Development and evaluation of an integrated clinical learning model to inform continuing education for acute care nurses

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Sociopathic attitudes to road safety

Injuries and deaths due to unsafe driving practices are a substantial health and socioeconomic burden to the community. Young socially disadvantaged males who are involved in a lifestyle of risky behaviour, crime and motor vehicle accidents seem unaffected by educational campaigns to improve safer driving. The aim is to develop a driving and social behavioural profile that may explain the lack of effectiveness of road safety advertising and suggest ways to refine educational strategies to reduce the risky lifestyle and associated harms among those most vulnerable, the 15-25 year olds. The procedure involved a quantitative and qualitative analysis through questionnaires, surveys and focus groups involving a comparison of populations (n = 668) by age, gender and socioeconomic status in three discrete Australian sites. Information gathered included issues related to road safety awareness, knowledge of advertising, personal and peer group attitudes as well as driving and life style history. The results indicate that within the community a highly visible profile of strong anti-social road safety activities by an educationally and economically disadvantaged sub-culture exists and this group seem impervious to road safety advertising and education initiatives. As the overall unsafe driving and risky antisocial behaviour is significant among 15-25 year olds within the community the solution is seen to be community based. A long-term (five to ten year) program has been posited; promoting community partnerships through consultative and local action committees at all levels creating locally designed formal and informal educational and mutual support programs.

Alternatives to the behavioural technicist approaches to study skills

The content and approach of study skills courses are critiqued and alternatives are suggested. It is proposed that an approach providing students with knowledge about the cognitive processes involved in mastering complex material would make the study skills teacher an agent of social change aiming for the enlightenment and emancipation of students and lecturers.

Developing a best practice model of refugee maternity care

Background: About one third of refugee and humanitarian entrants to Australia are women age 12—44 years. Pregnant women from refugee backgrounds may have been exposed to a range of medical and psychosocial issues that can impact maternal, fetal and neonatal health. Research question: What are the key elements that characterise a best practice model of maternity care for women from refugee backgrounds? This paper outlines the findings of a project which aimed at developing such a model at a major maternity hospital in Brisbane, Australia. Participants and methods: This multifaceted project included a literature review, consultations with key stakeholders, a chart audit of hospital use by African-born women in 2006 that included their obstetric outcomes, a survey of 23 African-born women who gave birth at the hospital in 2007—08, and a survey of 168 hospital staff members. Results: The maternity chart audit identified complex medical and social histories among the women, including anaemia, female circumcision, hepatitis B, thrombocytopenia, and barriers to access antenatal care. The rates of caesarean sections and obstetric complications increased over time. Women and hospital staff surveys indicated the need for adequate interpreting services, education programs for women regarding antenatal and postnatal care, and professional development for health care staff to enhance cultural responsiveness. Discussion and conclusions: The findings point towards the need for a model of refugee maternity care that comprises continuity of carer, quality interpreter services, educational strategies for both women and healthcare professionals, and the provision of psychosocial support to women from refugee backgrounds.

Parents’ perception of their children’s participation in physical activity

This paper describes parents' survey and interview responses about their children's participation in physical activity which were collected for the second part of a three phase project funded by the Commonwealth Department of Health and Family Services: Health Advancement Project through the auspices of ACHPER. In the first phase of the project, an extensive data base was compiled on children's participation in physical activity; the second phase investigated parents' and teachers' perceptions of their children's and students' participation in physical activity. The third phase, which is now underway, will use the first two phases to develop a set of resources with which to advocate for policy, programs and educational strategies to serve the needs of young people in Australia most effectively in relation to physical activity.

A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness

Introduction Poor medication adherence is common in children and adolescents with chronic illness, but there is uncertainty about the best way to enhance medication adherence in this group. The authors conducted a systematic review of controlled trials examining interventions that aim to improve medication adherence. Method A comprehensive literature search was undertaken to locate controlled trials that described specific interventions aiming to improve adherence to long-term medication, where participants were aged 18 years and under, medication adherence was reported as an outcome measure, and which could be implemented by individual health practitioners. Studies were reviewed for quality and outcome. Results 17 studies met inclusion criteria: seven studies examined educational strategies, seven studies examined behavioural interventions and three studies examined educational intervention combined with other forms of psychological therapies. Only two of seven studies reported a clear benefit for education on medication adherence, whereas four of seven trials indicated a benefit of behavioural approaches on medication adherence. One trial reported that combining education with behavioural management may be more effective than education alone. Studies which combined education with other non-medication specific psychological interventions failed to demonstrate a beneficial effect on medication adherence. Only two studies examined adherence-promoting interventions in young people with established adherence problems. Conclusion These findings suggest that education interventions alone are insufficient to promote adherence in children and adolescents, and that incorporating a behavioural component to adherence interventions may increase potential efficacy. Future research should examine interventions in high-risk groups.

Educational research and strategies of world-forming: The globe, the unconscious, and the child

The passion to eradicate alterity from the earth is also the passion for the home, the country, the dwelling, that authorizes this desire and rewards it. In its nationalism, parochialism and racism it constitutes a public and private neurosis. So, unwinding the rigid understanding of place that apparently permits me to speak, that guarantees my voice, my power, is not simply to disperse my locality within the wider coordinates of an ultimate planetary context. That would merely absolve me of responsibility in the name of an abstract and generic globalism, permitting my inheritance to continue uninterrupted in the vagaries of a new configuration. There is something altogether more precise and more urgent involved. For in the horror of the unhomely pulses the dread for the dispersal of Western humankind: the dread of a rationality confronted with what exceeds and slips its grasp. (Chambers, 2001, p. 196)

Learning Strategies for Digital Tools

Learning a digital tool is often a hidden process. We tend to learn new tools in a bewildering range of ways. Formal, informal, structured, random, conscious, unconscious, individual, group strategies, may all play a part, but are often lost to us in the complex and demanding processes of learning. But when we reflect carefully on the experience, some patterns and surprising techniques emerge. This monograph presents the thinking of seven students in MDN642, Digital Pedagogies, where they have deliberately reflected on the mental processes at work as they learnt a digital technology of their choice.

Nursing students’ knowledge and practice of infection control precautions : an educational intervention

Aim. This paper is a report of the effectiveness of a purpose-designed education program in improving undergraduate nursing students’ understanding and practice of infection control precautions. Background. The severe acute respiratory syndrome outbreak in 2003 highlighted that healthcare workers were under-prepared for such an epidemic. While many in-service education sessions were arranged by institutions in response to the outbreak, preservice nursing education has overlooked preparation for handling such infectious disease epidemics. Method. A quasi-experimental design was used and a 16-hour, purpose-designed infection control education programme was implemented for preservice nursing students in southern Taiwan. Self-administered questionnaires were distributed at three time points during the period September 2005 to April 2006 to examine the sustainability and effectiveness of the intervention. Results. A total of 175 preservice nursing students participated in the study. Following the education programme, students in the intervention group showed a statistically significant improvement across time in their knowledge of these precautions [F(2, 180) = 13Æ53, P < 0Æ001] and confidence in resolving infectionrelated issues [F(1Æ79, 168Æ95) = 3Æ24] when compared with those in the control group. Conclusion. To improve nursing students’ capacity in responding to infectious epidemics, an educational programme that integrates the theme of infection precautions, learning theory and teaching strategies is recommended for all nursing institutes.

Organizational rhetoric in the prospectuses of elite private schools : unpacking strategies of persuasion

Schools have seldom been examined by scholars in studies of organizational sites. Yet schools and the educational context in which they operate, offer potentially important insights into how organizations use rhetoric in their communications to persuade audiences and leverage advantage in the marketplace. This study, which utilises rhetorical analysis to examine the persuasive, yet ambiguous strategies used in 65 school prospectuses in Australia, revealed six strategies consistently used by schools to leverage competitive advantage and persuade internal and external audiences: identification, juxtapositioning, bolstering or self-promotion, partial reporting, selfexpansion and reframing or reversal. As well as illustrating how schools operate in the context of marketisation and privatization discourses in 21st century education, the organizational theory and methods utilised for the research demonstrates how rhetorical strategies draw on, as well as reproduce, socio-political and cultural discourses around economic and social privilege.

Microblogging as a literacy practice for educational communities

Microblogging is an emergent adolescent and adult literacy practice that has become popularized through platforms such as Twitter, Plurk and Jaiku, in the rise of Web 2.0 – “the social web”. Yet the potentials of microblogging for literacy learning in educational contexts is currently underexplored in the research and literature. This article draws on new research with 150 adolescent and adult participants in school and university contexts, which was made possible through cross-disciplinary collaboration between specialists English and Information and Communication Technologies (ICT) educators. Strategies are provided for teachers to establish their own microblogging networks, with suggested activities to enhance the literacy learning of adolescents in educational contexts.

Rethinking public service media and citizenship: digital strategies for news and current affairs at Australia’s Special Broadcasting Service

This article considers the concept of media citizenship in relation to the digital strategies of the Special Broadcasting Service (SBS). At SBS, Australia’s multicultural public broadcaster, there is a critical appraisal of its strategies to harness user-created content (UCC) and social media to promote greater audience participation through its news and current affairs Web sites. The article looks at the opportunities and challenges that user-created content presents for public service media organizations as they consolidate multiplatform service delivery. Also analyzed are the implications of radio and television broadcasters’ moves to develop online services. It is proposed that case study methodologies enable an understanding of media citizenship to be developed that maintains a focus on the interaction between delivery technologies, organizational structures and cultures, and program content that is essential for understanding the changing focus of 21st-century public service media.

School-based strategies to address cyber bullying

Bullying and victimisation among school age children is recognised as a major public health problem. The Australian Covert Bullying Prevalence Study (ACBPS) reports that just over one quarter (27%) of school students aged 8 to 14 years were bullied and 9% bullied others on a frequent basis (every few weeks or more often) (Cross et al., 2009). Bullying is associated with a host of detrimental effects, including loneliness (Nansel, Overpeck, Pilla, & Ruan, 2001), low self‐esteem (Jankauskiene, Kardelis, Sukys, & Kardeliene, 2008; Salmivalli, Kaukiainen, Kaistaniemi, & Lagerspetz, 1999), anxiety, depression (Kaltiala‐Heino, Rimpela, Rantanen, & Rimpela, 2000), suicide ideation (Kaltiala‐Heino, Rimpela, Marttunen, Rimpela, & Rantanen, 1999), impaired academic achievement (Nansel et al., 2001), and poorer physical health (Wolke, Woods, Bloomfield, & Karstadt, 2001).

Educational policy for citizenship in the early years in Australia

This paper explores how young children are constructed in educational policy for citizenship in Australia, investigating tensions between early childhood educational discourses that construct young children as active citizens and the broader discourses of citizenship in Australian educational policy. There is a widespread discourse within early childhood education that regards young children as citizens and democratic participants in their own lives. This view is a reflection of the oft cited Article 12 in the UN Convention on the Rights of the Child (UNCRC 1989). However, educational policy and curriculum for citizenship in Australia, by and large, adheres to age and stage understandings of children, implicitly deeming young children unable to conceptualise abstract ideas of what it means to ‘be a good citizen’. This paper is located in the borders and intersections between discourses of early childhood education, young children as active participants in their own lives and what it means to be an active citizen in Australia. We are concerned with the interweaving of these ideas and how they are played out in educational policy making. This is an important perspective to take for governing and policy making are exercises in harnessing existing ideas and discourses, thereby rendering strategies and tactics for managing populations thinkable and sayable (Rose 1999). The ‘views from the margins’ (Burman 2008, p. 7) can provide alternative perspectives on policymaking, illuminating discursive tactics and strategies.