Using ‘think aloud’ as a strategy for learning clinical reasoning in high fidelity case-based simulation for undergraduate nursing students

AIMS This paper reports on the implementation of a research project that trials an educational strategy implemented over six months of an undergraduate third year nursing curriculum. This project aims to explore the effectiveness of ‘think aloud’ as a strategy for learning clinical reasoning for students in simulated clinical settings. BACKGROUND Nurses are required to apply and utilise critical thinking skills to enable clinical reasoning and problem solving in the clinical setting [1]. Nursing students are expected to develop and display clinical reasoning skills in practice, but may struggle articulating reasons behind decisions about patient care. For students learning to manage complex clinical situations, teaching approaches are required that make these instinctive cognitive processes explicit and clear [2-5]. In line with professional expectations, nursing students in third year at Queensland University of Technology (QUT) are expected to display clinical reasoning skills in practice. This can be a complex proposition for students in practice situations, particularly as the degree of uncertainty or decision complexity increases [6-7]. The ‘think aloud’ approach is an innovative learning/teaching method which can create an environment suitable for developing clinical reasoning skills in students [4, 8]. This project aims to use the ‘think aloud’ strategy within a simulation context to provide a safe learning environment in which third year students are assisted to uncover cognitive approaches that best assist them to make effective patient care decisions, and improve their confidence, clinical reasoning and active critical reflection on their practice. MEHODS In semester 2 2011 at QUT, third year nursing students will undertake high fidelity simulation, some for the first time commencing in September of 2011. There will be two cohorts for strategy implementation (group 1= use think aloud as a strategy within the simulation, group 2= not given a specific strategy outside of nursing assessment frameworks) in relation to problem solving patient needs. Students will be briefed about the scenario, given a nursing handover, placed into a simulation group and an observer group, and the facilitator/teacher will run the simulation from a control room, and not have contact (as a ‘teacher’) with students during the simulation. Then debriefing will occur as a whole group outside of the simulation room where the session can be reviewed on screen. The think aloud strategy will be described to students in their pre-simulation briefing and allow for clarification of this strategy at this time. All other aspects of the simulations remain the same, (resources, suggested nursing assessment frameworks, simulation session duration, size of simulation teams, preparatory materials). RESULTS Methodology of the project and the challenges of implementation will be the focus of this presentation. This will include ethical considerations in designing the project, recruitment of students and implementation of a voluntary research project within a busy educational curriculum which in third year targets 669 students over two campuses. CONCLUSIONS In an environment of increasingly constrained clinical placement opportunities, exploration of alternate strategies to improve critical thinking skills and develop clinical reasoning and problem solving for nursing students is imperative in preparing nurses to respond to changing patient needs. References 1. Lasater, K., High-fidelity simulation and the development of clinical judgement: students' experiences. Journal of Nursing Education, 2007. 46(6): p. 269-276. 2. Lapkin, S., et al., Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clinical Simulation in Nursing, 2010. 6(6): p. e207-22. 3. Kaddoura, M.P.C.M.S.N.R.N., New Graduate Nurses' Perceptions of the Effects of Clinical Simulation on Their Critical Thinking, Learning, and Confidence. The Journal of Continuing Education in Nursing, 2010. 41(11): p. 506. 4. Banning, M., The think aloud approach as an educational tool to develop and assess clinical reasoning in undergraduate students. Nurse Education Today, 2008. 28: p. 8-14. 5. Porter-O'Grady, T., Profound change:21st century nursing. Nursing Outlook, 2001. 49(4): p. 182-186. 6. Andersson, A.K., M. Omberg, and M. Svedlund, Triage in the emergency department-a qualitative study of the factors which nurses consider when making decisions. Nursing in Critical Care, 2006. 11(3): p. 136-145. 7. O'Neill, E.S., N.M. Dluhy, and C. Chin, Modelling novice clinical reasoning for a computerized decision support system. Journal of Advanced Nursing, 2005. 49(1): p. 68-77. 8. Lee, J.E. and N. Ryan-Wenger, The "Think Aloud" seminar for teaching clinical reasoning: a case study of a child with pharyngitis. J Pediatr Health Care, 1997. 11(3): p. 101-10.

A snapshot of 40 years in early childhood education and care through oral histories

The year 2012 marked 40 years since the introduction of the Child Care Act 1972 and the federal government introduced financial support for the provision of child care services in Australia. Significant changes have occurred in social, political and theoretical contexts of early childhood education and care (ECEC) during this time. Bringing these to life, this paper investigates archival data of key changes in ECEC in association with oral histories of staff, parents and children associated with The Gowrie Qld during the years 1972‒2012. With narrative analysis considered alongside historical information, two dominant issues emerge as integral to ECEC in the past, now and the future. These are: 1) what constitutes effective teaching and learning in the educational program and 2) professional expectations in ECEC. Building an historical picture, this paper provides for critical reflection on the past to inform current and future practices.

Work integrated learning: Exposure to professional practice : expectations and challenges

Prior to graduation engineering students are expected to provide evidence of relevant experience in the workplace. This experience is expected to provide opportunities for exposure to the profession and to help students develop confidence, skills and capabilities as emerging professionals. This investigation considers the expectations and challenges in implementing WIL programs in different contexts. While this will inform the next iteration of engineering course development at QUT the issues and interventions described provide useful insights into options available and engineering curriculum design more broadly. This comparative analysis across three phases highlights expectations and challenges including stakeholder responsibilities, expectations, and assessment. The study draws on the findings of a 2005 investigation into the purpose and provision of WIL and findings of a 2012 Faculty review of the current WIL model. The enhancement of WIL through a series of developmental phases highlights strengths and weaknesses of various models. It is anticipated that this investigation will inform course development decisions on a whole-of-course approach to WIL that improves student engagement and learning experience. The importance of WIL is not disputed. However with industry expectations, increasing student numbers and cohort diversity the ways in which students and industry currently engage in WIL are not sustainable and more creative, flexible and engaging approaches are needed.

Certainties and uncertainties : ethics and professional identities of early childhood educators

This study is an inquiry into the professional identity constructions of early childhood educators, where identity is conceptualised as social and contextual. Through a genealogical analysis of narratives of four Queensland early childhood teachers, the thesis renders as problematic universal and fixed notions of what it is to be an early childhood professional. The data are the four teachers’ professional life history narratives recounted through a series of conversational interviews with each participant. As they spoke about professionalism and ethics, these teachers struggled to locate themselves as professionals, as they drew on a number of dominant discourses available to them. These dominant discourses were located and mapped through analysis of the participants’ talk about relationships with parents, colleagues and authorities. Genealogical analysis enabled multiple readings of the ways in which the participants’ talk held together certainties and uncertainties, as they recounted their experiences and spoke of early childhood expertise, relational engagement and ethics. The thesis concludes with suggestions for ways to support early childhood teachers and pre-service teachers to both engage with and resist normative processes and expectations of professional identity construction. In so doing, multiple and contextual opportunities can be made available when it comes to being professional and ‘doing’ ethics. The thesis makes an argument for new possibilities for thinking and speaking professional identities that include both certainty and uncertainty, comfort and discomfort, and these seemingly oppositional terms are held together in tension, with an insistence that both are necessary and true. The use of provocations offers tools through which pre-service teachers, teachers and teacher educators can access new positions associated with certainties and uncertainties in professional identities. These new positions call for work that supports experiences of ‘de-comfort’ – that is, experiences that encourage early childhood educators to step away from the comfort zones that can become part of expertise, professional relationships and ethics embedded within normative representations of what it is to be an early childhood professional.

Too great expectations?

Teachers have always been charged with the task of turning out the next generation of citizens—educated, healthy in mind, and healthy in body. The central question here is: how far should this responsibility extend? Just how much can we reasonably expect teachers to be responsible for? And just what should schools be responsible for? Obviously, teachers ought to be responsible for the fundamentals of learning, but should they be held accountable for what the children eat, or how they choose to behave, or for every single risk, direct or indirect, that could conceivably occur within the school grounds? These are precisely the kinds of expectation that have become part of educational life. Bit by bit, new forms of responsibility are being added to the site of the school and, more specifically, to the professional life of the teacher. The intention here is not necessarily to challenge any of these diverse changes, but rather to express concern about their cumulative effect on the ability of the school to do its primary job effectively.

Professional education in built environment and design

Early and rich conversations with a range of stakeholders – academics, professionals and graduates in their early years of practice – quickly clarified that the singular challenge for most parties centres on the ways in which courses prepare graduates for the pace, diversity and flux of contemporary professional practice.---------In pursuing understanding of this central challenge this study has focused on new graduates in BED disciplines by canvassing their views and those of two other major stakeholder groups (academic staff and professional practitioners in the disciplines studied). The first crucial years of a young graduate’s life in the workforce are shaped by a number of factors including the quality of the transition-to-work experience. The quality of this life-shaping transition is dependent on a range of factors including the ways in which graduates are educated in universities, their personal developmental characteristics and those of the professional people around them and the preparedness of workplaces and other professional groups to guide new recruits through the transition experience. This study makes recommendations about how the variations in transition experience, resulting from the vagaries of all these factors across a range of worksites, may be better understood, perhaps normalised, and, at least, supported. . Early and rich conversations with a range of stakeholders – academics, professionals and graduates in their early years of practice – quickly clarified that the singular challenge for most parties centres on the ways in which courses prepare graduates for the pace, diversity and flux of contemporary professional practice. The study proceeded through literature review, focus group interviews, national online survey and workshops. Through all these methods a number of challenges and factors essential to the transition experience, and the quality of education which precedes it, were identified. Firstly the study found further evidence of the importance of higher-order graduate capabilities, namely, the development of judgment, critical enquiry and strategic thinking. Alongside these capabilities the importance of the development of emotional intelligence, particularly interpersonal and social skills, was stressed by all stakeholders. At the time of writing the global economic crisis was providing challenges to the sector and its young graduates. This phenomenon proved the value of the development of resilience and persistence in graduates, the education system was called upon by all stakeholders as a place where the future-proofing of neophytes would ensure that the unknown challenges of the future could also be confronted. The study found that the challenges of transition to work are best supported by authentic undergraduate experiences both on and off campus, inside and outside classrooms, and that commencing professional life is made easier for new graduates when university courses and workplace settings develop, sustain and support high standards and high expectations of students. All these findings indicate the importance of stakeholder expectations, roles and responsibilities in respect of the transition-to-work experience. Whilst full agreement about how these things should occur is not necessary, a process (amongst stakeholders) which seeks value alignment around transition through discussion, debate and agenda-setting would probably assist to address what is seen as a major challenge in built environment and design education.

Community engagement and artful academic staff development : a return on expectations through collaborative practice

The changing ownership of roles in organisational work-life leads this paper to examine what universities are doing in their academic development practice through research at an Australian university where ‘artful’ collaboration with the real world aims to build capability for innovative academic community engagement. The paper also presents findings on the ‘return on expectations’ (Hodges, 2004) of community engagement for both academics and their organisational supervisors.

Researching professionals and online social networking : toward a professional doctorate

The professional doctorate is a degree that is specifically designed for professionals investigating real world problems and relevant issues for a profession, industry and/ or the community. The study on which this paper is based sought to track the scholarly skill development of a cohort of professional doctoral students who commenced their course in January 2008 at an Australian University. Via an initial survey and two focus groups held six months apart, the study aimed to determine if there had been any qualitative shifts in students’ understandings, expectations and perceptions regarding this developing knowledge and skills. Three key findings has emerged from this study were: (i) the appropriateness of using a blended learning approach for this doctoral cohort; (ii) the challenges of using wikis as an online technology of creating communities of practice: and (iii) that the transition from student to scholar is a process that is unlikely to be achieved in a short time frame.

Grading : harmonising standards and stakeholder expectations

This paper suggests that when a course is planned within one culture for delivery to members of another culture, appropriate quality control of assessment becomes an issue of major proportions. Based on their experience of presenting an Aid Agency-funded Masters course in a developing country in the Pacific, the authors describe the processes to address the needs and wants of all the stakeholders, with different cultural expectations. Maintaining a balance between domestic and Pacific student cohorts regarding resources and opportunities for study was especially challenging. However, grounding grades in course curriculum and clearly stated objectives permitted the teaching team to meet external requirements while maintaining their professional and academic freedom.

The teacher as reflexive professional : making visible the excluded discourse in teacher standards

In the current climate of accountability, political manoeuvring, changing curriculum, increasingly diverse student cohorts and community expectations, teachers, more than ever, need to develop the skills and abilities to be reflective and reflexive practitioners. This study examines national teacher professional standards from Australia and the UK to identify the extent to which reflexivity is embedded in key policy documents that are intended to guide the work of teachers in those countries. Using Margaret Archer's theories of reflexivity and morphogenesis, and methods of critical discourse analysis, we argue that these blueprints for teachers’ work exclude reflexivity as an essential and overarching discourse of teacher professionalism.

Through the eyes of the mentor : framing expectations within preservice teacher and mentor relationships

Mentoring relationships during pre-service education are a significant relationship through which emerging teachers negotiate their teacher identity (Iancu-Haddad & Oplatka, 2009; Hudson, 2010). It is therefore important to understand how mentor teachers frame their expectations. This paper explores mentoring relationships established within a Queensland partnership program funded through the Federal Government’s Improving Teacher Quality National Partnership Agreement (DEEWR, 2011). Within the broader policy context, these mentoring relationships were seen as an important space for pre-service teachers to experience cultural induction into Education Queensland schooling, and be advocates for quality teaching (Willis, Bahr, Bannah, & Welch, 2012). Interview and survey data from 14 teacher mentors were analysed using a dialectic constant comparison approach (Dick 2007). Three significant themes were identified. Mentor teachers’ understanding of their roles positioned pre-service teachers as either novices or alternatively as colleagues, and these had implications for the opportunities for learning that were then made available to the pre-service teachers. The mentor teacher’s beliefs about teaching as a practical craft, and how the mentor teachers judged a pre-service teacher’s “enthusiasm” were also analysed. Understanding the factors that guide teacher mentor approaches may inform future designs of mentoring and preservice teacher preparation programs.

A pilot study exploring Australian general practice nurses roles, responsibilities and professional development needs in well and sick child care

Aim Explore practice nurses' (PNs) role in child health and development, and advising parents about child health issues. Background Introduction of the four-year-old child health check into general practice in 2008 placed additional responsibilities on PNs in child health and wellness. This study explores their readiness to expand their practice into this area. Design Integrated mixed method design, self-report survey. Method A purpose-developed questionnaire explored demographics, child health roles and responsibilities, difficulties encountered, professional development needs, barriers and facilitators, and professional development activities undertaken in the past year. Surveys were posted to 218 PNs in one rural Division of General Practice (DGP) in Queensland, Australia; 29 responded. Results PNs reported a significant role in well and sick child care (93.1%) though few had a paediatric/child health background (14.3%). Roles included immunisations (92.3%), child health checks (65.4%), general child health and development (26.9%), asthma (23.1%), feeding (15.4%), fever (11.5%), settling/sleeping (11.5%). PNs were interested in learning more about (81.5%) and incorporating more child health into their practice (81.5%). Professional development in childhood growth and development (80.0%), health and illness (60.0%) and advising new mothers (20.0%) was needed. Conclusions PNs play a substantial role in child health, are unprepared for the complexities of this role and have preferred methods for undertaking professional development to address knowledge deficits. Implications for practice PNs are unprepared for an advanced role in child health and wellness. Significant gaps in their knowledge to support this role were identified. This ever-expanding role requires close monitoring to ensure knowledge precedes expectations to practice.

Professional conversations : a collaborative approach to support policy implementation, professional learning and practice change in ECEC

In 2012, Australia introduced a new National Quality Framework, comprising enhanced quality expectations for early childhood education and care services, two national learning frameworks and a new Assessment and Rating System spanning child care centres, kindergartens and preschools, family day care and outside school hours care. This is the linchpin in a series of education reforms designed to support increased access to higher quality early childhood education and care (ECEC) and successful transition to school. As with any policy change, success in real terms relies upon building shared understanding and the capacity of educators to apply new knowledge and to support change and improved practice within their service. With this in mind, a collaborative research project investigated the efficacy of a new approach to professional learning in ECEC: the professional conversation. This paper reports on the trial and evaluation of a series of professional conversations to support implementation of one element of the NQF, the Early Years Learning Framework (DEEWR,2009), and their capacity to promote collaborative reflective practice, shared understanding, and improved practice in ECEC. Set against the backdrop of the NQF, this paper details the professional conversation approach, key challenges and critical success factors, and the learning outcomes for conversation participants. Findings support the efficacy of this approach to professional learning in ECEC, and its capacity to support policy reform and practice change in ECEC.

Australian journalism students' motivations and job expectations : evidence from a survey across six universities

The value of tertiary journalism education is an often hotly-debated topic among journalism educators and in the industry. Yet, the voices of students are often not heard in these debates. For example, we know relatively little about why young people actually decide to study journalism, what area of journalism they want to work in and what they are looking for in a job. To shed more light on the student perspective, this paper reports on a survey of 320 undergraduate journalism students at six Australian universities. The results show that only a minority actually want to work in news journalism, while most prefer entertainment-focussed areas. Students are motivated mainly by a love for writing and because they like journalism as a profession. In terms of job characteristics, they are particularly interested in their own career progression, but also in the extent to which they can provide a public service.

The ACORN Standards : our aide memoire to professional practice

The Oxford English Dictionary defines a standard as “a required or agreed level of quality or attainment” or “principles of conduct informed by notions of honour and decency”. What does this mean for perioperative nurses? Standards provide minimum requirements for best practice and are regarded as generally accepted principles of patient care and perioperative management. In health care, standards provide a common language and set of expectations that enable health care professionals, systems and organisations to work together for best patient outcomes...