Nurse Education

This article examines five common misunderstandings about case-study research: (a) theoretical knowledge is more valuable than practical knowledge; (b) one cannot generalize from a single case, therefore, the single-case study cannot contribute to scientific development; (c) the case study is most useful for generating hypotheses, whereas other methods are more suitable for hypotheses testing and theory building; (d) the case study contains a bias toward verification; and (e) it is often difficult to summarize specific case studies. This article explains and corrects these misunderstandings one by one and concludes with the Kuhnian insight that a scientific discipline without a large number of thoroughly executed case studies is a discipline without systematic production of exemplars, and a discipline without exemplars is an ineffective one. Social science may be strengthened by the execution of a greater number of good case studies.

Back cover text: If the new fin de siècle marks a recurrence of the real, Bent Flyvbjerg’s Rationality and Power epitomizes that development and sets new standards for social and political inquiry. The Danish town of Aalborg is to Flyvbjerg what Florence was to Machiavelli: a laboratory for understanding the real workings of power, and for grasping what they mean to our more general concerns of social and political organization. Politics, administration, and planning are examined in ways that allow  a rare, in-depth understanding. The reader witnesses, firsthand, the classic and endless drama which defines what modernity and democracy are and can be.

This article presents the theoretical and methodological considerations behind a research method which the author calls ‘phronetic planning research’. Such research sets out to answer four questions of power and values for specific instances of planning: (1) Where are we going with planning? (2) Who gains and who loses, and by which mechanisms of power? (3) Is this development desirable? (4) What, if anything, should we do about it? A central task of phronetic planning research is to provide concrete examples and detailed narratives of the ways in which power and values work in planning and with what consequences to whom, and to suggest how relations of power and values could be changed to work with other consequences. Insofar as planning situations become clear, they are clarified by detailed stories of who is doing what to whom. Clarifications of that kind are a principal concern for phronetic planning research and provide the main link to praxis.

Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory Background. Effective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skills. While a number of strategies have been implemented and tested to promote these skills, educators have not been able consistently to predict their development. Self-regulated learning theory suggests that this development requires concurrent attention to both the cognitive and metacognitive dimensions of reasoning in nursing care contexts. Aims. This paper reports on a study to explore the impact of self-regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills. Methods. Integrative review of published literature in social science, educational psychology, nursing education, and professional education using the Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resource Information Center (ERIC), and American Psychological Association (PsychInfo) Databases. The search included all English language articles with the key words clinical reasoning, cognition, critical thinking, metacognition, reflection, reflective practice, self-regulation and thinking. Findings. Reflective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skill acquisition. This skill acquisition is best accomplished through teaching-learning attention to self-regulation learning theory. A critical analysis of the literature in the areas of critical thinking and reflective practice are described as a background for contemporary work with self-regulated learning theory. It is apparent that single-minded attention to critical thinking, without attention to the influence of metacognition or reflection, is but one perspective on clinical reasoning development. Likewise, single-minded attention to metacognition or reflection, without attention to the influence of critical thinking, is another perspective on clinical reasoning development. While strategies to facilitate critical thinking and reflective practice have been used in isolation from each other, there is evidence to suggest that they are inextricably linked and come together with the use of self-regulated learning prompts. Conclusions. Students and practising nurses are able to improve their cognitive and metacognitive skills in clinical contexts by using self-regulated learning Ó 2004 Blackwell Publishing Ltd 381 strategies. The self-regulated learning model in nursing is offered to support teaching and learning of reflective clinical reasoning in nursing practice contexts.

Taken together, the works of Jurgen Habermas and Michel Foucault highlight an essential tension in modernity. This is the tension between the normative and the real, between what should be done and what is actually done. Understanding this tension is crucial to understanding modern democracy, what it is and what it could be. It has been argued that an effective way of making democracy stronger is to strengthen civil society. This article contains a comparative analysis of the central ideas of Habermas and Foucault as they pertain to the question of democracy and civil society. More specifically, the discourse ethics of Habermas is contrasted with the power analytics and ethics of Foucault evaluating their usefulness for those interested in understanding, and bringing about, democratic social change.

The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal qualitative studyParker and Carlisle (Journal of Advanced Nursing24, 771–778) argue that there is a scarcity of empirical research focusing on issues such as supernumerary status and mentorship in Project 2000 courses from the students’ perspective. This paper presents the findings of a longitudinal cohort study using Grounded Theory to discover the effect(s) of mentorship on student nurses following the introduction of the 1992 programme of education leading to a Diploma of Higher Education in Nursing and registration with the United Kingdom Central Council (UKCC). The cohort consisted of 10 students from a large Scottish College of Nursing & Midwifery who were interviewed on five occasions during the three years of their course. Students also kept a diary to record their thoughts and experiences regarding mentorship during their practice placements. In addition, a further seven students volunteered to participate by diary only. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that Diploma students quickly lose their idealistic view of their mentor and over time develop an insight into the qualities they perceive are required of an effective mentor. Students quickly become aware of the importance of choosing good role models and learning their own mentor’s likes and dislikes as they realize this impinges on the outcome of their assessment. As students move into their Branch programme, a gradual distancing from their mentor is evident. This coincides with a development in their confidence, skills and a holistic perspective of care.

In this paper we argue that the use of the communicative theory of Jürgen Habermas in planning theory is problematic because it hampers an understanding of how power shapes planning. We posit an alternative approach based on the power analytics of Michel Foucault which focuses on ‘what is actually done’, as opposed to Habermas’s focus on ‘what should be done’. We discuss how the Foucauldian stance problematises planning, asking difficult questions about the treatment of legitimacy, rationality, knowledge and spatiality. We conclude that Foucault offers a type of analytic planning theory which offers better prospects than does Habermas for those interested in understanding and bringing about democratic social change through planning.

In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses-in 2005, there were 1·9 million licensed doctors and 1·4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold diff erence. Most of China's doctors (67·2%) and nurses (97·5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban-rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly signifi cant in explaining infant mortality.

Objectives: To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children.
Design: A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation-
formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE1 methodology. Due to the current paucity of
sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion.
Results: The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations.
Conclusion: Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.

This article provides an answer to what has been called the biggest problem in theorizing and understanding planning: the ambivalence about power found among planning researchers, theorists, and students. The author narrates how he came to work with issues of power and gives an example of how the methodology he developed for power studies—phronetic planning research—may be employed in practice. Phronetic planning research follows the tradition of power studies running from Machiavelli and Nietzsche to Michel Foucault and Pierre Bourdieu. It focuses on four value-rational questions: (1) Where are we going with planning? (2) Who gains and who loses, and by which mechanisms of power? (3) Is this development desirable? (4) What should be done? These questions are exemplified for a specific instance of Scandinavian urban planning. The author finds that the questions, and their answers, make a difference to planning in practice. They make planning research matter.

The Aalborg Project may be interpreted as a metaphor of modern politics, modern administration and planning, and of modernity itself. The basic idea of the project was comprehensive, coherent, and innovative, and it was based on rational and democratic argument. During implementation, however, when idea met reality, the play of Machiavellian princes, Nietzschean will to power, and Foucauldian rationality-as-rationalization resulted in the fragmentation of the project.

To review the literature on the use of simulation in the development of non-technical skills in nursing The potential risks to patients associated with learning 'at the bedside' are becoming increasingly unacceptable, and the search for innovative education and training methods that do not expose the patient to preventable errors continues. All the evidence shows that a significant proportion of adverse events in health care is caused by problems relating to the application of the 'non-technical' skills of communication, teamwork, leadership and decision-making. Simulation is positively associated with significantly improved interpersonal communication skills at patient handover, and it has also been clearly shown to improve team behaviours in a wide variety of clinical contexts and clinical personnel, associated with improved team performance in the management of crisis situations. It also enables the effective development of transferable, transformational leadershi...

In 1997, a revised system was introduced at the University of Glamorgan, Wales, to assess student nurse clinical competency. This was firstly as a result of concerns that the previous system was based on limited documentary evidence, and, secondly as the Welsh National Board for Nursing and Midwifery issued new competency statements.

Aim.  This paper reports a study examining the influence of age, ethnicity and part-time employment on nursing students’ academic performance for second year pathophysiology and nursing practice subjects.Background.  Age and ethnicity are known to be significant predictors of academic achievement among nursing students. The endemic nursing shortage has increased the impetus to diversify, resulting in more mature-age students and students from diverse ethnic and cultural groups in nursing programmes. There is increasing pressure for nursing students to participate in part-time employment whilst undertaking higher education, and this may affect their academic performance.Methods.  A prospective, quantitative survey design was used to collect data from a regional university in Australia over a 2-year period from 2001 to 2002. A total of 267 nursing students were included in the study.Findings.  More than three-quarters (78%) of second year students were participating in paid employment, with the majority in nursing-related jobs. Of those working, half did so more than 16 hours per week during the semester. Students who were not in paid employment had the highest academic achievements in both pathophysiology and nursing practice. Age was positively related with academic performance, but hours of part-time employment and ethnicity were negatively associated with academic performance, with the amount of time spent in paid employment being the strongest predictor of academic performance in both pathophysiology and nursing practice.Conclusion.  Working more than 16 hours per week had a detrimental impact on the academic performance of nursing students. More importantly, this study shows that nursing-related employment is not advantageous to students’ academic performance, even for a nursing practice-based subject. If the current practice of employing nursing students in clinical settings is to continue, this experience needs to be aligned to the academic curriculum if it is to be beneficial to students’ knowledge and skill acquisition.

Objective: This study was conducted to describe learning styles of third year nursing students. Design: An interventional study Setting: a public university in Jordan. Subjects: Used a purposive sample of 92 nursing students who were enrolled in maternity nursing course. Main Outcome measures: Measure the difference in learning styles of nursing students after introducing an intervention of PBL as a teaching methodology. Results: The dominant learning preference of the students was the read/write preference followed by the kinesthetic, still most of the students represented a multimodal learning preference. No significant difference was found between males and females. A significant difference in the learning preferences of the students in the pre-post test was found. In the pretest the mean of the total VARK score 13.9 (SD = 2) where as in the post test the mean of the total VARK score = 16.5 (SD = 3.5). In the pre-test 54% of students had a multimodal preference whereas 68% of students have a multimodal preference post-test. Conclusions: Most students are able to learn effectively as long as the instructor provides different learning activities in the areas assessed in VARK. Active learning might be enhanced in large classrooms by presenting models and demonstrations, discussions, debates, answering questions, and role playing.

In Europe, there have been reforms in nursing education during last years and many political papers have been published. The reforms have given need for harmonising nursing education. In spite of that, there are differences in nursing education system in Europe. In this paper, we describe some main policy papers in the field of nursing education and identify selected future challenges. These challenges have been named for developing cross-cultural collaboration, clinical learning environment, role of patients and teacher education. (M. Stolt), [email protected] (M. Saarikoski), [email protected] (A. Suikkala), [email protected] (H. Vaartio), [email protected] (H. Leino-Kilpi).

Online learning: enhancing nurse education?Aims of the study. The aim of this study was to explore the experiences of nursing students with `online' learning.Background. The need to integrate information technology into nursing education has been recognized and well documented. In spite of this, information technology remains a neglected subject in many nursing programmes. Strategies have been considered for increasing the integration of information technology in nursing education. One of the key issues identified is the need for research into the factors that contribute to optimal learning with information technology, specifically the need to explore issues that contribute to student frustration and satisfaction with learning. Within Australia, the incorporation of information technology as a core subject in nursing education is still relatively new. This article describes how one university used `online' learning to expose students to conceptual and experiential opportunities that enabled them to develop skills in the management of information technology.Methods. Twenty-one students participated in this qualitative study. Individual interviews were used to develop insights into student perceptions. Thematic analysis enabled refined themes to emerge. These themes formed the basis of focus group discussions. Focus groups were used to enhance and validate the information from one-to-one interviews by using group dynamics to add experiential richness to the data.Findings. Four major themes emerged: computer confidence, flexibility, active learning and practicalities of teaching.Conclusions. The integration of information technology into nursing education requires a dramatic change in thinking. The `learning curve' is steep for both student and educator and there are many issues that need to be considered. This research does not aim to provide solutions to the issues highlighted but rather offers recommendations for enhancing the teaching and learning experience.

The challenges confronting nurses in today's health care environments have highlighted the necessity for graduating students to feel both competent and prepared for practice. The aim of the aspect of the study reported in this article was to determine the relationship between the location of clinical placements and competence and preparedness for practice from the perspective of the nursing students. A quasi-experimental design using a pre-test post-test survey was used. The population consisted of all final year Bachelor of Nursing students at Queensland University of Technology, who undertook their clinical placement in either a rural or metropolitan location. The response rate was 65% in the pretest (n=137) and 57% in the posttest (n=121). The results of the study highlight the importance of both rural and metropolitan clinical environments in developing not only student competency but also students' satisfaction with their clinical experience. The results suggest that the selection of a rural placement is more likely to occur when students feel competent, confident and organised about their clinical experience. Strategies to increase students' perceptions of competence and confidence to undertake a rural placement are likely to increase students' selection to 'go rural'.

Goal: To provide healthcare professionals with comprehensive multidisciplinary expert recommenda-
tions for the acute care of severe limb trauma patients, both during the prehospital phase and after admission to a Trauma Centre.
Design: A consensus committee of 21 experts was formed. A formal conflict-of-interest (COI) policy was
developed at the onset of the process and enforced throughout. The entire guidelines process was
conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors
were advised to follow the rules of the Grading of Recommendations Assessment, Development and
Evaluation (GRADE1) system to guide assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations remained non-graded.
Methods: The committee addressed eleven questions relevant to the patient suffering severe limb trauma: 1) What are the key findings derived from medical history and clinical examination which lead to the patient’s prompt referral to a Level 1 or Level 2 Trauma Centre? 2) What are the medical devices that must be implemented in the prehospital setting to reduce blood loss? 3) Which are the clinical findings prompting the performance of injected X-ray examinations? 4) What are the ideal timing and modalities for performing fracture fixation? 5) What are the clinical and operative findings which steer
the surgical approach in case of vascular compromise and/or major musculoskeletal attrition? 6) How to
best prevent infection? 7) How to best prevent thromboembolic complications? 8) What is the best
strategy to precociously detect and treat limb compartment syndrome? 9) How to best and precociously
detect post-traumatic rhabdomyolysis and prevent rhabdomyolysis-induced acute kidney injury? 10)
What is the best strategy to reduce the incidence of fat emboli syndrome and post-traumatic systemic
inflammatory response? 11) What is the best therapeutic strategy to treat acute trauma-induced pain?
Every question was formulated in a PICO (Patient Intervention Comparison Outcome) format and the
evidence profiles were produced. The literature review and recommendations were made according to the GRADE1 methodology.
Results: The experts’ synthesis work and the application of the GRADE method resulted in 19 recommendations. Among the formalised recommendations, 4 had a high level of evidence (GRADE 1+/) and 12 had a low level of evidence (GRADE 2+/). For 3 recommendations, the GRADE method could not be applied, resulting in an expert advice. After two rounds of scoring and one amendment,
strong agreement was reached on all the recommendations.
Conclusions: There was significant agreement among experts on strong recommendations to improve
practices for severe limb trauma patients.

Aim: This paper reports the development and psychometric testing of the Satisfaction with Simulation Experience Scale, an instrument designed to measure and compare differences in satisfaction levels between nursing students exposed to medium and high fidelity human patient simulation manikins. Background: Student satisfaction is important to engaged and meaningful learning and it facilitates active and purposeful participation in simulation experiences. There are suggestions that student satisfaction may have some correlation with performance. Few studies have explored in a rigorous way the impact of manikin fidelity on nursing students' satisfaction with simulation experiences. Method: The items for the Satisfaction with Simulation Experience Scale were identified following a critical review of the literature. Content validly was established by use of an expert panel. During 2009 and 2010 the instrument was tested with second year (n = 268) and third year nursing students (n = 76) from one Australian university. Exploratory factor analysis with varimax rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Differences in satisfaction levels between groups were analysed using an independent t test. Responses to an open ended question were categorised using thematic content analysis. Results: The scale demonstrated satisfactory internal consistency (alpha 0.77). Exploratory factor analysis yielded a three-component structure termed Debriefing and Reflection, Clinical Reasoning, and Clinical Learning; each subscale demonstrated high internal consistency: 0.94; 0.86; 0.85 respectively. Mean satisfaction scores were high for each group. However, statistically significant differences were not apparent between second or third year students exposed to medium and high fidelity manikins. Content analysis identified 13 main categories including supplementing versus replacing clinical placements and the need for increased exposure to simulation sessions. Conclusion: The results of this study indicate that simulation is highly valued by students, irrespective of the level of fidelity. This raises questions about the value of investing in expensive simulation modalities. The Satisfaction with Simulation Experience Scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.

Web-based technologies are increasingly being used to create modes of online learning for nurses but their effect has not been assessed in nurse education. Assess whether participation in face-to-face discussion seminars or online asynchronous discussion groups had different effects on educational attainment in a web-based course. Non-randomised or quasi-experimental design with two groups-students choosing to have face-to-face discussion seminars and students choosing to have online discussions. The Core Methods module of a postgraduate research methods course. All 114 students participating in the first 2 yr during which the course teaching material was delivered online. Assignment mark for Core Methods course module. Background details of the students, their choices of modules and assignment marks were collected as part of the routine course administration. Students' online activities were identified using the student tracking facility within WebCT. Regression models were fit...

The first year as a graduate nurse-an experience of growth and development Aim. The aim of this paper was to illuminate how recently graduated nurses experience their first year as a nurse. Background. Graduate nurses are expected to identify themselves as members of an interdisciplinary team, to feel comfortable in chaos and to make and defend decisions. By graduation nurses expect to have the necessary competence to perform nursing. Recently graduated nurses lack competence, especially relating to leadership. Design. A qualitative design was chosen and 12 nurses working in hospitals and home care were individually interviewed. Method. The interviews were transcribed verbatim and the texts were analysed using manifest and latent content analysis. Results. The nurses gave descriptions covering numerous experiences, interpreted and categorised in the following eight subcategories: uncertainty and chaos; need for induction; need for a supportive environment; need for recognition; awareness of responsibility; need for positive experiences; becoming experienced; and managing challenges. These subcategories gave reason for the three categories: experience of being new; gaining nurse experience; and gaining competence. The nurses described a tough start as a nurse, but they most of all gave descriptions interpreted as an experience of growth and development, which constituted the theme in this study. Conclusions. Recently graduated nurses have a positive attitude to the challenges of being a new nurse. Although the initial period as a nurse was tough, the nurses appreciated their experiences because they learnt from them. Relevance to clinical practice. Recently graduated nurses should be spared from being the only nurse on duty. Employers both in hospital and home care should facilitate induction programmes for new graduate nurses.

Niccolò Machiavelli, the founder of modern political and administrative thought, made clear that an understanding of politics requires distinguishing between formal politics and what later, with Ludwig von Rochau, would become known as Realpolitik. No such distinction has been employed in the study of rationality. Yet I will argue that distinguishing between formal rationality and real rationality is as important for the understanding of rationality and planning as the distinction between formal politics and Realpolitik has been for understanding politics.

The effect of problem-based learning (PBL) on nursing students' approaches to learning has received scanty attention in nursing education. The purpose of the present study was to evaluate the effect of PBL on students' approaches to learning in clinical nursing education. Using a one-group before-after quasiexperimental design, the revised two-factor Study Process Questionnaire (R-SPQ-2F) was administered to compare students' approaches to learning before and after a period of clinical education in which PBL was implemented. Focus group interviews were used to elicit from students their PBL experience. Of the 237 students who participated in the study, 187 returned the R-SPQ-2F, representing a response rate of 78.9%. Twenty-eight of the students also participated in focus group interviews. The R-SPQ-2F scores indicated that for the deep approach to learning, the post-test mean score was noticeably higher than that at the pre-test (p = 0.005). No significant difference was observed between the pre-test and post-test mean scores for the surface approach to learning (p P 0.05). The four themes inductively derived from students' descriptions of their clinical education experience (motivated to learn; self-direction in learning; active, interactive and student-centred learning; and enjoyment in learning) also suggested that the students adopted a deep approach to learning during a period of clinical education in which PBL was implemented.

Most of the attrition from nursing courses occurs in the first year of study. Devising university strategies to reduce attrition requires an understanding of why students leave. The aim of this study was to explore whether students who leave a nursing course in the first semester leave for the same or different reasons than students who leave in the second semester of study. Seventeen students who had left the course were interviewed by telephone: seven in the first semester and ten in the second. In the first semester, students who leave consider themselves unprepared for university, have competing roles outside university and develop a strong dislike of the nursing course. They decide quickly that the course is unsuitable and leave. Those who leave in second semester would prefer to stay but events in their life create a crisis where they can no longer cope with university studies. These students hope to return to nursing whereas students who leave in the first semester are unlikely to consider returning. Attempts to retain students in the first semester may be futile as these students may be unsuited or uncommitted whereas there is greater scope to retain those who leave in the second semester.

Competence is one of the most commonly used words in nursing internationally, yet is a nebulous concept defined in diverse ways by different healthcare practitioners. The slippery nature of the concept often exists purely in the eye of the beholder however, the universal principles are deeply rooted in the measurement of the Registered Nurse's (RN) ability to perform effectively. Competence is a simpler thing to define when recognising where it does not exist in the form of incompetence. The aim of this paper is to present finding from a concept analysis that explored various facets of competence, particularly how it has been interpreted, applied and transformed over the years within nurse education in the United Kingdom. The analysis utilised a systematic review of contemporary evidence base based on theory construction by Walker and Avant (2005), a primary concern being to understand the underpinning conceptual principles that define the concept of competence and competency development and how these may be used to inform our understandings. The analysis identified how influential academics and professional bodies have attempted to provide definitions and concluded that it may be the existence of so many of these definitions, which has compounded the conundrum of what competence really is.

Journal of Clinical Nursing 14, 945-955 Supporting learners in clinical practice: capacity issues Aim. The aim of this paper is to report a study exploring, from the perspective of key stakeholders (mentors of nurses, managers of nurses, and modern matrons) in one English acute sector hospital, how decisions are made on how many learner Ó 2005 Blackwell Publishing Ltd 945

Factors affecting quality of oral care in intensive care units Aims. This paper presents a study to assess to nurses' attitudes and practices concerning oral care and to determine predictors of the quality of oral care in intensive care units. Background. The oropharynx of critically ill patients becomes colonized with potential respiratory pathogens; oral care has been shown to reduce oropharyngeal bacteria and ventilator-associated pneumonia. Methods. In April 2002, a random and national sample of 420 intensive care unit directors was asked to participate in the survey. Of invited directors, 126 (30%) agreed to participate and were sent questionnaires to be completed anonymously by their staff, and 102 institutions returned 556 surveys. This gave a response rate of 83% of those who consented to participate.

Background: Practical hands-on learning opportunities are viewed as a vital component of the education of health science students, but there is a critical shortage of fieldwork placement experiences. It is therefore important that these clinical learning environments are well suited to students' perceptions and expectations. Purpose: To investigate how undergraduate students enrolled in health-related education programs view their clinical learning environments and specifically to compare students' perception of their 'actual' clinical learning environment to that of their 'preferred/ideal' clinical learning environment. Method: The Clinical Learning Environment Inventory (CLEI) was used to collect data from 548 undergraduate students (55% response rate) enrolled in all year levels of paramedics, midwifery, radiography and medical imaging, occupational therapy, pharmacy, nutrition and dietetics, physiotherapy and social work at Monash University via convenience sampling. Students were asked to rate their perception of the clinical learning environment at the completion of their placements using the CLEI. Results: Satisfaction of the students enrolled in the health-related disciplines was closely linked with the five constructs measured by the CLEI: Personalization, Student Involvement, Task Orientation, Innovation, and Individualization. Significant differences were found between the student's perception of their 'actual' clinical learning environment and their 'ideal' clinical learning environment. Conclusion: The study highlights the importance of a supportive clinical learning environment that places emphasis on effective two-way communication. A thorough understanding of students' perceptions of their clinical learning environments is essential.

This paper analyses the current standing of nursing within the wider United Kingdom (UK) higher education (HE) environment and considers the development of academic identity within the sector, introducing a technology mediated approach to professional learning and development. A community of practice (CoP) is a way of learning based on collaboration among peers. Individuals come together virtually or physically, with a common purpose, defined by knowledge rather than task (Wenger 1998). In 2008, a small team of academics at Glasgow Caledonian University, School of Nursing, Midwifery and Community Health created and implemented iCoP, a project undertaken to pilot an international community of practice, where novices and expert academics collaborated to debate and discuss the complex transition from clinician to academic. Although not intended as a conventional research project, the developmental journey and emerging online discussion provide an insight into the collective thoughts and opinions of a multi-national group of novice academics. The article also highlights the key challenges, problems and limitations of working in an international online arena with professionals who traditionally work and thrive in a face to face, real time environment.

Education that captures the attention of students is an essential aspect of promoting meaningful, active learning. Rather than standing at the front of a group of learners simply speaking about a topic, teachers have the opportunity of livening up their teaching with humour, games, and other fun activities. This article critically evaluates the benefits and limitations of humour within nursing education as well as the use of games and fun activities as teaching strategies. Examples of various games and interactive activities are also provided.

Acute mental disorder necessitating admission to hospital is often accompanied by disturbed behaviour that threatens the health of the person concerned or that of those around them. A range of containment methods are used by psychiatric professionals to keep patients and staff safe. These strategies are strongly emotive and attract strong moral valuations, yet differ sharply between countries. This study set out to investigate the relationship between attitudes to these containment methods, and exposure to psychiatric education and practice. It was hypothesized that the culture of psychiatry in the study country would socialise students' views towards the locally dominant pattern of relative evaluations. Nine cohorts of student psychiatric nurses at different stages of their training at one UK University were asked to complete ratings on 11 containment methods. Results showed that containment methods fell into five groups, with Mechanical Restraint and Net Beds attracting the most severe disapproval. Neither the relative evaluation of methods, nor the intensity of those evaluations, changed systematically with duration of training. These findings support the interpretation that the relative evaluations of psychiatric containment methods are a property of wider national cultures, rather than an isolated tradition of psychiatric practice.

Delayed assessment and mismanagement of patient deterioration is a substantial problem for which educational preparation can have an impact. This paper describes the development of the FIRST 2 ACT simulation model based on well-established theory and contemporary empirical evidence. The model combines evidence-based elements of assessment, simulation, self-review and expert feedback, and has been tested in undergraduate nurses, student midwives and post-registration nurses. Participant evaluations indicated a high degree of satisfaction and substantial self-rated increases in knowledge, confidence and competence. This evidence-based model should be considered for both undergraduate and post-registration education programs.

Title. Creating context for critical thinking in practice: the role of the preceptor. Aim. This paper is a report of a study to determine the impact of the preceptor coaching component of a reflective contextual learning intervention on novice nurses' critical thinking skills during the first 6 months of their practice. Background. The use of preceptors to develop novice nurses' clinical skills has been well documented in the literature. However, there is little literature focused on preceptor involvement to develop novice nurses' critical thinking. Method. This small case study was conducted in the United States of America in 2004 with six nurse/preceptor dyads. Stake's qualitative instrumental case study design was used to evaluate the preceptor component of the contextual learning intervention. Stories of preceptor experiences were analyzed using Stake's phases of data analysis (i.e. description, categorical aggregation, establishing patterns, naturalistic generalizations). Specific questions (e.g. nature of coaching used by the preceptor) guided the analysis. Repeating patterns were coded and isolated and later collapsed as the analysis moved forward. Findings. Preceptors use of the contextual learning intervention created a context that stimulated novice nurses' critical thinking. Two main themes describe the novice nurses' critical thinking skills relative to the preceptor coaching: 1) critical thinking as organizing and carrying out tasks; and 2) critical thinking as intentional, reflective thinking. Conclusion. Preceptor education should incorporate the following components: understanding the impact of power and anxiety on critical thinking of novice nurses transitioning into practice; creating dialogue that invites questions in a reflective and critical manner; and challenging thinking through sharing of perspectives.

Bioscience Blended learning English as a second language (ESL) Web-based learning s u m m a r y Tailoring information to the needs of the learner is an important strategy in contemporary education settings. Web-based learning support, informed by multimedia theory, comprising interactive quizzes, glossaries with audio, short narrated Power Point Ò presentations, animations and digitised video clips were introduced in a first year Bachelor of Nursing biological sciences subject at a university in metropolitan Sydney. All students enrolled in this unit were invited to obtain access to the site and the number of hits to the site was recorded using the student tracking facility available on WebCT, an online course delivery tool adopted widely by many educational institutions and used in this study. Eighty-five percent of students enrolled in the subject accessed the learning support site. Students' perception of the value of a learning support site was assessed using a web-based survey. The survey was completed by 123 participants, representing a response rate of 22%. Three themes emerged from the qualitative data concerning nursing students' perception of the web-based activities: 'enhances my learning', 'study at my own pace', and 'about the activities: what I really liked/disliked'. Web-based interventions, supplementing a traditionally presented nursing science course were perceived by students to be beneficial in both learning and language development. Although students value interactive, multimedia learning they were not ready to completely abandon traditional modes of learning including face-to-face lectures. The findings of this study contribute to an understanding of how web-based resources can be best used to support students' learning in bioscience.

Nursing students are increasingly undertaking paid term-time employment to finance their living expenses and studies. However the type and duration of this part-time work is unknown; furthermore there is a limited evidence on the extent to which this part-time employment is impacting on academic performance and the student's experience of higher education. To address this shortfall this study undertook a cross-sectional survey of undergraduate nursing students to explore the incidence of student involvement in term-time employment and to develop an understanding of the relationship of employment on student's academic and clinical achievement, and on their experience of higher education. The results found that the vast majority of the sample were working in part-time employment during term-time. The average number of hours worked per week was sixteen. The number of hours worked per week was found to be a predictor of course performance, the student's experience of college and grades achieved. Students who worked greater hours reported negative outcomes in each of these three domains. The findings also support the contention that it is not working per se that has a detrimental effect on student outcomes but the numbers of hours' students are actually working while attending college. Therefore policy makers, educationalists and health service providers need to be aware of the burden that nursing students may have to contend with in combining work with their academic studies.

Title. Concept analysis: the importance of differentiating the ontological focus Aim. The aim of this paper is to clarify the philosophical underpinnings of concepts and concept analysis and the implications of their use through the lens of particular ontological perspectives. Background. Information on the philosophical foundations of concepts from an ontological and epistemological perspective is not readily identifiable in the international literature. Although some authors have made reference to the ontological perspectives of specific concept analysis processes, none have addressed the implications of the realist or relativist perspective in relation either to the analysis process or the implications of a particular ontological perspective on the meaning and utility of a specific concept. Method. We describe the evolution of concept analysis and influence of ontological paradigms on specific analysis methods. Using an historical review of concept development within nursing thought, we decode the language of concepts and processes of concept analysis, outline the importance of the ontological foundation of concept development, and describe the impact of concept use. Discussion. The nursing literature is dominated by concepts created from a realist perspective. Although recent nurse-authors have introduced evidence-based data to facilitate the development of a number of concepts, they have held fast to the perception that the 'best', most adequate or mature concepts transcend context. Conclusion. The theoretical shift from context-bound empirical analysis of concepts belies the complexity of nurses' work. Concepts are unapologetically contextbound. A concept that transcends context (based on realist ontology) will remain the same even when the context of praxis changes limiting its utility.