The impact of a model of nurse education to improve knowledge and recognition of delirium in older persons by registered nurses

Introduction: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people. Early recognition enables diagnosis and treatment of underlying cause/s, which can lead to improved patient outcomes. However, research shows knowledge and accurate nurse recognition of delirium and is poor and lack of education appears to be a key issue related to this problem. Thus, the purpose of this randomised controlled trial (RCT) was to evaluate, in a sample of registered nurses, the usability and effectiveness of a web-based learning site, designed using constructivist learning principles, to improve acute care nurse knowledge and recognition of delirium. Prior to undertaking the RCT preliminary phases involving; validation of vignettes, video-taping five of the validated vignettes, website development and pilot testing were completed. Methods: The cluster RCT involved consenting registered nurse participants (N = 175) from twelve clinical areas within three acute health care facilities in Queensland, Australia. Data were collected through a variety of measures and instruments. Primary outcomes were improved ability of nurses to recognise delirium using written validated vignettes and improved knowledge of delirium using a delirium knowledge questionnaire. The secondary outcomes were aimed at determining nurse satisfaction and usability of the website. Primary outcome measures were taken at baseline (T1), directly after the intervention (T2) and two months later (T3). The secondary outcomes were measured at T2 by participants in the intervention group. Following baseline data collection remaining participants were assigned to either the intervention (n=75) or control (n=72) group. Participants in the intervention group were given access to the learning intervention while the control group continued to work in their clinical area and at that time, did not receive access to the learning intervention. Data from the primary outcome measures were examined in mixed model analyses. Results: Overall, the effect of the online learning intervention over time comparing the intervention group and the control group were positive. The intervention groups‘ scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for delirium recognition when comparing T2 and T1 results (t=2.58 p=0.012) between the control and intervention group but not for changes in delirium recognition scores between the two groups from T3 and T1 (t=1.80 p=0.074). The majority of the participants rated the website highly on the visual, functional and content elements. Additionally, nearly 80% of the participants liked the overall website features and there were self-reported improvements in delirium knowledge and recognition by the registered nurses in the intervention group. Discussion: Findings from this study support the concept that online learning is an effective and satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction and usability for the registered nurse end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores and the improvement in delirium knowledge was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to registered nurses. It is envisaged that this knowledge would lead to improved recognition of delirium as well as improvement in patient outcomes however; translation of this knowledge attainment into clinical practice was outside the scope of this study. A critical next step is demonstrating the effect of the intervention in changing clinical behaviour, and improving patient health outcomes.

Bridging the gap between tertiary education and work : situated learning in accountancy

In professions such as teaching, health sciences (medicine, nursing), and built environment, significant work-based learning through practica is an essential element before graduation. However, there is no such requirement in professional accounting education. This paper reports the findings of an exploratory qualitative case study of the implementation of a Workplace Learning Experience Program in Accountancy at the Queensland University of Technology (QUT) in Australia. The interview-based study documents the responses of university students and graduates to this program. The study demonstrates that a 100 hour work placement in Accountancy can enhance student learning. It highlights the potential value of the application of sociocultural theories of learning, especially the concept of situated learning involving legitimate peripheral participation (Lave and Wenger 1991). This research adds to a small body of empirical accounting education literature relating to the benefits of work placements prior to graduation. The effectiveness of this short, for credit, unpaid program should encourage other universities to implement a similar work placement program as a form of pre-graduation learning in professional accounting education.

Translations of industry-based student learning and academic performances

We hypothesized that Industry based learning and teaching, especially through industry assigned student projects or training programs, is an integral part of science, technology, engineering and mathematics (STEM) education. In this paper we show that industry-based student training and experience increases students’ academic performances independent to the organizational parameters and contexts. The literature on industry-based student training focuses on employability and the industry dimension, and neglects in many ways the academic dimension. We observed that the association factors between academic attributes and contributions of industry-based student training are central and vital to the technological learning experiences. We explore international initiatives and statistics collected of student projects in two categories: Industry based learning performances and on campus performances. The data collected were correlated to five (5) universities in different industrialized countries, e.g., Australia N=545, Norway N=279, Germany N=74, France N=107 and Spain N=802 respectively. We analyzed industry-based student training along with company assigned student projects compared with in comparisons to campus performance. The data that suggests a strong correlation between industry-based student training per se and improved performance profiles or increasing motivation shows that industry-based student training increases student academic performance independent of organizational parameters and contexts. The programs we augmented were orthogonal to each other however, the trend of the students’ academic performances are identical. An isolated cohort for the reported countries that opposed our hypothesis warrants further investigation.

Does usability engineering matters for STEM education?

Technological maturity and the exponential growth of digital applications are contributing to lifestyle changes worldwide. Consequently, learning and teaching is demanding more effective sociotechnical interactions involving emerging technologies, as opposed to traditional, conventional face-to-face learning and teaching approaches. In this context, usability engineering is making significant contributions for improving computer and distance-based learning, both for learners and instructors, which have often been ignored when designing online learning and teaching applications. Usability testing is a central part of the human centered learning approach for developing sustainable STEM education from the socio-technological perspective. Our experiences with usability engineering and the impact of teaching low-cost rapid usability testing methods on knowledge translation from undergraduate to graduate courses to real-world practice (i.e. getting the methods out there in real use) are diverse and multi-modal. Our sample space has been hundreds of trained students who have learned how to do effective usability engineering in real-world situations at higher levels of realism (i.e. fidelity) and at a much lower cost than using traditional fixed usability labs. Furthermore, this low-cost rapid approach to usability engineering has been adopted by many of our graduates who are now managers, CIOs etc and who are using the methods routinely in their organizations in real world applications and scenarios. This knowledge has been used to improve design and implementation of a wide range of applications, including applications designed for teaching and learning.

Course evaluation : reconfigurations for learning with learning management systems

The introduction of online delivery platforms such as learning management systems (LMS) in tertiary education has changed the methods and modes of curriculum delivery and communication. While course evaluation methods have also changed from paper-based in-class-administered methods to largely online-administered methods, the data collection instruments have remained unchanged. This paper reports on a small exploratory study of two tertiary-level courses. The study investigated why design of the instruments and methods to administer surveys in the courses are ineffective measures against the intrinsic characteristics of online learning. It reviewed the students' response rates of the conventional evaluations for the courses over an eight-year period. It then compared a newly developed online evaluation and the conventional methods over a two-year period. The results showed the response rates with the new evaluation method increased by more than 80% from the average of the conventional evaluations (below 30%), and the students' written feedback was more detailed and comprehensive than in the conventional evaluations. The study demonstrated the possibility that the LMS-based learning evaluation can be effective and efficient in terms of the quality of students' participation and engagement in their learning, and for an integrated pedagogical approach in an online learning environment.

Do e-learning applications click with students globally? A study of the development and adoption of WriteCite.com

This paper traces the process of invention of adoption of WriteCite.com which is an internet based learning tool used by students to format citation lists. A number of theoretical issues relating to development and deployment of online learning tools are addressed in this paper. A significant finding in this paper is that adoption rate of new technologies amongst students, in this case for WriteCite.com, is not immediately global in nature despite the internet's ubiquity and the existence of internationally accepted bibliographic styles. Rather, and in contrast to neo theories of technology internationalisation, early-stage adoption tends to be geo-centric and concentrated in the US. In the case of WriteCite.com, which has not been sponsored by an academic institution, the findings reflect voluntary rates of globa adoption. From an applied perspective, the process of identifying globally contestable markets is relevant to developers of online learning tools.

Theorizing why in digital learning: Opening frontiers for inquiry and innovation with technology

Asking why is an important foundation of inquiry and fundamental to the development of reasoning skills and learning. Despite this, and despite the relentless and often disruptive nature of innovations in information and communications technology (ICT), sophisticated tools that directly support this basic act of learning appear to be undeveloped, not yet recognized, or in the very early stages of development. Why is this so? To this question, there is no single factual answer. In response, however, plausible explanations and further questions arise, and such responses are shown to be typical consequences of why-questioning. A range of contemporary scenarios are presented to highlight the problem. Consideration of the various inputs into the evolution of digital learning is introduced to provide historical context and this serves to situate further discussion regarding innovation that supports inquiry-based learning. This theme is further contextualized by narratives on openness in education, in which openness is also shown to be an evolving construct. Explanatory and descriptive contents are differentiated in order to scope out the kinds of digital tools that might support inquiry instigated by why-questioning and which move beyond the search paradigm. Probing why from a linguistic perspective reveals versatile and ambiguous semantics. The why dimension—asking, learning, knowing, understanding, and explaining why—is introduced as a construct that highlights challenges and opportunities for ICT innovation. By linking reflective practice and dialogue with cognitive engagement, this chapter points to specific frontiers for the design and development of digital learning tools, frontiers in which inquiry may find new openings for support.

Blended learning extension in a global collaborative learning environment

The advancement of technology and the internet have created global collaborative learning opportunities and changed learning and teaching in any discipline around the world, including in developing countries. The availability of web-based resources and high-speed internet infrastructure has extended the opportunities to conduct blended learning and new ways of distance learning beyond virtual class room webinars. The aim of this exploratory paper is to review the challenges and opportunities for increasing student engagement in virtual learning. A reflective analysis of international collaborative learning case studies, published articles and practices in virtual learning is used to explore the extension of blended learning organised and participated by institutions from multiple countries. The lessons learnt from flexible learning delivery in professional practice courses in Property Education are used to evaluate potential extensions of blended learning implementation in a global context.

Let's do it: A framework to investigate the affordances of experimental learning environments

BACKGROUND Experimental learning, traditionally conducted in on-campus laboratory venues, is the cornerstone of science and engineering education. In order to ensure that engineering graduates are exposed to ‘real-world’ situations and attain the necessary professional skill-sets, as mandated by course accreditation bodies such as Engineers Australia, face-to-face laboratory experimentation with real equipment has been an integral component of traditional engineering education. The online delivery of engineering coursework endeavours to mimic this with remote and simulated laboratory experimentation. To satisfy student and accreditation requirements, the common practice has been to offer equivalent remote and/or simulated laboratory experiments in lieu of the ones delivered, face-to face, on campus. The current implementations of both remote and simulated laboratories tend to be specified with a focus on technical characteristics, instead of pedagogical requirements. This work attempts to redress this situation by developing a framework for the investigation of the suitability of different experimental educational environments to deliver quality teaching and learning. PURPOSE For the tertiary education sector involved with technical or scientific training, a research framework capable of assessing the affordances of laboratory venues is an important aid during the planning, designing and evaluating stages of face-to-face and online (or cyber) environments that facilitate student experimentation. Providing quality experimental learning venues has been identified as one of the distance-education providers’ greatest challenges. DESIGN/METHOD The investigation draws on the expertise of staff at three Australian universities: Swinburne University of Technology (SUT), Curtin University (Curtin) and Queensland University of Technology (QUT). The aim was to analyse video recorded data, in order to identify the occurrences of kikan-shido (a Japanese term meaning ‘between desks instruction’ and over-the-shoulder learning and teaching (OTST/L) events, thereby ascertaining the pedagogical affordances in face-to-face laboratories. RESULTS These will be disseminated at a Master Class presentation at this conference. DISCUSSION Kikan-shido occurrences did reflect on the affordances of the venue. Unlike with other data collection methods, video recorded data and its analysis is repeatable. Participant bias is minimised or even eradicated and researcher bias tempered by enabling re-coding by others. CONCLUSIONS Framework facilitates the identification of experiential face-to-face learning venue affordances. Investigation will continue with on-line venues.

Towards automated content analysis of discussion transcripts: A cognitive presence case

In this paper, we present the results of an exploratory study that examined the problem of automating content analysis of student online discussion transcripts. We looked at the problem of coding discussion transcripts for the levels of cognitive presence, one of the three main constructs in the Community of Inquiry (CoI) model of distance education. Using Coh-Metrix and LIWC features, together with a set of custom features developed to capture discussion context, we developed a random forest classification system that achieved 70.3% classification accuracy and 0.63 Cohen's kappa, which is significantly higher than values reported in the previous studies. Besides improvement in classification accuracy, the developed system is also less sensitive to overfitting as it uses only 205 classification features, which is around 100 times less features than in similar systems based on bag-of-words features. We also provide an overview of the classification features most indicative of the different phases of cognitive presence that gives an additional insights into the nature of cognitive presence learning cycle. Overall, our results show great potential of the proposed approach, with an added benefit of providing further characterization of the cognitive presence coding scheme.

A user driven data mining process model and learning system

This paper deals with the problem of using the data mining models in a real-world situation where the user can not provide all the inputs with which the predictive model is built. A learning system framework, Query Based Learning System (QBLS), is developed for improving the performance of the predictive models in practice where not all inputs are available for querying to the system. The automatic feature selection algorithm called Query Based Feature Selection (QBFS) is developed for selecting features to obtain a balance between the relative minimum subset of features and the relative maximum classification accuracy. Performance of the QBLS system and the QBFS algorithm is successfully demonstrated with a real-world application

Case study of collaborative learning in two contexts : what do English language learners gain?

This chapter describes the use of collaborative learning as an approach to enhance English language learning by students from non-English speaking backgrounds. Communicative Language Teaching (CLT) principles were applied to two case studies, one comprising of undergraduate English as Foreign Language Learners in Turkey and the other involved English as Second Language learners in Australia. Social constructivism inspired communicative language teaching using collaborative learning activities such as team work, interactive peer-based learning, and iterative stages of learning matrix were incorporated to enhance students' learning outcomes. Data collected after the CLT intervention was made up of field notes, reflective logs and focus group interviews which revealed complementarities, as well as subtle differences between the two cases. The findings were summarized as learning dispositions; speaking fluency and confidence; learning diagnostics and completion deficiencies; task engagement, flow theory and higher order thinking skills; in addition to self efficacy and development of student identity. CLT has the potential to provide a more inclusive and dynamic education for diverse learners through vital outcomes and benefits which resonate with the real world.

Transformational learning in the workplace

Although transformative learning theory remains one of the most influential theories in the field of adult education, studies on fostering transformative learning, particularly in groups and in the workplace, remain sparse. This article summarises some evidence of transformational learning that influenced changes to practice, processes, and the organisational culture in a case study. It is based on a cohort of 12 worker-learners enrolled in a Graduate Certificate in Education (Executive Leadership) course offered by an Australian university (Queensland University of Technology). Data for this article were drawn from interviews with 10 participants, a focus group with 6 of them, their assessment presentations, and reflective notes of the course facilitators. Also included here are the effects on transformational learning of Taylor’s five elements of work-based learning design, Fuller and Unwins’ features of expansive learning, and Billett’s workplace pedagogies.

Bringing academics on board : encouraging institution-wide diffusion of e-learning environments

Rapid advances in educational and information communications technology (ICT)have encouraged some educators to move beyond traditional face to face and distance education correspondence modes toward a rich, technology mediated e-learning environment. Ready access to multimedia at the desktop has provided the opportunity for educators to develop flexible, engaging and interactive learning resources incorporating multimedia and hypermedia. However, despite this opportunity, the adoption and integration of educational technologies by academics across the tertiary sector has typically been slow. This paper presents the findings of a qualitative study that investigated factors influencing the manner in which academics adopt and integrate educational technology and ICT. The research was conducted at a regional Australian university, the University of Southern Queensland (USQ), and focused on the development of e-learning environments. These e-learning environments include a range of multimodal learning objects and multiple representations of content that seek to cater for different learning styles and modal preferences, increase interaction, improve learning outcomes, provide a more inclusive and equitable curriculum and more closely mirror the on campus learning experience. This focus of this paper is primarily on the barriers or inhibitors academics reported in the study, including institutional barriers, individual inhibitors and pedagogical concerns. Strategies for addressing these obstacles are presented and implications and recommendations for educational institutions are discussed.

A sustainable model for university-industry learning partnership : Issues for universities

Using work integrated learning (WIL) in university-industry learning partnerships as a means of developing the deeper and more complex skills of managers is receiving growing interest in the literature. This paper suggests that there are currently, two basic approaches to WIL – the traditional model and the customisation model. While each has strengths, each also has limitations. Responding the call of Patrick et al (2008) for more discussion and research on WIL stratagems, this paper proposes a third model – the sustainable learning partnership – as an option to encourage deeper, more complex and more long-term capacity building in management development.