Practice learning and nursing education: rethinking theory and design

The significant influence that practice learning plays within undergraduate nurse education cannot be overstated. By practice learning, I mean work-based learning immersed in the activities of nursing practice, typically involving learning undertaken in placements at hospitals and other clinical worksites. Practice learning is intended to achieve standards defined by professional regulatory bodies, and aims to enhance learners' capability and employability. Learning here refers to processes through which student nurses develop capabilities to practice effectively, critically, confidently and professionally in health care settings. Practice is a key concept in this thesis, much contested in debates about professional learning in practice which I will examine in detail in chapter 2. In terms of current policy regarding practice learning, I would, however, suggest that what we have at the moment is an inherited legacy which to date has not been robustly scrutinised. Based on my experiences as a nursing educator I came to believe that it was timely for a re-examination of policies, practices and philosophies underpinning the duration and structure of the current practice learning model. Taken together, the above experiences led me to focus this thesis on the following research question: How might practice learning experiences be better designed to promote nursing capability? This thesis brings together six published papers reporting studies that I conducted to explore this question, as well as chapters explaining the background literature, theory and methodology guiding these studies. My overarching aim is to contribute to the improved practice learning experiences of undergraduate student nurses, retaining them on programmes and easing their transition into the role of newly qualified practitioners (NQP). Chapter 1 charts the history of nursing educational developments. The aim is to demonstrate the influence of government and professional policy over nursing’s development from an apprentice-style model to the current-day academic model. In charting these developments alongside reviewing the contemporary research literature, what is obvious is that the issues of support, retention, models of practice learning and curricula to prepare nurses are perennial challenges. However, as a practice-based discipline, the focus of preparation has always remained grounded in practice. Chapter 2 sets forth the theoretical constructs of this thesis. During the course of conducting the studies reported in the publications of this thesis, I became frustrated with the relative lack of emphasis on contemporary learning theory in nursing education, and the paucity of supporting evidence for the ‘reflective’ theory that seems to be dominant in nursing. The discussion presented in this chapter aims to provide an overview of the major traditions of constructivism and reflective practice, as well as their historical theoretical foundations, which have been widely adopted in nurse education. I discuss the strengths and limitations of these theories as they apply to undergraduate nurses’ practice learning and capability development. These are then contrasted via the means of a critical discussion with more novel alternative models. These include situated learning theory and legitimate peripheral participation, and practice-based learning theory as advocated by contemporary writers such as Schatzki (2002). These theories changed my thinking about practice learning and informed my efforts to develop a more cogent understanding of learning through, for and at work for undergraduate nurse education. In setting out Chapter 3, I am presenting a brief overview of these publications for a nursing education audience. Firstly, I have included information that is generally considered important to this audience, such as details about the journal’s standing and article citations, the databases searched, and the percentage of my own contributions. Secondly, I report the studies from an evidence-based perspective of prediction and control aligned with the contexts of the commissioning process and the conduct of each project. By this I mean that I treat the findings in these papers as valid and credible within the stated limitations Chapter 4 presents the six publications in their entirety for the reader Chapter 5 explains the research methodology adopted in the papers presented for this thesis, and offers my critical reflections on these methodologies. I outline the philosophy that underpins the approach taken with the research studies, discussing the interpretive stance that was taken to research and the consequent choice of qualitative approaches. The chapter also discusses the strengths and limitations of the methods employed in each of my papers along with the means used to analyse the data, and the ethical considerations that an interpretive researcher must consider. In retrospect, given where my theoretical orientation has moved (as explained in chapter 2), I now look rather more critically on the premises of these studies, their categories of definition, multiple causes and uncertainties at play. In my reflections on the research approach, I explain some of these issues. In concluding this thesis, Chapter 6 details my recommendations and some future implications for policy and practice. It also explains my plans for carrying forward different methodological and theoretical approaches in my future research work examining nurses' practice learning

The effect of backpack strap configurations on gait

Abstract: Background The problem statement identified for this study concerns that to the researcher’s knowledge there have been no previous studies on the effect of backpack strap configurations on gait. Thus the present study is one of the first to investigate this topic, which is why the only variable that changes in this study is the strap configuration. The simple design and method of this study makes it easy to replicate and ensures that the data can be analysed with regards to whether the hip and/or chest strap has an effect on gait when compared to the control and traditional backpack conditions. Aim This study may aid in understanding how the configuration of backpack straps affects gait at a constant load. This may help provide postulating evidence of change of gait within the strap configurations and may lead to the need for further research on the matter. And additionally the results from this study may help improve backpack designs. Research methodology A quantitative, exploratory study was conducted, involving a sample of 50 participants between the ages of 18 and 35. The study was conducted as a single consultation where all the data was recorded by the Zebris FDM Gait Analysis System. The participants were required to walk across the measuring plate for 5 conditions. Namely: Control (no backpack), Traditional (2 shoulder straps), traditional with chest strap, traditional with chest + hip strap and traditional with hip strap. The backpack weight was maintained at approximately 10% body weight (BW) throughout the study. The data was analysed using descriptive statistics to analyse which backpack strap configuration had the most or least effect on gait, when compared to both the control and traditional conditions. Results The results of this study have shown that certain backpack strap styles do affect gait more than others. Most of the changes found in the spatiotemporal parameters were found to be statistically insignificant (p > 0,05) except for the stride time with regards to the chest + hip vi strap (p = 0,033), stride length for the hip strap (p = 0,025) and double stance phase for both traditional and chest + hip strap conditions (p = 0,029 and p = 0,039). The overall results of this study show that the chest strap has the most effect on the step width, the stride length increases with 10% BW backpack carriage regardless of strap configuration with the hip strap having the most effect. And finally that the double stance increases with 10% BW backpack carriage. Conclusion and recommendations It can be concluded that different backpack strap configurations affect gait in different ways. A summative result shows that the chest and/or hip strap combinations had the most effect The current study subsequently recommended that further research be done on this subject on various populations.M.Tech. (Chiropractic

Chemically tailored new sorbents for use into the 21^st century.

A series of chemically-tailored mesoporous materials has been synthesized via a liquid-crystal templating mechanism and characterized using a variety of techniques. Materials include a series of MCM-41-type solids (including aluminosilicates, purely siliceous, and iron-containing materials) and a series of organically-modified mesoporous silicas (including phenyl-, vinyl-, aminopropyl- and mercaptopropyl-functionalized samples). Two different synthesis compositions and three different sets of reaction conditions were tested for the synthesis of MCM-41. Characterization by XRD and N2 sorption demonstrated that synthesis under pressure at 100 °C yielded materials with a uniform pore structure and narrow pore size distribution. Samples with pore widths in the mesoporous range and specific surface areas of between 500 - 950 m2 g-1 were produced. The synthesis composition that used aluminium sulphate as the aluminium source was shown, by 27A1 MAS-NMR, to give a product, following calcination, containing tetrahedrally co-ordinated aluminium (necessary for acid catalysis). N2 adsorption on the organically-modified, samples, demonstrated that the incorporation of organic functions reduced the pore diameter and yielded microporous materials. The use of auxiliary organics as pore-swelling agents was investigated and mesitylene was proved to be successful in the formation of a mesoporous phenyl-modified material. The adsorption isotherms of water, benzene, n-butanol and t-butanol were measured for the phenyl-modified materials. N2, benzene and t-butanol sorption on the unswollen sample yielded Type I isotherms, confirming the sample’s microporosity. Type IV isotherms were given by these adsorptives on the mesitylene-swollen sample, demonstrating the presence of mesopores. n-butanol adsorption occurred via polar interactions with the surface hydroxyl groups of both samples and was sterically-hindered in the microporous sample. Water sorption (performed on the unswollen sample. only) gave a Type V isotherm demonstrating the sample’s hydrophobicity. IINS studies of the phenyl-modified silica containing adsorbed benzene, detected the presence of the adsorbed species and differentiated between structural phenyls and adsorbed benzene

Biopharmaceutical studies of slow release, subcutaneous polymeric drug delivery systems

Subcutaneously injected polymeric dosage forms have been used successfully to achieve sustained release of various drugs and peptides. A complex interplay of factors affect drug release rates from such dosage forms, such as nature of dosage form, drug and polymer properties, formulation variables etc. making the prediction of release characteristics challenging. In this thesis, the effect of drug lipophilicity on absorption rates from PLGA microspheres and in situ-forming depots was investigated. The beta-blockers were chosen as model drug compounds, being a homologous group of drugs having similar molecular weights and pKa values, yet widely differing lipophilicities. Alprenolol, metoprolol and atenolol were selected to represent the series based on their experimentally determined octanol-buffer partition coefficients. The first part of the study focused on formulation and characterisation of beta-blocker loaded microspheres with suitable in vitro release profiles. Microspheres were prepared by spray drying, and characterised in terms of particle size, surface morphology, drug loading and release. The beta-blockers represented a considerable challenge owing to their surface-active nature and tendency to suffer a large burst release from microspheres. Efforts were therefore directed towards modifying the formulation to improve the drug release profiles, including emulsion spray drying, addition of competing surfactants and hydrophobic ion pairing. The latter was successful in reducing burst and prolonging release, and microspheres were deemed suitable for in vivo investigation. In situ-forming depot preparations were also formulated with the aim of comparing release profiles and tissue compatibility with the preformed microspheres. Following initial experiments to ascertain intravenous clearance kinetics, the polymeric dosage forms were injected subcutaneously in rats. Drug plasma concentrations were analysed and absorption profiles were determined by deconvolution. It was found that the nature of the dosage form had a significantly greater impact on the rate and extent of absorption than the lipophilicity of the encapsulated drugs

Stressed at Birth: Investigating Fetal, Perinatal and Infant Growth and Health Disruption.

The trajectory and success of fetal, perinatal and infant growth and development is regulated and/or altered by a multitude of intrinsic and extrinsic factors. Both growth and development exhibit a degree of plasticity and thus may fluctuate in response to early life adversity. Non-adult skeletal remains therefore provide a tangible record of growth and health disruption as a consequence of stress in the early life course. This study represents the first extensive and integrated osteological and palaeopathological assessment of fetal, perinatal and infant growth and health disruption. It seeks to determine skeletal responses to adversity and to provide a comprehensive consideration of the potential pathogeneses, etiologies and contextual factors which can affect intrauterine and postnatal health and growth. A total of 423 individuals from 15 different archaeological and historical samples, spanning a ~2000-year time period, have been considered for analysis. Assessment reveals a complex and intricate narrative of health and growth disruption, revealing evidence of chronic early life exposure to stress, which resulted in death for these individuals. A total of 192 individuals had both dental and skeletal elements preserved and 20% (N=39) of these were found to show significant evidence of growth disruption. Individuals from all time periods are represented, but those from post-Medieval London were found to exhibit the highest frequency and severest evidence of growth disruption. Palaeopathological analysis revealed high prevalence rates of both cranial (70%) and postcranial (30%) lesions, with cranial changes consistently more common throughout all periods and samples. New bone formation was the most commonly identified type of lesion and is considered to reflect evidence of both nutritional and infectious health stressors. Furthermore, it is suggested that socioeconomic status was a dominant factor in regulating exposure to stress. Additionally, periods of rapid cultural change also correlated with increased evidence of fetal and infant stress. This thesis makes a number of important contributions regarding fetal, perinatal and infant growth and health during the early life course

The Relationship between Adverse Childhood Experiences and Sexual Risk Behavior in Incarcerated Male Youth

Youth involved in the criminal justice system exhibit elevated rates of sexual risk behavior (SRB), placing them at high risk for sexually transmitted infections (STIs) and other deleterious outcomes. High levels of youth-maternal connectedness have been shown to act as a protective factor for SRB in nationally representative studies and in studies with primarily White youth samples. However, there are mixed findings in the research literature on the association of maternal connectedness and SRB among African American and Latino youth, a population who are disproportionately over-represented in the criminal justice system. Additionally, no studies to date have examined the role of maternal connectedness in SRB among justice-involved youth. This dissertation used archived data to determine if maternal connectedness can buffer against the negative effects of adverse childhood experiences (ACEs) on SRB among justice-involved youth. A secondary aim was to explore the prevalence of ACEs among youth in the sample, including several new ACE items that focus on adversity occurring outside the home. Participants (N=263) were sentenced or detained adolescent males at a large correctional facility in New York City, aged 16-18 and predominantly African American and Latino. Data were collected from the baseline interview of an intervention study conducted from 2009-2010. Youth participated in an individually administered, computer-based survey covering a range of topics, such as sexual health history, family relationships, substance use, and exposure to adverse events. Consistent with the literature, our sample of detained youth reported a high degree of SRB and a significant number of adverse experiences. Logistic regression analysis found that total ACE scores do not predict risky sexual behavior, even when controlling for maternal connectedness, substance use, age, and number of days incarcerated/detained. However, every participant endorsed exposure to at least 2 ACEs and 92% endorsed exposure to 4 or more, suggesting that the restriction in range may have obfuscated a relationship between total ACE scores and sexual risk-taking. The new ACE items, including poverty, racial discrimination, and neighborhood violence were prevalent. Additionally, several of the individual ACE items, including physical abuse, emotional abuse, and racial discrimination were independently associated with sexual risk outcomes. Maternal connectedness was negatively correlated with one type of risky sexual behavior—frequency of substance use during sex. Maternal connectedness and total ACE scores were, as predicted, negatively correlated. These findings suggest that our sample of incarcerated youth have experienced such a profound degree of adversity and trauma that perhaps ACE scores alone cannot adequately predict their engagement in risky sex. The fact that so many of the adolescents in the study endorsed the new ACE items also provides strong support for dissemination of the revised ACE inventory. This study highlights the need for greater research on risk and protective factors influencing adolescent SRB, as well as psychosocial correlates of ACEs among at-risk youth. Furthermore, given the syndemic nature of SRB and high prevalence of STIs, HIV, and ACEs in urban communities of color, future research should consider a more comprehensive and integrative approach to preventing both childhood adversity and unwanted sexual risk outcomes. Directions for future research and clinical implications are discussed

The Role of REM Sleep in Ocular Dominance Plasticity Consolidation

Despite decades of research, the function of sleep remains controversial. One theory is that sleep plays a role in consolidating plasticity induced during prior waking. Ocular dominance plasticity (ODP) in the cat visual cortex is induced during waking monocular deprivation (MD) and consolidated during subsequent sleep. Extracellular signal-regulated kinase (ERK) signaling is required for ODP and is elevated during post-MD sleep, but its requirement during sleep is unknown. In Chapter 2, we investigated whether ERK activity is required during sleep for ODP consolidation by inhibiting the upstream activator of ERK (MEK) with intracortical infusions of U0126 into V1 during post-MD sleep. ERK inhibition abolished ODP consolidation, as measured by extracellular single unit recording. Furthermore, ERK inhibition reduced phosphorylation of eukaryotic initiation factor 4E (eIF4E) and post-synaptic density protein 95 (PSD-95) levels. MAP kinase-interacting kinase 1 (Mnk1) is activated by ERK and directly phosphorylates eIF4E; inhibition of Mnk1 mimicked the effects of ERK inhibition. These results show that activation of the ERK-Mnk1 pathway during post-MD sleep is required for ODP consolidation, and that this pathway promotes the synthesis of plasticity-related proteins such as PSD-95. However, sleep can be broadly subdivided into rapid eye movement (REM) and non-REM (NREM) sleep, but the relative contributions of these states to ODP and the ERK pathway are unknown. In Chapter 3, we examined whether REM sleep is required for ODP consolidation and ERK activation by depriving animals of REM sleep following six hours of waking MD. REM sleep deprivation (RSD) abolished ODP consolidation, as measured by optical imaging of intrinsic cortical signals, and reduced ERK phosphorylation in V1. These effects were not seen in a group that received NREM-fragmented sleep (as a control for the nonspecific effects of RSD). Furthermore, ODP and ERK phosphorylation correlated with the degree of beta-gamma activity in V1 during REM sleep, suggesting that neuronal activity patterns during REM promote ERK activation and ODP consolidation. Together, the findings in the following chapters suggest that, following the induction of cortical plasticity during waking, the ERK-Mnk1 pathway is activated during REM sleep, promoting the synthesis of plasticity-related proteins to consolidate cortical plasticity

Functional analysis of Rex, a sensor of the NADH/NAD+ redox poise in Streptomyces coelicolor

Maintenance of the intracellular NADH/NAD+ redox poise is vital for energy generation in cells. Gram-positive bacteria, including the antibiotic-producing organism, Streptomyces coelicolor, have evolved a regulatory protein Rex that both senses this ratio and mediates an adaptive response to changes in it. Rex is a dimeric redox-sensitive transcriptional repressor. It is capable of binding to both NAD+ and NADH, although only NADH is an effector, causing dissociation of the protein from operator (ROP) sites. As NADH levels rise during oxygen limitation Rex dissociates from its target genes allowing expression, which helps to restore the NADH/NAD+ ratio. Microarray-based expression studies had suggested that Rex regulated only a small number of genes. In this work, however, ChIP-on-chip analyses revealed 38 genes that are potential regulon members. Analysis of the Rex binding sites in S. coelicolor revealed new insights into the mode of binding and show that Rex can bind with low affinity to incomplete half sites. This work also focused on characterising two key Rex targets, ndh and nuoA-N, that encode non-proton-translocating and proton translocating NADH dehydrogenases, respectively. Whereas nuoAN is not essential and was not expressed in liquid media, ndh was essential for growth. Depletion of NDH from growing cells led to the induction of Rex target genes confirming that ndh and Rex play key roles in maintaining redox homeostasis. Structure-based dissection of Rex, via a close homologue in Thermus aquaticus, identified a key interaction between the NADH- and DNAbinding domains of Rex. An R29-D203’ salt-bridge, that traverses the NADH binding and DNA binding domains of Rex, appeared to stabilise the DNA-bound form of Rex, but is ‘broken’ in the presence of NADH. In the NADH-bound form of Rex, D203 alternatively interacts with Y111, which in turn interacts with the nicotinamide ring of NADH. In order to assess the importance of individual subunits in the dimeric Rex, a single-chain derivative was constructed and the NADH binding and DNA binding domains individually disrupted

Role of the heat shock transcription factor, Hsf1, in a major fungal pathogen that is obligately associated with warm-blooded animals

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