Learning Styles and the Most Preferred Teaching Methodology Among Sophomore Nursing Students

Learning Styles and the Most Preferred Teaching Methodology among Sophomore Nursing Students An Undergraduate Thesis Presented To the Faculty of the Institute of Nursing Far Eastern University In Partial Fulfillment of the Requirements for the Degree of Bachelor of Science in Nursing. Submitted By: Fernandez, Marjorie S. Flaga, Arlene M. Flores, Con Adrianne E. Flores, Jethro S. Flores, Kim Sheri L. Flores, Nonnette Adrian L. Floro, Giselle Ann DR. Foronda, Djenina R. Francia, Lovie Jay A. Frany, Lizairie Q. Fulgentes, Ezra M. BSN 114 / Group 56 Submitted to: Mr. Renante Dante Tan RN, MAN September 2010 APPROVAL SHEET The Thesis proposal entitled: Learning Styles and the Most Preferred Teaching Methodologies among Sophomore Nursing Students Prepared and submitted by: Fernandez, Marjorie S. , Flaga, Arlene M. , Flores, Con Adrianne E. , Flores, Jethro S. , Flores, Kim Sheri L. , Flores, Nonnette Adrian L. , Floro, Giselle Ann DR. , Foronda, Djenina R. , Francia, Lovie Jay A. , Frany, Lizairie Q. , Fulgentes, Ezra M. In Partial fulfillment of the requirements for the Degree of Bachelor OF Science in Nursing, this research proposal has been examined and recommended for acceptance and approval for oral examination. Renante Dante G. Tan Research Adviser Approved by the committee in Oral Examination with a grade of Ma. Belinda Buenafe RN, Ph. D. Josefina Florendo RN, MAN Associate Dean Institute of Nursing Esther Salvador RN, MAN Accepted and approved for partial fulfillment of requirements for the degree of Bachelor of Science in Nursing. Glenda S. Arquiza RN, Ph. D. Dean Institute of Nursing ACKNOWLEDGEMENT The researchers of group 56 of Far Eastern University, BSN 114 Batch 2011 would like to extend our deep appreciation and sincerest gratitude to the outstanding people who made the study possible. First and foremost we thank our ever loving God who was our strength during our weakness and our guide when we’re out of sight. To our cooperative respondents and to their respective clinical instructors, we are very grateful for their acceptance to make our research possible. To our parents, that despite our busy schedule at school, we thank them for their immeasurable love, deep understanding and never ending support. We would also like to thank our fellow group mates and friends for understanding and exerting efforts that despite the pressure and conflicts, we remained intact and united in fulfilling this study. We also like to thank Mr. Jay-el Viteno, for consulting us in our statistics that despite his busy schedule was able to make time and guide us in making and understanding our research statistics. To our research adviser, Mr. Renante Dante G. Tan RN, MAN, for sharing with us his precious time and his guidance in helping us to make this research work possible. We would also like to thank him for all the encouragement and for his immeasurable faith and support in this work. To our respective panelists, Josefina Florendo RN,MAN, Esther Salvador RN, MAN and Dr. Ma. Belinda Buenafe of the Institute of Nursing, for letting us spread our wings and believing in us more than we do. With this, we would like to dedicate our finished manuscript to all the people who became part of our journey. ABSTRACT Objective: To determine the learning styles of the sophomore nursing students in Far Eastern University and their most preferred teaching methodology in terms of didactics and in skills. Methods: This study was conducted at Far Eastern University during the period from Noember 2009 to September 2010. The total population of the sophomores were 630, through Sloven’s formula, we were able to come up with 245 students as the sample. The instrument used by the researchers has two parts. The first part was the Kolb’s Learning Style Inventory which was used to determine the learning style of the respondents while the second part which was a self-made instrument validated by three experts was used to determine their most preferred teaching methodology. Results: Majority of the respondents belong to Divergers which has a frequency of 81 out of the 245 respondents, 58 were accomodators, 57 were assimilators and 49 were convergers. Based on the findings, there was a significant difference between the learning styles of the sophomore nursing students. The researchers also came up with the result that all of the four learning styles have a common teaching methodology which was demonstration. In terms of didactics, accomodators and convergers preferred pure lecture/discussion without power point with a percentage of 27. 6 and 32. 7, respectively. Divergers and assimilators preferred pure lecture/discussion with the use of power point with a percentage of 23. 7 and 17. 2, respectively. Conclusion: The results showed that there was a significant relationship between the learning styles of the sophomore nursing students and their most preferred teaching methodology TABLE OF CONTENTS Title i Approval Sheet ii Acknowledgement iii Abstract iv Table of Contents vi List of Tables viii List of Figures ix Chapter IIntroduction Background of the Study 1 Statement of the Problem 2 Significance of the Study 3 Scope and Limitation 5 Chapter IITheoretical Framework Review of Related Literature 6 Research Paradigm 27 Research Hypothesis 28 The Main Variable of the Study 28 Definition of Terms 29 Chapter IIIResearch Methodology Research Design 33Population and Sample 33 Research Locale 34 Research Instruments 35 Validation of the Instruments 36 Data Collection Procedure 36 Statistical Treatment of Data 37 Chapter IVResults and Discussion 40 Chapter VSummary of Findings, Conclusions and Recommendations Summary of Findings 57 Conclusions 58 Recommendations 58 Bibliography 59 Books Journals Website Appendices A. Letter to the Dean 60 B. Kolb’s Learning Style Inventory 61 C. Learning Style Grid 63 D. Population of the Sophomore Nursing students included in the study per section. 64 E. Learning Styles of Sophomore Nursing Students 65 F. Learning Styles of Sophomore Nursing Students Of Sophomore Nursing Students per section in terms of didactics 66 G. Learning Styles and the Preferred Teaching Methodology Of SophomoreNursing Students per section in terms of skills 72 H. Curriculum Vitae 78 List of Tables 1. Frequency Distribution & Percentage of the 6 sections included in the study 34 2. Frequency & Percentage distribution of the 245 respondents as to their different learning styles 41 3. Frequency and Percentage Distribution of preferred teaching methodology of Sophomore Nursing Students as per learning style in terms of Didactics 43 4. Frequency and Percentage Distribution of Preferred Teaching Methodologies of Sophomore Nursing Students as per Learning Style in terms of Skills 46 5. Chi- Square Goodness of fit for the difference of the different learning styles 49 6. Chi Square Test of Independence for the significant relationship of Learning Styles of sophomore nursing students and their most preferred teaching methodologies in terms of didactics50 7. Chi Square Test of Independence for the significant relationship of Learning Styles of sophomore nursing students and their most preferred teaching methodologyin terms of skills52 List of Figures 1. Research Paradigm27 2. Learning Style Grid 63 CHAPTER I INTRODUCTION Background of the Study Students have different approach in learning and these what makes them unique. Thus, understanding on how they learn and helping them to learn is vital in any educational program. This can be especially important for students since they may have different ways on how to learn. Some students prefer to learn by group work while some would prefer learning alone, some also learn while listening to music while some students learn effectively by studying silently. Furthermore, some students learn by engaging into activities yet some learn by observation only. These different learning techniques affect the students especially their coping mechanisms in terms of learning. In high school, teachers tend to spoon-feed their students while in college, professors are different, for the reason that they seldom discuss to the students the entire topic or lesson. Instead, they only discuss the important ideas and would encourage the students to read more and study harder. On the other hand, there are so many teaching methodologies that can be used to enhance effectively a student’s learning capabilities. Some focuses on learning skills while others are more on enhancing knowledge. In Far Eastern University, particularly in the Institute of Nursing, a particular subject is usually divided into different concepts. Each concept is taught by specific professor who has mastery over the concept. These professors use different teaching methodology in educating the students. Some sticks to only one methodology, while others use different teaching methodologies. Some of the most commonly used teaching methodologies are: Lecture w/ powerpoint and role playing in didactics and demonstration in skills. In the study conducted by Hauer, Straub and Wolf (2005), nursing students were identified as having a learning style preference between that of a diverger and an assimilator. According to the study conducted by Elliot (2003) about the preferred teaching methodologies of nursing students, most students preferred case studies and group discussion/activities. The question now rises, with the advent of technological advancement such as CCTV (Closed-Circuit Television) and virtual laboratory, can case study and group discussion still be the most preferred teaching methodology among nursing students? Statement of the problem This study aimed to determine the relationship among learning styles of sophomore nursing students of Far Eastern University and their most preferred teaching methodology. Specifically, it sought to answer the following questions: 1. What is the learning style of Sophomore nursing students? a. Convergers b. Divergers c. Assimilators d. Accommodators 2. What is the most preferred teaching methodology of sophomore nursing students as to their learning styles in terms of: a. Didactics b. Skills 3. Is there a significant difference among the different learning styles of sophomore nursing students? 4. Is there a significant relationship in the learning styles of sophomore nursing students when grouped according to their most preferred teaching methodology in terms of: I. Didactics II. Skills Significance of the study The different learning styles of every student in the present time have a great impact on their academic performance. Everyone use different learning style to improve their own knowledge, some may be good in studying while listening to music, some students like to study alone in the four corners of their room, and some students learn easily if they are within a group study session. The researchers chose this topic because they want to challenge themselves to be more aware on how the students learn and grow in their own way and to know how the students learn and acquire knowledge. Nursing Practice The study would be helpful in guiding students with identifying their learning style as early as their second year in the institute of nursing. Therefore, having a good learning style that would match their most preferred teaching methodology could help them learn more effectively thus enhancing their knowledge. Having more knowledge could enable the students to be more proficient in the nursing practice. Nursing Administration The study provided awareness about the learning styles and the preferred teaching methodologies of sophomore nursing students, thus giving insights about the needs of the students as they learn. This study might also provide ideas on how to improve the education system for the benefit of the students. Nursing Education The result of this study should give nursing educators ideas on what specific teaching methodology to be used based on the students’ learning style. Furthermore, the nursing educator would have an insight as to what teaching methodology is best suited for the student providing a more student-centered teaching method that would aid the student to learn more effectively. Nursing Research The study of different learning styles of the students might contribute to nursing research through developing trustworthy evidence about issues of importance to the nursing profession, including nursing practice, education, administration and informatics. It made the study more significant in present time because through researching, the researchers might prove that the learning style/strategies might have advantage and disadvantage in studying. The importance of research in nursing is that because of broad support for evidenced base nursing practice, research has assumed heightened importance for nurses. Research finding from rigorous studies provide especially strong evidence for informing nurse’s decisions and actions. Nurses are accepting the need to the base specific nursing actions are clinically appropriate, cost effective, and result positive outcomes for clients. Scope and limitation The study focused on determining the relationship between the different learning styles and the most preferred teaching methodology of sophomore nursing students of the Far Eastern University during the first semester of school year 2010. The researcher used a descriptive correlational design. 245 sophomore nursing students were selected through purposive sampling technique. The study was conducted at Far Eastern University on July 17, 2010. The study did not include factors that may affect the result of the study such age and gender of the respondents as well as whether they really wanted to be in the nursing profession. Furthermore, the respondent’s level of stress and grades were also not included in the study. CHAPTER II THEORETICAL FRAMEWORK Learning According to Eric Kandel (2000) â€Å"Learning is the process by which we acquire knowledge about the world. † Learning is the process in which a person consciously takes their self farther away from ignorance. Ignorance is the lack of knowledge, the inability to understand something without guidance from an outside force. Ignorance can also be the willful act of not learning. ( Lindsea 2008 ) Learning Styles The literature basically indicates that there is wide acceptance of the concept of learning styles; however, there is disagreement on how to best measure learning styles (Coffield, et. al. , 2004). While the learning profession has long recognized the need for innovative instructional activities that relate to the diverse learning styles of learners, there is some question as to just how meaningful they are to the learning environment. That is, most researchers agree that people do have various learning styles and preferences, however, research tends to agree that it is relative unimportant as it is far more important to match the presentation with the nature of the subject, such as providing correct learning methods, strategies, and context; than matching individual preferences (Coffield, 2004). Perhaps David Merrill (2000) has the best philosophy for using learning styles — instructional strategies should first be determined on the basis of the type of content to be taught or the goals of the instruction (the content-by-strategy interactions) and secondarily, learner styles and preferences are then used to adjust or fine-tune these fundamental learning strategies. Finally, content-by-strategy interactions take precedence over learning-style-by-strategy interactions regardless of the instructional style or philosophy of the instructional situation. According to Rayner (2001) and Coffield (2001), the idea of a personal style in learning has clearly spread across the globe during the last decade to occupy a prominent place in professional discussion about learning and teaching. This means that the learning style of an individual matters in learning and also it affects teaching. Recent work by Burnett (2005) Cheminais (2002) and Reid (2005) identify that the different styles in learning serve as an important component in inclusive learning and teaching in the classroom. Indeed, Cheminais (2002) suggested that to be an effective and successful teacher, they should: (a) show respect for pupils’ individual learning styles and differences, (b) be responsive to pupils’ different learning styles, (c)use different levels of tasks and activities. Smith (2001) has stated that there are two methods related to grasping experience and these two are the Concrete Experience (CE) and Abstract Conceptualization (AC). In addition, he also suggested two methods in transforming experience and these are Reflective Observation (RO) and Active Experimentation (AE). These four modes are all engaged in the ideal learning process and must be incorporated together to have an effective learning based on Kolb’s Learning Theory. Individuals are likely to develop or use one-grasping experience approach and one experience-transforming approach. The combination of these two preferred approaches is the individual’s learning style (Smith, 2001). These learning styles are the following: converger, diverger, assimilator, and accommodator. Converger Convergers excel in making practical applications of ideas and in using deductive reasoning to solve problems. They use Active experimentation and abstract conceptualization as their approaches in transforming experience and grasping experience, respectively (Smith, 2001). They learn from thinking (Chiya, 2003). Diverger Divergers are characterized by concrete experience (feeling) and reflective observation (watching). They use imagination and see things in different points of view (Smith, 2001). They are learning from feeling (Chiya, 2003). Assimilator If convergers use deductive reasoning, assimilators on the other hand use inductive reasoning in creating theoretical models. They utilized abstract conceptualization and reflective observation as their preferred approaches (Smith, 2001). They learn from watching and listening (Chiya, 2003) Accommodator Accommodators are good in actively engaging with the world and actually doing things rather than merely reading about and studying them. They are characterized by concrete experience (feeling) and active experimentation (doing) (Smith, 2001). They learn from doing (Chiya, 2003). â€Å"The more learning styles learners use as their major learning styles, the more flexible and successful the learners are. If students use limited learning styles as their preference, it is more challenging for them to adjust to teachers’ teaching styles† (Chiya, 2003). An interpretation was amended & revised by Alan Chapman (March 2006), based on Kolb’s Learning Styles which explains that different people naturally prefer a certain single different learning style. Various factors influence a person's preferred style: notably in his experiential learning theory model (ELT) Kolb defined three stages of a person's development, and suggests that the propensity to reconcile and successfully integrate the four different learning styles improves as people mature through their development stages. The development stages that Kolb identified are: (a) Acquisition – birth to adolescence – development of basic abilities and ‘cognitive structures', (b) Specialization – schooling, early work and personal experiences of adulthood – the development of a particular ‘specialized learning style' shaped by ‘social, educational, and organizational socialization', (c) Integration – mid-career through to later life – expression of non-dominant learning style in work and personal life. Whatever influences the choice of style, the learning style preference itself is actually the product of two pairs of variables, or two separate ‘choices' that peole make, which Kolb presented as lines of axis, each with ‘conflicting' modes at either end: Concrete Experience – CE (feeling) —–V—–Abstract Conceptualization – AC (thinking) Active Experimentation – AE (doing) —–V—– Reflective Observation – RO (watching) Felder & Spurlin (2005) try to remedy the potential misuse of learning styles by pointing out that: (a) Learning style dimensions are scales, mild, moderate or extreme tendencies can be exhibited, (b) Learning style profiles are indicative of tendencies and individuals at one time or another will exhibit tendencies of the opposing characteristic, (c) Learning style preferences do not indicate a learner's strengths and weaknesses, only the preferred activity, (d) Learning style preferences may be subject to a learner's educational experience and ‘comfort'. Teaching Methodology Motivating students is a simple matter of rewards, gimmicks, and games. Students respond to teachers who can inspire while they teach. Creativity is essential. (Craft, 2010) According to Chiya (2003), students’ learning can be sometimes hindered by the gap between the students’ learning styles and the teachers’ teaching styles, and also the lack of instruction on learning strategies. Bridging this gap can only be achieved when the professors are aware of their students’ needs, capacities, potentials and most importantly, their learning styles (Rao, 2002). Discussion Lecture based format is the traditional passive way of learning. It involves situations where material is delivered to students. Recent studies show the effectiveness of active learning methods. A comparison of lecture combined with discussion versus active, cooperative learning methods by Morgan, Whorton, & Gunsalus (2000) demonstrated that the use of the lecture combined with discussion resulted in superior retention of material among students. The findings of a study by de Caprariis, Barman, & Magee (2001) suggest that lecture leads to the ability to recall facts, but discussion produces higher level comprehension. Further, research on group-oriented discussion methods has shown that team learning and student-led discussions not only produce favorable student performance outcomes, but also foster greater participation, self confidence and leadership ability (Perkins & Saris, 2001; Yoder & Hochevar, 2005). In considering an adapted practice model, substantial research highlights the usefulness of work-based mentorship and supervision as part of effective training strategies. Studies claim the one-to-one supervisory relationship was the most important element in clinical instruction (Saarikoski and Leino-Kilpi, 2002). Mentorship also facilitates learning opportunities, and supervises and assesses staff in the practice setting. Terminology frequently used to describe a mentor includes teacher, supporter, coach, facilitator, assessor, role model and supervisor (Hughes, 2004; Chow and Suen, 2001). This is supported by models advocating self-directed, evidence-based and problem-based learning. Demonstration According to Rosen, Salas, and Upshaw (2007, p. 6) demonstrations are often conceived of simply as an example of task performance; however, demonstrations are rightfully thought of as experiences where learners are prompted to actively process the informational content of the example and to systematically and reliably acquire targeted KSA’s and transfer them to the work environment. They define demonstration as a strategically crafted, dynamic example of partial or whole task performance or of characteristics of the task environment intended to increase the learner’s performance by illustrating (with modeling, simulation, or any visualization approach) the enactment of knowledge, skills, and attitudes (KSA’s) targeted for skill acquisition. † Demonstrations vary in terms of informational and physical characteristics (e. g. , content, form of presentation). Demonstrations also vary in terms of the activities that the learner engages in prior to, during and after observing the example of task performance. According to Fisher & Frey (2008), students need to be aware of the thinking process of the teacher. Demonstration uses a combination of verbal and visual elements to accomplish a task, skill, or strategy (Fisher & Frey, 2008). The demonstration includes the sequence of steps and the decisions that accompany each step so the next step makes sense. Errors to avoid are also noted to accomplish the task, skill or strategy (Fisher & Frey, 2008). After demonstrating the skill or strategy students can be led to know how and when to use their new skills. They can self-assess and evaluate the approaches they use to connect the learning to the next new skill that they learn. They can  begin to travel on the road to self-directed learning. Teachers who have a demonstrator or personal model teaching style tend to run teacher-centred classes with an emphasis on demonstration and modeling(School of Educators, 2010). This will help the students develops and apply skills and knowledge. According to the School of Educators (2010), a teacher with this type of teaching style might comment: â€Å"I show my students how to properly do a task or work through a problem and then I'll help them master the task or problem solution. It's important that my students can independently solve similar problems by using and adapting demonstrated methods. † This teaching style may help an instructor or a teacher to encourage student participation and adapting their presentation to include various learning styles. Students are expected to take some responsibility for learning what they need to know and for asking for help when they don't understand something. As lectures, they should aim for meaningful learning through active processes, not passive transmission of facts (Michael, 2001). Students have different preferred learning styles, experiences, background knowledge, and interests, therefore, according to Michael (2001) that we must use a variety of teaching strategies to maximize student learning. One such teaching strategy involves the use of interactive classroom demonstration. Student work cooperatively to gain meaningful learning of sometimes difficult neural concepts and at the time have fun with the subject (Michael, J. , 2001). Online Terrell ; Dringus (2000) investigated the effect of learning style on student success in an online learning environment and concluded that institutions offering online education programs should give consideration to the different learning styles of their students. According to Farmer (2006) online learning systems have forced teachers and learners to focus on discussion boards and shared communication spaces rather than on the individuals who are taking part in them. Online discussion is ‘group-centred’. It counters the greatest use of LMS (learning management systems) which is to post content online. It is the primary mode of online interaction for constructivist learning: learning based on interpretation and construction of the world rather than reflecting an external reality (Malinowski et al 2006). ‘Reflection and even dialogue are greatly limited in most campus based classrooms, online learning may in fact have an advantage in supporting collaboration and creating a sense of community. An online learning environment reflects a â€Å"group- centered† interaction pattern versus an â€Å"authority-centered pattern† of a face-to-face environment. ’ (Garrison 2006). Pelz (2004) stated that learning does not occur spontaneously among a group of students, whether the setting is face to face or online. Online discussion requires structure just as in a face-to-face setting. In essence, online discussions provide a vehicle where knowledge is facilitated by participants interacting cooperatively with others (critical thinking), to accomplish shared learning goals (social interdependence) particularly when the learning task focuses upon the solution of real-life problems (constructivist learning) (Williams ; Wache 2005). E-learning will take the form of complete courses, access to content for â€Å"just-in-time† learning, access to components, a la carte courses and services, and the separation of â€Å"courses† to acquire and test knowledge vs. content as an immediate, applicable resource to resolve an immediate, perhaps, one time only problem. Learning is and will continue to be a lifelong process, that could be accessed anywhere at anytime to meet a specific need or want. Hall added that more links to real-time data and research would become readily available. Given the progression of the definitions, then, web-based training, online learning, e-learning, distributed learning, internet-based learning and net-based learning all speak of each other (Hall ; Snider, 2000; Urdan ; Weggen, 2000). Reverting to Halls (2000) contention of e-learning in all-inclusive form, distance learning as planned interactive courses, as the acquisition of knowledge and skills at a distance through various technological mediums would seem to be one of e-learning possible disguises. Interestingly, Urdan ; Weggen (2000) saw e-learning as a subset of distance learning, online learning a subset of e-learning and computer-based learning as a subset of online learning. Given the review of definitions on all these terms ‘subset’ does not appear to be the most likely word to describe the relationship among these words and their forms. The definitions show a great depth of interdependence among themselves. While one person may narrowly define a term, another person could give it the all encompassing power. This communicates that e-learning, if given the all encompassing form, can be the larger circle of which all other terms would be overlapping at different times and extents given their user’s intention. Another rationale for this choice is that â€Å"just-in-time† learning is a major advantage of e-learning but not of distance learning. Distance learning purports planned courses, or planned experiences. E-learning does not only value planned learning but also recognizes the value of the unplanned and the self-directedness of the learner to maximize incidental learning to improve performance. Similar also to e-learning and its related terms is technology-based learning (Urdan ; Weggen 2000). Urdan ; Weggen shared that e-learning covers a wide set of applications and processes, including computer-based learning, web-based learning, virtual classrooms, and digital collaborations. For the purpose of their report, they further customized their definition to the delivery of content via all electronic media, including the Internet, intranets, extranets, satellite broadcast, audio/video tape, interactive TV, and CD-ROM. They warned, however, that e-learning is defined more narrowly than distance learning, which would include text-based learning and courses conducted via written correspondence. Like Hall ; Snider 2000), Urdan ; Weggen (2000) have set apart distance learning and e-learning in their glossaries, making, however, e-learning inclusive and synonymous to all computer-related applications, tools and processes that have been strategically aligned to value-added learning and teaching processes. E-learning is the acquisition and use of knowledge distributed and facilitated primarily by electronic means. This form of learning currently depends on networks and computers but will likely evolve into systems consisting of a variety of channels (e. g. , wireless, satellite), and technologies (e. g. , cellular phones, PDA’s) as they are developed and adopted. E-learning can take the form of courses as well as modules and smaller learning objects. E-learning may incorporate synchronous or asynchronous access and may be distributed geographically with varied limits of time. Group work (Brainstorming) According to the study of White et al (2005), group work was generally a positive experience for pharmacology and IT students. However, there were also 25% of the 126 respondents who responded to the open-ended questions with negative comments. These comments were the need for objective individual marks, avenues to decrease loafers, bias among friends in peer evaluations and concerns with confidentiality and anonymity with peer evaluation. The researchers here concluded that attitudes towards group work are probably negatively affected by group assessment and may be improved to some extent by using peer evaluation. Research proves that group work experience was generally positive for students across the different disciplines. They saw group work as a tool to develop life-long and generic skills in influencing and persuading, negotiating and team-building (Maiden, 2004). According to him, this method – group work promotes the development of the said skills. A research study of Reid et al (2005) showed that some students see group work as an undertaking that must be completed well. On the other hand, others see it as a tool for them that would help them advance their individual and collective knowledge. In additional, the approach that students take to their learning depends on the particular conceptions of the task at hand. According to Petrowski et al (2000), group work and creativity has begun in the 1950s and that until now, it is still debatable whether creativity is within a person, as a product or a process. Oral Recitation(Question and answer) | Questioning students not only allows the teacher to evaluate the level of understanding but also provides for feedback, fine tuning the levels of teaching, dealing with misconceptions early, as well as improving the educational material presented. Perhaps one of the most key thoughts beyond all the information above is very simple. Teaching is learning. To teach is to learn. Good teachers learn and adapt to their students, and expand or refine their teaching material as they learn about themselves as well. According to Jennifer Evans (2010), Oral recitation is the practice of having an entire class â€Å"recite important facts, identifications, definitions, and procedures within the instruction and later when they need to be revisited†. This method proves quite beneficial to students when acted out frequently in the classroom, though the time for each session should be kept rather short, not exceeding two and one-half minutes. Hearing it said aloud by their own mouths results in a higher level of confidence in the subject matter, while also ensuring that they fully understand a topic that requires  critical thinking. By engaging them in the learning process rather than just instructing, students will become far more interested in their education until they’re just itching for more knowledge. Also, the level of seriousness is kept to the maximum when students come to realize that this specific topic is vital enough for the entire class to participate in at once, further ensuring remembrance. This process of learning should not be set aside for the classroom alone, however; students of all ages, from elementary school to college, can use this tool to retain any form of information ranging in levels of difficulty. It’s advisable for students currently in their higher learning stages to just sit in a quiet room by themselves and recite whatever facts or definitions they may need aloud. First, they can start by reading straight out of their notes or textbook, allowing themselves to both see the words on the page while reading them out loud. Then, they can progress to the true test by verbally reciting without their paper. This should be repeated a number of times before the day of the test, allowing themselves weeks of prep time; however, once again it is imperative to not put too much strain on the subject. The more difficult the subject is, the more important it is for  a student to be able to recall it at the tip of a hat. Treating information in a more sophisticated way allows this to happen, as the mind will, too, treat the information will such  a high level of care. This method also incorporates the social time all young people need to truly becoming comfortable in their environment. Bitchener ; Watanabe (2008), the part of the exchange does not reflect what is characteristic of realistic communication (you do not usually correct what other people say when they are talking), the fact that student turned her attention to form in this precise moment has important implications for language learning, for it is an act of noticing a language item and how it should work. It is this aspect that helps us decide what to say (meaning) and how to say it, (form) depending on the situation in which we find ourselves and depending on what was said before by us and the other participants of the conversation. Although this process is mostly and best carried out unconsciously, â€Å"meaningful use of language will necessarily imply the establishment of relevant form-meaning mappings† (van den Branden, 2006). Powerpoint PowerPoint is best used when students are expected to retain complex graphics, animation, and figures. For alphanumeric information (e. g. text and numbers) Powerpoint as well as traditional presentations can be used. According to Shock (2008), if students are expected to retain information and/or concepts that are best conveyed through dialog or verbal explanation,  traditional presentations  appear to be best. This type of information should not be shared verbally in the presence of PowerPoint, because people tend to focus on that what is presented on the slides as opposed to what is verbalized. If students are expected to retain simple graphs and alphanumeric information that is verbalized and displayed visually, either presentation style is acceptable. Educational technologies are most effective when used properly. According to Savoy et al (2009), the ‘‘intelligent use† of educational technologies can be defined with three components (1) How people learn (cognitive component)? 2) How can the learning experience be facilitated (instruction component)? (3) How can technology be used to improve instruction and learning (technology component)? Over the years there has been re search to support the three components as individual entities and collectively as the cognitive theory of multimedia learning. The third component has received much attention as researchers try to evaluate the effectiveness of new educational technologies, particularly PowerPoint. Case Presentation It is now documented that students can learn more effectively when actively involved in the learning process (Bonwell and Eison, 1991; Sivan et al, 2001). The case study approach is one way in which such active learning strategies can be implemented in our institutions. There are a number of definitions for the term case study. For example, Fry et al (1999) describe case studies as complex examples which give an insight into the context of a problem as well as illustrating the main point. Davis and Wilcock defined case studies as student centred activities based on topics that demonstrate theoretical concepts in an applied setting. This definition of a case study covers the variety of different teaching structures used, ranging from short individual case studies to longer group-based activities. According to Onishi (2008) in most clinical teaching settings, case presentation is the most frequently used teaching and learning activity. From an educational viewpoint, the two important roles of case presentations are the presenter's reflective opportunity and the clinician educator's clues to diagnose the presenter. When a presenter prepares for a case presentation, he/she has to organize all the information collected from a patient. The presenter sometimes does not recall what to ask or to examine with relation to pertinent differential diagnoses while seeing a patient, and afterward he/she might note that more information should have been collected. He/she is able to note the processes by reflection-on-action and improve the processes the next time. Such a reflective process is the most important role of case conference for a presenter. According to Shochet, Cayea, Levine and Wright (2007), case presentation is a time-honored tradition in clinical medicine. Expert analysis of patient cases has been the stimulus for significant discovery and advances in clinical medicine. All clinical educators encounter â€Å"memorable cases† in their teaching roles. The case presentation can also be used by educators as a means to more deeply appreciate unique or challenging learner experiences, and by doing so, enhance teaching expertise. Dissemination of these cases may lead to discoveries and advances in the practice of medical education. Closed Circuit Television (CCTV) The advantages of video conferencing by using closed circuit television in educational institutions are well documented. Scholarly literature has indicated that videoconferencing technology reduces time and costs between remote locations, fill gaps in teaching services, increases training productivity, enables meetings that would not be possible due to prohibitive travel costs, and improves access to learning (Martin, 2005; Rose, Furner, Hall, Montgomery, Katsavras, ; Clarke, 2000; Townes-Young ; Ewing, 2005; West, 1999). Role Playing Role playing is a methodology derived from sociodrama that may be used to help students understand the more subtle aspects of literature, social studies, and even some aspects of science or mathematics. Further, it can help them become more interested and involved, not only learning about the material, but learning also to integrate the knowledge in action, by addressing problems, exploring alternatives, and seeking novel and creative solutions. According to Blatner (2008), role playing is the best way to develop the skills of initiative, communication, problem-solving, self-awareness, and working cooperatively in teams, and these are above all–certainly above the learning of mere facts, many if not most of which will be obsolete or irrelevant in a few years–will help these young people e prepared for dealing with the challenges of the Twenty-First Century. According to Pollock et al (2006), learning to participate is an important skill for humanities and social science s students to learn in today’s multi-stakeholder world. The role play method develops a greater understanding of the complexity of professional practice and enables students to develop skills to engage in multi-stakeholder negotiations within the controlled environment of the classroom. Role play in the classroom can be implemented in a number of ways. It can involve online elements as well as face-to-face interactions. The length of the process can also vary according to the aims of the activity. This guide will outline role play techniques found to be most useful for the social science classroom at a tertiary level. Role play in the classroom involves students actively in the learning process by enabling them to act as stakeholders in an imagined or real scenario. It is a technique that complements the traditional lecture and assignment format of tertiary level social science learning. In a role play, the teacher selects a particular event or situation that illuminates key theories or may be of importance to the topic of study. Students are given detailed background readings and assigned stakeholder roles as preparation. The format of interaction between stakeholders can be varied and may depend on time or resources available. The role play is concluded with a debriefing or reflection stage which reinforces the concepts introduced by the role play. Video Presentation Bassili (2006) conducted a study of college freshmen in a psychology course in order to determine whether they preferred face-to-face or streamed-video lecture delivery as a learning aid. He found that a majority of the students preferred the online video lectures. These findings imply that videotaped content, far from being a less effective vehicle for instruction, might actually increase learner motivation and interest in course material. Other articles outline the advantages of taping learner performances and asking students to watch and reflect upon these recordings. For example, some scholars have found that using videos as reflective diaries can promote critical thinking and reflection and thereby enhance learning development. Researchers have found that making reflective videos can benefit both teachers (Barton and Haydn 2006; Gebhard 2005) and students (Triggs and John 2004). Levy and Kennedy (2004) found evidence for this assertion within the specific context of the language learning classroom. They used computer video capture to record students' behavior during their audio conferencing study of Italian as a foreign language. The researchers found that these recordings became an effective tool for assisting students in visualizing and subsequently correcting their errors. Several other articles have discussed the potential impact of using videos in foreign language study. Herron, Cole, and Corrie (2000), for example, offer evidence that showing videos in the classroom allows instructors to expose language learners to authentic cultural information. Moreover, research suggests that Internet-based audiovisual resources can be effective language learning tools. Hanson-Smith (2004) describes the pedagogical benefits of using online videos as in-class learning resources. In addition, she lauds the fact that the Internet is increasing access to professional audiovisual resources that are free, authentic, and suitable for language learning development. Finally, many scholars have noted the benefits of implementing a video production component in language classes. For example, at the college level, Katchen, Morris, and Savova (2005) have explored the possibility of using video production to engage language learners, asking students to produce vocabulary-focused videos. They contend that the benefit of their approach is twofold. First, it allows students to produce videos using grammatical forms and lexical items that are relevant to them, increasing the chance that these forms and terms will be retained. Second, it facilitates the creation of learning resources for future students. Association of learning styles to teaching methodology In the study conducted by Csapo & Hayen (2006), it states that a mismatch between the learning style of faculty and students has been shown to increase the disparitybetween how faculty teaches and how students learn. This mismatch results in an ineffective learningprocess in the classroom. â€Å"The notion that allcognitive skills are identical at the collegiate level orin different training programs smacks of arroganceand elitism by either sanctioning one group's style oflearning while discrediting the styles of others orignoring individual differences altogether â€Å"Teachers did differ in their teaching styles and the results suggest an association between teaching styles and learning styles Based on the study of Chiya (2003), divergers are characterized by concrete experience (feeling) and reflective observation (watching) while assimilators utilized abstract conceptualization (thinking) and reflective observation (watching). It was obvious that divergers and assimilators both learn through reflective observation or through watching. According to Evans (2004), these differences in teaching styles may also have an impact on areas such as classroom arrangements, the organization and assessment of activities, teacher interactions with students and academically approaches, such as the use of questioning (Evans, 2004). Evans (2004) also stated that several teachers of today are looking at how to shift their lessons to meet new education purposes. However, discussions are still more teacher-centered than student-centered in some classrooms meaning, the lessons are still based on the preferences of the teacher rather than the students. The following information are synthesize from different local and foreign related literatures and studies: Learning style is unique in every individual. Learning is the process of acquiring knowledge. As we know, individuals are unique. Each in every one of us is different and so also our learning styles. Learning styles are the approach on how an individual grasp knowledge. There are four types of learning style: Converger, Diverger, Assimilator, and Accomodator. Each type of learning style is different in terms of the way they acquire knowledge. Convergers or Type I learners excel in making practical applications of ideas and in using deductive reasoning to solve problems. They use Active experimentation (doing) and abstract conceptualization (thinking) as their approaches in transforming experience and grasping experience, respectively. They learn from thinking. Divergers or Type II learners are characterized by concrete experience (feeling) and reflective observation (watching). They use imagination and see things in different points of view. They are learning from feeling. Assimilators or Type III learners on the other hand use inductive reasoning in creating theoretical models. They utilized abstract conceptualization (thinking) and reflective observation (watching) as their preferred approaches. They learn from watching and listening. Accomodators or Type IV learners are good in actively engaging with the world and actually doing things rather than merely reading about and studying them. They are characterized by concrete experience (feeling) and active experimentation (doing). They learn from doing. Teaching on the other hand, is the process of giving out information. Teaching is the means of providing knowledge to individuals. Same as learning styles, teaching methodologies are also unique for every teacher or instructor. Most instructors tend to stick with a specific teaching methodology. Teaching methodology has a great impact on the students. In association to learning styles, the preferred teaching methodologies. The review of the literature indicated howimportant understanding learning styles and the role of learning styles in the teaching/learning process was for effective teaching. Research Paradigm (Kolb diagrams updated May 2006) | Most Preferred teaching methodology in terms of: A. Didactics B. Skills | Shown in the figure above was a typical presentation of Kolb’s to continuum: the east-west called the Processing Continuum (how we approach a task), and the north-south axis is called the Perception Continuum (our emotional response, or how we think or feel about it. ). These learning styles are the combination of two lines of axis (continuums) each formed between what Kolb calls dialectically related modes of grasping experience (doing or watching), and transforming experience (feeling or thinking). An individual internally decide whether he/she wish to  do  or  watch, and  at the same time  decide whether to  think  or  feel. The result of these two decisions produces and helps to form their learning style. The individual chooses a way of grasping the experience, which defines his/her approach to it, and chooses a way to transform the experience into something meaningful and usable, which defines the emotional response to the experience. Having knowledge about the learning styles, the appropriate teaching methodology in terms of didactics and skills for a specific learning style can be determined and can be used for effective learning. Research Hypothesis On the basis of the questions proposed in this study the following hypotheses was tested: a. There is no significant difference between the learning styles of sophomore nursing students. b. There is no significant relationship on the different learning style between skills and didactics. The main variables of the study The different learning styles were the independent variable and the dependent variable was the most preferred teaching methodologies of sophomore nursing students in terms of didactics and skills. Definition of terms Conceptual definition: Learning Styles – various approaches or ways of learning Accommodator – a person who is willing to adapt oneself to other people’s convenience. Assimilator – a person who responds to new situations in conformity with what is already available to consciousness. Converger – one who has special ability in answering rational, unimaginative questions. Diverger – one who is capable of thinking imaginatively beyond the ordinary. Teaching Methodology – the types of principles and methods used for instruction. Didactics – teaching method  that follows a consistent scientific approach. Lecture discussion -an informative talk given as before an audience or class and usually prepared beforehand. Recitation – a written matter that is recited from memory. Power point presentation – The presentation is a collection of individual slides that contain information on a topic. Case presentation – refers to the collection and presentation of detailed information about a particular participant or small group, frequently including the accounts of subjects themselves. Brainstorming- Brainstorming is an informal way of generating topics to write about, or points to make about your topic. Students should simply open their minds to whatever pops into them. E-learning – the delivery of a learning, training or education program by electronic means. E-learning involves the use of a computer or electronic device in some way to provide training, educational or learning material. Group work – a ethod, used by professional social workers, of aiding a group or members of a group toward individual adjustment and increased participation in community activity by exploiting the mechanisms of group life. Reporting- to relate or tell about; present. Role playing – refers to the changing of one's behaviour to assume a role, either unconsciously to fill a social role, or consciously to act out an adopted role. Skills – teaching the learned  capacity to carry out pre-determined results often with the minimum outlay of  time,  energy, or both. Demonstration – the act of proving by the syllogistic process, or the proof itself. An exhibition; proof; especially, proof beyond the possibility of doubt; indubitable evidence, to the senses or reason. Video presentation – A video clip is a small section of a larger video presentation. A series of video frames are run in succession to produce a short, animated video. This compilation of video clips results in a video presentation. Operational Definition: Learning Styles – the method by which an individual acquire knowledge. Accommodator – they tend to get information by themselves; they can easily adapt to sudden changes. Assimilator – individuals who learn by thinking through ideas; they need certain evidences before making judgments. Converger – individuals who learn though practical application. Diverger – is an individual who learns through observation; they love to listen and share ideas. Teaching Methodologies – the strategies employed in teaching. Didactics – are teaching methods used in the classroom setting. Lecture discussion – giving information on a group of people or a class usually to educate. Recitation – giving an answer on a given question using what is previously learned. Power point presentation – the presentation of a slide show made up of slides containing information on a topic commonly used in giving information about a concept. Case presentation – a case specific presentation of data and information gathered from an individual or group of people. Brainstorming – a method of sharing ideas by â€Å"throwing† in whatever pops out of their mind about a certain subject matter. E-learning – method of imparting knowledge through the use of modern electronic devices or softwares. Group work – a method of sharing ideas and combining said ideas to form a unified body of information more commonly used by students. Reporting- presenting a detailed but brief information about a subject. Role playing – adopting and acting out the role or personality of someone else. Skills – a method of teaching the ability to develop a procedure repeatedly. Demonstration – a method of imparting knowledge by showing how something is being done. Video presentation – the use of recorded video or a series of video clips to impart knowledge on a certain subject matter. CHAPTER III RESEARCH METHODOLOGY Research design This study used descriptive correlational study as the research design. According to Polit and Beck (2008), â€Å"descriptive research is the second broad class of non-experimental studies and its purpose is to observe, describe and document aspects of a situation as it naturally occurs and sometimes to serve as a starting point for hypothesis generating or theory development. † This study described the learning styles of Sophomore Nursing students and their most preferred teaching methodology. It also determined if learning styles were associated to their most preferred teaching methodology. Population and Sample The respondents of this study were sophomore nursing students of Far Eastern University within the school year 2010 to 2011. The sophomore nursing students had a total population of 630. Using Sloven’s formula, the sample population of 245 was drawn. Table 1. Frequency Distribution and Percentage of the 6 sections included in the study Section| Frequency| Percentage (%) | BSN 313| 36| 14. 7| BSN 302| 48| 19. 6| BSN 304| 34| 13. 9| BSN 303| 48| 19. 6| BSN 305| 37| 15. 1| BSN SB3| 42| 17. 1| Total| 245| 100| The researchers used convenience sampling method in choosing the sections that were included in the study basing on the inclusion and exclusion criteria. Included in the study were sophomore students who were on deck during Mondays, those who were present during the data gathering and those who were willing to cooperate. Those excluded in the study were freshmen, junior and senior nursing students and those from other institutes, sections of sophomore nursing students who were on deck during Tuesdays, Wednesdays, Thursdays, Fridays and Saturdays and those who were absent during the data gathering procedure. All of the invalid questionnaires answered by the respondents were not included in the tallying. Research Locale The study was conducted at Far Eastern University specifically in the Institute of Nursing. It is a Private non-sectarian University, located in Nicanor Reyes Street, Sampaloc Manila which was suited for the respondents. The researchers had chosen Far Eastern University as a research locale because the behavior, experiences and characteristics that the researchers sought to observe fit the students of FEU specifically nursing students. Furthermore, FEU had adequate diversity or mix of students to achieve the research goal. In addition, entrance to the site was possible and access to the respondents can be granted. Research Instruments The instrument had two parts. The first part of the instrument was Kolb’s Learning Style Inventory (LSI) which was a standard questionnaire constructed by Kolb’s (1985. It was a 12 item self-description questionnaire that would determine the learning style of a particular person. After taking Kolb’s Learning Style Inventory and summing up the total number for each learning styles, it gave the difference between Concrete Experience (CE) and Abstract Conceptualization (AC) and the difference between Active Experimentation (AE) and Reflective Observation (RO). After determining the differences of each learning styles, it was plotted on the paradigm to determine the student’s learning styles as Diverger, Converger, Assimilator and Accommodator. The second part of the instrument was a self-made instrument. It was a structured questionnaire in which respondents were asked to choose their most preferred teaching methodology both in acquiring skills and learning from lectures. Validation of instrument The second part of the instrument was validated by three experts: the Associate Dean of the Institute of Nursing along with two other faculty members who had been on the academe for 5 years. The instrument was validated in terms of its face and content validity. A pilot test was conducted to ten (10) nursing students, after which the respondents were excluded from the actual data gathering procedure. They were able to answer all the questions in the instrument which yielded good results. Data Collection Procedure A letter addressed to Dr. Glenda S. Arquiza, Dean of the Institute of Nursing, was forwarded to ask permission to conduct the study. Moreover, the researchers of the study coordinated with the Level II coordinators to acquire the schedule of the selected respondents. The researcher used structured paper and pencil instrument in which the respondents were guided by a topic guide of questions to be asked and rank order questions which the respondent rank target concepts along a continuum, such as most to least. The respondents were asked to answer the Kolb’s Learning Style Inventory. From the sections present during the data gathering, the researchers used conveniece sampling in choosing the included sections for them to come up with the 245 respondents. The inventories were distributed by some of the members of the research team to the selected respondents and were collected right away after they finish answering the inventory. The data collection was conducted last July 17, 2010. All of the instruments which were valid and with complete answers were all included in the study. Statistical Treatment To organize the data collected, statistical tables were presented. This made the presentation of the data systematic and readily understandable. Furthermore, the following statistical formulas were used to analyze the data collected. The Sloven’s Formula was used to determine the number of minimum respondents to utilize. Its formula is as follows: n=N(1+N*e2) Where: n = number of samples N = total population e = margin of error To answer the first and the second problem statement which were â€Å"What is the learning style of sophomore Nursing students† and â€Å"What are the preferred teaching methodology of sophomore nursing students† Frequency & Percentage Distribution was used. Its formula is as follows: Percentage (%) = fnx 100 where: f = number of times the item occurs (frequency) n = total number of items To answer statement of the problem number 2, weighted mean was used to determine the average of the students who preferred a particular teaching methodology in terms of skills and didactics: Its formula is as follows: X=? fxn where: X = mean ? = summation f = number of times the items occur x = value of the item n = total number of items To answer statement of the problem number 3, â€Å"Is there a significant difference between the different learning styles† chi-square goodness of fit test was used. Its for

Leg Ulcers

Chapter One *A Brief Overview of a Venous Leg Ulcer *and the Assessment Process The nurse must have the skills and knowledge to identify a venous leg ulcer. Dowsett (2005) believes that it is important that nurses and other health care professionals look for the underlying cause of an ulcer. Whereas, the Royal College of Nursing (1998) has different views, and argues that, professionals who are fully trained in leg ulcer management should only be able to identify an underlying cause as it is easily mistaken that diagnosis of an arterial leg ulcer is made rather than venous which could cause serious treatment complications for the wound as well as the patient. There are major problems associated with a venous leg ulcer such as, pain, loss of mobility, financial implications and much more which will be discussed in chapter 3. Leg ulcers appear as shallow holes or craters in which the tissue underneath is exposed. They can vary in size, discolouration and depth (National Health Service Direct 2008) (NHS). The clinical factors of a venous leg ulcer are, lipodermatosclerosis (champagne bottle shaped leg) ,which is cellulites affecting the dermis and subcutaneous tissue (Finlay & Chowdhery, 2007), hyperpigmentation, derived red blood cells extravagated from dilated, leaky capillaries which produces areas of brown discolouration (Brown & Burns, 2007). Atrophic Blanche, where interspersed by visible engorged capillaries seen as tiny red dots just below the surface of the skin (Moffat et al, 2007). However before looking at the patients wound it is the nurses role to look at the patient holistically and find out past medical and family history as well as personal factor that could contribute to the condition (Moffat et al, 2007). There are essential details that the patient can tell the nurse about their ulcer and the factors that may contribute to this. Such factors are their full medical history these details should include varicose veins, diabetes, Deep Vein Thrombosis (DVT), previous leg surgery and any family history of leg ulceration (Dougherty and Lister 2004). The importance of this is that if a leg ulcer is diagnosed incorrectly, such as a venous ulcer being mistakenly diagnosed as an arterial one can have serious complications for the patient and causing further delays in the healing of the wound. Also the nurse must undertake baseline observations this includes, the patient’s weight, height, blood pressure (BP), oxygen saturations levels, temperature nd respiratory rate, and also the patient’s nutritional intake, urine samples and routine blood tests such as glucose and haemoglobin levels must be gained, as diabetes is present in approximately 5% of patients with leg ulcer (SIGN 1998). Murray (2004) also agrees with Dougherty & Lister (2004) & Bolton et al (2004) stating that that hyperglycaemia can have an e ffect in the wound healing process, as this can be linked with infection and decreased oxygen levels in the haemoglobin will slow down the healing process and go onto starve tissue. These factors are important to know as it plays a big part in the wound healing process. In clinical practice thesebasic observations are a vital part of information gained to ensure safer patient care and early recognition of deterioration. The key factor in order to gain a thorough assessment it is essential that the nurse must have is communication and listening skills not only for this purpose but also for a nurse patient relationship. Dealey, (1994) believes that fear is one of the most common experiences a human can feel and a patients illness release many fears, in which health care professionals are unable to identify when not allowing the patient to express their needs freely. If the patient has a full understanding of their condition they are more likely to comply with treatment regimes and have a more productive relationship with healthcare professional’s (Anderson 2006). The RCN (2008) states, that the nurse-patient relationship is founded on trust. The nurse patient relationship allows the conversation to flow easy in order to gain a holistic approach to the patients care. The Code (2008) also agrees that as nurses ‘we must listen to people in our care and respond to their concerns and preferences’. Much research has taken place regarding nurse patient relationships, McCabe (2002) carried out a study which aimed to explore and produce statements relating to the patients experiences of how nurses communicate. A qualitative phenomenological approach was used. This focuses on individual’s interpretations of experiences and ways in which they express them (Parahoo 1997), followed by unstructured questionnaires which were tape recorded and lasted for approximately thirty minutes. The results found that four themes emerged, these were, lack of communication, ‘attending’, empathy and friendly nurses. Therefore the conclusions were that in contrast to the literature, nurses are not good at communicating with patients, however nurses can communicate well if the task undertaken was a patient centred approach. Although research has taken place the limitations were that only eight patients participated, therefore this could reduce the validity and reliability of the study. Also with such a small sample the study could be used as a pilot study which could be replicated in the UK as this study was undertook in Ireland.

The Roles of Tonal and Segmental Information in Mandarin Spoken

Assignment 1 – Article Summary In their article, â€Å"the roles of tonal and segmental information in Mandarin spoken word recognition: an eyetracking study†, Malins and Joanisse investigate how suprasegmental features affect on-line auditory word perception. Current speech perception models have fallen short in accounting for suprasegmental features because all have been based on Indo-European languages. In this study, Malins and Joanisse extend the potential of suprasegmental features by examining the role of tone in auditory word recognition.Preliminary studies on which Malins and Joanisse based their study show that features of stress alone could not account for word constraint activation. One of the reasons that stress was a poor candidate for word constraint during lexical priming tasks was that they were situated within polysyllabic structures. Tone features, on the other hand, are situated within monosyllabic structures. Listeners of tonal languages are require d to make distinctions based on these features alone. In addition, these preliminary studies showed that tonal information was processed after segmental information.However, these propositions were brought into question as Liu and Samuel (2007) discovered that most of the preliminary studies in speech perception did not utilize contextual constraints. More recent studies seem to show that tonal features are more effective in constraining word activation when in a sentential context and segmental features more effective in word constraint in a lack of contextual information. Malins and Joanisse set out to examine the role of tonal features in Mandarin word recognition by employing the visual world paradigm.This would allow the use of eye tracking which would measure the on-line auditory processing among four competitor categories – segmental, cohort, rhyme and tonal. The segmental category shared all phonemic features except for tones, the cohort shared all but word final phon emes, the rhyme differed in onset consonant, and the tonal shared only tone. The following was hypothesized: tonal and segmental information would be accessed at very similar points in time and share equal potential for word recognition constraint.Additionally, rhyme competitors would be viewed more than unrelated items and that tonal categories would produce little interference effect with target items. Twenty-four native Mandarin speakers were chosen as participants in this study. The mean age was 28, although seven were excluded from the study due to excessive use of peripheral vision (lack of eye movement data). Experimental stimuli comprised of 27 monosyllabic Mandarin words. The unrelated distractor tones were comprised of phonologically unrelated segments.A picture array was shown on screen for 1. 5s followed by a . 5 second transition at which point the central fixation point appeared. Participants focused on the fixation point while selecting the correct target picture for the spoken utterance. When the auditory stimulus was provided, the time course was measured through observing eye movements. If there were significant interference between tone and segment, then processing times would be increased therefore suggesting comparable roles in constraining word activation.The pictures in the array provided conceptual constraint. This ensured that sub-lexical access was being observed. This visual word picture matching task was used to create an environment that demanded lexical access using conceptual constraint. This method would supplement the hypothesis by leading participants to utilize tonal information. In the tasks, the act of pressing a button demanded lexical access and the four competitor pictures provided the conceptual constraint. There were 280 experimental trials.The experimental setting was kept monolingual as to eliminate the potential for confounding effects of bilingual interference. The results of this study show that the competition be tween target words and competitors was greatest for the segmental and cohort categories. This is crucial because the segmental category diverged from the cohort in tonal information only and the cohort category diverged in segmental information. This supports the hypothesis that both tonal and segmental information show an equal role in word recognition.Furthermore, the time course information for both cohort and segmental categories were similar. This seemed to indicate that segmental and tonal information are both accessed at the same time. There were no data supporting the claim that rhyme competitors would be looked at more than the distractors. This went against the second hypothesis and was likely a result of a discontinuity between rhyming features in Mandarin compared to English. This study could help improve existing models of speech perception by providing a firmer basis for tonal processing in auditory word recognition.This might raise the question of how tonal informatio n should be represented in a speech perception model. Ye and Connine (1999) have proposed the use of ‘tonemes’ since they act as contrastive units that can be categorically perceived like their segmental counterparts. Through summarizing, I have come to a better understanding of how this study would influence the TRACE model. Particularly, how different levels of word representations are shaped by spreading activation — tonemes possibly being the newest.By accounting for suprasegmental features, a speech perception model would be much more robust and functional. One particular thought that has arisen as a result of this study is how tone recognition contrasts between the modalities of speech vs. music. Do they share overlapping neurological locations and functions? Also of interest is whether individuals with amusia (tone deafness) are able to utilize tones as contrastive units in a language? References Liu, S. , & Samuel, A. G. (2007).The role of Mandarin lexica l tones in lexical access under different contextual conditions. Language and Cognitive Processes, 22(4), 566–594. Malins, G. M. & Joanisse, M. F. (2010). The roles of tonal and segmental information in Mandarin spoken word recognition: an eyetracking study. Journal of Memory and Language, 62(4), 407-420. Ye, Y. , & Connine, C. M. (1999). Processing spoken Chinese: The role of tone information. Language and Cognitive Processes Special Issue: Processing East Asian Languages, 14(5–6), 609–630.

Negative effects of fast food Research Paper Example | Topics and Well Written Essays - 2000 words

Negative effects of fast food - Research Paper Example Health experts have found that all fast food tends to possess greater than 35% calories from fat, greater than10% calories from saturated fats, more than 35% sugar-derived calories and 200 calories in every serving of the snack (Ashakiran and Deepthi 7). This high-sugar, high –fat content implies that fast food consumers tend to have too much cholesterol thus increasing their likelihood of becoming obese. When a person becomes obese, the high percentage of cholesterol in their body triggers a number of conditions like high blood pressure. This eventually creates a chain of other complicated conditions like stroke and heart attack, which usually cause death or permanent paralysis. The great taste and large quantities that are served in most restaurants trigger greater craving for these food items and encourages people to eat more than they should. A number of other long-term health diseases have also been cited as potential consequences of eating fast food, and these include cancer. Junk food predisposes people to breast and prostate cancer especially when they begin eating such food at an early age. The clogging of arteries that arises from the habit also leads to osteoporosis, which is a condition of the bones and hypertension as well. It may also lead to the development of tooth decay owing to the high concentration of sugars in most of these snacks and drinks. In the short term, fast food causes sharp rises and declines in blood sugar thus perpetuating the susceptibility to diabetes, especially if this runs in the family. For persons without the diabetic gene, sharp increase and decreases in sugar causes lethargy, low concentration levels at work or in school, and hence low productivity. Currie et al (32) carried out an analysis of the overall effect of fast food on public health by collecting and analysing data from California, New Jersey and Michigan. Their intension was to

Lewis acid catalysts, eg. Fe3+, Ru3+, Zn2+, etc., for certain organic Thesis Proposal

Lewis acid catalysts, eg. Fe3+, Ru3+, Zn2+, etc., for certain organic transformations - Thesis Proposal Example te possesses a series of basic sites, reaction specificity is necessary for that particular interaction between acid and base so that the desired functionality is achieved and not the other. The Lewis acid predetermines the nature of the intermediate cationic specie. It can be an ion pair, a covalent compound with weak C-X bond or an intermediary compound (Suzuki 1557). Lewis acids found their applications in a range of carbon-carbon forming reactions. Usually, Mukaiyama aldol synthesis (Mukaiyama, Banno, and Narasaka 7503), Diels-Alder reactions (Clayden, Greeves, Warren, and Wothers 905) ene reactions and Friedel-Crafts reaction (Clayden, Greeves, Warren, and Wothers 920) are catalysed by commonly employed Lewis acids such as BF3, TiCl4, SnCl4 and AlCl3. These compounds can activate a series of organic groups and usually exist as dimers, trimmers or oligomers. In most cases, such reactions are highly efficient but with little or no chemo, region or stereoselectivity. It was noted that only small changes in ligands, surrounding the central metal ion can lead to monomeric structures in organic solvents thus increasing their acidity and reactivity. Also, these changes in ligands change the way the newly formed Lewis acids interact with their substrates, thus manifesting new selectivity (Yamamoto and Saito 239). As an example of the idea presented above, two compounds can be put forward: MAD (bis(2,6-di-tert-butyl-4methylphenoxide) methylaluminum) and ATPH (tris(2,6-diphenylphenoxide) tris(2,6-diphenylphenoxide)). Both compounds were prepared from Me3Al and the corresponding, highly substituted phenol according to the scheme below: Both compounds are highly useful in highly specific chemical transformation. It is possible to lower the activity of the Lewis acids prepared in a way that ATPH was by taking more electron donating organic substrates. Comparing to conventionally employed Lewis acids, it was established that the steric effect of the presented above

Writting assignment Essay Example | Topics and Well Written Essays - 500 words

Writting assignment - Essay Example Contrary, gender roles in tribal society are defined by the individual’s capability. Although women have the primary responsibility for domestic roles, other tribes allow women to take part in subsistence food production. Men are involved in the tough task, such as hunting and gathering which is occasioned during drought (Scupin Chapter 8). At times, both genders participate in agriculture making it a shared responsibility. The gender roles in the two societies are based on food production. In the band society, the role of the women is valued so much that they are not allowed to participate in dangerous assignments. Because of this, their roles revolve around domestic duties and caring of home gardens, which the society perceives to be safe. Similarly, the home gardens are next to their houses that they can easily manage. Similarly, the inadequacy of food supplies during dry spells makes men resort to other avenues other than farming. They resort to gathering food through hunting. This is a hard duty, which women are not performing (Erickson 16). Therefore, availability of food also play a role in reinforcing gender roles. On the other hand, tribes are not involved in gender role specialization as in the case of the band. Women play attention to food production because of the sedentary life that this society lives. They take actions towards preserving what they have (Otte). Similarly, any of the gender can take part in food production since they are all available for the task. In the band society, there is a division of labor where women play different roles in the food production. There are some roles such preparing the fields for planting that women do not do. This is left for men because it is a task, which demands a lot (Otte). Because of this, there is inequality in terms of gender. Both genders are not equal and participate in different levels in food production. On the other hand, tribal society has a relationship

Analyse the impact of factors that influence health and Essay

Analyse the impact of factors that influence health and well-being.(Health and Behaviour) - Essay Example Education serves as the most effective platform to not only empower people but also to introduce changes so that children can meet new challenges of the time with higher efficiency and adaptability. This is especially true for people with disability who have to face multiple barriers in the mainstream schools which are distinct in their lack of facilitating environment and insensitive approach to their needs and requirements. The various barriers to their inclusion in the mainstream schools necessitate social support and wider awareness of their needs and requirements that promotes or hinders their participation in the mainstream activities. Carrington & Holm, (2005) assert that in Australia inclusive education has evolved from the notion of integrating students with disabilities into regular schools. The paper would be discussing the myriad practices within the social support that may be adversely impacting the successful inclusion of children with disability into the mainstream Aus tralian education system. Health and environment have emerged as major social issues that are significantly impacted by the social parameters (hhb, 2011). WHO (2005) has broadly defined health as not merely being absence of disease or infirmity but a complete physical, mental and social well-being. Thus, holistic aspect of health becomes an important issue which incorporates the environment paradigms that influence the overall well-being of the individual. Key & Dowrick, (2001) claim that people with disability have always been marginalized in every sphere of life including education, employment and community living. The discrimination has adversely impacted not only their participation in the mainstream life but it has also been detrimental to their development as an individual. Thus the social model of disability has emerged as vital input that redefined disability in terms of facilitating environment that promotes their

Fowlers Stages of faith Essay Example | Topics and Well Written Essays - 13750 words

Fowlers Stages of faith - Essay Example FINDINGS AND DISCUSSION 43 CHAPTER V 54 CONCLUSION AND RECOMMENDATION 54 5.1. SUMMARY 55 5.2. CONCLUSION 56 5.3. RECOMMENDATIONS 57 5.4. FUTURE POSSIBILITY OF THE RESEARCH AND SOME DIFFICULTIES ENCOUNTERED 58 Bibliography 59 ABSTRACT 63 CHAPTER 1 INTRODUCTION 1.0. BACKGROUND OF THE STUDY Since the ancient period, humanity has constantly tried to understand people’s relation and position with the world, with the universe, with transcendental reality. The works of Plato and Aristotle offer how human beings may be able to apprehend their position in the cosmos (see Phaedrus, The Republic, The Metaphysics ). However, during the Middle Ages, when people’s nature is defined more in terms of their relation with God, faith seeking understanding has become an attestation of a person’s innate ability to ‘understand’ the person in relation with God. Nonetheless, the questions and the longing for answers do not end there. In this sense, the desire to understand the meaning of life, its purpose and its relation with God and Others have long been part of the questions underpinning human existence. This yearning has become more concrete in the midst of the angst rising from current human experiences, of the present human condition. In this regard, the necessity of understanding faith dimension in the lives of people in the contemporary period becomes more urgent as people try to find meaning and purpose for their lives. However, what is faith? Generally, faith is belief in the reality of a transcendental being. However, over the past few decades, a ‘different’ approach to faith has been given. James Fowler’s theory of faith development is considered as one of the most significant models of faith/spirituality development that has emerged (Stantrock, 1999; Parker, 2006). It seeks to chart the stages of faith within the chronological life span of a person (Fowler, 1981). As such, the model tries to explain the process by whic h individuals' perspectives on ultimate meanings and values change during the course of their life (Fowler, 1981). In this regard, Fowler’s stages of faith, the only recognized measure of faith development stages (Moseley, Jarvis, Fowler & Di Nicola, 1993), has attracted further studies, debates and added evaluation (Streib 2005; Parker, 2006). In lieu with this, the study will look into James Fowler’s stages of faith vis-a-vis Christian faith. 1.1. CONCEPTUAL FRAMEWORK As the study seeks to understand the relation between Fowler’s Stages of Faith and the Christian faith, the clarification of the connection between the two will allow for the development of more depth and deeper understanding of faith. This becomes essential as Fowler’s discourse on faith is considered as one of the most important developments in understanding the phenomenon of faith. Furthermore, it attempts to present the position that as Fowler’s faith and Stages of faith is used in addressing concerns in education, in counseling and other fields, it can be used to further explain the notion of faith within the Christian context. In this regard, if clarification of the connection between two conceptions of faith, then a wider and deeper appreciation of faith is possibly attained. It will enable people to discuss faith in seeming abstraction but in the view of concrete and measurable developments that is charted across a person’s life span. 1.2. Statement of the Study: The purpose of this research investigation was to use Fowler’

Commitment Assignment Example | Topics and Well Written Essays - 500 words

Commitment - Assignment Example Ted has had a demanding, but well paid job in a corporate finance firm but he and his wife Kate has decided to move to St. Louis to start a much more demanding, but poorly paying job as a personal finance advisor. However, the timing of the decision was wrong as the finance sector is going down. The job environment is not favorable. Small businesses are closing by the day; people in corporate world are loosing jobs. Ted and Kate are face with a decision to make: abandon the new job and go back to the old one (work in corporate finance); keep the job and embrace the â€Å"success† ethics of the personal finance advisor world; or keep the job and stick to their ethical convictions. The onus lies with Ted to make a decision, but he could also escalate it. Though Kate is not the decision-maker per se, she has a part to play. Now, Ted has a potentiality to be an exceptional advisor coupled with his moral scope and intellectual versatility. Projections of a vast client-base future with flexible and friendly schedule dominate the discourses of both of them. However, his vast knowledge and admirable ethics sees him sidelined as others in his field with unworthy morals and less knowledge are quite a success. Doing what is right for his clients as against what puts money in the pocket seems to be disadvantageous; only a few of such people get a lucky breakthrough. The non-rational escalation of commitment may occur where both Ted and Kate decides to keep Ted’s new job. This will not be so much as a result of the quest for success as the quest not to loss sunk cost. Thus, judgmental bias will facilitate this escalation. Although Ted recognizes that an initial poor choice has been made, impression management could lead him to embracing the â€Å"success† ethics of his sector which may pose a potential ethical issue. More so, Kate seems to be unfair in supporting the decision of Ted to remain

Consequences of Indecisions Essay Example for Free

Consequences of Indecisions Essay Consequences of Indecisions The characters are affected by their mistakes in Feed by M.T. Anderson because these characters are all caught up in their indecision to choose what they want to do with their lives. Violet’s father is all caught up in protecting his daughter, Violet the main character, from the negative affects of the feed and how people take advantage of it in a poor manner. He didn’t want that to happen to Violet. The Feed is a device that people in the novel use in their everyday lives. The Feed is a computer chip that gets installed into the brain allowing internet access where ever they are, exposing people to unlimited knowledge. This chip also allows them to have the internet as a part of them so it becomes a part of the brain thus making them all in some since, part robot. He never wanted to get Violet the Feed because he thought it would be terrible for her. He then realized that she needed it in order to have a productive future and live a decent life. The outcome of his delayed decision of installing the Feed caused negative affects on Violet. Violet has similar to her father’s thinking when it comes to the Feed. She can’t decide if she does or doesn’t want to be a part of society. She claims that she loves the Feed because of the knowledge that it has to offer. Violet wants the feed because she also yearns to be accepted into society. She then turns around and says that the Feed is a horrible thing because it separates people from the real world causing them to become unaware of what’s really happening in the world. She also malfunctions in result of being hacked. This is the major issue that Violet and her father come across. Since these characters can’t choose what they actually want with society and the Feed only ends up leading them to their destruction. Violets father’s distraction with his thoughts is caused by his indecision on society with how people act. Many people would think that Violets father was doing the right thing by limiting his daughter to the technology, and they are wrong. If he was so against society then he should have left with Violets mother or just leave in general to get away. If they moved away and he never got her the Feed and she would have never gone to the moon. Apparently those thoughts never occurred to him. So he is living in a society that he strongly dislikes and refuses to become fully part of. His  problem with picking what he wants influenced him to get the Feed installed into her daughter’s brain late, because he realized that she would need it in order to live there and have a successful life. He realized this after he went to a job interview and he still didn’t have the Feed so he couldn’t get the job. This hesitation that he had was because he wanted his daughter to have real knowledge that you actually had in your head from memory and education. Not lazy artificial knowledge that she didn’t need to think to know something. He was being stubborn and thought he was doing something good for her. Many people would say that he just wanted to protect her. Well if he really wanted to protect her then why didn’t he just take her and leave that place? At the same time he wants to be around this great technology with its unlimited opportunities. Since he couldn’t choose a side that he wanted to be on he ran into issues because he cou ldn’t choose one or the other. Sadly Violet acts similar to her father. when it comes to Violet , it’s obvious that she is different from everyone else. She knows more then other people do because she had time to think and learn before she got the Feed, along with homeschooling. She has a larger vocabulary then the people that she lives around. Violet also doesn’t have as wide of a vocabulary as her father. She isnt as intelligent as her father either. She is lonely to the point that she makes announcements into a trash can just to hear the echo of her own voice. She has no real close friends because of homeschooling, making her less exposed to other people in the world. Violet has similar indecisions as her father, being against the society and with it at the same time just doesn’t work. it has to be one or the other. If not then they will have plenty of issues, because when they go against the way how things function and try to change it only caused them problems that they have to pay for all on there own. Violets individuality and intelligence made her get into problems because she wanted to see if she could trick the Feed to prove that technology cant over power humans. As Violet goes to the mall to create another profile on her Feed it only backfires. She called this her project. Her project was to create an account that the Feed could not give options to for items that she may like. She tried creating this account by looking at random and odd things at the mall  that had nothing to do with each other, pretending to like them so that the Feed would think she takes an interest in them. This makes the Feed think that she would consider purchasing these items. Violets project backfired because she never bought anything that she made the Feed think she liked. The Feed was offering her these items, expecting her to buy some of them. When she never did apply to purchasing anything, Violet got hacked everything started to malfunction and her father couldnt pay for the care and FeedTech had no interest in helping her because she wasnt a good investment to society. No one from FeedTech or the inverters of FeedTech wanted to sponsor for her health needs be cause of her poor shopping records. These records stated, that she had looked up information on items and she didnt purchase any of them. Violets project was a horrible idea because her father couldnt afford to pay for all the tests that she needed. The warranty had also expired years ago. There is nothing that they can do for her now but wait as her father regrets not getting Violets Feed late. When Violet got hacked, it somehow damaged her Feed and no one was sure why. While she was in the hospital she was told by the doctors that her Feed should stabilize over time, it never did. Her Feed only progressed to worsen as time went on. Even when she was working on her project in the mall Violet didnt consider how her actions would affect her . She knew that attempting to mess with the Feed wasnt supposed to be done and that didnt stop her . She went and did it anyway, her indecision to go against the Feed failed because she only got worse in the end. Her body slowly stopped working over time. In the beginning she was losing all feeling in her foot. Similar to having a foot fall asleep. Of course this turned into her whole limbs losing feeling. This resulted in her losing all feeling in both of her legs causing her to fall down the stairs when she was home alone. FeedTech didnt want to help her because she made a record that stated how she doesnt buy anything that she takes int erest in. All because she couldnt make up her mind on what she wanted to do. She attempted to trick the Feed. Then she changed her mind when she was weak and tried getting help from FeedTech after she attempted to mess up the whole system. Since these characters can’t choose what they actually want with society. The Feed only ends up leading them to destruction. Violet and her father made so many mistakes that it came to the point where they couldn’t save her. They refused to cooperate with FeedTech so FeedTech wouldn’t pay for her repairs. When it came to her malfunctioning. They also refused to cover the cost because she messed up her Feed during her project at the mall when she was trying to trick the Feed so that it couldn’t predict or tell her what she would like. Since Violets father was so caught up in protecting his daughter he was protecting her to the point where his choices killed his daughter, destroying everything he has ever worked for because Violet is his life. Violet is all he has left because Violets mother ran away to Africa to escape the society that they claim to hate. When it turned out that them staying is a place that they dislike was all a mistake on its own. If they where going to stay they should have accepted the way things are. Violet and her father should have just given into the way of the Feed if they wanted to stay.

Audit of Syphilis Screening in Pregnancy

Audit of Syphilis Screening in Pregnancy Tables Table 1:Syphilis confirmatory test results for forty nine  pregnant woman 18 Table 2:Syphilis screening results of eleven new-borns of  positive syphilis mother 24 Table 3: Positive syphilis confirmatory test results for sixteen  pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening  for mothers 28 Figure 2: The laboratory turnaround time of syphilis screening  for new-borns 28 Tables Table 1: Syphilis confirmatory test results for forty nine pregnant woman 18 Table 2: Syphilis screening results of eleven new-borns of positive syphilis mothers 24 Table 3: Positive syphilis confirmatory test results for sixteen pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening for mothers Figure 2: The laboratory turnaround time of syphilis screening for new-borns ABSTRACT Objective: A re-audit of syphilis screening in pregnancy was carried out to ensure that the improvements in laboratory and clinical aspects of management for the antenatalof pregnant women with positive syphilis screening and their new-born babies fully met were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). Methods: Patients’ data were collected via query of the three databases: Clinisys Labcentre, Telepath and EuroKing. The n the data were analysed using Microsoft Access 2013. Results: Samples from Forty nine49 pregnant woman with positive syphilis results serology were referred to a reference laboratory laboratory were sent to MRI for syphilis serological confirmatory testing. Sixteen pregnant woman with of these women were confirmed to have had had positive syphilis were identified. Ten pregnant woman were re-tested screened at least twice during their pregnancy and six pregnant woman were only screened tested once during pregnancy. Over-testing of for treponemal IgM were seen in nineteen patients[h1] with non-reactive RPR titre. Only eleven babies born to mothers with syphilis were followed-up with serial serological tests for syphilis. Only four new-borns were fully screened. Some of the new-borns were not tested with treponemal IgM due to sample insufficiency. Conclusion: There were some improvements seen since the first audit which includes the changes of the confirmatory testing schedule in MRI, lower screening false positive rate, and increased follow-up of the new-borns. There were also things to improve in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of syphilis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h2]. In-house confirmatory testing should be considered to allow reduction of test turnaround time’s thereby aiding patient management.Improvements[h3] should be made in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of sy philis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h4]. 1.0  INTRODUCTION 1.1  Syphilis Syphilis is an infectious disease caused by Treponema pallidum (T.pallidum) subspecies pallidum. The disease is transmitted from human to human, and humans are its only known natural host (Woods 2005). Epidemiologically, in the UK, cases of syphilis have increased in England since 1997 led by a series of outbreaks reported from Manchester, London and Brighton (Health Protection Agency 2009). Since 1999, diagnoses of infectious syphilis have been made in heterosexuals where the outbreaks are linked to sex work, students and young people. But, there was a changing pattern of infection between 1999 and 2008, when seventy three percent of new diagnoses of infectious syphilis were reported in men who have sex with men (Health Protection Agency 2009). The transmission is primarily by sexual activity (Zeltser Kurban 2004) (vaginal and anal intercourse) and by direct contact with active primary or secondary lesions (Lafond Lukehart 2006) for example through oral sex and kissing at or near an infectious lesion (Kent Romanelli 2008). T.pallidum may invade the host through normal mucosal membranes and also through minor abrasions in the skin (Zeltser Kurban 2004) such as from sexual trauma, causing an inflammation, ulcer and then spreading through the blood stream to other parts of the body (Goh 2005). 1.2  Syphilis in Pregnancy Mothers with untreated syphilis may seriously complicate their pregnancy. Vertical transmission of T.pallidum across the placenta (Singh Romanowski 1999) can occur at any time during pregnancy (Vaules et al., 2000; Oswal Lyons 2008), this leads to wide dissemination of the spirochete in the fetus (Woods 2005). Fetal infection resulting in spontaneous abortion, still-birth, premature delivery, non-immune hydrops fetalis and also congenital infection (Singh Romanowski 1999; Vaules et al., 2000; Ledger 2000). Vertical transmission may occur at any stage of syphilis infection. However, the transmission is more common in mothers with primary and secondary stage of syphilis (Singh Romanowski 1999; Vaules et al., 2000; Oswal Lyons 2008) as the risk of transmission depends on the levels of spirochaetemia which are higher in these stages compared to other stages (Vaules et al., 2000). Syphilis may also be transmitted during birth by contact of the new born with the mother’s genita l lesion (Ledger 2000; Berman 2004). 1.3  Congenital Syphilis Signs of infection for early congenital syphilis may appear within the first two years of the infant’s life with clinical manifestations include hepatosplenomegaly, rash, fever, and signs of neurosyphilis, especially bulging fontanel, seizures, and cranial nerve palsies (Mattei et al., 2012; De Santis et al., 2012). As for late congenital syphilis, the sign of infection may only be seen over the first two decades with clinical manifestations such as frontal bossing, nasal cartilage destruction, and dental abnormalities (Mattei et al., 2012; De Santis et al., 2012). Congenital syphilis leads to multiple organ infection because of the widespread haematogenous dissemination (De Santis et al., 2012) that will further cause death in the fetus or new born. However, the disease is almost preventable if mothers with syphilis are treated early in pregnancy (Walker Walker 2007). 1.4  Serologic Test Diagnosis of syphilis is made based on clinical signs and symptoms, microscopic examination and serologic tests (Little 2005). Two types of serologic testing were available; non-treponemal specific tests and treponemal specific tests (Clyne Jerrard 2000). Non-treponemal tests are widely used for testing and screening for syphilis as they are rapid, simple and inexpensive (Ratnam 2005). The example of  non-treponemal tests include the Venereal Disease Research Laboratory (VDRL) test and the rapid plasma reagin (RPR) test (Kent Romanelli 2008). Due to the rate of false-positive results which present in about one to two percent for these tests, the positive results have to be confirmed by sets of treponemal-specific tests such as the T.pallidum particle agglutination (TPPA) test, T.pallidum haemagglutination (TPHA) test and treponemal enzyme immunoassay (EIA) test (Kent Romanelli 2008). 1.4.1  Antenatal Screening The detection and treatment of infectious syphilis are extremely important in preventing congenital syphilis (Chakraborty Luck 2007; Simms Broutet 2008). An effective antenatal screening programme can have a huge impact in the way of managing both mother and baby. All pregnant women should be screened for syphilis at their first antenatal appointment (French et al., 2009) and the test should be repeated early in the third trimester (Goh Thornton 2007). Also, all infants born to seropositive mothers should be examined at birth and at monthly intervals for three months until it is confirmed that serological tests are and remain negative (Oswal Lyons 2008). The primary screening tests recommended (Kingston et al., 2008) are either treponemal EIA or TPPA/TPHA. If the screening test is positive, it must be confirmed by either one of the opposite tests. VDRL or RPR will be performed when the confirmatory test gives positive results (Kingston et al., 2008). 1.5  Audit on Diagnostics of Syphilis in Pregnancy The diagnosis of infectious syphilis in women in the UK increased between 1999 and 2007. The increase of syphilis cases in women has also led to the re-emergence of congenital syphilis in the UK which may suggest sub-optimal management of patients with syphilis (Health Protection Agency 2009). In 2011, an audit on diagnosis of syphilis in pregnancy was performed at the Pennine Acute NHS Trust (PAHT) to ensure the syphilis screening in pregnant women and also the serological diagnostic of their new-born babies followed the UK standard for Microbiology Investigations in Serological Diagnosis of Syphilis which were introduced by Public Health England in 2007 (Public Health England 2014b). The purpose of introducing the standard was to assure equivalence in the investigation strategies in different laboratories across the UK (Public Health England 2014b). The audit reveals the concerns about the delays in syphilis confirmations and insufficient follow-up for new-borns of positive syphilis mothers. At least eighteen percent of positive syphilis cases took more than one month for confirmation and the turnaround time for eleven percent of the syphilis screening cases out of forty five cases took more than one week. It is also found that there was inconsistency in performing treponemal IgM test where fifty three percent of cases (twenty four cases out of forty five cases) were not tested for treponemal IgM. For the management of neonates, only four new-borns were followed-up and among four new-borns, only one have been followed up according to the guidelines. Recommendations made from the audit includes the improvement of time to confirmation of specimens, changes of confirmation test by using treponemal IgM to all pregnant woman, referral of all pregnant woman with inconclusive syphilis confirmation to Genitourinary Medicine (GUM) clinic and management of new-borns where follow-up should be completed according to the guidelines provided (Vladana et al., 2011). 1.6  Re-audit of Syphilis Screening in Pregnancy A re-audit of syphilis screening in pregnancy at the PAHT was performed to discover if changes made after the first audit recommendations have led to the improvement of services. The re-audit was carried out three years after the first audit done in 2011. The re-audit aimed to ensure that the improvements in laboratory and clinical aspects of management for the antenatal women with positive syphilis screening and their new-born babies were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). 2.0  METHODOLOGY 2.1  Background The PAHT comprises four major district general hospitals; North Manchester General, Fairfield General Hospital, Rochdale Infirmary and The Royal Oldham. Some 12,000 women annually present for antenatal care. Women usually attend for antenatal care at one of three antenatal clinics or one of several General Practice Clinics within the community. In the UK antenatal infectious disease screening is usually performed at three months gestation (http://www.screening.nhs.uk/). Women are offered screening for rubella immunity, hepatitis B virus infection, human immunodeficiency virus infection and T.pallidum (syphilis) infection. Among 12,000 women screened within the PAHT in the period 1st January 2013 to 31st December 2013, a series of forty nine pregnant woman with positive syphilis serology were identified. To determine whether syphilis screening and follow up care of babies born to these mothers followed the UK Guidelines of the Management of Syphilis (Kingston et al., 2008) and the Gui delines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013), a retrospective study was performed. 2.2  Diagnosis of Syphilis Pathway Patients’ blood sample was collected with informed consent at the antenatal clinic and laboratory test requests were made. The patients’ information was recorded in the maternity information system database; â€Å"EuroKing† (Euroking, Chertsey, Surrey, UK). Samples were transported to The Royal Oldham Hospital (TROH) microbiology laboratory via the hospital transport system to be tested. Patient demographic information was recorded in the laboratory data system Clinisys Labcentre (Clinisys, Chertsey, Surrey, UK). If the syphilis screening test was negative, a report was generated and then posted to the antenatal clinics where the sample came from. If the syphilis screening test was positive, the sample was sent to a reference laboratory, Manchester Medical Microbiology Partnership Laboratory at Manchester Royal Infirmary (MRI) for confirmatory testing. Testing at the MRI comprises two treponemal enzyme immunoassay tests for total treponemal antibody; a T.pallidum specific assay (EIA); the T.pallidum particle agglutination assay (TPPA); the reagin precipitin assay (RPR) and where appropriate a T.pallidum specific IgM enzyme immunoassay (IgM) in accordance with national guidelines (Kingston et al., 2008). These results were recorded in the MRI laboratory database system, (Telepath; CSC Healthcare, Banbury, Oxfordshire, UK) and a printed copy of the patient test results was sent back to TROH microbiology laboratory. The reference laboratory report was transcribed onto the Clinisys Labcentre system and a printed report was generated to be to the antenatal clinics. Finally, the patients’ report received by the antenatal clinics was recorded in the patients’ notes and updated in the EuroKing system. 2.3  Data Collection Data collection for the study was accomplished via query of the three databases: the PAHT laboratory database system, Clinisys Labcentre, the MRI database system, Telepath and the maternity information system database, EuroKing. The data gathered including the patients’ hospital number, NHS number and specimen number, date of birth, the date of sample collection and report, and also the syphilis serology data which includes the patients’ treponemal EIA, TPPA, RPR and treponemal IgM results. The sample collection and sample reported data were obtained to investigate the turnaround time taken for the diagnosis within the laboratory. 2.4  Analysis of Data The laboratory system data was presented as Microsoft Excel spreadsheets (Microsoft Corporation, Seattle, USA). All the patients’ data were then imported and assembled in Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). The data for the forty nine pregnant woman with positive syphilis serology were analysed using Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). 2.5  Clinical Audit This was conducted under the Clinical Audit provision of the NHS National Research Ethics Committee (National Research Ethics Service 2008). The work was registered and approved as a Clinical Audit with the Clinical Audit Department of the PAHT. Data analysed was anonymised before release from the Trust to comply with Data Protection Guidelines (Caldicott Committee 1997). The clinical audit used the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) as a standard. 3.0  RESULTS Fifty positive syphilis serology results were identified from forty nine pregnant woman undergoing routine antenatal infectious disease screening at TROH microbiology laboratory. All specimens were screened with Chemiluminescent Microparticle Immunoassay test using the Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA). The fifty specimens were also sent to the Manchester Medical Microbiology Partnership Laboratory, MRI which acts as a reference laboratory for syphilis serological confirmatory testing. 3.1  Confirmation Methods by MRI The reference laboratory confirms syphilis screening with two treponemal EIAs, a semi-quantitative TPPA, a semi-quantitative RPR, and where appropriate a T.pallidum specific EIA for IgM antibody in accordance with national guidelines (Kingston et al. 2008). The first treponemal EIA test was the same Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA) used at TROH for syphilis serological testing; the second treponemal EIA test used the DiaSorin Liaison XL System (DiaSorin S.p.A, Saluggia, Italy), the semi-quantitative TPPA was the Serodia TPPA Assay (Fujirebio Diagnostics, Inc., Tokyo, Japan), the semi-quantitative RPR was the Abbott Syfacard – RR card test (Abbott Diagnostics, Chicago, USA), and the T.pallidum specific EIA for IgM were run using CAPTIA Syphilis-IgM Assay (Trinity Biotech, Ireland, UK). Where necessary, further testing using T.pallidum specific immunoblotting and/or T.pallidum specific polymerase chain reaction testing are also used in confir mation testing. All specimens were confirmed using treponemal EIA, TPPA and RPR but only about twenty nine specimen out of fifty specimen were tested using treponemal IgM. There were seventeen positive screening with syphilis and thirty three negative screening with syphilis. Negative screening was defined by having negative results for either one or both treponemal EIA, TPPA titres of less than 1:80 and RPR titre of less than 1:2; positive results were defined by having positive results for both treponemal EIAs, a TPPA titre of greater than or equal to 1:160, RPR titre greater than or equal to 1:2 and positive results of treponemal IgM (Table 1). Table 1: Syphilis confirmatory test results for forty nine pregnant woman. Patient numbers with symbol â€Å"*† are pregnant woman with positive syphilis results. Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA InterpretationResult 1 1 Positive Negative Negative Negative Not Done Negative *2 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:320 Negative Negative 3 1 Positive Negative Negative Negative Not Done Negative 4 1 Positive Negative Negative Negative Not Done Negative *5 1 Positive Positive 1:5120 1:64 Not Done Positive 2 Positive Positive 1:5120 1:64 Not Done 3 Positive Positive 1:2560 1:8 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 6 1 Positive Negative Negative Negative Negative Negative *7 1 Positive Positive 1:640 Negative Not Done Positive *8 1 Positive Positive 1:1280 Negative Not Done Positive 2 Positive Positive 1:2560 1:1 Not Done 9 1 Negative Negative Negative Negative Not Done Negative 10 1 Positive Negative Negative Negative Negative Negative 11 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *12 1 Positive Positive 1:5120 1:4 Negative Positive 2 Positive Positive 1:5120 1:4 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Interpretation *13 1 Positive Positive 1:640 1:64 Not Done Positive 14 1 Positive Negative Negative Negative Negative Negative 15 1 Positive Negative Negative Negative Not Done Negative 16 1 Positive Negative Negative Negative Not Done Negative 17 1 Positive Negative Negative Negative Negative Negative 18 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *19 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:1280 Negative Not Done 20 1 Positive Negative Negative Negative Not Done Negative Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 21 1 Positive Negative Negative Negative Not Done Negative *22 1 Positive Positive 1:640 1:4 Not Done Positive 2 Positive Positive 1:1280 1:4 Not Done 23 1 Positive Negative Negative Negative Not Done Negative 24 1 Positive Negative Negative Negative Not Done