Reading comprehension Essay ABSTRACT. sion The (STRAT), authors evaluated instruction, strategies followed reciprocal same-age the effectiveness by practice + SA) (STRAT of explicit in teacher-led reading whole-class activities, peer-tutoring comprehen activities or cross-age peer-tutoring activities (STRAT + CA) on 2nd and 5th graders reading comprehen sion and self-efficacy For perceptions. 2nd multilevel graders, analyses revealed sig nificant STRAT and STRAT + CA effects; however, the effects did not last after fin the program. Fifth graders on the posttest better than ishing icantly in all 3 experimental control group their conditions Results peers. performed signif con also showed tinued growth for the STRAT and STRAT + CA conditions until at least 6 months after students finished the program. Moreover, on both the posttest and retention test, 5th graders in the STRAT + CA condition reported significantly fewer negative thoughts Key words: prehension, related to their elementary reading reading proficiency. multilevel education, strategies, modeling, peer tutoring, reading com self-efficacy RESEARCH, decoding instruction has had a long and continuous of attention and debate. However, a hiatus can be recorded in the study of history reading comprehension. Two decades ago, strategy intervention research was in instruction received renewed atten vogue, but only recently has comprehension with current studies building on what was accomplished in the 1980s. Now, tion, the challenge in reading comprehension research is to increase the efficacy of in struction in elementary schools by identifying the instructional practices and ac tivities that best serve to develop childrens self-monitoring for comprehension IN READING (Snow, Burns, Griffin, 1998). 291. This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions 292 The Journal Previously, students Once reading comprehension could decode, was considered comprehension was of Experimental Education to be a process of mastery: assumed to occur automatical ly (Dole, 2000). Research, however, has shown that good readers are character ized by more than just decoding skills. Cognitively based views of reading com readers use a flexible that proficient repertoire of prehension emphasize and regulating activities (Dole, Duffy, Roehler, comprehension monitoring includes both cognitive and metacognitive Pearson, 1991), which strategies (Baker Brown, 1984; Paris, Wasik, Turner, 1991; Pressley Allington, 1999; Pressley, Johnson, Symons, McGoldrick, Kurita, 1989). Cognitive strat egies can be defined as mental or behavioral activities that increase the likelihood such as rereading, activating prior background knowledge, of comprehension, and adjusting reading speed (Van Den Broek Kremer, 2000). Metacognitive strategies can be specified as self-monitoring and regulating activities that focus on the product and the process of reading, support readers awareness of com prehension, and assist in the selection of cognitive strategies as a function of text difficulty, situational constraints, and the readers own cognitive abilities (Lories, 1998; Van Den Broek Kremer; Weisberg, Dardenne, Yzerbyt, 1988). There is no reason to believe that all elementary students spon Unfortunately, and skills knowledge taneously develop essential cognitive and metacognitive Research reviews, however, reveal Allington, 1999). (Hartman, 2001; Pressley that monitoring and regulating skills and effective application of relevant strate can gies be taught (Dole et al. , 1991; Pressley, 2000; Pressley et al. , 1989). In this Jones, 1992; Block, 1993; respect, recent studies (Baumann, Seifert-Kessell, Dole et al. ; Dole, Brown, Thrathen, 1996; Pearson Fielding, 1991) and re of the National Reading Council (U. S. ; Snow et al. , 1998) underscore the ports value of explicit cognitive and metacognitive reading strategy instruction, for instruction takes the mystery out of the reading process, helping comprehension students assume control (Raphael, 2000, p. 76). As to the practice of teaching observation re reading, however, little has changed since Durkins (1978-1979) instruction. The dominant instructional practice is into comprehension students about text content, still very traditional, characterized by questioning with little explicit attention to the strategic aspects of processing and compre hending text (Aarnoutse, 1995; Paris Oka, 1986; Pressley, Wharton-McDon 1986). ald, Hampston, Echevarr? a, 1998; Weterings Aarnoutse, search In addition to the importance of explicit reading strategies instruction, research the effects program of an innovative on the cognitive, and social, (Belgium) comprehension for reading The study was school children. emotional by a supported of elementary development Research-Flanders. Research grant of the Fund for Scientific Assistantship to: Hilde Van Keer, Department be addressed should of Education, Correspondence Hilde. VanKeer E-mail: Henri Dunantlaan Ghent Ghent, 2, 9000 Belgium. University, This study was part of a investigation long-term in Flanders instruction of @ UGent. Be This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions 293 Van Keer Verhaeghe has revealed that the development of reading competence in the elementary can be encouraged by interaction with peers (Almasi, 1996; Fuchs, Fuchs, grades Mathes, Simmons, 1997; Johnson-Glenberg, 2000; Mathes Fuchs, 1994; Mathes, Torgesen, Allor, 2001; Palincsar Brown, 1984; Rosenshine Meis ter, 1994; Simmons, Fuchs, Fuchs, Mathes, Hodge, 1995). The traditional teacher-led evaluation interaction seems of pattern teacher question-student an to achieve insufficient actual response-teacher increase in comprehension, higher level cognition, and the application of self-regulation strategies (Cazden, 1986). Relying on the teachers interpretive authority causes students to become passive learners. to become Conversely, students readers, self-regulated need to take an active role and to recognize and resolve their own discrepancies with texts (Almasi; Gourgey, 2001). Research has demonstrated that this kind of ac tive reading behavior is promoted by providing students with opportunities to en gage in peer-led interaction about texts. More particularly, it has been shown that, through students discussions, peer implement, conferences, evaluate, and peer modify and tutoring, strategies, activities, cooperative and discuss of transfer strategies (Klingner Vaughn, 1996; Klingner, Vaughn, Schumm, 1998; Pal incsar Brown, 1984). Moreover, discussions between peers provide opportu nities for metacognitive (Palincsar, David, Winn, exchanges and modeling 1991). In this way, childrens knowledge about reading and reading strategies, as well as their ability to apply relevant strategies, increases. Despite these convincing research results, student-centered discussion with regard to is anything but common practice in most classrooms reading comprehension Stevens, (Alvermann, 2000). In the present study, we attempted to narrow the gap between prevailing in structional practice and research evidence in the field of reading comprehension instruction. An innovative approach, blending research-based strategies instruction and to practice opportunities strategic the from practices research fields, was designed, aforementioned implemented, More specifically, the innovations comprised two cornerstones: and evaluated. explicit reading reading in peer-tu toring dyads. Peer tutoring was introduced to stimulate student interaction be cause of the opportunities it creates to practice metacognitive skills. It should be noted that studies of peer tutoring in reading comprehension and thinking skills are relatively rare (Topping, 2001). Following research on peer-assisted learning strategies (e. g. , Fuchs, Fuchs, et al. , Mathes, 1997), c? as s wide peer tutoring (e. g. , Greenwood, 1991; Greenwood, Carta, Hall, 1988), and studies focusing on practicing reading strategies in small cooperative groups (e.g. , Brown, Pressley, Van Meter, Schuder, 1996; Palincsar Brown, 1984; Pressley et al, 1992; Stevens, Madden, Slavin, Famish, 1987; Stevens, Slavin, Famish, 1991), the present study involved training in comprehension strategies rather than tutoring students in word-level oral reading or low-level comprehension activities. Peer tutoring can be defined as people from similar social groupings who are This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions 294. The Journal of Experimental Education not professional teachers helping each other to leam, and learning themselves by teaching (Topping, 1996, p. 322). This definition covers a series of practices, in cluding peers as one-on-one teachers to provide individualized instruction, prac tice, repetition, and clarification of concepts (Topping, 1988; Utley Mortweet, 1997). Peer tutoring is structurally embedded in the curriculum and classroom organization and is characterized by specific role taking: One person has the job of tutor, while the other is the tutee (Topping, 1996). Moreover, effective peer tu tutor training (Bentz Fuchs, 1996;toring is characterized by a preceding Fuchs, Fuchs, Bentz, Phillips, Hamlett, 1994; Fuchs, Fuchs, Hamlett, Phillips, Karns, Dutka, 1997). With regard to the dyad composition, two variants can be tutoring refers to older students tutoring younger stu distinguished. Cross-age in same-age tutoring, children are paired with classmates. The variant in dents; students alternate regularly between the tutor and tutee role is called rec iprocal same-age tutoring (Fantuzzo, King, Heller, 1992). Peer tutoring has been successful in a variety of curriculum areas and age groups. Research has indicated positive effects on academic achievement for both tutor and tutee (Cohen, Kulik, Kulik, 1982; Fantuzzo, Davis, Ginsburg, 1995; which Fantuzzo, Polite, Grayson, 1990; Fantuzzo et al. , 1992; Greenwood et al. , 1988; Mathes et al. , 2001 ;Simmons et al. , 1995). In this respect, peer tutoring is not only about transmission from the more able and experienced to the less able (Topping, 1996); tutors seem to benefit even more from tutoring than students who receive et al. ; Lambiotte et al. , the individual tuition (Fitz-Gibbon, 1988; Greenwood 1987). This can be explained by the nature of tutoring a peer: Tutors are chal to engage in ac lenged to consider the subject fully from different perspectives, to identify and correct errors, to reorganize and clarify their own tive monitoring knowledge and understandings, and to elaborate on information in their explana tions (Fuchs Fuchs, 2000). Because the application of reading strategies re quires actively monitoring the reading process, peer tutoring may be considered a powerful learning environment for the acquisition of reading comprehension the reading process of another reader might facilitate the ac skills. Monitoring of self-monitoring skills and, hence, the adequate application of reading quisition (1978) the strategies. From a theoretical perspective, consistent with Vygotskys ory of socially mediated learning, the object of the dyadic interaction in the peer tutoring activities is the joint construction of text meaning by appropriate appli cation of relevant reading strategies to a wide range of texts and, in the long term, the intemalization and consistently self-regulative flexible use of strategic pro cessing whenever encountering texts that are challenging to comprehend. Furthermore, positive effects also have been found on tutors and tutees social and emotional functioning, especially with regard to self-efficacy perceptions, self-concepts, social relationships, and attitudes toward the curriculum areas treated in the tutoring sessions (e. g. , Cohen et al. , 1982; Fantuzzo et al. , 1992; Fantuzzo et al. , 1995; Greenwood et al. , 1988; Mathes Fuchs, 1994). Regard This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions 295 Van Keer Verhaeghe is an especially self-efficacy important construct, ing reading comprehension, that attention to strategy instruction alone is not sufficient to produce max given imum reading growth (Casteel, Isom, Jordan, 2000). Affective factors result in deeper engagement with text, which translates into superior achievement. Henk and Melnick (1995) asserted that self-efficacy judgments can affect an individ uals overall orientation to the process of reading; influence choice of activities; affect continued involvement, amount of effort expended during reading, and the in pursuing text comprehension; And ultimately affect degree of persistence achievement. Our aim in the present intervention study was to design, implement, and evalu ate complex sets of instructional interventions in authentic classrooms to enhance second and fifth graders reading comprehension achievement and self-efficacy perceptions toward reading. The specific contribution of the present study is the focus on peer-tutoring variants as instructional techniques to practice the use of reading. More strategies. comprehension we specifically, concentrated on an ex of practicing reading strategies in (a) plicit comparison teacher-led whole-class activities, (b) reciprocal same-age peer-tutoring activities, or (c) cross-age peer-tutoring activities within the same study for two different age groups. So far, cross- and same-age tutoring have not been compared within the same study, and there is only indirect reference material from themeta-analysis of of the relative merit Cohen and colleagues (1982) with regard to the differential impact. Furthermore, in the present study, we extend prior research by (a) sampling a larger number of studies; Participants than is typically the case in strategies-based comprehension (b) supporting teachers to implement the innovations in the natural classroom con text with the participation of all students of all abilities during an entire school year, which represents sensitivity to the interventions ecological validity; (c) tar geting students in the early and intermediate grades, populations that deserve more attention with regard tometacognitive and strategic behavior; (d) including maintenance long-term measures; (e) using standardized reading comprehension tests not directly linked to the treatment; and (f) applying multilevel modeling to take the hierarchical nesting of students in classes into account. Based on a review of the research literature and the aforementioned lines of reasoning, we formulated the following hypotheses for the study: Hypothesis teacher-led 1. Explicit whole-class reading or peer-tutoring graders reading comprehension prehension strategies instruction, activities, achievement more followed enhances by practice second and in fifth than traditional reading com instruction. 2. Practicing reading strategies in cross-age or reciprocal same-age peer-tutoring activities generates larger positive changes in second and fifth Hypothesis graders during comprehension whole-class achievement than more traditional activities. This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions teacher-led practice 296 The Journal Education of Experimental is more obvious for sec 3. Improvement in reading comprehension Hypothesis ond and fifth graders functioning as tutees and tutors, respectively, in cross-age peer-tutoring activities than for their peers alternating between the tutor and tutee roles in reciprocal same-age activities. Hypothesis 4. Cross-age and reciprocal same-age peer-tutoring activities second and fifth graders self-efficacy perceptions toward reading more ditional teacher-led instructional techniques. improve than tra 5. Improvement in self-efficacy perceptions toward reading is more Hypothesis obvious for second and fifth graders functioning as tutees and tutors, respective ly, in cross-age peer-tutoring activities than for their peers alternating roles in activities. same-age reciprocal Method Design We used a pretest, posttest, and retention test control group design. To ensure the ecological validity of the interventions, we included complete naturally com posed classes. Participating classes were assigned to one of four research condi tions. In the strategies-only condition (STRAT), the experimental intervention in cluded explicit reading strategies instruction, followed by practice in teacher-led whole-class settings. The experimental same-age (STRAT + SA) and cross-age included identical instruction in the (STRAT + CA) peer-tutoring conditions same cross-age dyads, or cross-age with combined strategies, In this respectively. tutoring. Finally, class-wide we respect, included practice students a control in reciprocal experienced either characterized group, or same-age same by tra activities without explicit strategies instruction ditional reading comprehension or peer tutoring. Classes were randomly assigned to the STRAT or tutoring con ditions. Within the tutoring conditions, teachers opted in favor of the STRAT + SA or STRAT + CA condition according to the readiness of a colleague to col laborate in the STRAT + CA activities. We selected control group classes to match the experimental teachers and classes. Because the classes were naturally composed and the assignment of classes to the conditions was not completely randomized, the design can be regarded as quasi-experimental. Participants In total, 444 second and 454 fifth graders from 44 classes in 25 different schools throughout Flanders (Belgium) participated in the study. Except for some small-scale initiatives of individual schools, peer tutoring was fairly unfamiliar at the time of the study. Other cooperative or interactive techniques, such as This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions 297 Van Keer Verhaeghe and circle time, were better known and more group work, group discussion, fre used. quently Except for one inner-city school in the STRAT condition with mainly a low so status and ethnic minority population, all schools had a predomi cioeconomic Flemish population. The majority of the children were from middle nantly white, class families. Except for one second-grade class including only girls, there was approximately an equal gender distribution: In second- and fifth-grade classes, on = = 18.55) of the students were boys. At 16. 54) and 48% (SD average, 53% (SD the beginning of the school year, second graders were aged, on average, 7 years and 4 months, and fifth graders were aged, on average, 10 years and 5 months. The majority of the students (402 in second and 422 in fifth grade) were native speakers. Because elementary school students in Flanders are not grouped by ability, classes are considered academically heterogeneous, which was con firmed by the pretest reading comprehension measures. Class size ranged from 15 to 28 students, with an average of approximately 21 (SD = 3.50) in the second grade, and from 10 to 30 students in the fifth grade, with an average of approxi = mately 22 (SD 5. 00) students per class. Second- and fifth-grade teachers had, on Dutch average, 11 and 20 years of teaching experience, respectively. Four of 22 second grade and 5 of 22 fifth-grade teachers were men. None of the teachers had previ ous experience in explicit reading strategies instruction or peer tutoring. We selected participating teachers from a group of approximately 100 second and fifth-grade teachers who were willing to take part in a long-term research study. All interested teachers received a questionnaire concerning their teaching practices and opinions regarding learning and instruction. The first step in the teacher-selection we selected ative and interactive to pace according was procedure student-oriented instructional or content. who Furthermore, of the schools of matching and classes this specifically, in applying experienced cooper and able to build in differentiation we based the throughout Flanders with More questionnaire. were techniques graphical distribution teachers on based teachers regard to selection on the geo and on the possibility teachers teaching experience, beliefs, and instructional practice; class size; students age; gender distribution; and dominating mother tongue. Table 1 shows the number of participating class es and students Measurement per condition. Instruments study, we used standardized tests to measure students reading achievement and decoding fluency. We administered question comprehension naires with respect to reading attitude, perceived competence, and preoccupation with attributions and self-efficacy perceptions toward reading. In the present Reading tests. We comprehension using Dutch standardized measured test batteries reading comprehension (Staphorsius Krom, This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions achievement 1996; Verhoeven, 298 The Journal TABLE 1. Number of Participating Education of Experimental Classes and Students Grade Fifth Second Condition Classes STRAT + SA STRAT + CA STRAT Control 6 5 Note. cross-age 163 124 444 22 = explicit whole-class STRAT teacher-led peer-tutoring 22 101 69 177 107 454 66 8 Students 91 3 group Total Classes Students reading comprehension strategies instruction followed by practice in = activities; SA activities; CA = same-age peer-tutoring reciprocal activities. 1993), which were selected based on the tests well-established psychometric the built-in adaptation to different student abilities, and the fact characteristics, that the tests address aspects of comprehension covered by the strategies part of occasion, we administered the experimental program. At each measurement with an increasing level of difficulty. The questions tiple-choice tence, the referral contained pretest second-grade asking relation for between short six the meaning words, stories, of each a word, the connection followed the meaning between by of sentences, tests 5 mul a sen and the theme of a text. We determined the scores by the number of correct answers. The second-grade post- and retention tests consisted of four and three different stories, respectively, each followed by 4 to 10 multiple-choice questions, with a total of 25 questions per test. More specifically, questions concerning the content of a text (demanding a clear understanding of the meaning of words and sen tences, the referral relation between words, the connection between sentences, and the theme of the text) and questions concerning the communication between the author and the reader of the text (e.g. , objective of the author, intended target group, the authors attitude toward the matter raised) could be distinguished. Both types of questions required integration of information on different textual levels (words, sentences, paragraphs, text) and were more or less equally distrib uted over the 25 questions per text. After discussing an example, students com pleted the tests individually. To examine the tests internal consistency, Cron bachs a coefficients were calculated on our own data, yielding high reliability scores of . 90 (n = 432) for the pretest, . 84 (n = All) for the posttest, and . 83 (n = 385) for the retention test. In fifth grade, the tests consisted of three modules of 25 multiple-choice ques tions each. All students took the first module of the test. Depending on these first This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions 299 Van Keer Verhaeghe results, students further completed an easier or more difficult module. Two types of questions requiring the integration of information on different textual levels could be distinguished: questions concerning the content and questions concern ing the communication the author between and the reader. an After stu example, dents completed the tests individually. Scores were determined by summing the correct answers. For the reading comprehension test, IRT-modeled scores were on Item Response Theory (IRT), a common scale had been de available: Based allowing us to veloped for different grades and test versions (easy-difficult), or more difficult part of the test. Because they are all on the compare the easier same scale, the IRT-modeled scores also allow for direct comparison of the re occasions. To verify the relia sults a student obtained at different measurement bility of the three modules of the pre-, post-, and retention tests, we computed Cronbachs a coefficients on our own data. Table 2 indicates that reliability of all measures comprehension was acceptable. test. We included second graders decoding fluency, which is a Decoding fluency combination of accuracy and decoding speed (Chard, Simmons, Kameenui, 1998), as an additional variable, because fluency can be considered a mediating factor on students reading comprehension achievement (Pressley, 2000). A stan dardized test (Brus, 1969) was administered individually to all second graders; students were asked to read unrelated words with an increasing level of difficul ty during exactly 1min. The score was determined by counting the number of words read correctly. We collected fluency data in second-grade classes only be cause it is recognized that reading fluency is generally well developed at the end of the third grade (Bast Reitsma, 1998; Sticht James, 1984) and because it was too time to test consuming all fifth graders as well. individually on self-efficacy perceptions and related causal attributions. With Questionnaire in the framework of the present study, we developed a questionnaire to measure TABLE a Coefficients 2. Cronbachs Comprehension for the Fifth-Grade Reading Tests Measurement occasion Posttest Pretest Test module n n an a .81 1 .76 2 3 .66 Note. At each measurement used. 468 167 271 occasion a different Retention test a .72 .76 .74 test with 442 256 175 an increasing This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions .76 .79 .77 41 level of difficulty 403 362 was 300. The Journal Education of Experimental students preoccupation with positive or negative thoughts or related causal attri butions with regard to their reading ability. Inspired by the work of Ames (1984), we asked children to report how often such thoughts crossed their mind before, during, or after reading. Factor analysis revealed that success attributions and positive thoughts about ones own reading competence on the one hand and fail ure attributions and negative self-efficacy perceptions on the other hand are very (1984) and closely related. This result is in line with the findings of Marsh and Debus (1984), who stated that self-attribu Marsh, Cairns, Relich, Barnes, can tions seen be as or expressions indicators ones of or self-concept self-effi we constructed two scales reflecting negative and cacy perceptions. Therefore, about ones own reading abilities. It should be positive thoughts, respectively, noted that capturing the incidence of self-efficacy-related thoughts does not give a direct measure of students self-efficacy perception but rather indicates the de a student is preoccupied with such thoughts. In this respect, related to (meta)cognitive activity than data collected gree to which data are more means the directly of more traditional a However, questionnaires. self-concept by inci high dence of negative self-efficacy-related thoughts can be considered an indication of a low self-efficacy perception, but such a conclusion cannot be drawn from a low incidence of positive self-efficacy-related thoughts. The latter suggests only that the student is not preoccupied with thoughts about reading proficiency or success. We administered read graders and completed at each the questionnaire the questionnaire measurement occasion. In individually. second Fifth all grade, items were read out loud to and judged individually by the students. As can be seen in Table 3, reliability was high for the negative subscale, but it was somewhat lower for the positive subscale. To investigate the validity of the both questionnaire, TABLE scales were correlated a Coefficients 3. Cronbachs Preoccupation With Attributions with for the scholastic the Questionnaire Measurement 2nd grade Success Concerning occasion attributions negative 2nd grade 5th grade and self-efficacy perceptions Failure Posttest 5th grade anananan scale attributions positive sub and Self-Efficacy Perceptions Pretest Questionnaire competence .63 419 .69 441 .75 402 .71 426 367 .83 408 .84 368 .81 393 and self-efficacy perceptions .77 This content downloaded on Fri, 15 Feb 2013 01:52:54 AM All use subject to JSTOR Terms and Conditions 301 Van Keer Verhaeghe scale of a Dutch Profile for Children (Harter, version of the Self-Perception 1985). These analyses revealed that both positive and negative self-efficacy per ceptions were significantly (p 0. 01) correlated with the scholastic self-concept subscale with r = -. 40 (pretest) and r = -. 37 (posttest) for the negative self-effi = . 22 = . 19 cacy subscale and r (posttest) for the positive self-ef (pretest) and r subscale. ficacy scale. Although we mainly focused on students self-effi cacy perceptions directly related to reading activities, we administered an exist (Veerman, Straathof, Treffers, Van den Bergh, ing self-concept questionnaire ten Brink, 1997), which is a Dutch version of the Self-Perception Profile for Children (Harter, 1985). Because the questionnaire was not appropriate for sec Perceived competence ond graders, we used the instrument with the fifth-grade group only. To verify the reliability of the different scales, we computed Cronbachs a coefficients. As can be seen in Table 4, the reliability of the measures was acceptable. As to the ques tionnaires validity, Veerman and colleagues investigations into the validity of self-report reported that, compared with other scales, the validity can be judged as moderate. Reading attitude scale. Both second and fifth graders completed a Dutch Read ing Attitude Scale (Aarnoutse, 1996) at the pre- and posttest. Fifth graders read and completed the questionnaire individually.
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12/15/2019 0 Comments Review of a memoir Essay Example | Topics and Well Written Essays - 1250 wordsReview of a memoir - Essay Example
In her previous years, she was used to eating sea slugs in summers. This was however a practice that she only did during this time in another region. Moving to other regions would teach her various ways of living with diverse culture. Encountering a change in eating diets changed her way of viewing life since they were different altogether. Meanwhile, during her stay, she found herself in a soap opera as a fearless Jiexy, who was aggressive and sexy altogether. During these acting sessions, she was exposed to a number of challenges. First, she is acting in another country where the people use a different language and have different way of life. With such prevalent situations, she was forced to cope up with the language and way of life. Though this was a hard task, she seemed to be well prepared to tackle this challenge. Secondly, she was not familiar with the culture of this place. Therefore, the change in culture would be a setback in her acting career. This was a stage where she had to engage with the new culture to make the possible moves that would be relevant to the soap opera in china. Though she was finding it hard to cope with the china culture, she was excellent in the acting career (DeWoskin 10). Thirdly, she had a challenge in merging the two cultures. On one hand, she had to act a role in a soap opera, which displayed the Chinese culture. ... This is similar to a person that is living a double life. People that live double lives have to make sure they make possible changes to remain relevant at any given point. Otherwise, if they do not change their way of life and culture at different points, they are not likely to remain relevant. For instance, when acting in a Chinese soap opera, the actors should display the Chinese culture and all other aspects that are closely related to the Chinese culture. Similarly, she will have to stick to the culture she has been interacting with all these rime. However, copying the other culture without becoming relevant it will not show impressive results especially to the concerned parties. Apparently, she learned the new ways of living and the different cultures in a short while and was excellent in living in between two cultures that are explicitly different (DeWoskin 11). Though she was used to the Chinese culture, there are some instances that displayed bizarre incidence. For instance, companies in the country were in large numbers while consumerisms were highly adored. In deeper insights, DeWoskin is interested on how the Chinese view foreign women. Similarly, she is interested on how Chinese men view the foreigners in their country. For instance, it is explicitly seen that there is a tendency of Chinese men seducing foreign women in the country. With such instances, it is clear that the Chinese men are in love with the outside world and would wish to be associated with such kinds. Similarly, Chinese masses would wish to see the foreigners dressed in coats with fur, shining jewelry and suggestive dresses. This is the notion that is created in China as they would wish to see foreigners that are dressed in fur coats, Exploring The Role Transition Student To Qualified Nurse Nursing Essay
In this essay the author will explore the role transition from student nurse to qualified member of staff and discuss in brief some roles and responsibilities of the newly qualified nurse (NQN). Focus will be placed on delegation and administration of Patient Group Directions (PGDs) as two responsibilities of the NQN who is both a delegator and a dispenser of medicines. Delegation can be challenging for NQNs as it involves entrusting designated tasks to non-qualified member of staff while still retaining professional accountability. Administration of PGDs will be discussed as well as group protocol arrangements for medicines administration has become over the last few years valuable to nurses, especially those working in settings where immunisation programmes and family planning services are delivered. Roles of the newly qualified nurse Critical discussion (400 words) Contemporary nursing has changed considerably in terms of its roles and responsibilities. A big turnaround came with the change in the European Working Time Directive which reduced drastically the working hours of junior doctors, leading to Registered Nurses (RNs) extending their roles and undertaking tasks traditionally carried out by medical professionals (McKenna et al, 2004; Kessler et al, 2010). In order to meet patient needs and to fill the gaps left by those nurses, Healthcare Assistants (HCAs) were then expected to start extending their skills and assume delivery of care that was previously the domain of registered staff (Kessler et al, 2010, Griffiths and Robinson, 2010). This was a positive step for modernising nursing careers with nurses now working across boundaries and with the creation of new specialist roles (DH, 2006a), but naturally it decreased at the same time engagement in direct patient care (Kessler et al, 2010). Registered nurses (RN) in the United Kingdom are expected to acquire the necessary knowledge and skills to meet Nursing and Midwifery Council (NMC) standards, which aim at guiding and supporting them in the delivery of high quality care. Nurses are expected to delegate, lead and supervise other nurses and healthcare professionals and have therefore to gain and develop analytical, problem-solving and decision-making skills (NMC, 2010) both during their training and throughout their nursing career. Even with development of the RN role If nursings original professional identity is to be uphold, it essential that NQNs enter the profession sensitive to its core values and roles, even while trying to advance practice (Harmer, 2010). Rationale for role choice (200 words) The author chose the role of delegation both Role 1 Delegation (700 words) RN are expected to organise and supervise the work of HCAs and the ability to delegate effectively is central to their success (Curtis and Nicholl, 2004) The NMC Code of Conduct (2008b) stresses that RN must delegate effectively and establish that anyone they delegated to is able to carry out their instructions. In addition it states that nurses must confirm that the outcome of the delegated tasks meet required standards and that anyone they are responsible for, is supervised and supported. The employer is in turn the one responsible for ensuring that HCAs have sufficient training and education to competently undertake the aspects of care which a RN is expected to delegate to them (NMC, 2008a). The NMC fails however to give a reasoned justification as to why the RN is still accountable for the delegated tasks if the employer is the one responsible for confirming competency or if indeed the RN is expected to confirm this her/himself how she/he is expected to effectively gain knowledge of the education, training and qualifications of all HCAs they work with in clinical practice (including bank staff). Both the RCN and the DH have sought in the past further clarification from the NMC as far as delegation and accountability are concerned as the advice provided by the body has been regarded as confusing (Harrison, 2007) HCAs education and training is not mandatory and standardised in terms of content, assessment and accreditation (Griffiths and Robinson, 2010) and therefore there is no default quality assurance on their competencies so caution and uncertainty is to be expected from the RN when delegating work as she/he could see her/his registration put at stake for any error in judgement (Kessler et al, 2010. This is because although the HCA retains responsibility in their actions carrying out the delegated task, the RN is ultimately accountable (NMC, 2004, RCN, 2006a) to their regulatory and professional body. Accountability is a key element of professional practice and it is intimately linked with delegation. RNs are professionally accountable to the NMC for any actions and omissions in their practice and must be able to justify their decisions. Failure to comply with the code may bring their fitness to practice into question and jeopardize their registration (NMC, 2008b). RNs are also accountable to both civil and criminal law, their employer (NMC, 2009, Dimond, 2008) and on a moral dimension, to themselves (Dimond, 2008). If tasks are matched successfully against HCAs skills and knowledge though, delegation can result in improved productivity and efficiency as this makes best use of available human resources. In some cases if the clinical area is particularly understaffed, delegation becomes a necessity, rather than an option. Effective delegation can potentially enable RNs to focus on doing fewer tasks well, rather than many talks inadequately (Curtis and Nicholl, 2004) and can create a more motivated and co-operative team (Eaton, 2009). On the other hand studies suggest that excessive task delegation can lead to feelings of frustration as nurses end up having less contact with patients than they originally hoped for. Accountability issues can also lead to increased levels of stress (Takase et al, 2005). Research has found that in order to comply with the code of conduct nurses can spend large amounts of time inducting, training and supervising HCAs (McKenna et al, 2004) on tasks that HCAs were theoretically undertaking to alleviate nurses workload (Kessler et al, 2010). Demands of supervision can also compromise the time NQN should be devoting to consolidate and develop their clinical skills (Griffiths and Robinson, 2010). Paradoxically, literature suggests that experienced HCAs frequently act as unofficial mentors to NQN and are seen as a significant source of formal and informal knowledge and guidance to less experiences members of staff (Griffiths and Robinson, 2010, Kessler et al, 2010). The process of delegation assumes inevitably a hierarchical command structure (Curtis and Nicholl, 2004) which could easily pose challenges for NQN, whom in real terms are expected to supervise and be accountable for HCAs who may be considerably more experienced. Role 2 PGD (700 words) PGDs provide a legal mechanism to administer and/or supply medicines to patients by a specific range of health care professionals, without the need of consultation with a doctor or a dentist (NPC, 2009). A PGD is written instruction for the supply or administration of a licensed medicine(s) in a specifically identified clinical scenario that is not aimed at a specific patient, but rather at any patient that meets the criteria established on that PGD. The PGD must be written up at a local level by a multidisciplinary team including a doctor, a pharmacist and a representative of any professional group expected to dispense under the PGD. For a PGD to be valid it must be signed by a doctor or a dentist and a senior pharmacist, ideally the ones involved in developing the direction. It must also be authorised by the PCT or NHS trust which will use it (MHRA, 2010a). PGDs can only be administered by registered healthcare professionals such as nurses, midwifes, health visitors, paramedics, radiographers, etc. Each PGD must however, list individually the names of the registered professionals allowed to dispense under the direction. A senior individual in each profession should assume the responsibility to ensure that all designated dispensers in the PGD are fully competent, registered and trained professionals. (DH, 2006b). A PGD can act as a direction to a nurse to supply and/or administer prescription-only medication to patients that meet the criteria, based on the nurses assessment of their needs and without needed to refer to a doctor for an individual prescription (RCN, 2006b) The supply and administration of medicines under a PGD should be reserved for specific circumstances where it is advantageous for patient care, it does not compromise patient safety and is consistent with professional accountability (MHRA, 2010a, NPC, 2009, DH, 2006b), as the nurse must always act within their own expertise and competence (DH, 2006b). PGDs are a convenient way of recognising nurses ability to use medication to the benefit of the patient and any registered professional dispensing medication under the terms of a PGD should act in accordance with the NMC Code of Conduct and the NMC Standards for Medicines Management (RCN, 2006b). The legislation requires that every PGD must contain key information: the place where the PGD will be used (eg. primary or acute care), the date the directive comes into force and the date it expires (it is recommended good practice that PGDs should be reviewed every two years), a description of the medicine to which the PGD applies (both the name and the purpose of the medication should be included, eg. analgesic or oral contraceptive), class of the healthcare professional able to supply/administer the medication (the PGD should clearly state which of the professional groups can use but each individual can only do so if she/he is named individually), the signature of a doctor/dentist and a pharmacist (only approved prescribers as doctors/dentists), signature by a representative of an appropriate health organisation (eg. chief executive of a trust), the clinical condition to which the PGD applies to (a description of the problem a patient must present with in order to receive medication under the directive), a description of patients that are to be excluded from treatment under the PGD (detailed guidance on which circumstances a patient should be excluded and provided with an individual prescription, eg. complex medical condition or a specific medical problem), a description of when further advice should be sought from a doctor/dentist and when to arrange for referrals (a patient might meet the criteria set on the directive but depending on which specifics they present, further advice might still be needed from a medical professional), details of the appropriate dosage, maximum total dosage, quantity, pharmaceutical form and strength, route, frequency of administration, minimum and maximum period over which the medication should be administrated and the legal status of the drug should all be specified (this ensures that the correct medicine is given in the right dose for the appropriate length of time), relevant warnings including potential adverse reactions (as with any medicines it is essential to be aware of any contra-indications of potential adverse effects), details of any follow-up action and under which circumstances (a patient might need to be seen again in order to detect if the medication had the desired effect) and finally a statement of records to be kept for audit purposes (the directive must specify which records need to be kept, eg. as a minimum full patient details and full information regarding the drugs that has been administrated) (MHRA, 2010a, NPC, 2009, RCN, 2006b) PGDs cannot be used in independent and public sector care homes or independent sector schools that provide healthcare services outside the NHS. (MHRA, 2010b) PGDs can only be used in the NHS and other services funded by the NHS but provided by the private, voluntary or charitable sector. Certain non-NHS organisations such as independent hospitals, agencies and clinics registered under the Care Standards Act 2000, prisons healthcare services and police services, and defence medical services can however use PGDs for the sale, supply and/or administration of medicines (NPC, 2009) NQN registered with the NMC and on the live register are allowed to administer medication under a PGD, providing they are one of the named dispensers on the directive. However, because robust clinical judgement is necessary to assess the patient prior to administration, a more experienced member of the nursing team is likely to be named over a NQN. Both the RCN and NMC offer no specific recommendations for the administration (or not) of medicines under a PGD, by a NQN. There are also no specific national training programmes for PGD, however individual organisations must ensure that any professional administering medication under a PGD is competent to do so (DH, 2006b) Conclusion (300 words) The role of the RN has expanded considerably over the last years. NQN now enter the profession expected to assume roles of leadership, delegation and supervision very shortly afterwards being students nurses and working with alongside and under the protection of their mentors. As soon as they gain their pin number and join the NMC register a whole new raft of expectations is placed upon them. Many NQN however reportedly feel unprepared and overwhelmed by their new responsibilities, making the period of transition very stressful rather than exciting and truly enjoyable. Delegation is a fundamental skill every RN and NQN must gain and develop in order to be able to manage their workload effectively in clinical practice. Delegating as a NQN can be challenging as often the recipient of the task is a more experienced member of the team, for whom she/he is still yet professionally accountable. Medicines administration is another responsibility of the RN. PGDs have become increasingly important tools for nurses working in clinical settings delivering immunisation, working in travel clinics and family planning services. With many NQN now opting to join community services, PGDs become increasingly relevant to them. |