Working at the coal face: The contribution of Programme Tutors in supporting practice-based learning in nursing

This paper reports the findings of a Centre for Excellence in Teaching and Learning-funded project to explore key features of effective support for pre-registration nursing students in practice settings. Background The cultivation of positive practice learning environments for students of nursing, including high quality learning support, has been long established as a thorny issue for nurse educators and practitioners. Indeed it was a key theme for the very first nursing research series, supported by the Royal College of Nursing, in the early 1980’s. This included Fretwell’s (1982) work on ward teaching and learning, Orton’s (1981) work on the ward learning environment and Ogier’s (1982) work on the role of the ward sister. Since then there has been an explosion of research in this area. As a profession we have a responsibility to ensure high quality learning support for students in practice settings. If we do not, there will be wide-ranging implications for the quality of patient care, work-related stress, role satisfaction, retention and attrition and professional reputation. Given the significant investment in nurse education and the need to retain nurses in the workforce, it is unsurprising therefore that the practice learning environment has emerged as a key policy issue in the United Kingdom and internationally. Previous research indicates that relationships between the learner and staff are crucial in supporting learning in practice (Pearcey and Elliott, 2004) and that ‘learning is maximised when the learner is effectively partnered with a clinician and experiences are shared’ (Henderson et al., 2009, p.178). In this context, The Programme Tutor (PT) – a role unique to the pre-registration nursing programme at The Open University (OU) – is crucial in facilitating learning in the practice setting. The purpose of the PT role is to work longitudinally with both students and their mentors to support learning in practice and monitor student progress. The PT therefore plays a pivotal role in facilitating learning in the practice setting, aspects of which may have potential for transfer to the wider health education sector. Objectives The overall aim of the project was to critically examine the experiences of a sample of PTs supporting students and mentors on the pre-registration nursing programme at the OU in order to identify the key features of effective PT practice. These features would then inform the continuing development of the programme. Two PTs were recruited as co-researchers on the project, the objectives of which were to: • Explore PT’s experiences of supporting students and mentors • Explore PT’s views regarding student progression • Identify how PTs ‘grow’ into their role • Identify enabling and disabling factors contributing to role effectiveness • Examine the boundaries between the role of the PT and mentor • Explore variations in the PT role across the UK. Data collection and analysis A sample of 20 PTs working on the final practice module of the pre-registration nursing programme, and located across the nations and regions of the UK, was identified. Following ethical approval, telephone interviews were conducted using an interview guide informed by both a review of the literature and the experience of the PT co-researchers. Telephone interviews were used in preference to individual face-to-face interviews in order to accommodate the dispersed geographical spread of participants. The interviews were recorded using digital recording equipment and following transcription, conventional approaches to qualitative data analysis were used to identify common themes across the data. The ethical principles of confidentiality, anonymity and informed consent were upheld throughout the study. The sample was assured that confidentiality would be maintained at all times throughout the project. Anonymity was protected by using pseudonyms both for PTs and organisations. Informed consent was gained at the start of the project and participants were able to withdraw from the project at any stage. Findings suggest that PTs find their role both rewarding and vital in the context of creating supportive learning environments and ultimately supporting students’ transition to become registered practitioners. Being an effective communicator and establishing and maintaining relationships with students, mentors and service managers was described as crucial to the success of the role. Understanding the pressures within practice environments and being able to acknowledge the realities of ‘working at the coalface’ enabled PTs to support both students and mentors in such settings. Conclusion This paper will elaborate more fully the findings of the project, illustrated with reference to verbatim quotes from the data. Although a role unique to the OU pre-registration nursing programme, there may be aspects of the role which could be transferable to other practice-based learning settings. This will be interactively debated with conference delegates. (word count 800) References Fretwell, J. E. (1982) Ward teaching and Learning, Royal College of Nursing, London. Henderson, A., Twentyman, M., Eaton, E., Creedy, D., Stapleton, P. and Lloyd, B. (2009) Creating supportive clinical learning environments: an intervention study, Journal of Clinical Nursing, 19, pp.171-182. Ogier, M. E. (1981) An ideal sister, Royal College of Nursing, London Orton, H. D. (1981) Ward learning climate, Royal College of Nursing, London Pearcey, P. A. and Elliott, B. E. (2004) Student impressions of clinical nursing, Nurse Education Today, 18, pp.29-31

Where Were Court Cases Heard in Northern Iberia in the Early Middle Ages and Were These Community Places?

There is some good, though limited, evidence of community space in northern Iberia in the later tenth century. These are the spatial zones defined by the remit of local meetings at which business was transacted. There is no evidence that court cases were heard at such meetings. Rather, court cases were held at places associated with kings, and places associated with powerful landowners and churches. All of these places were used by their own proper communities whereas for court cases they were used by a temporary judicial community that was convened to deal with a case. As ever, communities were multiple and overlapping, and different communities could use community space

Resolving the brainstem contributions to attentional analgesia

Previous human imaging studies manipulating attention or expectancy have identified the periaqueductal gray (PAG) as a key brainstem structure implicated in endogenous analgesia. However, animal studies indicate that PAG analgesia is mediated largely via caudal brainstem structures, such as the rostral ventromedial medulla (RVM) and locus coeruleus (LC). To identify their involvement in endogenous analgesia, we used brainstem optimized, whole-brain imaging to record responses to concurrent thermal stimulation (left forearm) and visual attention tasks of titrated difficulty in 20 healthy subjects. The PAG, LC, and RVM were anatomically discriminated using a probabilistic atlas. Pain ratings disclosed the anticipated analgesic interaction between task difficulty and pain intensity (p < 0.001). Main effects of noxious thermal stimulation were observed across several brain regions, including operculoinsular, primary somatosensory, and cingulate cortices, whereas hard task difficulty was represented in anterior insular, parietal, and prefrontal cortices. Permutation testing within the brainstem nuclei revealed the following: main effects of task in dorsal PAG and right LC; and main effect of temperature in RVM and a task × temperature interaction in right LC. Intrasubject regression revealed a distributed network of supratentorial brain regions and the RVM whose activity was linearly related to pain intensity. Intersubject analgesia scores correlated to activity within a distinct region of the RVM alone. These results identify distinct roles for a brainstem triumvirate in attentional analgesia: with the PAG activated by attentional load; specific RVM regions showing pronociceptive and antinociceptive processes (in line with previous animal studies); and the LC showing lateralized activity during conflicting attentional demands. SIGNIFICANCE STATEMENT Attention modulates pain intensity, and human studies have identified roles for a network of forebrain structures plus the periaqueductal gray (PAG). Animal data indicate that the PAG acts via caudal brainstem structures to control nociception. We investigated this issue within an attentional analgesia paradigm with brainstem-optimized fMRI and analysis using a probabilistic brainstem atlas. We find pain intensity encoding in several forebrain structures, including the insula and attentional activation of the PAG. Discrete regions of the rostral ventromedial medulla bidirectionally influence pain perception, and locus coeruleus activity mirrors the interaction between attention and nociception. This approach has enabled the resolution of contributions from a hub of key brainstem structures to endogenous analgesia

A DNA toolbox for non-invasive genetic studies of sambar deer (Rusa unicolor)

Invasive sambar deer (Rusa unicolor) are having significant detrimental impacts on natural environments in south-eastern Australia. Little, however, is known about their ecology, limiting evidence-based management strategies directed at reducing deer impacts. Genetic data, generated from DNA isolated from deer scats, can be used to fill ecological knowledge gaps. This study outlines a non-invasive genetic sampling strategy by which good-quality DNA from a single deer scat can be used to determine (1) species of origin, (2) sex and (3) a unique DNA profile. DNA from deer tissue and sambar deer scat samples were used to develop and optimise molecular methods to collect reliable genetic information. A DNA toolbox is presented that describes how to find, collect and store scat samples, isolate DNA and use molecular markers to generate informative genetic data. Generating genetic data using this approach will support studies aimed at acquiring ecological knowledge about sambar deer. Such knowledge will be critical for developing evidence-based recommendations to improve on-ground management decisions for sambar deer

“I just started pretending they were there and they just kept staying with me”: a qualitative study into primary school-aged children’s perceptions of the purpose and functions their imaginary companions serve for them, particularly in school and with school work

Children's imaginary companions are a very common yet surprisingly under-researched phenomenon. This qualitative study investigates children's perceptions of their imaginary companion(s) and uncovers the functions they serve for the children, especially in relation to academic demands made by school. The research process is explored in detail and some particular considerations involved when conducting research with children are outlined. Seven children aged between seven and ten (primaryaged pupils), who had a current imaginary companion, participated in semi-structured interviews and themes were identified from interview transcripts. Findings derived from a thematic analysis reveal two over-arching themes, namely 'the child's relationship with their imaginary companion(s)' and 'problem-solving'. Several separate sub-themes contributed to these two over-arching themes. The findings are discussed in relation to children's cognitive, social and emotional development. Although only two boys reported their imaginary companions being at school, others helped with homework; therefore most of the imaginary companions in this study help with school work. They provide answers, offer reassurance that answers are correct, embody self-talk techniques, suggest approaches/strategies, provide visual cues and offer ready-made characters for stories. Implications of the findings for educational psychologists and practitioners are highlighted and areas for future research into imaginary companions are suggested

Delineating genetic management units of sambar deer (Rusa unicolor) in south-eastern Australia, using opportunistic tissue sampling and targeted scat collection

Context: Invasive species are major drivers of biodiversity loss, requiring management to reduce their ecological impacts. Population genetics can be applied to delineate management units, providing information that can help plan and improve control strategies. Aim: The present study aims to use a genetic approach to test the existence of three previously proposed sambar deer populations in south-eastern Australia. In doing so, the study aims to delineate management units of sambar deer in south-eastern Australia. Methods: Sambar deer DNA was sourced opportunistically from tissue samples and targeted scat collection. Samples were collected from three areas in Victoria, south-eastern Australia: Mt Cole (MC), French Island (FI) and eastern Victoria (EV). Contemporary population structure was assessed using a suite of 11 polymorphic microsatellite markers. The number of maternal sambar deer lineages in south-eastern Australia was investigated through sequencing of the mitochondrial (mt)DNA control region. Key results: Three distinct genetic clusters were identified. Differentiation among inferred clusters was found to be high, with FST ranging from 0.24 between EV and FI clusters and 0.48 between MC and FI clusters. Two mtDNA haplotypes were identified; R.u1 was found throughout EV and FI, and R.u2 was unique to MC. DNA isolated from scats provided reliable data and proved critical for sampling areas where hunting and culling of deer are not generally undertaken. Conclusions: Three genetically distinct sambar deer management units in south-eastern Australia are defined-MC, FI and EV. Sambar deer control strategies should be applied to each management unit independently. This may be difficult or infeasible for the EV management unit, which is large and geographically complex. Further research may help identify additional fine-scale genetic structure in EV, allowing smaller, more practicable management units to be identified. Implications: Genetic data can be used to identify management units for invasive species, which will be critical for the development of future management strategies and improving control operations. The approach outlined here could also be applied to improve the management of other introduced deer species in south-eastern Australia. © 2022 CSIRO Open Access

Infant feeding knowledge, attitudes,and beliefs predict antenatal intention among first-time mothers in Queensland

Aim: This study assessed infant feeding knowledge, attitudes, and beliefs among women from Queensland, Australia, in their first pregnancy. Antenatal feeding intention in this group was described, and the hypothesis was tested that antenatal knowledge, attitudes, and beliefs about infant feeding are associated with antenatal intention for the duration and exclusivity of breastfeeding for the infant’s first year. Subjects and Methods: The Feeding Queensland Babies Study is a prospective survey of infant feeding attitudes and behaviors among first-time mothers in Queensland, Australia. Data on infant feeding knowledge, attitudes, beliefs, and intention were collected antenatally, and an Infant Feeding Attitudes Score was calculated. Results: Although 85% of respondents endorsed breastfeeding as most appropriate for infants, 11% valued formula feeding equally. Intention to give any breastmilk during the first weeks was 98%, but it fell to 18% during the second year. More than one-quarter of women reported intention to introduce foods other than breastmilk before 5 months of infant age. The infant feeding attitudes and beliefs score correlated positively with feeding intention for breastfeeding and the introduction of complementary solids. Conclusions: Enhancing women’s knowledge of recommendations and their understanding of breastfeeding’s specific benefits and the reasons for recommended scheduling of feeding transitions may positively impact breastfeeding exclusivity and duration and the age-appropriate introduction of complementary solids. Communication of detailed feeding recommendations for the infant’s first year and specific information about the health benefits of breastfeeding should be a goal of healthcare providers working with pregnant women

Developments in Australian general practice 2000–2002: what did these contribute to a well functioning and comprehensive Primary Health Care System?

BACKGROUND: In recent years, national and state/territory governments have undertaken an increasing number of initiatives to strengthen general practice and improve its links with the rest of the primary health care sector. This paper reviews how far these initiatives were contributing to a well functioning and comprehensive primary health care system during the period 2000–2002, using a normative model of primary health care and data from a descriptive study to evaluate progress. RESULTS: There was a significant number of programs, at both state/territory and national level. Most focused on individual care, particularly for chronic disease, rather than population health approaches. There was little evidence of integration across programs: each tended to be based in and focus on a single jurisdiction, and build capacity chiefly within the services funded through that jurisdiction. As a result, the overall effect was patchy, with similar difficulties being noted across all jurisdictions and little gain in overall system capacity for effective primary health care. CONCLUSION: Efforts to develop more effective primary health care need a more balanced approach to reform, with a better balance across the different elements of primary health care and greater integration across programs and jurisdictions. One way ahead is to form a single funding agency, as in the UK and New Zealand, and so remove the need to work across jurisdictions and manage their competing interests. A second, perhaps less politically challenging starting point, is to create an agreed framework for primary health care within which a collective vision for primary health care can be developed, based on population health needs, and the responsibilities of different sectors services can be negotiated. Either of these approaches would be assisted by a more systematic and comprehensive program of research and evaluation for primary health care