The development and evaluation of an innovative nursing practice model to improve undergraduate nursing students' competence in paediatric physical assessment

Introduction The purpose of this study was to develop, implement and evaluate the impact of an educational intervention, comprising an innovative model of clinical decisionmaking and educational delivery strategy for facilitating nursing students‘ learning and development of competence in paediatric physical assessment practices. Background of the study Nursing students have an undergraduate education that aims to produce graduates of a generalist nature who demonstrate entry level competence for providing nursing care in a variety of health settings. Consistent with population morbidity and health care roles, paediatric nursing concepts typically form a comparatively small part of undergraduate curricula and students‘ exposure to paediatric physical assessment concepts and principles are brief. However, the nursing shortage has changed traditional nursing employment patterns and new graduates form the majority of the recruitment pool for paediatric nursing speciality staff. Paediatric nursing is a popular career choice for graduates and anecdotal evidence suggests that nursing students who select a clinical placement in their final year intend to seek employment in paediatrics upon graduation. Although concepts of paediatric nursing are included within undergraduate curriculum, students‘ ability to develop the required habits of mind to practice in what is still regarded as a speciality area of practice is somewhat limited. One of the areas of practice where this particularly impacts is in paediatric nursing physical assessment. Physical assessment is a fundamental component of nursing practice and competence in this area of practice is central to nursing students‘ development of clinical capability for practice as a registered nurse. Timely recognition of physiologic deterioration of patients is a key outcome of nurses‘ competent use of physical assessment strategies, regardless of the practice context. In paediatric nursing contexts children‘s physical assessment practices must specifically accommodate the child‘s different physiological composition, function and pattern of clinical deterioration (Hockenberry & Barrera, 2007). Thus, to effectively manage physical assessment of patients within the paediatric practice setting nursing students need to integrate paediatric nursing theory into their practice. This requires significant information processing and it is in this process where students are frequently challenged. The provision of rules or models can guide practice and assist novice-level nurses to develop their capabilities (Benner, 1984; Benner, Hooper-Kyriakidis & Stannard, 1999). Nursing practice models are cognitive tools that represent simplified patterns of expert analysis employing concepts that suit the limited reasoning of the inexperienced, and can represent the =rules‘ referred to by Benner (1984). Without a practice model of physical assessment students are likely to be uncertain about how to proceed with data collection, the interpretation of paediatric clinical findings and the appraisal of findings. These circumstances can result in ad hoc and unreliable nursing physical assessment that forms a poor basis for nursing decisions. The educational intervention developed as part of this study sought to resolve this problem and support nursing students‘ development of competence in paediatric physical assessment. Methods This study utilised the Context Input Process Product (CIPP) Model by Stufflebeam (2004) as the theoretical framework that underpinned the research design and evaluation methodology. Each of the four elements in the CIPP model were utilised to guide discrete stages of this study. The Context element informed design of the clinical decision-making process, the Paediatric Nursing Physical Assessment model. The Input element was utilised in appraising relevant literature, identifying an appropriate instructional methodology to facilitate learning and educational intervention delivery to undergraduate nursing students, and development of program content (the CD-ROM kit). Study One employed the Process element and used expert panel approaches to review and refine instructional methods, identifying potential barriers to obtaining an effective evaluation outcome. The Product element guided design and implementation of Study Two, which was conducted in two phases. Phase One employed a quasiexperimental between-subjects methodology to evaluate the impact of the educational intervention on nursing students‘ clinical performance and selfappraisal of practices in paediatric physical assessment. Phase Two employed a thematic analysis and explored the experiences and perspectives of a sample subgroup of nursing students who used the PNPA CD-ROM kit as preparation for paediatric clinical placement. Results Results from the Process review in Study One indicated that the prototype CDROM kit containing the PNPA model met the predetermined benchmarks for face validity and the impact evaluation instrumentation had adequate content validity in comparison with predetermined benchmarks. In the first phase of Study Two the educational intervention did not result in statistically significant differences in measures of student performance or self-appraisal of practice. However, in Phase Two qualitative commentary from students, and from the expert panel who reviewed the prototype CD-ROM kit (Study One, Phase One), strongly endorsed the quality of the intervention and its potential for supporting learning. This raises questions regarding transfer of learning and it is likely that, within this study, several factors have influenced students‘ transfer of learning from the educational intervention to the clinical practice environment, where outcomes were measured. Conclusion In summary, the educational intervention employed in this study provides insights into the potential e-learning approaches offer for delivering authentic learning experiences to undergraduate nursing students. Findings in this study raise important questions regarding possible pedagogical influences on learning outcomes, issues within the transfer of theory to practice and factors that may have influenced findings within the context of this study. This study makes a unique contribution to nursing education, specifically with respect to progressing an understanding of the challenges faced in employing instructive methods to impact upon nursing students‘ development of competence. The important contribution transfer of learning processes make to students‘ transition into the professional practice context and to their development of competence within the context of speciality practice is also highlighted. This study contributes to a greater awareness of the complexity of translating theoretical learning at undergraduate level into clinical practice, particularly within speciality contexts.

Object-centric process models and the design of flexible processes

Mainstream business process modelling techniques promote a design paradigm wherein the activities to be performed within a case, together with their usual execution order, form the backbone of a process model, on top of which other aspects are anchored. This paradigm, while eective in standardised and production-oriented domains, shows some limitations when confronted with processes where case-by-case variations and exceptions are the norm. In this thesis we develop the idea that the eective design of exible process models calls for an alternative modelling paradigm, one in which process models are modularised along key business objects, rather than along activity decompositions. The research follows a design science method, starting from the formulation of a research problem expressed in terms of requirements, and culminating in a set of artifacts that have been devised to satisfy these requirements. The main contributions of the thesis are: (i) a meta-model for object-centric process modelling incorporating constructs for capturing exible processes; (ii) a transformation from this meta-model to an existing activity-centric process modelling language, namely YAWL, showing the relation between object-centric and activity-centric process modelling approaches; and (iii) a Coloured Petri Net that captures the semantics of the proposed meta-model. The meta-model has been evaluated using a framework consisting of a set of work ow patterns. Moreover, the meta-model has been embodied in a modelling tool that has been used to capture two industrial scenarios.

Nutrients build-up and wash-off processes in urban land uses

This thesis describes outcomes of a research study conducted to investigate the nutrient build-up and wash-off processes on urban impervious surfaces. The data needed for the study was generated through a series of field investigations and laboratory test procedures. The study sites were selected in urbanised catchments to represent typical characteristics of residential, industrial and commercial land uses. The build-up and wash-off samples were collected from road surfaces in the selected study sites. A specially designed vacuum collection system and a rainfall simulator were used for sample collection. According to the data analysis, the solids build-up on road surfaces was significantly finer with more than 80% of the particles below 150 ìm for all the land uses. Nutrients were mostly associated with the particle size range below 150 ìm in both build-up and wash-off samples irrespective of type of land use. Therefore, the finer fraction of solids was the most important for the nutrient build-up and particulate nutrient wash-off processes. Consequently, the design of stormwater quality mitigation measures should target particles less than 150 ìm for the removal of nutrients irrespective of type of land use. Total kjeldahl nitrogen (TKN) was the most dominant form of nitrogen species in build-up on road surfaces. Phosphorus build-up on road surfaces was mainly in inorganic form and phosphate (PO4 3-) was the most dominant form. The nutrient wash-off process was found to be dependent on rainfall intensity and duration. Concentration of both total nitrogen and phosphorus was higher at the beginning of the rain event and decreased with the increase in rainfall duration. Consequently, in the design of stormwater quality mitigation strategies for nutrients removal, it is important to target the initial period of rain events. The variability of wash-off of nitrogen with rainfall intensity was significantly different to phosphorus wash-off. The concentration of nitrogen was higher in the wash-off for low intensity rain events compared to the wash-off for high intensity rain events. On the other hand, the concentration of phosphorus in the wash-off was high for high intensity rain events compared to low intensity rain events. Consequently, the nitrogen washoff can be defined as a source limiting process and phosphorus wash-off as a transport limiting process. This highlights the importance of taking into consideration the wash-off of low intensity rain events in the design of stormwater quality mitigation strategies targeting the nitrogen removal. All the nitrogen species in wash-off are primarily in dissolved form whereas phosphorus is in particulate form. The differences in the nitrogen and phosphorus wash-off processes is principally due to the degree of solubility, attachment to particulates, composition of total nitrogen and total phosphorus and the degree of adherence of the solids particles to the surface to which nutrients are attached. The particulate nitrogen available for wash-off is removed readily as these are mobilised as free solids particles on the surface. Phosphorus is washed-off mostly with the solids particles which are strongly adhered to the surface or as the fixed solids load. Investigation of the nitrogen wash-off process using bulk wash-off samples was in close agreement with the investigation of dissolved fraction of wash-off solids. This was primarily due to the predominant nature of dissolved nitrogen. However, the investigation of the processes which underpin phosphorus wash-off using bulk washoff samples could lead to loss of information. This is due to the composition of total phosphorus in wash-off solids and the inherent variability of the wash-off process for the different particle size ranges. This variability should preferably be taken into consideration as phosphorus wash-off is predominantly in particulate form. Therefore, care needs to be taken in the investigation of the phosphorus wash-off process using bulk wash-off samples to ensure that there is no loss of information and hence result in misleading outcomes. The investigation of different particle size ranges of wash-off solids is preferable in the interest of designing effective stormwater quality management strategies targeting phosphorus removal.

Patterns of engagement in workplace learning amongst employees from social sectors

Continuous learning and development has become increasingly important in the information age. However, employees with limited formal education in lower status occupations may be disadvantaged in their opportunities for development, as their jobs tend to require more limited knowledge and skills. In mature age, such workers may be subject to cumulative disadvantage with respect to work related learning and development, as well as negative stereotyping. This thesis concerns work related learning and development from a lifespan development psychology perspective. Development across the lifespan is grounded in biocultural co-constructivism. That is, the reciprocal influences of the individual and environment produce change in the individual. Existing theories and models of adaptive development attempt to explain how developmental resources are allocated across the lifespan. These included the Meta- theory of Selective Optimisation with Compensation, Dual Process Model of Self Regulation, and Developmental Regulation via Optimisation and Primary and Secondary Control. These models were integrated to create the Model of Adaptive Development for Work Related Learning. The Learning and Development Survey (LDS) was constructed to measure the hypothesised processes of adaptive development for work related learning, which were individual goal selection, individual goal engagement, individual goal disengagement, organisational opportunities (selection and engagement), and organisational constraints. Data collection was undertaken in two phases: the pilot study and the main study. The objective of the pilot study was to test the LDS on a target population of 112 employees from a local government organisation. Exploratory factor analysis reduced the pilot version of the survey to 38 items encompassing eight constructs which covered the processes of the model of adaptive development for work related learning. In the main study, the Revised Learning and Development Survey (R-LDS) was administered to another group of 137 employees from the local government organisation, as well as 110 employees from a private healthcare organisation. The purpose of the main study was to validate the R-LDS on two different groups to provide evidence of stability, and compare survey scores according to age and occupational status to determine construct validity. Findings from the main study indicated that only four constructs of the R-LDS were stable, which were organisational opportunities – selection, individual goal engagement, organisational constraints – disengagement and organisational opportunities – engagement. In addition, MANOVA studies revealed that the demographic variables affected organisational opportunities and constraints in the workplace, although individual goal engagement was not influenced by age. The findings from the pilot and main study partially supported the model of adaptive development for work related learning. Given that only four factors displayed adequate reliability in terms of internal consistency and stability, the findings suggest that individual goal selection and individual goal disengagement are less relevant to work related learning and development. Some recent research which emerged during the course of the current study has suggested that individual goal selection and individual goal disengagement are more relevant when goal achievement is impeded by biological constraints such as ageing. However, correlations between the retained factors support the model of adaptive development for work related learning, and represent the role of biocultural co-constructivism in development. Individual goal engagement was positively correlated with both opportunity factors (selection and engagement), while organisational constraints – disengagement was negatively correlated with organisational opportunities – selection. Demographic findings indicated that higher occupational status was associated with more opportunities for development. Age was associated with fewer opportunities or greater constraints for development, especially for lower status workers.

Accelerated computation of cyclic steady state for simulated-moving-bed processes

Industrial applications of the simulated-moving-bed (SMB) chromatographic technology have brought an emergent demand to improve the SMB process operation for higher efficiency and better robustness. Improved process modelling and more-efficient model computation will pave a path to meet this demand. However, the SMB unit operation exhibits complex dynamics, leading to challenges in SMB process modelling and model computation. One of the significant problems is how to quickly obtain the steady state of an SMB process model, as process metrics at the steady state are critical for process design and real-time control. The conventional computation method, which solves the process model cycle by cycle and takes the solution only when a cyclic steady state is reached after a certain number of switching, is computationally expensive. Adopting the concept of quasi-envelope (QE), this work treats the SMB operation as a pseudo-oscillatory process because of its large number of continuous switching. Then, an innovative QE computation scheme is developed to quickly obtain the steady state solution of an SMB model for any arbitrary initial condition. The QE computation scheme allows larger steps to be taken for predicting the slow change of the starting state within each switching. Incorporating with the wavelet-based technique, this scheme is demonstrated to be effective and efficient for an SMB sugar separation process. Moreover, investigations are also carried out on when the computation scheme should be activated and how the convergence of the scheme is affected by a variable stepsize.

In-session processes in online counselling with young people : an exploratory approach

Aims : The aim of this study was to conduct an exploratory investigation into the in-session processes and behaviours that occur between therapists and young people in online counseling. Method: The Consensual Qualitative Research method was employed to identify in-session behaviours and a coding instrument was developed to determine their frequency of use and assess whether nuances carried in the meaning of text messages have an influential effect during sessions. Eighty-five single-session transcripts were examined in total by two independent coders. Results: Sample statistics revealed that, on average, rapport-building processes were used more consistently across cases with both types of processes having a moderately strong positive effect on young people. However, closer examination of these processes revealed weaker positive effects for in-session behaviours that rely more heavily on verbal and non-verbal cues to be accurately interpreted. Implications for Practice and Future Research: These findings imply that therapists may focus more on building rapport than accomplishing tasks with young people during online counselling sessions due to the absence of verbal and non-verbal information when communicating via text messages.

Mathematical modelling in the early school years

In this article we explore young children's development of mathematical knowledge and reasoning processes as they worked two modelling problems (the Butter Beans Problem and the Airplane Problem). The problems involve authentic situations that need to be interpreted and described in mathematical ways. Both problems include tables of data, together with background information containing specific criteria to be considered in the solution process. Four classes of third-graders (8 years of age) and their teachers participated in the 6-month program, which included preparatory modelling activities along with professional development for the teachers. In discussing our findings we address: (a) Ways in which the children applied their informal, personal knowledge to the problems; (b) How the children interpreted the tables of data, including difficulties they experienced; (c) How the children operated on the data, including aggregating and comparing data, and looking for trends and patterns; (c) How the children developed important mathematical ideas; and (d) Ways in which the children represented their mathematical understandings.

Interdisciplinary modelling

This article examines one approach to promoting creative and flexible use of mathematical ideas within an interdisciplinary context in the primary curriculum, namely, through modelling. Three classes of fifth-grade children worked on a modelling problem, The First Fleet (Australia’s settlement), situated within the curriculum domains of science and studies of society and environment. Reported here are the cycles of development displayed by one group of children as they worked the problem, together with the range of models created across the classes. Children developed mathematisation processes that extended beyond their regular curriculum, including identifying and prioritising key problem elements, exploring relationships among elements, quantifying qualitative data, ranking and aggregating data, and creating and working with weighted scores. Aspects of Goldin’s (2000, 2007) affective structures also appeared to play an important role in the children's mathematical developments.

The 10% rule. Maximising learning through collaborative game design

This paper presents a retrospective view of a game design practice that recently switched from the development of complex learning games to the development of simple authoring tools for students to design their own learning games for each other. We introduce how our ‘10% Rule’, a premise that only 10% of what is learnt during a game design process is ultimately appreciated by the player, became a major contributor to the evolving practice. We use this rule primarily as an analytical and illustrative tool to discuss the learning involved in designing and playing learning games rather than as a scientifically and empirically proven rule. The 10% rule was promoted by our experience as designers and allows us to explore the often overlooked and valuable learning processes involved in designing learning games and mobile games in particular. This discussion highlights that in designing mobile learning games, students are not only reflecting on their own learning processes through setting up structures for others to enquire and investigate, they are also engaging in high-levels of independent inquiry and critical analysis in authentic learning settings. We conclude the paper with a discussion of the importance of these types of learning processes and skills of enquiry in 21st Century learning.

Milk : students building mobile learning games in everyday places

This paper explores how mobile games can transform everyday places into dynamic learning spaces filled with information and inspiration. It discusses the motivation inherent in playing games and creating games for others, and how this stimulates an iterative process of creation and reflection and evokes a natural desire to engage in learning. The use of MiLK at the Adelaide Botanic Gardens is offered as a case in point. MiLK is an authoring tool that allows students and teachers to create and share SMS games for mobile phones. A group of South Australian high school students used MiLK to play a game, create their own games and play each other’s games during a day at the gardens. This paper details the learning processes involved in these activities and how the students reflected on their learning, conducted peer assessment, and engaged in a two-way discussion with their teacher about new technologies and their implications for learning. The paper concludes with a discussion of the needs and requirements of 21st Century learners and how MiLK can support constructivist and connectivist teaching methods that engage learners and may produce an appropriately skilled future workforce.

How can we exploit mobile data to customise learning based on a student’s environmental surroundings?

User-Based intelligent systems are already commonplace in a student’s online digital life. Each time they browse, search, buy, join, comment, play, travel, upload, download, a system collects, analyses and processes data in an effort to customise content and further improve services. This panel session will explore how intelligent systems, particularly those that gather data from mobile devices, can offer new possibilities to assist in the delivery of customised, personal and engaging learning experiences. The value of intelligent systems for education lies in their ability to formulate authentic and complex learner profiles that bring together and systematically integrate a student’s personal world with a formal curriculum framework. As we well know, a mobile device can collect data relating to a student’s interests (gathered from search history, applications and communications), location, surroundings and proximity to others (GPS, Bluetooth). However, what has been less explored is the opportunity for a mobile device to map the movements and activities of a student from moment to moment and over time. This longitudinal data provides a holistic profile of a student, their state and surroundings. Analysing this data may allow us to identify patterns that reveal a student’s learning processes; when and where they work best and for how long. Through revealing a student’s state and surroundings outside of schools hour, this longitudinal data may also highlight opportunities to transform a student’s everyday world into an inventory for learning, punctuating their surroundings with learning recommendations. This would in turn lead to new ways to acknowledge and validate and foster informal learning, making it legitimate within a formal curriculum.

Adiabatic compression testing - part I : historical development and evaluation of fluid dynamic processes including shock-wave considerations

Adiabatic compression testing of components in gaseous oxygen is a test method that is utilized worldwide and is commonly required to qualify a component for ignition tolerance under its intended service. This testing is required by many industry standards organizations and government agencies. This paper traces the background of adiabatic compression testing in the oxygen community and discusses the thermodynamic and fluid dynamic processes that occur during rapid pressure surges. This paper is the first of several papers by the authors on the subject of adiabatic compression testing and is presented as a non-comprehensive background and introduction.

Idealistic quantum psychopathology : a way forward?

Quantum psychopathology holds the so called “quantum mind” hypothesis, which is controversial. In addition, this hypothesis focuses attention onto quantum processes in the brain, and how this may relate to psychopathological issues. This is very “low level”. As a consequence, it is challenging to form bridges to “higher level” problems related to psychopathology. By adopting the stance used in the quantum interaction community or researchers, this reply puts forward the idea that an idealistic approach may circumvent the controversy and opens the way for addressing challenges at higher levels of psychopathology.