Strategic development of a master's program on the World Wide Web.

Quality teaching requires more than masterful professors. In today's academic environments, leaders in educational institutions have responsibilities to supply fiscal and human resources that support settings conducive to learning and that instill human, educational, and professional values. Recent technologic advances have shifted the capacities to deliver programs of study outside traditional classrooms. The World Wide Web can deliver nursing courses that are complex, multimedia, and interactive. Planning to offer a degree program on-line requires examining the organization's mission and philosophy as well as allocating human and fiscal resources to the project. As leaders implement innovations, such as distance learning on-line, they must address the organization's political challenges and cultural changes. When leaders seek to introduce innovation within their organizations, they must be prepared for excitement as well as anxiety and resistance. Leadership also requires evaluating performance and outcomes for quality education. In addition, they strive to meet expectations of quality of all stakeholders. J Prof Nurs 17:166-172, 2001.

A lesson from the last nursing shortage: the influence of work values on career satisfaction with nursing.

With an emerging national nursing shortage and evidence of dissatisfied registered nurses, it is useful to revisit the issue of satisfaction by analyzing data from the prior nursing shortage in 1989. The authors explore the relationships that work values have on the satisfaction that nurses experience with a career in nursing. The relevance of the findings are discussed within the context of the nursing shortage.

Creating Web-based, multimedia, and interactive courses for distance learning.

A case study describes how faculty at Saint Louis University School of Nursing have developed computer-based, multimedia courses for master's and post-master's nursing education. Lectures with slide presentations are recorded digitally and encoded for multimedia streaming over the World Wide Web for distance learning. The technology is explained in detail in terms of the specific technologies used for lecture and course development. How this technology supports graduate student learning is also presented.

Characteristics of patient visits to nurse practitioners and physician assistants in hospital outpatient departments.

Many authors have described differences between nurse practitioners and physician assistants. Most studies have compared physician with nonphysician providers' practice. Few studies have compared nurse practitioners and physician assistants, and none has used a national data base. This exploratory, atheoretical research examined which of the following characteristics predicted patients being seen by nurse practitioners and physician assistants: patient and hospital demographics, diagnosis, diagnostic/screening services, therapeutic services, and disposition of the visit. The data set used for analysis was the 1992 National Hospital Ambulatory Medical Care Survey. Based on a multistage probability design yielding national estimates for patient visits in hospital outpatient settings, the National Hospital Ambulatory Medical Care Survey showed that there were 2,847 weighted patient visits to either nurse practitioners or physician assistants (4.6 million patient visits using national estimates). Results of multivariate logistic regression suggest that nurse practitioners were the most likely nonphysician provider for outpatients receiving more health promotion and counseling (therapeutic) services and for those needing women's and children's services. Outpatients in rural areas predicted visits to physician assistants. As more nonphysician providers enter the work force, the results of this research may assist with understanding the utilization of nurse practitioners and physician assistants in primary care.

Denervation-induced sprouting of intact peripheral afferents into the cuneate nucleus of adult rats.

In adult monkeys with dorsal rhizotomies extending from the second cervical (C2) to the fifth thoracic (T5) vertebrae, cortex deprived of its normal inputs regained responsiveness to inputs conveyed by intact peripheral afferents from the face [T.P. Pons, P.E. Garraghty, A.K. Ommaya, J.H. Kaas, E. Taub, M. Mishkin, Massive reorganization of the primary somatosensory cortex after peripheral sensory deafferentation, Science 252 (1991) 1857-1860]. It has been suggested that the extent of this massive topographic reorganization may be due to the establishment of novel connections between intact afferents and neurons denervated after dorsal rhizotomy [P.E. Garraghty, D.P. Hanes, S.L. Florence, J.H. Kaas, Pattern of peripheral deafferentation predicts reorganizational limits in adult primate somatosensory cortex, Somatosens. Motor Res. 11 (1994) 109-117]. Using adult rats with comparably extensive dorsal rhizotomies, we employed anatomical tracing techniques to address this possibility. Subcutaneous hindpaw injections of horseradish peroxidase conjugated to either wheat germ agglutinin or cholera toxin subunit B revealed aberrant expansions of gracile projections into the cuneate and, in one case, external cuneate nucleus within three months of the deafferentation. It seems plausible that such modest sprouting of ascending projections at the level of the brainstem may form functional connections which, through divergence, ultimately drive a larger population of neurons in cortex. This new growth may well account for both the substantial cortical reorganization observed in the 'Silver Spring monkeys' [T.P. Pons, P.E. Garraghty, A.K. Ommaya, J.H. Kaas, E. Taub, M. Mishkin, Massive reorganization of the primary somatosensory cortex after peripheral sensory deafferentation, Science 252 (1991) 1857-1860] and the 'referred sensation' phenomena (see J.P. Donoghue, Plasticity of adult sensorimotor representations, Curr. Opin. Neurobiol., 5 (1995) 749-754 for review) reported to follow proximal limb amputations in humans.

Motoneuron development after deafferentation. I. dorsal rhizotomy does not alter growth in the spinal nucleus of the bulbocavernosus (SNB).

The spinal nucleus of the bulbocavernosus (SNB) and the dorsolateral nucleus (DLN) are sexually dimorphic motor nuclei in the rat lumbar spinal cord. During postnatal development, SNB and DLN motoneurons grow substantially in measures of soma size, dendritic length, and radial dendritic extent. SNB motoneurons exhibit a biphasic pattern of dendritic growth, where there is an initial period of exuberant growth followed by a period of retraction to mature lengths by 7 weeks. In this experiment, we examined whether primary afferent input to the SNB nucleus was necessary for the normal postnatal growth of SNB motoneurons. We partially deafferented the SNB via unilateral dorsal rhizotomy of lumbosacral dorsal roots in male rats at 1 week of age. Using cholera toxin horseradish peroxidase (BHRP) to visualize SNB motoneurons, we examined SNB motoneuron morphology at 4 and 7 weeks of age. SNB motoneurons in rhizotomized males developed normally; measures of dendritic length in rhizotomized males were typically exuberant at 4 weeks of age, and declined significantly to mature lengths by 7 weeks of age. In addition, dorsal rhizotomy did not alter the development of SNB motoneuron soma size or radial dendritic extent. These results are discussed in reference to sensorimotor connections in the SNB, the extent of the deafferentation, and dendrodendritic interactions.

Motoneuron development after deafferentation: II. dorsal rhizotomy does not block estrogen-supported growth in the dorsolateral nucleus (DLN).

The lumbar spinal cord of the rat contains two sexually dimorphic motor nuclei, the spinal nucleus of the bulbocavernosus (SNB) and the dorsolateral nucleus (DLN). Postnatally, SNB and DLN motoneurons grow substantially and reach their adult morphology by 7 weeks of age. The masculinization of SNB and DLN motoneuron dendrites depends upon steroid hormones. After early castration, the growth of SNB and DLN dendrites is markedly attenuated, but testosterone replacement restores this growth. In the SNB, initial dendritic growth is also supported in castrates treated with estrogen. By using castration and hormone replacement techniques, we examined the development of DLN motoneuron morphology in estrogen-treated castrated rats to determine if estrogen also supports the growth of DLN motoneurons. In addition, given that dorsal root ganglia may be a site of estrogen action, we tested the hypothesis that estrogen acts at primary afferents to support DLN dendritic growth. Thus, we attempted to block the potential trophic effect of estrogen by performing unilateral dorsal rhizotomies in estrogen-treated castrates. DLN motoneuron morphology was analyzed at 4 and 7 weeks of age by using cholera toxin horseradish peroxidase (BHRP) histochemistry. As found for SNB motoneurons, estrogen treatment transiently supported development. DLN motoneurons in estrogen-treated castrates developed normally through 4 weeks of age, but by 7 weeks, DLN motoneuron morphology in estrogen-treated castrates was no longer different from that in oil-treated castrates. Moreover, deafferentation via unilateral dorsal rhizotomy did not inhibit estrogen's ability to masculinize the early development of DLN motoneurons. Thus, the trophic effect of estrogen did not appear to act via the dorsal root ganglia to support the early postnatal development of DLN motoneurons.

Sexually dimorphic neuron number in lumbosacral dorsal root ganglia of the rat: development and steroid regulation.

Rats possess a sexually dimorphic neuromuscular system that controls penile reflexes critical for copulation. This system includes two motor nuclei in the lumbar cord and their target musculature in the perineum. The spinal nucleus of the bulbocavernosus (SNB) and the dorsolateral nucleus (DLN) motoneuron populations and their target perineal muscles are much larger in males than in females. The sex difference in motoneuron number develops via androgen-regulated differential cell death during the perinatal period; androgen also regulates retention of the target muscles. The developmental pattern and steroid sensitivity of peripheral afferents to the SNB/DLN motor nuclei were previously unknown. In order to characterize the peripheral sensory component of the dimorphic SNB/DLN system, the neurons of the relevant dorsal root ganglia (DRGs) were quantified in terms of number, size, and androgen sensitivity at various perinatal ages. DRG neuron number is greatest prenatally, then decreases in both sexes after birth; the timing and pattern of neuron number development are similar to those seen in the SNB and DLN. Postnatally, males have more DRG neurons than females, as a result of greater neuron death in the DRGs of females. Females treated with testosterone propionate during the perinatal period exhibit masculine development of DRG neuron number. Thus, the normal development of DRG neuron number parallels that of the SNB/DLN motor nuclei and target muscles in pattern and timing, is sexually dimorphic, and is regulated by androgen.

The odds for success on NCLEX-RN by nurse candidates from a four-year baccalaureate nursing program.

First-time nurse candidates from a four-year baccalaureate nursing program were examined to identify predictors of success on NCLEX-RN. Five logistic regression models were tested to see if specific variables increased nurse candidates' odds for success or failure. The use of admission criteria was the poorest model in predicting performance. Cumulative grade point averages (GPAs) suggested that the end of the sophomore year was the best time for predicting success and the end of the junior year was best for predicting failure. Age was inversely related to successful performance in three of the five models. Using cumulative nursing GPAs, the likelihood of predicting success on NCLEX-RN increased at the end of each academic year.

Success-failure on the National Council Licensure Examination for Registered Nurses by nurse candidates from an accelerated baccalaureate nursing program.

Nine years of data from first-time nurse candidates taking the National Council Licensure Examination for Registered Nurses (NCLEX-RN) were examined to identify predictors of successful performance and determine probabilities of success. Using logistic regression, four statistical models at strategic time periods during an accelerated baccalaureate nursing program were tested to see when intervention might be initiated to influence student performance on the NCLEX-RN. By the end of the first semester the model could predict failure for 94 per cent of those who failed, but it was less consequential in correctly predicting success of those who passed. Significant variables placing nurse candidates at risk included their first-semester grade point average, sex, and whether they were foreign educated. By the end of the second semester, with each full letter grade increase in cumulative grade point average, nurse candidates had a 46 times better chance of passing the NCLEX-RN; American-educated nurse candidates had a 4.5 times better chance of passing than their foreign-educated counterparts. At the end of the final semester, with each full letter grade increase on the final cumulative grade point average, nurse candidates had a 97 times greater likelihood of performing successfully on the NCLEX-RN.

Preparing nurses to use microcomputers for the work of management.

Communications and information systems are expanding rapidly in health care organizations today. That nurses must not only be computer literate but also consumers of information technologies emerges as a professional imperative. This is especially true for nurses in management and administration. Therefore, exposing them to current technologies becomes crucial in their academic experience. Educating students to use business software applications and to understand their output will yield a leading edge to those preparing for management decision-making.

Business software for nurse executives.

Nurse executives are encouraged to be innovative with computer applications for effective management. Business software systems useful for nurse executive are compared in this article.