Next Generation NCLEX®: Using the ACEN Standards and Criteria to Prepare

Recently, the National Council of State Boards of Nursing (NCSBN) announced the addition of a special research section of the National Council Licensure Examination (NCLEX®) to collect data on new items that could “expand or enhance measurement of entry-level nursing competency including clinical judgment” (National Council of State Boards of Nursing, 2019b). While the licensure examination has always assessed graduates’ ability to utilize clinical judgment, the measurements to determine the graduate’s clinical judgment have evolved. NCSBN’s proposed revisions to the licensure examination, often referred to as Next Generation NCLEX®, are designed to better assess and evaluate clinical judgment for entry-level practice. This article provides a brief overview of what is currently understood about Next Generation NCLEX® and describes how the Accreditation Commission for Education in Nursing (ACEN) Standards and Criteria can be used to help faculty proactively prepare students for practice and the licensure examination. Even if a program’s historical pass rates have been at the national mean or minimally 80% or higher, it is time to be proactive and prepare for the potential Next Generation NCLEX®.     

What Next? The Next Transit from Biology to Diagnostics: Next Generation Sequencing for Immunogenetics

The human genome project triggered the introduction of next generation sequencing (NGS) systems. Although originally developed for total genome sequencing, metagenomics and plant genetics, the ultra-deep sequencing feature of NGS was utilized for diagnostic purposes in HIV resistance and tropism as well in detecting new mutations and tumor clones in oncology. Recent publications exploited the feature of clonal sequencing for immunogenetics to dissolve the growing number of ambiguities. This concept is quite reliable if all exons of interest are tested and the amplification region includes flanking introns. Challenging questions on quality control, cost effectiveness, workflow, and management of enormous loads of data remain if NGS is considered as routine method in the immunogenetics laboratory. If solved, NGS has big potential to have a major impact on immunogenetics by way of providing ambiguity-free HLA-typing results faster, but will also have a great influence on how immunogenetics testing and workflows are organized.     

Clinical Judgement and Next Generation NCLEX® – A Positive Direction for Nursing Education!

Nurse educators are buzzing about the National Council State Boards of Nursing’s Next Generation National Council Licensure Examination (NCLEX®) (NGN). This significant change of test item style is based upon thoughtful and powerful evidence, supported by the Clinical Judgment Model (CJM). Faculty have questioned on how to prepare students for the possible NGN changes. This article explores simple and quick ways to incorporate the CJM into every classroom, laboratory, simulation, and clinical experience.     

What Motivates Our Practice Colleagues to Precept the Next Generation?

Relationships between faculty and clinical preceptors are crucial to nurse practitioner student education. Developing partnerships between faculty and preceptors is challenging for schools of nursing. One large nursing school invited 531 preceptors to participate in a survey identifying barriers and benefits to precepting nurse practitioner students. The survey-identified top barriers were related to effects on workload and productivity. Benefits to precepting included having a strong desire to teach and grow the profession and incentives such as access to educational programs and recognition through academic relationships. Survey information led to the development of a preceptor-centered portal on the school’s website.     

Herbal or complementary medicine: fact or fiction?

Although herbal medications have been used in medical therapy since the dawn of civilization, they have not undergone careful scientific assessment. Some herbal derivations are exceptional and have become standard therapy in cardiovascular disease; eg, digitalis, reserpine, and aspirin. The high prevalence of herbal use around the world and in the United States today may have a negative impact on patient care when herbal preparations are used in combination with medications ordered by healthcare providers who are not advised of the patient's use of herbs. Healthcare providers need to be familiar with all herbal medications in order to prevent potentially serious reactions between conventional and herbal medications. They should be asking patients about herbal use when first obtaining a medical history. Patients who use alternative therapies do not tell their healthcare providers about such use.     

Does Threat Enlarge Nociceptive Reflex Receptive Fields?

Threat-induced pain modulation can increase survival by amplifying physiological and behavioral reactions toward danger. Threat can also modulate spinal nociception, suggesting engagement of endogenous top-down circuitry. A unique method to assess spinal nociception is via reflex receptive fields (RRF) associated with the nociceptive withdrawal reflex (NWR, a protective spinally-mediated reflex). The size of nociceptive RRFs can be modulated by top-down circuitry with the enlargement of RRFs related to increased spinal nociception. Threat has been previously shown to enhance pain and spinal nociception, but the relationship between threat and RRFs has not been investigated. The present study investigated this issue in 25 healthy individuals. RRFs were determined from NWRs measured by electromyography of the tibialis anterior following electrocutaneous stimulations. RRFs and pain were assessed during periods in which participants were under threat of unpredictable painful abdominal stimulations and when they were not under threat. Results indicated that threat periods led to significantly higher pain, larger nociceptive RRFs and NWR magnitudes. These findings imply that threat produces changes in protective reflexes related to spinal nociceptive sensitivity and increased pain perception. This is likely mediated by top-down circuitry that enhances dorsal horn nociceptive neurons by enlarging RRFs and amplifying ascending pain signals.PerspectiveThis article presents the enlargement of RRF during periods of threat. The results from this study may help clarify the mechanism underlining emotional modulation of spinal nociception.     

Aging: compensation or maturation?

Neuroimaging studies of healthy aging often reveal differences in neural activation patterns between young and elderly groups for episodic memory tasks, even though there are no differences in behavioral performance. One explanation typically offered is that the elderly compensate for their memory deficiencies through the recruitment of additional prefrontal regions. The present study of healthy aging compared magnetoencephalographic (MEG) time-courses localized to specific cortical regions in two groups of subjects (20-29 years and >or=65 years) during a visual delayed-match-to-sample (DMS) task. MR morphometrics and neuropsychological test results were also examined with the hope of providing insight into the nature of the age-related differences. The behavioral results indicated no differences in performance between young and elderly groups. Although there was a main effect of age on the latency of the initial peak in primary/secondary visual cortex, these longer latencies were not correlated with the performance of elderly on the DMS task. The lateral occipital gyrus (LOG) revealed qualitatively different patterns of activity for the two age groups corroborated by neuropsychological test results. Morphometric results for the young versus elderly groups revealed less white (WM) and gray matter (GM) volumes in the frontal lobes of the elderly. When a group of middle-aged subjects (33-43 years) was included in the morphometric analyses, the middle-aged subjects revealed statistically greater WM volumes in frontal and parietal cortex suggesting immature WM tracts in the young. Perhaps our elderly utilized a different strategy compared to the young due to the different brain maturation levels of these groups.