Using ‘think aloud’ as a strategy for learning clinical reasoning in high fidelity case-based simulation for undergraduate nursing students

AIMS This paper reports on the implementation of a research project that trials an educational strategy implemented over six months of an undergraduate third year nursing curriculum. This project aims to explore the effectiveness of ‘think aloud’ as a strategy for learning clinical reasoning for students in simulated clinical settings. BACKGROUND Nurses are required to apply and utilise critical thinking skills to enable clinical reasoning and problem solving in the clinical setting [1]. Nursing students are expected to develop and display clinical reasoning skills in practice, but may struggle articulating reasons behind decisions about patient care. For students learning to manage complex clinical situations, teaching approaches are required that make these instinctive cognitive processes explicit and clear [2-5]. In line with professional expectations, nursing students in third year at Queensland University of Technology (QUT) are expected to display clinical reasoning skills in practice. This can be a complex proposition for students in practice situations, particularly as the degree of uncertainty or decision complexity increases [6-7]. The ‘think aloud’ approach is an innovative learning/teaching method which can create an environment suitable for developing clinical reasoning skills in students [4, 8]. This project aims to use the ‘think aloud’ strategy within a simulation context to provide a safe learning environment in which third year students are assisted to uncover cognitive approaches that best assist them to make effective patient care decisions, and improve their confidence, clinical reasoning and active critical reflection on their practice. MEHODS In semester 2 2011 at QUT, third year nursing students will undertake high fidelity simulation, some for the first time commencing in September of 2011. There will be two cohorts for strategy implementation (group 1= use think aloud as a strategy within the simulation, group 2= not given a specific strategy outside of nursing assessment frameworks) in relation to problem solving patient needs. Students will be briefed about the scenario, given a nursing handover, placed into a simulation group and an observer group, and the facilitator/teacher will run the simulation from a control room, and not have contact (as a ‘teacher’) with students during the simulation. Then debriefing will occur as a whole group outside of the simulation room where the session can be reviewed on screen. The think aloud strategy will be described to students in their pre-simulation briefing and allow for clarification of this strategy at this time. All other aspects of the simulations remain the same, (resources, suggested nursing assessment frameworks, simulation session duration, size of simulation teams, preparatory materials). RESULTS Methodology of the project and the challenges of implementation will be the focus of this presentation. This will include ethical considerations in designing the project, recruitment of students and implementation of a voluntary research project within a busy educational curriculum which in third year targets 669 students over two campuses. CONCLUSIONS In an environment of increasingly constrained clinical placement opportunities, exploration of alternate strategies to improve critical thinking skills and develop clinical reasoning and problem solving for nursing students is imperative in preparing nurses to respond to changing patient needs. References 1. Lasater, K., High-fidelity simulation and the development of clinical judgement: students' experiences. Journal of Nursing Education, 2007. 46(6): p. 269-276. 2. Lapkin, S., et al., Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clinical Simulation in Nursing, 2010. 6(6): p. e207-22. 3. Kaddoura, M.P.C.M.S.N.R.N., New Graduate Nurses' Perceptions of the Effects of Clinical Simulation on Their Critical Thinking, Learning, and Confidence. The Journal of Continuing Education in Nursing, 2010. 41(11): p. 506. 4. Banning, M., The think aloud approach as an educational tool to develop and assess clinical reasoning in undergraduate students. Nurse Education Today, 2008. 28: p. 8-14. 5. Porter-O'Grady, T., Profound change:21st century nursing. Nursing Outlook, 2001. 49(4): p. 182-186. 6. Andersson, A.K., M. Omberg, and M. Svedlund, Triage in the emergency department-a qualitative study of the factors which nurses consider when making decisions. Nursing in Critical Care, 2006. 11(3): p. 136-145. 7. O'Neill, E.S., N.M. Dluhy, and C. Chin, Modelling novice clinical reasoning for a computerized decision support system. Journal of Advanced Nursing, 2005. 49(1): p. 68-77. 8. Lee, J.E. and N. Ryan-Wenger, The "Think Aloud" seminar for teaching clinical reasoning: a case study of a child with pharyngitis. J Pediatr Health Care, 1997. 11(3): p. 101-10.

An innovative design and studio-based CS degree

The University of Queensland has recently established a new design-focused, studio-based computer science degree. The Bachelor of Information Environments degree augments the core courses from the University's standard CS degree with a stream of design courses and integrative studio-based projects undertaken every semester. The studio projects integrate and reinforce learning by requiring students to apply the knowledge and skills gained in other courses to open-ended real-world design projects. The studio model is based on the architectural studio and involves teamwork, collaborative learning, interactive problem solving, presentations and peer review. This paper describes the degree program, its curriculum and rationale, and reports on experiences in the first year of delivery.

Complex modelling in the primary/middle school years

The world’s increasing complexity, competitiveness, interconnectivity, and dependence on technology generate new challenges for nations and individuals that cannot be met by continuing education as usual (Katehi, Pearson, & Feder, 2009). With the proliferation of complex systems have come new technologies for communication, collaboration, and conceptualisation. These technologies have led to significant changes in the forms of mathematical and scientific thinking that are required beyond the classroom. Modelling, in its various forms, can develop and broaden children’s mathematical and scientific thinking beyond the standard curriculum. This paper first considers future competencies in the mathematical sciences within an increasingly complex world. Next, consideration is given to interdisciplinary problem solving and models and modelling. Examples of complex, interdisciplinary modelling activities across grades are presented, with data modelling in 1st grade, model-eliciting in 4th grade, and engineering-based modelling in 7th-9th grades.

Abduction : the writing of a historical novel

This is a practice-led project consisting of a historical novel Abduction and related exegesis. The novel is a third person intimate narrative set in the mid-nineteenth century and is based on actual events and persons caught up in, or furthering, the mass dispossession of small farmers in Scotland known as the ‘Clearances’. The narrative focuses on the situation in the Outer Hebrides and northern Scotland. It is based on documented facts leading up to a controversial trial in 1850 that arose because a twenty year old woman of the period (the central protagonist, Jess Mackenzie) eloped with a young farmer to escape her parent’s pressure to marry a rival suitor, himself a powerful lawyer and ‘factor’ at the centre of many of the Clearances. The young woman’s independent ideas were ahead of her time, and the decisions she made under great pressure were crucial in some dramatic events that unfolded in Scotland and later in the colony of Victoria, to which she and her new husband emigrated soon after the trial. The exegesis is composed of two unequal parts. It briefly considers the development of the literary historical fiction genre in the nineteenth century with Walter Scott in particular, a genre found useful in representing women’s issues of the Victorian era by Victorian and contemporary authors. The exegesis also briefly considers the appropriateness of the fiction genre (as opposed to creative nonfiction) in creating the lived experience in a fact-based work. The major part of the exegesis is a detailed, reflective analysis of the problem-solving process involved in writing the novel, structured by reference to Kate Grenville’s Searching for the Secret River – a work of metawriting that explains her creative process in researching and writing historical fiction based on fact.

goDesign travelling design workshop program for regional secondary students

goDesign Travelling Workshop Program for Regional Secondary Students was an initiative of Queensland University of Technology (QUT) and the Design Institute of Australia (DIA) Queensland Branch, which aligned with the DIA unleashed: Queensland design on tour 2010 Exhibition. It was designed be delivered by university design academics in state secondary schools in Chinchilla, Mt Isa, Quilpie, Emerald, Gladstone and Bundaberg between February and September 2010, to approximately 95 secondary students and 24 teachers from the subject areas of visual art, graphics and industrial technology and design. A talk by a visiting design practitioner whose work was displayed in the exhibition, also features in the final day of the program in each town, and student work from the workshop was displayed in the exhibition alongside the professional design work. The three-day workshop is a design immersion program for regional Queensland Secondary Schools, which responds to specific actions outlined in the Queensland Government Design Strategy 2020 to ‘Build Design Knowledge and Learning’ and ‘Foster a Design Culture’. Underpinned by a place-based approach and the integration of Dr Charles Burnette’s IDESIGN teaching model, the program gives students and teachers the opportunity to explore, analyse and reimagine their local town through a series of scaffolded problem solving activities around the theme of ‘place’. The program allows students to gain hands-on experience designing graphics, products, interior spaces and architecture to assist their local community, with the support of design professionals. Students work individually and in groups on real design problems learning sketching, making, communication, presentation and collaboration skills to improve their design process, while considering social, cultural and environmental opportunities. The program was designed to facilitate an understanding of the value of design thinking and its importance to regional communities, to give students more information about various design disciplines as career options, and provide a professional development opportunity for teachers. Advisory assistance for the program was gained through Kelvin Grove State College, Queensland Studies Authority and QMI/Manufacturing Skills Queensland Manager, Manufacturing & Engineering Gateway Schools Project.

Multiple perspectives of design thinking in business education

Business education leaders have expressed interest in learning more about design and design thinking and their contributions to better problem framing, problem solving and to generating new solutions. Many business schools have engaged in educational programs with students from multiple disciplines, applying design thinking to business problems around workplace issues. This paper investigates a range of educational programs that teach design thinking to students in business education, at undergraduate and postgraduate levels around the world. We identify four patterns of program delivery that are emerging: human-centered design, integrative thinking, design management and design as strategy and discuss contributions from each. We expect that these four patterns of program delivery will continue and predict an increasing focus on programs around design as strategy in the near future.

A rebirth of physical activity in parents : applying a theory-based approach

Physical inactivity is a serious concern both nationally and internationally. Despite the numerous benefits of performing regular physical activity, many individuals lead sedentary lifestyles. Of concern, though, is research showing that some population sub-groups are less likely to be active, such as parents of young children. Although there is a vast amount of research dedicated to understanding people.s physical activity-related behaviours, there is a paucity of research examining those factors that influence parental physical activity. More importantly, research applying theoretical models to understand physical activity decision-making among this at-risk population is limited. Given the current obesity epidemic, the decline in physical activity with parenthood, and the many social and health benefits associated with regular physical activity, it is important that adults with young children are sufficiently active. In light of the dearth of research examining parental physical activity and the scant research applying a theory-based approach to gain this understanding, the overarching aim of the current program of research was to adopt a mixed methods approach as well as use sound theoretical frameworks to understand the regular physical activity behaviour of mothers and fathers with young children. This program of research comprised of three distinct stages: a qualitative stage exploring individual, social, and psychological factors that influence parental regular physical activity (Stage 1); a quantitative stage identifying the important predictors of parental regular physical activity intentions and behaviour using sound theoretical frameworks and testing a single-item measure for assessing parental physical activity behaviour (Stage 2); and a qualitative stage exploring strategies for an intervention program aimed at increasing parental regular physical activity (Stage 3). As a thesis by publication, eight papers report the findings of this program of research; these papers are presented according to the distinct stages of investigation that guided this program of research. Stage One of the research program comprised a qualitative investigation using a focus group/interview methodology with parents of children younger than 5 years of age (N = 40; n = 21 mothers, n = 19 fathers) (Papers 1, 2, and 3). Drawing broadly on a social constructionist approach (Paper 1), thematic analytic methods revealed parents. understandings of physical activity (e.g., requires effort), patterns of physical activity-related behaviours (e.g., grab it when you can, declining physical activity habits), and how constructions of social role expectations might influence parents. physical activity decision making (e.g., creating an active family culture, guilt and selfishness). Drawing on the belief-based framework of the TPB (Paper 2), thematic content analytic methods revealed parents. commonly held beliefs about the advantages (e.g., improves parenting practices), disadvantages (e.g., interferes with commitments), barriers (e.g., time), and facilitators (e.g., social support) to performing regular physical activity. Parents. normative beliefs about social approval from important others or groups (e.g., spouse/partner) were also identified. Guided by theories of social support, Paper Three identified parents. perceptions about the specific social support dimensions that influence their physical activity decision making. Thematic content analysis identified instrumental (e.g., providing childcare, taking over chores), emotional (e.g., encouragement, companionship), and informational support (e.g., ideas and advice) as being important to the decision-making of parents in relation to their regular physical activity behaviour. The results revealed also that having support for being active is not straightforward (e.g., guilt-related issues inhibited the facilitative nature of social support for physical activity). Stage Two of the research program comprised a quantitative examination of parents. physical activity intentions and behaviour (Papers 4, 5, 6, and 7). Parents completed an extended TPB questionnaire at Time 1 (N = 580; n = 288 mothers, n = 292 fathers) and self-reported their physical activity at Time 2, 1 week later (N = 458; n = 252 mothers, n = 206 fathers). Paper Four revealed key behavioural (e.g., improving parenting practices), normative (e.g., people I exercise with), and control (e.g., lack of time) beliefs as significant independent predictors of parental physical activity. A test of the TPB augmented to include the constructs of self-determined motivation and planning was assessed in Paper Five. The findings revealed that the effect of self-determined motivation on intention was fully mediated by the TPB variables and the impact of intention on behaviour was partially mediated by the planning variables. Slight differences in the model.s motivational sequence between the sexes were also noted. Paper Six investigated, within a TPB framework, a range of social influences on parents. intentions to be active. For both sexes, attitude, perceived behavioural control, group norms, friend general support, and an active parent identity predicted intentions, with subjective norms and family support further predicting mothers. intentions and descriptive norms further predicting fathers. intentions. Finally, the measurement of parental physical activity was investigated in Paper Seven of Stage Two. The results showed that parents are at risk of low levels of physical activity, with the findings also revealing validation support for a brief single-item physical activity measure. Stage Three of the research program comprised a qualitative examination of parents. (N = 12; n = 6 mothers, n = 6 fathers) ideas for strategies that may be useful for developing and delivering an intervention program aimed at increasing parental physical activity (Paper 8). Parents revealed a range of strategies for what to include in a physical activity intervention designed for parents of young children. For example, parents identified persuasion and information type messages, problem-solving strategies that engage parents in generating a priority list of their lifestyle commitments, and behavioural modification techniques such as goal setting and incentives. Social intervention strategies (e.g., social comparison, counselling) and environmental approaches (e.g., community-based integrative parent/child programs) were also identified as was a skill-based strategy in helping parents generate a flexible life/family plan. Additionally, a range of strategies for how to best deliver a parental physical activity intervention was discussed. Taken as a whole, Paper Eight found that adopting a multifaceted approach in both the design and implementation of a resultant physical activity intervention may be useful in helping to increase parental physical activity. Overall, this program of research found support for parents as a unique group who hold both similar and distinctive perceptions about regular physical activity to the general adult population. Thus, these findings highlight the importance of targeting intervention strategies for parents of young children. Additionally, the findings suggest that it might also be useful to tailor some messages specifically to each sex. Effective promotion of physical activity in parents of young children is essential given the low rate of activity in this population. Results from this program of research highlight parents as an at-risk group for inactivity and provide an important first step in identifying the factors that influence both mothers. and fathers. physical activity decision making. These findings, in turn, provide a foundation on which to build effective intervention programs aimed at increasing parents. regular physical activity which is essential for ensuring the health and well-being of parents with young children.

Early childhood education

Young children are the most vulnerable and most at risk of environmental challenges, current and future. Yet, early learning around environment and sustainability issues and topics has been neglected and underrated in early childhood education even though there is an expanding body of research literature – from economics, neuroscience, sociology and health – that shows that early investments in human capital offer substantial returns for individuals and for communities and have a long reach into the future. Early childhood education for sustainability (ECEfS) - a synthesis of early childhood education (ECE) and education for sustainability (EfS) - builds on groundings in play, outdoor learning and nature education, but takes a stronger focus on learning about, and engagement with, environmental and sustainability issues. Child participation and agency is central to ECEfS and can relate, for example, to local environmental problem-solving such as water and energy conservation or waste reduction in a childcare centre, kindergarten or preschool, or young children’s social learning for Indigenous Reconciliation and cultural inclusivity. While the ECE field has been much slower than other educational sectors in taking up the challenges of sustainability, this situation is rapidly changing as early childhood practitioners begin to engage – it is fast moving from the margins of early childhood curriculum and pedagogic decision-making into the mainstream. This presents challenges, however, as ECEfS is somewhat misunderstood and misrepresented and, as a new field, is under-researched and under-theorised.

Data modelling with first-grade students

This paper argues for a renewed focus on statistical reasoning in the beginning school years, with opportunities for children to engage in data modelling. Results are reported from the first year of a 3-year longitudinal study in which three classes of first-grade children (6-year-olds) and their teachers engaged in data modelling activities. The theme of Looking after our Environment, part of the children’s science curriculum, provided the task context. The goals for the two activities addressed here included engaging children in core components of data modelling, namely, selecting attributes, structuring and representing data, identifying variation in data, and making predictions from given data. Results include the various ways in which children represented and re represented collected data, including attribute selection, and the metarepresentational competence they displayed in doing so. The “data lenses” through which the children dealt with informal inference (variation and prediction) are also reported.

The nature of juristic paradigms : exploring the theoretical and conceptual relationship between adversarialism and therapeutic jurisprudence

Problem solving courts appear to achieve outcomes which are not common in mainstream courts. There are increasing calls for the adoption of more “therapeutic” and “problem solving” practices by mainstream judges in civil and criminal courts in a number of jurisdictions, most notably in the United States and Australia. Currently, a judge who sets out to exercise a significant therapeutic function is quite likely to be doing so in a specialist court or jurisdiction, outside the mainstream court system, and, arguably, from outside the adversarial paradigm itself. To some extent, his work is tolerated but marginalized. But do therapeutic and problem solving functions have the potential to define, rather than complement, the role of judicial officers? The basic question addressed in this paper is, therefore, whether the judicial role could evolve to be not just less adversarial, but fundamentally non-adversarial. In other words, could we see--or are we seeing--a paradigm shift not just in the colloquial, casual sense of the word, but in the strong, worldview changing sense meant by Thomas Kuhn?

Can creativity be taught? And why should it be?

CreativityMoneyLove has an important question at its core – ‘what does the education and skills system need to look like in order for people to lead fulfilled creative lives, and in order for the creative and cultural industries in the UK to thrive?’ It is a question that is currently being asked by politicians and policy makers in different ways, in respect to different sections of industry, as they search for levers to economic growth. The aim of this publication is to give creative practitioners, employers and key thinkers a platform to express their views. Creativity as a concept is not an isolated part of the education system. It has the potential to underpin the entire way we learn, in order to build more imaginative, innovative and thoughtful people who can prosper in a rapidly changing world. It is vital therefore that we ask those at the forefront of their fields how they think the system could and should be changing. We have asked people to consider education in the broadest sense, from the school curriculum to vocational training, from university teaching to informal learning. The opinions expressed here are not our own. Many are overtly political, controversial, inspirational, and contradictory. We wanted to capture those views here, at this particular moment in time, when some key decisions are being made about the future of education in the UK. As two agencies that are in a position to take some of the ideas forward, this is an important part of the process of our own strategic thinking for the future. For A New Direction and Creative & Cultural Skills, the content generated through CreativityMoneyLove will provide the stimulus for a range of conversations, interventions, projects and discussions with young people, policy makers, employers, educators and creative practitioners. The dialogue has started at www.creativitymoneylove.co.uk, where all the pieces are also published online, and the bank of opinion can be added to. Spread the word, and add your own article on the subject.

Some reflections about P2M : the place of the mirror

The purpose of this paper is to provide some insights about P2M, and more specifically, to develop some thoughts about Project Management seen as a Mirror, a place for reflection…, between the Mission of organisation and its actual creation of Values (with s: a source of value for people, organisations and society). This place is the realm of complexity, of interactions between multiple variables, each of them having a specific time horizon and occupying a specific place, playing a specific role. Before developing this paper I would like to borrow to my colleague and friend, Professor Ohara, the following, part of a paper going to be presented at IPMA World Congress, in New Delhi later this year in November 2005. “P2M is the Japanese version of project & program management, which is the first standard guide for education and certification developed in 2001. A specific finding of P2M is characterized by “mission driven management of projects” or a program which harness complexity of problem solving observed in the interface between technical system and business model.” (Ohara, 2005, IPMA Conference, New Delhi) “The term of “mission” is a key word in the field of corporate strategy, where it expresses raison d’être or “value of business”. It is more specifically used for expressing “the client needs” in terms of a strategic business unit. The concept of mission is deemed to be a useful tool to share essential content of value and needs in message for complex project.” (Ohara, 2005, IPMA Conference, New Delhi) “Mission is considered as a significant “metamodel representation” by several reasons. First, it represents multiple values for aspiration. The central objective of mission initiative is profiling of ideality in the future from reality, which all stakeholders are glad to accept and share. Second, it shall be within a stretch of efforts, and not beyond or outside of the realization. Though it looks like unique, it has to depict a solid foundation. The pragmatic sense of equilibrium between innovation and adaptation is required for the mission. Third, it shall imply a rough sketch for solution to critical issues for problems in reality.” (Ohara, 2005, IPMA Conference, New Delhi) “Project modeling” idea has been introduced in P2M program management. A package of three project models of “scheme”, “system” and “service” are given as a reference type program. (Ohara, 2005, IPMA Conference, New Delhi) If these quotes apply to P2M, they are fully congruent with the results of the research undertaken and the resulting meta-model & meta-method developed by the CIMAP, ESC Lille Research Centre in Project & Program Management, since the 80’s. The paper starts by questioning the common Project Management (PM) paradigm. Then discussing the concept of Project, it argues that an alternative epistemological position should be taken to capture Page 2 / 11 the very nature of the PM field. Based on this, a development about “the need of modelling to understand” is proposed grounded on two theoretical roots. This leads to the conclusion that, in order to enables this modelling, a standard approach is necessary, but should be understood under the perspective of the Theory of Convention in order to facilitate a situational and contextual application.

Australian Tax Analysis [8th Edition]

Now in its eighth edition, Australian Tax Analysis: Cases, Commentary, Commercial Applications and Questions has a proven track record as a high level work for students of taxation law written by a team of authors with many years of experience. Taking into account the fact that the volume of material needed to be processed by today’s taxation student can be overwhelming, the well-chosen extracts and thought-provoking commentary in Australian Tax Analysis, 8th edition, provide readers with the depth of knowledge, and reasoning and analytical skills that will be required of them as practitioners. As well as the carefully selected case extracts and the helpful commentary, each chapter is supplemented by engaging practice questions, involving problem-solving, commercial decision-making, legal analysis and quantitative application. All these elements combined make Australian Tax Analysis an invaluable aid to the understanding of a subject that can be both technical and complex.

Analysing and improving a recruitment process : a teaching case for developing business process improvement capabilities

The demand for Business Process Management (BPM) is rapidly rising and with that, the need for capable BPM professionals is also rising. Yet, only a very few structured BPM training/ education programs are available, across universities and professional trainers globally. The ‘lack of appropriate teaching resources’ has been identified as a critical issue for BPM educators in prior studies. Case-based teaching can be an effective means of educating future BPM professionals. A main reason is that cases create an authentic learning environment where the complexities and challenges of the ‘real world’ can be presented in a narrative enabling the students to develop crucial skills such as problem solving, analysis and creativity-within-constraints, and to apply the tools and techniques within a richer and real (or proxy to real) context. However, so far well documented BPM teaching cases are scarce. This article aims to contribute to address this gap by providing a comprehensive teaching case and teaching notes that facilitates the education of selected process improvement phases, namely identification, modelling, analysis, and improvement. The article is divided into three main parts: (i) Introductory teaching notes, (ii) The case narrative, and (iii) Student activities from the case and teaching notes.

Supporting the learning of rapid application development in a database environment

Intelligent Tutoring Systems (ITSs) are computer systems designed to provide individualised help to students, learning in a problem solving context. The difference between an ITS and a Computer Assisted Instruction (CAI) system is that an ITS has a Student Model which allows it to provide a better educational environment. The Student Model contains information on what the student knows, and does not know, about the domain being learnt, as well as other personal characteristics such as preferred learning style. This research has resulted in the design and development of a new ITS: Personal Access Tutor (PAT). PAT is an ITS that helps students to learn Rapid Application Development in a database environment. More specifically, PAT focuses on helping students to learn how to create forms and reports in Microsoft Access. To provide an augmented learning environment, PAT’s architecture is different to most other ITSs. Instead of having a simulation, PAT uses a widelyused database development environment (Microsoft Access). This enables the students to ask for help, while developing real applications using real database software. As part of this research, I designed and created the knowledge base required for PAT. This contains four models: the domain, student, tutoring and exercises models. The Instructional Expert I created for PAT provides individualised help to the students to help them correctly finish each exercise, and also proposes the next exercise that a student should work on. PAT was evaluated by students enrolled in the Databases subject at QUT, and by staff members involved in teaching the subject. The results of the evaluation were positive and are discussed in the thesis.