensure the provision of safe and effective care to the cardiac patient. Benner's theory of novice-to-expert led to the development of an evidence-based scenario for the care of the patient with chest pain using risk-free high-fidelity simulation environments that focused on assessment, history taking, and communication, while evaluating improvements in the competency of nurses providing care to chest pain patients. Thirty-six nurses volunteered in the study. Feedback from nurse educators, which led to modifications to the scenario, preceptor evaluation of participants during simulation, and post simulation feedback of participants, were analyzed using an inductive and exploratory theme analysis. Participants reported they learned meaningful information but felt somewhat confused regarding the correct course of action when multiple events occurred simultaneously. Preceptors' feedback identified participant failure to meet stated scenario expectations. Quantitative analysis of data, using one sample t test, compared the pre- and post-test scores measuring participant knowledge on assessment, history taking, and communication. Although knowledge scores increased, the difference was not clinically significant based on the negative feedback from both preceptor and participants. Accurate appraisal of nurses' competency in assessment, history-taking, and communication skills is needed prior to exposure to simulation. Simulation scenarios may be more clinically significant when tailored to an individual participant's competency levels.

This research consisted of two studies. The purpose of the first study was to examine the presence and quality of fidelity of implementation as reported in recent early reading intervention research. A comprehensive search of kindergarten through third-grade reading interventions published between the years 2005 and 2011 was conducted. Articles that met the inclusion search criteria were analyzed according to fidelity dimensions. Findings from the first study indicated an increase in fidelity reporting from 2001 to 2005. Few articles, however, analyzed the relationship between fidelity of implementation and student outcomes. While there has been an increase of early reading intervention studies reporting fidelity, there is a lack of studies reporting fidelity in relation to student outcomes. Many studies are reporting multiple dimensions of fidelity, but few studies assess the program differentiation dimension. The second study was an exploratory study focused on the fidelity dimension of program differentiation as applied to two early reading interventions from an experimental study. A fidelity observation instrument was created using evidence-based reading practices. The fidelity observation instrument was then used to evaluate instructional practices, teacher responsiveness, and student engagement of an experimental and comparison reading intervention at three time points to examine program differentiation. Latent constructs were created using exploratory factor analysis and were then used to compute an effect size called the achieved relative strength index, which is the difference between two experimental conditions. Findings from the exploratory factor analysis in the second study indicated items loaded onto three latent constructs: (a) instructional practices, (b) teacher responsiveness, and (c) student engagement. The instructional practice achieved relative strength index effect size was large for the experimental group. The achieved relative strength index effect size for both teacher responsiveness and student engagement was small, indicating little difference between the two conditions. The second study in this research endeavor addressed that gap by applying the achieved relative strength index effect size to an early reading intervention study and demonstrating one way to capture program differentiation. Finally, implications for future research were addressed as part of the study.

"A thesis submitted in partial fulfillment of the requirements for fellowship in the Insurance institute of America, incorporated." / Bibliography: p. 87-88.

"A thesis submitted in partial fulfillment of the requirements for fellowship in the Insurance institute of America, incorporated." / Bibliography: p. 87-88.

No description available.

Beneficial consumer outcomes are most likely when behavior-analytic interventions are implemented with high procedural fidelity (i.e., degree to which the procedure is implemented as intended). Video self-monitoring, which involves teaching staff members to monitor their own procedural fidelity when watching recordings of themselves, can be used to improve and maintain high procedural fidelity, but video self-monitoring requires additional staff time and resources. In-vivo self-monitoring, which involves monitoring procedural fidelity during or immediately following implementing a behavior-analytic intervention, could be a cost-effective option. However, in-vivo self-monitoring needs additional research to understand its effects on procedural fidelity. This current study analyzed the effects of in-vivo self-monitoring on the procedural fidelity of three behavior technicians implementing discrete trial instruction with children with autism. We used a nonconcurrent multiple baseline across participants design to teach participants how to score their procedural fidelity during their discrete trial instruction session. Data suggested that in-vivo self-monitoring was effective for two out of three participants, and those two participants were more likely to be accurate in their self-scored procedural fidelity. Procedural fidelity for the third participant did not increase with in-vivo or video self-monitoring, and the third participant was less likely to be accurate in their self-scored procedural fidelity. During baseline and intervention, two out of three participants were more likely to error on the consequence portion of discrete trial instruction. Results of this evaluation were used to inform the supervisors about the efficacy of self-monitoring for each staff member, and implications of using self-monitoring in practice is discussed.

The extent to which interventions are implemented as intended is called treatment integrity (TI). Given that it is unreasonable to expect 100% TI in applied settings, a through understand of TI is essential to appropriately train teachers. This understanding must include the types of TI errors that may be committed and how these effect student learning. It is essential to study TI errors because of the real-world implications for students, including eligibility decisions for special education services, which are based upon students’ responses to inventions. It is not possible to make educational decisions on intervention effectiveness unless it is clear that evidence-based practices have been implemented accurately. If TI is low, it is impossible to determine which services and interventions a student requires. Further, measuring the fidelity with which interventions are applied allows for a more thorough and accurate understanding of which components of an intervention are effective, necessary, and feasible. A broader understanding of which TI errors are most significant, as well as measuring the necessary levels of TI, will lead to more accurate information about how to implement evidence-based practices. The purpose of this study is to gain a more nuanced understanding of TI failures in the form of errors of commission and the role commission errors have on participant responsiveness (Power, 2005). This study extends the results of DiGennaro Reed et al. (2011) by including an intermediate (80%) level of TI which may more accurately represent an attainable level of TI in applied settings. For two of four students, more errors of commission were related to lower skill acquisition. For the other two students, idiosyncratic patterns of responding emerged.

With its widespread use across the country and increasing evidence of its effectiveness, the wraparound process has been accepted widely as a feasible alternative to restrictive residential treatments for children with severe emotional and behavioral disorders. Yet wraparound has been implemented and conceptualized in such a variety of ways that many have begun to question whether it truly is a single definable approach. Recently, a conceptual model for wraparound was offered that included ten essential elements as the key ingredients for this approach. Subsequently, the Wraparound Fidelity Index (WFI) was designed to measure the degree to which an intervention adheres to these ten elements. The purpose of the current study was to use data collected via the WFI to provide the first empirical test of wraparound’s conceptual model. Programs providing wraparound to children with severe emotional and behavioral disorders and their families used the WFI to collect data from caregivers (n = 481), youths (n = 355; 11 to 19 years), and resource facilitators (n = 610). Confirmatory factor analysis (CFA) was used to test the fit of a series of structural models consistent with the proposed element model of wraparound. First, CFA models were examined separately for each of the elements. Second, CFA models that represent the full wraparound model were tested, separately for each of the three informants. And third, a multitrait-multimethod (MTMM) analysis was conducted using a final CFA model including all elements (traits) and the three informants (methods). Findings supported the majority of elements and WFI items when tested separately at the first step. However, at the second step, only the youth model provided adequate fit to the data. Significant modification was necessary to yield admissible solutions for the caregiver and resource facilitator models. Finally, an inadmissible solution resulted when the three informants and revised model were tested in step three. Implications of the findings for the wraparound process, the WFI, and future research are discussed.

No description available.

Thesis (Master of Engineering) University of Florida, Summer 1992. / "Summer 1992." Description based on title screen as viewed on March 30, 2009. Includes bibliographical references (p. 80-81). Also available in print.