Perceptions of online learning in an Australian university : Malaysian students' perspectives

Several researchers have reported that cultural and language differences can affect online interactions and communications between students from different cultural backgrounds. Other researchers have asserted that online learning is a tool that can improve teaching and learning skills, but, its effectiveness depends on how the tool is used. Therefore, this study aims to investigate the kinds of challenges encountered by the international students and how they actually cope with online learning. To date little research exists on the perceptions of online learning environments by international Asian students, in particular Malaysian students who study in Australian Universities; hence this study aims to fill this gap. A mixed-method approach was used to collect quantitative and qualitative data using a modified Online Learning Environment Survey (OLES) instrument and focus group interviews. The sample comprised 76 international students from a university in Brisbane. Thirty-five domestic Australian students were included for comparison. Contrary to assumptions from previous research, the findings revealed that there were few differences between the international Asian students from Malaysia and Australian students with regard to their perceptions of online learning. Another cogent finding that emerged was that online learning was most effective when included within blended learning environments. The students clearly indicated that when learning in a blended environment, it was imperative that appropriate features are blended in and customised to suit the particular needs of international students. The study results indicated that the university could improve the quality of the blended online learning environment by: 1) establishing and maintaining a sense of learning community; 2) enhancing the self motivation of students; and 3) professional development of lecturers/tutors, unit coordinators and learning support personnel. Feedback from focus group interviews, highlighted the students‘ frustration with a lack of cooperative learning, strategies and skills which were expected of them by their lecturers/tutors in order to work productively in groups. They indicated a strong desire for lecturers/tutors to provide them prior training in these strategies and skills. The students identified four ways to optimise learning opportunities in cross-cultural spaces. These were: 1) providing preparatory and ongoing workshops focusing on the dispositions and roles of students within student-centred online learning environments; 2) providing preparatory and ongoing workshops on collaborative group learning strategies and skills; 3) providing workshops familiarising students with Australian culture and language; and 4) providing workshops on strategies for addressing technical problems. Students also indicated a strong desire for professional development of lecturers/tutors focused on: 1) teacher attributes, 2) ways to culturally sensitive curricula, and 3) collaborative learning and cooperative working strategies and skills, and 4) designing flexible program structures. Recommendations from this study will be useful to Australian universities where Asian international students from Malaysia study in blended learning environments. An induction program (online skills, collaborative and teamwork skills, study expectations plus familiarisation with Australian culture) for overseas students at the commencement of their studies; a cultural awareness program for lecturers (cultural sensitivity, ways to communicate and a better understanding of Asian educational systems), upskilling of lecturers‘ ability to structure their teaching online and to apply strong theoretical underpinnings when designing learning activities such as discussion forums, and consistency with regards to how content is located and displayed in a learning management system like Blackboard. Through addressing the research questions in this study, the researcher hopes to contribute to and advance the domain of knowledge related to online learning, and to better understand how international Malaysian students‘ perceive online learning environments. These findings have theoretical and pragmatic significance.

Under the carpet : the politics and trauma of patient harm

Few studies have investigated iatrogenic outcomes from the viewpoint of patient experience. To address this anomaly, the broad aim of this research is to explore the lived experience of patient harm. Patient harm is defined as major harm to the patient, either psychosocial or physical in nature, resulting from any aspect of health care. Utilising the method of Consensual Qualitative Research (CQR), in-depth interviews are conducted with twenty-four volunteer research participants who self-report having been severely harmed by an invasive medical procedure. A standardised measure of emotional distress, the Impact of Event Scale (IES), is additionally employed for purposes of triangulation. Thematic analysis of transcript data indicate numerous findings including: (i) difficulties regarding patients‘ prior understanding of risks involved with their medical procedure; (ii) the problematic response of the health system post-procedure; (iii) multiple adverse effects upon life functioning; (iv) limited recourse options for patients; and (v) the approach desired in terms of how patient harm should be systemically handled. In addition, IES results indicate a clinically significant level of distress in the sample as a whole. To discuss findings, a cross-disciplinary approach is adopted that draws upon sociology, medicine, medical anthropology, psychology, philosophy, history, ethics, law, and political theory. Furthermore, an overall explanatory framework is proposed in terms of the master themes of power and trauma. In terms of the theme of power, a postmodernist analysis explores the politics of patient harm, particularly the dynamics surrounding the politics of knowledge (e.g., notions of subjective versus objective knowledge, informed consent, and open disclosure). This analysis suggests that patient care is not the prime function of the health system, which appears more focussed upon serving the interests of those in the upper levels of its hierarchy. In terms of the master theme of trauma, current understandings of posttraumatic stress disorder (PTSD) are critiqued, and based on data from this research as well as the international literature, a new model of trauma is proposed. This model is based upon the principle of homeostasis observed in biology, whereby within every cell or organism a state of equilibrium is sought and maintained. The proposed model identifies several bio-psychosocial markers of trauma across its three main phases. These trauma markers include: (i) a profound sense of loss; (ii) a lack of perceived control; (iii) passive trauma processing responses; (iv) an identity crisis; (v) a quest to fully understand the trauma event; (vi) a need for social validation of the traumatic experience; and (vii) posttraumatic adaption with the possibility of positive change. To further explore the master themes of power and trauma, a natural group interview is carried out at a meeting of a patient support group for arachnoiditis. Observations at this meeting and members‘ stories in general support the homeostatic model of trauma, particularly the quest to find answers in the face of distressing experience, as well as the need for social recognition of that experience. In addition, the sociopolitical response to arachnoiditis highlights how public domains of knowledge are largely constructed and controlled by vested interests. Implications of the data overall are discussed in terms of a cultural revolution being needed in health care to position core values around a prime focus upon patients as human beings.

A Cochrane review on the effects of end-of-life care pathways : do they improve patient outcomes?

Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. The aim of this review was to assess the effects of end-of-life care pathways (EOLCP), compared with usual care (no pathway) or with care guided by a different end-of-life care pathway, across all healthcare settings (e.g. hospitals, residential aged care facilities, community). We searched the Cochrane Register of Controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register, MEDLINE, EMBASE, review articles and reference lists of relevant articles. The search was carried out in September 2009. All randomised controlled trials (RCTs), quasi-randomised trials or high quality controlled before and after studies comparing use versus non-use of an EOLCP in caring for the dying were considered for inclusion. The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review. Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. There are now recent concerns regarding the big scale roll-out of EOLCP despite the lack of evidence, nurses should report any safety concerns or adverse effects associated with such pathways.

Psychoanalytic perspectives on substance use and antisocial personality disorder

Psychoanalysis and related psychodynamic psychotherapies have historically had a limited engagement with substance use and antisocial personality disorders. This in part reflects an early preoccupation with ‘transference neuroses’ and in part reflects later de-emphasis of diagnosis and focus on therapeutic process. Nonetheless, psychoanalytic perspectives can usefully inform thinking about approaches to treatment of such disorders and there are psychoanalytic constructs that have specific relevance to their treatment. This paper reviews some prominent strands of psychoanalytic thinking as they pertain to the treatment of substance abuse and antisocial personality disorders. It is argued that, while Freudian formulations lead to a primarily pessimistic view of the prospect of treatment of such disorders, both the British object relations and the North American self psychology traditions suggest potentially productive approaches. Finally the limited empirical evidence from brief psychodynamically informed treatments of substance use disorders is reviewed. It is concluded that such treatments are not demonstrably effective but that, since no form of psychotherapy has established high efficacy with substance use disorders, brief psychdynamic therapies are not necessarily of lesser value than other treatments and may have specific value for particular individuals and in particular treatment contexts.

Planning volunteer responses to low-volume mass gatherings: do event characteristics predict patient workload?

INTRODUCTION: Workforce planning for first aid and medical coverage of mass gatherings is hampered by limited research. In particular, the characteristics and likely presentation patterns of low-volume mass gatherings of between several hundred to several thousand people are poorly described in the existing literature. OBJECTIVES: This study was conducted to: 1. Describe key patient and event characteristics of medical presentations at a series of mass gatherings, including events smaller than those previously described in the literature; 2. Determine whether event type and event size affect the mean number of patients presenting for treatment per event, and specifically, whether the 1:2,000 deployment rule used by St John Ambulance Australia is appropriate; and 3. Identify factors that are predictive of injury at mass gatherings. METHODS: A retrospective, observational, case-series design was used to examine all cases treated by two Divisions of St John Ambulance (Queensland) in the greater metropolitan Brisbane region over a three-year period (01 January 2002-31 December 2004). Data were obtained from routinely collected patient treatment forms completed by St John officers at the time of treatment. Event-related data (e.g., weather, event size) were obtained from event forms designed for this study. Outcome measures include: total and average number of patient presentations for each event; event type; and event size category. Descriptive analyses were conducted using chi-square tests, and mean presentations per event and event type were investigated using Kruskal-Wallis tests. Logistic regression analyses were used to identify variables independently associated with injury presentation (compared with non-injury presentations). RESULTS: Over the three-year study period, St John Ambulance officers treated 705 patients over 156 separate events. The mean number of patients who presented with any medical condition at small events (less than or equal to 2,000 attendees) did not differ significantly from that of large (>2,000 attendees) events (4.44 vs. 4.67, F = 0.72, df = 1, 154, p = 0.79). Logistic regression analyses indicated that presentation with an injury compared with non-injury was independently associated with male gender, winter season, and sporting events, even after adjusting for relevant variables. CONCLUSIONS: In this study of low-volume mass gatherings, a similar number of patients sought medical treatment at small (<2,000 patrons) and large (>2,000 patrons) events. This demonstrates that for low-volume mass gatherings, planning based solely on anticipated event size may be flawed, and could lead to inappropriate levels of first-aid coverage. This study also highlights the importance of considering other factors, such as event type and patient characteristics, when determining appropriate first-aid resourcing for low-volume events. Additionally, identification of factors predictive of injury presentations at mass gatherings has the potential to significantly enhance the ability of event coordinators to plan effective prevention strategies and response capability for these events.

The PSS : From Flat Maps to Layered Perspectives - the contribution of the Airport Metropolis Planning Support System (PSS) to sub-regional planning in the Brisbane Airport case environment

Conventional planning and decision making, with its sectoral and territorial emphasis and flat-map based processes are no longer adequate or appropriate for the increased complexity confronting airport/city interfaces. These crowed and often contested governance spaces demand a more iterative and relational planning and decision-making approach. Emergent GIS based planning and decision-making tools provide a mechanism which integrate and visually display an array of complex data, frameworks and scenarios/expectations, often in ‘real time’ computations. In so doing, these mechanisms provide a common ground for decision making and facilitate a more ‘joined-up’ approach to airport/city planning. This paper analyses the contribution of the Airport Metropolis Planning Support System (PSS) to sub-regional planning in the Brisbane Airport case environment.

Perspectives on practical experiences in professional education : an editorial and introduction

How important are the practical experiences through which our neophyte professionals are prepared for the real world of work? P. E. P. E. (Practical Experiences in Professional Education) Inc has generated this book with, not only, the aim of disseminating knowledge through networks within the professional silos of distinctive disciplines but to generate a space and platform for generic concepts and practices that can be examined and incorporated across many disciplines. Mentoring, ethics and transitioning into the profession are explored in the book but each chapter illustrates how PEPE Inc has within its community a culture of engagement, experimentation and deep thinking that connects all aspects of learning in the field. Ken Zeichner’s research clearly shows that field experiences are important occasions for professional learning rather than merely times for pre-service candidates to demonstrate or apply things previously learned. Susan Groundwater-Smith acknowledges PEPE Inc on being a leader in supporting the evolution of a developmental practicum curriculum in the initial education of professionals, mainly in the field of education, but also with respect to the preparation of health and allied professionals, those preparing to become social workers and even in professional practices such as engineering and architecture.

Implementation of ICD-11... perspectives from the Australian Bureau of Statistics

As the development of ICD-11 progresses, the Australian Bureau of Statistics is beginning to consider what will be required to successfully implement the new version of the classification. This paper will present early thoughts on the following: building understanding amongst the user community of upcoming changes and the implications of those changes; the need for training of coders and data users; development of analytical methods and conduct of comparability studies; processes to test, accept and implement new or updated coding software; assessment of coding quality; changes to data analyses and reporting processes; updates to regular publications; and assessing the resources required for successful implementation.

Impact of disability on families : Grandparents’ perspectives

Background Caring for a child with a disability can be a unique and challenging experience, with families often relying on informal networks for support. Often, grandparents are key support resources, yet little is known about their roles and experiences. Reporting on data collected in a larger Australian study, this article explores grandparents' experiences of caring for a child with a disability and the impact on their family relationships and quality of life. Method A qualitative purposive sampling design was utilised; semi-structured interviews were conducted with 22 grandparents (17 women, 5 men) of children with a disability. Grandparents ranged in age from 55 to 75 years old and lived within a 90-min drive of Brisbane, Australia. Interviews were transcribed and responses analysed using a thematic approach, identifying categories, themes and patterns. Findings Four key themes characterised grandparents' views about their role in the family: holding own emotions (decision to be positive), self-sacrifice (decision to put family needs first), maintaining family relationships (being the ‘go-between’) and quality of life for family in the future (concerns about the future). Conclusions Grandparents are central to family functioning and quality of life, but this contribution comes with a significant cost to their own personal well-being. Implications for policy, practice and research are discussed, particularly grandparents' fear that their family could not cope without their support.

Improving patient privacy and confidentiality in one regional Emergency Department – a quality project

Background: Patient privacy and confidentiality (PPaC) is an important consideration for nurses and other members of the health care team. Can a patient expect to have confidentiality and in particular privacy in the current climate of emergency health care? Do staff who work in the Emergency Department (ED) see confidentiality as an important factor when providing emergency care? These questions are important to consider. Methods: This is a two phased quality improvement project, developed and implemented over a six month period in a busy regional, tertiary referral ED. Results: Issues identified for this department included department design and layout, overcrowding due to patient flow and access block, staff practices and department policies which were also impacted upon by culture of the team, and use of space. Conclusions: Changes successful in improving this issue include increased staff awareness about PPaC, intercom paging prior to nursing handover to remove visitors during handover, one visitor per patient policy, designated places for handover, allocated bed space for patient reviews/assessment and a strategy to temporarily move the patient if procedures would have been undertaken in shared bed space. These are important issues when considering policy, practice and department design in the ED.

How design of the physical environment impacts early learning : educators and parents perspectives

This research explores the quality and importance of the physical environment of two early learning centres on the Sunshine Coast in Queensland, utilising qualitative interviews with parents (n=4) and educators (n=4) to understand how design might impact on children’s development and a quantitative rating (the Early Childhood Physical Environment Rating Scale; ECPERS) to assess the quality of the physical built environment and infrastructure. With an average ECPERS quality rating, thematic analysis of the interviews revealed that educators and parents viewed the physical environment as important to a child’s development, although the quality of staff was predominant. Early learning centres should be ‘homely’, inviting, bright and linked to the outdoors, with participants describing how space “welcomes the child, makes them feel safe and encourages learning”. Four key themes characterised views: Emotional Connection (quality of staff and physical environment), Experiencing Design (impact of design on child development), Hub for Community Integration (relationships and resources) and Future Vision (ideal physical environment, technology and ratings). With participants often struggling to clearly articulate their thoughts on design issues, a collaborative and jargon-free approach to designing space is required. These findings will help facilitate discussion about the role and design of the physical environment in early childhood centres, with the tangible examples of ‘ideal space’ enhancing communication between architects and educators about how best to design and reconfigure space to enhance learning outcomes.

Multiple perspectives on engaging future engineers

Engaging future engineers is a central topic in everyday conversations on engineering education. Considerable investments have been made to make engineering more engaging, recruit and retain aspiring engineers, and to design an education to prepare future engineers. However, the impact of these efforts has been less than intended. It is imperative that the community reflects on progress and sets a more effective path for the future.

Identifying parent perspectives to guide active travel intervention with small populations : case study in Denver, Colorado

This paper investigates a strategy for guiding school-based active travel intervention. School-based active travel programs address the travel behaviors and perceptions of small target populations (i.e., at individual schools) so they can encourage people to walk or bike. Thus, planners need to know as much as possible about the behaviors and perceptions of their target populations. However, existing strategies for modeling travel behavior and segmenting audiences typically work with larger populations and may not capture the attitudinal diversity of smaller groups. This case study used Q technique to identify salient travel-related attitude types among parents at an elementary school in Denver, Colorado; 161 parents presented their perspectives about school travel by rank-ordering 36 statements from strongly disagree to strongly agree in a normalized distribution, single centered around no opinion. Thirty-nine respondents' cases were selected for case-wise cluster analysis in SPSS according to criteria that made them most likely to walk: proximity to school, grade, and bus service. Analysis revealed five core perspectives that were then correlated with the larger respondent pool: optimistic walkers, fair-weather walkers, drivers of necessity, determined drivers, and fence sitters. Core perspectives are presented—characterized by parents' opinions, personal characteristics, and reported travel behaviors—and recommendations are made for possible intervention approaches. The study concludes that Q technique provides a fine-grained assessment of travel behavior for small populations, which would benefit small-scale behavioral interventions

The subjective experience of negative symptoms : characteristics of emotional withdrawal

According to the diagnosis of schizophrenia in the DSM-IV-TR (American Psychiatric Association, 2000), negative symptoms are those personal characteristics that are thought to be reduced from normal functioning, while positive symptoms are aspects of functioning that exist as an excess or distortion of normal functioning. Negative symptoms are generally considered to be a core feature of people diagnosed with schizophrenia. However, negative symptoms are not always present in those diagnosed, and a diagnosis can be made with only negative or only positive symptoms, or with a combination of both. Negative symptoms include an observed loss of emotional expression (affective flattening), loss of motivation or self directedness (avolition), loss of speech (alogia), and also a loss of interests and pleasures (anhedonia). Positive symptoms include the perception of things that others do not perceive (hallucinations), and extraordinary explanations for ordinary events (delusions) (American Psychiatric Association, 2000). Both negative and positive symptoms are derived from watching the patient and thus do not consider the patient’s subjective experience. However, aspects of negative symptoms, such as observed affective flattening are highly contended. Within conventional psychiatry, the absence of emotional expression is assumed to coincide with an absence of emotional experience. Contrasting research findings suggests that patients who were observed to score low on displayed emotional expression, scored high on self ratings of emotional experience. Patients were also observed to be significantly lower on emotional expression when compared with others (Aghevli, Blanchard, & Horan, 2003; Selton, van der Bosch, & Sijben, 1998). It appears that there is little correlation between emotional experience and emotional expression in patients, and that observer ratings cannot help us to understand the subjective experience of the negative symptoms. This chapter will focus on research into the subjective experiences of negative symptoms. A framework for these experiences will be used from the qualitative research findings of the primary author (Le Lievre, 2010). In this study, the primary author found that subjective experiences of the negative symptoms belonged to one of the two phases of the illness experience; “transitioning into emotional shutdown” or “recovering from emotional shutdown”. This chapter will use the six themes from the phase of “transitioning into emotional shutdown”. This phase described the experience of turning the focus of attention away from the world and onto the self and the past, thus losing contact with the world and others (emotional shutdown). Transitioning into emotional shutdown involved; “not being acknowledged”, “relational confusion”, “not being expressive”, “reliving the past”, “detachment”, and “no sense of direction” (Le Lievre, 2010). Detail will be added to this framework of experience from other qualitative research in this area. We will now review the six themes that constitute a “transition into emotional shutdown” and corresponding previous research findings.