The primacy of vital signs – Acute care nurses’ and midwives’ use of physical assessment skills: A cross sectional study

BACKGROUND: Registered nurses and midwives play an essential role in detecting patients at risk of deterioration through ongoing assessment and action in response to changing health status. Yet, evidence suggests that clinical deterioration frequently goes unnoticed in hospitalised patients. While much attention has been paid to early warning and rapid response systems, little research has examined factors related to physical assessment skills. OBJECTIVES: To determine a minimum data set of core skills used during nursing assessment of hospitalised patients and identify nurse and workplace predictors of the use of physical assessment to detect patient deterioration. DESIGN: The study used a single-centre, cross-sectional survey design. SETTING and PARTICIPANTS: The study included 434 registered nurses and midwives (Grades 5-7) involved in clinical care of patients on acute care wards, including medicine, surgery, oncology, mental health and maternity service areas, at a 929-bed tertiary referral teaching hospital in Southeast Queensland, Australia. METHODS: We conducted a hospital-wide survey of registered nurses and midwives using the 133-item Physical Assessment Skills Inventory and the 58-item Barriers to Registered Nurses’ Use of Physical Assessment scale. Median frequency for each physical assessment skill was calculated to determine core skills. To explore predictors of core skill utilisation, backward stepwise general linear modelling was conducted. Means and regression coefficients are reported with 95% confidence intervals. A p value < .05 was considered significant for all analyses. RESULTS: Core skills used by most nurses every time they worked included assessment of temperature, oxygen saturation, blood pressure, breathing effort, skin, wound and mental status. Reliance on others and technology (F = 35.77, p < .001), lack of confidence (F = 5.52, p = .02), work area (F = 3.79, p = .002), and clinical role (F = 44.24, p < .001) were significant predictors of the extent of physical assessment skill use. CONCLUSIONS: The increasing acuity of the acute care patient plausibly warrants more than vital signs assessment; however, our study confirms nurses’ physical assessment core skill set is mainly comprised of vital signs. The focus on these endpoints of deterioration as dictated by early warning and rapid response systems may divert attention from and devalue comprehensive nursing assessment that could detect subtle changes in health status earlier in the patient's hospitalisation.

Class participation as a learning and assessment strategy in law : facilitating students’ engagement, skills development and deep learning

Assessment has widely been described as being ‘at the centre of the student experience’. It would be difficult to conceive of the modern teaching university without it. Assessment is accepted as one of the most important tools that an educator can deploy to influence both what and how students learn. Evidence suggests that how students allocate time and effort to tasks and to developing an understanding of the syllabus is affected by the method of assessment utilised and the weighting it is given. This is particularly significant in law schools where law students may be more preoccupied with achieving high grades in all courses than their counterparts from other disciplines. However, well-designed assessment can be seen as more than this. It can be a vehicle for encouraging students to learn and engage more broadly than with the minimums required to complete the assessment activity. In that sense assessment need not merely ‘drive’ learning, but can instead act as a catalyst for further learning beyond what a student had anticipated. In this article we reconsider the potential roles and benefits in legal education of a form of interactive classroom learning we term assessable class participation (‘ACP’), both as part of a pedagogy grounded in assessment and learning theory, and as a platform for developing broader autonomous approaches to learning amongst students. We also consider some of the barriers students can face in ACP and the ways in which teacher approaches to ACP can positively affect the socio-emotional climates in classrooms and thus reduce those barriers. We argue that the way in which a teacher facilitates ACP is critical to the ability to develop positive emotional and learning outcomes for law students, and for teachers themselves.

‘Hiring a Nashville sensation’ : using narrative learning to develop the problem solving skills of contract law students

This article discusses the design of interactive online activities that introduce problem solving skills to first year law students. They are structured around the narrative framework of ‘Ruby’s Music Festival’ where a young business entrepreneur encounters various issues when organising a music festival and students use a generic problem solving method to provide legal solutions. These online activities offer students the opportunity to obtain early formative feedback on their legal problem solving abilities prior to undertaking a later summative assessment task. The design of the activities around the Ruby narrative framework and the benefits of providing students with early formative feedback will be discussed.

Are you on board? The role of design-led innovation in strengthening key partnerships within an Australian airport

A popular lexicon for announcing partnerships within aviation is being ‘on-board’. Like boarding a plane, business partnerships requires trust in the expertise and the philosophy of another organisation. This paper reports upon the process and findings from the completion of a customer engagement project within a leading Australian Airport, as part of the wider uptake of design-led innovation. The project was completed bilaterally with Airport Corporation and prominent retail business partner undertaking a design-led approach to collaboratively explore an observed market trend affecting the performance of both businesses. A design-led catalyst facilitated the completion of this project, working within the Airport Corporation to disseminate the skills and philosophy of design over an 18 month period using an action research method. Findings reveal that the working environment necessary for design to be utilised requires; trust in the design-led approach as a new and exploratory way of completing work; leadership within the execution and delivery of project deliverables, and; a shared intrinsic motivation to develop new skills through a design-led approach which challenges a business-as-usual mentality (BAU). Design-led innovation can be deployed specifically to strengthen business partnerships through collaborative and explorative customer engagement.

Teaching manufacturing engineering at tertiary institutions in conjunction with engineering design and engineering materials

Tertiary institutions now face serious challenges. Modern industry requires engineering graduates with strong knowledge of modern technologies, highly practical focus, management skills, ability to work individually and in a team, understanding of environmental issues and many other skills and graduate attributes. Institutions in the tertiary sector change courses and modify curriculum to reflect challenges of the modern industry and make engineering graduates better prepared for the “real world”. Queensland University of Technology in the recent years introduced an innovative structure of engineering courses with a common core for Bachelor of Engineering Mechanical, Infomechatronics and Medical, where manufacturing is taught in conjunction with engineering design and engineering materials. In this paper we discuss the innovative curriculum structure, teaching and learning approaches of coherent delivery of manufacturing in conjunction with engineering design and

From music student to industry professional: An entrepreneurial learning design

This design-based research project addresses the gap between formal music education curricula and the knowledge and skills necessary to enter the professional music industry. It analyses the work of a teacher/researcher who invited her high school students to start their own business venture, Youth Music Industries (YMI). YMI also functioned as a learning environment informed by the theoretical concepts of communities of practice and social capital. The students staged cycles of events of various scales over a three-year period, as platforms for young artists to engage and develop new, young audiences across Queensland, Australia. The study found that students developed an entrepreneurial mindset through acquisition of specific skills and knowledge. Their learning was captured and distilled into a set of design principles, a pedagogical approach transferrable across the creative industries more broadly.

Using a free online questionnaire to determine the skills, competencies and knowledge required to work in a digital library environment in Australia

This paper discusses the data collection technique used to determine the skills and knowledge required of academic librarians working in a digital library environment in Australia. The research was undertaken as part of the researcher’s master’s thesis conducted at Tallinn University. The data collection instrument used was a freely available online survey tool, and its advantages and disadvantages are discussed in terms of the desired outcomes and circumstances surrounding the thesis project. Decisions regarding the design of the questionnaire are also discussed.

Employability skills: Perspectives from a knowledge-intensive industry

Purpose: While the global education debate remains focused on graduate skills and employability, the absence of a shared language between student, academic and industry stakeholder groups means that defining industry skills requirements is both essential and difficult. The aim of this study was to assess graduate skills requirements in a knowledge intensive industry from a demand perspective as distinct from a curriculum (supply) viewpoint. Design/methodology/approach: Skills items were derived from a breadth of disciplines across academic, policy and industry literature. CEOs and senior managers in the innovation and commercialisation industry were surveyed regarding perceptions of skills in graduates and skills in demand by the firm. Two rounds of exploratory factor analyses were undertaken to examine employers’ perceptions of the skills gap. Findings: First order analysis resolved 10 broad constructs that represent cognitive, interpersonal and intrapersonal skills domains as applied in this industry. Knowledge, leadership and interprofessional collaboration feature as prominent skills. Second order analysis revealed employers’ perceptions of graduate skills specifically centre on organisational fit and organisational success. An over-arching theme relates to performance of the individual in organisations. Research limitations/implications: Our findings suggest that the discourse on employability and the design of curriculum need to shift from instilling lists of skills towards enabling graduates to perform in a diversity of workplace contexts and expectations centred on organisational purpose. Originality/value: In contrast to the heterogeneous nature of industry surveys, we targeted a homogenous sector that is representative of knowledge intensive industries. This study contributes to the broader stakeholder dialogue of the value and application of graduate skills in this and other industry sectors.

Flexible learning design in curriculum delivery promotes student engagement and develops metacognitive learners: An integrated review

Historically, university students have been the passive recipients of face-to-face instructor designed and led classes (Hudson, 2014; Myers et al., 2011). Technological advancement, however, has provided an opportunity for greater flexibility around educational structure; students are starting to expectmore fromtertiary education providers, specifically around the delivery and provision of education (Myers et al., 2011). For universities to meet the ever-changing needs of the student they need to consider the integration of flexible learning designs into their curricula. The consequent willingness of the faculty to rethink the design and delivery of curricula has seen a recent shift in the design and delivery of education. As universities strive to promote student engagement, active learning, and communities of enquiry, they are moving progressively towards flexible learning models, virtual interaction and student centric curricula (Heise and Himes, 2010; Hsu and Hsieh, 2011). The challenge this shift creates is how to best engage students throughout their studies in order to produce graduates with the skills necessary for societal and professional sustainability (Castle and McGuire, 2010). Despite a wealth of literature addressing this topic, there is a paucity of substantive, conclusive outcomes as to the efficacy of its full implementation and potential for producing capable learners. This integrative review therefore aims to inform curriculum delivery that is flexible, student centric and scaffolds learning. It also aims to identify whether this approach assists in the development of metacognitive learners.

Teaching independent learning skills in the first year: A positive psychology strategy for promoting law student well-being

Empirical evidence in Australia and overseas has established that in many university disciplines, students begin to experience elevated levels of psychological distress in their first year of study. There is now a considerable body of empirical data that establishes that this is a significant problem for law students. Psychological distress may hamper a law student’s capacity to learn successfully, and certainly hinders their ability to thrive in the tertiary environment. We know from Self-Determination Theory (SDT), a conceptual branch of positive psychology, that supporting students’ autonomy in turn supports their well-being. This article seeks to connect the literature on law student well-being and independent learning using Self-Determination Theory (SDT) as the theoretical bridge. We argue that deliberate instruction in the development of independent learning skills in the first year curriculum is autonomy supportive. It can therefore lay the foundation for academic and personal success at university, and may be a protective factor against decline in law student psychological well-being.

Interaction design for tablet based edutainment systems for mathematical education of primary student

Mathematics has been perceived as the core area of learning in most educational systems around the world including Sri Lanka. Unfortunately, it is clearly visible that a majority of Sri Lankan students are failing in their basic mathematics when the recent grade five scholarship examination and ordinary level exam marks are analysed. According to Department of Examinations Sri Lanka , on average, over 88 percent of the students are failing in the grade 5 scholarship examinations where mathematics plays a huge role while about 50 percent of the students fail in there ordinary level mathematics examination. Poor or lack of basic mathematics skills has been identified as the root cause.

Exploring an innovative educational approach to facilitating student nurses' clinical-reasoning skills in North Sulawesi Province, Indonesia

This study examined the effect of an educational intervention utilizing principles of cognitive apprenticeship on students’ ability to apply clinical reasoning skills within the context of a purpose-built clinical vignette. A quasi-experimental, non-equivalent control-group design was used to evaluate the effect of the educational intervention on students’ accuracy, inaccuracy and self-confidence in clinical reasoning. This study makes an important contribution to nursing education by providing evidence to understand how best to facilitate nursing students’ development of clinical reasoning.

Design: Our future

'Design: Our Future', was an important and exciting call to arms for Queensland Design and Technology teachers at the INTAD State Conference 2015 held at Harristown State High School Toowoomba on the 25 June. As the Australian Government increasingly recognises design thinking as “a ubiquitous capability for innovation” (Commonwealth of Australia, 2013:90) to support a viable manufacturing sector in the Asian century, this represents an opportunity for Design and Technology teachers to provide leadership in the cultivation of these generic skills, behaviours and mindsets through secondary school education in Australia. This article, based on the conference keynote speech, outlines the value of design in education for the creative knowledge economy, the implications for Australian design and technology teachers, and the challenges ahead to ensure our future workforce is not superseded by robots.

Design thinking pedagogy: The educational design ladder

As global industries change and technology advances, traditional education systems might no longer be able to supply companies with graduates who possess an appropriate mix of skills and experience. The recent increased interest in Design Thinking as an approach to innovation has resulted in its adoption by non-design-trained professionals. This development necessitates a new method of teaching Design Thinking and its related skills and processes. As a basis for such a method, this research investigated 51 selected courses across 28 international universities to determine what Design Thinking is being taught (content), and how it is being taught (assessment and learning modes). To support the teaching and assessment of Design Thinking, this paper presents The Educational Design Ladder, an innovative resource/model that provides a process for the organisation and structuring of units for a multidisciplinary Design Thinking programme.

Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.