Alliance for Clinical Education (ACE): setting community standards through collaboration.

Today's clinical nursing education challenges center around managing complex issues related to clinical placements. The increased numbers and varying levels of nursing students, acuity and intensity of the clinical setting, and rise of regulatory and accrediting mandates provided impetus for the establishment of the Alliance for Clinical Education (ACE). This article describes community standards established by partnering educational programs and clinical agencies in the Denver, Colorado, and surrounding areas. ACE is successfully confronting the challenges of effectively using scarce clinical placements, validating student orientation mandates, and facilitating the availability and development of qualified clinical faculty. Examples of tools and resources created by ACE to provide uniformity in meeting mutual expectations and requirements are described. The power of collaboration and sharing expertise is described by current initiatives, which reflect the ability to influence policy and shape community standards to support excellence in clinical nursing education.

Angry drivers: a test of state-trait theory.

Tested hypotheses from state-trait theory applied to anger while driving. College student drivers high in trait driving anger were compared to drivers low in trait driving anger. High anger drivers were more frequently angered in day-to-day driving (frequency hypothesis). They reported more intense anger in their most angering driving situations, when visualizing provocative driving events, and in day-to-day driving (intensity hypothesis). Driving diaries and surveys showed they engaged in more aggressive behavior and expressed their anger through more verbal, physical, and vehicular means (aggression hypothesis). They reported handling of their anger less well when visualizing provocative events and on the Adaptive/Constructive Expression scale (reduced adaptive expression hypothesis). They engaged in risky behavior (risky behavior hypothesis) and experienced more moving violations, close calls, and losses of concentration, but not more major or minor accidents (partial support for crash-related outcomes hypothesis). High anger drivers were more generally angry and impulsive and employed more negative, less controlled forms of general anger expression. Results supported state-trait theory and added to the literature showing that high anger drivers have some other psychological and behavioral characteristics that may interact negatively with anger behind the wheel.

Anger, aggression, and risky behavior: a comparison of high and low anger drivers.

This research tested hypotheses from state-trait anger theory applied to anger while driving. High and low anger drivers drove equally often and as many miles, but high anger drivers reported more frequent and intense anger and more aggression and risky behavior in daily driving, greater anger in frequently occurring situations, more frequent close calls and moving violations, and greater use of hostile/aggressive and less adaptive/constructive ways of expressing anger. In low impedance simulations, groups did not differ on state anger or aggression; however, high anger drivers reported greater state anger and verbal and physical aggression in high impedance simulations. High anger drivers drove at higher speeds in low impedance simulations and had shorter times and distances to collision and were twice as likely to crash in high impedance simulations. Additionally, high anger drivers were more generally angry. Hypotheses were generally supported, and few gender differences were noted for anger and aggression.

Cognitive-behavioral treatment of high anger drivers.

Relaxation and cognitive-relaxation interventions were compared to a no treatment control in the treatment of high anger drivers. The cognitive portion of the cognitive-relaxation condition adapted the style of Beck's cognitive therapy, particularly use of Socratic questions and behavioral experiments and tryouts, to driving anger reduction. Both interventions lowered indices of driving anger and hostile and aggressive forms of expressing driving anger and increased adaptive/constructive ways of expressing driving anger. The cognitive-relaxation intervention also lowered the frequency of risky behavior. Both interventions lowered trait anger as well. Limitations and implications for treatment and research were discussed.

The driving anger expression inventory: a measure of how people express their anger on the road.

Four ways people express their anger when driving were identified. Verbal Aggressive Expression (alpha=0.88) assesses verbally aggressive expression of anger (e.g., yelling or cursing at another driver); Personal Physical Aggressive Expression (alpha=0.81), the ways the person uses him/herself to express anger (e.g., trying to get out and tell off or have a physical fight with another driver); Use of the Vehicle to Express Anger (alpha=0.86), the ways the person uses his/her vehicle to express anger (e.g., flashing lights at or cutting another driver off in anger); and Adaptive/Constructive Expression (alpha=0.90), the ways the person copes positively with anger (e.g., focuses on safe driving or tries to relax). Aggressive forms can be summed into Total Aggressive Expression Index (alpha=0.90). Aggressive forms of expression correlated positively with each other (rs=0.39-0.48), but were uncorrelated or correlated negatively with adaptive/constructive expression (rs=-0.02 to -0.22). Aggressive forms of anger expression correlated positively with driving-related anger, aggression, and risky behavior; adaptive/constructive expression tended to correlate negatively with these variables. Differences in the strengths of correlations and regression analyses supported discriminant and incremental validity and suggested forms of anger expression contributed differentially to understanding driving-related behaviors. Theoretical and treatment implications were explored.