Evaluation of the Maryland Next Gen Test Bank Project: Implications and Recommendations.

AIM: The aim of this study was to evaluate the development and impact of a project to create a statewide test bank of Next Generation NCLEX®-style items. BACKROUND: Using a train-the-trainer model, champions created an open access resource of Next Generation NCLEX-style items to use to teach clinical judgment and then trained peers on item writing and test bank use. METHOD: Stufflebeam's CIPP (context, inputs, process, and products) model provided the framework for the evaluation. Data were synthesized from multiple sources including participation rates, item utilization, and survey data. RESULTS: Twenty faculty from 13 schools were trained as champions and submitted 54 case studies, 33 bowties, and 21 trend items to the test bank. Items were used over 60,000 times in the first year. CONCLUSION: The statewide test bank met a need for more teaching resources. The train-the-trainer model was an effective strategy for helping faculty learn to prepare for Next Generation NCLEX.

Retaining the Best: Recognizing What Meaningful Recognition Is to Nurses as a Strategy for Nurse Leaders.

OBJECTIVE: The purpose of this study was to identify what meaningful recognition is to nurses in a postpandemic healthcare landscape. BACKGROUND: The COVID pandemic has exacerbated the critical need to retain our nursing workforce. Meaningful recognition as a component of a healthy work environment can be a strategy to retain nurses. Identifying what is considered meaningful recognition to nurses will optimize organizational use of it. METHODS: A descriptive correlational design was used. Members of Sigma Theta Tau in the state of Maryland were asked to respond to an online survey consisting of demographic data and questions exploring meaningful recognition and the healthy work environment using tools with established reliability and validity. Deidentified data from 163 respondents were collected. RESULTS: Meaningful recognition strategies that meant the most to nurses in this study were: 1) reasonable payment for level of service provided; 2) public recognition within the organization and the profession; and 3) opportunities for professional development. Trends in desired meaningful recognition varied across ethnic/racial and gender groups. CONCLUSIONS: Meaningful recognition to nurses is as diverse as the nursing population. It is important that instruments be developed to capture the rich cultural and ethnic differences in relation to what is considered meaningful recognition to the nursing workforce. Although pay, public recognition, and opportunities for advancement were seen in this study as important forms of meaningful recognition, a deeper exploration across ethnic, racial, and gender groups is needed. This study underscored that one size of meaningful recognition does not fit all.

Maryland Action Coalition: Academic Progression Takes Several Pathways.

AIM: The purpose of this article is to provide an overview of the Maryland Action Coalition academic progression activities. BACKGROUND: Maryland is predicted to be one of four states that will experience a shortage of 10,000 or more registered nurses in 2025. The Maryland Action Coalition has committed to the Institute of Medicine's Future of Nursing recommendation that 80 percent of nurses be educated at the baccalaureate (or higher) level. METHOD: Various approaches to seamless academic progression are described. The Maryland articulation model was revised to reflect new academic models. RESULTS: More BS and BSN degrees have been awarded, and more employers have advertised a preference for RNs who have completed a baccalaureate degree. CONCLUSION: Maryland is developing a solid foundation to ensure that the state has a well-educated nursing workforce to meet the complex health needs of all residents.

Survey of advanced practice student clinical preceptors.

Most nursing schools use preceptors to provide critical elements of practice, instruction, and supervision. It is important to understand the factors influencing preceptors to volunteer their time and expertise. The purpose of this survey of advanced practice student clinical preceptors was twofold: to determine the barriers to and motivators for providing clinical mentoring and evaluation, and to determine the need for educational preparation to facilitate their roles as clinical preceptors. An online survey was distributed to a convenience sample of active clinical preceptors from multiple graduate-level programs. Responses to items in the categories of organizational support; rewards, disincentives, and barriers; relationship with school of nursing faculty members; and preparation for the preceptor role offered insights into the challenges and rewards that preceptors experience in their practice settings. This study's findings will be useful in understanding some of the issues that contribute to the shortages.

Assessing an interdisciplinary health care model: the Governor's Wellmobile Program.

This article assesses the applicability of Bronstein's (2003) generic model of interdisciplinary collaboration in the context of a newly created collaboration providing community-based health care services, the Governor's Wellmobile Program. An analysis of the program's quarterly reports and interviews with faculty and students involved in the collaboration offers an assessment of the model and implications for interdisciplinary social work practice in community health care delivery.

Brain atrophy and white matter hyperintensity change in older adults and relationship to blood pressure. Brain atrophy, WMH change and blood pressure.

Hypertension is a major risk factor for stroke and dementia and is associated with white matter hyperintensities (WMH) and reduced brain volumes. We measured the increase in WMH volume, and rate of cerebral atrophy over two years, in hypertensive subjects participating in the Study on COgnition and Prognosis in the Elderly (SCOPE), receiving candesartan or placebo, and normotensive controls. We recruited 163 subjects who had MRI (FLAIR and volumetric T1) at 2 and 4 years after baseline assessment. From these two scans, volumetric change in WMH (n = 133) and brain atrophy rates (n = 95) were determined. Total WMH fraction increased in both normotensive and treated hypertensive groups (p < 0.01) median change: 0.05% of brain volume [range: -0.45% to 1.51%]. Deep WMH increased in hypertensive (p = 0.001) but not the normotensive group. The number of subjects with an increase of total WMH in the 5(th) quintile differed between the treatment groups (chi square p = 0.006), being greatest in the placebo group (32%), then candesartan (20%) then normotensive (5%). Regression analysis found significant predictors of change in WMH to be blood pressure and initial deep WMH, but not treatment group. Increased atrophy rate was predicted by baseline systolic blood pressure (p = 0.02) but was not associated with measures of WMH. Similar to WMH, there was a trend with treatment, with atrophy in normotensive < Candesartan < Placebo (Spearman's rho = 0.23, p = 0.026). Hypertension in older people is associated with increased rates of progressive whole brain atrophy and an increase in WMH. These changes are independent. Successful hypertension treatment was associated with reduced risk of WMH progression and possibly brain atrophy.

Cognitive associations of subcortical white matter lesions in older people.

Hyperintense lesions (HL), as visualized on T2-weighted or FLAIR MRI, are a common finding in older people, but their clinical significance and influence on cognitive function remain to be clarified. We investigated the relationship between HL in deep white and gray matter structures and cognition in older subjects. We recruited 154 nondemented (Mini-Mental State Examination > 24) subjects (79 males) over the age of 70 from primary care (103 subjects with mild hypertension and 51 normotensive subjects). All subjects underwent FLAIR and proton density and T2-weighted axial 1.5-tesla MRI scans (slice thickness: 5 mm). The scans were rated for the presence and distribution of HL in the subcortical gray matter (caudate, putamen, globus pallidus, thalamus) and associated white matter tracts (internal/external capsule). Subjects (n = 149) underwent a comprehensive cognitive assessment involving tests of attention, processing speed, episodic memory, working memory, and executive function. Partial correlations (correcting for age, systolic blood pressure, and New Adult Reading Test [NART] score) were performed to investigate the relationship between cognition and white matter change. HL were found in 49% of subjects. HL in both the gray (thalamus and caudate) and white matter were significantly associated with impaired cognitive function in tasks involving processing speed and/or executive function, but showed no associations with episodic or working memory. HL in both subcortical gray matter structures and associated fiber tracts correlate with impairments in attention, executive function and processing, and memory retrieval speed in nondemented older community-dwelling subjects. Such lesions may be an important cause of age-related attentional and executive dysfunction in the elderly, as well as temporal lobe and hippocampal changes that have previously been reported to be associated with impairments to the ability to actually store and retrieve information from memory.