Development and evaluation of an integrated clinical learning model to inform continuing education for acute care nurses

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Review of refugee mental health assessment: Best practices and recommendations

This article focuses on mental health assessment of refugees in clinical, educational and administrative-legal settings in order to synthesise research and practice designed to enhance and promote further development of culturally appropriate clinical assessment services during the refugee resettlement process. It specifically surveys research published over the last 25 years into the development, reliability measurement and validity testing of assessment instruments, which have been used with children, adolescents and adults from refugee backgrounds, prior to or following their arrival in a resettlement country, to determine whether the instruments meet established crosscultural standards of conceptual, functional, linguistic, technical and normative equivalence. The findings suggest that, although attempts have been made to develop internally reliable, appropriately normed tests for use with refugees from diverse cultural and linguistic backgrounds, matters of conceptual and linguistic equivalence and test–retest reliability are often overlooked. Implications of these oversights for underreporting refugees' mental health needs are considered. Efforts should also be directed towards development of culturally comparable, valid and reliable measures of refugee children's mental health and of refugee children's and adults' psychoeducational, neuropsychological and applied memory capabilities.

Children with special health care needs : social and learning competence in the early years

The number of children with special health care needs surviving infancy and attending school has been increasing. Due to their health status, these children may be at risk of low social-emotional and learning competencies (e.g., Lightfoot, Mukherjee, & Sloper, 2000; Zehnder, Landolt, Prchal, & Vollrath, 2006). Early social problems have been linked to low levels of academic achievement (Ladd, 2005), inappropriate behaviours at school (Shiu, 2001) and strained teacher-child relationships (Blumberg, Carle, O‘Connor, Moore, & Lippmann, 2008). Early learning difficulties have been associated with mental health problems (Maughan, Rowe, Loeber, & Stouthamer-Loeber, 2003), increased behaviour issues (Arnold, 1997), delinquency (Loeber & Dishion, 1983) and later academic failure (Epstein, 2008). Considering the importance of these areas, the limited research on special health care needs in social-emotional and learning domains is a factor driving this research. The purpose of the current research is to investigate social-emotional and learning competence in the early years for Australian children who have special health care needs. The data which informed this thesis was from Growing up in Australia: The Longitudinal Study of Australian Children. This is a national, longitudinal study being conducted by the Commonwealth Department of Families, Housing, Community Services and Indigenous Affairs. The study has a national representative sample, with data collection occurring biennially, in 2004 (Wave 1), 2006 (Wave 2) and 2008 (Wave 3). Growing up in Australia uses a cross-sequential research design involving two cohorts, an Infant Cohort (0-1 at recruitment) and a Kindergarten Cohort (4-5 at recruitment). This study uses the Kindergarten Cohort, for which there were 4,983 children at recruitment. Three studies were conducted to address the objectives of this thesis. Study 1 used Wave 1 data to identify and describe Australian children with special health care needs. Children who identified as having special health care needs through the special health care needs screener were selected. From this, descriptive analyses were run. The results indicate that boys, children with low birth weight and children from families with low levels of maternal education are likely to be in the population of children with special health care needs. Further, these children are likely to be using prescription medications, have poor general health and are likely to have specific condition diagnoses. Study 2 used Wave 1 data to examine differences between children with special health care needs and their peers in social-emotional competence and learning competence prior to school. Children identified by the special health care needs screener were chosen for the case group (n = 650). A matched case control group of peers (n = 650), matched on sex, cultural and linguistic diversity, family socioeconomic position and age, were the comparison group. Social-emotional competence was measured through Social/Emotional Domain scores taken from the Growing up in Australia Outcome Index, with learning competence measured through Learning Domain scores. Results suggest statistically significant differences in scores between the two groups. Children with special health care needs have lower levels of social-emotional and learning competence prior to school compared to their peers. Study 3 used Wave 1 and Wave 2 data to examine the relationship between special health care needs at Wave 1 and social-emotional competence and learning competence at Wave 2, as children started school. The sample for this study consisted of children in the Kindergarten Cohort who had teacher data at Wave 2. Results from multiple regression models indicate that special health care needs prior to school (Wave 1) significantly predicts social-emotional competence and learning competence in the early years of school (Wave 2). These results indicate that having special health care needs prior to school is a risk factor for the social-emotional and learning domains in the early years of school. The results from these studies give valuable insight into Australian children with special health care needs and their social-emotional and learning competence in the early years. The Australia population of children with special health care needs were primarily male children, from families with low maternal education, were likely to be of poor health and taking prescription medications. It was found that children with special health care needs were likely to have lower social-emotional competence and learning competence prior to school compared to their peers. Results indicate that special health care needs prior to school were predictive of lower social-emotional and learning competencies in the early years of school. More research is required into this unique population and their competencies over time. However, the current research provides valuable insight into an under researched 'at risk' population.

Book Review: "Rethinking Learning in Early Childhood Education" written by Nicola Yelland, Libby Lee, Maureen O’Rourke & Cathie Harrison

There is a growing body of work that responds to the impact of the rapid uptake of information and communication technology (ICT) on education (Buckingham, 2003; Cheung, 2003; Cuban, 2003; Leung, 2003; Prensky, 2005; Green & Hannon, 2007; Brooks-Gunn & Donahue, 2008; Lyman et al, 2008). Mostly, this work has been positioned in the context of upper-primary or secondary classrooms. More recently, there has been a growing call for research about the impact of ICT on the early years or in early childhood contexts. This text initiates a response to that call. The authors concur that today’s children are a generation who create, learn, work, play and communicate very differently from their parents and teachers (Buckingham, 2003), and that classroom activity needs to reflect this difference.

Supporting refugee students in schools : what constitutes inclusive education?

The worldwide rise in numbers of refugees and asylum seekers suggests the need to examine the practices of those institutions charged with their resettlement in host countries. In this paper we investigate the role of one important institution – schooling – and its contribution to the successful resettlement of refugee children. We begin with an examination of forced migration and its links with globalisation, and the barriers to inclusion confronting refugees. A discussion of the educational challenges confronting individual refugee youth and schools is followed by case studies of four schools and the approaches they had developed to meet the needs of young people from a refugee background. Using our findings and other research, we outline a model of good practice in refugee education. We conclude by discussing how educational institutions might play a more active role in facilitating transitions to citizenship for refugee youth through an inclusive approach.

Evaluating the benefits of public bicycle schemes needs to be undertaken carefully

A letter in response to an article by David Rojas-Rueda, Audrey de Nazelle, Marko Tainio, Mark J Nieuwenhuijsen, The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study. BMJ 2011;343:doi:10.1136/bmj.d4521 (Published 4 August 2011) This paper sets out to compare the health benefits of the Bicing scheme (Barcelona's public bicycle share scheme) with possible risks associated with increased bicycle riding. The key variables used by the researchers include physical activity, exposure to air pollution and road traffic injury. The authors rightly identify that although traffic congestion is often a major motivator behind the establishment of public bicycle share schemes (PBSS), the health benefits may well be the largest single benefit of such schemes. Certainly PBSS appear to be one of the most effective methods of increasing the number of bicycle trips across a population, providing additional transport options and improving awareness of the possibilities bicycles offer urban transport systems. Overall, the paper is a useful addition to the literature, in that it has attempted to assess the health benefits of a large scale PBSS and weighed these against potential risks related to cyclists exposure to air pollution and road traffic injuries. Unfortunately a fundamentally flawed assumption related to the proportion of Bicing trips replacing car journeys invalidates the results of this paper. A future paper with up to date data would create a significant contribution to this emerging area within the field of sustainable transport.

Aspiration levels and educational choices: An experimental study

The explanation of social inequalities in education is still a debated issue in economics. Recent empirical studies tend to downplay the potential role of credit constraint. This article tests a different potential explanation of social inequalities in education, specifically that social differences in aspiration level result in different educational choices. Having existed for a long time in the sociology of education, this explanation can be justified if aspiration levels are seen as reference points in a prospect theory framework. In order to test this explanation, this article applies the method of experimental economics to the issue of education choice and behaviour. One hundred and twenty-nine individuals participated in an experiment in which they had to perform a task over 15 stages grouped in three blocks or levels. In order to continue through the experiment, a minimum level of success was required at the end of each level. Rewards were dependent on the final level successfully reached. At the end of each level, participants could either choose to stop and take their reward or to pay a cost to continue further in order to possibly receive higher rewards. To test the impact of aspiration levels, outcomes were either presented as gains or losses relative to an initial sum. In accordance with the theoretical predictions, participants in the loss framing group choose to go further in the experiment. There was also a significant and interesting gender effect in the loss framing treatment, such that males performed better and reached higher levels.

Early intervention music therapy : reporting on a 3-year project to address needs with at-risk families

Sing & Grow is an early intervention music therapy project presented to families with additional needs, or those at risk of experiencing disadvantage due to social and/or economic circumstances that may impact on their parenting experiences. The aim of the project is to provide short term music therapy programs to families in communities where access to such services may be limited. The program is strengths-based and focuses on building upon a parent’s capacity to relate to and respond to their child’s emotional and developmental needs.

From classroom resistance to school reform

In the project described in this chapter, a group of educationally disengaged high school students investigated their peers' perspectives of factors related to low aspiration for and access to university. On the basis of their findings, they created an informative DVD to address the student needs.

Evaluating educational software : a historical overview and the challenges ahead

Teachers are under increasing pressure from government and school management to incorporate technology into lessons. They need to consider which technologies can most effectively enhance subject learning, encourage higher order thinking skills and support the performance of authentic tasks. This chapter reviews the practical and theoretical tools that have been developed to aid teachers in selecting software and reviews the software assessment methodologies from the 1980s to the present day. It concludes that teachers need guidance to structure the evaluation of technology, to consider its educational affordances, its usability, its suitability for the students and the classroom environment and its fit to the teachers’ preferred pedagogies.

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

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

Understanding the diversity of non-specialised units within Australian property degrees

Building on the recommendations of the Bradley Review (2008), the Australian Federal government intends to promote a higher level of penetration of tertiary qualification across the broader Australian community which is anticipated to result in increased levels of standardisation across university degrees. In the field of property, tertiary academic programs are very closely aligned to the needs of a range of built environment professions and there are well developed synergies between the relevant professional bodies and the educational institutions. The strong nexus between the academic and the professional content is characterised by ongoing industry accreditation which nominates a range of outcomes which the academic programs must maintain across a range of specified metrics. Commonly, the accrediting bodies focus on standard of minimum requirements especially in the area of specialised subject areas where they require property graduates to demonstrate appropriate learning and attitudes. In addition to nominated content fields, in every undergraduate degree program there are also many other subjects which provide a richer experience for the students beyond the merely professional. This study focuses on the nonspecialised knowledge field which varies across the universities offering property degree courses as every university has the freedom to pursue its own policy for these non-specialised units. With universities being sensitive to their role of in the appropriate socialisation of new entrants, first year units have been used as a vehicle to support students’ transition into university education and the final year units seek to support students’ integration into the professional world. Consequentially, many property programs have to squeeze their property-specific units to accommodate more generic units for both first year and final year units and the resulting diversity is a feature of the current range of property degrees across Australia which this research will investigate. The matrix of knowledge fields nominated by the Australian Property Institute for accreditation of degrees accepted for Certified Practising Valuer (CPV) educational requirement and the complementary requirements of the other major accrediting body (RICS) are used to classify and compare similarities and differences across property degrees in the light of the streamlining anticipated from the Bradley Review.