Instructor comfort level in high-fidelity simulation.

BACKGROUND: The literature in the use of simulation in nursing education has expanded significantly over the past 5-10 years. What it is like as an instructor who facilitates this experience is largely unexplored. This paper is part of a larger ethnographic study, and represents findings related to the comfort level of instructors facilitating in high-fidelity simulation (HFS). OBJECTIVES: The question of what is it like to engage in simulated clinical experiences as an instructor is presented in this paper. DESIGN AND PARTICIPANTS: Twenty instructors participated in two separate focus groups and two instructors participated in individual interviews. The average years of nursing experience for this group was over 20 years, whereas the number of years of experience as a clinical instructor was less than five years. METHODS: Ethical approval was obtained from two academic institutions. A focused ethnography was conducted and included two terms of participant observations, recorded field notes, individual interviews and focus groups. Data was coded and then sorted for themes related to the instructor experience. RESULTS: The primary results focus on the comfort level of instructors in HFS, and what instructors believe this meant to student learning in HFS. CONCLUSIONS: What the instructor does during HFS and how they feel about their ability to facilitate HFS has a perceived effect on student learning.

Screening and assessing adolescent asthmatics for anxiety disorders.

The purpose of this study was to evaluate a strategy designed to permit early detection of anxiety disorders in adolescent asthmatics. Adolescents with asthma (N = 53) were screened for anxiety disorders using the Trait subscale of the State-Trait Anxiety Inventory for Children [STAI-C (Trait)] and the Multidimensional Anxiety Scale for Children (MASC). Adolescents and their parents were individually evaluated by a nurse trained in the administration of the Anxiety Disorders Interview Schedule-IV: Parent and Child Versions (ADIS-IV: P&C). Of the participants, 21 (40%) met the diagnostic criteria for one or more anxiety disorders. The STAI-C (Trait) was more effective than the MASC in screening adolescents for risk of coexisting anxiety disorders. Nurses trained to administer the ADIS-IV: P&C diagnosed anxiety disorders with a high degree of accuracy. These results have important implications for resolving the problem of unrecognized and untreated anxiety disorders in the adolescent asthmatic population.

Cognitive-behavioral treatment combined with asthma education for adults with asthma and coexisting panic disorder.

This study tested the efficacy of a nurse-administered 8-week group treatment program for adults with asthma suffering from coexisting panic disorder. The program consisted of cognitive behavioral treatment (CBT) for panic disorder combined with asthma education (AE). Forty-eight women with a confirmed diagnosis of asthma and panic disorder were randomly allocated to a treatment condition (n=25) and a wait-list control condition (n=23). Twenty-five participants--15 in the treatment group and 10 in the wait-list control group--completed treatment. Repeated measures ANOVA procedures were used to compare the groups on panic and asthma outcomes at posttreatment and 6-month follow-up. The results demonstrate that the CBT-AE program is capable of producing substantial and durable antipanic and antianxiety treatment effects and led to substantial but nonsustained improvement in morning peak-flow expiratory rate and asthma-related quality of life. Implications of these findings for this clinical population are addressed.

A case study of comorbidities: vocal cord dysfunction, asthma, and panic disorder.

The purpose of this case study was to describe the nature of the symptom episodes experienced by a 24-year-old woman diagnosed with VCD, asthma, and panic disorder. A multiple card sort procedure was used to identify the type, order of presentation, and severity of symptoms experienced by the participant during her typical symptom episodes. Seven types of symptom episodes were investigated including VCD, asthma, and panic episodes; and co-occurring or combined episodes of VCD and asthma; VCD and panic; asthma and panic; and VCD, asthma, and panic. The variability and complexity of the participant's symptom episodes, which are described, led to the development of a new VCD/asthma/panic comorbidities symptom classification system.

Screening and assessing adult asthmatics for anxiety disorders.

The purpose of this study was to evaluate a strategy designed to permit early detection of anxiety disorders in asthmatics. Ninety-one adult asthmatics were screened for anxiety disorders using the Sheehan Patient Rated Anxiety Scale (SPRAS) and the Anxiety Sensitivity Index (ASI) and then individually evaluated by a nurse trained in the administration of the Anxiety Disorders Interview Schedule-IV (ADIS-IV. Thirty-five (38%) of the participants met the diagnostic criteria for one or more anxiety disorders. Comparison of the SPRAS and ASI findings revealed that the SPRAS was more effective in detecting asthmatics likely to be suffering from coexisting anxiety disorders. Comparison of the nurses diagnostic formulations with those of an expert revealed that trained nurses using the ADIS-IV can diagnose anxiety disorders in the asthmatic population with a high degree of accuracy. These results have implications for resolving the problem of unrecognized and untreated anxiety disorders in the asthmatic population.