Developing professional attributes in critical care nurses using Team-Based Learning.

Australian nurses prepare for specialty practice by undertaking postgraduate theoretical and clinical education in partnership models between universities and hospitals. In our global healthcare system, nurses require advanced critical thinking and strong communication skills to provide safe, high quality patient care. Yet, few education programs focus on developing these skills. Team-Based Learning (TBL) is a specific educational strategy that encourages and rewards students to think critically and solve clinical problems individually and in teams. The aim of this study was to investigate critical care nursing students' perceptions and experiences of TBL after it was introduced into the second half of their postgraduate specialty course. Following Ethics Committee approval, thirty-two students were invited to participate in an extended response questionnaire on their perceptions of TBL as part of a larger study. Data were analyzed thematically. Postgraduate students perceived their professional growth was accelerated due to the skills and knowledge acquired through TBL. Four themes underpinned the development and accelerated acquisition of specialty nurse attributes due to TBL: Engagement, Learning Effectiveness, Critical Thinking, and Motivation to Participate. Team-Based Learning offered deep and satisfying learning experiences for students. The early acquisition of advanced critical thinking, teamwork and communication skills, and specialty practice knowledge empowered nurses to provide safe patient care with confidence.

Doing the right thing at the right time: Assessing responses to patient deterioration in electronic simulation scenarios using course-of-action analysis

International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-to-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-access Web-based patient deterioration program (FIRSTACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants' performance in the whole program demonstrated a significant improvement in knowledge and skills (P ≤ .001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18% took the "best course of action" (the right actions and timing), with most (70%) completing the right actions but in the wrong order. The remaining 12% produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.

Piloting the feasibility of head-mounted video technology to augment student feedback during simulated clinical decision-making: an observational design pilot study

BACKGROUND: Clinical decision-making is a complex activity that is critical to patient safety. Simulation, augmented by feedback, affords learners the opportunity to learn critical clinical decision-making skills. More detailed feedback following simulation exercises has the potential to further enhance student learning, particularly in relation to developing improved clinical decision-making skills. OBJECTIVE: To investigate the feasibility of head-mounted video camera recordings, to augment feedback, following acute patient deterioration simulations. DESIGN: Pilot study using an observational design. METHODS: Ten final-year nursing students participated in three simulation exercises, each focussed on detection and management of patient deterioration. Two observers collected behavioural data using an adapted version of Gaba's Clinical Simulation Tool, to provide verbal feedback to each participant, following each simulation exercise. Participants wore a head-mounted video camera during the second simulation exercise only. Video recordings were replayed to participants to augment feedback, following the second simulation exercise. Data were collected on: participant performance (observed and perceived); participant perceptions of feedback methods; and head-mounted video camera recording feasibility and capability for detailed audio-visual feedback. RESULTS: Management of patient deterioration improved for six participants (60%). Increased perceptions of confidence (70%) and competence (80%), were reported by the majority of participants. Few participants (20%) agreed that the video recording specifically enhanced their learning. The visual field of the head-mounted video camera was not always synchronised with the participant's field of vision, thus affecting the usefulness of some recordings. CONCLUSION: The usefulness of the video recordings, to enhance verbal feedback to participants on detection and management of simulated patient deterioration, was inconclusive. Modification of the video camera glasses, to improve visual-field synchronisation with participants' actual visual field, is recommended to further explore this technology for enhancing student performance.

Less is more: development and evaluation of an interactive e-atlas to support anatomy learning

An Interactive electronic Atlas (IeA) was developed to assist first-year nursing students with interpretation of laboratory-based prosected cadaveric material. It was designed, using pedagogically sound principles, as a student-centered resource accessible to students from a wide range of learning backgrounds. It consisted of a highly simplified interactive interface limited to essential anatomical structures and was intended for use in a blended learning situation. The IeA's nine modules mirrored the body systems covered in a Nursing Biosciences course, with each module comprising a maximum of 10 pages using the same template: an image displaying a cadaveric specimen and, in most cases, a corresponding anatomical model with navigation panes (menus) on one side. Cursor movement over the image or clicking the menu highlighted the structure with a transparent overlay and revealed a succinct functional description. The atlas was complemented by a multiple-choice database of nearly 1,000 questions using IeA images. Students' perceptions of usability and utility were measured by survey (n = 115; 57% of the class) revealing mean access of 2.3 times per week during the 12-week semester and a median time of three hours of use. Ratings for usability and utility were high, with means ranging between 4.24 and 4.54 (five-point Likert scale; 5 = strongly agree). Written responses told a similar story for both usability and utility. The role of providing basic computer-assisted learning support for a large first-year class is discussed in the context of current research into student-centered resources and blended learning in human anatomy.

A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB) on student learning

BACKGROUND: High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. OBJECTIVES: To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. DESIGN AND SETTING: Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. PARTICIPANTS: A population of 489 final-year nursing students in programs of study leading to license to practice. METHODS: Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. RESULTS: Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001. DISCUSSION: The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning. CONCLUSION: The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students.

On the fast track speeding nurses into the future: a two year Bachelor of Nursing for graduates of other disciplines

It has been suggested in nursing literature that a bachelor's degree should be the pre-requisite to professional nursing education and registration. The perceived advantages of graduates entering the nursing profession led faculty in the School of Nursing La Trobe University to introduce in 1997 an innovative two-year Bachelor of Nursing (BN) program, believed to be the first in Australia, for graduates of other disciplines. A problem-based learning (PBL) approach was selected to facilitate the teaching learning process. Data to evaluate the progress of the accelerated students were collected by examining their previous degree background, conducting a focus group discussion mid year and comparing the students' academic results with those completing the traditional three-year course. Findings indicate that students in the accelerated course were highly motivated but experienced significant stress. In part the stress emanated from the need to identify their own learning needs. However, despite their concerns most accelerated students scored at least as well both clinically and academically as traditional students. Moreover, in six of the seven final year subjects each group studied the accelerated students performed better.

Simulation to practice: developing nursing skills in mental health: an Australian perspective

A variety of developments in nursing education in Australia including some innovative and exciting models, educational enterprises between education and industry, and evidence of developing strengths in research and professional alliances on a national level have been discussed recently. This paper presents Simulation to Practice as an example of an educational program that can maximise skill mastery for nurses in mental health fields as practised by Deakin University in Victoria, Australia. The program is multimodal and is under-pinned by a problem-solving approach and has an online presentation. The extension of nursing skills through this approach encourages nurses to take theoretical skills to practice during these scenarios which help student nurses to gain experience through simulated real life characters. These sessions, while challenging at the time, were highly valued by students and seen as a beneficial part of their learning as a beginning nurse and often instrumental in moving comprehensively trained students into mental health careers.

Key stakeholders' expectations of educational outcomes from Australian critical care nursing courses: a Delphi study

Background
Educational preparation for critical care nursing in Australia varies considerably in terms of the level of qualification resulting in a lack of clarity for key stakeholders about student outcomes.

Objectives
The study aim was to identify and reach consensus regarding the desired learning outcomes from Australian post-registration critical care education programs as demonstrated through the graduate's knowledge, skills and attitudes.

Design
A Delphi technique was used to establish consensus between educators, managers, clinicians and students regarding learning outcomes expected of graduates with a Graduate Certificate, Graduate Diploma and Master level qualification in critical care nursing.

Participants
A total of 164 critical care nurses (66 clinicians, 48 educators, 32 managers and 18 students) participated and 99 questionnaires were returned in the first round (response rate 60%). Fifty-seven questionnaires were returned for Round 2 (response rate 58%).

Methods
Learning outcomes were obtained from the Australian College of Critical Care Nurses Competency Standards for Specialist Critical Care Nurses. Some statements included more than one characteristic, and these were split to create learning outcomes with one characteristic per item. A survey of Australian higher education providers of critical care education provided additional learning outcomes, for a total of 73 learning outcomes for the first Delphi round.

Results
Findings suggest that patient comfort, safety, professional responsibility and ethical conduct are deemed most important for all three levels of educational preparation. There was a lack of emphasis on clinical practice issues for all levels. Participants placed higher emphasis on learning outcomes related to complex decision-making, leadership, supervision, policy development and research for Graduate Diploma and Master level programs.

Conclusion
The findings have implications for curriculum development and the profession with regards to the level of educational preparation required of critical care nurses and suggest that further work is required before clear recommendations can be made for desired educational outcomes from critical care nursing programs in Australia.

Nursing educations and graduates : profiles for 2001 and projections for 2002

The present study was commissioned for the National Review of Nursing Education. This is the second of two national studies commissioned to map in detail nursing education programs and to profile and make future projections regarding graduates from undergraduate and postgraduate nursing education courses in Australia.

The first study was undertaken in 2001 by Deakin University School of Nursing under the auspices of the 2001 Evaluation Investigations Project titled "Nursing Education and Graduates: Profiles for 1999, and 2000 with projections for 2001". This project sought data on nursing education within Australia in order to improve the accuracy of nursing education databases and to strengthen the ability of DETYA to provide advice on workforce planning. Issues that arose from that project included differences in data sets for undergraduate nursing courses in Australia and the complex process of attempting to tease out and accurately quantify postgraduate specialty courses when a trend towards postgraduate generic courses was evident. Approximately 26% of postgraduate domestic student enrolment data were reported utilising a generic nursing course category.

The purpose of this study was, therefore, twofold. Firstly, this study validated and extended the existing database developed in the previous study mapping in detail the full range of undergraduate programs offered by tertiary education providers across Australia that lead to an initial qualification and entry into nursing practice.

New data about the following was sought:

* Undergraduate nursing degrees (both three-year and four-year courses);
* Double/combined nursing degrees;
* Courses offered by private universities;
* Four-year bachelor degrees that concurrently provide both initial nurse registration and preparation for specialty nursing practice;
* Courses that facilitate ‘fast-tracking’ of students for initial nurse registration with previous tertiary or nursing studies,
* Hours and configuration of clinical experience in undergraduate nursing courses.

Clinical education : a challenging component of undergraduate nursing education

Clinical education is an essential part of every undergraduate nursing curriculum. The main benefits are that it allows students to put theory into practice and experience the realities of the practice- based nursing profession. Limitations include the unstable nature of the clinical area as a learning environment and the challenges this produces with students' assessments. This article reviews the literature and concludes there is room for significant improvement in the area of clinical education and numerous strategies can be implemented to do so.

Collaboration : integrating education and clinical practice : The Case of La Trobe University/The Alfred Clinical School of Nursing

A Clinical School of Nursing combines resources, opportunities and benefits for hospital and university staff as well as students. Collaboration is essential in the partnership between the two institutions and aspects will be explored in this paper, including antecedent conditions of organisational commitment, cooperation and trust, identification of costs, and a formal agreement. Collaboration itself is built on cooperative endeavour, willing participation, shared planning and decision making, a team approach, and shared responsibility and power. These attributes are readily identifiable in this exciting initiative.

Variables influencing the mathematics performance of first-year tertiary students : a case study

The need to understand which factors most strongly affect performance in first-year mathematics programs at Khon Kaen University (KKU), in North Eastern Thailand, provided the main focus of the study which is described. First-year mathematics students in the 1990-1991 academic year, from four KKU faculty groups (Medicine and Nursing, Agriculture, Science and Education, and Engineering) were involved in this study. Research literatures addressing variables which were likely to influence performance in early tertiary mathematical study, and variables associated with difficulties in learning mathematics at the transition from upper secondary school to tertiary studies, were reviewed. The first major aim of the study was to identify the variables which were good predictors of first-year mathematics performance at KKU. Results from stepwise multiple regression analyses indicated that the following predictor variables were statistically significant and entered the regression equations for most Faculty groups: School Mathematics Achievement, Self-Esteem, Study Habits in Mathematics, and Faculty of Study. Other predictor variables that sometimes entered regression equations (depending on the Faculty group) were Socio-Economic-Status, Mathematics Language Competence, Mathematics Confidence, Attitude Towards Mathematics, and Gender. Depending on Faculty group, the statistically significant variables accounted for between 11% and 74% of scores on fist-year KKU mathematics examinations. The predictor variables contributed much more to the variance of scores on first-semester mathematics examinations than to the variance of scores on second-semester mathematics examinations. It was also found that scores on the Direct Entry Examination Mathematics test (administered by KKU) and the School Mathematics Achievement test (developed and administered by the author) had stronger correlations with first-year KKU mathematics performance than did scores on the National Entry Examination Mathematics tests (administered by the Thai Ministry of University Affairs). Scores on the three pre-university mathematics achievement test instruments were better predictors of first-semester mathematics performance than of second-semester mathematics performance. It was found that the mean Mathematics Confidence of male students was statistically significantly higher than that of female students, but there were no statistically significant gender differences in Mathematics Misplaced Confidence. Only about 30% of the main sample ( 30% of the male and 30% of the female sample groups) had appropriate confidence in mathematics, that is, they thought their answers were correct when they were, in fact, correct, and they thought they were wrong when they were, in fact, incorrect. So far as Faculty performance differences were concerned, Engineering students had the highest Mathematics Confidence scores, followed by the Medicine and Nursing group of students and the Science and Education group students. Agriculture students had the lowest mean Mathematics Confidence score. No statistically significant differences occurred in Mathematics Misplaced Confidence between different Faculty groups. The second main aim of the study was to investigate why many first-year students experienced difficulties in coping with their mathematics units. A small group of senior secondary mathematics teachers, university mathematics lecturers, and first-year mathematics students were interviewed during the first semester of the 1990-1991 academic year. Interviews were conducted by the author according to a questionnaire format, and were aimed at identifying factors causing difficulty in the transition from senior secondary to university mathematical study. The analysis of the quantitative data together with the interview data indicated that the major sources of difficulty were associated with: (a) students' mathematical abilities; (b) curriculum content; (c) course organisation; (d) students' study habits; (e) instructional styles; and (f) assessment procedures. The results of the investigation are discussed in the light of the relevant literature and related research. The study concludes with recommendations which are addressed to mathematics teachers and education administrators in senior secondary schools in Thailand, to the Thai Ministry of Education, and to the KKU Department of Mathematics.

Reflective positioning : the impact of conversations in the social and cultural environment of midwifery practice settings on professional learning for students

Literature reviews on the topic of reflection and reflective practice encompassed midwifery, nursing, medicine, allied health, education and professional education. This investigation also included socio-psychological theories by leading authors such as Benner (nursing), Schön (professional education) and positioning theory by Harré and others. Positioning is a psycho-sociological ontology in which individuals metaphorically position themselves within three entities: people, institutions, and societies, where conversations are constructed and make an impact upon the social world. The social and cultural structures and interactions developed in Archer’s morphogenesis were examined in terms of the impact of possible encounters and the transformational effects of learning experiences in practice settings. These bodies of work provided the theoretical framework for the author’s research of students’ experiences in midwifery education for postgraduate students from which selected excerpts with three participating students and their supervising midwives are presented. These excerpts are related to reflective practices and the professional conversations conducted between students and midwives. It was found that reflective positioning applied in midwifery education by students can serve as an analytical tool in explaining social and cultural elements of clinical placements to influence and transform their learning. The potency of conversations that occur in everyday moment-to-moment interactions do contribute to students’ induction in professional midwifery practice and their identity formation as a midwife.

Video streaming: Implementation and evaluation in an undergraduate nursing program

Video streaming technology enables video content, held on the web sites, to be streamed via the web. We report the implementation and evaluation of video streaming in an undergraduate nursing program in a metropolitan university in Australia. Students (n = 703) were emailed a survey with a 15% response rate. We found that 91% (n = 74) of respondents stated that video streaming assisted their learning. Forty-six percent(n = 50) of students had difficulty accessing video streaming (particularly at the beginning of the study period). Over a 97-day period there were 8440 “hits” to the site from 1039 different internet protocol (IP) addresses. There were 4475 video streaming sessions undertaken by users. Video streaming was used for reviewing previously attended lectures (52%, n = 56), examination preparation (34%, n = 37), viewing missed lectures (27%, n = 29) and class preparation (9%, n = 10). Our experience with the introduction of video streaming has met with general enthusiasm from both students and teaching staff. Video streaming has particular relevance for rural students.