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

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

Building support for learning within a Doctor of Education programme

Professional doctorates were introduced in the 1990s for practitioners to research ‘real-world’ problems relevant to their respective workplace communities and contexts. An array of difficulties faces professional doctoral students as they transition from professionals to practitioner researchers. This study sought to understand the learning journey of a cohort of students at an Australian university and to assess whether the cohort approach provided the necessary support for students to reach their scholarly destinations. Throughout the first 18 months of the programme, focus group interviews and surveys were conducted to gauge students’ experiences and to evaluate developments for support within the programme. Utilising a socio-cultural perspective helped identify and explain the importance of shared practice in fostering learning, the development of academic and researcher identities, and the role of communities of practice. Challenges of managing time and overcoming the professional and academe divide were facilitated by the evolving developments of the programme.

The constraints-based approach to motor learning : Implications for a non-linear pedagogy in sport and physical education

Recently, a constraints- led approach has been promoted as a framework for understanding how children and adults acquire movement skills for sport and exercise (see Davids, Button & Bennett, 2008; Araújo et al., 2004). The aim of a constraints- led approach is to identify the nature of interacting constraints that influence skill acquisition in learners. In this chapter the main theoretical ideas behind a constraints- led approach are outlined to assist practical applications by sports practitioners and physical educators in a non- linear pedagogy (see Chow et al., 2006, 2007). To achieve this goal, this chapter examines implications for some of the typical challenges facing sport pedagogists and physical educators in the design of learning programmes.

The role of academic community in higher learning : Alternatives to a drive-thru education

The purpose of our paper is to illustrate the fundamental importance of developing academic community among first year students. We argue that a sense of academic community is of fundamental importance in combating the effects of the neo-liberal economic discourse on higher education, and that the values of higher education are incongruent with those of economic rationalism. The discursive commodification of the student, and of education itself, works against the formation of community, both within the university environment and in the wider society. We argue that, at present, the dominant discourse shaping the social practice of higher education is that of neo-liberal economics. Community values stand in opposition to the dominant discourse, and are integral to the long-term survival of a socially critical and socially responsive society. We conclude that the importance of establishing a sense of academic community during the first year of university is justified by its ultimate value to society.

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

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

Improving the provision of learning assistance services in higher education

This study is motivated by the need to look continually for ways to improve Griffith University's learning assistance services so that they meet the changed needs of stakeholders and are at the same time cost-effective and efficient. This study uses the conceptual tools of cultural-historical activity theory and expansive visibilisation to investigaate the developmenet and transformation of learning assistance services at Griffith University, one of Australia's largest mult-campus universities.

Scaffolding techniques : a teacher training for cooperative learning in Thailand primary education

In general, the benefits of using cooperative learning include academic achievement, communication skills, problem-solving, social skills and student motivation. Yet cooperative learning as a Western educational concept may be ineffective in a different learning system. The study aims to investigate scaffolding techniques for cooperative learning in Thailand primary education. The program was designed to foster Thai primary school teachers’ cooperative learning implementation that includes the basic tenets of cooperative learning and socio-cognitive based learning. Two teachers were invited to participate in this experimental teacher training program for one and a half weeks. Then the teachers implemented a cooperative learning in their mathematics class for six weeks. The data from teacher interview and classroom observation indicated that the both teachers are able to utilise questions to scaffold their students’ engagement in cooperative learning. This initiative study showed that difficulty or failure of implementing cooperative learning in Thailand education may not be derived from cultural difference. The paper discussed the techniques the participant teachers applied with proactive scaffolding, reactive scaffolding and scaffolding questions that can be used to facilitate the implementation of cooperative learning in Thai school.

Theorising a model for teaching and assessing reflective learning in higher education

The importance of reflection in higher education, and across disciplinary fields is widely recognised; it is generally included in university graduate attributes, professional standards and program objectives. Furthermore, reflection is commonly embedded into assessment requirements in higher education subjects, often without necessary scaffolding or clear expectations for students. Despite the rhetoric around the importance of reflection for ongoing learning, there is scant literature on any systematic, developmental approach to teaching reflective learning across higher education programs/courses. Given that professional or academic reflection is not intuitive, and requires specific pedagogic intervention to do well, a program/course-wide approach is essential. This paper draws on current literature to theorise a new, transferable and customisable model for teaching and assessing reflective learning across higher education, which foregrounds and explains the pedagogic field of higher education as a multi-dimensional space. We argue that explicit and strategic pedagogic intervention, supported by dynamic resources, is necessary for successful, broad-scale approaches to reflection in higher education.

An ecological footprint for an early learning centre : identifying opportunities for early childhood sustainability education through interdisciplinary research

In this study, engineers and educators worked together to adapt and apply the ecological footprint (EF) methodology to an early learning centre in Brisbane, Australia. Results were analysed to determine how environmental impact can be reduced at the study site and more generally across early childhood settings. It was found that food, transport and energy consumption had the largest impact on the centre’s overall footprint. In transport and energy, early childhood centres can reduce their impact through infrastructure and cultural change, in association with changed curriculum strategies. Building design, the type of energy purchased and appliance usage can all be modified to reduce the energy footprint. The transport footprint can be reduced through more families using active and public transport, which can be encouraged by providing information, support and facilities and appropriate siting of new centres. Introducing the concept of ecological footprint in early childhood education may be an effective way to educate children, staff and parents on the links between the food they eat, land usage and environmental impact. This study responds directly to the call in this journal for research focused on early childhood education and for more to be made of interdisciplinary research opportunities.

High fidelity simulation; challenges encountered in developing and implementing student learning experiences, staff education and researching approaches to learning

High fidelity simulation as a teaching and learning approach is being embraced by many schools of nursing. Our school embarked on integrating high fidelity (HF) simulation into the undergraduate clinical education program in 2011. Low and medium fidelity simulation has been used for many years, but this did not simplify the integration of HF simulation. Alongside considerations of how and where HF simulation would be integrated, issues arose with: student consent and participation for observed activities; data management of video files; staff development, and conceptualising how methods for student learning could be researched. Simulation for undergraduate student nurses commenced as a formative learning activity, undertaken in groups of eight, where four students undertake the ‘doing’ role and four are structured observers, who then take a formal role in the simulation debrief. Challenges for integrating simulation into student learning included conceptualising and developing scenarios to trigger students’ decision making and application of skills, knowledge and attitudes explicit to solving clinical ‘problems’. Developing and planning scenarios for students to ‘try out’ skills and make decisions for problem solving lay beyond choosing pre-existing scenarios inbuilt with the software. The supplied scenarios were not concept based but rather knowledge, skills and technology (of the manikin) focussed. Challenges lay in using the technology for the purpose of building conceptual mastery rather than using technology simply because it was available. As we integrated use of HF simulation into the final year of the program, focus was on building skills, knowledge and attitudes that went beyond technical skill, and provided an opportunity to bridge the gap with theory-based knowledge that students often found difficult to link to clinical reality. We wished to provide opportunities to develop experiential knowledge based on application and clinical reasoning processes in team environments where problems are encountered, and to solve them, the nurse must show leadership and direction. Other challenges included students consenting for simulations to be videotaped and ethical considerations of this. For example if one student in a group of eight did not consent, did this mean they missed the opportunity to undertake simulation, or that others in the group may be disadvantaged by being unable to review their performance. This has implications for freely given consent but also for equity of access to learning opportunities for students who wished to be taped and those who did not. Alongside this issue were the details behind data management, storage and access. Developing staff with varying levels of computer skills to use software and undertake a different approach to being the ‘teacher’ required innovation where we took an experiential approach. Considering explicit learning approaches to be trialled for learning was not a difficult proposition, but considering how to enact this as research with issues of blinding, timetabling of blinded groups, and reducing bias for testing results of different learning approaches along with gaining ethical approval was problematic. This presentation presents examples of these challenges and how we overcame them.

The professional conversation : a new approach to professional learning in early childhood education and care

In 2009, Australia celebrated the introduction of a national Early Years Learning Framework. This is a critical component in a series of educational reforms designed to support quality pedagogy and practice in early childhood education and care (ECEC) and successful transition to school. As with any policy change, success in real terms relies upon building shared understanding and the capacity of educators to apply new knowledge and support change and improved practice within their service. With these outcomes in mind, a collaborative research project is investigating the efficacy of a new approach to professional learning in ECEC: The professional conversation. This paper provides an overview of the professional conversation approach, including underpinning principles and the design and use of reflective questions to support meaningful conversation and learning.

New perspectives on context-based chemistry education : using a dialectical sociocultural approach to view teaching and learning

Context-based chemistry education aims to improve student interest and motivation in chemistry by connecting canonical chemistry concepts with real-world contexts. Implementation of context-based chemistry programmes began 20 years ago in an attempt to make the learning of chemistry meaningful for students. This paper reviews such programmes through empirical studies on six international courses, ChemCom (USA), Salters (UK), Industrial Science (Israel), Chemie im Kontext (Germany), Chemistry in Practice (The Netherlands) and PLON (The Netherlands). These studies are categorised through emergent characteristics of: relevance, interest/attitudes motivation and deeper understanding. These characteristics can be found to an extent in a number of other curricular initiatives, such as science-technology-society approaches and problem-based learning or project based science, the latter of which often incorporates an inquiry-based approach to science education. These initiatives in science education are also considered with a focus on the characteristics of these approaches that are emphasised in context-based education. While such curricular studies provide a starting point for discussing context-based approaches in chemistry, to advance our understanding of how students connect canonical science concepts with the real-world context, a new theoretical framework is required. A dialectical sociocultural framework originating in the work of Vygotsky is used as a referent for analysing the complex human interactions that occur in context-based classrooms, providing teachers with recent information about the pedagogical structures and resources that afford students the agency to learn.

Investigating higher education and secondary school web-based learning environments using the WEBLEI

Classroom learning environments are rapidly changing as new digital technologies become more education-friendly. What are students’ perceptions of their technology-rich learning environments? This question is critical as it may have an impact on the effectiveness of the new technologies in classrooms. There are numerous reliable and valid learning environment instruments which have been used to ascertain students’ perceptions of their learning environments. This chapter focuses on one of these instruments, the Web-based Learning Environment Instrument (WEBLEI) (Chang & Fisher, 2003). Since its initial development, this instrument has been used to study a range of learning environments and this chapter presents the findings of two example case-studies that involve such environments.