Dimensions and reliability of a hospital safety climate questionnaire in Chinese health-care practice

The aim of the current study was to examine the dimensions and reliability of a hospital safety climate questionnaire in Chinese health-care practice. To achieve this, a cross-sectional survey of health-care professionals was undertaken at a university teaching hospital in Shandong province, China. Our survey instrument demonstrated very high internal consistency, comparing well with previous research in this field conducted in other countries. Factor analysis highlighted four key dimensions of safety climate, which centred on employee personal protection, employee interactions, safetyrelated housekeeping and time pressures. Overall, this study suggests that hospital safety climate represents an important aspect of health-care practice in contemporary China.

Improving criteria and feedback in student assessment in law

Spurred on by both the 1987 Pearce Report1 and the general changes to higher education spawned by the “Dawkins revolution” from 1988, there has been much critical self-evaluation leading to profound improvements to the quality of teaching in Australian law schools.2 Despite the changes there are still areas of general law teaching practice which have lagged behind recent developments in our understanding of what constitutes high quality teaching. One such area is assessment criteria and feedback. The project Improving Feedback in Student Assessment in Law is an attempt to remedy this. It aims to produce a manual containing key principles for the design of assessment and the provision of feedback, with practical yet flexible ideas and illustrations which law teachers may adopt or modify. Most of the examples have been developed by teachers at the University of Melbourne Law School. The project was supported in 1996 by a Committee for the Advancement of University Teaching grant and the manual will be published late in 1997.3 This note summarises the core principles which are elaborated further in the manual.

Yhteisöllisyys voimavarana yliopisto-opetuksen ja -opiskelun kehittämisessä

A sense of community as a resource for developing university teaching and learning The aim of this doctoral research was to determine how a sense of community can be a resource for developing university teaching and learning. The theoretical background is linked to social sciences, social psychology, university pedagogy and educational sciences. The thesis is comprised of two separate studies. Study I consisted of an action research project in which a model of cooperatively developing a teaching and learning culture was created and tested. The focus of study I was the university pedagogy programme of the Faculty of Agriculture and Forestry. The results demonstrated that the theoretical framework and the methods of cooperative learning provide useful tools for developing an academic learning and teaching culture. The approach helps to create a benevolent learning atmosphere. The cooperative learning culture used in the action research project reflected the traditional academic learning culture and also caused a collision between the two cultures. The aim of study II was to determine how Open University students and Bachelor’s degree students experience their teaching-learning environment and the importance of the learning community and peer support to their studies. The results indicated that, with the exception of support from other students, the Open University students experienced their teaching-learning environments on average more positively than the Bachelor’s degree students. According to the Open University students, their own motivation and interest was the most important factor that enhanced studying. Furthermore, the most common factors delaying their studies were their life situation and a lack of time. The sense of community and social relations mainly promoted studying. Open University students experienced that they were supported by their teachers, tutors, other students, the working community, family and hobbies. The research demonstrated that the methods that make good use of communal resources are negotiation of shared goals and rules, working in various small groups, emphasis on shared and individual responsibilities and assessment of the product and the process of learning. The resources of the academic community can be developed if the members of the community develop, in addition to the communal working methods, their communal sensitivity. In other words, they should have an understanding of social psychological and sociological concepts that they can use for observing communal phenomena.

Laadukasta yliopisto-opetusta kehittämässä : Laadukkaan yliopisto-opetuksen kehittäminen ja yliopistopedagogisen koulutuksen yhteys opetuksen kehittämiseen Helsingin yliopiston opettajilla

Objectives. The purpose of this study was to examine the development of high-quality university teaching among the teachers of the University of Helsinki. Furthermore, the relation of university pedagogical training to development of teaching was analyzed. This study introduces a new perspective to the research of quality of university teaching by considering quality from the teaching development perspective. The individual level examination was done from teacher's perspective. The development of high-quality university teaching was approached through three factors of teaching development defined by Biggs (2003). These factors are 1) the level of thinking about teaching on which the teaching development is based on (can also be called the quality model), 2) the methods for and 3) the impediments to teaching development. The research of Trigwell and Prosser (1996), Lindblom-Ylänne, Nevgi and Postareff (2004) and Postareff, Lindblom-Ylänne and Nevgi (2007) and the ideas of Ramsden (1992) have been central sources to this study. Methods. This study was a survey study. The data was collected with an electronic questionnaire in the spring of 2007. The sample consisted of 655 person of which some had and some had not university pedagogical training. Total of 251 answered the study. The data was mainly analyzed with SPSS statistical programme. Item analysis, principal component analysis, nonparametric Kruskal-Wallis and Mann-Whitney tests, correlation and crosstabulation were the methods used to analyze the data. Results and conclusions. According to the results it seems that the teachers of the University of Helsinki have good basis for developing high-quality university teaching. The 3rd level of thinking about teaching, which emphasizes student-centred features, could be identified on majority of the teachers. The use of teaching development methods was comprehensive. Most frequently used methods were related to the enhancement of content knowledge. In general the impediments to teaching development were not considered to be very significant. The most significant impediments were the factors related to lack of appreciation of teaching and factors related to lack of time meant for the planning and developing of teaching. Differences were found according to sex, teaching experience, degree, position and faculty. This study also showed that university pedagogical training seems to have a positive relation to the development of high-quality university teaching among the teachers of University of Helsinki. According to the results when the amount of teachers university pedagogical training increased, the 3rd level of thinking about teaching could be identified more often. Teachers also used more often teaching development methods related to cooperation and active participation and enhancement of pedagogical skills. Furthermore, they considered the factors related to lack of pedagogical skills and motivation to be lesser impediments to teaching development.

Yliopiston oppimis- ja opetuskäsitykset murroksessa : Teknillistieteellisen alan opettajien käsityksiä ja lähestymistapoja alan oppimiseen ja opetukseen

The starting point for this study was university teaching and teachers and specifically their changing role when confronting the Finnish University Reform and the student-focused theories of learning. Teachers’ pedagogical thinking and pedagogical content knowledge were also part of the theoretical framework. In the research of conceptions of and approaches to learning and teaching, the qualitative classifications of Säljö and Marton (1976; 1997), Ramsden (1992), Kember (1997) and Trigwell and Prosser (1999) were utilised. Two study questions were raised (1) What kind of conceptions of and approaches to learning do engineering science teachers have? and (2) What kind of conceptions of and approaches to teaching do engineering science teachers have? The relationship between teachers’ conceptions and teaching was also examined. The research material was collected in autumn 2008 by interviewing teachers and by observing teaching in the Department of Energy Technology at Helsinki University of Technology. Altogether two tutorials and ten lectures were observed. Each teacher of the observed lectures was interviewed once. The interviews were carried out as semi-structured theme interviews. In the analysis of the research material phenomenographical approach was adapted. The study revealed many kinds of conceptions of and approaches to learning and teaching in the teachers’ speech. On the basis of the research material, the conceptions and approaches that the teachers declare do not always reflect their actions in the teaching situation. The surface approaches to learning and teacher-focused approaches to teaching and conceptions of receiving and transmission of knowledge were parallel. Instead the teachers’ declarations of the deep approaches to learning and student-focused approaches to teaching were partly in conflict with how the teacher taught. When striving towards student-centered teaching culture attention should be paid to the development of teachers’ pedagogical thinking and pedagogical content knowledge. The culture and the structures of the educational institution should also be considered.

Contemplating Whitehead's freedom and discipline

This paper extends the previous application of Alfred Whitehead's educational ideas to the domain of enterprise education. In doing so, a unique approach to enterprise education is illustrated that links students to their reality whilst also connecting the curriculum to contemporary entrepreneurship theory. The paper reports upon past cycles of reflective practice related to the developing hic et nunc teaching and learning framework. Two specific findings of note have emerged. First, that student' learning outcomes are enhanced through the oscillating influence of freedom and discipline. However, in the absence of either factor, sub-optimal outcomes are seen to occur. That is, an imbalance between freedom and discipline has resulted in sub-optimal outcomes from either a lack of student interest or an inability to adequately apply acquired knowledge. Where gains have been made, the most obvious process has been through consultation with students. Second, that the students also play an important role in shaping the nature of the learning environments within which they interact. Both findings are of significant importance to all academics charged with the responsibility of developing enterprise education curriculum. The main implication of the paper is that in the absence of sound pedagogical practises, it is possible that enterprise programs may develop a tendency to reinforce past practises. The processes of constructive alignment and criterion-based assessment are argued to offer avenues through which students can influence the educational process. They also provide the educator with a reflective pathway through which continual improvements are constantly possible. This paper provides other academics with a window through which to view the ongoing development of a process that has been recognised nationally for teaching excellence and influenced many fine young entrepreneurs. The paper also draws attention to a set of core educational philosophies that have transferable value to any academic setting. It is noted that the task of developing a learner-centred curriculum for enterprise education has been an entrepreneurial endeavour in itself. Many mistakes have been made and many memorable achievements have been celebrated.

Características pessoais e institucionais e comportamentos de autocuidado de docentes de enfermagem segundo os modos adaptativos de Roy: estudo em Instituições Públicas do Estado do Rio de Janeiro

Este trabalho enfoca a promoção da vida através de comportamentos saudáveis, tendo como objetivos: delinear o perfil sociodemográfico e institucional/profissional dos docentes de enfermagem e analisar seus hábitos de vida, segundo os modos adaptativos de Roy. Foi utilizada a Teoria de Sister Callista Roy, destacando-se os modos de adaptação: fisiológico, autoconceito e interdependência. Implementou-se o método descritivo, quantitativo, transversal através da técnica de autorelato em amostra de 101 docentes. Para investigar esses aspectos, utilizou-se dois questionários, um deles com a escala de Likert, adaptado para a pesquisa. A produção de dados transcorreu de janeiro a março de 2009, após aprovação do Comitê de Ética em Pesquisa, Protocolo 2187, e concordância das quatro instituições públicas de ensino universitário, do Estado do Rio de Janeiro-Brasil, selecionadas. Os dados obtidos foram submetidos á estatística, aplicando-se medidas de tendência central. Quanto ao perfil docente: predomina a faixa etária de 40 a 59 anos, com 69,3%, de união estável. Relacionando cor e crença religiosa, constatou-se 37,6% de católicos brancos. Dos 50 docentes, 5% têm residência própria, na zona norte. Possuem renda individual acima de 8 salários mínimos, 67,32%, a maioria com vínculo trabalhista. No tempo de serviço, 22,94% situam-se entre 11 a 15 anos, com carga horária de 20 a 40 horas. Quanto à titulação, 42,56% são doutores e 80,2% possuem um tipo de regime estatutário. Concernente aos Modos Adaptativos de Roy foi atribuído, predominantemente, o conceito A- hábitos de vida saudável, aos modos Fisiológicos e de Autoconceito, seguindo-se o de Interdependência, que apresentou quatro conceitos B- em busca de hábitos de vida saudável, sendo o mais homogêneo dos três modos. Identificou-se que o Modo Fisiológico foi heterogêneo, pois os valores das medidas de tendência central se distanciam entre si. Concluindo-se que o pressuposto formulado atendeu parcialmente às expectativas dos docentes por utilizarem, em benefício próprio, seus saberes sobre o cuidar promovendo o bem-estar com qualidade. Considerou-se que a interdependência pode ser conquistada pelos sujeitos, visto que o enfrentamento das suas atividades profissionais, paralelamente ao viver pessoal, pode ser motivo de satisfação com o trabalho docente, remuneração recebida, ambiente institucional, relações de poder/saber no trabalho, além da possibilidade de atender sua necessidade gregária promovendo o convívio com a família e amigos. Lembra-se que lidar com pessoas cujas subjetividades devem ser objetivadas, visando sua compreensão para o atendimento de saúde, exige equilíbrio e progresso das dimensões corporais física, mental e espiritual do profissional.

Formação de Formadores e Educação Superior na cibercultura: itinerâncias de Grupos de Pesquisa no Facebook

Esta tese origina-se da pesquisa de doutoramento na Universidade do Estado do Rio de Janeiro UERJ - Proped e tem como objetivo compreender a formação do formador no contexto da cibercultura e como este vem estruturando sua atuação na docência universitária. Este trabalho faz parte do eixo 2 da Pesquisa Institucional A cibercultura na era das redes sociais e da mobilidade: novas potencialidades para a formação de professores. O campo da pesquisa foi a rede social Facebook. Constituíram-se praticantes da pesquisa seis professores-formadores do ProPEd e seus orientandos. A pertinência desta pesquisa inscreveu-se num amplo movimento da perspectiva epistemológica da multirreferencialidade com os cotidianos e pelo método atualizado da pesquisa-formação. A intenção primeira deste trabalho consistiu em mapear as experiências e itinerâncias do formador em suas práticas cotidianas nos espaçostempos da cibercultura. Tencionamos que a sistematização de ambiências formativas articulando o espaço da universidade e das redes sociais criou redes de docência e aprendizagem. Como dispositivos de pesquisa, lançamos mão de oficinas, interações nas redes sociais, conversas, participação nos grupos de pesquisa. A tese revela que a formação do formador na cibercultura forja outros espaçostempos de pesquisa acadêmica e de criação de dispositivos online. Revela também que os usos do digital em rede pelos praticantes da pesquisa fizeram emergir processos de orientação coletiva, de experiências formadoras e de articulação da interface cidadeuniversidade, estabelecendo outros sentidos para a prática pedagógica e para a pesquisa acadêmica

The Role of SoTL in Classroom Innovation.

The Scholarship of Teaching and Learning (SoTL) is being promoted as an activity for teaching-focused academics in the UK. However, support for SoTL is not a priority for most institutions, and formal provision for such support may not extend beyond the postgraduate certificate in higher education that is offered for new academic staff. This paper examines the experiences of SoTL of a group of twenty-one Life Sciences academics from a range of UK universities. It explores the role that SoTL has to play in developing classroom innovation in a structured and scholarly manner, and the consequences to both teaching staff and students, if SoTL is not supported as an academic activity throughout the careers of teaching-focused academics.

Experiences during three generations of web based learning. Six years of web based communication

This paper tells the story of how a set of university lectures developed during the last six years. The idea is to show how (1) content, (2) communication and (3) assessment have evolved in steps which are named “generations of web learning”. The reader is offered a stepwise description of both didactic foundations of university lectures and practical implementation on a widely available web platform. The relative weight of directive elements has gradually decreased through the “three generations”, whereas characteristics of self-responsibility and self-guided learning have gained in importance. -Content was in early times presented and expected to be learned but in later phases expected to be constructed for examples of case studies. -Communication meant in early phases to deliver assignments to the lecturer but later on to form teams, exchange standpoints and review mutually. -Assessment initially consisted in marks invented and added up by the lecturer but was later enriched by peer review, mutual grading and voting procedures. How much “added value” can the web provide for teaching, training and learning? Six years of experience suggest: mainly insofar as new (collaborative and selfdirected) didactic scenarios are implemented! (DIPF/Orig.)

RuhrCampusOnline: Hochschulübergreifendes E-Learning in der Universitätsallianz Metropole Ruhr

Das Projekt RuhrCampusOnline zielt darauf ab, hochschulübergreifende Lehre für die Partnerhochschulen der Universitätsallianz Metropole Ruhr (UAMR) auf der Basis von Blended-Learning-Arrangements zu implementieren. Der Beitrag stellt die strategische Bedeutung dieses Vorhabens für die Universitäten im Ruhrgebiet dar und beschreibt die Organisation und Vorgehensweise im Projekt. Ziel ist es, einen Pool von Kursen zu implementieren, die einen hohen Online-Anteil haben, und von Studierenden hochschulübergreifend genutzt werden. Über die Internet-Plattform RCO werden diese Kurse sichtbar gemacht, das Belegen der Veranstaltung realisiert und der Austausch von Leistungspunkten unterstützt. Der Beitrag stellt erste Erfahrungen nach einem Jahr Projektlaufzeit vor. (DIPF/ Orig.)

Eradication of endotracheal tube biofilm by nebulised gentamicin.

Objective: To compare the efficacy of gentamicin, nebulised via the endotracheal tube (ET), with that of parenteral cefotaxime or parenteral cefuroxime in preventing the formation of ET biofilm.

Setting: General intensive care units in two university teaching hospitals.

Design: The microbiology of ET biofilm from 36 ICU patients eligible to receive antibiotic prophylaxis was examined. Peak and trough tracheal concentrations of gentamicin, cefotaxime or cefuroxime were measured in each patient group, on the 2nd day of intubation.

Patients: Twelve patients received gentamicin (80 mg) nebulised in 4 ml normal saline every 8 h, 12 cefotaxime (1 g, 12 hourly) and 12 cefuroxime (750 mg, 8 hourly). Prophylaxis was continued for the duration of intubation.

Measurements and results: Samples of tracheal secretions were taken on the 2nd day of ventilation for determination of antibiotic concentrations. Following extubation, ETs were examined for the presence of biofilm. Pathogens considered to be common aetiological agents for VAP included Staphylococcus aureus, enterococci, Enterobacteriaceae and pseudomonads. While microbial biofilm was found on all ETs from the cephalosporin group, microbial biofilm of these micro-organisms was found on 7 of the 12 ET tubes from patients receiving cefotaxime [S. aureus (4), pseudomonads (1), Enterobacteriaceae (1), enterococcus (1)] and 8 of the 12 ET tubes from patients receiving cefuroxime [Enterobacteriaceae (6), P. aeruginosa (1) and enterococcus (1)]. While microbial biofilm was observed on five ETs from patients receiving nebulised gentamicin, none of these were from pathogens for ventilator-associated pneumonia (VAP). Tracheal concentrations of both cephalosporins were lower than those needed to inhibit the growth of pathogens recovered from ET tube biofilm. The median (and range) concentrations for cefotaxime were 0.90 (<0.23–1.31) mg/l and 0.28 (<0.23–0.58) mg/l for 2 h post-dose and trough samples, respectively. Two hours post-dose concentrations of cefuroxime (median and range) were 0.40 (0.34–0.83) mg/l, with trough concentrations of 0.35 (<0.22–0.47) mg/l. Tracheal concentrations (median and range) of gentamicin measured 1 h post-nebulisation were 790 (352–>1250) mg/l and then, before the next dose, were 436 (250–1000) mg/l.

Conclusion: Nebulised gentamicin attained high concentrations in the ET lumen and was more effective in preventing the formation of biofilm than either parenterally administered cephalosporin and therefore may be effective in preventing this complication of mechanical ventilation.

Impaired endothelium-dependent vasodilatation is a novel predictor of mortality in intensive care

Objective: Endothelial function may be impaired in critical illness. We hypothesized that impaired endothelium-dependent vasodilatation is a predictor of mortality in critically ill patients.
Design: Prospective observational cohort study.
Setting: Seventeen-bed adult intensive care unit in a tertiary referral university teaching hospital. Patients: Patients were recruited within 24 hrs of admission to the intensive care unit.
Interventions: The SphygmoCor Mx system was used to derive the aortic augmentation index from radial artery pulse pressure waveforms. Endothelium-dependent vasodilatation was calculated as the change in augmentation index in response to an endothelium-dependent vasodilator (salbutamol).
Measurements and Main Results: Demographics, severity of illness scores, and physiological parameters were collected. Statistically significant predictors of mortality identified using single regressor analysis were entered into a multiple logistic regression model. Receiver operator characteristic curves were generated. Ninety-four patients completed the study. There were 80 survivors and 14 nonsurvivors. The Simplified Acute Physiology Score II, the Sequential Organ Failure Assessment score, leukocyte count, and endothelium-dependent vasodilatation conferred an increased risk of mortality. In logistic regression analysis, endothelium-dependent vasodilatation was the only predictor of mortality with an adjusted odds ratio of 26.1 (95% confidence interval [CI], 4.3-159.5). An endothelium-dependent vasodilatation value of 0.5% or less predicted intensive care unit mortality with a sensitivity of 79% (CI, 59-88%) and specificity of 98% (CI, 94-99%).
Conclusions: In vivo bedside assessment of endothelium-dependent vasodilatation is an independent predictor of mortality in the critically ill. We have shown it to be superior to other validated severity of illness scores with high sensitivity and specificity.

Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse Drug Events in Older Hospitalized Patients

Background: Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness.

Methods: We prospectively studied 600 consecutive patients 65 years or older who were admitted with acute illness to a university teaching hospital over a 4-month interval. Potentially inappropriate medicines were defined by both Beers and STOPP criteria. Adverse drug events were defined by World Health Organization–Uppsala Monitoring Centre criteria and verified by a local expert consensus panel, which also assessed whether ADEs were causal or contributory to current hospitalization. Hallas criteria defined ADE avoidability.Wecompared the proportions of patients taking Beers criteria PIMs
and STOPP criteria PIMs with avoidable ADEs that were causal or contributory to admission.

Results: A total of 329 ADEs were detected in 158 of 600 patients (26.3%); 219 of 329 ADEs (66.6%) were considered causal or contributory to admission. Of the 219 ADEs, 151(68.9%)considered causal or contributory to admission were avoidable or potentially avoidable. After adjusting for age, sex, comorbidity, dementia, baseline activities of daily living function, and number of medications, the likelihood of a serious avoidable ADE increased significantly when STOPP PIMs were prescribed (odds ratio, 1.847; 95% confidence interval [CI], 1.506-2.264; P.001); prescription of Beers criteria PIMs did not significantly increase ADE risk (odds ratio, 1.276; 95% CI, 0.945-1.722; P=.11).

Conclusion: STOPP criteria PIMs,unlike Beers criteria PIMs, are significantly associated with avoidable ADEs in older people that cause or contribute to urgent hospitalization.