Uncertainty, Reflection, and Designer Identity Development

Uncertainty is a defining quality of the design space and it stands to reason that designers’ personal attitudes toward uncertainty may influence design processes and outcomes via cognitive, affective, and/or behavioral channels. Individual attitudes and behavior patterns related to uncertainty may constitute a critical element of designer identity, which represents the synthesis of knowledge, action, and being. This qualitative study examined how graduate students in an instructional design course reflected on their experiences and beliefs regarding uncertainty. Participants were more reflective when discussing a general experience with uncertainty than their current attitudes toward uncertainty in design. Findings support the use of narrated reflection in design education related to uncertainty and identity. Implications for design education interventions and design are discussed

Design Ideas, Reflection, and Professional Identity: How Graduate Students Explore the Idea Generation Process

Within design thinking, designers are responsible for generating, testing, and refining design ideas as a means to refine the design problem and arrive at an effective solution. Thus, understanding one’s individual idea generation experiences and processes can be seen as a component of professional identity for designers, which involves the integration of knowledge, action, and being in support of the professional self. Using written journal responses from graduate students in an introductory course in instructional design, this study explored how students used reflection to reconstruct experiences relating to the emergence of design ideas. Findings indicate that students were able to use reflection in support of professional identity development concerning design ideas, although attention to emotional aspects was lacking and many struggled to move from descriptive writing to meaning-making. Implications for professional identity development for designers and for future research are discussed

Reflection and Professional Identity Development in Design Education

Design thinking locates the designer as the arbiter of the design space, personally responsible for managing uncertainty, leveraging failures, and gaining insight through reflection to maintain momentum and deliver meaningful design outcomes. As design education becomes more closely aligned with design thinking, the field will need to shift its understanding of the role of the designer and support students in developing professional identities that reflect this understanding. This study investigated the use of reflective writing in an introductory design course to help students explore and interpret their design beliefs, experiences, and self-awareness. The results indicate that authorial presence, analysis, and narrative quality are common qualities in reflective responses, but emotion is notably lacking from student writing. Students were highly reflective in relation to a general experience with uncertainty and least reflective when discussing ideation processes. Implications for design education and research are discussed

Developing Designer Identity Through Reflection

As designers utilize design thinking while moving through a design space between problem and solution, they must rely on design intelligence, precedents, and intuition in order to arrive at meaningful and inventive outcomes. Thus, instructional designers must constantly re-conceptualize their own identities and what it means to be a designer. Within instructional design, professional identity development is intimately linked to the concept of design precedents. Reflective practice appears to be a natural avenue for supporting identity development in student designers, as it challenges them to think deeply about concepts and experiences through interpretation, evaluation, and revision. The authors conducted a preliminary study examining how graduate students in instructional design use reflection to build their identity as instructional designers within a design thinking framework. While this study was preliminary in nature, it represents an important first step in exploring how instructional design students can use reflective practice to develop the foundations of their professional identity, particularly within the design thinking framework

Instructional Designers as Reflective Practitioners: Developing Professional Identity through Reflection

As the design thinking approach becomes more established in the instructional design (ID) discourse, the field will have to reconsider the professional identity of instructional designers. Rather than passively following models or processes, a professional identity rooted in design thinking calls for instructional designers to be dynamic agents of change who use reflective thinking to navigate the design space and develop solutions to ill-structured problems. Graduate programs in ID will also need to prepare students to manage the complexities they will encounter in their professional practice, including the establishment of design precedents, reflective thinking skills, and the foundations of professional identity. This research explored the use of reflective writing assignments in an introductory ID graduate course, with results indicating that most students are able to engage in meaningful reflection in relation to prompts concerning design concepts, experiences, and identity attributes, although no clear patterns of improvement emerged over time. Future directions for research include the use of feedback and the structure of prompts (including frequency of writing assignments and wording of prompts) to support improved student performance

Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol

Abstract Background Health professionals strive to deliver high-quality care in an inherently complex and error-prone environment. Underreporting of medical errors challenges attempts to understand causative factors and impedes efforts to implement preventive strategies. Audit with feedback is a knowledge translation strategy that has potential to modify health professionals’ medical error reporting behaviour. However, evidence regarding which aspects of this complex, multi-dimensional intervention work best is lacking. The aims of the Safe Medication Audit Reporting Translation (SMART) study are to: 1. Implement and refine a reporting mechanism to feed audit data on medication errors back to nurses 2. Test the feedback reporting mechanism to determine its utility and effect 3. Identify characteristics of organisational context associated with error reporting in response to feedback Methods/design A quasi-experimental design, incorporating two pairs of matched wards at an acute care hospital, is used. Randomisation occurs at the ward level; one ward from each pair is randomised to receive the intervention. A key stakeholder reference group informs the design and delivery of the feedback intervention. Nurses on the intervention wards receive the feedback intervention (feedback of analysed audit data) on a quarterly basis for 12 months. Data for the feedback intervention come from medication documentation point-prevalence audits and weekly reports on routinely collected medication error data. Weekly reports on these data are obtained for the control wards. A controlled interrupted time series analysis is used to evaluate the effect of the feedback intervention. Self-report data are also collected from nurses on all four wards at baseline and at completion of the intervention to elicit their perceptions of the work context. Additionally, following each feedback cycle, nurses on the intervention wards are invited to complete a survey to evaluate the feedback and to establish their intentions to change their reporting behaviour. To assess sustainability of the intervention, at 6 months following completion of the intervention a point-prevalence chart audit is undertaken and a report of routinely collected medication errors for the previous 6 months is obtained. This intervention will have wider application for delivery of feedback to promote behaviour change for other areas of preventable error and adverse events.http://deepblue.lib.umich.edu/bitstream/2027.42/111741/1/13012_2015_Article_260.pd

Use of an audit with feedback implementation strategy to promote medication error reporting by nurses

Aims and objectivesTo outline the development and effect of an audit with feedback implementation strategy that intended to increase the rate of voluntary medication error reporting by nurses.BackgroundMedication errors are a serious global health issue. Audit with feedback is a widely used implementation strategy that has potential to modify nurses’ reporting behaviour and improve medication error reporting rates.DesignQuasi‐experimental implementation study (fulfilling the TIDieR checklist) with two pairs of matched wards at a private hospital in Australia was conducted from March 2015–September 2016. One ward from each pair was randomised to either the intervention or control group.MethodNurses within intervention wards received audit with feedback on a quarterly basis over a 12‐month implementation period. Control wards underwent quarterly audits only (without feedback). Feedback consisted of a one‐page infographic poster, with content based on medication error data obtained from audits and the hospitals’ risk management system (RiskMan). The primary outcome—rate of medication errors reported per month—was determined in both groups at pre‐implementation, implementation and postimplementation phases. Differences between groups were compared using generalised linear mixed models with Poisson distribution and log link.ResultsA nonsignificant intervention effect was found for rate of medication errors reported per month. Interestingly, when combining data from both groups, a significant increasing time trend was observed for medication errors reported per month across pre‐implementation and implementation phases (80% increase).ConclusionsThe audit with feedback strategy developed in the present study did not effectively influence the voluntary reporting of medication errors by nurses.Relevance to clinical practiceDespite the lack of intervention effects, the use of a published checklist to optimise the reporting quality of this study will contribute to the field by furthering the understanding of how to enhance audit with feedback implementation strategies for nurses.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163422/2/jocn15447.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163422/1/jocn15447_am.pd

Patient perceptions of deterioration and patient and family activated escalation systems-a qualitative study

Aims and objectivesTo investigate the experiences of patients who received a medical emergency team review following a period of clinical deterioration and their views about the potential use of a patient and family activated escalation system.BackgroundDelay or failure by health professionals to respond to clinical deterioration remains a patient safety concern. Patients may sometimes identify subtle cues of early deterioration prior to changes in vital signs. In response to health professional and system failures, patient and family activated escalation systems have been mandated and implemented in Australia. However, little research has evaluated their effectiveness nor taken patients&rsquo; perspectives into account.DesignQualitative exploratory descriptive design was used.MethodsPurposive sampling was used. Semistructured interviews were undertaken in 2014 with 33 patients who required medical emergency team intervention. Data were collected from one private and one public hospital in Melbourne, Victoria, Australia. The framework method was used to analyse the data.ResultsAll patients stated that it was the clinician who detected and responded to deterioration. Private patient participants were unaware of the medical emergency team system, and felt escalating care was not their responsibility. These patients reported being too sick to communicate prior to and during medical emergency team review and did not favour a patient and family activated escalation system. Public patients were well informed about the medical emergency team system yet expressed concerns around overriding clinicians if activating a patient and family activated escalation system.ConclusionPatient participation during a period of deterioration is restricted by their clinical condition and limited medical knowledge. Patients felt comfortable to communicate concerns to clinicians but felt they would not activate the patient and family activated escalation system. This behoves clinicians to actively listen and respond to patient concerns.<br /

Women\u27s decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study

BACKGROUND: Vaginal birth after caesarean (VBAC) is an alternative option for women who have had a previous caesarean section (CS); however, uptake is limited because of concern about the risks of uterine rupture. The aim of this study was to explore women\u27s decision-making processes and the influences on their mode of birth following a previous CS. METHODS: A qualitative approach was used. The research comprised three stages. Stage I consisted of naturalistic observation at 33-34&nbsp;weeks\u27 gestation. Stage II involved interviews with pregnant women at 35-37&nbsp;weeks\u27 gestation. Stage III consisted of interviews with the same women who were interviewed postnatally, 1 month after birth. The research was conducted in a private medical centre in northern Taiwan. Using a purposive sampling, 21 women and 9 obstetricians were recruited. Data collection involved in-depth interviews, observation and field notes. Constant comparative analysis was employed for data analysis. RESULTS: Ensuring the safety of mother and baby was the focus of women\u27s decisions. Women\u27s decisions-making influences included previous birth experience, concern about the risks of vaginal birth, evaluation of mode of birth, current pregnancy situation, information resources and health insurance. In communicating with obstetricians, some women complied with obstetricians\u27 recommendations for repeat caesarean section (RCS) without being informed of alternatives. Others used four step decision-making processes that included searching for information, listening to obstetricians\u27 professional judgement, evaluating alternatives, and making a decision regarding mode of birth. After birth, women reflected on their decisions in three aspects: reflection on birth choices; reflection on factors influencing decisions; and reflection on outcomes of decisions. CONCLUSIONS: The health and wellbeing of mother and baby were the major concerns for women. In response to the decision-making influences, women\u27s interactions with obstetricians regarding birth choices varied from passive decision-making to shared decision-making. All women have the right to be informed of alternative birthing options. Routine provision of explanations by obstetricians regarding risks associated with alternative birth options, in addition to financial coverage for RCS from National Health Insurance, would assist women\u27s decision-making. Establishment of a website to provide women with reliable information about birthing options may also assist women\u27s decision-making

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 /