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.

Evaluating automatic road detection across a large aerial imagery collection

The automated extraction of roads from aerial imagery can be of value for tasks including mapping, surveillance and change detection. Unfortunately, there are no public databases or standard evaluation protocols for evaluating these techniques. Many techniques are further hindered by a reliance on manual initialisation, making large scale application of the techniques impractical. In this paper, we present a public database and evaluation protocol for the evaluation of road extraction algorithms, and propose an improved automatic seed finding technique to initialise road extraction, based on a combination of geometric and colour features.

Web searcher interaction with the Dogpile.com metasearch engine

Metasearch engines are an intuitive method for improving the performance of Web search by increasing coverage, returning large numbers of results with a focus on relevance, and presenting alternative views of information needs. However, the use of metasearch engines in an operational environment is not well understood. In this study, we investigate the usage of Dogpile.com, a major Web metasearch engine, with the aim of discovering how Web searchers interact with metasearch engines. We report results examining 2,465,145 interactions from 534,507 users of Dogpile.com on May 6, 2005 and compare these results with findings from other Web searching studies. We collect data on geographical location of searchers, use of system feedback, content selection, sessions, queries, and term usage. Findings show that Dogpile.com searchers are mainly from the USA (84% of searchers), use about 3 terms per query (mean = 2.85), implement system feedback moderately (8.4% of users), and generally (56% of users) spend less than one minute interacting with the Web search engine. Overall, metasearchers seem to have higher degrees of interaction than searchers on non-metasearch engines, but their sessions are for a shorter period of time. These aspects of metasearching may be what define the differences from other forms of Web searching. We discuss the implications of our findings in relation to metasearch for Web searchers, search engines, and content providers.

Defining a session on Web search engines

Detecting query reformulations within a session by a Web searcher is an important area of research for designing more helpful searching systems and targeting content to particular users. Methods explored by other researchers include both qualitative (i.e., the use of human judges to manually analyze query patterns on usually small samples) and nondeterministic algorithms, typically using large amounts of training data to predict query modification during sessions. In this article, we explore three alternative methods for detection of session boundaries. All three methods are computationally straightforward and therefore easily implemented for detection of session changes. We examine 2,465,145 interactions from 534,507 users of Dogpile.com on May 6, 2005. We compare session analysis using (a) Internet Protocol address and cookie; (b) Internet Protocol address, cookie, and a temporal limit on intrasession interactions; and (c) Internet Protocol address, cookie, and query reformulation patterns. Overall, our analysis shows that defining sessions by query reformulation along with Internet Protocol address and cookie provides the best measure, resulting in an 82% increase in the count of sessions. Regardless of the method used, the mean session length was fewer than three queries, and the mean session duration was less than 30 min. Searchers most often modified their query by changing query terms (nearly 23% of all query modifications) rather than adding or deleting terms. Implications are that for measuring searching traffic, unique sessions may be a better indicator than the common metric of unique visitors. This research also sheds light on the more complex aspects of Web searching involving query modifications and may lead to advances in searching tools.

Internship : interpreting micropolitical contexts

Many university faculties of education across Australia employ a model of internship for final semester pre-service teacher education students to help them make a smooth transition into the teaching profession. While a growing body of research has explored pre-service teachers’ experiences of their practicum, including the internship, which is the final professional experience within a course of study, very little work has considered micropolitics as a lens through which to interpret interns’ relationships with their school supervisors/mentors. This paper uses a micropolitical framework to interpret reflective reports written by 145 Bachelor of Education (primary) interns who recorded their perceptions of their professional learning experience within the context of a relationship with their school-based mentors. Several key themes are identified that highlight interns’ reports of a range of micropolitical strategies at play. The paper concludes by raising a number of implications for universities and schools regarding how better to facilitate interns’ transition into the profession.

Patterns and transitions of query reformulation during web searching

Purpose – To investigate and identify the patterns of interaction between searchers and search engine during web searching. Design/methodology/approach – The authors examined 2,465,145 interactions from 534,507 users of Dogpile.com submitted on May 6, 2005, and compared query reformulation patterns. They investigated the type of query modifications and query modification transitions within sessions. Findings – The paper identifies three strong query reformulation transition patterns: between specialization and generalization; between video and audio, and between content change and system assistance. In addition, the findings show that web and images content were the most popular media collections. Originality/value – This research sheds light on the more complex aspects of web searching involving query modifications.

Pollutant concentrations within households in Lao PDR and association with housing characteristics and occupants' activities

The paper presents the results of a study conducted to investigate indoor air quality within residential dwellings in Lao PDR. Results from PM 10, CO, and NO2 measurements inside 167 dwellings in Lao PDR over a five month period (December 2005-April 2006) are discussed as a function of household characteristics and occupant activities. Extremely high PM10 and NO2 concentrations (12 h mean PM10 concentrations 1275 ± 98 μg m-3 and 1183 ± 99 μg m-3 in Vientiane and Bolikhamxay provinces, respectively; 12 h mean NO2 concentrations 1210 ± 94 μg m-3 and 561 ± 45 μg m-3 in Vientiane and Bolikhamxay, respectively) were measured within the dwellings. Correlations, ANOVA analysis (univariate and multivariate), and linear regression results suggest a substantial contribution from cookingandsmoking.The PM10 concentrations were significantly higher in houses without a chimney compared to houses in which cooking occurred on a stove with a chimney. However, no significant differences in pollutantconcentrations were observed as a function of cooking location. Furthermore, PM10 and NO2 concentrations were higher in houses in which smoking occurred, suggestive of a relationship between increased indoor concentrations and smoking (0.05 < p < 0.10). Resuspension of dust from soil floors was another significant source of PM10 inside the house (634 μg m-3, p < 0.05).

Young adults’ accounts of scientific knowledge when responding to a television news report of contested science

This paper reports one aspect of a study of 28 young adults (18–26 years) engaging with the uncertain (contested) science of a television news report about recent research into mobile phone health risks. The aim of the study was to examine these young people’s ‘accounts of scientific knowledge’ in this context. Seven groups of friends responded to the news report, initially in focus group discussions. Later in semi-structured interviews they elaborated their understanding of the nature of science through their explanations of the scientists’ disagreement and described their mobile phone safety risk assessments. This paper presents their accounts in terms of their views of the nature of science and their concept understanding. Discussions were audio-recorded then analysed by coding the talk in terms of issues raised, which were grouped into themes and interpreted in terms of a moderate social constructionist theoretical framing. In this context, most participants expressed a ‘common sense’ view of the nature of science, describing it as an atheoretical, technical procedure of scientists testing their personal opinions on the issue, subject to the influence of funding sponsors. The roles of theory and data interpretation were largely ignored. It is argued that the nature of science understanding is crucial to engagement with contemporary socioscientific issues, particularly the roles of argumentation, theory, data interpretation, and the distinction of science from common sense. Implications for school science relate primarily to nature of science teaching and the inclusion of socioscientific issues in school science curricula. Future research directions are considered.

Helping undergraduate students across disciplines and cultures actively engage and collaborate as equal members of a community of scholars : peer review within an e-learning environment

At the international level, the higher education sector is currently being subjected to increased calls for public accountability and the current move by the OECD to rank universities based on the quality of their teaching and learning outcomes. At the national level, Australian universities and their teaching staff face numerous challenges including financial restrictions, increasing student numbers and the reality of an increasingly diverse student population. The Australian higher education response to these competing policy and accreditation demands focuses on precise explicit systems and procedures which are inflexible and conservative and which ignore the fact that assessment is the single biggest influence on how students approach their learning. By seriously neglecting the quality of student learning outcomes, assessment tasks are often failing to engage students or reflect the tasks students will face in the world of practice. Innovative assessment design, which includes new paradigms of student engagement and learning and pedagogically based technologies have the capacity to provide some measure of relief from these internal and external tensions by significantly enhancing the learning experience for an increasingly time-poor population of students. That is, the assessment process has the ability to deliver program objectives and active learning through a knowledge transfer process which increases student participation and engagement. This social constructivist view highlights the importance of peer review in assisting students to participate and collaborate as equal members of a community of scholars with both their peers and academic staff members. As a result of increasing the student’s desire to learn, peer review leads to more confident, independent and reflective learners who also become more skilled at making independent judgements of their own and others' work. Within this context, in Case Study One of this project, a summative, peer-assessed, weekly, assessment task was introduced in the first “serious” accounting subject offered as part of an undergraduate degree. The positive outcomes achieved included: student failure rates declined 15%; tutorial participation increased fourfold; tutorial engagement increased six-fold; and there was a 100% student-based approval rating for the retention of the assessment task. However, in stark contrast to the positive student response, staff issues related to the loss of research time associated with the administration of the peer-review process threatened its survival. This paper contributes to the core conference topics of new trends and experiences in undergraduate assessment education and in terms of innovative, on-line, learning and teaching practices, by elaborating the Case Study Two “solution” generated to this dilemma. At the heart of the resolution is an e-Learning, peer-review process conducted in conjunction with the University of Melbourne which seeks to both create a virtual sense of belonging and to efficiently and effectively meet academic learning objectives with minimum staff involvement. In outlining the significant level of success achieved, student-based qualitative and quantitative data will be highlighted along with staff views in a comparative analysis of the advantages and disadvantages to both students and staff of the staff-led, peer review process versus its on-line counterpart.

Murray-Darling basin governance : the focus of the law

The legal arrangements for the management of the Murray-Darling Basin in Australia have changed significantly over the years. The Constitution of the Commonwealth has led to the legal arrangements for the management of the Murray-Darling Basin. The Water Act 2000 of Queensland aimed at advancing sustainable management and efficient use of water and other resources by establishing a system for the planning, allocation and use of water. The Water Management Act 2000 of New South Wales ensures the sustainable and integrated management of the water resources of the state benefiting the present and future generations. The Natural Resources Management Act 2004 of South Australia applies to water resources and to other natural resources. The Act aimed at assisting the achievement of ecologically sustainable development in the state.

Mapping Australia's philanthropic investment in women and girls

The Australian Women Donors Network (Women Donors) partnered the Australian Centre for Philanthropy and Nonprofit Studies (ACPNS) at QUT to conduct this research. No studies exist on the size or sources of philanthropic giving in Australia directed intentionally towards the needs of women and girls. The survey aims to fill this knowledge gap and create a baseline for understanding trends and views in this area. Because the survey treads some new ground, its findings raise questions as well as giving answers. Encouragingly, 100 people from across the philanthropy spectrum completed the survey, embracing 41 individual donors and other respondents from various foundation types. Given the population difference, this response compares well with the 145 respondents to the USA-based Foundation Center’s 2009 European study (reported in 2011). The survey was designed for givers generally, not just those involved in giving to women and girls specifically. It is possible, though, that people with an interest in funding this area were more likely to participate. This potential oversampling may inflate the figures on funding women and girls to some degree. Also, because the population size of Australian philanthropists is unknown, no claims can be made that this information is generalizable to all Australian funders. Nonetheless, some patterns and themes emerge from the 100 responses.

Gaseous and particle emissions from an ethanol fumigated compression ignition engine

A 4-cylinder Ford 2701C test engine was used in this study to explore the impact of ethanol fumigation on gaseous and particle emission concentrations. The fumigation technique delivered vaporised ethanol into the intake manifold of the engine, using an injector, a pump and pressure regulator, a heat exchanger for vaporising ethanol and a separate fuel tank and lines. Gaseous (Nitric oxide (NO), Carbon monoxide (CO) and hydrocarbons (HC)) and particulate emissions (particle mass (PM2.5) and particle number) testing was conducted at intermediate speed (1700 rpm) using 4 load settings with ethanol substitution percentages ranging from 10-40 % (by energy). With ethanol fumigation, NO and PM2.5 emissions were reduced, whereas CO and HC emissions increased considerably and particle number emissions increased at most test settings. It was found that ethanol fumigation reduced the excess air factor for the engine and this led to increased emissions of CO and HC, but decreased emissions of NO. PM2.5 emissions were reduced with ethanol fumigation, as ethanol has a very low “sooting” tendency. This is due to the higher hydrogen-to-carbon ratio of this fuel, and also because ethanol does not contain aromatics, both of which are known soot precursors. The use of a diesel oxidation catalyst (as an after-treatment device) is recommended to achieve a reduction in the four pollutants that are currently regulated for compression ignition engines. The increase in particle number emissions with ethanol fumigation was due to the formation of volatile (organic) particles; consequently, using a diesel oxidation catalyst will also assist in reducing particle number emissions.

Digital intermediary: Korean transnational cinema

Since censorship was lifted in Korea in 1996, collaboration between Korean and foreign filmmakers has grown in both extent and visibility. Korean films have been shot in Australia, New Zealand and mainland China, while the Korean digital post-production and visual effects firms behind blockbusters infused with local effects have gone on to work with filmmakers from greater China and Hollywood Korean cinema has become known for its universal storylines, genre experimentation and high production values. The number of exported Korean films has increased, as has the number of Korean actors starring in films made in other countries. Korea has hosted major international industry events. These milestones have facilitated an unprecedented international expansion of the Korean film industry. With the advent of the 'digital wave in Korea the film industry's transition to digital production practices this expansion has accelerated Korean film agencies the pillars of the national cinema have played important parts in this internationalisation, particularly in promoting Korean films and filmmakers outside Korea and in facilitating international events in Korea itself Yet, for the most part, projects involving Korean filmmakers working in partnership with filmmakers from other countries are the products of individuals and businesses working outside official channels. That is, they are often better understood as 'transnational rather than 'national' or 'international' projects. In this article, we focus on a range of collaborations involving Korean, Australian, New Zealand and Chinese filmmakers and firms. These collaborations highlight some of the forces that have shaped the digital wave in the Korean film industry, and illustrate the increasingly influential role that the 'digital expertise of Korean filmmakers is playing in film industries, both regionally and around the world.

Genotype x culture media interaction effects on regeneration response of three indica rice cultivars

Interactive effects of genotypes with callus induction and regeneration media combinations on green plantlet regeneration response were studied for three indica rice (Oryza sativa L.) cultivars, IR-72, IR-54 and Karnal Local. Isolated mature-embryoswere used to derive scutellar callus and fifteen media combinations involvingMS, N6, R2, SK1 and some modifications were tested. Regeneration percentage as well as the shoot-bud induction frequency were influenced by genotype, callus induction medium, regeneration medium, interaction between genotype and the two media (callus induction and regeneration) as well the interaction between the callus induction medium and regeneration medium. Basal media combination of SK1m (callusing) and MS (regeneration) was found to be the best for cv. Karnal Local in which regeneration frequency of 88% and shoot-bud induction of 233% was observed. In IR-72, the highest regeneration frequency of 47.5% and shoot-bud induction frequency of 77% was obtained on MS-MS combination. In IR-54, highest regeneration frequency (25%) was recorded on MMS(N)-MMS(N) combination, whereas, highest frequency of shoot-bud induction (50%) was observed on MMS(S)-MS combination. Although genotype and the composition of the callus induction basal medium were the major determinants of regeneration response, an overall analysis of variation also revealed a significant interaction between the media used for de-differentiation (callusing) and re-differentiation (plantlet regeneration)