Non-threatening Environment Research Articles

Students’ experience and evaluation of peer‐to‐peer learning innovation

The “Study Buddy Support” (SBS) scheme was first employed for pathology students during the second semester of 2013 for the medical radiation science undergraduate program. Following the first summative assessment (FSA), students deemed “at risk” of failing (buddies) (n = 23) and high-achieving students (buddy leaders, BLs) (n = 6) from the same year level were invited to participate in the scheme. Seeking to provide students with supplementary learning and strategies, participating buddies (n = 9) and BLs (n = 2) followed the study plan given by the course coordinator to revise all the course topics in order to prepare for the final examination. Final examination results for participating “at risk” students showed a 28.2% improvement in comparison to an 8% improvement for the non-participants. Qualitatively, the SBS scheme provided mutual benefits for all involved, both buddies and BLs. The buddies reported greater confidence and interest in the course material. Similarly, the consolidation of knowledge, development of networking and leadership skills were considered highly constructive by the BLs. In the future, offering SBS sessions via virtual classrooms would give students flexibility to engage in this supportive peer- based scheme in a non-threatening environment.

Beyond the drugs: nonpharmacologic strategies to optimize procedural care in children.

Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of nonpharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue, and procedural sedation. Based both on well-established theoretical frameworks as well as an increasing body of scientific evidence NPS need to be regarded an inextricable part of procedural comfort care. Procedural comfort care must always start with a child-friendly, nonthreatening environment in which well-being, confidence, and self-efficacy are optimized and maintained. This requires a reconsideration of the medical spaces where we provide care, reduction of sensory stimulation, normalized professional behavior, optimal logistics, and coordination and comfort-directed and age-appropriate verbal and nonverbal expression by professionals. Next, age-appropriate distraction techniques and/or hypnosis should be readily available. NPS are useful for all types of medical and dental procedures and should always precede and accompany procedural sedation. NPS should be embedded into a family-centered, care-directed policy as it has been shown that family-centered care can lead to safer, more personalized, and effective care, improved healthcare experiences and patient outcomes, and more responsive organizations.

Impact of Nintendo Wii Games on Physical Literacy in Children: Motor Skills, Physical Fitness, Activity Behaviors, and Knowledge.

Physical literacy is the degree of fitness, behaviors, knowledge, and fundamental movement skills (agility, balance, and coordination) a child has to confidently participate in physical activity. Active video games (AVG), like the Nintendo Wii, have emerged as alternatives to traditional physical activity by providing a non-threatening environment to develop physical literacy. This study examined the impact of AVGs on children’s (age 6–12, N = 15) physical literacy. For six weeks children played one of four pre-selected AVGs (minimum 20 min, twice per week). Pre and post measures of motivation, enjoyment, and physical literacy were completed. Results indicated a near significant improvement in aiming and catching (p = 0.06). Manual dexterity significantly improved in males (p = 0.001), and females felt significantly less pressured to engage in PA (p = 0.008). Overall, there appears to be some positive impact of an AVG intervention on components of physical literacy.

MAXIMIZING STUDENTS’ LEARNING EXPERIENCE THROUGH DIFFERENTIATED INSTRUCTIONS IN AN ICT-INTEGRATED ENVIRONMENT

Singapore’s education landscape is weaved in a collage of diverse learning profiles due to her multi-faceted society. A multitude of teaching strategies is thus imperative to cater to a classroom of diverse learners who differ not only culturally and linguistically but also in their cognitive abilities, background knowledge and learning preferences. It thus becomes mandatory, to explore different strategies to ensure and maintain high level of engagement and motivation throughout the lesson. Tomlinson (2004c) points out that the teacher is the professional in the classroom, using appropriate techniques, assisting each learner to reach his or her potential within the learning context. Thus, in an effort to maximize all students’ learning experience, there are significant efforts made by teachers to implement differentiated instructions. According to Tomlinson and Strickland (2005), teachers usually differentiate instruction by adjusting one or more of the following: the content; the process; or the product. This paper explicates how this possibility has been applied in an ICT-based teaching and learning programme known as 10 IS Aksara for Malay Language. This programme, which is done in collaboration with schools, is initiated by the Educational Technology Division (ETD) of the Ministry of Education (MOE), Singapore. It adopts a learner-centered approach which is well-balanced between teacher facilitated activities and web-based individual assignments. The availability of an online personalized learning space, incorporating the thoughtful blend of face-to-face and 1:1 online learning allows for multitude of possibilities for the teacher to design differentiated lessons to cater to the different abilities. From the point of content selection to the final individual online assessment, differentiated Instruction is carefully weaved in seamlessly throughout the lesson.Through such lessons, it was evident that there was a significant impact on the students final output. Students with lower learning ability were able to relate better in a non-threatening environment when the assignments were pitched at their level and thus became more confident learners. Assignments given to higher learning ability students, on the other hand, were more challenging. These provided them the opportunity to further explore and expand their learning experience.

Peer Assisted Tutorial to cultivate self-directed learning practice among first year medical students in Anatomy

Background & Objectives: Anatomy is the foundation stone of medical education upon which knowledge is built over time. Tutorials are a part of curriculum along with routine dissection and practical in teaching anatomy. A conventional tutorial lacks active learning habits among students. Knowledge explosion demands the students to inculcate self-directed learning habits from the beginning of medical education. Peer assisted tutorials is one such strategy to imbibe self-directed learning culture. Methodology: The study was conducted on regular tutorial batch of 25 students in 2 groups (group A & B) with 2 topics (brachial plexus & mammary gland) by cross over method. Pre and post test was administered followed by immediate feedback questionnaire. Results: The study revealed improvement in post test scores of both group but statistically significant in study groups. There was significant improvement in comparison of post test scores between study and control wings of group A (brachial plexus) but not in group B (mammary gland). The questionnaire revealed peer learning was active, interactive which fostered in depth understanding of subject in a non-threatening learning environment. Interpretation & Conclusion: The benefits and drawbacks of the innovation are discussed and compared with earlier studies. Peer learning supports the saying “to teach is to learn twice” which is evident from this study. Key words: Peer learning, Self-directed learning, Active learning, Anatomy, Tutorials

Community Health Worker Perspectives on Recruitment and Retention of Recent Immigrant Women in a Randomized Clinical Trial.

This study explores the recruitment and retention strategies used by community health workers who enrolled Korean Americans in a church-based, randomized trial to promote mammogram and Papanicolaou tests and retained them for 6 months. We conducted 4 focus groups with 23 community health workers. Data were analyzed using a thematic analysis. Themes were identified in relation to recruitment: personal networks, formal networks at churches, building on trust and respect, and facilitating a nonthreatening environment. Themes were identified for retention: trust and peer support. Qualified, well-trained community health workers can recruit and retain hard-to-reach immigrant women in a randomized trial by using multiple culturally sensitive strategies.

정신질환자간호 시뮬레이션교육이 간호학생의 임상실습에 대한 불안과 자신감에 미치는 효과

Nursing students experienced anxiety and fear of building relationships with psychiatric patients due to lack of professional knowledge about metal illness and skill to take care of the patients. The simulation education is known as an effective teaching-learning method since being performed in a non-threatening environment similar to clinical setting. The purpose of this nonequivalent quasi-experimental study was to identify the effect of simulation on anxiety and self-confidence about the psychiatric-mental health nursing practice. The third year nursing students at a three year nursing program were participated in this study. For the experimental group (N=28) the simulation education using the standardized patient based on the scenario for patients with schizophrenia was performed, and for the control group (N=18), the debated education applying the case study same as for the experimental group was made in the class. Using SPSS, t-test and ANCOVA were analyzed to compare the anxiety and self-confidence between the experimental and control groups. As a result of the study, the anxiety score on psychiatric-mental health nursing clinical practice of the experimental group significantly decreased, compared to that of the control group, but the self-confidence score for the performance of psychiatric nursing care showed no significant differences between the groups. Accordingly the simulation education can be an effective educational method to reduce anxiety about psychiatric-mental health nursing clinical practice for nursing students.

Implementing peer learning to prepare students for OSCEs.

First-year nursing students undertaking a first-year clinical skills module were given an opportunity to take part in a voluntary peer learning scheme, where they would learn from more senior students. It was envisaged this would help the students prepare for the module's summative assessment-an objective structured clinical examination (OSCE), which students can find stressful. The first-year students found peer learning helped them improve clinical skills, reduced anxiety and increased their self-confidence, and they appreciated the non-threatening learning environment and constructive feedback. The more senior students felt it helped prepare them for their mentoring role after registration. Incorporating peer learning more widely into the curriculum would allow it to be evaluated in more depth.

High-Fidelity Contrast Reaction Simulation Training: Performance Comparison of Faculty, Fellows, and Residents

PurposeReactions to contrast material are uncommon in diagnostic radiology, and vary in clinical presentation from urticaria to life-threatening anaphylaxis. Prior studies have demonstrated a high error rate in contrast reaction management, with smaller studies using simulation demonstrating variable data on effectiveness. We sought to assess the effectiveness of high-fidelity simulation in teaching contrast reaction management for residents, fellows, and attendings. MethodsA 20-question multiple-choice test assessing contrast reaction knowledge, with Likert-scale questions assessing subjective comfort levels of management of contrast reactions, was created. Three simulation scenarios that represented a moderate reaction, a severe reaction, and a contrast reaction mimic were completed in a one-hour period in a simulation laboratory. All participants completed a pretest and a posttest at one month. A six-month delayed posttest was given, but was optional for all participants. ResultsA total of 150 radiologists participated (residents = 52; fellows = 24; faculty = 74) in the pretest and posttest; and 105 participants completed the delayed posttest (residents = 31; fellows = 17; faculty = 57). A statistically significant increase was found in the one-month posttest (P < .00001) and the six-month posttest scores (P < .00001) and Likert scores (P < .001) assessing comfort level in managing all contrast reactions, compared with the pretest. Test scores and comfort level for moderate and severe reactions significantly decreased at six months, compared with the one-month posttest (P < .05). ConclusionsHigh-fidelity simulation is an effective learning tool, allowing practice of “high-acuity” situation management in a nonthreatening environment; the simulation training resulted in significant improvement in test scores, as well as an increase in subjective comfort in management of reactions, across all levels of training. A six-month refresher course is suggested, to maintain knowledge and comfort level in contrast reaction management.

Exploring how children express feelings and emotions in an online support group

Support groups provide opportunities for participants to express and get in touch with their feelings and emotions. For children such groups provide a non-threatening environment in which they can share their feelings and concerns openly with one another. The wide range of social networking options made easily accessible via mobile technologies has seen children increasingly connecting with their peers in search of emotional support. For parents and professionals alike the question arises as to whether these online groups provide the positive support environment necessary to ensure children feel comfortable sharing their emotional concerns. In this study qualitative content analysis of the communications shared between the young members of an online support group for siblings of children with special needs revealed that participants felt confident to openly express a range of strong feelings and emotions, including hate, love, confusion, hurt, fear, jealousy and embarrassment.

Thinking it Through: Mental Rehearsal and Performance on 2 Types of Laparoscopic Cholecystectomy Simulators

Simulation-based training (SBT) in laparoscopic cholecystectomy (LCCY) provides an opportunity for junior residents to learn the procedure in a safe, nonthreatening environment. Mental rehearsal (MR) has the potential of augmenting skill acquisition. This project investigated the correlation between MR of LCCY with performance on 2 different types of simulators: a procedural task (PT) training model and virtual reality (VR) machine. Prospective, quasi-experimental design with purposeful sampling. Postgraduate years (PGYs) 1 through 3 general surgical residents underwent standardized, distributed SBT in LCCY on either a PT trainer or a VR machine with group-based MR undertaken before 2 SBT sessions. Participants completed a pre-MR and post-MR session mental imagery questionnaire (MIQ) containing 8-items using a 7-point Likert-type scale. Data related to VR objective measures and PT video-based performances were also collected. Total scale mean scores were calculated for the first MR session and the second MR session and were compared using the t test. Pearson correlation analysis of MIQ scores with performance scores was determined. Louisiana State University Health New Orleans Health Sciences Center in New Orleans, Louisiana. This health sciences center is a tertiary care, academic state institution located in the Southeastern United States. A total of 21 PGYs 1 through 3 general surgery residents participated. They were purposefully divided into the PT and VR training groups to allow for even PGY distribution. Of the 21 participants, 19 completed both training sessions (n = 10 for PT [PGY1 = 4, PGY2 = 4, PGY3 = 2] and n = 9 for VR [PGY1 = 4, PGY2 = 3, PGY3 = 2]). After the Bonferroni adjustment, significant gains in the MIQ items related to confidence, visual imagery, and knowledge of the procedure were found. VR performance data demonstrated some statistically significant improvements. A significant negative correlation was present between the two-handed clip-and-cut VR task and MIQ gains. Group MR in LCCY before SBT on a VR machine is related to improved performance time for the VR two-handed clip-and-cut task. MR may be a useful adjunct to SBT LCCY. Future work will look at the translation of these skills to clinical practice.

Simulation as a learning Approach and its Influence on Self-Efficacy and Intrinsic Motivation of Nursing Students

Abstract Simulation provides a safe, non-threatening learning environment, which allows for the development of student self-efficacy and confidence when attempting skills in the actual clinical environment. Aim of the study: to assess the effect of simulation as a learning approach on self-efficacy and intrinsic motivation of the first year medical nursing student in Damanhour University (Egypt). Settings: Faculty of Nursing Damanhour University. Sampling all medical surgical nursing students enrolled at the first year, (n=311) at the academic year 2014-2015. Tools: Two tools were used to collect data. Tool I: General Self-Efficacy Scale (GSE) Tool II: Intrinsic Motivation Inventory (IMI); as well as demographic characteristics. Results: Confidence level and intrinsic motivation increased significantly post – simulation intervention. A significant positive weak correlation between total self- efficacy and total intrinsic motivation. There is a statistical significant difference between self-efficacy and both gender and studying hours. Conclusion Simulation is an active learning strategy that can effectively be integrated into all levels of nursing education to foster student-centered instruction. Results of this study showed that there was a significant difference in the students' self – efficacy and intrinsic motivation after using simulation. Recommendation Educators should be encouraged to use the various forms of simulation when appropriate with nursing students.

Standardized Patient Encounters Improved Athletic Training Students' Confidence in Clinical Evaluations

Context Researchers have reported that interacting with standardized patients (SPs) is a worthwhile and realistic experience for athletic training (AT) students. These encounters enhance students' interviewing skills, confidence as a clinician, clinical skill development, and interpersonal communication. Objective To determine how SP encounters impacted students' confidence in performing clinical evaluations. Design Pretest-posttest survey design. Setting Athletic training simulation lab. Patients or Other Participants Thirty-five students from the junior (n = 20) and senior (n = 15) AT cohorts from a public liberal arts institution in the Southeast. Intervention(s) Athletic training students completed 2 SP encounters per semester throughout an academic year in the AT program, totaling 4 SP encounters. Main Outcome Measure(s) Each student completed a 17-item Likert scale (1 = strongly disagree, 5 = strongly agree) that rated confidence levels immediately before and after each SP encounter. The confidence rating assessed students' confidence regarding how the SP encounter affected their confidence in completing patient evaluations (eg, identifying history questions, interpreting results of special tests). We computed descriptive statistics for all items Wilcoxon signed rank tests determined differences in pre-encounter and should be postencounter confidence ratings. Results Overall, students from both cohorts reported that the SP encounter improved confidence in completing clinical evaluations. Specifically, students reported a significant increase from pre-encounter to postencounter confidence ratings after nutrition-based (Z = −2.991, P = .004), knee (Z = −3.261, P = 0.001), concussion (Z = −3.294, P = .001), psychosocial intervention (Z = −3.062, P = .002), and general medical (Z = −3.524, P &amp;gt; .001) SP encounters. Conclusions The authenticity and fidelity of the SP encounter provided the AT students a real-time clinical evaluation in a nonthreatening environment. Students reported that their confidence improved after each encounter. By providing these experiences, AT students can become comfortable interacting with patients in clinical evaluations.

Evaluation from inside Out: The Experience of Using Local Knowledge and Practices to Evaluate a Program for Adolescent Girls in India through the Lens of Gender and Equity

This article describes an interesting approach where the evaluators recognised the value of using local community knowledge and experience in evaluating a Government of India program for the development and empowerment of adolescent girls. The evaluators tried to integrate participatory and appreciative approaches and looked at the evaluation process through a gender and equity lens. The evaluators went beyond the mandate of evaluation and focused on building evaluation capacity by fostering ownership of the program among stakeholders and encouraging the community to be the active agents of change. Instead of traditional evaluation where evaluators are outsiders, we engaged the stakeholders in the evaluation. All the stakeholders, including the funding agency, a non-government organisation (NGO), the adolescent girls and the wider community were engaged in varying degrees—from defining the objectives, designing questions, data collection and data analysis in the context of their aspirations and expectations, so that it could be an occasion for recognition and celebration of their strengths. The local project implementers and the adolescent girls themselves re-evaluated their own responses and used them in a particular context to further empower themselves. We used principles of the strength-based approach and framed appreciative questions, which recognised the strengths of the community and NGO staff. This created a non-threatening environment, which stimulated open sharing of experiences. Further, this resulted in reinforcing the evaluation process by improving the quality and richness of data that the community produced itself, which would not have been the case in a traditional evaluation. Additionally, a gender and equity lens was used to conduct the evaluation in six multi-ethnic districts, populated with religious and linguistic minorities, and an indigenous population. The gender and equity lens allows recognising the systematic discrimination based on gender, caste and class. The evaluation was able to probe whether the program assessed time, mobility, poverty and accessibility constraints of girls, and accounted for intersectional discrimination.

Cuento Therapy: Cultural Attunement in a Spanish-Speaking Alcohol and Drug Recovery Treatment Program: A Qualitative Case Study

The Latina/o population is the fastest growing ethnic minority in the United States, yet the population faces barriers to access mental health services due to a number of reasons. This qualitative case study was undertaken to address barriers to mental health for Spanish-speaking clients by implementing Cuento (folktales) Therapy, first introduced by Costantino, Malgady, and Rogler. The current study was adapted from the original intervention with (n=10) adult Latina/o clients in an alcohol and drug outpatient recovery program in Los Angeles, California. Group members read culturally relevant folktales during a 6-month period. A pre and post-test was used to assess participants’ experiences in the alcohol and drug outpatient recovery program conducted in English and the adapted Spanish cuentos group. An Acculturation Scale was used to assess participants’ level of acculturation and language. Results of the study support that cultural attunement is important when working with Latina/o clients. Therefore, three themes emerged: (1) cuentos were experienced as a culturally relevant therapeutic modality, (2) the Cuento Therapy intervention also created a comfortable nonthreatening environment, and (3) the cuentos group facilitated participation in therapy of all group members.

Physiotherapy students’ perceptions about the learning opportunities included in an introductory clinical module

Background. Clinical education forms a core component of physiotherapy training. However, the transition from the classroom to clinical learning environments can be challenging. An introductory clinical placement with appropriate learning opportunities is therefore important to ensure that learning outcomes are reached. Objectives. To determine second-year physiotherapy students’ perceptions about the learning opportunities provided in an introductory clinical module and to determine their perception about the attainment of the learning outcomes. Methods. A descriptive case study was undertaken, using mixed methodology. All 39 second-year physiotherapy students were invited to participate. Data were collected using a self-developed questionnaire which focused on the outcomes of the module and the perceived value of the learning opportunities. A focus group discussion was conducted with a random subset (n=15) of the population. Results. The response rate to the questionnaire was 79% (n=31). Peer learning by observing senior students, demonstrations by clinical lecturers and the assessment of specific skills were perceived by students to be particularly useful. However, several learning opportunities did not contribute effectively to learning. Participants highlighted a transitional process between classroom and clinical environments during which they became aware and could respond mentally to the demands of a clinical placement. Conclusions. The clinical education introductory module provided valuable opportunities, where students learnt productively in a non-threatening learning environment. Junior students linked theoretical and practical concepts to clinical implementation. Peer mentoring and progressive mastering were valuable learning strategies. Reflection and students’ emotional adjustment to clinical practice are topics for further investigation.

Avenues for Professional Development: Faculty Perspectives from an Indian Medical School

Medical school faculty in India are challenged to balance teaching and professional development. Melaka Manipal Medical College (MMMC), Manipal Campus, Manipal University, India offers the Bachelor of Medicine and Bachelor of Surgery (MBBS) program. The institution incorporates certain effective practices based on adult learning principles which are aimed at fostering the professional development of faculty members. The present study was undertaken to explore the perceptions of faculty members regarding the scope for professional development at Melaka Manipal Medical College, Manipal Campus. In September 2009, a questionnaire comprising items (23) focusing on five adult learning principles (active participation, relevant learning, constructive feedback, safe, non-threatening environment and previous experiences) was designed and faculty members (n=23) were asked to respond to it on a 5-point Likert scale. Additionally, a force field analysis was conducted by asking the faculty to identify three factors which facilitated them to consciously get involved in professional development activities. They were also asked to identify three unfavorable factors that hindered their professional development. Among the five characteristics, relevant learning was found to have a high mean score. Frequency analysis of responses revealed that at Melaka Manipal Medical College, there was ample scope for relevant self-learning that fosters professional development (91.3%). Force field response analysis revealed Melaka Manipal Medical College offered considerable flexibility and opportunities for continuing professional development along with faculty members' prevailing role as teachers. Nevertheless, the need for more research facilities and funds was highlighted. Adherence to adult learning principles may provide avenues for professional development in medical schools. An organized attempt to make the medical school faculty aware of the scope of these practices appears to be necessary to nurture professional development in settings where there are resource constraints.

Introduction of a novel, mobile, nurse-led prostate cancer education and testing service

Testing for prostate cancer (PCa) remains a controversial issue with conflicting professional recommendations resulting in wide variation in general practitioner’s opinions, and advice to patients. As a result some men may not receive information about their risk of developing PCa, and are therefore unable to make a decision about undergoing testing. A nurse-led program was established for delivery of information about PCa, and providing convenient testing opportunities in the workplace. The program was evaluated and found to be an efficient and wellreceived model for delivery of this health related initiative. Objective: The aim of this paper is to describe the development and evaluation of a mobile, nurse-led PCa education and testing service. Setting: PCa information and testing in work-place environment. Primary Argument: Controversy exists regarding the risks and benefits of PCa testing. Guidelines are conflicting, with one consistent premise being that men should be provided with enough information to make an informed decision. General practitioner’s uncertainty about appropriate advice, and men’s reluctance to engage in health seeking behaviours, make provision of information to men regarding the risks and benefits of PCa testing a challenge. This novel nurseled work-place service helps overcome some of the identified difficulties in men accessing information to enable them to make an informed decision regarding PCa testing and to undergo this testing. Conclusion: The provision of work-place group education sessions and follow-up individual nurse-led consultation and testing sessions was well received and provided an opportunity for men to access information regarding PCa, and to undergo testing if appropriate, in a convenient, non-threatening environment.

Induction seminars as professional learning communities for beginning teachers

This paper explores the operation and contribution of induction seminars operated as learning communities for new teachers. Mixed methods were used: 378 new teachers and 29 seminar leaders completed questionnaires, 16 new teachers and 14 seminar leaders were interviewed, and 20 seminar meetings were observed. Findings showed that seminar discussions focused primarily on coping with discipline problems, building self-confidence, and developing a professional identity. The main contribution of the seminars was emotional support provided in a non-threatening environment. Findings imply that seminars can be a significant supplement to in-school mentoring for the professional development and adjustment of new teachers.

Freirean Participatory Approach: Developing Interactive Listening Skills in the English as a Second Language (ESL) Classroom

Drawing on Paulo Freire’s participatory approach, this paper aims to analyze learning and teaching strategies that foster student motivation and English as a Second Language (ESL) listening to enhance ESL learning. This approach allows students to critically think about their educational goals and identify their strengths and weaknesses in the production of knowledge. Empirical studies from 1992 to 2013 were collected and analyzed guided by content analysis approach. This paper demonstrates that cooperative learning promotes a non-threatening environment conducive for learning. Findings confirm that lecturer talk and lecturers’ questions elicit students’ use of ESL through speech production. The findings suggest that the use of student questions to promote communication from diverse perspectives is a significant motivational tool. Finally, after demonstrating the implications of learning and teaching strategies, this paper offers a set of recommendations to help lecturers and researchers in promoting student motivation and developing ESL listening. DOI: 10.5901/mjss.2014.v5n11p101