Safety in numbers 4: The relationship between exposure to authentic and didactic environments and nursing students' learning of medication dosage calculation problem solving knowledge and skills.

Advancing the art and science of education practice requires a robust evaluation of the relationship between students' exposure to learning and assessment environments and the development of their cognitive competence (knowing that and why) and functional competence (know-how and skills). Healthcare education translation research requires specific education technology assessments and evaluations that consist of quantitative analyses of empirical data and qualitative evaluations of the lived student experience of the education journey and schemata construction (Weeks et al., 2013a). This paper focuses on the outcomes of UK PhD and USA post-doctorate experimental research. We evaluated the relationship between exposure to traditional didactic methods of education, prototypes of an authentic medication dosage calculation problem-solving (MDC-PS) environment and nursing students' construction of conceptual and calculation competence in medication dosage calculation problem-solving skills. Empirical outcomes from both UK and USA programmes of research identified highly significant differences in the construction of conceptual and calculation competence in MDC-PS following exposure to the authentic learning environment to that following exposure to traditional didactic transmission methods of education (p < 0.001). This research highlighted that for many students exposure to authentic learning environments is an essential first step in the development of conceptual and calculation competence and relevant schemata construction (internal representations of the relationship between the features of authentic dosage problems and calculation functions); and how authentic environments more ably support all cognitive (learning) styles in mathematics than traditional didactic methods of education. Functional competence evaluations are addressed in Macdonald et al. (2013) and Weeks et al. (2013e).

Safety in numbers 6: Tracking pre-registration nursing students' cognitive and functional competence development in medication dosage calculation problem-solving: the role of authentic learning and diagnostic assessment environments.

Tracking the progress of pre-registration nursing students' medication dosage calculation problem-solving (MDC-PS) competence development is critical both to ensure achievement of professional and regulatory requirements and to evaluate the validity and reliability of nursing education preparation programmes. This paper focuses on the outcomes of a three-year professional healthcare education evaluation study that tracked the progress of 210 nursing students following the foundation programme and child, adult, mental health and learning disability branch programmes of a UK undergraduate pre-registration nursing degree programme. Outcome measures indicated that despite many students displaying a range of arithmetical deficits on entry to the undergraduate programme, exposure to the safeMedicate environment and practice based learning environments facilitated all 210 participants demonstration of:

Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure.

BACKGROUND: Heart failure, a condition predominantly affecting the elderly, represents an ever-increasing clinical and financial burden for the NHS. Cardiac rehabilitation, a service that incorporates patient education, exercise training and lifestyle modification, requires further evaluation in heart failure management. AIM: The aim of this study was to determine whether a cardiac rehabilitation programme improved on the outcomes of an outpatient heart failure clinic (standard care) for patients, over 60 years of age, with chronic heart failure. METHODS: Two hundred patients (60-89 years, 66% male) with New York Heart Association (NYHA) II or III heart failure confirmed by echocardiography were randomised. Both standard care and experimental groups attended clinic with a cardiologist and specialist nurse every 8 weeks. Interventions included exercise prescription, education, dietetics, occupational therapy and psychosocial counselling. The main outcome measures were functional status (NYHA, 6-min walk), health-related quality of life (MLHF and EuroQol) and hospital admissions. RESULTS: There were significant improvements in MLHF and EuroQol scores, NYHA classification and 6-min walking distance (meters) at 24 weeks between the groups (p<0.001). The experimental group had fewer admissions (11 vs. 33, p<0.01) and spent fewer days in hospital (41 vs. 187, p<0.001). CONCLUSIONS: Cardiac rehabilitation, already widely established in the UK, offers an effective model of care for older patients with heart failure.

The learning curve: the advantages and disadvantages in the use of focus groups as a method of data collection.

Focus groups are not simply a discussion between people, but are focused interviews exploring interactions between participants. In this paper, Ian Mansell, Glynis Bennett, Ruth Northway, Donna Mead and Laurie Moseley explore the complexities and practicalities of using focus groups in research, with reference to a study of palliative care services.

Exploring doctor and patient views about risk communication and shared decision-making in the consultation.

BACKGROUND: There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice. OBJECTIVE: To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process. DESIGN: Qualitative analysis of semi-structured interview data. SETTING AND PARTICIPANTS: Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software. RESULTS: Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study. CONCLUSION: Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.