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.

The graduate attributes we've overlooked : enhancing graduate employability through career management skills

Recent shifts in education and labour market policy have resulted in universities being placed under increasing pressure to produce employable graduates. However, contention exists regarding exactly what constitutes employability and which graduate attributes are required to foster employability in tertiary students. This paper argues that in the context of a rapidly changing information- and knowledge-intensive economy, employability involves far more than possession of the generic skills listed by graduate employers as attractive. Rather, for optimal economic and social outcomes, graduates must be able to proactively navigate the world of work and self-manage the career building process. A model of desirable graduate attributes that acknowledges the importance of self-management and career building skills to lifelong career management and enhanced employability is presented. Some important considerations for the implementation of effective university career management programs are then outlined.

The skin awareness study : promoting thorough skin self-examination for skin cancer among men 50 years or older

Background: Incidence and mortality from skin cancers including melanoma are highest among men 50 years or older. Thorough skin self-examination may be beneficial to improve skin cancers outcomes.--------- Objectives: To develop and conduct a randomized-controlled trial of a video-based intervention to improve skin self-examination behavior among men 50 years or older.--------- Methods: Pilot work ascertained appropriate targeting of the 12-minute intervention video towards men 50 years or older. Overall, 968 men were recruited and 929 completed baseline telephone assessment. Baseline analysis assessed randomization balance and demographic, skin cancer risk and attitudinal factors associated with conducting a whole-body skin self-examination or receiving a whole-body clinical skin examination by a doctor during the past 12 months.--------- Results: Randomization resulted in well-balanced intervention and control groups. Overall 13% of men reported conducting a thorough skin self-examination using a mirror or the help of another person to check difficult to see areas, while 39% reported having received a whole-body skin examination by a doctor within the past 12 months. Confidence in finding time for and receiving advice or instructions by a doctor to perform a skin self-examination were among the factors associated with thorough skin self-examination at baseline.---------- Conclusions: Men 50 years or older can successfully be recruited to a video-based intervention trial with the aim reduce their burden through skin cancer. Randomization by computer generated randomization list resulted in good balance between control and intervention group and baseline analysis determined factors associated with skin cancer early detection behavior at baseline.

The awareness and explication of disciplinarity across four senior-secondary subject areas

This paper issues a challenge to the notion of domain-general teaching and learning, positing that different subject areas require distinct approaches to developing student knowledge and understanding. The aim has been to observe and compare awareness and explication of disciplinarity in four senior secondary school subjects: Biology, History, Music and Physics. Specifically, we were interested in: (1) teachers’ concepts of what it means to ‘know the discipline’, to ‘think like a disciplinary expert’ and to ‘teach and learn the discipline’; and (2) how teachers draw these concepts together to build student knowledge in the classroom. The research informs educational practice and policy, in particular curricular initiatives involving interdisciplinary curricula.

Bahrain skills gaps study : tourism, construction, and education skills plans

The tourism, construction, and education plans and skills strategies (embedded in project reports) were developed as part of a nation-wide comprehensive research project covering current, emerging and future skills deficiencies and requirements in Bahrain’s labour market. The research covered the majority of economic sectors and activities in the Kingdom and will serve as a basis for formulating industry and occupational outlooks as well as career guidance and awareness activities by academic and training institutions across Bahrain. It will provides foundation work for industry skills councils in order to conduct and achieve a uniform system of occupational standards across industries, occupations and job levels.

Academic career development workshop for research students and early career academics

For research students and early career academics, universities offer resources that help develop their research skills – for example, critical theory development, literature reviews, research methods, data analysis, writing skills, etc. However, building a successful career in academia poses a wide range of new challenges in addition to the pure academic craft of research. The resources and resilience one needs in order to shape an academic career path often appear ambiguous, particularly in the innately transformative field of Internet research. In response to feedback from AoIR members, this full-day workshop seeks to address this concern by offering a supportive and constructive environment to discuss career development related issues that are of specific interest to research students and early career academics.

Public awareness of “green” and “energy efficient” residential property : an empirical survey based on data from New Zealand

Purpose – The purpose of this paper is to examine the buyer awareness and acceptance of environmental and energy efficiency measures in the New Zealand residential property markets. This study aims to provide a greater understanding of consumer behaviour in the residential property market in relation to green housing issues ---------- Design/methodology/approach – The paper is based on an extensive survey of Christchurch real estate offices and was designed to gather data on the factors that were considered important by buyers in the residential property market. The survey was designed to allow these factors to be analysed on a socio-economic basis and to compare buyer behaviour based on property values. ---------- Findings – The results show that regardless of income levels, buyers still consider that the most important factor in the house purchase decision is the location of the property and price. Although the awareness of green housing issues and energy efficiency in housing is growing in the residential property market, it is only a major consideration for young and older buyers in the high income brackets and is only of some importance for all other buyer sectors of the residential property market. Many of the voluntary measures introduced by Governments to improve the energy efficiency of residential housing are still not considered important by buyers, indicating that a more mandatory approach may have to be undertaken to improve energy efficiency in the established housing market, as these measures are not valued by the buyer. ---------- Originality/value – The paper confirms the variations in real estate buyer behaviour across the full range of residential property markets and the acceptance and awareness of green housing issues and measures. These results would be applicable to most established and transparent residential property markets.

Spaces of hybridity : creating a sense of belonging through spatial awareness

When the colonisers first came to Australia there was an urgent desire to map, name and settle. This desire, in part, stemmed from a fear of the unknown. Once these tasks were completed it was thought that a sense of identity and belonging would automatically come. In Anglo-Australian geography the map of Australia was always perceived in relationship to the larger map of Europe and Britain. The quicker Australia could be mapped the quicker its connection with the ‘civilised’ world could be established. Official maps could be taken up in official history books and a detailed monumental history could begin. Australians would feel secure in where they were placed in the world. However, this was not the case and anxieties about identity and belonging remained. One of the biggest hurdles was the fear of the open spaces and not knowing how to move across the land. Attempts to transpose colonisers’ use of space onto the Australian landscape did not work and led to confusion. Using authors who are often perceived as writers of national fictions (Henry Lawson, Barbara Baynton, Patrick White, David Malouf and Peter Carey) I will reveal how writing about space becomes a way to create a sense of belonging. It is through spatial knowledge and its application that we begin to gain a sense of closeness and identity. I will also look at how one of the greatest fears for the colonisers was the Aboriginal spatial command of the country. Aborigines already had a strongly developed awareness of spatial belonging and their stories reveal this authority (seen in the work of Lorna Little, Mick McLean) Colonisers attempted to discredit this knowledge but the stories and the land continue to recognise its legitimacy. From its beginning Australian spaces have been spaces of hybridity and the more the colonisers attempted to force predetermined structures onto these spaces the more hybrid they became.

Max Dupain and the photography of Australian architecture

This thesis considers Max Dupain (1911-1992) and his contribution to the development of architectural photography in Australia. Through his continuous and prolific output over six decades of professional photography Dupain greatly stimulated awareness of and interest in Australian architecture. Before Dupain began specialising in the field, little consistent professional architectural photography had been practised in Australia. He and some of his close associates subsequently developed architectural photography as both a specialised branch of photography and - perhaps more significantly - as a necessary adjunct to architectural practice. In achieving these dual accomplishments, Dupain and like-minded practitioners succeeded in elevating architectural photography to the status of a discipline in its own right. They also gave Australians generally a deeper understanding of the heritage represented by the nation's built environment. At the same time, some of the photographic images he created became firmly fixed in the public imagination as historical icons within the development of a distinctive Australian tradition in the visual arts. Within his chosen field Dupain was the dominant Australian figure of his time. He was instrumental in breaking the link with Pictorialism by bringing Modernist and Documentary perspectives to Australian architectural photography. He was an innovator in the earlier decades of his professional career, however, his photographic techniques and practice did not develop beyond that. By the end of the 1980s he had largely lost touch with the technology and techniques of contemporary practice. Dupain's reputation, which has continued growing since his death in 1992, therefore arises from reasons other than his photographic images alone. It reflects his accomplishment in raising his fellow citizens' awareness of a worthwhile home-grown artistic tradition.

Mentoring experiences as professional development for leaders in environmental education : the cascade of influence

Environmental education is a field which has only come of age since the late nineteen sixties. While its content and practice have been widely debated and researched, its leadership has been minimally studied and, therefore, is only partially understood. The role of mentoring in the development of leaders has been alluded to, but has attracted scant research. Therefore, this study explores the importance of mentoring during the personal and professional development of leaders in environmental education. Four major research questions were investigated. Firstly, have leaders been men to red during their involvement with environmental education? Secondly, when and how has that mentoring taken place? Thirdly, what was the personal and professional effectiveness of the mentoring relationship? Fourthly, is there any continuation of the mentoring process which might be appropriate for professional development within the field of environmental education? Leaders were solicited from a broad field of environmental educators including teachers, administrators, academics, natural resource personnel, business and community persons. They had to be recognized as active leaders across several environmental education networks. The research elicited qualitative and quantitative survey data from fifty seven persons in Queensland, Australia and Colorado, USA. Seventeen semi-structured interviews were subsequently conducted with selected leaders who had nominated their mentors. This led to a further thirteen 'linked interviews' with some of the mentors' mentors and new mentorees. The interview data is presented as four cases reflecting pairs, triads, chains and webs of relationships- a major finding of the research process. The analysis of the data from the interviews and the surveys was conducted according to a grounded theory approach and was facilitated by NUD.IST, a computer program for non-numerical text analysis. The findings of the study revealed many variations on the classical mentoring patterns found in the literature. Gender and age were not seen as mportant factors, as there were examples of contemporaries in age, older men to younger women, older women to younger men, and women to women. Personal compatibility, professional respect and philosophical congruence were critical. Mentoring was initiated from early, mid and late career stages with the average length of the relationship being fourteen years. There was seldom an example of the mentoree using the mentor for hierarchical career climbing, although frequent career changes were made. However, leadership actions were found to increase after the intervention of a mentoring relationship. Three major categories of informal mentoring were revealed - perceived,acknowledged and deliberate. Further analysis led to the evolution of the core concept, a 'cascade of influence'. The major finding of this study was that this sample of leaders, mentors and new mentorees moved from the perception of having been mentored to the acknowledgment of these relationships and an affirmation of their efficacy for both personal and professional growth. Hence, the participants were more likely to continue future mentoring, not as a serendipitous happening, but through a deliberate choice. Heightened awareness and more frequent 'cascading' of mentoring have positive implications for the professional development of future leaders in environmental education in both formal and informal settings. Effective mentoring in environmental education does not seek to create 'clones' of the mentors, but rather to foster the development of autonomous mentorees who share a philosophical grounding. It is a deliberate invitation to 'join the clan'.