Operational Readiness: Redesigning Advanced Practice Registered Nurse (APRN) Curriculum for an Evolving Battlefield.

INTRODUCTION: The Global War on Terror and the ensuing Overseas Contingency Operations has rapidly transformed the U.S. military's strategic philosophy for warfare. The paradigm shift to unconventional warfare has forced military medicine to adapt with the rapidly evolving battle space. To this end, large fixed facility hospitals are being replaced with highly mobile and austere medical platforms that serve farther forward. The transition in operational health care has challenged the role of all health care team members.Through the evolution of the modern battlefield, nursing roles have grown and expanded beyond the traditional roles and peacetime practice. Nurses are seeing greater autonomy and scope of practice in operational settings while caring for patient pathologies that are often different than at home. The expansion of practice extends beyond the registered nurse at the bedside to the Advanced Practice Registered Nurse (APRN) that serves in the provider role. Through anecdotal reports, and a growing body of literature, that APRN operational practice is different than in the traditional health care setting. MATERIALS AND METHODS: Although a variety of organizations have codified knowledge, skills and attitudes (KSAs) relevant to operational practice, no formal APRN operational curriculum currently exists. Using an adaptation of Kern's Six-Step Model of curriculum design, we describe a curriculum development process used to improve and focus educational experiences to better prepare APRNs for evolving operational roles. RESULTS: Through deliberate approaches the GSN has reimagined its operational readiness curriculum for the preparation of the military APRN on the evolving battlefield. The GSN has operationalized APRN operational readiness through the integration of operationally relevant curriculum designed around interprofessional education experiences. Through this curricular design, GSN APRN students are provided with operationally relevant experiences in the context of authentic military scenarios. Through these encounters, we believe, allows our students to successfully develop the clinical, operational and teamwork skills to successfully perform care in austere and operational settings. CONCLUSIONS: This manuscript describes a novel approach to provide operational readiness education to military APRN students. Through an evaluation of the current literature, expert reports and information of the current operational requirements, the USU GSN has developed a model and curricula for APRN operational readiness that lie beyond the traditional skills in the peacetime setting. Through this plan of instruction, USU GSN APRN students will have the requisite skills to meet the evolving operational needs of the Department of Defense.

On the Role of Error in Motor Learning.

The authors report 5 experiments that explored the role of error in motor learning. Participants practiced 4 distinct keypress sequences that varied in the amounts of advance information (i.e., choice) about which key to press next in the sequence. The amount of advance information resulted in differing levels of error during practice, which in general, was inversely related to retention performance. Although these findings support a beneficial role of error in motor learning, they also suggest that not all errors are equal in the learning process. Rather, we make a distinction between factors that induce errors that have desirable influences on learning compared to those that have undesirable effects.