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

Theme Paper for Curriculum innovation and enhancement theme AIM: This paper reports on a research project that trialled an educational strategy implemented in an undergraduate nursing curriculum. The project aimed to explore the effectiveness of ‘think aloud’ as a strategy for improving clinical reasoning for students in simulated clinical settings. BACKGROUND: Nurses are required to apply and utilise critical thinking skills to enable clinical reasoning and problem solving in the clinical setting (Lasater, 2007). Nursing students are expected to develop and display clinical reasoning skills in practice, but may struggle articulating reasons behind decisions about patient care. The ‘think aloud’ approach is an innovative learning/teaching method which can create an environment suitable for developing clinical reasoning skills in students (Banning, 2008, Lee and Ryan-Wenger, 1997). This project used the ‘think aloud’ strategy within a simulation context to provide a safe learning environment in which third year students were assisted to uncover cognitive approaches to assist in making effective patient care decisions, and improve their confidence, clinical reasoning and active critical reflection about their practice. MEHODS: In semester 2 2011 at QUT, third year nursing students undertook high fidelity simulation (some for the first time), commencing in September of 2011. There were two cohorts for strategy implementation (group 1= used think aloud as a strategy within the simulation, group 2= no specific strategy outside of nursing assessment frameworks used by all students) in relation to problem solving patient needs. The think aloud strategy was described to students in their pre-simulation briefing and allowed time for clarification of this strategy. All other aspects of the simulations remained the same, (resources, suggested nursing assessment frameworks, simulation session duration, size of simulation teams, preparatory materials). Ethics approval has been obtained for this project. RESULTS: Results of a qualitative analysis (in progress- will be completed by March 2012) of student and facilitator reports on students’ ability to meet the learning objectives of solving patient problems using clinical reasoning and experience with the ‘think aloud’ method will be presented. A comparison of clinical reasoning learning outcomes between the two groups will determine the effect on clinical reasoning for students responding to patient problems. CONCLUSIONS: In an environment of increasingly constrained clinical placement opportunities, exploration of alternate strategies to improve critical thinking skills and develop clinical reasoning and problem solving for nursing students is imperative in preparing nurses to respond to changing patient needs.

Can a community pharmacy sleep assessment tool aid the identification of patients at risk of sleep disorders in the community : a pilot study

Background: When experiencing sleep problems for the first time, consumers may often approach community pharmacists for advice as they are easily accessible health care professionals in the community. In Australian community pharmacies there are no specific tools available for use by pharmacists to assist with the assessment and handling of consumers with sleep enquiries. Objective: To assess the feasibility of improving the detection of sleep disorders within the community through the pilot of a newly developed Community Pharmacy Sleep Assessment Tool (COP-SAT). Method: The COP-SAT was designed to incorporate elements from a number of existing, standardized, and validated clinical screening measures. The COP-SAT was trialed in four Australian community pharmacies over a 4-week period. Key findings: A total of 241 community pharmacy consumers were assessed using the COP-SAT. A total of 74 (30.7%) were assessed as being at risk of insomnia, 26 (10.7%) were at risk of daytime sleepiness, 19 (7.9%) were at risk of obstructive sleep apnea, and 121 (50.2%) were regular snorers. A total of 116 (48.1%) participants indicated that they consume caffeine before bedtime, of which 55 (47%) had associated symptoms of sleep onset insomnia. Moreover, 85 (35%) consumed alcohol before bedtime, of which 50 (58%) experienced fragmented sleep, 50 (58%) were regular snorers, and nine (10.6%) had apnea symptoms. The COP-SAT was feasible in the community pharmacy setting. The prevalence of sleep disorders in the sampled population was high, but generally consistent with previous studies on the general population. Conclusion: A large proportion of participants reported sleep disorder symptoms, and a link was found between the consumption of alcohol and caffeine substances at bedtime and associated symptoms. While larger studies are needed to assess the clinical properties of the tool, the results of this feasibility study have demonstrated that the COP-SAT may be a practical tool for the identification of patients at risk of developing sleep disorders in the community.

Widening participation in university learning

This paper reports how one Australian university and the Queensland Department of Education and Training (DET) are working together to increase the number of school students from low socio-economic backgrounds enrolling in undergraduate university degrees. This innovative program involves university lecturers and school teachers working together in the delivery and assessment of four Bachelor of Education units (or subjects) to a cohort of Year eleven and twelve students at a secondary school. Focus group interviews collected data from 26 students, 7 parents, 4 school and 3 university staff to assess the effectiveness of the program. All stakeholders viewed the program as a highly valuable opportunity to experience university learning with 31 high school graduating students being made offers to enter full-time university in the 2010 and 2011. This positive result has particular significance in the current drive in Australia and elsewhere to increase the participation in higher education of young people from under-represented groups.

The Capacity to Share : A Study of Cuba's International Cooperation in Educational Development

Since 1959, international cooperation has been a key feature of Cuba’s commitment to egalitarian social well-being. Aspects of this experience have been well documented , in general and with reference to specific initiatives across human development and occupational sectors. Others have been little examined, of which education is one. This book describes the internationalism of Cuban education policy as practised in Cuba and in other parts of the Global “South.”

Challenging Educational Underdevelopment: The Cuban Solidarity Approach as a Mode of South-South Cooperation

The Capacity to Share is the first book to document how Cubans share their highly developed educational services with other low-income states, especially those in Africa, Latin America, and the Caribbean. A variety of international and Cuban authors break new ground in presenting this research. They investigate the experiences of people who have studied in Cuba on scholarships from the Cuban government, the implications for their home countries, and the work of Cuban teachers and administrators to support education in other countries. The authors discuss how the Cuban "solidarity" approach prioritizes global educational cooperation for mutual support, rather than imposing conditional aid. The book offers original and unusual insights into issues of culture, education, aid, development, and change as they relate to low-income states.

Assessment of real-time networks and timing for process bus applications

Widespread adoption by electricity utilities of Non-Conventional Instrument Transformers, such as optical or capacitive transducers, has been limited due to the lack of a standardised interface and multi-vendor interoperability. Low power analogue interfaces are being replaced by IEC 61850 9 2 and IEC 61869 9 digital interfaces that use Ethernet networks for communication. These ‘process bus’ connections achieve significant cost savings by simplifying connections between switchyard and control rooms; however the in-service performance when these standards are employed is largely unknown. The performance of real-time Ethernet networks and time synchronisation was assessed using a scale model of a substation automation system. The test bed was constructed from commercially available timing and protection equipment supplied by a range of vendors. Test protocols have been developed to thoroughly evaluate the performance of Ethernet networks and network based time synchronisation. The suitability of IEEE Std 1588 Precision Time Protocol (PTP) as a synchronising system for sampled values was tested in the steady state and under transient conditions. Similarly, the performance of hardened Ethernet switches designed for substation use was assessed under a range of network operating conditions. This paper presents test methods that use a precision Ethernet capture card to accurately measure PTP and network performance. These methods can be used for product selection and to assess ongoing system performance as substations age. Key findings on the behaviour of multi-function process bus networks are presented. System level tests were performed using a Real Time Digital Simulator and transformer protection relay with sampled value and Generic Object Oriented Substation Events (GOOSE) capability. These include the interactions between sampled values, PTP and GOOSE messages. Our research has demonstrated that several protocols can be used on a shared process bus, even with very high network loads. This should provide confidence that this technology is suitable for transmission substations.

Grameen Bank's social performance disclosure : responding to a negative assessment by Wall Street Journal in late 2001

Purpose – The aim of this paper is to establish a linkage between negative global media news towards Grameen Bank (GB), the largest microfinance organisation in the developing world, and the extent and type of annual report social performance disclosures by GB, over the nine-year period 1997-2005. Design/methodology/approach – Content analysis instruments are utilised to analyse GB annual report social disclosure. Findings – The study finds that GB's community poverty alleviation disclosures account for the highest proportion of total social disclosures in the period 1997-2005. The results of this study are particularly significant in relation to poverty alleviation – the issue attracting severe criticism from the Wall Street Journal (WSJ?) late in 2001. The community poverty alleviation disclosures by GB are significantly greater over the four years following the negative news in the WSJ than in the four years before. The results suggest that GB responds to a negative media story or legitimacy threatening news via annual report social disclosures in an attempt to re-establish its legitimacy. Originality/value – This paper contributes to the literature because in the past there has been no research published linking global media attention to the social disclosure practices of major organisations in developing countries

Examining the Assessment Opportunities for Cultural Connectedness for Student Learning : A Sociocultural Analysis

The disparity that exists between the highest and lowest achievers together with deficit approaches to teaching, learning and assessment raise serious equity issues related to fairness, validity, culture and access, which were analysed in a recent Australian Research Council funded project. This chapter explores the potential that exists for teachers to work with Indigenous Teacher Assistants (ITAs) to secure cultural connectedness in teaching, learning and assessment of Indigenous students. The study was a design experiment, which was conducted in seven Catholic and Independent primary schools in northern Queensland and involved semi-structured focus group interviews with Year 4 and 6 Indigenous students, principals, teachers and Indigenous Teacher Assistants. Classroom observations and document analyses were also conducted. This corpus of data was analysed using a sociocultural theoretical lens. The use of a sociocultural analysis helped to identify cultural influences, Indigenous students’ funds of knowledge and values. The information from this analysis was made explicit to teachers to demonstrate how they could enhance their pedagogic and assessment practices by embracing and extending the cultural spaces for learning and teaching of Indigenous students. The way in which teachers construct their interactions for greater cultural connectedness and enhanced learning would appear to rely on relationship building with Indigenous staff, Indigenous students’ cultural knowledge, and improved understanding of assessment and related equity issues.

Logan Basin Water Resource Plan : environmental assessment of the southern Moreton Bay islands. Technical Advisory Panel Report: Stage 1.

This report is a technical assessment of the hydrological environment of the southern Moreton Bay islands and follows the terms of reference supplied by the then Queensland Department of Natural Resources and Water. The terms of reference describe stage 1 as a condition assessment and stage 2 as an assessment of the implications of water planning scenarios on future condition. This report is the first stage of a two-stage investigation whose primary purpose is to identify and assess groundwater dependent ecosystems (GDEs) and the groundwater flow regimes necessary to support them. Within this context, the groundwaters themselves are also considered and comment made on their condition. Information provided in this report will inform an amendment to the Logan Basin Water Resource Plan to incorporate the southern Moreton Bay islands. The study area is the water resource plan amendment area, which includes North and South Stradbroke islands and the smaller islands between these and the mainland, including the inhabited smaller rocky islands—namely, Macleay, Russell, Karragarra, Lamb and Coochiemudlo islands. This assessment is largely a desktop study based on existing information, but incorporates some field observations, input from experts in specific areas and community representatives, and the professional experience and knowledge of the authors. This report reviews existing research and information on the southern Moreton Bay area with an emphasis on North Stradbroke Island, as it represents the largest and most regionally significant groundwater resource in southern Moreton Bay. The report provides an assessment of key waterrelated environmental features, their condition and their degree of dependence on groundwater. This report also assesses the condition and status of ecosystems within this region. In addition, the report identifies information gaps, uncertainties and potential impacts; reviews groundwater models that have been developed for North Stradbroke Island; and makes recommendations on monitoring and research needs.

Valid and reliable assessment of wellness among adolescents : do you know what you’re measuring?

Measuring wellness among adolescents is an emerging trend among professionals and researchers endeavouring to influence youth as they establish lifestyle patterns in this critical period of life. This discussion highlights instruments used to measure wellness among adolescents, and considers the empirical data supporting their validity and reliability amongst adolescents. In summary, Adolescent wellness is an important indicator of future health and lifestyle habits. There are a number of tools available to measure wellness, each with its own focus, depending on the definition or model from which it was developed. This may cause debate regarding the appropriateness of some instruments for evaluating wellness. The majority of wellness evaluation approaches reported among adolescents have less than ideal validation. A ‘gold standard’ definition could lead to the standardisation of a theoretical model against which wellness instruments could be validated. The absence of peer reviewed studies reporting psychometric testing for wellness evaluation instruments among adolescents is concerning given their growing popularity and highlights a priority area for future research in this field.

Assessment of the application of contingent valuation theory to bio-sequestered carbon

The issue of carbon sequestration rights has become topical following the United Nations Convention on Climate Change (United Nations 1992 at page 1414) and the subsequent Kyoto Protocol (United Nations Climate Change Secretariat 1998) which identified emissions trading as one of the mechanisms to reduce greenhouse gas emissions. Australian states have responded by creating a legal framework for the recognition of rights to bio-sequestered carbon. There is a lack of uniformity in the approach of each state to the recognition of these rights, which vary from the creation of new and novel interests in land to the adoption of more traditional rights such as a profit a prendre. Rights to bio-sequestered carbon are likely to have an impact on the utility, marketability, value and financing of rural land holdings. Despite the creation of the legal framework for recognition of rights to sequestrated carbon, there has been a delay in the introduction of a formalised carbon trading scheme in Australia. In the absence of an established carbon market, this paper addresses the applicability of contingent valuation theory to assess the value of bio-sequestered carbon rights to a rural land holder. Limitations and potential controversies associated with this application of contingent valuation theory are also addressed in this paper.

Mobius markets : professional families in rural educational markets

Australia has many isolated communities that require human services provided by qualified professionals. Maintaining a viable and equitable spread of such educational capital across space as a public good is a challenge. Reports investigating this problem repeatedly point to ‘family issues’ such as limited options for children’s education, and limited access to ongoing professional development, as deterrents for rural/remote employment despite lucrative incentive schemes. This paper draws on semi-structured interviews with 30 parents of school-aged children, who work as doctors, nurses, teachers and police in six rural/remote towns in Queensland. We asked them how their family units reconcile career opportunities with educational strategy for family members over time and space. This paper considers these issues as a sociology of education problem in a context of educational marketisation and spiralling credentialism. This paper offers the concept of ‘mobius markets’ to capture the cyclical and intergenerational process underway in middle class professional families of investing in educational capitals, maintaining or maximising their value and profiting from them. A mobius strip is the topological anomaly of a single loop with one twist in it, whereby the loop becomes one continuous surface, not the double-sided shape it appears to be. This project is interested in how the middle class professional family is similarly on a constant circuit, investing in educational capitals, upgrading their currency/value, and profiting from them. This elaborated sense of educational markets extends the more usual sociological focus on school choice.

A self-assessment tool for knowledge management implementation in the construction industry

Knowledge management (KM) provides a structured process to establish the link between knowledgebased assets within an organisation and its desired business objectives. Although KM issues are becoming increasingly important to the construction industry, there is currently no measurement tool for assessing the implementation of KM programmes. This paper reports on the development of such a tool which can be used as both a means of self-assessment and also for benchmarking purposes. Important practices needed for successful KM implementation were identified from the literature and via a self-administered survey targeting large and medium construction organisations in Hong Kong. Survey findings demonstrate the potential of the proposed self-assessment tool to measure the individual’s perception of the relative importance of KM antecedents and practices, also providing early insight of KM implementation by highlighting the negative gaps between what “is” and “should be” happening, thus identifying areas that need re alignment of KM strategies and tactics. The paper also suggests this tool could be further developed to help organisations to formulate and modify their KM programmes according to their own specific internal business environment, and the nature of their projects.

Validation of the Educational Stress Scale for Adolescents (ESSA) in Vietnam

Introduction To date, there has been little systematic, quantitative research on the links between academic pressure and mental health among adolescents in Asia, and none in Vietnam. In part, this is because of a lack of appropriate tools to measure this complex phenomenon. This study was to validate the Educational Stress Scale for Adolescents (ESSA), developed and tested in China, with the aim of fostering further research in Asia. Methods A total of 1283 students were recruited in 3 secondary schools and 3 high schools in Ho Chi Minh City, Vietnam. Anonymous, selfreport questionnaires included the ESSA and previously validated measures of mental health. Results Among the 1226 questionnaires available, 54% of respondents were female. The mean age was 15.3 years. Students reported substantial study burden. The ESSA had good internal consistency, and factorial validity and concurrent validity were established. Conclusion The ESSA is a suitable measure for school-based mental health research in Asia.