Learning transitions-a descriptive study of nurses' experiences during advanced level nursing education

BACKGROUND: Building capacity in a changing health care system is a challenge for advanced nursing education programs. Master-level nursing education is increasingly becoming the required education level for specialist nurses, and additional studies are needed to learn more about students' experiences and learning transitions while undertaking such education. This study aimed to explore nursing students' experience of their learning transitions while undertaking advanced nursing education and to describe how they translated the new knowledge and competence they gained into clinical practice. METHODS: We used a qualitative research design with narrative self-reported reflections. 34 nurses (95 % women) from both urban and rural areas working with children, with adults in outpatient and inpatient endocrinology clinics in hospitals or with adults, including older people, attending primary health care services participated in the study. We collected data at two time points 15 months apart. Time one was the first week of the advanced nursing education, and time two was the completion of the education program. We used Malterud's modification of Giorgi's phenomenological analysis, otherwise known as systematic text condensation, to analyze the data. RESULTS: Two core themes captured the participants' experiences. The first theme was "assessing the situation of people with diabetes from a different perspective", with the subthemes "an expanded perspective of practice and higher level of reflection", "applying critical thinking in practice" and "changing patient-nurse relationships in diabetes care". The second core theme was "a change in participants' perception of their professional position", with the subthemes "a greater knowledge base enhancing professional confidence" and "a more equal position within the professional team". CONCLUSIONS: The study provides in-depth information about transition into advanced nursing education and can inform curriculum developers, nurse educators, policy-makers and nursing managers about how nursing education broadened participants' perspectives of nursing and enhanced their confidence and professional position.

"I tell ya who needs educatin’”: non-Indigenous cultural self-awareness and prisoner education.

Glen says, “current education is colonial; it ain’t ours. I tell ya who needs educatin’, wadjellas”. Glen is a Noongar man who, along with several other Aboriginal adults living in Western Australia, teaches me in a PhD research project about prisoner education from their perspective. His words pose a question for wadjellas like myself who are raised, taught and work in a white neo-colonial society. We have been raised in, taught in and work in a colonial system. As non-Aboriginal people we have unearned privileges which are often invisible and unacknowledged. How then to address the outcomes of this in a way that might lead to working co-operatively alongside Aboriginal people? What kind of ‘educatin’ could teach us about our own unacknowledged privilege and the disadvantage this can lead to for others? Is the standard cross-cultural awareness training enough?This paper shares some of the teachings of Glen and other participants in this research. It expresses the view that, ultimately, the usually unacknowledged legacy of colonisation and associated issue of denied Aboriginal sovereignty lies at the heart of much of the disadvantage experienced by Aboriginal people today when considering education and the prison system. Addressing gaps in non-Indigenous cultural self-awareness by learning from Aboriginal people is an important factor in improving their experiences of education.

Community aged care case managers transitioning to consumer directed care: more than procedural change required

Consumer directed care (CDC) is increasing in community aged care. However, limited information is available to successfully transition social workers and other case managers to their new role. This paper reports on a case study of six senior case managers who supervised staff in three Australian community-aged care agencies as they transitioned from agency directed care to consumer directed care. A change management framework was used to analyse the qualitative data collected in 12 semistructured interviews. A key finding is that changes in values, attitudes, and organisational culture are needed before staff can fully implement CDC principles of service user self-determination, empowerment, and choice. Process changes needed to assist staff transition to CDC are: using a change management strategy that maximises certainty; monitoring and responding to feelings of anxiety through ongoing consultations; and providing ongoing education and support in group sessions.

Learning to become an international work-based learner

In this chapter you will learn
• Key success factors for work-based learning students across cultures
• The importance of learning another way to think, write and act to be a successful work-based learning student in a multi-cultural context
• How to build your own personal learning network and wider environment, which will be essential in helping and motivating you through your studies
• How to continually improve your academic performance through self-reflection and self-leadership
• How to plan for and manage

Protocol-directed sedation versus non-protocol-directed sedation to reduce duration of mechanical ventilation in mechanically ventilated intensive care patients (review)

Background : The sedation needs of critically ill patients have been recognized as a core component of critical care and meeting these is vital to assist recovery and ensure humane treatment. There is growing evidence to suggest that sedation requirements are not always optimally managed. Sub-optimal sedation incorporates both under- and over-sedation and has been linked to both short-term (e.g. length of stay) and long-term (e.g. psychological recovery) outcomes. Various strategies have been proposed to improve sedation management and address aspects of assessment as well as delivery of sedation.

Objectives : To assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit (ICU) patients. We looked at various outcomes and examined the role of bias in order to examine the level of evidence for this intervention.

Search methods : We searched the Cochrane Central Register of Controlled trials (CENTRAL) (2013; Issue 11), MEDLINE (OvidSP) (1990 to November 2013), EMBASE (OvidSP) (1990 to November 2013), CINAHL (BIREME host) (1990 to November 2013), Database of Abstracts of Reviews of Effects (DARE) (1990 to November 2013), LILACS (1990 to November 2013), Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990 to November 2013), and reference lists of articles. We re-ran the search in October 2014. We will deal with any studies of interest when we update the review.

Selection criteria : We included randomized controlled trials (RCTs) conducted in adult ICUs comparing management with and without protocol-directed sedation.

Data collection and analysis : Two authors screened the titles and abstracts and then the full-text reports identified from our electronic search. We assessed seven domains of potential risk of bias for the included studies. We examined the clinical, methodological and statistical heterogeneity and used the random-effects model for meta-analysis where we considered it appropriate. We calculated the mean difference (MD) for duration of mechanical ventilation and risk ratio (RR) for mortality across studies, with 95% confidence intervals (CI).

Main results : We identified two eligible studies with 633 participants. Both included studies compared the use of protocol-directed sedation, specifically protocols delivered by nurses, with usual care. We rated the risk of selection bias due to random sequence generation low for one study and unclear for one study. The risk of selection bias related to allocation concealment was low for both studies. We also assessed detection and attrition bias as low for both studies while we considered performance bias high due to the inability to blind participants and clinicians in both studies. Risk due to other sources of bias, such as potential for contamination between groups and reporting bias, was considered unclear. There was no clear evidence of differences in duration of mechanical ventilation (MD -5.74 hours, 95% CI -62.01 to 50.53, low quality evidence), ICU length of stay (MD -0.62 days, 95% CI -2.97 to 1.73) and hospital length of stay (MD -3.78 days, 95% CI -8.54 to 0.97) between people being managed with protocol-directed sedation versus usual care. Similarly, there was no clear evidence of difference in hospital mortality between the two groups (RR 0.96, 95% CI 0.71 to 1.31, low quality evidence). ICU mortality was only reported in one study preventing pooling of data. There was no clear evidence of difference in the incidence of tracheostomy (RR 0.77, 95% CI 0.31 to 1.89). The studies reported few adverse event outcomes; one study reported self extubation while the other study reported re-intubation; given this difference in outcomes, pooling of data was not possible. There was significant heterogeneity between studies for duration of mechanical ventilation (I2 = 86%, P value = 0.008), ICU length of stay (I2 = 82%, P value = 0.02) and incidence of tracheostomy (I2 = 76%, P value = 0.04), with one study finding a reduction in duration of mechanical ventilation and incidence of tracheostomy and the other study finding no difference.

Authors' conclusions : There is currently insufficient evidence to evaluate the effectiveness of protocol-directed sedation. Results from the two RCTs were conflicting, resulting in the quality of the body of evidence as a whole being assessed as low. Further studies, taking into account contextual and clinician characteristics in different ICU environments, are necessary to inform future practice. Methodological strategies to reduce the risk of bias need to be considered in future studies.

Stillness and movement: a bodily approach to photography

My paper will address both Duration and temporality of the ‘still’ imageand Sensorial and bodily experience of photography through a discussion of a recent body of work ‘Fly Rhythm’, a series of photographs and video works exhibited in a gallery context.By acknowledging the inter-relationship between the body and the camera my project seeks to challenge a perceived separation between performance and photography. Fly Rhythm was conceived through a performative somatic process. Through using a custom made camera I was able to negotiate time and space to create a visual drawing of movement and stillness together in photography. The resultant images are discussed as a notation of body movement – a record of bodily history enabled through a self imposed discipline of learning to read light.I initially constructed a human size camera to understand how photography works. Spending time inside observing the way light moves and affects the formation of sight is also a way of embodying the act of photography. I responded by making a bespoke camera that enabled light to be captured during extended periods while moving. My project is dependent upon a self-imposed discipline of intuiting light’s strength and erratic changes, a skill developed by making analogue prints while inside a camera obscura. Once I had developed an ability to read light’s changes and gain an understanding of camera mechanics I made durational recordings moving through the landscape on Bruny Island Tasmania and industrial sites in Melbourne, photographs exhibited as part of Fly Rhythm. I will discuss these prints in context with the idea that light is a conduit through which past and present fuse together in a bodily act of photographing and processing images.I will explore durational aspects of photography by discussing light’s relative motion while taking photographs without using the viewfinder or composing images in the traditional way. Rather, the camera at the end of my arm is directed through how I read light therefore a choreography notated in the prints – a kind of body signatureMy practice enables a new the way of seeing, in a spontaneous hand held process creating a sense of embodiment. By analyzing process my paper will consider how the body together with analogue and 21st century digital technology coalesce cross-disciplinary practice combining visual art, performance and photographic disciplines.I also explored limitations of digital light in contrast with ‘natural’ light by a making a gamut of dissolving colour determined by the software based on two pixels. Projected into the ambient light ‘Glide’ is an 11minute durational work installed at the Substation Contemporary Art Space in Melbourne Australia.

Studying mathematics teacher education: analysing the process of task variation on learning

Self-study of variations to task design offers a way of analysing how learning takes place. Over several years, variations were made to improve an assessment task completed by final-year teacher candidates in a primary mathematics teacher education subject. This article describes how alterations to a task informed on-going developments in self-study of one assessment task employed in an online subject. Analysis of my journal, notes from conversations with colleagues, teacher candidates’ work on the task and responses to online forums, and survey data inspired variations focused on better exploration of key concepts involved in the task, raising of focal awareness, developing a stronger professional eye in the students and the author, adaptations for multiple curriculum levels, and explorations of dual teacher–student perspectives. The overall challenge has been to support teacher candidates to learn to design effective open-ended tasks with a critical professional eye. Descriptions of the changes made to the task and the development of my own professional eye as a consequence of the application of self-study are included. Data show that variations to the task increased teacher candidates’ understanding of mathematics problem posing and generated pedagogical insights for task design.

Positive changes in self-management and disease severity following climate therapy in people with psoriasis

The aim of this study was to investigate the impact of climate therapy on self-management in people with psoriasis. This was a prospective study of 254 adults with chronic psoriasis who participated in a 3-week climate therapy (CT) programme. The 8-scale Health Education Impact Questionnaire (heiQ) was completed at baseline, after 3 weeks of CT, and 3 months later. Change was assessed using paired sample t-tests mean (95% confidence interval) change scores (range 1-4). All heiQ scales showed statistically significant improvement after 3 weeks of CT. The greatest improvement was in Health-directed activity, followed by Emotional distress, and Skill and technique acquisition. At the 3-month follow-up, only the Emotional distress scale remained improved. In addition, disease severity (self-administered PASI; SAPASI) improved significantly from before CT to 3 weeks and 3 months after CT. This study suggests that CT provides a range of benefits that are important to people with psoriasis, particularly in the short term. A challenge is how to achieve long-term benefits.

Assessment of student development and learning in IB PYP schools

The aim of this study is to examine how International Baccalaureate (IB) Primary Years Programme (PYP) schools define the purpose of educational assessment in their assessment policies and practices. Educational assessment in this study is broadly defined to include standardized tests, and formative and summative assessment. This investigation offers a deeper understanding of the assessment cultures of eight PYP schools and provides insights into the current assessment literacy of teachers. The researchers employed a multiple case-study approach, with two phases of data collection: an online survey of teachers and detailed teacher focus groups and coordinator interviews to follow-up on themes identified in the survey. Assessment in the PYP case-study schools was described as holistic and ongoing, and involved a wide range of assessment strategies. Assessment as learning, however, emerged as an approach still in development in the schools. Teachers enthusiastically supported the development of learner profile attributes, although assessing progress in any particular attribute was regarded as challenging. Finally, while teacher feedback and student self-assessment were common practices, teachers were more equivocal about peer assessment. The authors conclude the report with a number of recommendations for further improving PYP assessment practices.

Personality and English as a foreign language learning in Aceh: a sociocultural approach

 This study explores the reciprocal relationship between personality and foreign language classroom learning from sociocultural perspectives. The findings indicate that personality and previous life experience impacted on the participants’ responses to the classroom communicative events in complex ways. Self-development occurred depending on the way participants utilized events and social circumstances.

Examining the effect of time constraint on the online mastery learning approach towards improving postgraduate students' achievement

Time control plays a critical role within the online mastery learning (OML) approach. This paper examines the two commonly implemented mastery learning strategies – personalised system of instructions and learning for mastery (LFM) – by focusing on what occurs when there is an instructional time constraint. Using a large data set from a postgraduate finance course offered at an Australian university, we explore students' online quiz-completion patterns, then empirically investigate whether the imposition of an instructional time constraint in the OML approach has an impact on their final-examination performance. Our results suggest that the LFM strategy with an instructional time constraint has a positive impact on students' learning behaviour and contributes to better overall academic performance. Further, our findings suggest that facilitators should be encouraged to implement an instructional time constraint when adopting an OML approach.

Em busca de um novo paradigma organizacional com base na learning organization - o caso do Instituto Internacional de Projeciologia e Consciênciologia

Esta dissertação apresente o conceito Organização de Aprendizagem e propostas paradigmáticas inovadoras para administração. Dentre eles, o Paradigma Paraeconômico idealizado por guerreiro Ramos, o Paradigma Consciencial de Waldo Vieira e os Paradigmas sociais de Burrel e Morgan. O objetivo é por meio do estudo de caso de uma organização sem fins lucrativos, dedicada à Pesquisa do Fenômeno da Consciência, o IIPC, entender o pré-sistema, Organização de aprendizagem e estudar novos paradigmas para gestão com pessoas, no contexto atual. Além disso, se busca também, classificar o Instituto Internacional de Projeciologia e Conscienciologia como ajustado ou não ao pré-sistema de Peter Senge, dentro da realidade de empresas de Terceiro Setor. Por fim, se conclui que o modelo Conscienciocêntrico, originário do Paradigma Consciencial, se aproxima bastante do modelo de Senge, baseado nas cinco disciplinas, indo além no que diz respeito ao autoconhecimento e cultura organizacional fomentadora da reciclagem e aprendizagem.

A Internet como tecnointeração da aprendizagem: valorização da cultura e identidade juvenil

The present study investigates Internet as technological interaction in the school environment as a resource of the teaching-learning process. It aims to discuss the lack of synchronicity between proposals of educational access for Internet use and types of access and interaction applied by youngsters. For the development of this research, I resorted to a qualitative, descriptive and explanatory research focused on a group whose subjects are youngsters from eleven to fifteen years of age in a catholic school which belongs to a group of private teaching schools in Natal city, Rio Grande do Norte state. As methodological option it focus on a group and the observation of its participation, discourse analysis and ethnography, considering facts and data of the pedagogical practice concerning the focused theme, besides the attempt to know the youngsters everyday at school and the relationship between them and juvenile cultures. It recognizes the existence of two moments of the focused group: the first related to internet use like technological interaction; the second concerns to the way Internet is problematic as technological interaction in classroom learning. While contacting with youngsters, the study discusses the concepts of Media Environments, Culture, Identity, Network, Consumption and Citizenship. It recognizes that it is relevant for the school to consider Internet a pedagogical tool, directed not just at research, but mostly as learning environment and as learning construction in a collaborative way. It points out the need of approach between school and media environment, reevaluating the pedagogical practice, offering a new evaluation proposal (self-evaluation). It suggests a renewal in the teacher's pedagogical practice in the classroom and using Internet, valuing the connection between technological interaction and communication as motivation elements of student s learning construction and their effective participation in decisions involving citizenship. It gives priority to educational work directed at the establishment of dialogic relationship between codes, learning and contents, leading to the new findings domain in the media environment, enabling the development of abilities and performances directed at the recognition and consumption of information from a critical reading of the media

Navegando nas ondas dos saberes do ser: uma conversa com a sexualidade à luz da corporeidade.

This study aimed to provide a continuing education towards raising teachers for reflection and effective sexual education within the school environment as a possible route of self-education and training of teachers of elementary school. More specifically aim to facilitate through the Continuing Education to discuss the knowledge of the body and knowledge of human sexuality, presenting them as core knowledge in the integral formation of individuals and promote discussion of a Human-centered education Teaching in a vocational training and human .In this sense, we dialogue with the human teaching preconized by Arroyo (2002, 2004) along with the humanization (hominization) of the individuals through education, under Freire´s perspective of the being more (2003) as well as his ideas, Pineau´s (2003) and Josso´s (2004) about the educational practice understanding as a way to build up the autonomy of the individuals who we intend to educate. We defend the inclusion of the body as an essential learning element according to the principles of corporeity presented by Assman (2001), whose comprehension is that every learning experience has a corporal inscription. Furthermore, the knowledge about human sexuality cannot be excluded from this process since the sexuality is inherent of individuals and is constructed and reconstructed during their existence. Our view of the world and of man is supported by the knowledge of the complexity (Morim, 2004) trying to surpass the mechanist view that sees them through the duality view, fragmenting them. For the discussion and construction of knowledge that search for the confluence of these knowledges about the being and the educational practice, aiming at the individual integral formation starting from the process of self-formation/self-knowledge, we´ve directed our research-action-formation having as compass the theoretical-methodological postulate of the research-action (Barbier, 2002; Morin, 2004; Thiollent, 2004) because it makes the participation of all the involved people in the process of resolution or surpassing of problem solving possible. We´ve used the continuing formation as a way of access for data collection, applying a questionnaire with open questions for the ones involved in the research. Based on the findings it´s been possible to infer that for the teaching formation it is necessary the inclusion of the Human sexuality and corporeity theme, so that the teacher can surpass the biological view of sexuality and also the expansion of the mechanist view of the body. To do so, we suggest that the teaching formation happens supported by the teaching capacitation and formation according to Maturana (2004), bringing teaching knowledges (Tardiff, 2002), which contribute effectively for the responsibility to educate people for life.

HOW FAR do WE GET USING MACHINE LEARNING BLACK-BOXES?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)