Faculty of Education - Theses
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ItemSpecialist nurses’ engagement with an online bioscience subject: a quantitative analysis( 2020)Bioscience has been a fundamental element of Australian nursing education programs since the early 1990s. The term bioscience in nursing curricula encompasses elements of physiology, pharmacology, immunology, genetics, biochemistry and pathophysiology. In postgraduate programs the capacity to link bioscience concepts to complex healthcare problems is required for competent and safe specialist nursing practice. The types of teaching and learning technologies utilised to engage specialist nurses with theoretical content in technology-enhanced learning environments are constantly evolving. Technology-enhanced learning involves the contemporaneous use of information technologies to augment teaching and learning. This approach has been widely accepted in various forms; the conventional mode of delivery for postgraduate bioscience subjects is frequently online. There is however, an absence of robust empirical evidence to substantiate the effectiveness of online learning on learning outcomes. In particular, there is a limited understanding of the relationship between students’ learning behaviours, readiness to learn and their academic achievement within technology-enhanced learning environments. The aim of this thesis research program was to establish whether postgraduate specialist nurses’ learning behaviours and readiness to learn, contribute to variability in academic achievement when studying bioscience via a technology-enhanced learning environment. An exploratory descriptive cohort study was conducted in two phases. Learning analytics were used in Phase 1 to identify nurses’ learning behaviours and explore the relationship between these behaviours and academic achievement. Learning behaviours included the total time spent online, the total number of logins, and the total number and frequency of hits on specific content areas. Hit activity was linked to topic summaries, webinars, formative multiple choice questions (MCQs) and online library readings. The endpoint measure of academic achievement was a combination of the cumulative mark for five summative assessments. Based on learning outcomes, participants were categorised into three groups according to their achievement level; high (greater than or equal to 75%), medium (64% to 74%) and low achievers (less than or equal to 63%). In Phase 2 a cross section of students from Phase 1 completed the Self-Directed Readiness Scale for Nursing Education (SDRSNE) survey (Fisher et al., 2001). This instrument was used to measure specialist nurses’ readiness for self-directed learning. Comprised of 40 items, the SDRSNE measured self-management, desire for learning and self-control. Respondents rated each item on a Likert scale with anchors from 1 (strongly disagree) to 5 (strongly agree). Descriptive and inferential statistics were used to explore the data. Participants in this study accessed online information more than 70,000 times over two semesters. While the average time spent online was over 48 hours there was substantial variability in the number of times individual students logged into the subject, the total time they spent online and the number of hits in content areas. Learning behaviours did not differ according to level of academic achievement, but there were trends in the data that warranted scrutiny. High and medium achieving students had a similar number of logins and hits but high achievers spent more time online. Topic summaries were the most frequently accessed online content followed by webinar recordings, online library readings and practice quizzes. No particular resource or content area was associated with improved learning outcomes or level of academic achievement. Specialist nurses undertaking an online bioscience subject demonstrated improved learning outcomes over time, with high achievers demonstrating the greatest knowledge gain when comparing pre and post quiz results. Mean scores for low, medium and high achievers in four summative MCQ were consistent and similar throughout the semester. Specialist nurses in this study demonstrated high levels of self-reported readiness to undertake self-directed learning and the SDRSNE was shown to be a valid and reliable tool for assessing readiness to learn in this cohort. There was no evidence of a relationship between a specialist nurses SDRSNE and their learning outcomes, and no substantiative relationship between SDRSNE and learning behaviours. Specialist nurses were ready to undertake self-directed online learning and actively engaged with the bioscience subject, achieving learning gains over the semester that demonstrated the effectiveness of the subject. There was however, no clear relationship between learning behaviours and learning outcomes, indicating that the learning of bioscience by specialist nurses is complex and multifactorial. Findings from this research provide valuable insights into online learning as a pedagogical tool for bioscience and nursing education. Future studies designed to test the effectiveness of active, collaborative online learning strategies will enable those involved in education to explore the links between students preferred learning behaviours and learning outcomes. There is opportunity to develop a variety of synchronous and asynchronies learning strategies to accommodate and acknowledge the diverse learning behaviours of students while simultaneously identifying students that may be at risk. Future research should focus on learner to content, learner to instructor and learner to learner interactions in technology-enhanced learning environments. Facilitating nurses’ understanding of bioscience principles is challenging; multiple factors impact upon the mastery of bioscience concepts. The findings from this study offer nurse educators and curriculum designers baseline data to guide and support innovations to shape contemporary student focused online learning.
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ItemGraduate nurse preceptorship( 2004)Recent research has established that the supervision relationship is the single most important factor for the effectiveness of any professional supervision (Kilminster & Jolly 2000). However there is a lack of reliable research identifying the effects of supervision in health care and, until recently, little research in Australia or internationally acknowledging the effectiveness of supervision specifically in acute health care settings (Sloan 1998, Palsson, Hallberg & Norberg 1994, Begat, Severisson & Berggren 1997, Hyrkas, Koivula & Paunomen 1999). The established research highlights the importance of developing Australian based graduate preceptorship research, particularly from the perspective of the graduate nurse and nurse preceptor, focusing on these nurses' experiences in the context of the acute health care setting. This pilot study was therefore intended to provide insights into the effectiveness of the preceptor in the supervision role within the Australian acute healthcare setting. The primary focus of this project was to ascertain the extent to which nurse preceptors effectively address graduate nurses' professional needs. The data collected in this study enabled the identification, exploration and cross checking of shared and alternate themes, and the development of a theoretical framework, encompassing these participants' graduate preceptorship experiences, incorporating a range of interrelationships and interactions.
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ItemThe learning needs of non-English-speaking-background student nurses( 1998)This thesis has investigated the learning needs of non-English-speaking-background (NESB) students in a tertiary nursing course and whether they are being met. It has reviewed literature predominently from Australia, Britain and the USA. Whilst there are similarites it has been recognised that all situations are not the same so the literature has been used appropritely to establish the theoretical framework for the study and in the support of the research findings. Qualitative methodology has been used focusing on observation, survey, and interview methods from two groups studied, ie., NESB students and academics. The findings from the two groups researched, are expressed as results; from students who have analysed that their learning as affected by predominently academic factors, such as reading and writing for assessments and professional documentation, and on a minor level by language and cultural expectations in relation to teaching/learning. Academic findings support students responses but also identify some professional nursing issues such as expectations of students as affecting the learning needs of these students. The recommendations of this thesis are to provide better academic support for NESB students and to effect greater academic and university awareness of the learning needs of NESB students.
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ItemNurse educators use of scoring rubrics to determine varying levels of clinical performance in the perioperative setting( 2005)This research evolved out of the need to design and validate an instrument for the assessment of competencies within the specialised area of the Operating Suite. The study represents an attempt to develop an instrument underpinning the unit of competency NR 4 - The Instrument Nurse from the Australian College of Operating Room Nurses standards (2004). Both holistic and analytical rubrics were developed that were aligned to the ACORN Standard and underpinned by the Dreyfus (1981) model in accordance with the rules established by Griffin and colleagues (2001). Three video clips that captured the varying performances of instrument nurses in the operating suite were recorded and used as prompts for rating. Forty raters were required to judge the performance of the candidates in each video clip using an Analytical Observation Form, Holistic Performance Level Rubrics and Holistic Competence Rubrics. The study found that the holistic rubrics led to more consistent judgements than the analytical rubrics, yet the latter provided more diagnostic information for intervention purposes. Despite less consistency, the results revealed that the Analytical Observation Form had sufficient construct validity as determined by the Item Separation Index (Rasch, 1960). The study also revealed that the Analytical Observation Form had high internal consistency and greater inter-rater reliability when average ratings were used. The findings had direct implications for theory, practice and future research.
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ItemEvaluation of a Cancer/Palliative Nursing Care subject and a comparison of processes and outcomes for traditional classroom and distance education teaching modes of delivery( 2000)This Evaluation is concerned with the educational outcomes of a postgraduate subject, 'Cancer/palliative care nursing 1'. The subject is taught in the classroom as well as by distance education in the print medium and, as well as considering the outcomes for the subject per se, the Evaluation also compares the outcomes for each teaching mode. The questions addressed in the Evaluation are: a) does the delivery of the subject (regardless of the method used) have the outcomes that might be expected of a postgraduate diploma level subject? and b) are students taught by distance education mode disadvantaged by comparison with students who are taught by traditional classroom methods? There is an abundance of literature on distance education, most of which uses, explicitly or implicitly, classroom teaching as a largely unexamined exemplar by which distance education is judged. This thesis critically examines the distance education literature and identifies factors salient to a comparison of these two methods of teaching. The Evaluation method is based on the theory-driven approach advocated by Chen (1990) and incorporates an adaptation of the program logic framework put forward by Funnell (1996). It incorporates two methods of evaluation: the subject's outcomes measured against a prescription; and, a comparison of the distance education outcomes with classroom teaching outcomes. A prescription of how the subject should be delivered and the outcomes that should be expected was developed from stakeholder interviews, informed by a critical review of the distance education literature and the evaluator's knowledge of the discipline. A method of measuring the actual delivery of the subject against the prescription (regardless of the teaching mode) was devised and a minimum acceptable standard of success established. Substantive methods used include both qualitative and quantitative data gathered by questionnaires, interviews, classroom observations and a content analysis of the study guide used by distance education students. The Evaluation findings are that on most, but not all, outcome measures the subject met the set standard of success. One outcome unspecified in the prescription (although implied) was the increased clinical confidence engendered by undertaking this subject. Students taught by the traditional mode gained from classroom interaction although the degree of interactivity was found to depend on the personal qualities of lecturers and students and the structure of teaching sessions. Distance education students were not disadvantaged by this teaching mode and on some measures, such as being able to study at their own pace or the grades they achieved, could be said to be advantaged.
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ItemA discursive model of professional identity formation and cultural agency in midwifery education : a framework to guide practice and research( 2002)The study of professional identity formation of midwives, grounded in the clinical frontline professional conversations of students with their preceptors/midwives, was developed to inform practice and research in postgraduate midwifery education. It also set out to contribute to the development of a methodology and conceptual model concerning the discursive acts/actions of the students and their preceptors/midwives in particular social episodes, which could be integrated into naturalistic modes of social science. The professional identity of three student participants and the social conditions of institutional practice are immanent throughout their discourses related to safe midwifery practices at the intersection of both private purposes and social exigencies. The acts/actions of private experience and public expression were performed according to a social system of customs, rules, and regulations to promote safe and skilled midwifery practice. The students were exposed, during their induction into practice and through systematic appraisals of their professional development, to the overt judgments of midwives in the culturally rich environment of maternity services. In this research project, self-identity, multiple personas, and social structures in frontline conversations were studied. Positioning theory, developed by Harre and others, was used to make determinate the storylines, positioning, and illocutionary force of each student's agency in discourse and presented as a dynamic alternative to the concept of role. Positioning theory is presented as a dynamic alternative to the concept of role in analysing social episodes in professional education. The current pedagogy of reflective practice has been critiqued to elaborate a new epistemology of midwifery education rooted in social realism. The localised psychological spaces, afforded in educational discourses and framed by dimensions of public/private positioning and individual/collective accountability, were explored to present a schematic model, after Harre, of personal being in professional identity formation. Three ontological domains include the semiotics of midwifery practice, agency of students, and professional structures, which appeared in some form within each social episode and presented in the students' accounts. The orienting theory of discursive positioning permits the study of the relationship between these ontological levels and allows progress toward a transformational model of social action in midwifery. This model offers a more dynamic theory of socially situated learning in codifying the ontology of experiences and concepts for future midwifery practice.
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ItemClinical congruence : where graduate nurse clinical reality meets organisational clinical requirements( 2004)In the mid 1980s, education associated with the requirement for registration as a Nurse in the State of Victoria moved from a hospital-based system into the university setting. This move brought with it many and varied requirements for change within the health care setting. The students of nursing were now no longer a part of the workforce, they were transient visitors in the patient care setting with very specific clinical requirements to be met; and they were there for less time! This research project is not about whether this change in preparation should have occurred. It is well accepted amongst the profession that this was necessary to raise the status of the nursing professional. We now have registered nurses with a primary degree in nursing or health science. The question here however, is what clinical capacities do the newly graduates and registered nurses have when they enter the clinical workforce, and what clinical capacities are required by the health care institutions that are employing them. Have these institutions an accurate and realistic knowledge of the clinical capacities of the newly graduated registered nurses they employ? This research concentrated on the self-perceived and reported clinical capacities of newly graduated registered nurses as they entered the clinical environment and the clinical capacities required by the clinical areas that employed them. Clinical congruence was then measured between these two sources. The findings demonstrated that in a supported environment, where graduates can expect and receive clinical support and mentorship, clinical congruence:is likely to be achieved. However, in an environment where clinical skills are required to be undertaken at an unsupervised level, there were a significant number of distinct clinical skills for which the graduates report unpreparedness. Graduates and Nurse Managers alike agreed that increased clinical experience during the undergraduate preparation time is optimal, but the universities indicated that the fiscal and chronological constraints of a three-year degree program, in an environment where there is a cost incurred for the clinical experience, is difficult to achieve. This research demonstrates, in a tangible way, the need for a supported Graduate Transition Program to facilitate the consolidation and / or achievement of clinical competency for the graduates as they enter the workforce. This support will assist in ensuring the maintenance of a dynamic nursing workforce into the 21st century to meet the needs of the Victorian community at a time when it is most vulnerable during the period of ill health.
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ItemOf secrets, sorrows, and shame: undergraduate nurses' experiences of death and dying( 2007)This phenomenological study explores the lived experiences of undergraduate nursing students who cared for the dying and deceased whilst on clinical placement. To this point, studies on this phenomenon have focused on the experienced, qualified nurse. The purpose of this study was to gain an understanding of the impacts of caring for the dying and deceased, on the student-nurse, and the implications for nursing education. The ten study participants were undergraduates enrolled in the Bachelor of Nursing program at a metropolitan-based university in Melbourne. The study of their experiences, from the perspectives of the student-nurses, was conducted using a semi-structured interview for data collection. Analysis of the data, using a Miles and Huberman (1994) style matrix, revealed four emergent themes: intensity of emotion; perceptions, growth and awareness; and opportunities. These themes were explored to yield results which established there were often profound, and sometimes disturbing, impacts of grief for both the student-nurse, the patient, and others. This study contributes to the This phenomenological study explores the lived experiences of undergraduate nursing students who cared for the dying and deceased whilst on clinical placement. To this point, studies on this phenomenon have focused on the experienced, qualified nurse. The purpose of this study was to gain an understanding of the impacts of caring for the dying and deceased, on the student-nurse, and the implications for nursing education.
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ItemThe clinical learning of pre-registration student nurses: challenges for clinicians' practice( 2005)This research investigated to what extent does workplace supervision of undergraduate nursing students by registered nurse clinicians confront clinical practice in the acute care hospital setting. Significant aspects of this are clinical education of nursing students mainly in Australia, the persisting difficulties of access to clinical placements, educational preparation of clinical supervisors and the clinical learning environment. This contextual study was an iterative case study, which was undertaken in five stages, each stage prerequisite to, and informing the next. The findings revealed the extent of collaboration between four participating universities and a major metropolitan teaching hospital. Perceptions of the educational role of the registered nurse clinician were explored as seen by nurse unit managers, the undergraduate student nurses, clinical teachers and the clinicians themselves. Also factors were identified in the clinical environment which the participants thought could influence undergraduate students' learning. The study concludes with recommendations to increase accessibility to clinical places, and the preparation, support, and recognition of the clinicians for their clinical education role.
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ItemHealing hands: a study of the healing skills and practices of overseas educated registered nurses and the implications for nurse education in Australia( 1996)Australia's health care clientele reflects the diversity of this multicultural society. Patients and health care professionals have expectations of health care which may not be met to their satisfaction, or needs. The perceived inadequacies and increased demands on the Australian health care system are reflected in the literature and by active political lobbying, thus there is an urgent need to investigate how the health care system can be improved or modified to meet these deficits. One mechanism which may provide some of the changes required, is to utilise the skills, experience, and qualifications of Non-English Speaking Background (NESB) nurses. In utilising this valuable and available resource nursing education curricula can be modified to adequately incorporate transcultural nursing practices so that nurses can provide culturally sensitive nursing care for their patients. This study describes some of the dimensions of the cultural diversity in Australia, as it relates to health care. In particular reflections and observations of NESB educated nurses of the Australian health care system are discussed, in particular standards of care, nursing care, nursing education and issues related to the interweaving of cultural diversity within the Victorian health care system and the nursing profession. The purpose of this study is to provide insights on how to enrich the education of all nurses to meet the challenges of caring for Australia's multicultural population. Recommendations for the establishment of the Migrant Health Professionals Network and additional courses to meet the specific needs of NESB health professionals have already come to fruition.