Enhancing clinical decision making: development of a contiguous definition and conceptual framework.

Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The developed definition was "Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action." A contiguous framework for clinical decision making specific for nurse practitioners is also proposed. Having a clear and unique understanding of clinical decision making will allow for consistent use of the term, which is relevant given the changing educational requirements for nurse practitioners and broadening scope of practice.

Implementation of an interprofessional educational model.

Despite literature that supports the benefits of interprofessional collaboration among healthcare practitioners, such as better patient outcomes and more efficient use of resources, many education programs continue to educate in silos, leading to a lack of awareness of the role of other disciplines. The nurse practitioner role, as example, requires positive collaboration with other healthcare providers, including physicians. The authors describe the development, implementation, and evaluation of an innovative interprofessional clinical educational model that was integrated into a nurse practitioner curriculum, as well as lessons learned during the first 2 years this program has been in place.

Implementing team-based learning in a nurse practitioner curriculum.

Team-based learning (TBL) is an innovative, learner-centered teaching strategy that promotes active learning. The authors describe their experience with implementing TBL in an adult-gerontology acute and primary care course for nurse practitioners as well as their evaluation of student outcomes.

Online learning versus simulation for teaching principles of mechanical ventilation to nurse practitioner students.

Patient simulation is increasingly used in the education of healthcare providers, yet few studies have compared simulation to other teaching modalities. The purpose of this study was to determine differences in knowledge acquisition and student satisfaction between two methods of teaching the principles of mechanical ventilation to advanced practice nursing (APN) students: high-fidelity patient simulation (including face-to-face instruction) versus an online, narrated PowerPoint presentation. Twenty APN students were randomized to either the simulation or online teaching method in this pre/posttest study. Measures included a 12-item knowledge questionnaire and a 5-item satisfaction survey. Both groups had significant improvement in knowledge scores from pretest to posttest, but knowledge scores were not significantly different at posttest between groups. Student satisfaction with their learning method was significantly higher in the simulation group. Students choosing to participate in the alternative teaching method after study completion preferred the simulation to the online method.

Cervical cancer: what should we tell women about screening?

Cervical cancer is the second most common cancer among women worldwide, with significantly higher rates in developing areas, especially in Africa, the Caribbean, and Latin America (Parkin, Bray, Ferlay, & Pisani, 2005). In contrast, incidence and mortality rates of cervical cancer in the United States have declined significantly among women of all ethnic and racial groups; it is not among the top 10 leading causes of new cancer cases in women (American Cancer Society [ACS], 2006b; Edwards et al.,2005).

Educating women regarding the early detection of endometrial cancer--what is the evidence?

Endometrial cancer, cancer of the lining of the uterus, is the most common gynecologic malignancy in the United States, with an estimated 40,880 new cases diagnosed in 2005 (American Cancer Society [ACS], 2005a). Fortunately, mortality rates for endometrial cancer are relatively low, with 96% of women living five years or longer after being diagnosed with localized disease. Most women (72%) are diagnosed with localized disease (Ries et al., 2002) because early-stage, localized disease most often presents with abnormal uterine bleeding, leading many women to seek prompt medical attention, ultimately resulting in early detection (ACS, 2005a).

Depressive symptoms prescreening and postscreening among returning participants in an ovarian cancer early detection program.

Ovarian cancer is the fourth leading cause of cancer mortality among women. Previous research has shown that initial ovarian cancer screening has the potential to cause depressive symptoms among women at increased risk for the disease but no study has evaluated depressive symptoms shortly after screening. This article explores depressive symptoms prescreening and postscreening in women returning to participate in an ovarian cancer early detection program. Seventy-two women, with a mean age of 48, most with a family history of ovarian cancer and/or a personal history of breast cancer, completed the Center for Epidemiologic Studies Depression Scale (CES-D) immediately prior to screening and 1 week following. CES-D scores at prescreening (13%) were significantly lower than previously reported. No statistical differences in CES-D scores before and after screening were found, although 75% of women with elevated pre-CES-D scores had scores below the cutoff at postscreening. Although our numbers are lower than reported in previous studies, they are important because they emphasize the need for continued assessment of individuals who may be at greater risk for psychological distress related to cancer screening. Internationally, nurses play an important role in the recognition and support of patients undergoing cancer screening.

Recommending a minimum English proficiency standard for entry-level nursing.

When nurses who are educated internationally immigrate to the United States, they are expected to have English language proficiency in order to function as a competent nurse. The purpose of this research was to provide sufficient information to the National Council of State Boards of Nursing (NCSBN) to make a defensible recommended passing standard for English proficiency. This standard was based upon the Test of English as a Foreign Language (TOEFL). A large panel of nurses and nurse regulators (N = 25) was convened to determine how much English proficiency is required to be minimally competent as an entry-level nurse. Two standard setting procedures, the Simulated Minimally Competent Candidate (SMCC) procedure and the Examinee Paper Selection Method, were combined to produce recommendations for each panelist. In conjunction with collateral information, these recommendations were reviewed by the NCSBN Examination Committee, which decided upon an NCSBN recommended standard, a TOEFL score of 220. Because the adoption of this standard rests entirely with the individual state, NCSBN has little more to do with implementing the standard, other than answering questions and providing documentation about the standard.