Understanding the essential elements of work-based learning and its relevance to everyday clinical practice

williams c. (2010) Journal of Nursing Management  18, 624–632
Understanding the essential elements of work-based learning and its relevance to everyday clinical practice Aim To critically review the work-based learning literature and explore the implications of the findings for the development of work-based learning programmes. Background With NHS budgets under increasing pressure, and challenges to the impact of classroom-based learning on patient outcomes, work-based learning is likely to come under increased scrutiny as a potential solution. Evidence from higher education institutions suggests that work-based learning can improve practice, but in many cases it is perceived as little more than on-the-job training to perform tasks. Evaluation The CINAHL database was searched using the keywords work-based learning, work-place learning and practice-based learning. Those articles that had a focus on post-registration nursing were selected and critically reviewed. Key issues Using the review of the literature, three key issues were explored. Work-based learning has the potential to change practice. Learning how to learn and critical reflection are key features. For effective work-based learning nurses need to take control of their own learning, receive support to critically reflect on their practice and be empowered to make changes to that practice. Conclusions A critical review of the literature has identified essential considerations for the implementation of work-based learning. A change in culture from classroom to work-based learning requires careful planning and consideration of learning cultures. Implications for nursing management To enable effective work-based learning, nurse managers need to develop a learning culture in their workplace. They should ensure that skilled facilitation is provided to support staff with critical reflection and effecting changes in practice. Contribution to New Knowledge This paper has identified three key issues that need to be considered in the development of work-based learning programmes.     

Exercising attention within the classroom

Aim To investigate whether increased physical exercise during the school day influenced subsequent cognitive performance in the classroom. Method A randomized, crossover‐design trial (two weeks in duration) was conducted in six mainstream primary schools (1224 children aged 8–11y). No data on sex was available. Children received a teacher‐directed, classroom‐based programme of physical exercise, delivered approximately 30 minutes after lunch for 15 minutes during one week and no exercise programme during the other (order counterbalanced across participants). At the end of each school day, they completed one of five psychometric tests (paced serial addition, size ordering, listening span, digit‐span backwards, and digit‐symbol encoding), so that each test was delivered once after exercise and once after no exercise. Results General linear modelling analysis demonstrated a significant interaction between intervention and counterbalance group (p<0.001), showing that exercise benefitted cognitive performance. Post‐hoc analysis revealed that benefits occurred in participants who received the exercise intervention in the second but not the first week of the experiment and were also moderated by type of test and age group. Interpretation Physical exercise benefits cognitive performance within the classroom. The degree of benefit depends on the context of testing and participants’ characteristics. This has implications for the role that is attributed to physical exercise within the school curriculum.     

Prevalence of motor‐skill impairment in preterm children who do not develop cerebral palsy: a systematic review

Aim Motor skill impairment is a common negative outcome in children born preterm who do not develop cerebral palsy (CP). This study aimed to conduct a systematic review of current data to provide an accurate estimate of the prevalence of non‐CP motor impairment in preterm children at school age. Method We searched the Medline, PubMed, and PsycInfo databases and relevant journals to identify all studies published post‐1990 that reported the prevalence of motor impairment in school‐aged children born preterm (<37wks’ gestation) using standardised motor assessment batteries. We applied a range of exclusionary criteria, with 11 studies included in the final analyses. We identified two levels of motor impairment commonly reported – mild–moderate and moderate – and conducted a random effects meta‐analysis to produce a prevalence estimate for each. Results The pooled estimate for mild–moderate impairment in preterm children was 40.5/100. and for moderate motor impairment the estimate was 19.0/100. There was also a trend for lower motor impairment levels in samples born before 1990 compared with those born after 1990. Interpretation Children born preterm are at increased risk of motor impairment, with prevalence three to four times greater than in the general population. This highlights the need for improved surveillance and intervention strategies in this group of children.     

Power of variance component linkage analysis to detect quantitative trait loci

Expressions are derived for the sample size required to achieve a given power in variance component linkage analysis of a quantitative trait in unascertained samples. For simplicity an additive model, comprising effects due to a single QTL, residual additive genetic factors, and individual-specific random environmental variation, is considered. Equations are given relating sample size to trait heritability for sibpairs, sib trios, nuclear families having two and three sibs, and arbitrary relative pairs. The effects of nonzero residual additive genetic variance and parental information are discussed, and a scale relationship for sample sizes with sibships and nuclear families is derived. For larger sampling structures such as extended pedigrees the inheritance space is randomly sampled and the relevant equations are solved numerically. Comparative power curves are presented for sibships of size 2–4 and for an extended pedigree of 48 individuals. Simulation results for sibpairs confirm the validity of the theoretical results.     

Genetics of platelet reactivity in normal,healthy individuals

Summary. Background: The Platelet Function Analyzer‐100 (PFA‐100) is widely used to measure platelet reactivity in whole blood under high shear. Objective: To characterize the genetic component of platelet reactivity among normal individuals, using the PFA‐100. Methods: We compared baseline platelet reactivity with sex, age, platelet count, hematocrit, plasma von Willebrand factor antigen (VWF:Ag), and alleles of seven candidate genes: integrin subunits α2 (ITGA2) and β3 (ITGB3), platelet glycoproteins GPIbα (GP1BA) and GPVI (GP6), purinogenic receptors (P2RY1 and P2RY12) and cyclooxygenase‐1 (COX1). Results: Based on linear and logistic regression models, we report an inverse correlation between baseline closure time (CT) initiated by collagen plus epinephrine (CEPI) and plasma VWF:Ag level, ITGA2 807T and P2RY1 893C, and an inverse correlation between baseline CT initiated by collagen plus adenosine diphosphate (CADP) and P2RY1 893C or GP1BA ‐5C. Conclusions: These results indicate that genetic polymorphisms in ITGA2 and P2RY1 combine with plasma VWF:Ag levels to modulate baseline platelet reactivity in response to collagen plus EPI, while genetic differences in P2RY1 and GP1BA significantly effect platelet responses to collagen plus ADP. Our results demonstrate that the PFA‐100 can be used to evaluate the effects of genetic predictors of platelet function.     

Health claims for food made in Australian magazine advertisements

Aim: The aim was to describe the level of health claims being used in magazine advertisements, the categories of foods carrying health claims, and the types of benefits being claimed for particular foods or food ingredients. Data were compared with similar studies of food labels and Internet sites to reflect the impact of rule governance of the different media and highlight implications for the current proposed changes in food standards legislation. Methods: From January to June 2005, a survey of all print advertisements for food in Australia's 30 top‐selling magazines was undertaken. The results were compared with those from a 1996 survey of health claims in Australian magazines and more recent surveys of claims for food on product labels and on Internet sites. Results: The survey found that 29.5% of 390 advertisements for food carried a health claim. Many of the claims were high‐level claims (29%) or therapeutic claims (8%), which are not permitted by current food standards. The most common benefits being promoted related to cardiovascular disease, energy, cancer and weight control, and most claims referred to the effect of the whole food, rather than specific ingredients. Results were similar to previous studies of food labels and Internet sites. Conclusion: Health claims are being used widely in the print advertising of food products in Australia. Moreover, the presence of high‐level and therapeutic claims in this media bears significant implications for the implementation of rules governing health claims on foods across the different media.     

Depression in mothers and behaviour problems with their preschool children

A follow-up study of 224 families of a birth cohort of 272 families in a multi-ethnic poor socio-economic municipality in Melbourne when the children were 4 years old showed that 27% of the mothers were depressed. There was no difference in the depression rate between Australian-born and immigrant mothers, a finding in marked contrast to the first year of the study when the depression rate was significantly higher in those immigrant mothers who had been in Australia for less than 3 years, were unable to speak English and who did not have an extended family or close friends. Depression in this group of mothers was attributed to resettlement problems, which over a period of three years had ameliorated. At 4 years the most important factor associated with depression in both Australian-born and immigrant mothers was the quality of marital relationships. Lack of an intimate support relationship made mothers more vulnerable to the stresses of child care and rearing, home-making and life events. In Australian-born mothers only, another significant factor in vulnerability to depression, was their early childhood experiences of being reared in a disruptive home or in an institution and of being unwanted. In immigrant mothers, but not in Australian-born mothers, life events were significantly correlated with depression. The depressed mothers, both Australian-born and immigrant, perceived their 4 year old children to have significantly more behavioural problems than mothers who were not depressed.     

Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children

Objective: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland.
Methodology: A cross-sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles.
Results: Only 54% (95% Cl 44–63%) of the children had adequate immunity (10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% Cl 96–100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of 1:8) to poliovirus 2, only 93% (95% Cl 86–96%) and 60% (95% Cl 50–69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% Cl 90–98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles.
Conclusions: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.