The lived experience of new graduate nurses successfully completing NCLEX-RN

Background and objective: The NCLEX pass rate is considered the primary indicator of program quality. Much literature exists regarding pre-graduation efforts aimed at aiding students to prepare for the NCLEX-RN exam, while there is little available on post-graduation efforts. This project was conducted to identify the post-graduation experiences of successful NCLEX-RN test takers as they prepared to complete the exam.Methods: This was a qualitative descriptive study utilizing a phenomenological framework to determine the lived experience of new graduates preparing to complete the NCLEX-RN exam.Results: Four main themes were identified as relevant to post graduation experiences including: (a) Finding Motivation, (b) Study Tactics, (c) Taking a Break, and (d) The Testing Experience. Additionally, few of the participants took it for granted that they were going to pass the exam, they reported wishing they had spent more time preparing, and with regard to studying, several described wishing they had started earlier.Conclusions: It will be beneficial for faculty to discuss potential strategies for success to utilize after graduation, including expectations of testing day, setting a realistic timetable to test, overcoming lack of motivation to preparation for the exam, and careful scheduling of coaching and study sessions.

Cognition, Metacognition, and Self-Regulated Learning

Psychology’s attention to mental events took root in the middle of the 19th century and grew through studies of learning, forgetting, and problem solving. Following several decades during which behaviorism dominated the field, cognitive studies of learning rapidly expanded after the mid-1960s. Foci for research concerned how learners acquire different kinds information, particularly declarative knowledge, procedural knowledge, and schemas, and identifying cognitive operations learners can apply to transform experience into knowledge. What learners know significantly shapes what they learn. Prior knowledge often benefits learning, but inaccurate knowledge, called misconceptions, and skills applied indiscriminately can impede it. Effort to learn, called cognitive load, is not a unary concept. Designing learning tasks to focus cognition in ways germane to content is one key to effective instruction. Learners can think about their cognition and its properties. This is metacognition. Examples include judgments of whether and what is learned, planning shaped by the relative success in tasks and affective experiences, and decisions to abandon risky or unproductive tasks. Measures of metacognition, predominantly learners’ reports as opposed to direct indicators, correlate modestly with achievement, but this may reflect that students are not often educated in study tactics and learning strategies. Metacognition is a key factor in learners’ decisions about which study tactics and learning strategies they use, and a challenge learners face is overcoming overconfidence about what they know. The metacognitive decision-making event is modeled as an If–Then production. Metacognitive control of how learners choose to go about learning is conditional on metacognitive monitoring of conditions the learner believes will influence learning processes and outcomes. When learners experiment with approaches to learning, they engage in self-regulated learning (SRL). SRL is a very energetic area of research that spans investigations into learners’ metacognition about conditions for learning, operations on information, products resulting from those operations, and evaluations of products in terms of standards the learner holds; the COPES model. Like its foundation in metacognition, SRL also correlates modestly with achievement and is similarly challenged by relying on learners’ self-reports about SRL. However, learners can be taught how to better apply SRL which may realize benefits to achievement.

Therapeutic approaches to the Rational Use of trip­le combination therapy with a fixed combination of amlodipine, indapamide and perindopril arginine (TRIPLE COMBINATION) in patients with hypertension who do not control blood pressure on conventional treatment. (Description and main results of the TRIO program)

Aim To study tactics of outpatient physicians in choosing the treatment when the previous double antihypertensive therapy (AHT) fails and to analyze the effectivity of an amlodipine/indapamide/perindopril arginine triple combination (TC).Material and methods The program included 1252 patients with arterial hypertension (AH); the TC group consisted of 992 (79.23 %) patients (38.3 % males; age, 61.6 [55.0; 67.9]); the control group included 260 (20.77 %) patients (37.7 % males; age, 60.6 [53.3; 67.4]). The main inclusion criteria were essential AH, age 18-79 years, insufficient response to previous AHT (clinical systolic blood pressure (SBP) >140–179 mm Hg). The study duration was three months. The following parameters were evaluated: dynamics of clinical and ambulatory BP (BP self-monitoring (BPSM); frequency of achieving the first goal of <140 / 90 mm Hg and the goal of <130 / 80 mm Hg); and changes in glomerular filtration rate (GFR) and quality of life (QoL). Responses to TC were analyzed in groups with different ranges of increased baseline SBP in patients with AH and diabetes mellitus (DM)/impaired glucose tolerance (IGT), overweight or obesity, and chronic kidney disease (CKD, reduced estimated GFR (eGFR <60 ml/min/1.73 m2). Safety was evaluated based on records of adverse events (AEs).Results The TC group had a more severe condition at baseline by clinical parameters and history and had higher baseline BP, which made difficult the intergroup comparison. Nevertheless at three months, the decrease in clinical SBP was more pronounced in the TC group (from 162.1 to 126.8 mm Hg, Δ=35.7 mm Hg) than in the control group (from 157.8 to 128.4 mm Hg, Δ=29.4 mm Hg). 87.8% of patients in the TC group and 81.9 % (р=0.012) in the control group achieved the first BP goal of <140 / 90 mm Hg; 34.3% and 28.2% of patients, respectively, achieved the BP goal of <130 / 80 mm Hg (р=0.055). The more effective SBP control in the TC group was associated with a pronounced BP decrease with higher BP values at baseline, which was also confirmed by an analysis in subgroups with SBP 140–160, 160–180, and >180 mm Hg. The TC treatment was associated with a pronounced antihypertensive effect with respect of BPSM values, improved QoL, and renal function. Significant decreases in BP and achievement of BP goals by a vast majority of patients receiving TC were also observed in subgroups with DM or IGT, overweight and/or obesity, and CKD. AEs were observed during the treatment only in 8 patients (0.64 %), which confirmed good tolerability and high safety of the therapy.Conclusion The study results demonstrated a therapeutic effect of the amlodipine/indapamide/perindopril arginine fixed-dose combination (Triplixam®). This effect was evident as control of clinical BP with any baseline BP level, including different ranges of increased SBP, in AH combined with DM, IGT, obesity, and CKD, which offers advantages over a subjective choice of AHT. TC improved BPSM values, QoL indexes, provided nephroprotection, and was well tolerated.