The significance of personal learning environments (PLEs) in nursing education: extending current conceptualizations.

Background - Personal learning environments (PLE) have been shown to be a critical part of how students negotiate and manage their own learning. Understandings of PLEs appear to be constrained by narrow definitions that focus primarily on technological engagement with a range of web tools and associated applications. This paper addresses a gap in the literature around PLEs for students currently enrolled in undergraduate nursing degrees. Purpose - To provide in-depth insights into how undergraduate students of nursing manage and experience their learning. Methods - This was an international multi-site qualitative study, utilizing focus groups. A schedule of 10 questions and nominal group techniques were used. Findings - Whilst the focus groups took place in very different geographical locations, there were strong similarities in student understandings of effective PLEs. These went well beyond current technological definitions. Findings were organized into three major themes; technologies, learning modalities and influencing factors. Discussion - We propose a broader understanding of PLEs that acknowledges individual personal and cultural contexts which we call the personally significant learning environment (PSLE). There is a need for greater investigation of how students understand and systematize their PSLE. Conclusions - This paper and our findings will be of interest to educators, researchers and institutions for developing appropriate frameworks that may maximize learning outcomes, encourage cultural sensitivities and facilitate greater understandings of how to support students to create appropriate PSLEs

Understanding the ecology of the Personally Significant Learning Environment (PSLE): one year on.

Background - Personal learning environments (PLE) have been shown to be critical in how students negotiate, manage and experience their learning. Understandings of PLEs are largely restricted by narrow definitions that focus on technology alone. The idea of a PLE is often conflated with virtual learning environments. In this presentation, we draw on empirical findings from an international study. Our findings will be of interest to students, educators, researchers and institutions and will facilitate a more in depth understanding of how to support students to create appropriate PLEs for effectively managing their own learning

A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency

Background Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why?Methods The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use.Results 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents&rsquo; function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.Conclusion This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.<br /

Realist synthesis : illustrating the method for implementation research

BackgroundRealist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question \u27what interventions and strategies are effective in enabling evidence-informed healthcare?\u27 The strengths and challenges of conducting realist review are also considered. MethodsThe realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses. ResultsBased on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area. ConclusionsRealist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review. <br /

The effects of action learning on nurses' use of a fetal health surveillance guideline with low-risk labouring women

Strategies for implementing evidence in clinical practice are often applied with an aim to change provider behaviour and improve patient outcomes. In Canada, many health professionals in birthing units use continuous electronic fetal monitoring rather than intermittent auscultation, despite the fact that continuous electronic fetal monitoring is associated with increased caesarean section and obstetrical intervention rates without benefit to the fetus. Based on a synthesis of credible research, there are national and international guidelines recommending intermittent auscultation for low-risk labouring women. The purpose of this study was to evaluate two interventions, interactive education and Action Learning, that aimed to increase nurses' use of intermittent auscultation in low-risk labouring women as per the Society of Obstetricians and Gynecologists of Canada Fetal Health Surveillance Clinical Practice Guideline (Liston & Crane, 2002). Guided by Roger's (2003) theory of diffusion of innovation and the promoting action on research implementation in health services (PARiHS) framework (Kitson et al., 2008), I conducted a two-phase study. In the first phase, I used a pre-post design with staff nurses (N = 93) to evaluate the effectiveness of an educational intervention. In the second phase, I used a randomized controlled trial design to evaluate the effectiveness of the Action Learning strategy with staff nurses (N = 62) and randomized the nurses to either Action Learning or Usual Care. During labour, 270 consecutively admitted women who met the low-risk inclusion criteria received their care from either an Action Learning or a Usual Care nurse. Neither the interactive education intervention nor the Action Learning intervention had a significant effect on the nurses' use of guideline appropriate care, during episodes of care for low-risk labouring women. Various types of data were explored to determine their influence on the nurses' guideline adherenceLes stratégies de mise en œuvre des données probantes dans la pratique clinique sont souvent appliquées dans le but de modifier le comportement des fournisseurs de soins et d'améliorer les résultats des patients. Au Canada, de nombreux professionnels de la santé travaillant dans des unités d'accouchement surveillent constamment le rythme cardiaque du fœtus plutôt que de manière intermittente. Des directives nationales et internationales, recommandent l'auscultation intermittente pour les femmes en travail à faible risque. L'objectif de cette étude était d'évaluer deux types d'intervention : la formation interactive et l'apprentissage actif, destinées à augmenter l'usage de l'auscultation intermittente par le personnel infirmier pour les femmes en travail à faible risque, conformément à la directive de pratique clinique pour la surveillance de la santé du fœtus, directive fournie par la SOGC (Liston & Crane, 2002). En m'appuyant sur la théorie de la diffusion des innovations de Rogers (2003) et sur le modèle PARiHS – promoting action on research implementation in health services (Kitson et al., 2008), j'ai mené une étude en deux phases. Dans la première phase, j'ai utilisé un modèle avant-après avec des infirmières soignantes (N = 93) pour évaluer l'efficacité d'une intervention éducative. Dans la seconde phase, j'ai utilisé une méthodologie d'essai comparatif aléatoire pour évaluer l'efficacité de la stratégie d'apprentissage actif et j'ai assigné de manière aléatoire les infirmières (N = 62) au groupe bénéficiant de l'apprentissage actif ou au groupe dispensant les soins habituels. Durant le travail, 270 femmes admises consécutivement et répondant au critère de faible risque, ont reçu les soins d'une infirmière ayant suivi un apprentissage actif ou d'une infirmière dispensant les soins habituels. Ni l'intervention éducative interactive ni la stratégie d'apprentissage actif n'ont eu d'effet significatif s

“Breastfeeding in public” for incarcerated women: the baby-friendly steps

Abstract Background Women are the fastest-growing population in carceral facilities in Canada. Most incarcerated women are mothers, with above-average parity. The incarceration of women has implications not only for women’s health, but for that of their children. For example, how is breastfeeding and access to human milk supported in the context of imprisonment? Both carceral and health services are publicly-funded and administered in Canada. Due in part to the well-documented ill-health burden of imprisoned women, health and carceral functions overlap in the spaces of confinement. This paper discusses “breastfeeding in public” in relation to imprisoned women: separated from the public, yet in publicly-funded spaces under public servant control. With increasing adoption of Baby Friendly Hospital Initiative (BFI) Ten Steps in Canadian health centres, there is a need to consider the health centre spaces precluded from its application and make visible the women and children affected. This paper uses the BFI Steps as a lens to consider the environment of confinement for the breastfeeding incarcerated person. The exclusion of breastfeeding and access to human milk for imprisoned women and children extends the punitive carceral function beyond the experience of incarceration and beyond the experience of the convicted mother. Discussion Carceral facilities lack breastfeeding policies, foundational to breastfeeding support. Despite high fertility and parity among incarcerated women, carceral health care providers are not required to demonstrate maternity and reproductive health care specialization. The overarching mission of carceral institutions remains security, and support for breastfeeding among incarcerated women is hampered in spaces of conflict, punishment, surveillance and control. A minimal requirement to support exclusive breastfeeding is to promote the mother being with the infant and most incarcerated mothers are separated from their infants. Incarcerated women lack support, information, and community connections for extended breastfeeding beyond six months. Carceral facilities are not welcoming environments for breastfeeding families. Despite the incompatibility of breastfeeding with incarceration, BFI Step 10, coordinating discharge, demonstrates opportunity for improvement through community and health care provider engagement. Conclusion Incarceration challenges the reach and applicability of the BFI Steps to enhance breastfeeding and to problematize the idea of breastfeeding “in public.

Teaching Knowledge Synthesis Methods through Online Research Consultations: A Story of Invisible Labour

Requests to meet with academic librarians for support on knowledge synthesis (KS) projects have escalated due to an increasing number of learners embarking on KS projects as part of their course work, along with the recommendation in KS methods guidance to consult with a research librarian to ensure a comprehensive search. While there are program descriptions and evaluations of library-led and other KS methods training for groups or self-directed learning opportunities, little evidence examines the teaching practices of academic librarians in individual KS research consultations. The objective of this research is to explore teaching encounters during online KS research consultations and describe the often invisible aspects of that labour through the findings from an online-mediated, focussed ethnographic study. The study draws on data from focus groups, observations and interviews, as well as autoethnographic sources. We use a sociomaterial lens to analyze the stories in the data and illuminate the complexities of the virtual, synchronous teaching encounter between academic health librarians and learners. We present a composite narrative elaborating on the social, technical, and material elements assembled before, during, and after an online KS methods consultation to emphasize the invisible and affective labour of librarian teaching practices about comprehensive searching and KS methods.Les demandes de rencontre avec des bibliothécaires universitaires pour obtenir un soutien dans le cadre de projets de synthèse des connaissances (SC) ont augmenté en raison du nombre croissant d'apprenants qui se lancent dans des projets de SC dans le cadre de leur travail de cours, ainsi que de la recommandation, dans les conseils sur les méthodes de SC, de consulter un.e bibliothécaire de recherche pour garantir une recherche exhaustive. Bien qu'il existe des descriptions et des évaluations de programmes de formation pour des groupes et des méthodes d'apprentissage autonome offerts par les bibliothèques, peu d’études examinent les pratiques d'enseignement des bibliothécaires universitaires lors de consultations individuelles. L'objectif de cette recherche est d'explorer, par le biais d'une étude ethnographique focalisée et médiatisée en ligne, les rencontres pédagogiques qui se produisent lors de consultations de soutien aux projets de synthèse des connaissances et de décrire les aspects souvent invisibles de ce travail. L'étude s'appuie sur des données provenant de groupes de discussion, d'observations et d'entretiens, ainsi que sur des sources auto-ethnographiques. Nous utilisons une lentille sociomatérielle pour analyser les thèmes qui y ressortent et éclairer les complexités de la rencontre virtuelle d'enseignement synchrone entre les bibliothécaires de santé universitaires et les apprenants.  Nous présentons un récit composite qui explore les éléments sociaux, techniques et matériels assemblés avant, pendant et après une consultation en ligne sur les méthodes de SC afin de souligner le travail invisible et affectif du travail d'enseignement des bibliothécaires qui se produit lorsqu’ils enseignent les méthodes de recherche exhaustives et de synthèse des connaissances

The 23-item Evidence Based Practice-Knowledge Attitudes and Practices (23-item EBP-KAP) survey: Initial validation among health professional students

Purpose: To date, research exploring evidence-based practice (EBP) among students and early career professionals has been primarily discipline-specific and there is limited research considering the general university learning environment. When the education and application of EBP is studied, it mainly considers cognition and skills. There is a gap in the literature with respect to our understanding of EBP-related attitudes and practices alongside knowledge. This gap exists across health disciplines, as there is both limited EBP literature and a lack of generally applicable measures in this area to make transdisciplinary comparisons. Method: Two studies, with independent samples, were conducted to psychometrically test a transdisciplinary survey of knowledge, attitudes, and practices of the use of evidence in academic and practice settings. One hundred and nine students from two health professional disciplines participated in Study 1 and 366 students from four health professional disciplines participated in Study 2. Students completed a self-administered paper-based or an online survey. Results: Results from Study 1 directly informed Study 2. A confirmatory factor analysis confirmed in Study 2 that four subscales (knowledge, attitudes about EBP, professional practice and learning, information retrieval practices) discovered in Study 1 were a good fit to the data with an independent transdisciplinary sample. Divergent and construct validity were demonstrated through low covariances among the subscales and significant within-subject comparisons of mean differences between the subscales in both studies. Discussion: Sufficient reliability and validity has been obtained to warrant continued use and testing. Next steps will include distributing the survey to students and healthcare professionals in other universities and other countries. Keywords: Attitudes, Evidence-based practice, Knowledge, Practices, Scale developmen

Additional file 1: of What is the extent and quality of documentation and reporting of fidelity to implementation strategies: a scoping review

Definitions for populating data extraction columns. (DOCX 13 kb