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Although case management in higher education is a relatively new phenomenon, the challenges presented by COVID-19 have forced many institutions to deliver emergency services in an extremely rapid f...

Financial stress is implicated in poor health and decreased Quality of Life (QOL). The purpose of this project was to assess the 2-year effect of a financial education program on the health of single, low-income women. A total of 30 women were enrolled and 20 continued through follow-up. Two years following intervention, women demonstrated a $8,026 increase in mean annual income and significant improvements in health-related QOL and hopefulness. Half of the participants lost weight, and while not statistically significant, mean weight decreased by 2.2 pounds. Trends in decreased fast food consumption were observed. The results suggest that financial education has a significant, sustained effect on the health and health-related QOL of single, women of low income.

Objective The purpose of the study is to determine the immediate effect of Bowen Therapy in pressure pain threshold and postural sway of healthy individuals. Design Crossover, randomized, and double blinded study. Setting University. Participants Participants aged 18 years old or over, naive to Bowen therapy were recruited among university students. An a priori sample size calculation determined that 34 participants were needed. Methods Each participant attended two sessions and received Bowen Therapy and a sham procedure. The order in which Bowen or the sham procedure were administered was randomized. All participants had their postural control and pressure pain thresholds assessed in sessions 1 and 2 both at baseline and at the end of the session. Main outcome measurements Postural control was assessed using a force plate and centre of pressure antero-posterior and medio-lateral displacement, velocity and total sway area were calculated. Pressure pain threshold was measured at 10 different body sites on the paraspinal muscles from C1 to S1 using an electronic algometer. Result The results showed a significant increase in the anteroposterior displacement ( p = 0.04) and a significantly lower decrease in the mean velocity ( p = 0.01) of the centre of pressure and a significant increase in the pressure pain thresholds of two (out of ten; p ≤ 0.04) body sites in the group receiving Bowen Therapy compared to the group receiving the sham. No other significant differences were found. Conclusions The findings suggest that Bowen Therapy has inconsistent immediate effects on postural control and pain threshold in healthy subjects. Further studies are needed using symptomatic participants.

Background and Purpose.Given the complexity of the current health care environment, effective clinical reasoning skills are fundamental to making critical patient care decisions. The purpose of this study was to explore the clinical reasoning abilities of students across time in 1 professional Docto

BACKGROUND AND PURPOSEIf faculty members want to better understand student learning and the development of student reasoning abilities, avenues to gain insight into student thinking are needed. Sound teaching and learning strategies should be studied and shared to improve this educational process. In order to improve our ability as teachers, we must engage in inquiry into the process of teaching along with the evidence of student learning, the outcome of teaching.1 As described by Ernest Boyer, an inquiry driven approach consistent with the scholarship of teaching may best help us understand critical issues in the assessment of student learning.2Scholarship of teaching and learning projects allow educators to evaluate teaching strategies by using assessment of student learning as a primary source of evidence.2,3 To understand the development of a complicated ability such as clinical reasoning, one must investigate the evidence of student learning, as well as the teaching strategies linked to it. Shulman describes it well, saying:To prompt learning, you've got to begin with the processes-the inside from the inside out. The first influence on new learning is not what teachers do pedagogically but the learning that's already inside the learner.Bps36'Clinical reasoning is a multifactorial and complex phenomenon.4 Research in the health professions identifies clinical reasoning used in clinical practice as a collaborative and reflective process that involves contentspecific knowledge, engagement of the patient and family in understanding the clinical problem, and incorporation of critical contextual factors. All of these factors lead to deliberative decision making and sound clinical judgment.4,5 As defined by Christensen et al, clinical reasoning is the thinking and decision making process used for examination and patient management.6 The American Physical Therapy Association (APTA) recognizes the importance of clinical reasoning as a required practice skill.7 The Commission on Accreditation of Physical Therapy Education (CAPTE) requires that all physical therapist (PT) education programs develop and assess clinical reasoning skills as a professional practice expectation.8 Students must be able to utilize clinical reasoning to enhance patient care and minimize errors in practice.A nonnegotiable component or foundation for the development of clinical reasoning is the students' ability to engage in self-monitoring and critical self-reflection. The ability to monitor self, stop the action, bring different frames of perspective to the situation, see the context of the problem, and grapple with the uncertainty of the situation are skills that depend on self-monitoring and critical self-reflection.9'12 Learners are engaged in a life-long process of honing their skills to be attentive, mindful, and nonjudgmental. These skills go well beyond the traditional notions of analytical thinking and looking for the right answer or definitive piece of evidence that are far too often seen as the most important aspects of critical thinking.1'11,13Due to the multidimensional nature of clinical reasoning, assessment of this skill is challenging for educators and clinical instructors. There are few standardized tools available to evaluate student clinical reasoning abilities in physical therapy. Most of the existing assessment tools were developed for use in other health care professions and assess critical thinking rather than clinical reasoning.14 Some of these tools include the Health Science Reasoning Test and the California Critical Thinking Skills Test.15 While critical thinking is an important skill for all students, we argue here that clinical reasoning is a more robust concept, as it not only focuses on the mental processes, but also includes the connections between these processes and the behaviors that are shared between the patient, practitioner, and the environment.16The following tools and teaching strategies have been used with some success to assess clinical reasoning: the script concordance test, concept mapping, thinking aloud, quantitative standardized tests, reflection, interviews, and focus groups. …

Background Subcutaneous injection into an elevated skin fold poses a risk of "bilateral exposure" injury whereby the needle pierces the opposite side of a skin fold and subsequently enters the tissue of the health care worker (HCW). Methods Retrospective review was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data. Data from 2,402 injuries occurring during subcutaneous injection were included for analysis. Descriptive data, statistical comparisons, and a logistic regression model reporting relative risk are provided. Results Eighty-five bilateral exposure injuries were identified between 2000 and 2009, representing 3.5% (n/N=85/2,402) of all injection-related percutaneous injuries. 65.4% Of the variance in bilateral exposure injury occurrence is explained through examination of the following: (1) manual elevation ("pinching") subcutaneous tissue prior to injection; (2) thin/emaciated patient; (3) injection of insulin; (4) injection of heparin; (5) injection of enoxaparin (Lovenox); (6) if a safety device was used; and (7) whether the health care worker was wearing gloves at the time of the injury (χ 2 7 = 424.2; P Conclusion Manual tissue elevation should be avoided to minimize the risk of bilateral exposure injuries.

Background and Purpose. Critical thinking, knowledge, skill, and self-reflection are the hallmarks of clinical reasoning in physical therapy. Teaching and measuring a highly complex entity such as clinical reasoning is a challenging task and often requires multiple pedagogies and assessments. Knowledge and skill are frequently assessed by educators, but critical thinking and skills of reflection are not. Previous studies have used standardized tests to assess clinical reasoning skills of physical therapist students. These studies report conflicting findings potentially due to the fact that neither test was designed to test critical thinking of allied health practitioners. The Health Sciences Reasoning Test (HSRT) was designed specifically for health science students with questions written in a health care context.Participants. In 2008, 63 students, 37 from a public East Coast university and 26 from a private Midwest university were recruited to complete the HSRT.Method. The students completed the HSRT at 3 points in their education: upon entry to the program, prior to final affiliations, and again just prior to graduation.Outcomes. Analysis indicated a statistically significant change for the total score as well as the deductive and analysis subscales. Post-hoc analysis indicated these differences occurred between times 1 and 2 for the total score as well as both subscales. There was a significant difference between the 2 schools after adjusting for variance in initial test scores. The Midwest school's mean score (24.85) was greater than the east coast school's (22.42), and this difference was significant F^sub l^ = 12.65; P Conclusion. The HSRT was able to detect change in critical thinking scores. This finding, coupled with those of a previous study in which the HSRT was able to detect differences between experts and novices, indicate the HSRT may have validity and therefore may be a useful tool for assessing the critical thinking skills of physical therapist students.Key Words: Assessment, Clinical reasoning, Critical thinking.INTRODUCTIONThe Commission on Accreditation of Physical Therapy Education (CAPTE) requires physical therapist education programs to develop and assess students' clinical reasoning skills.1 While clinical reasoning skills have always been an important component of physical therapist education, this mandate, coupled with direct access and the move to a doctoring profession, increases the importance of teaching and assessing clinical reasoning skills of physical therapist students.Clinical reasoning refers to the thinking and decision-making process used during examination and management of patients.2 It is a complex mechanism that requires basic scientific knowledge, clinical competence, the ability to self-reflect, and critical thinking skills. Critical thinking is the disciplined, intellectual process of applying skillful reasoning as a guide to belief or action and involves the cognitive abilities of analysis, interpretation, inference, evaluation, and explanation.3 The relationship between critical thinking and clinical reasoning is poorly understood and the terms are often interchanged. Clinical reasoning can be conceptualized as critical thinking within a specific domain or a particular point of view of a field, in this case the field of physical therapy. Physical therapists apply the components of critical thinking about and within the field of physical therapy, which has a certain point of view. This point of view is based on the objects, events, and investigations we consider in our area of expertise.4 The result of this critical thinking within our domain of practice and within the point of view of the field can be considered clinical reasoning. If one accepts this postulate then the skills required for critical thinking (ie, analysis, interpretation, inference, evaluation, and explanation) would be considered inherent in the clinical reasoning process but would be used contextually within the domain of physical therapy. …

Using data from the California Board of Registered Nursing Surveys of 1997, 2004, 2006 and 2008, this study explores demographic, human capital, and work environment changes in the Hispanic RN population and compared these changes to those occurring among non-Hispanic Whites. Results find several significant differences between the two groups. The most important finding is that Hispanic RNs enter and leave the profession at younger ages than their non-Hispanic White counterparts. There is an abrupt decrease in the proportion of Hispanic RNs after age 50, while the proportion non-Hispanic White continues to increase until age 65. Decided action is needed to increase recruitment and retention of Hispanic RNs in order to increase nurse-patient concordance and abate the looming nurse shortage.

Background In 2007 and 2008, 115 patients were found to be either certainly or presumptively infected with the hepatitis C virus through the reuse of contaminated medication vials at two southern Nevada endoscopy clinics. A subsequent joint investigation by federal and state agencies found multiple breaches of infection control protocols. There was also strong anecdotal evidence that among clinic staff, unsafe patient care conditions often went unreported because of a general fear of retaliation. At the request of the Nevada legislature's Legislative Committee on Health Care, a study was conducted to examine Nevada RNs' experiences with workplace attitudes toward patient advocacy activities. This article presents the study findings and reviews how one public health tragedy led to the creation of effective health care policy. Methods A study questionnaire was developed and tested for reliability and validity. Questionnaires were then sent to an initial sample of 1,725 Nevada RNs, representing 10% of all RNs in the Nevada State Board of Nursing database with active licenses and current Nevada addresses. Results The response rate was modest at 33% (564 respondents). Of those who responded, 34% indicated that they'd been aware of a patient care condition that could have caused harm to a patient, yet hadn't reported it. The most common reasons given for nonreporting included fears of workplace retaliation (44%) and a belief that nothing would come of reports that were made (38%). Conclusions The study findings underscore the need for a shift in organizational culture toward one that encourages clear and open communication when patient safety may be in jeopardy. These findings were ultimately used to support the passage of whistleblower protection legislation in Nevada. Keywords Las Vegas hepatitis C outbreak, patient advocacy, whistleblower.

The purposes of this study were to describe a home exercise program (HEP) consisting of respiratory exercise and stretching thoracic muscles and to determine how regular participation in this program affected pulmonary function, chest wall excursion, physical function, and quality of life in community-dwelling older adults. Thirty-seven volunteers (mean age 80.5 years) participated in a twice daily HEP for 6 weeks. Twenty-two subjects completed the program. Pulmonary function, chest wall excursion (CWE), the 6-minute walk test (6MWT), the physical performance test (PPT), and RAND SF-36 quality of life survey (SF-36) were administered before and after the exercise program. Increases in CWE, 6MWT, and PPT were statistically significant. In conclusion, community-dwelling older adults participating in a 6-week stretching and respiratory exercise program demonstrated improved CWE and function.

The phenomenon of career inactivity in professional nursing has been historically portrayed in the literature as a major cause of disequilibrium in the registered nurse labor market. However, there remains a general lack of understanding of the diverse forces that shape the inactive nurse pool and the likelihood that this population will return to nursing. The purpose of this study was to examine the population of registered nurses who are active in the labor market but work in nonnursing employment. Specifically, this study sought to determine the relative importance of nonworkplace- and workplace-related reasons for working outside of nursing. The results demonstrate that dissatisfaction with the nursing workplace is the key reason cited by actively licensed nurses for working outside of nursing employment. These findings suggest that policy and employer remedies are needed to improve the nursing workplace.

A retrospective review of secondary injury data was used to evaluate the characteristics of percutaneous injuries from safety-engineered sharp devices. Injury rates and safety device activation rates differed by healthcare provider type. Approximately 22.8%–32% of injuries could have been prevented had an available safety feature been activated after use.

Background Physical therapists work in complex health care systems requiring professional competence in clinical reasoning and confidence in decision-making skills. For novice physical therapists, the initial practice years are a time for developing professional identity and practical knowledge. Objectives The study purpose was to extend previous research describing the experiences, learning, and professional development of 11 promising novice therapists during their first year of practice. The present study examined the continued development of the same therapists during their second year of clinical practice. Design Seven researchers from 4 physical therapist educational programs in the eastern and midwestern United States used a longitudinal, qualitative, multiple case study approach. Methods Eleven physical therapist graduates identified as “promising novices” were recruited using purposive sampling. Participants ranged in age from 24 to 29 years and entered varied practice settings. Data were collected for 2 years using semistructured interviews, reflective journals, and participant observation. Results A conceptual model describing the participants' ongoing development during the second year of practice emerged. The 3 themes were formal and informal learning, increasing confidence and expansion of skills, and engagement in an environment characterized by collaborative exchange and opportunities for teaching. The second year represented consolidation and elaboration of practice-based learning and skills. The expansion of confidence, skills, and responsibilities and the externalization of learning the participants experienced promoted professional role formation. Learning previously directed inward and self-focused turned outward, fueled by growing self-confidence. Conclusions Research illuminating the professional role formation experienced during early clinical practice is not widely available. The current study and further research into the learning and development of novice practitioners may assist educators in the design of pedagogical strategies and learning environments that enhance the professional development of physical therapists.

Background Despite their overwhelming efficacy, safety-engineered sharp devices (SESDs) cause a residual fraction of injuries. Although the fraction of injuries from SESDs is less than that reported for nonsafety devices, it remains a “preventable fraction” and is a sizable target for further advances. Methods A retrospective review of 3,297 percutaneous injuries from hollow bore safety-engineered devices occurring between 2001 and 2009 was conducted examining the Exposure Prevention Information Network (EPINet) needlestick surveillance data. Results Nurses sustain 64.6% of all SESD injuries. 42.9% Of SESD injuries occur after device use and are likely preventable through consistent and effective use of safety-engineered technology. Excluding injuries that occurred during device use or between procedural steps, 71.8% (n/N = 28/39) of physician injuries, 58.2% (n/N = 645/1,109) of injuries to nurses, and 45.8% (n/N = 88/192) of injuries to phlebotomists occurred when an available SESD was not fully activated. Conclusion Passive devices that do not require action on the part of the end user to engage a safety feature currently represent a small portion of the SESD market. Wider dissemination of a broader array of passive SESDs coupled with continual education of end users is essential to an effective sharps injury prevention program.

IntroductionUnscheduled re-attendances (UR) continue to pose a problem to the Paediatric Emergency Department (PED) and there is paucity of research on this topic. 5% of PED attendances are UR.1 Although some are inevitable, it is important to identify strategies to minimise such attendances.ObjectivesTo estimate the size of the problem, identify high risk patient groups and determine other factors (system or doctor) related to UR within an inner city PED.MethodsAll patients under the age of 17, who reattended within 72 h, over a 28-day period, were identified and their Emergency Department notes reviewed.Results91 children were identified, which represented an UR rate of 3.88%, of which 69 (76%) were under 5 years old. Gastroenteritis (GE) and upper respiratory tract infection (URTI) were the predominant causes of UR. 67% of children were assessed by a junior doctor (JD {< ST2}) on initial presentation. On re-attendance, 74% were again assessed by a JD contrary to department policy and on both occasions less than half were discussed with a senior doctor. Only 70% were discharged with a documented safety net advising appropriate re-attendance. Four children had a revised diagnosis on re-attendance and 22% were ultimately admitted.ConclusionsUR is an important performance indicator and a periodic review should be a part of clinical governance activity. High risk groups for UR were