The impact of a model of nurse education to improve knowledge and recognition of delirium in older persons by registered nurses

Introduction: Delirium is a serious issue associated with high morbidity and mortality in older hospitalised people. Early recognition enables diagnosis and treatment of underlying cause/s, which can lead to improved patient outcomes. However, research shows knowledge and accurate nurse recognition of delirium and is poor and lack of education appears to be a key issue related to this problem. Thus, the purpose of this randomised controlled trial (RCT) was to evaluate, in a sample of registered nurses, the usability and effectiveness of a web-based learning site, designed using constructivist learning principles, to improve acute care nurse knowledge and recognition of delirium. Prior to undertaking the RCT preliminary phases involving; validation of vignettes, video-taping five of the validated vignettes, website development and pilot testing were completed. Methods: The cluster RCT involved consenting registered nurse participants (N = 175) from twelve clinical areas within three acute health care facilities in Queensland, Australia. Data were collected through a variety of measures and instruments. Primary outcomes were improved ability of nurses to recognise delirium using written validated vignettes and improved knowledge of delirium using a delirium knowledge questionnaire. The secondary outcomes were aimed at determining nurse satisfaction and usability of the website. Primary outcome measures were taken at baseline (T1), directly after the intervention (T2) and two months later (T3). The secondary outcomes were measured at T2 by participants in the intervention group. Following baseline data collection remaining participants were assigned to either the intervention (n=75) or control (n=72) group. Participants in the intervention group were given access to the learning intervention while the control group continued to work in their clinical area and at that time, did not receive access to the learning intervention. Data from the primary outcome measures were examined in mixed model analyses. Results: Overall, the effect of the online learning intervention over time comparing the intervention group and the control group were positive. The intervention groups‘ scores were higher and the change over time results were statistically significant [T3 and T1 (t=3.78 p=<0.001) and T2 and T1 baseline (t=5.83 p=<0.001)]. Statistically significant improvements were also seen for delirium recognition when comparing T2 and T1 results (t=2.58 p=0.012) between the control and intervention group but not for changes in delirium recognition scores between the two groups from T3 and T1 (t=1.80 p=0.074). The majority of the participants rated the website highly on the visual, functional and content elements. Additionally, nearly 80% of the participants liked the overall website features and there were self-reported improvements in delirium knowledge and recognition by the registered nurses in the intervention group. Discussion: Findings from this study support the concept that online learning is an effective and satisfying method of information delivery. Embedded within a constructivist learning environment the site produced a high level of satisfaction and usability for the registered nurse end-users. Additionally, the results showed that the website significantly improved delirium knowledge & recognition scores and the improvement in delirium knowledge was retained at a two month follow-up. Given the strong effect of the intervention the online delirium intervention should be utilised as a way of providing information to registered nurses. It is envisaged that this knowledge would lead to improved recognition of delirium as well as improvement in patient outcomes however; translation of this knowledge attainment into clinical practice was outside the scope of this study. A critical next step is demonstrating the effect of the intervention in changing clinical behaviour, and improving patient health outcomes.

Productivity and time use during occupational therapy and nutrition/dietetics clinical education : a cohort study

Background: Currently in the Australian higher education sector higher productivity from allied health clinical education placements are a contested issue. This paper will report results of a study that investigated output changes associated with occupational therapy and nutrition/dietetics clinical education placements in Queensland, Australia. Supervisors’ and students’ time use during placements and how this changes for supervisors compared to when students are not present in the workplace is also presented. Methodology/Principal Findings: A cohort design was used with students from four Queensland universities, and their supervisors employed by Queensland Health. There was an increasing trend in the number of occasions of service delivered when the students were present, and a statistically significant increase in the daily mean length of occasions of service delivered during the placement compared to pre-placement levels. For project-based placements that were not directly involved in patient care, supervisors’ project activity time decreased during placements, with students undertaking considerably more time in project activities. Conclusions/Significance: A novel method for estimating productivity and time use changes during clinical education programs for allied health disciplines has been applied. During clinical education placements there was a net increase in outputs, suggesting supervisors engage in longer consultations with patients for the purpose of training students, while maintaining patient numbers. Other activities are reduced. This paper is the first time these data have been shown and form a good basis for future assessments of the economic impact of student placements for allied health disciplines.

Is mental health education really needed?

Dietitians play a key role in supporting and advocating for the physical health care of mental health (MH) consumers, with 68-80% seeing clients with associated depression issues in Australia. The DAA Mental Health Curricula Project found dietetic training in MH was inadequate and recommended increased MH education. A MH resource package was developed and sent to universities in 2010 for incorporation into teaching. The aim of this study was to assess dietetic students’ baseline MH knowledge, attitudes and exposure prior to dietetics coursework and package implementation. An online survey measured dietetic students’ mental health knowledge (MHK), attitudes towards mental illness (MHA) and previous exposure to mental illness. MHK was assessed by sixteen dietetics-specific questions. MHA were measured by Day’s Mental Illness Stigma Scale. Exposure was assessed using an adapted version of Eack’s Social Work Students’ Experiences with Schizophrenia questions. Fifty-nine dietetic students (30% response rate) from two universities were surveyed at the beginning of dietetic coursework. Survey responses revealed students had low MHK (mean 5.48, scale 0-16) with no significant difference between cohorts (p=0.67). Half of respondents (n=31) recorded never or rarely being in contact with people with mental illness. 82% of respondents (n=48) reported having no or little experience with mental illness. Data suggests low levels of sitgmatising attitudes about people with mental illness. Given the high prevalence of clients with MH issues in everyday dietetic practice, this study is a first step in addressing integration of MH education into dietetics training.

Educational accountability tests, social and legal inclusion approaches to discrimination for students with disability : a national case study from Australia

The UN Convention on the Rights of Persons with Disability (CRPD) promotes equal and full participation by children in education. Equity of educational access for all students, including students with disability, free from discrimination, is the first stated national goal of Australian education (MCEETYA 2008). Australian federal disability discrimination law, the Disability Discrimination Act 1992 (DDA), follows the Convention, with the federal Disability Standards for Education 2005 (DSE) enacting specific requirements for education. This article discusses equity of processes for inclusion of students with disability in Australian educational accountability testing, including international tests in which many countries participate. The conclusion drawn is that equitable inclusion of students with disability in current Australian educational accountability testing in not occurring from a social perspective and is not in principle compliant with law. However, given the reluctance of courts to intervene in education matters and the uncertainty of an outcome in any court consideration, the discussion shows that equitable inclusion in accountability systems is available through policy change rather than expensive, and possibly unsuccessful, legal challenges.

Reasonable adjustments in assessment : putting law and policy into practice in Australia

The Australian Disability Standards for Education 2005 (Cth) require education providers to make reasonable adjustments in educational assessment so that students with disability can participate on the same basis as other students and be able to demonstrate what they know and can do. Reasonableness is governed by a determination of the balance of interests, benefits and detriment to the parties involved. The Standards require providers to consult with students and associates on adjustments, although guidance on how consultation should occur and how the views of students and associates are to be taken into account is vague. In this article, we identify three principles to be considered in order to put appropriate and effective reasonable adjustments in assessment into practice. While Australian law and assessment contexts are used to examine intentions, expectations and practices in educational assessment for students with disability, we argue that these three principles must be considered in any national education system to ensure equitable assessment practices and achieve equitable educational inclusion for students with disability.

Intercultural competence in engineering education : who are we teaching?

BACKGROUND There is little doubt that our engineering graduates’ ability to identify cultural differences and their potential to impact on engineering projects, and to work effectively with these differences is of key importance in the modern engineering practice. Within engineering degree programs themselves there is also a significant need to recognise the impact of changing student and staff profiles on what happens in the classroom. The research described in this paper forms part of a larger project exploring issues of intercultural competence in engineering. PURPOSE This paper presents an observational and survey study of undergraduate and postgraduate engineering students from four institutions working in groups on tasks with a purely technical focus, or with a cultural and humanitarian element. The study sought to explore how students rate their own intercultural competence and team process and whether any differences exist depending on the nature of the task they are working on. We also investigated whether any differences were evident between groups of first year, second year and postgraduate students. DESIGN/METHOD The study used the miniCQS instrument (Ang & Van Dyne, 2008) and a Bales Interaction Process Analysis based scale (Bales, 1950; Carney, 1976) to collect students self ratings of group process, task management, and cultural experience and behaviour. The Bales IPA was also used for coding video observations of students working in groups. Survey data were used to form descriptive variables to compare outcomes across the different tasks and contexts. Observations analysed in Nvivo were used to provide commentary and additional detail on the quantitative data. RESULTS The results of the survey indicated consistent mean scores on each survey item for each group of students, despite vastly different tasks, student backgrounds and educational contexts. Some small, statistically significant mean differences existed, offering some basic insights into how task and student group composition could affect self ratings. Overall though, the results suggest minimal shift in how students view group function and their intercultural experience, irrespective of differing educational experience. CONCLUSIONS The survey results, contrasted with group observations, indicate that either students are not translating their experience (in the group tasks) into critical self assessment of their cultural competence and teamwork, or that they become more critical of team performance and cultural competence as their competence in these areas grows, so their ratings remain consistent. Both outcomes indicate that students need more intensive guidance to build their critical self and peer assessment skills in these areas irrespective of their year level of study.

Australia at the crossroads : a review of school science practical work

In Australia we are at a crossroad in science education. We have come from a long history of adopting international curricula, through to blending international and Australian developed materials, to the present which is a thoroughly unique Australian curriculum in science. This paper documents Australia’s journey over the past 200 years, as we prepare for the unveiling of our first truly Australian National Curriculum. One of the unique aspects of this curriculum is the emphasis on practical work and inquiry-based learning. This paper identifies seven forms of practical work currently used in Australian schools and the purposes aligned with each form by 138 pre-service and experienced in-service teachers. The paper explores the question “What does the impending national curriculum, with its emphasis on practical inquiry mean to the teachers now, are they ready?” The study suggests that practical work in Australian schools is multifaceted, and the teacher aligned purposes are dependent not only upon the age of the student, but also on the type of practical work being undertaken. It was found that most teachers are not ready to teach using inquiry-based pedagogy and cite lack of content knowledge, behaviour management, and lack of physical resources and availability of classroom space as key issues which will hinder their implementation of the inquiry component of Australia’s pending curriculum in science.

The relationship between entertainment producers and higher education providers

Cameron, Verhoeven and Court have noted that many screen producers do not see their tertiary education as being beneficial to their careers. We hypothesise that Universities have traditionally not trained students in producing skills because of the division of labour between Faculties of Art and Faculties of Business; and because their focus on art rather than entertainment has downplayed the importance of producing. This article presents a SOTL (Scholarship of Teaching and Learning) whole-of-program evaluation of a new cross-Faculty Bachelor of Entertainment Industries at QUT, devoted to providing students with graduate attributes for producing including creative skills (understanding story, the aesthetics of entertainment, etc), business skills (business models, finance, marketing, etc) and legal skills (contracts, copyright, etc). Stakeholder evaluations suggest that entertainment producers are highly supportive of this new course.

The creative citizen : understanding the value of design education programs in the knowledge economy

The knowledge economy relies on the diffusion and use of knowledge as well as its creation (Houghton and Sheenan, 2000). The future success of economic activity will depend on the capacity of organisations to transform by increasing their flexibility. In particular, this transformation is dependant on a decentralised, networked and multi-skilled workforce. To help organisations transition, new strategies and structures for education are required. Education systems need to concentrate less on specialist skills and more on the development of people with broad-based problem solving skills that are adaptable, with social and inter-personal communication skills necessary for networking and communication. This paper presents the findings of a ‘Knowledge Economy Market Development Mapping Study’ conducted to identify the value of design education programs from primary through to tertiary level in Queensland, Australia. The relationship of these programs to the development of the capacities mentioned above is explored. The study includes the collection of qualitative and quantitative data consisting of a literature review, focus groups and survey. Recommendations for the future development of design education programs in Queensland, Australia are proposed, and future research opportunities are presented and discussed.

Thinking about Australia and its location in the modern world in the Australian Curriculum : history

The first national history curriculum is being implemented in Australia from 2013. As with the curriculums of other nations, this curriculum has evolved in response to a range of factors and its merits continue to be debated. In critiquing the sort of history education approach encapsulated in the new curriculum, I discuss some of the contextual factors and debates that have shaped the Australian Curriculum: History v0.3 (ACARA, 2012). In doing so, I also explore some of the recent international literature on how students think and learn about history in the classroom. In the third and final part of the paper, I raise some logistical issues and also question how students might engage with the notion of Australia as a nation in the modern world rapidly reshaped by the transformations occurring in Asia and share some concerns about the curriculum’s ‘world history approach’ for Year 10.

Re-imagining STEM : peer scaffolding ICT in initial teacher education

In this paper, we report on how peer scaffolding was used to effect change in tertiary teaching practice and academic disposition in the use of Information and Communication Technology (ICT) in Science teaching and learning. We present a small-scale case study investigating the practice of one of this paper’s authors. It is told through two salient episodes which narratively describe the scaffolding used to support a teaching experiment. This was made possible through the national Teaching Teachers for the Future Project (2011-2012) which aimed to enhance the technological pedagogical capability of pre-service teachers across Australia. The outcome was a demonstrable shift in the academic’s disposition towards the use and benefits of ICT in teaching science and an increase in skills and confidence for both the academic and his students. This study and its outcomes fit within the contemporary push to “re-imagine” the teaching of Science, and more broadly of STEM, in schools.

Re-imagining STEM : peer scaffolding ICT in Initial Teacher Education

In this paper, we report on how peer scaffolding was used to effect change in tertiary teaching practice and academic disposition in the use of Information and Communication Technology (ICT) in Science teaching and learning. We present a small-scale case study investigating the practice of one of this paper’s authors. It is told through two salient episodes which narratively describe the scaffolding used to support a teaching experiment. This was made possible through the national Teaching Teachers for the Future Project (2011-2012) which aimed to enhance the technological pedagogical capability of pre-service teachers across Australia. The outcome was a demonstrable shift in the academic’s disposition towards the use and benefits of ICT in teaching science and an increase in skills and confidence for both the academic and his students. This study and its outcomes fit within the contemporary push to “re-imagine” the teaching of Science, and more broadly of STEM, in schools.

A sociological quantitative study about Chineseness and Chinese heritage language for young Chinese Australian adults in urban Australia

The relationship between Heritage Language and ethnic identity has gained significant research ground in North America. However, there is a dearth of similar research conducted in other regions of the world. There seems to be little if any work investigating the link between Chinese Australians’ ethnic identity and their Chinese Heritage Language. This sociological quantitative study interpreted Chinese Australians’ “Chineseness” as their ethnic identity, linked this “Chineseness” to their Chinese Heritage Language, and did so by virtue of Bourdieu’s key concept ‘habitus’. 227 cases were analyzed by Structural Equation Modelling. The result demonstrated a statistically significant strong positive relationship between Chinese Australian urban young adults’ “Chineseness” and their self-perceptions of their Chinese Heritage Language proficiency (r=.73). This paper explained the findings in light of Bourdieu’s (1991) contention that people make choices about languages according to the habitus they have.

Changing learning to improve practice : hand hygiene education in Queensland medical schools

The aim of Queensland Health’s ‘Clean hands are life savers’ program is to change the culture and behaviour of healthcare workers related to hand hygiene. Hand hygiene is considered to be the most effective means of preventing pathogen cross-transmission and healthcare-associated infections. Most hospitals throughout Queensland as well as Australia now manage a hand hygiene program to increase the hand hygiene compliance of all healthcare workers. Reports taken from routine hand hygiene observations reveal that doctors are usually less compliant in their hand-washing practices than other healthcare worker groups. The Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP) has attempted to have an impact on this challenging group through their Medical Leadership Initiative. With education as a core component of the program, efforts were made to ensure our future doctors were receiving information that aligned with Queensland Health standards during their formative years at medical school. CHRISP met with university instructors to understand what infection prevention education was currently included in the curriculum and support the introduction of new learning activities that specifically focused on hand hygiene. This prompted change to the existing curriculum and a range of interventions were employed with mixed success. Although met with challenges, methods to integrate more infection prevention teaching were found.