Self-directed learning: faculty and student perceptions.

This article reports the results of a qualitative study that explored faculty and student perceptions of self-directed learning (SDL) and investigated factors that facilitate or impede it. This study was conducted at McMaster University with faculty and students in a 4-year undergraduate nursing program. Data were collected from 47 faculty and 17 students by means of focus groups that were audiotaped and transcribed. Content analysis was conducted to identify common themes in faculty and student transcripts. The themes that emerged provide insight into the educational strategy of self-directed learning and can be summarized by the following major points: (1) commitment to SDL requires students and faculty to understand the value of empowering learners to take increased responsibility for decisions related to learning; (2) students engaged in self-directed learning undergo a transformation that begins with negative feelings (i.e., confusion, frustration, and dissatisfaction) and ends with confidence and skills for lifelong learning; and (3) faculty development is important to ensure high levels of competency in facilitating self-directed learning.

Two MHC surface amino acid differences distinguish foreign peptide recognition from autoantigen specificity.

KRN T cells can recognize two self MHC alleles with differing biological consequences. They respond to the foreign peptide RN(42--56) bound to I-A(k) or alternatively initiate autoimmune arthritis by interacting with a self Ag, GPI(282--294), on I-A(g7). Five surface amino acid differences between the two MHC molecules collectively alter which peptide side chains are recognized by the KRN TCR. In this study, it is shown that mutation of only two of these residues, alpha 65 and beta 78, in I-A(k) to their I-A(g7) counterparts is sufficient to allow recognition of the TCR contacts from GPI(282--294). To provide a detailed mechanism for the specificity change, the distinct contributions of each of these two mutations to the global effect on peptide specificity were analyzed. The alpha65 mutation is shown to broaden the spectrum of amino acids permissible at P8 of the peptide. In contrast, the beta 78 mutation alone blocks KRN TCR interaction with I-A(k) and requires the simultaneous presence of the alpha 65 mutation to preserve recognition. In the presence of the alpha 65 mutation, the beta 78 residue broadens peptide recognition at P3 and prevents recognition of the P8 L in RN(42--56), thus producing the observed specificity shift. These results localize the functionally relevant differences between the surfaces of two self-restricted MHC molecules to two residues that have counterbalanced positive and negative contributions to interaction with a single TCR. They highlight how subtle structural distinctions attributable to single amino acids can stand at the interface between foreign Ag responsiveness and pathogenic autoreactivity.

Developing a teaching portfolio in nursing education: a reflection.

Presenting teaching accomplishments through a portfolio promotes self-reflection and provides direction for improvement and advancement decisions. The authors examine experiences, insights, and reflections about their participation in a pilot project introducing teaching portfolios. Themes of taking stock, documenting practice, and reflecting emerge. Their experiences of completing teaching portfolios and personal growth as educators and colleagues are described.

Fast-tracking in baccalaureate nursing education: one Canadian response to students with advanced standing.

Accelerated nursing programmes for non-nursing college graduates were developed primarily to address a shortage of nurses in the USA. This article describes a unique Canadian programme which has evolved in response to demand from an increasingly older and well-qualified applicant pool for recognition of their relevant previous educational experience. In an 8-week period in the summer of 1993, 18 students completed the requirements for Year I of the 4-year baccalaureate nursing programme. When compared to their generic counterparts, these 'fast-trackers' were found to be older, more likely to be part-time and, at the end of Year 2 were academically equivalent. Students in the programme were highly enthusiastic, citing the benefits of saving a year of student costs and of entering the profession a year earlier. Faculty involved with the programme were positive about the benefits for students, although a drawback for full-time faculty was the impact of a heavy summer teaching load on other scholarly activities. Because of the programme's success, consideration is now being given to extending the fast-track option beyond Year I.

Predictors of success on the Canadian Nurses Association testing service (CNATS) examination.

This retrospective study examined the relationship of selected admissions variables and in-course performance to success in the Canadian Nurses Association Testing Service (CNATS) examinations of 114 students admitted directly from secondary school to a four-year integrated, problem-based learning (PBL) baccalaureate nursing program in Canada. Data were analyzed using two separate hierarchical stepwise regression equations. The first equation examined a set of secondary school grades (Ontario Academic Credits, or OACs) used to calculate university admission averages and their ability to predict CNATS performance. OAC English was found to be the best predictor, followed by OAC chemistry and the admission average obtained on other OAC subjects. The second regression equation looked at in-course grades as potential predictors of CNATS scores. The basic sciences variable proved to be the best predictor, followed by research methodology, first-year Nursing Concepts I, a problem-based nursing average, and a clinical practice average. Findings support the continued use of English and chemistry as admission criteria. The basic sciences courses and first-year nursing courses also emerged as statistically significant predictors of licensure examination success.

Evaluation of registered nurses follow-up on the reported immunization status of children attending child care centres.

The purpose of this study was to evaluate whether follow-up by nurses increased the reported rate of correctly immunized preschoolers in child care centres (CCCs). Records from 14 randomly selected CCCs from the Hamilton-Wentworth area (n = 514 records) were assessed for the number of correctly immunized preschoolers by two nurses operating in different centres. The nurses advised the centres about all incomplete records and reminded parents to update their child's immunization status. One nurse revisited all her assigned centres two to five weeks later. Both nurses returned to the CCCs to reevaluate the records two to eight months after the initial contact. 382 records were available for the second review (25% drop out rate). The reported rates increased significantly for all immunizations. There was no difference when the follow-up intervention was greater. This study suggests that monitoring records improves the completeness of the records in CCCs; 19.9% of child records were updated (76 of 382). In 3.4% of cases (13 of 382), the children received immunizations that had been previously missed.

Follow-up of participants in a preschool hearing screening program in child care centres.

As part of its response to the Ontario Ministry of Health recommendation that communication disorders in preschool children be identified, the Hamilton-Wentworth Department of Public Health Services performed hearing screening tests on all preschool children in child care centres. Parents of children who had failed the hearing screening test were recommended to take their child to their family physician for further assessment. Out of 1,844 children tested between September 1990 and February 1991, 35 children failed the pure-tone audiometry test administered by nurses. A telephone follow-up interview determined that 26 children with screening test failures had received some medical follow-up. Eight children had a confirmed hearing problem; of these, five were newly diagnosed with a hearing problem, all resulting from fluid build-up in the middle ear. Three children were treated, with two having improved hearing. Of the two children not treated, one was reported to have improved hearing. As with other recently reported preschool hearing screening programs, this study raises doubts about the usefulness of such programs.

How can local health agencies improve health knowledge and skills of child care centre operators?

As the number of child care centres increases across Canada, local health agencies are increasingly involved in health issues within these facilities. 90% of operators of the 98 child care centres in an Ontario community responded to a mail survey distributed by the local health unit to determine health needs in these facilities. Infectious disease was reported to be the major health problem of the children. 76% of operators requested information about infectious diseases, in particular through use of written materials made available to their centre. The level of education of operators was high with 79% having completed community college courses. Over 70% of operators had attended continuing education sessions or workshops on child abuse, growth and development and nutrition; fewer operators reported attending sessions on infectious diseases, child safety, parent-child relationships and dental health. As a result of the needs assessment, a health unit multidisciplinary team has met and initiated a number of activities including meeting with child care centre operators, publication of newsletter for operators, and development of educational materials.

Exploration of rapid bedside monitoring of coagulation and fibrinolysis parameters during thrombolytic therapy.

Monitoring coagulation parameters during thrombolytic therapy could be useful for prediction and treatment of haemorrhagic episodes. Technology based on dry reagent chemistry has been developed that allows rapid (less than 10 min) assays on small samples of whole blood. The assay principle is based on the restriction of motion of paramagnetic particles during fibrin polymerization, and subsequent liberation of particle motion during fibrinolysis. This technology was used to monitor prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen levels and fibrinolysis profiles during thrombolytic therapy with tissue plasminogen activator for acute myocardial infarction. The PT and aPTT obtained with the COAG-1 correlated well with conventional assays (r = 0.93 and 0.92 for PT and aPTT, respectively; p = 0.0001). Fibrinogen estimates, obtained by COAG-2 also correlated well with modified Clauss assays (r = 0.86, p = 0.0001). The rapid determination of the aPTT may improve management of adjunctive anticoagulant therapy following thrombolysis. The fibrinolysis profile may be useful during thrombolytic therapy to verify that a lytic state has been achieved, to monitor the lytic state throughout therapy, and to verify that the lytic state normalizes once therapy has been completed.

Mothers' attitudes and their children's behaviors in 3-year-olds born prematurely and at term.

A sample of 94 mothers and their 3-year-old children participated in a cross-sectional study to measure maternal overprotective attitudes and children's behavior problems. Mothers in the full-term group (n = 47) were matched to mothers in the preterm group (n = 47) on maternal age, maternal education, and marital status. The groups were balanced for the child's gender, birth order, and mother's nationality. The subjects answered the Mother-Child Relationship Evaluation (MCRE) to measure maternal attitudes and the Behavior Screening Questionnaire (BSQ) to measure behavior problems in preschoolers. Overall, children born prematurely have the same incidence of behavior problems as children born full-term. However, the subgroup of preterms who had respiratory distress syndrome (RDS) had a higher incidence of behavior problems. Conversely, the results suggest that mothers of children born prematurely without RDS have more overprotective attitudes towards their children. Maternal overprotection is minimally associated with behavior problems.