Predicting Survivorship Appointment Nonattendance in a Community Cancer Center: A Machine-Learning Approach.

Understanding and predicting cancer survivors' health care utilization is critical to promote quality care. The consultative system of survivorship care uses a onetime consultative appointment to transition patients from active treatment into survivorship follow-up care. Knowledge of attributes associated with nonattendance at this essential appointment is needed. An ability to predict patients with a likelihood of nonattendance would be of value to practitioners. Unfortunately, traditional data modeling techniques may not be useful in working with large numbers of variables from electronic medical record platforms. A variety of machine-learning algorithms were used to develop a model for predicting 843 survivors' nonattendance at a comprehensive community cancer center in the southeastern United States. A parsimonious model resulted in a k-fold classification accuracy of 67.3% and included three variables. Practitioners may be able to increase utilization of follow-up care among survivors by knowing which patient groups are more likely to be survivorship appointment nonattenders.

Validity of a Single Activity Question for Clinical Assessment of Older Women.

Physical activity is an important part of clinical assessment. However, objective measurement can be expensive and burdensome. The current study validated a single activity question for use in clinical assessment. Ninety-seven older women (mean age = 73.7 years, SE = 0.7) completed an activity questionnaire and measurement of anthropometrics, body composition, and strength. Activity level was reported as not active, somewhat active, active, and very active. Activity level was significantly related to hours of light, moderate, and vigorous activity; body mass index (BMI); waist circumference; percent fat and lean mass; and strength (p < 0.05). When activity levels were collapsed into two groups (not active + somewhat active, and active + very active), women in the high activity group (n = 48) were significantly (p < 0.05) more active, had healthier BMI and waist circumference values, less fat and more lean mass, and were stronger than women in the low activity group (n = 49). A single activity question is valid for use in clinical assessment. [Journal of Gerontological Nursing, 46(12), 15-22.].

Physical activity-related quality of life in breast cancer survivors compared to healthy women.

OBJECTIVE: To evaluate physical activity-related quality of life (PAQOL) in breast cancer survivors compared to healthy women. METHODS: Physical activity level was measured as not active, somewhat active, active or very active. Intensity was reported as hours per week of light, moderate and vigorous activity. Physical activity-related quality of life was measured with the Vitality Plus Scale, a self-report instrument developed and validated to measure exercise-related health benefits. RESULTS: Compared to healthy women (n = 23), breast cancer survivors (n = 23) were older (57.0 ± 2.3 vs. 49.0 ± 1.1 years; p < .01) and reported more light activity (4.1 ± 0.6 vs. 2.4 ± 0.5 hr/week; p < .05), but no differences in PAQOL. However, when grouped by physical activity level there were no differences in age, but inactive women (n = 30) had higher body mass index (29.3 ± 1.0 vs. 25.1 ± 1.1 kg/m2 ; p < .05) and reported less moderate (1.3 ± 0.4 vs. 3.6 ± 0.8 hr/week; p < .05) and vigorous (0.2 ± 0.1 vs. 1.9 ± 0.5 hr/week; p < .01) activity than active women (n = 16). Furthermore, active women reported higher overall PAQOL, greater energy levels and quicker sleep onset than inactive women (p < .05). CONCLUSIONS: In these women, moderate and vigorous physical activity and PAQOL were not influenced by breast cancer survivorship. Despite diagnosis, active women who engaged in greater amounts of moderate and vigorous activity reported better PAQOL than inactive women.

Senior NCLEX-RN Coaching Model: Development and Implementation.

BACKGROUND: A host of interventions have been used to improve NCLEX outcomes, yet scant evidence exists to show the influence of academic coaching on pass rates. PURPOSE: To improve NCLEX confidence/readiness and pass rates in a baccalaureate nursing program, an NCLEX Coaching Model was developed and implemented. METHOD: Senior students were paired with faculty for 6 weeks of NCLEX coaching. Students self-assessed strengths, risk factors, and challenges related to NCLEX preparation. Coaches and students co-developed the NCLEX Preparation and Success Plan using standardized NCLEX predictor scores. Success plans represented individualized preparation strategies focused on specific NCLEX Client Needs categories. RESULT: National Council Licensure Examination confidence/readiness scores improved significantly, and first-time NCLEX pass rates improved slightly after coaching. CONCLUSION: An NCLEX Coaching Model can build student confidence/readiness and promote NCLEX success among nursing students. Peplau's Theory of Interpersonal Relations was useful in guiding development and implementation of a coaching model.

Upper Extremity Strength Imbalance after Mastectomy and the Effect of Resistance Training.

The purpose of this non-randomized pre/post comparison trial was to explore the effect of resistance training (RT) on upper extremity strength imbalance in breast cancer survivors. Seventeen right-side dominant female breast cancer survivors (age: 58.2±2.7 years; BMI: 27.8±1.1 kg/m 2 ) with right-sided (RSM) or left-sided (LSM) mastectomy completed strength testing (30-second arm curl) before and after an 8-week RT program. At baseline, LSM (n=8) had equal strength bilaterally (right=16.8±1.1 repetitions; left=16.4±1.4 repetitions), whereas RSM (n=9) had impaired strength on the right (16.7±1.3 repetitions) compared to the left (18.6±1.1 repetitions) side ( p <0.01). After RT, RSM increased strength by 25% on the right (initially weaker) side and 19% on the left (initially stronger) side, which resolved the imbalance. By comparison LSM increased 19% on both sides that were initially equal in strength. Based on our findings, breast cancer survivors with dominant-side mastectomy are at risk for upper extremity strength imbalance that can be resolved with a relatively short-term RT program.

Moving toward heutagogical learning: Illuminating undergraduate nursing students' experiences in a flipped classroom.

BACKGROUND: Nurse educators rely on the tenets of educational theory and evidence-based education to promote the most effective curriculum and facilitate the best outcomes. The flipped classroom model, in which students assume personal responsibility for knowledge acquisition in a highly engaging and interactive environment, supports self-directed learning and the unique needs of clinical education. OBJECTIVE: To understand how students perceived their experiences in the flipped classroom and how students' learning dispositions were affected by the flipped classroom experience. DESIGN: A phenomenological approach was used to gain deeper understanding about students' perspectives, perceptions and subjective experiences of the flipped classroom model. The focus of the study was on characteristics of student learning. PARTICIPANTS: Fourteen Bachelors of Science of Nursing (BSN) students at a regional university in the southeastern United States. METHODS: Using data transcribed from face-to-face, semi-structured interviews, experiential themes were extracted from the qualitative data (student-reported experiences, attributes, thoughts, values, and beliefs regarding teaching and learning in the context of their experience of the flipped classroom) using Graneheim's and Lundman's (2004) guidelines; and were coded and analyzed within theoretical categories based on pedagogical, andragogical or heutagogical learning dispositions. RESULTS: Experiential themes that emerged from students' descriptions of their experiences in the flipped classroom included discernment, challenge, relevance, responsibility, and expertise. CONCLUSIONS: The flipped classroom model offers promising possibilities for facilitating students' movement from learning that is characteristic of pedagogy and andragogy toward heutagogical learning.

Lean mass influences overnight changes in hydration, blood pressure and strength in community-dwelling older women.

We evaluated the hypothesis that greater lean mass promotes better overnight hydration, improved postural blood pressure and greater strength. Thirty women, aged 71 ± 0.9 years (mean ± SE), completed one measurement in a euhydrated state and another the following morning after an overnight fast. Measurements included hydration, lean mass, orthostatic blood pressure and strength. Participants were grouped by fat-free mass index (FFMI), with cut-points defined as low (< 15.0 kg/m(2)) and normal (≥ 15.0 kg/m(2)). Women with normal FFMI had significantly greater hydration (p < 0.01), lean mass (p < 0.001) and upper body strength (p < 0.05), while those with low FFMI had more unstable blood pressure. On day 1, women with low FFMI experienced significant postural systolic blood pressure changes from sitting to standing (-11.3 ± 4.0 mmHg, p < 0.05). On day 2, they experienced significant systolic changes from lying to sitting (-8.0 ± 2.2 mmHg, p < 0.01) and sitting to standing (-14.9 ± 5.5 mmHg, p < 0.05), and diastolic changes from lying to sitting (-8.9 ± 2.8 mmHg, p < 0.05). In conclusion, overnight fluid shifts in older women with low lean mass result in unstable postural blood pressure and loss of strength that increases the risk for early morning falls.

Cognitive load, emotion, and performance in high-fidelity simulation among beginning nursing students: a pilot study.

Establishing the impact of the high-fidelity simulation environment on student performance, as well as identifying factors that could predict learning, would refine simulation outcome expectations among educators. The purpose of this quasi-experimental pilot study was to explore the impact of simulation on emotion and cognitive load among beginning nursing students. Forty baccalaureate nursing students participated in teaching simulations, rated their emotional state and cognitive load, and completed evaluation simulations. Two principal components of emotion were identified representing the pleasant activation and pleasant deactivation components of affect. Mean rating of cognitive load following simulation was high. Linear regression identiffed slight but statistically nonsignificant positive associations between principal components of emotion and cognitive load. Logistic regression identified a negative but statistically nonsignificant effect of cognitive load on assessment performance. Among lower ability students, a more pronounced effect of cognitive load on assessment performance was observed; this also was statistically non-significant.

The flipped classroom: strategies for an undergraduate nursing course.

This article presents the authors' experience with flipping a fundamental concepts of nursing course for students in an undergraduate baccalaureate program. Authors describe implementing a flipped class, practical strategies to transform students' learning experience, and lessons learned. This article serves as a guide to faculty and programs seeking to develop and implement the flipped class model in nursing education.

Change in quality of life among breast cancer survivors after resistance training: is there an effect of age?

To evaluate the effect of age on quality of life (QOL) in breast cancer survivors after resistance training, 20 women were assigned to 1 of 2 groups based on age (YRT 40-59 yr, ORT 60-80 yr). Both groups completed 3 sets of 8 exercises twice a week for 8 wk. Measurements were obtained before and after the training program. QOL was measured using the Body Image and Relationship Scale (BIRS). Both groups improved in chest press (p < .001), leg press (p < .001), arm curls (p < .05), and chair stands (p < .001). For QOL, YRT reported greater improvements compared with ORT in BIRS total score (Group × Time interaction, p = .002) and strength and health subscale score (Group × Time interaction, p = .001), and greater age was related to greater perceived impairment (BIRS total: r = .61, p = .004; strength and health subscale: r = .69, p = .001). Despite significant improvements in strength and function, older women perceived relatively little improvement in QOL compared with younger women, and age had a differential negative influence on improvements in QOL.

Complex hospital discharges: justice considered.

How do we respond to the patient who no longer needs inpatient care but refuses to leave the hospital? Complex hospital discharges commonly involve consideration of legal, financial, clinical, and practical issues. Yet, the ethical and contextual issues embedded in complex inpatient discharges are of concern and have not received adequate attention by medical ethicists. The aim of this work is to encourage clinicians and administrators to incorporate a justice rubric when approaching inpatient discharge dilemmas. This paper presents justice as the ethical principle most neglected in situations involving complex discharges and suggests that a justice focused lens allows clinicians and administrators to move beyond notions of patient autonomy in crafting morally responsible hospital discharge decisions that reflect efficient stewardship of an appropriate share of medically indicated services. This issue deserves additional attention from medical ethicists in the future.

Allow-natural-death (AND) orders: legal, ethical, and practical considerations.

Conversations with patients and families about the allow-natural-death (AND) order, along with the standard do-not-resuscitate (DNR) order during end-of-life (EOL) decision-making, may create engagement and understanding while promoting care that can be defended using enduring notions of autonomy, beneficence, and professional duty. Ethical, legal, and pragmatic issues surrounding EOL care decision-making seem to suggest discussion of AND orders as one strategy clinicians could consider at the individual practice level and at institutional levels. A discussion of AND orders, along with traditional DNR orders is presented. This is followed by argument and counter-argument focused on ethical, legal, and practical issues germane to EOL care decision-making associated with use of AND orders.

Dose and sequence of simulation and direct care experiences among beginning nursing students: a pilot study.

Accumulating suggests human patient simulation is an effective instructional technique. Simulated clinical experiences may be a reasonable substitute for direct care experiences. Educators and regulators need to know what mix of simulation and direct care promotes learning and how these experiences can be designed to help nursing students achieve essential outcomes. The goal of this pilot study was to identify a model to promote development of clinical judgment among beginning nursing students. Principles related to types of learning and practice (blocked by type or interleaved) were used in exploring simulation and direct care design schema. Using a 50% interleaved simulation design schema, robust clinical judgment scores and positive perceptions of learning were identified among beginning students participating in a basic nursing concepts and skills course. Further study is warranted to determine whether this schema is effective in other nursing courses or with novice-level students from diverse health care disciplines.

Clinical ethics support services: an evolving model.

Ethical issues arising in clinical practice are complex and clinicians must be able to manage the needs of ethically vulnerable patients and families. This paper describes a model for providing Clinical Ethics Support Services as a broad spectrum of care for management of conflict and ethically difficult situations in health care and describes how an ethics consultation process was transformed to a Holistic Care Continuum for managing the needs of ethically vulnerable patients. During a 4-year journey at a regional medical center, a Family Support Team played a central role in identification of ethically vulnerable patients/family, interdisciplinary connectivity, and iterative engagement in the clinical milieu. Concepts of professional advocacy and interdisciplinary perspectives resulted in a model for ethically sound patient care promoting communication among patients/family, staff, and professionals; clarification of interdisciplinary roles and responsibilities; establishment of mutually derived goals and shared solutions; and implementation of interventions maximizing institutional resources.

Improvements in quality of life in women after resistance training are not associated with age.

Twenty-three women completed a resistance training program three or four days per week. At baseline and after eight weeks they completed the Vitality Plus Scale measuring exercise-related changes in quality of life. Greater scores indicated better quality of life. Significant improvements in quality of life (p < .001), upper body strength (p < .001), and lower body strength (p < .001) were observed despite training frequency. Age was not associated with quality of life or strength either pre- or posttraining. Resistance exercise three days a week improved quality of life in women, and these improvements were not influenced by age.

PDA-assisted simulated clinical experiences in undergraduate nursing education: a pilot study.

BACKGROUND: Descriptive literature on use of personal digital assistants (PDAs) in nursing education exists; but, quantitative outcome-driven studies of efficacy are lacking. Few studies have explored the integration of technologies like simulated clinical experiences (SCEs) with informatics competencies. AIM: The purpose of this pilot study was to determine if nursing students' knowledge and attitude scores following a PDA-assisted SCE would be equivalent to textbook-assisted scores. METHOD: Using a convenience sample of first-semester baccalaureate students and an equivalence design, multiple lessons were learned about the use of PDAs in the context of SCE. RESULTS/CONCLUSION: Learning was supported through use of PDAs in place of traditional text references; students viewed PDAs as beneficial resources in the provision of care; PDA use prompted reflection and triggered important need-learning connections; orientation to the use of PDAs promoted positive student attitudes; and use of PDAs helped meet nursing informatics curricular requirements.

Quality of life and perceived educational needs among older cancer survivors.

The purpose of this study was to evaluate perceived educational needs regarding nutrition and exercise in older cancer survivors. One hundred ninety survivors, age 70.7 (7.5), completed a Survey of Needs developed from the City of Hope Quality of Life model. Fifty percent reported distress related to poor appetite, 60% reported distress related to weight change, 64% reported distress related to balance/walking/mobility difficulty, and 79% reported distress related to fatigue. Weight change, poor appetite, balance/walking/mobility difficulty, and fatigue were significantly associated with distress related to (a) managing household activities, (b) caring for family, (c) maintaining a sense of well-being, (d) coping with grief and loss, and (e) managing stress. Despite distress associated with weight change, poor appetite, mobility difficulty, and fatigue, respondents did not recognize a need for education regarding nutrition and exercise. Findings suggest that evaluating older survivors' perceptions of needs may be necessary prior to designing interventions for care.

Comparison of body composition measurement with whole body multifrequency bioelectrical impedance and air displacement plethysmography in healthy middle-aged women.

Our purpose was to evaluate accuracy of multifrequency bioelectrical impedance analysis (MFBIA) using air displacement plethysmography (ADP) as the criterion measure. Body composition of 27 women was assessed by ADP followed immediately by MFBIA. There was a strong relationship (p = .01) between ADP and MFBIA in absolute lean mass (r = 0.80), absolute fat mass (r = 0.99), percent lean mass (r = 0.91), and percent fat mass (r = 0.91). Although MFBIA consistently overestimated lean mass and underestimated fat mass compared with ADP, agreement between measurements was within 2%-3% body fat. An accurate assessment tool, MFBIA can be useful in clinical settings.

Simulation in an undergraduate nursing curriculum: implementation and impact evaluation.

Although endorsed by nursing professional bodies and incorporated into undergraduate nursing curricula, high-fidelity simulation has undergone little evaluation at the program or curriculum levels. A comprehensive program evaluation of a Simulation Demonstration Project was undertaken to explore the influence of simulation across an undergraduate curriculum in a college of nursing. The focus of the evaluation was on program activities accomplished (implementation evaluation) and the extent to which program objectives and outcomes were met (impact evaluation). The Nursing Education Simulation Framework (NESF) was used to arrange multiple variables to be explored and to support the use of diverse simulation-related data sources. The framework was helpful in both guiding the evaluation and interpreting the results at the curriculum level from implementation and impact perspectives. Although continued use and testing of the NESF is warranted, findings from the study supported the utility of the NESF in program evaluation of simulation at the curriculum level.

Needs of older cancer survivors in a community cancer care setting.

This study describes the unique supportive care needs and associated distress among older adults receiving cancer survivorship care in a community cancer center. The psychological and social changes that accompany aging may influence the impact of cancer, so documenting the distinctive experiences of older survivors is critical to the development of evidence-based practice guidelines. A secondary analysis of data was conducted using results from a survey of adult cancer survivors. Data were available from a convenience sample of 307 survivors receiving care in a community cancer care setting who volunteered to complete a Survey of Needs. Fatigue, fear of recurrence, sleep disturbance, balance/walking/mobility difficulties, long-term effects of treatment, and body changes were most frequently reported. Results suggest assessment of older adult cancer survivors' experiences related to physical symptoms, symptom management, and interest in education targeting physical effects common to survivorship.