Using e-learning to increase the preparedness and confidence of nurses to perform buttonhole cannulation

Arteriovenous fistulae are considered the gold standard for haemodialysis vascular access. Their use can be fraught with complications for both the patient and cannulator, with knowledge, expertise and skills being key factors in reducing access associated morbidity. There is mounting evidence demonstrating the efficacy of the buttonhole technique. One disturbing problem noted with the buttonhole experience has been an increased rate in site infections, anecdotally attributed to poor buttonhole site preparation. Enhanced knowledge and skills for nurses are crucial in increasing patient comfort and improving outcomes.

Although knowledge and skill acquisition related to vascular access are often the focus of individual institutional educational initiatives, a national evidence based program that provides free equitable access to all nurses does not exist in Australasia. A survey of Australasian Nephrology Educators’ identified the need for more effective and consistent delivery of clinical education for nurses using innovative, web‐based approaches that support the tenets of e-learning methodologies. This paper will discuss the development and implementation of an e-learning program for buttonhole cannulation. The preparedness of participants to professionally engage with buttonhole cannulation and their self-efficacy (estimates) in undertaking learning about the clinical procedure using e-learning will be evaluated. In addition it will highlight the benefits of inter‐organizational partnerships and how they can facilitate positive change in teaching and learning practices aimed at improving patient outcomes. This project has unique characteristics that collectively provide value, distinction and innovation to patients, nurses, and renal departments across Australasia. As the e-learning program is founded on evidence based practice this project is easily transferable to an international context.

Detecting and managing depressed patients : palliative care nurses' self-efficacy and perceived barriers to care

Background: Depression is a highly prevalent yet under-recognized and under-treated psychiatric illness in patients receiving palliative care. Nurses are the front-line health care professionals in these settings and are well-positioned to detect depressive symptoms and initiate pathways to care. Previous research suggests, however, that nurses' confidence and skills in relation to this task are low, and there appear to be a number of barriers within these settings that may impede nurses' engagement in this process.

Methods: To further investigate these factors, a quantitative study was carried out with 69 palliative care nurses from three palliative care services in Australia.

Results: A number of issues were identified, including the need for further training in the signs and symptoms of depression, issues around discussing depression with patients and their family members, and difficulty differentiating depressive symptoms from grief.

Conclusion: These findings provide insight into specific areas in which palliative care nurses would benefit from further training to improve detection rates for depression in this vulnerable population.

Glaucoma and on-road driving performance

PURPOSE. To investigate the on-road driving performance of patients with glaucoma.

METHODS. The sample comprised 20 patients with glaucoma and 20 subjects with normal vision, all licensed drivers, matched for age and sex. Driving performance was tested over a 10-km route incorporating 55 standardized maneuvers and skills through residential and business districts of Halifax, Nova Scotia, Canada. Testing was conducted by a professional driving instructor and assessed by an occupational therapist certified in driver rehabilitation, masked to participant group membership and level of vision. Main outcome measures were total number of satisfactory maneuvers and skills, overall rating, and incidence of at-fault critical interventions (application of the dual brake and/or steering override by the driving instructor to prevent a potentially unsafe maneuver). Measures of visual function included visual acuity, contrast sensitivity, and visual fields (Humphrey Field Analyzer; Carl Zeiss Meditec, Inc., Dublin, CA; mean deviation [MD] and binocular Esterman points).

RESULTS. There was no significant difference between patients with glaucoma (mean MD = −1.7 dB [SD 2.2] and −6.5 dB [SD 4.9], better and worse eyes, respectively) and control subjects in total satisfactory maneuvers and skills (P = 0.65), or overall rating (P = 0.60). However, 12 (60%) patients with glaucoma had one or more at-fault critical interventions, compared with 4 (20%) control subjects (odds ratio = 6.00, 95% CI, 1.46–24.69; higher still after adjustment for age, sex, medications and driving exposure), the predominant reason being failure to see and yield to a pedestrian. In the glaucoma group, worse-eye MD was associated with the overall rating of driving (r = 0.66, P = 0.002).

CONCLUSIONS. This sample of patients with glaucoma with slight to moderate visual field impairment performed many real-world driving maneuvers safely. However, they were six times as likely as subjects with normal vision to have a driving instructor intervene for reasons suggesting difficulty with detection of peripheral obstacles and hazards and reaction to unexpected events.

The structure of academic prose : intercultural and interdisciplinry dimensions

In the contemporary world of increasing internationalisation of scholarship the ability to communicate in the “lingua franca” of global research communities and familiarity with relevant academic genres is crucial to attaining research visibility in the academy. Native English language competency does not guarantee the possession of knowledge and skills about how to manipulate the language structure of academic genres to produce the kind of scholarly prose acceptable in the community of readers. This task is even more challenging to Non-NESB academic writers, mainly because the purpose of academic writing is both informative and rhetorical, and the information packaging strategies are likely to be discipline and culture bound.
Communication in professional academic culture is carried out and codified by selected genre categories which function as the media for scholarly discussions. This presentation focuses on the structure of a research paper, the most widely established form of presenting academic research. With an increasing internationalisation of scholarship, the schema of a research paper faces two potentially conflicting sets of forces. At one end are the forces of established conventions of the rhetorical pattern of research papers which are modelled on the structure of an “Anglo” research paper. On the other are the forces of norms for text construction of the author’s culture of socialization.

I discuss analytical approaches to the examination of the relational organisation of this genre exploring both intercultural and interdisciplinary dimensions. I examine paratactic and hypotactic configurations of the structure of research paper, providing examples of relational strategies utilised by native and no-native English speaker writers representing Anglo and non-Anglo discourse communities.

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

Design and Sample Qualitative interviews of 15 rural and remote nurses.

Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP—an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

Results Nurses found the training provided new—or built on existing—knowledge of alcohol misuse and offered practical hands-on “real life” skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Learning in social action : the informal and social learning dimensions of circumstantial and lifelong activists

This paper explores the informal and social learning dimensions of activists as they learn skills and knowledge through participating in social action. In doing this I draw on Lave and Wenger's epistemology of situated learning and Bourdieu's theory of "habitus". I argue activists learn an array of community development skills in the social environment of activism. I claim activists' learning is cognitive, embodied and situated in practice. This paper is based on empirical research in Australia, where in-depth interviews were conducted with activists to uncover their important pedagogy. It explores the learning dimensions of two groups of activists. "Lifelong activists" who have generally been involved in student politics and have participated in activism over many years, and "circumstantial activists" who become involved in protest due to a series of life circumstances. This paper claims that while both groups' learning is social and informal, lifelong activists tend to develop their skills incrementally by being involved in the fertile site of student politics. On the other hand, circumstantial activists, not having had the benefit of early immersion in a community of practice, are rapid learners. They are frequently taken out of their comfort zone as activists and need to acquire new knowledge and skills urgently in order to practise effectively. Some circumstantial activists remain on the periphery of activism and never fully immerse themselves in the practices of activism. I argue there is much to be gained from understanding learning in social action, an epistemology of adult learning which deserves greater prominence in current adult education discourse.

The pedagogy of protest : learning through crisis and the case study of Terry Hicks

This article explores the learning dimensions of circumstantial activists, activists who come to protest due to a significant life issue or crisis event, which has contributed to their motivation to campaign. The article is a case study of Terry Hicks who campaigned for more than 6 years to have his son released from Guantanamo Bay, a United States military prison in Cuba, for suspected terrorism. It outlines the learning dimensions of circumstantial activists as they participate in social change with particular reference to Terry's case and reveals that circumstantial activists' learning is fast paced and rapid. Responding to crisis and potential loss, circumstantial activists are frequently taken out of their comfort zones and on to a learning edge because they need to acquire new knowledge and skills very quickly in order to be effective as activists. The emotions are crucial to their motivation and desire to campaign and in Terry's case particularly because of his familial connection to his son David. As activists become more experienced they learn to "manage" their emotions. The article uncovers the community development skills and knowledge that is acquired by circumstantial activists as they learn mainly informally on the job of activism.

Increasing professionalism of higher education managers and administrators : Focusing on research managers and administrators

The aim of this paper is to discuss the increasing professionalism of research managers and administrators. The paper firstly discusses recent changes to the research environment and follows with changes to research administration. Then follows with the discussion of the research method and research findings. Data was collected through semi-structured interviews with research managers and administrators working in various Higher Education Institutions in the North West of England during the period from June to August 2005. Four interviewees were research managers and administrators working in research support and another four working in research students support areas. Two research support officers and two research student administrators have research backgrounds while the other two have administration background. The interview questions aim to seek the interviewees comments on the development of knowledge and skills that facilitate them to perform their role and the preference modes for delivering the professional development events. The interviewees working on different areas have different requirement on their knowledge requirement. The interviewees working in research student support area think it is important to develop their knowledge on their understanding of students needs. While, the interviewees working in research support suggested that it is important to be kept updated on changes to the research environment and relevant policies. The interviewees with different backgrounds have different skills training needs. Interviewees with research background suggested it is important to provide research skills training for colleagues who do not have research background. On the other hand, interviewees with administration background think their administration skills should be further enhanced. All interviewees prefer that professional development events be delivered in informal mode, such as conference and workshops.

International vocational education and training - the migration and learning mix

International VET students have divergent, shifting and in some cases multiple purposes for undertaking their VET courses. Students' motives may be instrumental and/or intrinsic and can include obtaining permanent residency, accumulating skills that can secure good employment, gaining a foothold that leads to higher education, and/or personal transformation. Moreover, students' study purposes and imagining of acquired values are neither fixed nor unitary. They can be shaped and reshaped by their families and personal aspirations and by the social world and the learning environment with which they interact. We argue that, whatever a student's study purpose, s/he needs to engage in a learning practice and should be provided with a high quality education. Indeed, we insist this remains the case even if students enroll only in order to gain the qualifications needed to migrate. The paper details the association between migration and learning, and argues that the four variations emerging from the empirical data of this study that centre on migration and skills' accumulation better explain this association than does the 'international VET students simply want to migrate' perspective. We conclude with a discussion of why the stereotype that holds VET international students are mere 'PR hunters' is unjust and constitutes a threat to the international VET sector.

Identifying and developing effective approaches to foster intercultural understanding in schools

This paper provides a systematic review of education literature focused on identifying school-based approaches for developing students’ intercultural understanding. Studies were assessed using selection criteria and then critically appraised for study quality. A key finding from the review is that developing students’ intercultural understanding beyond cultural awareness requires students and teachers to take a critical approach toward cultural diversity, as well as the opportunity for ongoing intercultural and intergroup contact. Studies reported that only building cultural awareness and knowledge is not enough to promote long-term changes in attitudes. There is a need for more rigorously evaluated longitudinal school-based interventions. Finally, studies consistently call for investment in teachers’ professional and personal intercultural capabilities. The paper concludes by calling for school-based interventions that are informed by best practice approaches at a whole school level in order to effectively develop students’ intercultural attitudes and skills.

Towards a cultural historical theory of knowledge mapping: collaboration and activity in the zone of proximal development

This chapter locates knowledge mapping within the theoretical framework of cultural historical activity theory. Cultural historical activity theory provides an analytic tool for understanding how knowledge maps can act as “stimuli-means”: a cultural artefact that can mediate the performance of subjects (Vygotsky, 1978 ). Knowledge maps possess Vygotsky’s double nature: they not only enable students to enact academic practice but also allow refl ection on that practice. They enable students to build an “internal cognitive schematisation of that practice” (Guile, 2005 , p.127). Further, cultural historical activity theory gives the tools to analyse the social context of our use of knowledge maps and thus consider the mediating rules (tacit and explicit) and division of labour that mediate our use of knowledge maps. Knowledge maps can be viewed as acting within Brandom’s ( 2000 ) space of reasons , which allows learners to use reasons to develop and exchange judgements based on shareable, theoretically articulated concepts and collectively develop the ability to restructure their knowledge and enact these judgements (Guile, 2011 ). In particular multimodal collaborative knowledge maps can act as Vygotsky’s (Vygotsky, 1978 ) zone of proximal development , where teacher and peer-to-peer interaction allow students to solve problems and learn concepts and skills that they would be otherwise unable to tackle.

Issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a qualitative study

Aims and objectives
To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses.

Background
Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present.

Design
A qualitative exploratory design was employed.

Methods
Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes.

Results
Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements.

Conclusions
The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory.

Relevance to clinical practice
Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential.

How school and university supervising staff perceive the pre-service teacher education practicum: A comparative study

This paper reports on research conducted in two Australian universities to evaluate factors that are perceived to significantly impact on the professional experiences of pre-service teachers during practicum. Contextualised within teacher education programs in an urban university in Tasmania and a regional university in Queensland, the particular focus of this paper is the beliefs and experiences of school and university supervising staff members regarding the efficacy of the practicum in enabling students to integrate into practice the knowledge and skills they have acquired in their university coursework. Findings generated from the comparative analysis of both mixed methods studies revealed some differences but predominantly a number of similarities between the perceptions of the two samples of school practitioners and university staff members towards practicum. Three key findings are presented and discussed in this paper.

The presence of mathematics anxiety in future primary school teachers and factors affecting abatement

This study reflects on the implementation of various teaching initiatives for reducing anxiety toward mathematics in students studying to become primary school teachers. We highlight similarities between these practices and those promoted by the 'Whole Teacher' approach - in particular, the aim to develop attitudes along with knowledge and skills. Here, the negative past associations with mathematics and anxiety toward mathematics that students bring with them have been a key consideration when designing the subject content and delivery. Given the important role these students will have in shaping mathematics education in the future, we suggest frameworks such as that of the 'Whole Teacher' could be extended to the university setting. We investigate four years of student feedback pertaining to a first year undergraduate mathematics unit, contending that the teaching initiatives introduced over time have helped students develop a positive attitude toward mathematics. We note, however, that the student-teacher relationship was still the most prominent factor directly identified by students who previously had a fear or negative attitude toward mathematics.

“Tough, loyal, reputable”: D/discourses and subcultures in police vocational training

Warrior, Tough-love family, and Perfect self were identified as prevailing D/discourses (i.e., words, tools, beliefs, thinking styles) in police vocational training (i.e., vocational knowledge and skills to fulfil police operations). This paper provides an overview of research into the ‘discourse-practice’ (Cherryholmes 1988, p.34) framework of policing in a police vocational training environment with recruits. The research distinguished the dominant subcultures and prevailing D/discourses, and analysed the impact of these on individuals’ identity, subjectivity, agency, learning and membership within the policing community.