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.

Building engaged, sustainable online communities : a case study of an adventure travel website

This paper will provide an overview of a join research initiative being developed by the Queensland University of Technology in conjunction with the Australian Smart Services Cooperative Research Centre in relation to the development and analysis of online communities. The intention of this project is to initially create an exciting and innovative web space around the concept of adventure travel and then to analyse the level of user engagement to uncover possible patterns and processes that could be used in the future development of other virtual online communities. Travel websites are not a new concept and there are many successful examples currently operating and generating profit. The intention of the QUT/Smart Services CRC project is to analyse the site metrics to determine the following: what specific conditions/parameters are required to foster a growing and engaged virtual community; when does the shift occur from external moderation to a more sustainable system of self-moderation within the online community; when do users begin to take ownership of a site and take an invested interested in the content and growth of an online community; and how to retain active contributors and high-impact power users on a long-term basis. With the travel website rapidly approaching release, this paper begins the process of reflection, outlining the process undertaken and the findings so far aggregated whilst also positioning the project within the greater context of current online user participation and user generated content research.

Knowledge management in policing : the case of police complaints and police crime

This article is concerned with knowledge management in policing police crime. Police crime is defined as crime committed by police officers on duty. There seems to be a tendency to consider police crime as a result of bad practice rather than the acts of criminals. However, examples illustrate that criminal acts are intentionally carried out by police officers on duty. The article looks at the kinds of knowledge which agencies require to investigate police complaints and police crime successfully.

Contributions of knowledge-based foundations of universities in knowledge city formation : a Malaysian case study

Purpose – In the 21st Century, as knowledge, technology and education are widely accepted to play key roles in the local economic development, the importance of making space and place for knowledge production is, therefore, on the rise resulting many city administrations and urban policy-makers worldwide restructuring their cities to become highly competitive and creative. Consequently, this has led to a new type of city form, knowledge city, and a new approach in their development, knowledge-based urban development. In this context, knowledge-based foundations of universities are regarded as one of the key elements for knowledge-based urban development and knowledge city formation due to their ability to provide a strong platform for knowledge generation, marketing and transfer. This paper aims to investigate the role and importance of universities and their knowledge-based foundations in the context of developing countries, particularly in Malaysia, in building prosperous knowledge cities of the era of the knowledge economy. Design/Methodology/Approach – The main methodological techniques employed in this research includes: a thorough review of the literature on the role of universities in spatial and socio-economic development of cities; a best practice analysis and policy review of urban and regional development policies targeting to use of university clusters in leveraging knowledge-based development, and; a case study in Malaysia with a review of various policy documents and strategic plans of the local universities and local and state authorities, interviews with key actors, and a trend analysis of local socio-economic and spatial changes. Originality/Value – This paper reports the findings of a pioneering research on examining the role and impact of universities and their knowledge-based foundations, in the context of Malaysia, in building knowledge cities of the era of the knowledge economy. By undertaking a case study investigation in Bandar Seri Iskandar, which is a newly emerging Malaysian knowledge city, located in Perak, Malaysia, the paper sheds light on an important issue of the 21st Century of how universities contribute to the knowledge-based development of cities. Practical Implications – Universities with their rich knowledge-based foundations are increasingly being recognised as knowledge hubs, exercising a strong influence in the intellectual vitality of the city where they are embedded. This paper reveals that universities, in joint action with business and society at large, are necessary prerequisites for constructing and maintaining knowledge societies and, therefore, building prosperous knowledge cities. In light of the literature and case findings, the paper sheds light on the contribution of knowledge-based foundations of universities in knowledge city formation and provides generic recommendations for cities and regions seeking knowledge city transformation.

Web 2.0 applications in enterprises and education

Web 2.0 technology and concepts are being used increasingly by organisations to enhance knowledge, efficiency, engagement and reputation. Understanding the concepts of Web 2.0, its characteristics, and how the technology and concepts can be adopted, is essential to successfully reap the potential benefits. In fact, there is a debate about using the Web 2.0 idiom to refer to the concept behind it; however, this term is widely used in literature as well as in industry. In this paper, the definition of Web 2.0 technology, its characteristics and the attributes, will be presented. In addition, the adoption of such technology is further explored through the presentation of two separate case examples of Web 2.0 being used: to enhance an enterprise; and to enhance university teaching. The similarities between these implementations are identified and discussed, including how the findings point to generic principles of adoption.

Influences on student learning in engineering : some results from case study fieldwork

This paper closely examines factors affecting students’ progression in their engineering programs through fieldwork conducted at three Australian universities. To extract clues on how specific teaching methods can be used to maximize learning, the investigation considered factors such as understanding how students take in, process and present information. A number of focus groups were conducted with students and the data gathered was combined with survey results of students’ and academics’ learning styles. The paper reports on the process followed, and provides some analysis of the gathered data, as part of an Australian Learning and Teaching Council, ALTC, Associate Fellowship program.

The business of fashion : entrepreneurship and enterprise learning for the new ‘creative’ global marketplace – the Australian case study [Abstract]

While the fashion industry is normally first to recognise trends and embrace creativity, fashion designers are sometimes the last to acknowledge that business acumen and entrepreneurial skills are needed. However, fashion designers and entrepreneurs are now all members of the new ‘creative’ global marketplace with its inherent need to sell globally and be competitive with international brands. For the Australian industry, this tension creates enormous pressures due to Australia’s small population (and market/s), the decreasing textile and manufacturing base, the increase of ‘creative’ micro businesses and with this the increasing number of young Australians wanting to start their own fashion business. This paper highlights the current size of the Australian fashion industry, the trend for small business models, the ‘career portfolio’ entrepreneur and strategies Australian universities are undertaking to address students wishing to enter the business of fashion. It also identifies case studies where enterprise learning pedagogy has been successfully implemented into the business education of an Australian fashion program and concludes with recommendations for an enterprise pedagogy that creates authentic learning, while working with industry and community stakeholders in flexible university formats.

Practice and procedure : a recent Court of Appeal case examines the meaning of 'third party payer' in terms of Part 3.4 of the Legal Profession Act 2007.

In Legal Services Commissioner v Wright [2010] QCA 321 the Queensland Court of Appeal allowed an appeal from the first instance decision. The decision involved the construction of “third party payer” in Part 3.4 of the Legal Profession Act 2007 (Qld).

Property investment, construction and economic growth : the case of Malaysia

It is generally accepted that there is a close relationship between property investment and construction activity. The construction sector plays a crucial role in economic development, especially for a developing nation such as Malaysia. However, the volume of new properties added to the property market is only a fraction of the total volume of the property market. Is the conventional assumption of the relationship between property investment and construction supported by empirical data? This paper revisits the tripartite relationships between economic growths, property investment and construction activities with official Malaysian 2000Q1-2010Q4 quarterly time series data. The Granger causality tests are used to establish the causality runs from the GDP to the value of property transactions, and the growth of construction activities to GDP growth. The result is expected to be useful for policymakers and industrial practitioners in formulating industrial policies and corporate strategies.

Comparing retail union strategy in a neoliberal context : the case of Australia and New Zealand

Retail employees are amongst the most vulnerable workers in the context of neoliberal market economies. In many countries, low paid retail employees comprise around 10 per cent of the workforce (ABS 2011). The retail labour market is typically highly feminised and youthful, with many employees in part time and various forms of precarious employment (Tailby & Pollert 2011). However, the industry and its trade unions have rarely been the focus of academic study (Tilly & Carré 2011). This paper thus aims to analyse and compare trade union strategies in the retail industry in Australia and New Zealand, by utilising findings from a larger comparative study. The respective unions studied are the Shop Distributive and Allied Workers Union (SDA) in Australia and the National Distribution Union (NDU) in New Zealand. Data from interviews with union officials at different levels and from different regional locations in Australia and NZ are analysed. Union policy documents are also utilised to support the empirical data. Key findings from the comparison of retail unions’ strategy in Australia and NZ include: 1) the importance of institutional factors and internal political differences in shaping and constraining union strategies; 2) different emphases on external relationships and variations in partnership approaches; 3) the need to recruit to ‘stand still’ by retail unions in both countries; and, 4) similarities and differences in the unions’ organising approaches. The paper concludes by examining the implications of these findings for retail unions’ strategic choices and their ability to deliver workplace justice for employees.

Raman spectroscopy of the multianion mineral gartrellite-PbCu(Fe3+,Cu)(AsO4)2(OH,H2O)2

The multianion mineral gartrellite PbCu(Fe3+,Cu)(AsO4)2(OH,H2O)2 has been studied by a combination of Raman and infrared spectroscopy. The vibrational spectra of two gartrellite samples from Durango and Ashburton Downs were compared. Gartrellite is one of the tsumcorite mineral group based upon arsenate and sulphate anions. Crystal symmetry is either triclinic in the case of an ordered occupation of two cationic sites, triclinic due to ordering of the H bonds in the case of species with 2 water molecules per formula unit, or monoclinic in the other cases. Characteristic Raman spectra of the minerals enable the assignment of the bands to specific vibrational modes. These spectra are related to the structure of gartrellite. The position of the hydroxyl and water stretching vibrations are related to the strength of the hydrogen bond formed between the OH unit and the AsO4 anion.

Assessing financial reporting comparability across institutional settings : the case of pension accounting

The drive for comparability of financial information is to enable users to distinguish similarities and differences in economic activities for an entity over time and between entities so that their resource allocation decisions are facilitated. With the increased globalisation of economic activities, the enhanced international comparability of financial statements is often used as an argument to advance the convergence of local accounting standards to international financial reporting standards (IFRS). Differences in the underlying economic substance of transactions between jurisdictions plus accounting standards allowing alternative treatments may render this expectation of increased comparability unrealistic. Motivated by observations that, as a construct, comparability is under-researched and not well understood, we develop a comparability framework that distinguishes between four types of comparability. In applying this comparability framework to pension accounting in the Australian and USA contexts, we highlight a dilemma: while regulators seek to increase the likelihood that similar events are accounted for similarly, an unintended consequence may be that preparers are forced to apply similar accounting treatment to events that are, in substance, different.

The relationship between organizational and professional commitment in the case of project workers : implications for project management

The purpose of this article is to investigate the relationship between organizational and professional commitment of project workers. We first present (1) role-conflict theory and exchange theory to establish the multiple dimensions of commitment (affective, continuance, and normative) and (2) social identity theory to support our argument for different foci of commitment—organization and profession. Building on these theoretical lenses, we present the literature review that compares organizational and professional commitment of project workers with respect to the three dimensions of commitment. Adopting a positivist approach and a sample of 141 project workers, we use Pearson’s correlation to identify the relationship between affective organizational and affective professional, continuance organizational and continuance professional, and normative organizational and normative professional commitment. We report significant correlation between affective organizational commitment and affective professional commitment of project workers. The correlations between continuance organizational commitment and continuance professional commitment and normative organizational commitment and normative professional commitment are moderate. We then discuss the implications of these findings for the project management profession.

Learning Landscapes 2.0: Adaptable educational environments

This project has blended two streams of enquiry: temporary and transportable construction technology, and flexible blended-learning environments. It seeks to develop prototypes for a series of environments suited for the activities of learning (future-proofed schools), as practiced in the twenty first century. The research utilises techniques of: historic survey, case study, first-hand observation, and architectural design (as research). The design comprises three major components: The determinate landscape: in-situ concrete ‘plate’ that is permanent. The indeterminate landscape: a kit of pre-fabricated 2-D panels assembled in a unique manner at each site to suit the client and context; manufactured to the principles of design-for-disassembly. The stations: pre-fabricated packages of highly-serviced space connected through the determinate landscape. This project was submitted to the ‘Future Proofing Schools’ competition (professional category) in October 2011. The competition was part of a research project supported under the Australian Research Council’s Linkage Grant funding scheme (project LP0991146).

Development priority zoning (DPZ)-led scenario simulation for regional land use change : the case of Suichang County, China

China has experienced an extraordinary level of economic development since the 1990s, following excessive competition between different regions. This has resulted in many resource and environmental problems. Land resources, for example, are either abused or wasted in many regions. The strategy of development priority zoning (DPZ), proposed by the Chinese National 11th Five-Year Plan, provides an opportunity to solve these problems by coordinating regional development and protection. In line with the rational utilization of land, it is proposed that the DPZ strategy should be integrated with regional land use policy. As there has been little research to date on this issue, this paper introduces a system dynamic (SD) model for assessing land use change in China led by the DPZ strategy. Land use is characterized by the prioritization of land development, land utilization, land harness and land protection (D-U-H-P). By using the Delphi method, a corresponding suitable prioritization of D-U-H-P for the four types of DPZ, including optimized development zones (ODZ), key development zones (KDZ), restricted development zones (RDZ), and forbidden development zones (FDZ) are identified. Suichang County is used as a case study in which to conduct the simulation of land use change under the RDZ strategy. The findings enable a conceptualization to be made of DPZ-led land use change and the identification of further implications for land use planning generally. The SD model also provides a potential tool for local government to combine DPZ strategy at the national level with land use planning at the local level.