Self-Directed Learning in the era of the COVID-19 pandemic

The COVID-19 pandemic severely impacted teaching and learning at higher education institutions (HEIs), and this book disseminates research findings on a series of cross-campus online initiatives of the North-West University (NWU) to ensure high-quality self-directed learning, whilst simultaneously attending to the need for inclusion and diversity in this challenging context. The golden thread running through the 13 chapters is how this HEI responded to the pandemic in a creative way through its investment in online virtual student excursions, based on problem-based, cooperative learning and gamification principles to support self-directed learning. Whereas virtual excursions usually refer to learning opportunities where ‘a museum, author, park or monument is brought to the student’ (Hehr 2014:1), the virtual excursion in our context is an activity system (Engeström 1987) where students’ learning is scaffolded across the zone of proximal development (Vygotsky 1978) and where their ‘social and pedagogical boundaries are stretched or expanded’ (De Beer & Henning 2011:204). Students engage as Homo ludens, the playing human (Huizinga 1955), in learning activities embedded in an ill-structured problem, and through reflective activities, they are encouraged to reflect on their own naïve understandings or biases. This ‘tension’, or in Veresov (2007) parlance, ‘dramatical collisions’, provides a fertile learning space for self-directed learning

Self-Directed Learning in the era of the COVID-19 pandemic

The COVID-19 pandemic severely impacted teaching and learning at higher education institutions (HEIs), and this book disseminates research findings on a series of cross-campus online initiatives of the North-West University (NWU) to ensure high-quality self-directed learning, whilst simultaneously attending to the need for inclusion and diversity in this challenging context. The golden thread running through the 13 chapters is how this HEI responded to the pandemic in a creative way through its investment in online virtual student excursions, based on problem-based, cooperative learning and gamification principles to support self-directed learning. Whereas virtual excursions usually refer to learning opportunities where ‘a museum, author, park or monument is brought to the student’ (Hehr 2014:1), the virtual excursion in our context is an activity system (Engeström 1987) where students’ learning is scaffolded across the zone of proximal development (Vygotsky 1978) and where their ‘social and pedagogical boundaries are stretched or expanded’ (De Beer & Henning 2011:204). Students engage as Homo ludens, the playing human (Huizinga 1955), in learning activities embedded in an ill-structured problem, and through reflective activities, they are encouraged to reflect on their own naïve understandings or biases. This ‘tension’, or in Veresov (2007) parlance, ‘dramatical collisions’, provides a fertile learning space for self-directed learning

Teaching and Learning of Clinical Competence in Ghana: Experiences of Students and Post-Registration Nurses

Despite the growing demand for competent nurses to fill the shortage gap, nursing education institutions have not always been able to equip students with the requisite clinical competence needed in the practice setting. Several studies have described the experiences of undergraduate nursing students in the clinical learning environment. No study was found on the experiences of diploma nursing students and post-registration nurses regarding the teaching and learning of clinical competence in Ghana. This study, therefore, sought to describe the experiences and perceptions of diploma nursing students and post-registration nurses regarding the teaching and learning of clinical competence in Ghana. A qualitative descriptive research design was employed in this study. Fifty-five (55) participants, comprising 40 students and 15 post-registration diploma nurses, from six research sites were recruited into focus group discussions (FGDs) using a maximum variation purposive sampling technique. A thematic framework method was used to analyze the data with the aid of ATLAS.ti software. Three themes emerged from the focus group discussions: nursing education institutional factors; clinical placement design, implementation, and system challenges; challenges of clinical teaching and learning. We conclude that the current approach to clinical nursing education, such as the overreliance on clinical placement and the use of more teacher-centered teaching approaches, are ineffective in facilitating the development of clinical competence. A review of the nursing curriculum, inculcating evidence-based simulation modalities, and an adequate investment in nursing education may be required to ensure effective nursing education in the study setting

A Simulation-Based Clinical Nursing Education Framework for a Low-Resource Setting: A Multimethod Study

Simulation-based clinical education is a useful strategy for teaching, learning, and assessing clinical competence in health professions education. However, the use of simulation-based clinical nursing education (SBCNE) in low-resource settings such as Ghana has been hampered by the lack of a context-specific framework to guide its design, implementation, and evaluation. This study sought to develop a context-specific framework to guide the design, implementation, and evaluation of SBCNE in a low-resource setting. The study employed a sequential multimethod design, comprising a scoping review; qualitative descriptive design (situational analysis) made up of two parts–focus group discussions (FGDs) with post-registration nurses and nursing students, and semi-structured interviews with nurse educators; and narrative synthesis of the scoping review and situational analysis data, used to develop a draft SBCNE framework for a low-resource setting. The draft SBCNE framework was evaluated by stakeholders of nursing education and practice using nominal group discussions. The framework is comprised of five constructs (context, planning, design, community of learning, and outcomes). The user-centric, comprehensive, context-specific SBCNE framework has the potential to enhance the implementation of simulation in nursing education and the development of clinical competence in a low-resource setting. As a result, we urge nursing leaders and nurse educator unions to take the lead in lobbying regulatory bodies, the central government, and their development partners to provide the necessary financial support and resources for the implementation of the framework and adoption of SBCNE in low-resource settings

Sex-specific associations of body composition measures with cardiac function and structure after 8 years of follow-up

We investigated the prospective associations of body composition with cardiac structure and function and explored effect modification by sex and whether inflammation was a mediator in these associations. Total body (BF), trunk (TF) and leg fat (LF), and total lean mass (LM) were measured at baseline by a whole body DXA scan. Inflammatory biomarkers and echocardiographic measures were determined both at baseline and follow-up in the Hoorn Study (n = 321). We performed linear regression analyses with body composition measures as determinant and left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) or left atrial volume index (LAVI) at follow-up as outcome. Additionally, we performed mediation analysis using inflammation at follow-up as mediator. The study population was 67.7 ± 5.2 years and 50% were female. After adjustment, BF, TF and LF, and LM were associated with LVMI with regression coefficients of 2.9 (0.8; 5.1)g/m2.7, 2.3 (0.6; 4.0)g/m2.7, 2.0 (0.04; 4.0)g/m2.7 and − 2.9 (− 5.1; − 0.7)g/m2.7. Body composition measures were not associated with LVEF or LAVI. These associations were not modified by sex or mediated by inflammation. Body composition could play a role in the pathophysiology of LV hypertrophy. Future research should focus on sex differences in regional adiposity in relation with diastolic dysfunction

Sex differences in the longitudinal relationship of low-grade inflammation and echocardiographic measures in the Hoorn and FLEMENGHO Study

Background This study aimed to determine the within-person and between-persons associations of low-grade inflammation (LGI) and endothelial dysfunction (ED) with echocardiographic measures related to diastolic dysfunction (DD) in two general populations and whether these associations differed by sex. Methods Biomarkers and echocardiographic measures were measured at both baseline and followup in the Hoorn Study (n = 383) and FLEMENGHO (n = 491). Individual biomarker levels were combined into either a Z-score of LGI (CRP, SAA, IL-6, IL-8, TNF-α and sICAM-1) or ED (sICAM-1, sVCAM-1, sE-selectin and sTM). Mixed models were used to determine within-person and between-persons associations of biomarker Z-scores with left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) and left atrial volume index (LAVI). These associations were adjusted for a-priori selected confounders. Results Overall Z-scores for LGI or ED were not associated with echocardiographic measures. Effect modification by sex was apparent for ED with LVEF in both cohorts (P-for interaction = 0.08 and 0.06), but stratified results were not consistent. Effect modification by sex was apparent for TNF-α in the Hoorn Study and E-selectin in FLEMENGHO with LVEF (P-for interaction≤0.05). In the Hoorn Study, women whose TNF-α levels increased with 1-SD over time had a decrease in LVEF of 2.2 (-4.5;0.01) %. In FLEMENGHO, men whose E-selectin levels increased with 1-SD over time had a decrease in LVEF of 1.6 (-2.7;-0.5) %. Conclusion Our study did not show consistent associations of LGI and ED with echocardiographic measures. Some evidence of effect modification by sex was present for ED and specific biomarkers