Work integrated learning: A whole of curriculum approach

The School of Nursing and Midwifery at Edith Cowan University, Western Australia is currently developing an innovative work integrated learning masters to service the needs of students and industry. As this paper details, the program is aimed at Registered Nurses and Midwives to support and develop the skills to conceptualise and implement a work integrated program of study, the products of which are then used as recognised assessment items. Unlike many other work integrated learning initiatives, this curriculum is entirely work integrated learning based with early units of study providing students with the foundational skills and conceptual understanding required to implement a series of employment based projects and work based activities. Importantly, central to this program is the requirement for students to map their program of learning against essential and desirable criteria, congruent with an ability to frame an argument of competence, substantiated by quality evidence. During the course, students undertake a series of ‘traditionally taught’ units that are designed to support entry into clinical specialty practice areas. The largest proportion of units however, will support students to undertake project activities that address the needs of their employer, whilst also contributing to a portfolio of evidence required as part of the master’s award. The program’s philosophy is underpinned by a trilateral relationship between the student, industry and the University. The relationship developed through the implementation of the program enables capacity building, both for the student and for industry through the provision of advanced practitioners who align with the local and strategic goals of their organisation

Revealing meaning from story: The application of narrative inquiry to explore the factors that influence decision making in relation to the withdrawal of life-sustaining treatment in the intensive care unit

This paper considers the effectiveness of narrative inquiry as a research method in collecting and analyzing stories from a purposive sample of intensive care nurses and doctors, regarding their perceptions of the factors that influence decision-making in relation to the withdrawal of life sustaining treatment. Delaying the withdrawal of treatment when it is clearly indicated, may result in unnecessary patient suffering at the end of life, distress for the family as well as moral distress for staff. In narrative inquiry participants’ first-hand accounts of their experiences are told through story; the focus of analysis is the story, with the story becoming the object of investigation. Initially, participants’ stories were restoried to produce narratives that were co-constructed between researcher and participant. Narrative analysis, employing McCormack’s lenses and the interconnected analytical lenses, facilitated vertical analysis of each narrative. Horizontal analysis through thematic analysis facilitated the derivation of themes that were consistent within or across narratives. We detail here how narrative inquiry methodology was effective in revealing the meaning participants gave to their decision-making experiences through story, offering a broader understanding of the factors that impact on decision-making regarding the withdrawal of life-sustaining treatment. The study’s findings were powerful, derived from narratives rich and thick in description, depicting a multi-dimensional interpretation of the participants’ perceptions of their decision-making experiences. Participants experienced transformative learning through the narrative process, which led to changes in ways of working in the study setting. Recommendations arose to enhance clinical practice and education in this vital area of practice as a result of this study. The application of narrative inquiry enabled the discovery of significant findings as an avenue to challenge legislation and current opinion regarding the autonomy and role of the family in decision-making

The Human Serum Metabolome

Continuing improvements in analytical technology along with an increased interest in performing comprehensive, quantitative metabolic profiling, is leading to increased interest pressures within the metabolomics community to develop centralized metabolite reference resources for certain clinically important biofluids, such as cerebrospinal fluid, urine and blood. As part of an ongoing effort to systematically characterize the human metabolome through the Human Metabolome Project, we have undertaken the task of characterizing the human serum metabolome. In doing so, we have combined targeted and non-targeted NMR, GC-MS and LC-MS methods with computer-aided literature mining to identify and quantify a comprehensive, if not absolutely complete, set of metabolites commonly detected and quantified (with today's technology) in the human serum metabolome. Our use of multiple metabolomics platforms and technologies allowed us to substantially enhance the level of metabolome coverage while critically assessing the relative strengths and weaknesses of these platforms or technologies. Tables containing the complete set of 4229 confirmed and highly probable human serum compounds, their concentrations, related literature references and links to their known disease associations are freely available at http://www.serummetabolome.ca

Whose death is it anyway? Withdrawal of life-sustaining treatment: An exploration of the experiences of intensive care nurses and doctors

Background: This study explores the experiences of intensive care nurses and doctors relating to the withdrawal of life-sustaining treatment (WLST) from imminently dying patients and considers the factors that affect decision-making and the process of WLST. Also considered are the perceptions of collaboration between nurses and doctors during the decision-making process, how WLST affects the two professional groups and their ethical perspectives in relation to WLST. Method: Narrative Inquiry was employed for this study; a purposive sample of intensive care nurses and doctors were invited to recount stories of their involvement in WLST. Of interest were experiences of ethical tension, experiences of collaboration, or lack of collaboration in decision-making concerning WLST. Data analysis: Participants’ stories were treated as data to derive themes that were reasonably consistent within or across stories. Initially, narrative analysis facilitated ‘restorying’; each narrative being co-constructed between researcher and participant. Applying McCormack’s lenses, further interpretive stories were written; followed by thematic analysis. Conclusions: In the facility where the study was conducted, doctors were emphatic that it was their decision to withdraw treatment, or there was shared decision-making with the family. However, concerns about traumatising the family and potential litigation could potentiate the continuation of treatment if family consensus could not be reached. This revealed that substitute decision-makers, supported by vague and ambiguous laws, may have contributed to protracting the dying process; potentially increasing patient suffering. The family became the ultimate decision-makers and the two entities that would be considered to support good end-of-life care, the law and the patient’s family, could be the two entities that form a barrier to it. The nurses perceived that the wishes of the family often took precedence over the best interests of the patient. The doctors wished to limit pointless suffering but when compelled to continue treatment, their approach changed; perceiving the maintenance of sedation negated the potential for suffering. However, the initial decision to consider WLST was made to limit suffering, when at that time, the patient was sedated. This could be viewed as a self-protective mechanism for doctors; the nurses had no such protective mechanism. Overall, collaboration in decision making was limited; disagreements about the goals of treatment could engender moral distress, leading to conflict between professional groups. The doctors believed that when they continued treatment for dying patients, it was either in the best interests of the patients or their families; portraying ethical perspectives affiliated to beneficence and therefore, utilitarianism. However, nurses considered that continuing, what they considered to be non-beneficial treatment, suffering, and thus, harm was inflicted on patients and their families by protracting the patients’ dying process; portraying ethical perspectives affiliated to nonmaleficence and therefore, deontology. These are powerful findings that add to the body of knowledge in this field of research. The major recommendations of the study are that policy reform is warranted, with medical experts being involved in policy development. Mass public education is key to ensure substitute decision-makers fully understand the implications of the decisions they make

Involvement in sport and intention to consume alcohol: an exploratory study of UK adolescents

We tested the hypothesis that school “athletes” and “non-athletes” differ in intentions to consume alcohol and get drunk, attitudes toward alcohol, and perceptions of subjective norms. We also investigated, using the theory of reasoned action, whether athletic involvement is a factor in predicting alcohol-related intentions. Data were obtained from students in a stratified sample of schools in a major Welsh city. Male athletes were significantly more likely than male non-athletes to intend to get drunk and to believe friends would approve of their alcohol consumption. For males, sporting involvement was a significant predictor of likelihood of getting drunk. In contrast, female athletes showed significantly more negative attitudes than did female non-athletes toward drinking alcohol. Differences in intentions were nonsignificant

The emotional intelligence of registered nurses commencing critical care nursing

Background: Critical care is described as complex, detailed healthcare in a unique, technologically rich environment. Critical care nursing requires a strong knowledge base and exceptional clinical and technological skills to cope in this demanding environment. Many registered nurses (RNs) commencing work in these areas may lack resilience, and because of the stress of the critical care environment, coping mechanisms need to be developed. To prevent burnout and to enable critical care nurses to function holistically, emotional intelligence (EI) is essential in the development of such coping mechanisms. Objective: The aim of this study was to describe the EI of RNs commencing work in critical care units in a private hospital group in Gauteng, South Africa. Method: The design used for this study was a quantitative descriptive survey. The target population were RNs commencing work in critical care units. Data were collected from RNs using the Trait Emotional Intelligence Questionnaire – Short Form and analysed using the Statistical Package for the Social Sciences software. Results: The sample (n = 30) had a mean age of 32 years. Most of the participants (63%) qualified through the completion of a bridging course between 2010 and 2012. The majority (62%) of the sample had less than 2 years’ experience as RNs. Conclusion: The EI of RNs commencing work in a critical care environment was indicative of a higher range of Global EI, with the well-being factor scoring the highest, followed by the emotionality factor, then self-control, with the sociability factor scoring the lowest

Humanising the curriculum: The role of a Virtual World

Objective: Technology has changed our world; changed the way we communicate, the way we do business and the way education is delivered. As a result, undergraduate student cohorts come to university equipped with new technology, and educators need to transform the delivery of the curricula to satisfy a variety of learning styles. Nursing education, in particular, is developing and transforming to incorporate technology into the learning environment. Clinical placement opportunities are often sparse and alternative experiences need to be considered. Across nursing curricula, it has been recognised that technology has the capacity to provide real-life learning experiences that promote student engagement and meet the learning needs of a diverse student cohort. Methods: This paper will discuss the development of a “Virtual World” in an undergraduate nursing program in Western Australia. The Virtual World initiative is designed to support students to understand the holistic, health-centred intent of the curriculum. Results: Initial results have shown that the Virtual World and humanising the curriculum, has increased learner engagement, improved critical thinking and decision-making. It has enhanced and maintained a high level of student satisfaction and self efficacy as well as assisting the development of graduate nurses who perceive themselves as health advocates, problem-solvers and organisers of care. Research will continue to follow the use of the Virtual World model, incorporating a virtual family and its integration into the undergraduate nursing curriculum. Conclusions: In the current climate of nurse education and due to a reduction in availability of clinical placements, alternative authentic experiences need to be offered. The development of the Virtual World has enabled meaningful participation in a safe and supportive learning environment

The hidden benefits of writing retreats: Academic development and social interaction for nurses

Not only do nurse academics teach, research, supervise, engage in professional development and professional organisations, they are compelled as academic nurse educators to write for publication, a task that involves expertise, creativity, skill and large amounts of time.. This article describes a qualitative reflective analysis of the themes which surfaced during an offsite writing retreat attended by nurse faculty. The authors of this paper discovered an added invaluable benefit of their time at writing retreat: time to engage in social interactions that benefit their professional and personal development. In addition through experience of the retreat has been the increase in publications through the commitment to output, and academic development through engagement in mentoring, collegial partnerships, informal learning, and reflection