Use of telehealth simulation to teach the enhanced primary care RN role through community/public health-focused simulations.

America is facing a primary care provider shortage. Enhanced primary care RNs (EPC-RNs), registered nurses working at the top of their practice scope, can be an important part of community-based primary care provision. Typically, community health nursing education has not included primary care-based clinical experiences, and there is a clinical site shortage. Teaching students about EPC-RN roles can be an important domain of community/public health nursing education. Simulation is a creative pedagogical approach to learning about the EPC-RN role. The purpose of this manuscript is to 1) describe EPC-RN Telehealth Simulation development; and 2) describe student simulation feedback. Nursing faculty and simulation experts designed five simulations for community health students to teach about the EPC-RN role, incorporating recommendations from the Quad Council Coalition of Public Health Nursing Organizations community/public health nursing competencies and the National Competencies for Registered Nurses in Primary Care. Retrospective, descriptive quantitative, and qualitative student feedback data (n = 519) was collected through QuestionPro over multiple semesters. Student feedback data demonstrated support of the use of the simulations in community/public health nursing education. The EPC-RN Telehealth Simulations prepared pre-licensure nursing students to practice in community-based primary care settings. Innovative, sustainable experiences such as this can improve community/public health nursing education.

Accelerated Ultraviolet Treatment of Carbamazepine and NDMA in Water under 222 nm Irradiation.

Krypton chloride (KrCl*) excimer ultraviolet (UV) light may provide advantages for contaminant degradation compared to conventional low-pressure (LP) UV. Direct and indirect photolysis as well as UV/hydrogen peroxide-driven advanced oxidation (AOP) of two chemical contaminants were investigated in laboratory grade water (LGW) and treated secondary effluent (SE) for LPUV and filtered KrCl* excimer lamps emitting at 254 and 222 nm, respectively. Carbamazepine (CBZ) and N-nitrosodimethylamine (NDMA) were chosen because of their unique molar absorption coefficient profiles, quantum yields (QYs) at 254 nm, and reaction rate constants with hydroxyl radical. Quantum yields and molar absorption coefficients at 222 nm for both CBZ and NDMA were determined, with measured molar absorption coefficients of 26 422 and 8170 M-1 cm-1, respectively, and QYs of 1.95 × 10-2 and 6.68 × 10-1 mol Einstein-1, respectively. The 222 nm irradiation of CBZ in SE improved degradation compared to that in LGW, likely through promotion of in situ radical formation. AOP conditions improved degradation of CBZ in LGW for both UV LP and KrCl* sources but did not improve NDMA decay. In SE, photolysis of CBZ resulted in decay similar to that of AOP, likely due to the in situ generation of radicals. Overall, the KrCl* 222 nm source significantly improves contaminant degradation compared to that of 254 nm LPUV.

Expanding nursing simulation programs with a standardized patient protocol on therapeutic communication.

Simulation is used with greater frequency by nursing programs to strengthen the learning process of student nurses. Best practices suggest active learning with the addition of standardized patients engages the student in realistic lifelike scenario. Therefore, the aim of the research study was to have nursing student's self-evaluate classroom learned communication skills through practical application on a standardized mental health patient simulated scenario. Undergraduate nursing students registered for three successive mental health nursing courses during one academic year were recruited. A self-reported pre/post survey measured the nursing student's level of confidence of learned therapeutic communication skills, preparation to engage their skills in clinical experience, and satisfaction with the standardized patient simulated experience. The self-reported online pre/post questionnaire return rate was 72.5% (N-116). The pre/post results suggest the standardized simulated experience enhanced nursing student confidence  p < .001; the nursing students felt prepared for clinical as noted by the mean score of 7.78 of 10 and overall were satisfied with the simulation process with a mean score of 8.04 of 10. The addition of the standardized patient in a mental health simulated experience promoted an active learning environment that highlighted individualized confidence in therapeutic communication skills through a realistic application process.

Effect of case study versus video simulation on nursing students' satisfaction, self-confidence, and knowledge: A quasi-experimental study.

BACKGROUND: Research on simulation in nursing education has demonstrated the positive impact active, experiential learning has on student satisfaction, self-confidence, and knowledge. As a result, simulation laboratories with high-fidelity human patient simulators have become a common adjunct to clinical teaching. It is important to also promote active learning in the classroom setting; however, there is limited evidence on using video simulations in large classrooms. OBJECTIVES: This study sought to determine if using a video simulated unfolding case study as part of the didactic classroom, as compared to a traditional written case study, improved students' satisfaction, self-confidence, and knowledge. DESIGN: A two-group, quasi-experimental design was used. SETTINGS: The study occurred at a University in the southeastern United States. PARTICIPANTS: A total of 165 baccalaureate nursing students participated. METHODS: The control group received a written case study, while the intervention group received video simulation of the same case study and student satisfaction, self-confidence, and knowledge were measured upon completion. Data analysis used descriptive statistics and t-tests. Qualitative comments were also provided by students and analyzed for themes. RESULTS: There were no statistically significant differences, with both groups reporting a high level of satisfaction and self-confidence. The percent of knowledge questions answered correctly was higher for the video simulation group for all seven questions. Four themes were identified from participant words: A better understanding, Able to apply learning to a patient scenario, Engaged in learning, and Visualizing it helps. CONCLUSIONS: Results suggest the use of video simulation in the classroom may deepen students' understanding of classroom content and provide an additional mode for learning to enhance classroom lecture. Use of video simulation to augment classroom teaching is suggested as a strategy for engaging learners.

Computer-based simulation: Effective tool or hindrance for undergraduate nursing students?

BACKGROUND: Undergraduate nursing programs continuously strive to improve student learning outcomes within the simulation lab experience. As a result, simulation labs are evaluating computer-based simulation programs to engage the millennial student learner. OBJECTIVE: Examine undergraduate nursing student perceptions and experiences when given a computer-based simulation program as a preparation prior to their simulated lab experience. METHODS: A mixed method strategy was used to evaluate the data. Eighty-two senior undergraduate nursing students voluntarily participated in the study and completed the preparation program prior to the students' simulated lab experience. Measures included a retrospective/pretest survey of past simulated experience and posttest survey with focus groups, after the first and last simulation debriefing of the semester. Quantitative and qualitative data were collected and evaluated as separate perspectives and then merged. RESULTS: Analysis of the numeric data suggested the introductory program positively enhanced learning. Narrative data elicited six themes: improved prioritization, role modeled nursing care, individualized preparedness, engaged critical thinking, decreased level of anxiety and increased confidence in the lab. Quantitative and qualitative perspectives suggested that reinforcement of learned concepts through the computer-based simulation scenarios were central to positive student performance during the simulation lab experience. CONCLUSION: Preparatory computer-based simulation programs improved simulation lab experiences by encouraging individualization of student learning and was found to be an effective marker to improve student learning.

Potential Activities of Freshwater Exo- and Endo-Acting Extracellular Peptidases in East Tennessee and the Pocono Mountains.

Proteins constitute a particularly bioavailable subset of organic carbon and nitrogen in aquatic environments but must be hydrolyzed by extracellular enzymes prior to being metabolized by microorganisms. Activities of extracellular peptidases (protein-degrading enzymes) have frequently been assayed in freshwater systems, but such studies have been limited to substrates for a single enzyme [leucyl aminopeptidase (Leu-AP)] out of more than 300 biochemically recognized peptidases. Here, we report kinetic measurements of extracellular hydrolysis of five substrates in 28 freshwater bodies in the Delaware Water Gap National Recreation Area in the Pocono Mountains (PA, United States) and near Knoxville (TN, United States), between 2013 and 2016. The assays putatively test for four aminopeptidases (arginyl aminopeptidase, glyclyl aminopeptidase, Leu-AP, and pyroglutamyl aminopeptidase), which cleave N-terminal amino acids from proteins, and trypsin, an endopeptidase, which cleaves proteins mid-chain. Aminopeptidase and the trypsin-like activity were observed in all water bodies, indicating that a diverse set of peptidases is typical in freshwater. However, ratios of peptidase activities were variable among sites: aminopeptidases dominated at some sites and trypsin-like activity at others. At a given site, the ratios remained fairly consistent over time, indicating that they are driven by ecological factors. Studies in which only Leu-AP activity is measured may underestimate the total peptidolytic capacity of an environment, due to the variable contribution of endopeptidases.