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

Transforming growth factor-beta promotes rhinovirus replication in bronchial epithelial cells by suppressing the innate immune response

Rhinovirus (RV) infection is a major cause of asthma exacerbations which may be due to a deficient innate immune response in the bronchial epithelium. We hypothesized that the pleiotropic cytokine, TGF-?, influences interferon (IFN) production by primary bronchial epithelial cells (PBECs) following RV infection. Exogenous TGF-?(2) increased RV replication and decreased IFN protein secretion in response to RV or double-stranded RNA (dsRNA). Conversely, neutralizing TGF-? antibodies decreased RV replication and increased IFN expression in response to RV or dsRNA. Endogenous TGF-?(2) levels were higher in conditioned media of PBECs from asthmatic donors and the suppressive effect of anti-TGF-? on RV replication was significantly greater in these cells. Basal SMAD-2 activation was reduced when asthmatic PBECs were treated with anti-TGF-? and this was accompanied by suppression of SOCS-1 and SOCS-3 expression. Our results suggest that endogenous TGF-? contributes to a suppressed IFN response to RV infection possibly via SOCS-1 and SOCS-3

Mechanical strain causes adaptive change in bronchial fibroblasts enhancing profibrotic and inflammatory responses

Asthma is characterized by periodic episodes of bronchoconstriction and reversible airway obstruction; these symptoms are attributable to a number of factors including increased mass and reactivity of bronchial smooth muscle and extracellular matrix (ECM) in asthmatic airways. Literature has suggested changes in cell responses and signaling can be elicited via modulation of mechanical stress acting upon them, potentially affecting the microenvironment of the cell. In this study, we hypothesized that mechanical strain directly affects the (myo)fibroblast phenotype in asthma. Therefore, we characterized responses of bronchial fibroblasts, from 6 normal and 11 asthmatic non-smoking volunteers, exposed to cyclical mechanical strain using flexible silastic membranes. Samples were analyzed for proteoglycans, ?-smooth muscle actin (?SMA), collagens I and III, matrix metalloproteinase (MMP) 2 &amp; 9 and interleukin-8 (IL-8) by qRT-PCR, Western blot, zymography and ELISA. Mechanical strain caused a decrease in ?SMA mRNA but no change in either ?SMA protein or proteoglycan expression. In contrast the inflammatory mediator IL-8, MMPs and interstitial collagens were increased at both the transcriptional and protein level. The results demonstrate an adaptive response of bronchial fibroblasts to mechanical strain, irrespective of donor. The adaptation involves cytoskeletal rearrangement, matrix remodelling and inflammatory cytokine release. These results suggest that mechanical strain could contribute to disease progression in asthma by promoting inflammation and remodelling responses.<br/

Soluble ADAM33 initiates airway remodeling to promote susceptibility for allergic asthma in early life

Asthma is a chronic inflammatory airways disease that usually begins in early life and involves gene-environment interactions. Although most asthma exhibits allergic inflammation, many allergic individuals do not have asthma. Here, we report how the asthma gene A Disintegrin and Metalloprotease (ADAM)33, acts as local tissue susceptibility gene that promotes allergic asthma. We show that enzymatically active soluble (s)ADAM33 is increased in asthmatic airways and plays a role in airway remodeling, independent of inflammation. Furthermore, remodeling and inflammation are both suppressed in Adam33 null mice after allergen challenge. When induced in utero or added ex vivo, sADAM33 causes structural remodeling of the airways, which enhances post-natal airway eosinophilia and bronchial hyperresponsiveness following sub-threshold challenge with an aeroallergen. This substantial gene-environment interaction helps to explain the end-organ expression of allergic asthma in genetically susceptible individuals. Finally, we show that sADAM33-induced airway remodeling is reversible, highlighting the therapeutic potential of targeting ADAM33 in asthma

Listening to teachers: a qualitative exploration of teaching practices in higher and further education, and the implications for digital

To bring about lasting changes around the use of technology to support teaching and learning in colleges and universities, we need to understand the practices that teaching staff undertake and the challenges they face. Effective, sustained change comes from a place of working in service to pedagogies. This report captures the findings of our recent work to develop a thorough understanding of the practices of teaching in colleges and universities. Our starting point A Jisc co-design project in 2016 was the starting point for a consultation to gain a richer understanding of what next generation digital learning environments might look like. In a wide-ranging and in-depth consultation we asked questions that focused on the potential of technology, the range of activities that staff currently undertake and what activities they would like in the future. The resulting report, next generation [digital] learning environments: present and future focused on many of these areas, providing a baseline of current and emerging technology-based practices. During that consultation many contributors raised questions about how behaviours of staff working in learning and teaching have changed since the first widespread deployment of virtual learning environments (VLEs) and other educational technologies in the 1990s. As it’s our mission to continue to provide solutions, advice and guidance on the use of technology to support learning and teaching we must remain focused on what the sector needs and wants from digital learning environments. This imperative is the driver for the current report. We wanted to develop deeper understanding about practice around learning and teaching with the aim of gaining insights beyond the technology-led. We’ve captured the voices and experiences of teachers in higher and further education, drawing on senior and junior teaching scholars across a broad range of academic disciplines. From more than 22 hours of interviews and several workshops we’ve distilled a series of themes and ideas for future development. The authors have provided indicative quotes from interviewees in the text rather than a comprehensive catalogue. We used a contextual inquiry approach. This is a process whereby individuals are interviewed about their practices in an open-ended format and within a particular frame designed to find out what they do, what their motivations are, what personal history contributes to these practices and how they are impacted by current macro- and micro-contexts. This is standard practice in user experience research, especially at the beginning of design processes, and it is valued in particular for being distinct from ‘lab’ investigations of behaviour that are distanced from the context in which people habitually do their work. In what follows, we describe the motivations for the contextual inquiry project and the themes that have emerged, and then explore the implications of some of those themes for Jisc’s next generation digital

Getting to know you: Engagement and relationship building: First interim national positive futures case study research report

This report represents the culmination of the first phase of the Positive Futures (PF) Case Studies Research Project rather than a definitive set of findings as such. Rather like the PF programme itself it is very much a work in progress which is evolving all the time in the context of the action research approach we have adopted. This approach involves a cycle of action and reflection, with both the projects and research adapting in relation to the themes that emerge from the study as it progresses. Nevertheless whilst this element of the research has been concerned as much with the establishment of relations with projects and participants as investigating the relationships between them, we have begun to identify a number of tentative themes and findings. These themes are presented in a fashion which is intended to guide the future direction of projects every bit as much as to gain abstract theoretical insight. Yet this recognition of the importance of practicality and direction should not distract from the importance of gaining a wider contextual feel for the programme. For whilst this summary is intended to highlight the key themes emerging from the research and the policy and practice issues associated with them, it is in the detail of the main report that a full appreciation of the PF approach emerges. It is from the more narrative accounts in these subsequent parts that we have drawn the conclusions and recommendations presented here and which will provide the baselines against which we assess future progress. Indeed these accounts are themselves drawn from three regional reports focused on the seven case studies that constitute the overall national research project

Modulation of human airway barrier functions during Burkholderia thailandensis and Francisella tularensis Infection: Running Title: Airway Barrier Functions during Bacterial Infections

The bronchial epithelium provides protection against pathogens from the inhaled environment through the formation of a highly-regulated barrier. In order to understand the pulmonary diseases melioidosis and tularemia caused by Burkholderia thailandensis and Fransicella tularensis, respectively, the barrier function of the human bronchial epithelium were analysed. Polarised 16HBE14o- or differentiated primary human bronchial epithelial cells (BECs) were exposed to increasing multiplicities of infection (MOI) of B. thailandensis or F. tularensis Live Vaccine Strain and barrier responses monitored over 24–72 h. Challenge of polarized BECs with either bacterial speciescaused an MOI- and time-dependent increase in ionic permeability, disruption of tight junctions, and bacterial passage from the apical to the basolateral compartment. B. thailandensis was found to be more invasive than F. tularensis. Both bacterial species induced an MOI-dependent increase in TNF-α release. An increase in ionic permeability and TNF-α release was induced by B. thailandensis in differentiated BECs. Pretreatment of polarised BECs with the corticosteroid fluticasone propionate reduced bacterial-dependent increases in ionic permeability, bacterial passage, and TNF-α release.TNF blocking antibody Enbrel® reduced bacterial passage only. BEC barrier properties are disrupted during respiratory bacterial infections and targeting with corticosteroids or anti-TNF compounds may represent a therapeutic option

The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Acute Lymphoblastic Leukemia in Adults: An Evidence-based Review

AbstractEvidence supporting the role of hematopoietic stem cell transplantation (SCT) in the therapy of acute lymphoblastic leukemia in adults (≥15 years) is presented and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published medical literature and for grading the quality and strength of the evidence, and the strength of the treatment recommendations. Treatment recommendations based on the evidence are presented and were reached unanimously by a panel of acute lymphoblastic leukemia experts. The priority areas of needed future research for adult acute lymphoblastic leukemia are: definition of patients at high risk in first complete remission, beyond Philadelphia chromosome positive; outcomes of SCT in older (>50 years) adults; determination if reduced intensity versus myeloablative conditioning regimens yield an equivalent graft-versus-leukemia effect with reduced toxicity; monitoring of minimal residual disease to achieve disease control before SCT; and the use of cord blood and other alternative sources of stem cells for use in adult SCT recipients