Simulated patient scenario development: A methodological review of validity and reliability reporting.

INTRODUCTION: Some healthcare scholars (educators and researchers) develop their own simulated patient scenarios to address specific learning objectives. Clear processes of validity and reliability are needed in the development of simulated scenarios for the purpose of replication and the transfer of findings to other contexts. METHODS: This paper reports a methodological review of CINAHL to determine how valid and reliable simulated patient scenarios are developed. We reviewed 375 abstracts based on specific inclusion and exclusion criteria to yield 17 qualifying records. Data about the discipline, population, type of simulation, and validity and reliability processes were extracted. RESULTS: Selected records were from nursing, medicine, and paramedicine. While some studies used high-fidelity simulations, some used low-fidelity or a combination of high- and low-fidelity simulations. Scholars validated scenarios by using personal experience, consulting experts, or requesting participant feedback. They also examined different types of validity (face, content, construct). Most studies did not address how reliability of scenarios was determined. To ensure consistency in scenario delivery, some studies piloted scenarios with participants, or examined performance through video-tapes or virtual patients. CONCLUSIONS: This review shows that scholars use inconsistent processes to develop valid and reliable simulated patient scenarios, often overlooking evidence-based approaches to determining validity and reliability. Future practices pertaining to scenario development should use systematic processes in determining validity and reliability so simulation exercises can be replicated in other contexts.

Brief report: how anxiously withdrawn preadolescents think about friendship.

Previous research suggests that anxiously withdrawn preadolescents demonstrate success in forming friendships, yet these friendships tend to be of lesser quality. Drawing on Selman's (1980) theory of interpersonal understanding, we compared levels of friendship understanding between anxiously withdrawn preadolescents and a sample of non-withdrawn age mates. Fifth graders (N = 116; 58% girls; mean age = 10.33 yrs) completed same-sex friendship and social behavior nominations, as well as a semi-structured clinical interview assessing understanding of various friendship issues in response to a hypothetical friendship dilemma. Results suggest that anxiously withdrawn preadolescents demonstrated lower levels of friendship understanding for some, but not all, friendship issues that may be related to friendship quality. The findings suggest that social cognitive assessments of friendship may be useful in understanding the friendship successes and difficulties of anxiously withdrawn preadolescents.

Influenza H1N1 2009 in Canterbury: a case study in pandemic response co-ordination.

BACKGROUND AND CONTEXT: Reviews of overseas pandemic responses have suggested that stronger links between primary care and other parts of the health sector are required. The influenza A (H1N1) 2009 ('H1N1 09') pandemic was the first real test of New Zealand's pandemic preparedness. ASSESSMENT OF PROBLEM: In the six months from May to October 2009, there were 595 confirmed cases of H1N1 09 in Canterbury, with 187 hospitalisations and three deaths. This paper describes the way a range of Canterbury agencies worked together in a co-ordinated health-led response aimed at minimising the impact of H1N1 09 in the community and maintaining effective health care services for both influenza and non-influenza patients. STRATEGIES FOR IMPROVEMENT: Key strategies included sector-wide response co-ordination, intelligence and communications, a combined public health/primary care response during the 'containment' phase, and universal red/green streaming supported by dedicated 'flu centres and an 0800 call centre during the 'manage it' phase. LESSONS: Despite the considerable impact of the H1N1 09 virus in Canterbury, health care services were not overwhelmed. The key lesson learned from the Canterbury H1N1 09 response has been the importance of preparing and working together across the sector.

Attachment, Social Information Processing, and Friendship Quality of Early Adolescent Girls and Boys.

Sixth-graders (N = 223; 109 girls) completed questionnaires assessing their attachment security with their mothers and fathers, their social information processing (SIP) when faced with ambiguously caused hypothetical negative events involving a close friend, and the quality of the relationship with that friend. Aspects of more maladaptive SIP were significantly related to lower levels of security. The overall pattern of results did not provide strong evidence for mediation, although boys' anger did tend to mediate the relation between attachment to mother and friendship quality. Results are consistent with attachment theory and suggest that the mechanisms connecting attachment and friendship are specific with regard to the relationships boys and girls have with their fathers and mothers.

Attachment, self-worth, and peer-group functioning in middle childhood.

We evaluated links between peer-group functioning and indicators of attachment security in relation to both mother and father in middle childhood, among 73 10-year-olds (37 girls). Children's perceptions of security with both parents, coping styles with mother, and self-worth were assessed. Classmates, teachers, and mothers evaluated the participants' peer-related behavioral characteristics. Children's perceptions of security to both parents were related to others' appraisals of their social competence; perceptions of security to father were related to lower aggression. We did not find child gender effects, but children had higher security scores in relation to mother than to father. Self-worth perceptions mediated the relation between attachment and social competence.

Social information processing and coping strategies of shy/withdrawn and aggressive children: does friendship matter?

The primary objectives of this investigation were to examine the attributions, emotional reactions, and coping strategies of shy/withdrawn and aggressive girls and boys and to examine whether such social cognitions differ within the relationship context of friendship. Drawn from a sample of fifth and sixth graders (M age = 10.79 years; SD = .77), 78 shy/withdrawn, 76 aggressive, and 85 control children were presented with hypothetical social situations that first involved unfamiliar peers, and then a mutual good friend. Results revealed group and gender differences and similarities, depending on the relationship context. From our findings emerges a central message: friends' involvement during interpersonal challenges or stressors mitigates children's attributions, emotions, and coping responses.

The best friendships of shy/withdrawn children: prevalence, stability, and relationship quality.

The mutual best friendships of shy/withdrawn and control children were examined for prevalence, stability, best friend's characteristics, and friendship quality. Using peer nominations of shy/socially withdrawn and aggressive behaviors, two groups of children were identified from a normative sample of fifth-grade children: shy/withdrawn (n = 169) and control (nonaggressive/nonwithdrawn; n = 163). Friendship nominations, teacher reports, and friendship quality data were gathered. Results revealed that shy/withdrawn children were as likely as control children to have mutual stable best friendships. Withdrawn children's friends were more withdrawn and victimized than were the control children's best friends; further, similarities in social withdrawal and peer victimization were revealed for withdrawn children and their friends. Withdrawn children and their friends reported lower friendship quality than did control children. Results highlight the importance of both quantitative and qualitative measures of friendship when considering relationships as risk and/or protective factors.

Attachment, Friendship, and Psychosocial Functioning in Early Adolescence.

Fifth-graders' (N = 162; 93 girls) relationships with parents and friends were examined with respect to their main and interactive effects on psychosocial functioning. Participants reported on parental support, the quality of their best friendships, self-worth, and perceptions of social competence. Peers reported on aggression, shyness and withdrawal, and rejection and victimization. Mothers reported on psychological adjustment. Perceived parental support and friendship quality predicted higher global self-worth and social competence and less internalizing problems. Perceived parental support predicted fewer externalizing problems, and paternal (not maternal) support predicted lower rejection and victimization. Friendship quality predicted lower rejection and victimization for only girls. Having a supportive mother protected boys from the effects of low-quality friendships on their perceived social competence. High friendship quality buffered the effects of low maternal support on girls' internalizing difficulties.

Infant attachment and temperament as predictors of subsequent externalizing problems and cardiac physiology.

BACKGROUND: The primary objective of this study was to examine the extent to which both individual child temperament and parent-child relationship quality independently and/or interactively predicted physiological, psychosocial, and behavioral 'outcomes'. Employing a longitudinal prospective design over three years, statistical associations were found among infant attachment, uninhibited temperament, and 4-year behavioral and physiological functioning that supported a bio-psychosocial model of development. METHOD: Three cohorts totaling 140 children and their mothers visited the laboratory for observational assessments of attachment classification at age 14 months (Strange Situation), behavioral inhibition at 24 months, and social behaviors with unfamiliar peers at age 4 years. Cardiac measures of heart rate and respiratory sinus arrhythmia (RSA) were collected at every time point. At age 4 years maternal ratings of child temperament and behaviors were also obtained. RESULTS: Analyses of variance (ANOVAs) with inhibition group (high, moderate, low) and attachment classification (A, B, C) revealed that the low inhibited group had significantly higher activity level scores and displayed significantly less reticence at 4 years compared to the moderately and highly inhibited groups. Infants who had an avoidant attachment with their mothers had more externalizing problems (aggressive behaviors) at age 4 than either securely or ambivalently attached infants. This predictive relation, however, was qualified by an interaction whereby avoidant attachment and uninhibited temperament together predicted a higher incidence of externalizing behavior problems. Moreover, infants' avoidant attachment was not concurrently but predictively associated with lower heart rate and high RSA at age 4 years. Therefore, an avoidant mother-child relationship in infancy could influence the development of an underaroused autonomic profile in early childhood. CONCLUSIONS: Consistent with bio-psychosocial models of development, these findings support the contention that both early child temperament and parent-child relationship quality contribute to subsequent psychological/behavioral and physiological functioning.

Predicting preschoolers' externalizing behaviors from toddler temperament, conflict, and maternal negativity.

Rarely have researchers elucidated early childhood precursors of externalizing behaviors for boys and girls from a normative sample. Toddlers (N = 104; 52 girls) were observed interacting with a same-sex peer and their mothers, and indices of conflict-aggression, emotion and behavior dysregulation, parenting, and child externalizing problems were obtained. Results indicated that boys initiated more conflictual-aggressive interactions as toddlers and had more externalizing difficulties 2 years later, yet girls' (not boys') conflict-aggressive initiations at age 2 were related to subsequent externalizing problems. When such initiations were controlled for, emotional-behavioral undercontrol at age 2 also independently predicted externalizing problems at age 4. Moreover, the relation between conflict-aggressive initiations at age 2 and externalizing problems at age 4 was strongest for dysregulated toddlers. Finally, the relation between age 2 conflict-aggressive initiations and age 4 externalizing problems was strongest for those toddlers who incurred high levels of maternal negativity. These findings illustrate temperament by parenting connections in the development of externalizing problems.

Stability and social-behavioral consequences of toddlers' inhibited temperament and parenting behaviors.

A prospective longitudinal design was employed to ascertain whether different types of behavioral inhibition (i.e., traditional, peer-social) were stable from toddler to preschool age, and whether inhibited temperament and/or parenting style would predict children's subsequent social and behavioral problems. At Time 1, 108 toddlers (54 males, 54 females) and their mothers were observed in the Traditional Inhibition Paradigm and in a toddler-peer session; then at age 4 years, 88 children were observed with unfamiliar peers, and maternal ratings of psychological functioning were obtained. How mothers and their toddlers interacted was also observed. Results revealed meaningful connections between toddler inhibition, maternal intrusive control and derision, and nonsocial behaviors at age 4. Both forms of toddler inhibition predicted socially reticent behavior during free play at 4 years. If mothers demonstrated relatively high frequencies of intrusive control and/or derisive comments, then the association between their toddlers' peer inhibition and 4-year social reticence was significant and positive; whereas if mothers were neither intrusive nor derisive, then toddlers' peer inhibition and 4-year reticence were not significantly associated. Thus, maternal behaviors moderated the relation between toddlers' peer inhibition and preschoolers' social reticence.